Junior Doctors Contracts

Kevin Foster Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

My hon. Friend speaks wisely, as ever, on this. The fact is that we have moved a very long way to meet one of the BMA’s biggest concerns: that there should still be premium pay on Saturdays. For doctors who work regularly at weekends this is a very good deal—better than that for pretty much anyone else in the public sector. That is why we think that the reasonable thing to do would have been to accept the deal and not to call these wholly unnecessary strikes.

[Kevin Foster (Torbay) (Con)]

I know my right hon. Friend will agree that a dispute over pay cannot justify a threat to withdraw emergency cover. Will he confirm that after the new contract comes in no doctor will be treating patients while working their 91st hour in the same week, and that he will be looking at the availability not just of junior doctors but of other support services that are needed to deliver the seven-day services we have pledged to provide?

[Mr Hunt]

Absolutely. My hon. Friend is quite right to point out that the seven-day NHS vision is not just about junior doctors but about support services for junior doctors that will make the provision of care to their patients at weekends not just better for those patients but much more rewarding for them. It is immensely frustrating for doctors not to be able to get diagnostic tests back quickly because it is the weekend. We want to sort out all those problems. That will be better for doctors and better for patients.

Brain Tumours

Kevin Foster Excerpts

Monday 18th April 2016 Westminster Hall

[Wendy Morton (Aldridge-Brownhills) (Con)]

It is a pleasure to serve under your chairmanship this afternoon, Ms Buck. Along with others, I congratulate the hon. Member for Warrington North (Helen Jones) on introducing this debate. Maria Lester should also be congratulated on raising this issue; I do not wish to state the obvious, but without her petition there would have been no debate here today, so we would not have had the opportunity to share many personal stories and to raise this important issue with the Minister. It has also been an opportunity for me personally to learn more about this subject. As a newer Member of Parliament, I am still struck by how often constituents come to us and share their very personal experiences and stories with us; it is often very moving and very touching.

An earlier speech touched on people’s ignorance of this subject matter. In doing research for today’s debate and in sitting here listening, I, for one, have learned an awful lot—and I am sure I have an awful lot more to learn. As we heard today, the Petitions Committee released its report on funding for research in March. That report called for more investment in research into brain tumours and revealed the distress of many sufferers and their families whose lives have been devastatingly affected. It also helpfully explored the reasons behind the historical underfunding of research under successive Governments. I was quite shocked to read that brain tumours are the ninth most common cancer in the UK and they kill more children and adults under 40 than any other cancer—yet, while the incidence is increasing, there has been little extra allocated to research. That is one reason today’s debate is so important.

[Kevin Foster (Torbay) (Con)]

My hon. Friend makes powerful points. While I congratulate my constituent, Peter Jordan, on his efforts—he recently completed the Plymouth half marathon to raise funds for this cause—does she agree that, given the figures she has mentioned, what we need to see is real commitment from the Government to funding research?

[Wendy Morton]

I am grateful to my hon. Friend for his intervention. Yes, I do hope that the Government are listening today. We must continue to raise this matter. As a local MP, I recently read a heartbreaking email from a grandmother about her grandson. I then received an email from a mother, telling me about her son. At that point, it hit home that the grandmother’s grandson was the mother’s son. It highlighted to me that it is not just sons, daughters or grandchildren who are affected, but cousins, aunts, friends and colleagues; it extends way beyond the immediate family. Those emails compelled me to come along today and speak in this debate. The young boy sadly passed away, aged just 14, after surgery, chemo and radiotherapy, seven years after being diagnosed with a high-grade tumour. I cannot imagine how that family must have felt. Sadly, as we have heard from the many examples shared with us today, that family is not alone.

Charities, clinicians and scientists do amazing work. My hon. Friend the Member for Torbay (Kevin Foster) spoke about people who raise money through charities, doing sponsored runs, marathons and all manner of things for causes that are very close to their hearts. Yet, although technological advances help, brain tumours remain very difficult to treat and continue to take many, many lives each year—too many lives. I conclude simply by saying that I am looking forward to the Minister’s response, especially on how to raise awareness, how to improve research and, ultimately, how to improve the outcome for patients and their families.

--- Later in debate ---

[Nicola Blackwood]

The right hon. Gentleman, and friend, has made an important point and I hope the Minister will respond to it. However, we should note at this stage that the overall story of childhood cancer over the last 30 years is positive. Eight in 10 children with cancer survive five years or more, compared with just three in 10 during the 1960s. We should congratulate the Government on that because it is clear that the work and funding we put into fighting cancer is money well spent. As we have heard, unlike most cancers, brain tumours are on the rise and research is underfunded, and because the money spent on cancer is effective, we must put that right.

I want to focus on childhood cancers, for obvious reasons. Despite causing more than a third of childhood cancer deaths, brain tumours receive only 6% of childhood cancer funding. Childhood cancers account for less than 1% of cancer diagnoses in the UK and of that 700 children are diagnosed with a brain tumour every year. It is the most common form of cancer affecting children and the most lethal, killing 160 children every year.

We must consider childhood cancer funding in its own right because children’s cancers are biologically very different from adult cancers and to treat them effectively requires specifically tailored research and treatment. The effect of the funding shortage, ethical challenges and small cohorts mean that 50% of childhood cancers are part of a clinical trial and the remainder are treated using standard treatment guidelines such as the Milan protocol. There are risks with that approach.

As we have heard, cancer treatment is a brutal regime and can cause long-term disability. That is particularly true of childhood brain tumour survivors, 60% of whom are left with life-altering disability. In a few cases like Skye’s, these effects can be fatal.

[Kevin Foster]

My hon. Friend is making some powerful points, as other speakers have. Investment in this area is vital. The costs of caring for those lifelong disabilities as well as preventing deaths are why the Government should invest in this area—invest to save money in the long run.

[Nicola Blackwood]

My hon. Friend makes a good point. This is not a subsidy; it is an investment that will reap a return.

Currently, there is no formal infrastructure to collect and share data about standard treatment guidelines. Consultants working incredibly hard to save the lives of young patients struggle with their inability quickly to access information about the potential adverse effects of very tough treatment regimes. In all my correspondence about this with NHS England and others, the response is, “We’re trying, but it’s very difficult.” That is not good enough because all life-saving cancer innovations are difficult and, given the stakes, I simply cannot accept that the problem is insoluble. The architecture for collecting the data is in place, but the lack of formal data collection requirements and a single responsible body can have devastating consequences.

Currently, the National Cancer Registration Service and Public Health England are developing a pilot to improve data gathering and I welcome that, but it seems that it will be retrospective. It may yield research benefits, but it falls short of the real-time data necessary to guide clinicians. When Skye’s consultant noted that he was deteriorating fast, she could not easily find out whether any other children on the Milan protocol had experienced the same side effects and she was reduced to phoning colleagues ad hoc to ask their opinion one by one as Skye got worse. In the end, it was too late.

In so many ways, we are making tremendous strides in the UK in tackling cancer, including childhood cancer, but the absence of monitoring the adverse effects of standard treatment for childhood cancer can lead to lifelong disability and death. In an ideal world, all childhood cancers would be the subject of a full clinical trial, but we must recognise the challenges associated with research into childhood cancers where cohorts of rarer cancers can be incredibly small and ethical issues are more complex, making it difficult to recruit participants. This means that even with increased funding, which is clearly essential, some childhood cancers will have to be treated through standard treatment protocols.

I hope the Minister—I believe he is a man of action—will listen to the arguments that all of us here have made today about funding concerns and take action to rectify data gathering and standard treatment protocols. If those adverse effects are properly collected, recorded and shared, we may be able to avoid more cases like Skye’s and to increase survival rates of childhood cancers even more.

Contaminated Blood

Kevin Foster Excerpts

Tuesday 12th April 2016 Commons Chamber

[Kevin Foster (Torbay) (Con)]

It is a pleasure to follow the Father of the House, the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), and to be able to follow on from all the work done to bring this debate to the Floor of the House. I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) on securing it; it was a pleasure for me, as a member of the Backbench Business Committee, to support the proposal that this debate be held today.

Contaminated blood and the impact on victims was one of the first issues to come into my inbox after I was elected. Someone came to my surgery who had had a condition but had been otherwise healthy, only to find that they were to have decades of pain and disability because of the treatment they had for that condition—that is almost heartbreaking. Virtually all their life prospects have disappeared because of a treatment they received that they thought would make them better.

It is worth examining the scale of this disaster in our NHS system. We are talking about 4,700 people with bleeding disorders and 28,000 other people becoming infected with hepatitis C; and 1,200 with bleeding disorders and 100 other individuals getting HIV. Of course these people were getting that condition at a time when the medical understanding of it was very limited and the life expectancy was incredibly short. Thankfully, many people have benefited from the advances in medical science since 1985, which have allowed them to keep living, but they still face all the issues that come with that illness and—let us be candid—the stigma that still comes with it from those ignorant about what can cause it.

The issue is about looking at the time that has elapsed. I am sure that, like me, my predecessor, Adrian Sanders, who pursued a number of cases diligently during his time as the MP for Torbay, would not have expected that after 18 years his successor would still be talking about this issue and still be having to speak up for the constituents affected by this scandal, at least one of whom is in the Gallery today. We know that a patchwork of five schemes is in place, and reference has been made to that. To be fair, £390 million has already been paid out, but the impact on these people has been so devastating that it is right that we are looking again at what the appropriate level of compensation is.

It was appropriate that last year the Prime Minister issued an apology. That is something so simple, but it took until 2015 for it to happen. I agree that we are not in a court of law today, but it is right that we seek to provide some form of justice to those who for so long have found themselves on the receiving end of life-changing conditions.

[Bob Stewart (Beckenham) (Con)]

We have used the word “justice” all the way through this debate. I have listened to it all and I was not intending to intervene, but I must say that in fact there is no justice we can give people who have contaminated blood—that has been taken away from them. All we can do is give them the best possible help, financially and in care terms. They will never get justice, and it is improper to suggest they can—we cannot do it, it is too late, they have had that taken away and money will not compensate.

[Kevin Foster]

I thank my hon. and gallant Friend for such a thoughtful intervention. We cannot give them justice; we cannot restore them back to where they were before the impact of this scandal, but we can compensate them. We can try to mitigate the impact and give them a life that is appropriate, as best we can. Today’s debate is right to focus on that.

[Mrs Flick Drummond (Portsmouth South) (Con)]

Will my hon. Friend give way?

[Kevin Foster]

Briefly, but I am conscious of Mr Deputy Speaker’s guidance.

[Mrs Drummond]

My hon. Friend has mentioned some of the impacts, and I think there is an impact relating to housing. A lot of people with very low incomes are finding it difficult to access reasonable housing, including my constituent Sally Vickers, who has been told by Portsmouth City Council that she cannot be rehoused, despite a threatening condition caused by receiving contaminated blood. Does my hon. Friend not agree that the Minister needs to advise local authorities to make sure that the housing is adequate for such people?

[Kevin Foster]

I thank my hon. Friend for that intervention. This is also about making sure local authorities are aware of the support packages and the possible impact on benefit calculations. During my time as a councillor in Coventry I was approached by someone who was constantly being invited in for a fraud interview because they were receiving funds from one of the trusts. Those trained in these trusts have mostly retired now because of the time that has elapsed since this was put in place; the numbers involved are very small so new members of staff would not be so familiar with this. To be fair, that particular incident was resolved.

Initially, my constituents were pleased to hear that a consultation was going to happen and that £25 million would be available. They waited for it, but when it was announced it is safe to say that they were extremely disappointed. The problems, which have already been listed, include the fact that recipients could receive less than they do now, as some of the top-ups and support may be abolished. Some of the support could rely on assessments. I say that tentatively, as I have looked at this issue of repeated assessments. As a member of the Public Accounts Committee, I have looked at the work of the Department for Work and Pensions, and there is no great enthusiasm to see more people going through an annual assessment, particularly when, for many of these people, only a miracle cure will make any form of difference. The conditions are lifelong and permanent. They have been with them for decades and are not likely to be something from which they will recover.

I hope that the Government will relook at the proposals they put out for consultation, and take on board the comments from the all-party group, which have been put forward in a constructive and genuinely helpful way. I ask the Minister to take a view on what is being done in Scotland, and to explain why the UK Government do not think that the Scottish model would be appropriate here. If there is a particular reason, let us hear it. For me, it seems that the model has been welcomed and could be taken forward here.

I do hope that, after 30 years, we can finally take a step forward, deliver justice and ensure that people get the compensation for which they have waited so long. They need a resolution to these matters, which have been going on for decades.

Dementia and Alzheimer’s Disease

Kevin Foster Excerpts

Tuesday 12th April 2016 Westminster Hall

[Stuart Blair Donaldson (West Aberdeenshire and Kincardine) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I, too, congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. This subject is close to my heart, as I am sure it is for many people here in Westminster Hall, given the attendance today. I am sure that many hon. Members have a close friend or a family member who has suffered from dementia.

There is no doubt that dementia is a horrible disease that robs sufferers of their personality and their memories—everything that makes them them. The disease also puts severe strain on families and family relationships, as they try to understand and come to terms with it. As my hon. Friend the Member for Airdrie and Shotts (Neil Gray) said, it is important to make the point that dementia is not a natural part of ageing.

Some 90,000 people in Scotland are living with dementia, and we have heard today about the different factors that come into play in treating dementia, whether that is research, caring for people with dementia or supporting people who are caring for them. A number of my hon. Friends have mentioned the Scottish Government’s rights-based approach to dementia. Dementia is a disease and it can have a cure. It is great to have heard from many hon. Members about the work going on in their constituencies, whether it is universities or charities that are looking to research a cure.

There has been a lot of talk about carers as the unsung heroes of dementia care. An organisation in my constituency, the Forget Me Not Club, provides more than 500 hours of free care a week. I was amazed at the expertise that the people there had. Heather Morrison and her team do a fantastic job. They told me a couple of stories that I would like to share. They had one client who would continually stamp on the kitchen floor and the family could not work out why the person was doing that. It turned out that the kitchen floor had been designed in tiles of black and white and they thought that the black tiles were raised, so they were trying to stamp them with their feet. That was one part of their dementia. Another sufferer would not wash with soap when they went to the bathroom. It turned out that the soap was the same colour as the sink and bath. They could not see it, which was why they would not wash.

The expertise and experience of the people who work day in, day out with those suffering from dementia is so valuable, and it is so important that we praise the carers. That is why I welcome, as my hon. Friend did, the passing of a carers Bill in the Scottish Parliament earlier this year to enshrine in law for the first time the rights of carers. Furthermore, the Scottish Government’s carers strategy recognises that carers must be seen as equal partners in the delivery of care, as their support enables people to live at home, in their own communities, safely, independently and with dignity. I also welcome the Scottish National party’s pledge to raise carer’s allowance to match jobseeker’s allowance if re-elected.

We have heard that familiarisation is a very important part of tackling dementia and caring for people who have dementia. Not going into hospital and not becoming institutionalised is so important for people with dementia, which is why the Scottish Government identified, in their proposal for the national dementia strategy for 2016 to 2019, a number of challenges to be dealt with, including tackling avoidable hospitalisation, which worsens outcomes for people with dementia every time.

The hon. Member for Strangford mentioned the risks of alcohol as well as other lifestyle factors in contributing to dementia. It is important that we tackle the public health issues around that. I welcome the fact that the Scottish Government are taking steps to encourage people to remain physically and socially active, to discourage isolation and to encourage behaviour that has been recommended by the Caerphilly study.

[Kevin Foster (Torbay) (Con)]

I congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. Does the hon. Member for West Aberdeenshire and Kincardine (Stuart Blair Donaldson) agree that the Torbay Dementia Action Alliance’s memory café is exactly the sort of community initiative that can help to provide support to patients suffering from and living with dementia, and to their carers?

[Stuart Blair Donaldson]

I completely agree with the hon. Gentleman. There are a number of strategies and community initiatives. In my constituency, another initiative is live music appreciation. Dementia sufferers and their carers can go along, listen to live music and join in if they want to. That was my first interaction with the Forget Me Not Club in my constituency, and it was a great thing to see.

Finally, the Scottish Government’s national dementia strategy also incorporates Alzheimer Scotland’s five pillars model of post-diagnostic support. Alzheimer Scotland does a fantastic job in providing advice, support and all manner of things for those suffering from dementia and for their carers. Its five pillars model includes:

“Planning for future decision-making…Supporting community connections…Understanding the illness and managing symptoms …Peer support… Planning for future care.”

All the things that charities, local communities, communities and the Government do will help people to live well with dementia.

Junior Doctors: Industrial Action

Kevin Foster Excerpts

Thursday 24th March 2016 Commons Chamber

[Ben Gummer]

I disagree with the gentleman on two points. First, we have been trying to get around the negotiating table for over three and a half years, but it requires both sides to negotiate, and I am afraid the BMA has refused to do so. When only one party is at the table, negotiations cannot continue. Secondly, it is not just bad for patients; it is also bad for doctors in terms of their careers and what they want, which is to provide the best possible care for patients. That is why I urge all doctors not to withdraw emergency cover at the end of next month.

[Kevin Foster (Torbay) (Con)]

Does the Minister agree that whatever the dispute, the threat to withdraw emergency cover is one that nobody should condone, and will he join me in urging the BMA to withdraw the threat immediately?

[Ben Gummer]

I will join my hon. Friend. I only hope those on the Opposition Front Bench will also join him.

Bowel Cancer Screening Age

Kevin Foster Excerpts

Tuesday 8th March 2016 Westminster Hall

[Caroline Ansell]

I thank my hon. Friend for his contribution.

[Kevin Foster (Torbay) (Con)]

I welcome the fact that my hon. Friend has secured this debate. My mother was diagnosed with bowel cancer at 56 and, ironically, my father, who was 60 at the time, had received the screening kit five months previously. Does my hon. Friend agree that that shows the need to review the age at which people are screened?

[Caroline Ansell]

I agree, and I hope we can put that need forward today. I know that the Minister and her Department are working hard in this area and that they are all the time seeking to secure better outcomes. I hope that they might just revisit the screening age as part of that.

It has been really moving to hear from right hon. and hon. Members about their own experiences and about the losses they have suffered. Lauren is here today, having lost her mum. What a terrible tragedy that is. It feels especially poignant that we are here so soon after celebrating mother’s day.

With today’s advances in life expectancy, 56—the age at which Lauren’s mother died— is incredibly young, yet if Lauren’s mother had lived in Scotland, she would have been screened three times before the age at which she was diagnosed, increasing the chances of early detection and therefore survival. Learning that must have been a bitter blow. England has, however, led in this area. In 2006, we became the first home nation and one of the first countries in the world to offer routine screening for bowel cancer, with the faecal occult blood test, or FOBT, being sent every two years to those aged 60 to 69—later extended to 74. However, a year later Scotland implemented the same screening, with the crucial difference that it would begin from the age of 50.

The national screening committee, which ran FOBT pilots in the early 2000s, felt that 50 was the right age at which to begin to screen. It noted a lower take-up of the test in 50 to 60-year-olds compared with those over the age of 60, but recommended that the Government take measures to address that. However, when deciding on final implementation it was recognised that, due to a shortage of endoscopy equipment and with substantially higher incidence rates over the age of 60, screening would begin with that age group. It is conceded that more than 80% of those diagnosed with bowel cancer are over the age of 60.

A University of Sheffield study recommended that offering both bowel scope screening and the FOBT from the age of 60 would maximise survival rates and have the important trade-off of being cost-effective. Yet the same study also found that the FOBT would substantially lower the number of deaths by as much as 23% if it was run for 50 to 69-year-olds, whereas running it from the age of 60 only would reduce the number of deaths by only 14%. It is hard to talk about percentages but, just to bring the debate back to the personal level, that significant 9% would have included Lauren’s mum, and perhaps other people we know.

We know that there is a clear upward incidence of bowel cancer over the age of 50. The rate of bowel cancer roughly triples between one’s 40s and one’s 50s, before doubling again in one’s 60s. We all should be aware of the signs and take precautions in our diet and lifestyle to prevent and detect bowel cancer—and, yes, perhaps we ought to shed the very British attitude that we must keep calm and carry on, and seek out our GP. More must be done to improve screening uptake rates. Bowel cancer screening rates remain disappointingly low nationwide, having barely moved above those achieved in the pilot 16 years ago.

NHS (Charitable Trusts Etc) Bill

Kevin Foster Excerpts

Friday 22nd January 2016 Commons Chamber

[Michael Tomlinson]

I envisage the consultation being as wide as possible. My hon. Friend mentions everyone who has been to see “Peter Pan”, and that would be a pretty wide consultation—perhaps not everyone has seen “Peter Pan” and I highly recommend that those who have not, do so. I envisage that the principle is that it is as wide a consultation as possible.

The Bill, which has wide support on both sides of the House, is the product of a public consultation, so I fail to see how Members can disagree with this proposal.

[Kevin Foster (Torbay) (Con)]

I thank my hon. Friend for giving way; he is being incredibly generous in taking interventions. Every charity has a group of people it benefits. Does my hon. Friend agree that for this consultation to have any meaning, it would have to be with the entire area of benefit, which could in some cases involve literally millions of people? Does he also agree that most of them would probably feel their charitable funds would be better spent getting on with the job, rather than having a very large consultation about who appoints a director of the trustees?

[Michael Tomlinson]

I understand that point, which is similar to other points questioning the benefit and the cost, but I respectfully suggest that the benefit outweighs the cost in this case and that the public, seeing that they are consulted, would once again be re-engaged with the political process, which I think my hon. Friend should support.

--- Later in debate ---

[Michael Tomlinson]

In which case, let me turn to that very point. As my hon. Friend rightly says, my amendment 4 contains the word “appropriate”. We can all envisage inappropriate public consultations. I again contend that this term should be relatively uncontroversial, because we all know what it means. An inappropriate consultation would be too short or would take place over a festive period such as Christmas, when either people would not have the opportunity to respond or an insufficient number would have the opportunity to do so. Although I welcome the opportunity to expand on the word “appropriate”, I believe it is pretty obvious what it means.

[Kevin Foster]

The word “appropriate” also relates to the level of the thing to be consulted upon. We have a tradition in this country: certain things—for example, Britain’s membership of the European Union—are decided by consulting every member of the public in a referendum. Other issues such as school funding also affect the wider public, but on issues such as who is a director of something we do not usually go to the length of a full public consultation to decide the process. This is about what is appropriate given the nature of the issue, as well as what is appropriate in terms of the time of year the consultation is held and how long we give people to respond.

[Michael Tomlinson]

I am very grateful for that helpful intervention. I would wish to expand on the issue of an EU referendum, but I suspect that Mr Speaker would encourage me to move on, so I will not be tempted down that line. I understand the point my hon. Friend makes and will merely respectfully suggest that the word “appropriate” speaks for itself and requires no further elaboration.

Given your encouragement, Mr Speaker, I will now move on to amendments 5 and 6, which also stand in my name and that of my hon. Friend the Member for Erewash. They seek to remove the requirement that the regulations may make provision consequential to the removal of the Secretary of State’s powers; in effect, they would remove the affirmative resolution procedure and insert the negative one. They are simple amendments, so I will not take up your time in debating them at length, Mr Speaker. In effect, the debate is being held now, as is perfectly appropriate, and it would therefore be unnecessary in this case to bring it back.

--- Later in debate ---

[Mr Rees-Mogg]

I raised the question of what the word “appropriate” meant earlier and I was indeed intending to come back to it. Appropriate, inappropriate, unacceptable and disappointing are those new Labour words that get dropped into conversations and they mean remarkably little or what, in a Humpty Dumptyish way, what the person hearing them wishes to think that they mean. What is an appropriate consultation? There is no qualification or clarification in the amendment, so what is it intended to achieve? Does “appropriate” mean that signs should be put on noticeboards, as with planning issues? Does it mean that letters should be written to local residents? Does it mean that something should be squirrelled away on the internet? Does it mean that a paper should be laid before this House, or put in the Library, where, no doubt, many people would follow its contents closely? Or does “appropriate” mean that the Secretary of State has a word in his office with the permanent secretary, saying, “Do you think this would be a good idea, Sir Humphrey?”, then Sir Humphrey replies, “Well, you would be very brave, Minister,” and then the idea is dropped on the basis of that consultation? Does it mean the Secretary of State can have a word at home with his family—with his kitchen cabinet—telling them that he is minded to appoint or not appoint a few trustees? I could tell all sorts of anecdotes about how that used to happen in the good old days, but I think it might be wandering slightly from the point. “Appropriate” is a very imprecise word and legislation ought to be precise.

[Kevin Foster]

My hon. Friend is giving us the benefit of his usual style of speech—[Interruption.] Of fashionable speech, yes. It is certainly in fashion on a Friday to hear my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) speak so well. Does he agree that the problem is that “appropriate” can mean anything under the sun and that various people have different views? For example, with the recent pension changes, some have said that the information should appear in adverts in the press and others that it should be provided in individual hand-delivered letters. This term is so vague and really would have to be defined. I think it is strange to say that we want to consult if we are handing out something that is unlikely to get more than a handful of responses given its detailed and technical nature. That will merely build up in the public’s mind the idea that yet again people have decided what they will do and are now consulting on it.

[Mr Rees-Mogg]

I agree with my hon. Friend. I want to finish on this set of amendments by saying that this House should be jealous of its role as the major focus of consultation in the nation. We were elected to represent our constituents and therefore to express views on these issues. That is why we are here, and what is done with consultation so often is a pretence. It is not about the Government wanting the wisdom of the millions before making up their mind but about the Government wanting the comfort of having been through a rigmarole to get what they wanted in the first place. We should not give up our authority lightly or increase the power of the Executive.

I know want to turn briefly to the amendments tabled by my hon. Friend the Member for North West Hampshire, which are absolutely glorious in their conception. They basically reverse what the Bill is trying to do in the first place, which is a great thing for him to have slipped past our ever-attentive Clerks. That does not often happen on Report. Perhaps the amendments—and this is why our Clerks in their wisdom let them go through—would ensure that there is a safeguard. Safeguards may be sensible. There have been occasions where charities have got into trouble when public money is being spent. Although it is broadly considered a good idea to remove the power from the Secretary of State to appoint trustees so that a decision is made more locally and so that the construction of the charities may be more suitable for the local organisations—that has a great deal of support —we know that something will go wrong at some point.

That is not a particularly Cassandra-like view to take; it is just the experience that we have. We know that there will be a small charitable hospital that puts all its money into an Icelandic bank, for example, and suddenly loses it. The trustees get criticised and attacked, or they write 3,000 letters a year to elderly ladies asking them for money and are seen to have behaved badly. Then somebody will come forward, probably a Member of this House, who will ask the Secretary of State at Question Time, “Why is it that you, Secretary of State, are not doing anything to stop this problem arising? Why have you not kept those residual powers? Why did you not ensure that when the Bill went through Parliament, there was a safeguard, something to protect—”

[Mr Rees-Mogg]

My hon. Friend makes an interesting and important point. NHS charities are different because of the structure of the national health service and the conception of the national health service in people’s minds. There is much less of an immediate governmental interest, or concern with, ordinary private charities that were founded sometimes centuries ago with grants from generous benefactors that through the mists of time have evolved and developed. NHS charities work side by side with the state in all that they do, so they are a marginal extension of the state rather than something completely different from it. If we draw a Venn diagram of the third sector, we have a part that is very private and another part that is very much state. NHS charities are very much in the state part of the Venn diagram.

[Kevin Foster]

I thank my hon. Friend for giving way. He is generous with his time, as always. He talks about NHS charities being close to the state and therefore needing particular provision, but many other charities work closely with our national health service. I think of Rowcroft hospice in my constituency which provides palliative care across south Devon. Why, then, safeguard only certain charities? Why not expand it to all? The amendments do not strike me as worth while.

[Mr Rees-Mogg]

My hon. Friend ignores the starting point, which is that the Secretary of State makes the appointments, whereas that has never been the case for other charities. They have evolved differently, whereas NHS charities are evolving out of the NHS, more towards the private sector. To put in place a safeguard which one hopes would not be used seems to me quite a prudent thing to do. It says, “This is our hope, this is our intention. We expect it to work and we think it will work in the vast majority of cases and make NHS charities more like other private sector charities.”

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[Mr Rees-Mogg]

I quibble about the word “rescue”. It is not so much rescue as fire. If the trustees do things badly, the Secretary of State may fire them and put other people in their place. That would not encourage slackness, idleness or malpractice. It would encourage probity, forthrightness and good management. The logic of my hon. Friend’s argument supports what I am saying, rather than what he thought he was promoting.

My hon. Friend the Member for North West Hampshire has proposed extremely sensible, prudent measures that will keep a broad eye on what is going on.

[Kevin Foster]

I am listening to the points being made, but I am still struggling to understand why a handful of NHS charities performing wrongly would be any different from any other charity performing wrongly. I see the hon. Member for Bristol South (Karin Smyth) in her place. We remember the recent discussions in the Public Accounts Committee about the Kids Company collapse. Why should we not have a good system of charity regulation, rather than a specific power, as suggested in the amendments?

[Mr Rees-Mogg]

I reiterate—I am sorry, Mr Speaker, to reiterate. I may be becoming repetitive, but I hope not yet tediously repetitive; that may come at a later stage. We need to look at the starting point. These charities are coming out of the control of the Secretary of State. To move them completely away from his control in one fell swoop may be relatively imprudent, whereas to do it more cautiously and keep a safeguard is perfectly sensible. By contrast, in the case of charities that have never been under the Secretary of State and have never had their trustees appointed by the Government, it is perfectly sensible to leave them with their existing regulatory system.

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[Mr Rees-Mogg]

I go back to what I said earlier about where NHS charities sit. By virtue of the money being given to a charity that supports the NHS, that money comes into the public purview and is subject to the way in which the public sector ought to ensure the good management of money. That is why I think it is appropriate—“appropriate”; I am using that awful word—rather, suitable and proper that it should be audited thoroughly to make sure that assets are not handed over that should not be handed over or misappropriated, and to give confidence to this House, and indeed to the other place, that moneys are being sensibly protected. These are very modest amendments.

[Kevin Foster]

Does my hon. Friend agree that some of his comments strike against the heart of this Bill, which says that these charities should be independent so that people feel encouraged to donate to them rather than feeling that by doing so they are replacing what could be, or they might believe should be, funded by the Government. Saying that it becomes public money when donated hits at the whole point of the Bill.

[Mr Rees-Mogg]

What a pleasure it is to see you taking the Chair, Madam Deputy Speaker. We have been waiting for this happy hour to arrive to help us carry our debates forward.

No, I do not think my hon. Friend is right. When people give money to a charity that is linked to the Government, they are even more concerned that it will be spent well, and they therefore want extra protections to assure them of that.

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[Mr Rees-Mogg]

My hon. Friend’s kindness towards the Comptroller and Auditor General is, I am sure, noted in many other places beyond this one, and I expect that his office would be delighted not to have the extra work. However, my hon. Friend is missing a point that I may already have laboured, so I will labour it only once more. This is a transition phase. This money is very close to public money. It is in a Neverland, one might say, in that it is not quite separate from charitable money and not quite ordinary public expenditure. Therefore, keeping an eye on how it is used in the most formal and protected way, at least in an initial stage, is a prudent way of ensuring that the assets are not used or transferred unsuitably.

Amendment 9 is different in nature and arises from a constituency issue. A constituent of mine, with the support of the NHS, established a charity that put defibrillator boxes around the country. These are very admirable boxes that operate in conjunction with the ambulance service and have been shown to save lives by ensuring that defibrillation equipment is available throughout small villages across the country. It has been a most successful charitable endeavour.

While my constituent was working with the ambulance trusts, they wrote to him to say that it was perfectly all right—indeed, they wanted him to do this—to put the ambulance service logo on the boxes, so that people would know that they were formally connected to the NHS. He then received a letter out of the blue from some little-known bureaucracy that protects the NHS logo. I understand the reasons for that: we do not necessarily want random private companies to call themselves the NHS or for unrelated businesses to use the logo. Some protection is needed, but the letter struck me as a heavy-handed way of going about things. It was an excessive response to something that was linked to the NHS and that was, at its core, a health issue operating with and through the support of the NHS.

The amendment would merely make it straightforward for the Secretary of State to overrule the whole procedure. When there is an issue of this kind, the Secretary of State would have the power to say, “Well, there may be this bureaucracy that safeguards the NHS logo, but I am overruling it and giving permission for the logo to be used, because I think it is a sensible thing to do.”

The reason I like the amendment is that, in a strange way, it relates to what this place is about. It is about seeking redress of grievance for our constituents when they are badly treated by bureaucracy. The best way of doing that is not through independent, unaccountable and unelected bodies that have been separated off from Government, but by a Minister being held accountable at the Dispatch Box. That is how we get things put right for our constituents.

This very small amendment would simply allow the Secretary of State to short-circuit the system when it is behaving badly. It provides that the permission given by the Secretary of State can be cancelled with six months’ notice, which is a reasonable amount of time for people to change any boxes, stationery or anything else they may have with the NHS logo on it, if they are found to have been abusing the permission or for some other reason. The principle that power should be with democratically elected people, and that it should be there to override offshoots of bureaucracy that nobody previously knew about or cared for, is a very good and sound one. As I understand it, the issue that my constituent has had has been mainly sorted out, but the amendment would be a better and clearer way of dealing with such things.

Of the amendments that I have tabled, amendment 9 is of the greatest importance to me. As is the case with so much of what I have been saying, it is about the fundamental principle of what we are trying to do when we legislate. We are trying to ensure democratic accountability and the rights of our constituents, and not to be constantly handing things over to ever-growing bureaucracies.

[Kevin Foster]

The primary aim of this Bill is to make very clear that the charities are independent of the Government. The NHS logo relates to an organisation that is the epitome of what many people see the public sector as being about—that is, the Government. My hon. Friend’s amendment would, therefore, strike at the very heart of the Bill and make it less worthy.

[Mr Rees-Mogg]

My hon. Friend is absolutely wrong. He has misunderstood, misconstrued and possibly even misread the amendment, which uses the word “may”. I am not compelling the Secretary of State to go out and chuck the logo on to every box he sees all over the country or to spray the NHS logo on every shopping centre he passes. I do not see him as a vandal going around with a spray can and a little cut-out stencil, spraying “NHS” on everything or engraving it on our foreheads when we come into the Chamber. That is not what the amendment proposes—it uses the word “may”. It says that when those charities that work immeasurably closely—hand in glove, on some occasions—with the national health service find it useful to use the logo and the Secretary of State thinks it is a good idea, he may give them the authority to do so.

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[Kit Malthouse]

I do not, and the reason is that the Secretary of State currently has control of the appointment of trustees. That is exactly why. If I were Secretary of State—I assume that the same is true of the current Secretary of State and past Secretaries of State—I would be very careful about who I appointed, so that I was sure that I was handing that fiduciary duty to people whom I trusted and who had an element of accountability to me.

[Kevin Foster]

My hon. Friend is being very generous in taking interventions. I want to get to the nub of his amendments. The examples that he has cited of corporate governance, and Alan Yentob’s emotional blackmail in respect of the Kids Company charity, relate to general issues of regulation. Why should NHS charities be different? We are trying to make them independent. Why should the Bill be amended in this way? I do not think that my hon. Friend would argue that any time a business or charity goes wrong, the solution is for the Government to appoint a director, so why is he making that argument in respect of this Bill?

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[Kit Malthouse]

My hon. Friend is right. Proposed subsection (2B) in amendment 1 provides that the Secretary of State would be allowed to use the powers only by permission of the House. I am with my hon. Friend in his desire to protect the House’s privileges and powers. I did not get elected to give the Government a free run. When the good people of North West Hampshire elected me, they placed two votes: one for a Government and the other for somebody to hold them account. I will try to do that job. Should the Secretary of State wish to step in, he would have to lay a statutory instrument before both Houses of Parliament and seek their support. It could not be done easily, on a whim or through a signature on a piece of paper. It would require debate and examination, and need all of us to do our job of scrutiny and reach a settled decision to allow him to step in. I recognise that it is a fundamental step and that an element of separation should be maintained.

[Kevin Foster]

My hon. Friend is generous with his time. In my constituency, Torbay Hospital League of Friends has operated successfully for 60 years, raising millions of pounds for the benefit of local people. A picture is being painted of needing a step-in power, but the whole process that must be gone through to achieve it, which my hon. Friend has just outlined, probably makes the amendment meaningless. Why do these charities need such a provision when other successful charities that are linked to hospitals do not?

[Kit Malthouse]

My hon. Friend is a dog with a bone. As I have explained—I think five times—I believe that the charities that we are considering are different because of the inextricable link with the institution that they serve. In the public’s mind, they are just a vehicle to give the money to the hospital and the national health service. Indeed, many boast about the percentage of money given to them that will be spent on the wards of a hospital. Those charities are seen co-funding, along with the Government, the NHS. I can see that not everybody is convinced, but I hope that others will speak in support of my amendments.

As I have said, the provision would be in the House’s control through a statutory instrument. It is not as though the Secretary of State could act unilaterally. We would all have control.

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[Kit Malthouse]

My hon. Friend will make a great diplomat when the time comes. I agree there is the possibility of misbehaviour by politicians, but we politicians come with a great advantage. We have had a few thousand people vote for us and those few thousand people can vote us out if they think we have behaved badly. There are not many other people in public life who come with that brake on their behaviour.

[Kevin Foster]

I will make this my last intervention. My hon. Friend has been very generous. With the provisions in the Bill I was expecting today to go off on a trip to Neverland. Instead, with all the death, doom and disaster in this speech I feel we are in an episode of “EastEnders.” Does he not agree that there is a very large area of charity regulation to deal with things going wrong and difficulties emerging? Charities will still be subject to that. Merely allowing the Secretary of State to appoint the odd trustee will not deal with any systemic problems. That is what the wider area of regulation is there for.

[Kit Malthouse]

Many years ago, my mother and father went on a camping trip in Europe. On their first night, they pulled in, in their Thames van, to what they thought was a campsite. In the dark, my father attempted to pitch the tent. Every time he tried to hammer a tent peg into the ground it went “Ping!” and disappeared off into the darkness. Only in the morning did he realise he had been trying to hammer the tent pegs into a concrete tennis court. That is how I feel this morning.

I have tried to explain many times now that these charities are different. They come with a badge upon them that says to the public they are partially in the public sector. Secretaries of State will always have an eye to their conduct, because what they do will impact politically and financially on the national health service and on whichever party happens to be running it at the time. I realise that, in the eyes of the sponsors, I might be pushing water uphill. Most people know I am a relatively optimistic person and I am hesitant to put these pessimistic circumstances to the House; nevertheless, someone has to do it.

I will move on now, finally, to other amendments. Amendment 9, in the name of my hon. Friend the Member for North East Somerset, seems eminently sensible and reflects exactly the point I have been making about the special connection. In these days of the internet, it is quite easy to download the NHS logo from any hospital website, affix it to a piece of paper and fire it off to raise money. I am sure it has, on occasion, been used fraudulently to raise money. I therefore completely support his wish to have some kind of control over the use of the logo, the name and the brand.

Giving that power to the Secretary of State seems eminently sensible to me, not least because these charities maintain most of their fundraising ability through their connection with the NHS. The leverage is extremely powerful and very useful. Many will raise millions and millions of pounds off the back of their connection with the NHS and they should be encouraged to do so. The judicious use of the brand, the logo and the name is absolutely to be supported, but it needs to be done in a relatively nimble way. The only way I can think to do that is via the permission of the Secretary of State, so I support the amendment.

Unfortunate amendment 4 deals with consultation. As I said in my intervention earlier, during my career in local and city politics consultation became the bane of my life, and of my residents’ lives. We all knew, when we participated in a consultation, that the decision had broadly been taken already and that the politician or Department in question was largely going through the motions to make sure they were not judicially reviewed or challenged.

Of course, the notion of consultation was promulgated by the Blair Government. It is a characteristic of our managerial, technocratic politics. Where we have a House filled with conviction politicians who know what they believe, and that what they believe is right for the country, they do not need to go out and consult. They consult once every four or five years through general elections and display the philosophical sheet-anchor that sits underneath every decision they make. However, when politicians drift from their basic principles into unknown waters, they feel a bit uncertain. They feel a need to consult, to be told what to do and to get a feel. That is what politicians do these days: they have focus groups and polls. They consult constantly about their image and what they should and should not do.

I would therefore like to play a small part in doing our bit to rein back the amount of consultation. We could get to a situation where this House becomes redundant. With the advent of technology, the thing that naturally follows consultation is permanent referendums where everybody can vote from their desks, and we do not need to have a House that discusses and debates from points of experience and different aspects. I therefore firmly oppose the amendment.

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[Wendy Morton]

Absolutely. As I am explaining, the amendments, worthy of consideration though they be, are not necessary in the light of the research I have done, and they would fundamentally change the objectives of the Bill.

The amendment to make

“provision for one trustee to be appointed by the NHS institution…for whose benefit the charitable trust exists”

is an interesting one, but again I do not believe it necessary. Under the new independent charity model there can be a “blend of trustees”, meaning there can be a link to the hospital—on the proviso that the NHS members remain in the minority. That is important. When we are seeking to move away from Secretary of State appointments to a more independence model for special charities, it is the word “independence” that is crucial. These charities are seeking to be independent of Government for fundraising and many other purposes.

[Kevin Foster]

My hon. Friend may be aware that the Public Accounts Committee recently considered a report on the sustainability of NHS trusts, many of which are in deficit. Does she agree that if they had a right to appoint a trustee, it could reinforce in the public’s mind that these charities are about back-filling money into the NHS that could or should be provided by the Government rather than being independent charities providing extra money to what is provided by the Government and the public sector?

[Wendy Morton]

My hon. Friend raises an interesting point. The key point of my private Member’s Bill is to enable this group of charities to achieve what they said they wanted in the consultation, which is a shift away from the Secretary of State’s powers to appoint so that they can demonstrate independence. The charity world has moved on so much since charities were first created, and the model of governance needs to change in the same way.

What makes this particularly interesting is that previous rules surrounding the appointment of individual trustees were restricted to one linked person only. In any case, I believe that the new arrangements in the Bill—not the amendments—are far better and far more beneficial because this “blend of trustees” helps further to help and enhance communications and understanding by both the charity and the trust. Surely that can only be a good thing.

If I may, as the Member in charge of the Bill, I would like to touch on amendment 9, which deals with the use of the NHS logo and was tabled by my hon. Friend the Member for North East Somerset (Mr Rees-Mogg). I shall not make too many references to fashion. Although I could make many a link between logos—and, indeed, brands—and fashion, I shall leave Members to draw their own conclusions about the fashion, style or otherwise of my hon. Friend. To be fair, he raised the issue of the NHS logo on Second Reading, so it is only right for him to bring it forward today as an amendment for consideration. I bow, if not to his fashion sense, to the grace and eloquence of his style in speaking to his amendment today. Perhaps we could share some lessons.

The term “logo” can be defined as a symbol or other small design adopted by an organisation to identify its products, uniforms, vehicles or perhaps a company or organisation. It is often uniquely designed for ready recognition, and I think the NHS logo fits that definition. It is instantly recognisable, and the public know exactly what it is all about. However, I cannot support the amendment because I believe it is a matter best explored through the Department of Health or perhaps through the memorandum of understanding, which is part of the move to independent charity status. It should not become part of this Bill.

At risk of sounding—hopefully not appearing—more like Hook than Wendy Darling, I will bring my comments to a conclusion by simply saying that although we have explored worthwhile amendments this morning and raised some important points, I shall not support any of those amendments.

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Furthermore, I believe that the amendment would have an undue impact on the process of making all NHS charities with appointed trustees independent, or returning them to a corporate model. By reintroducing the role of the Secretary of State, we would give the impression that where that process had not taken place the status quo was adequate, which contradicts what was said by NHS charities during the consultation that was conducted during the last Parliament. I therefore cannot support amendment 2, and must politely ask my hon. Friend the Member for North West Hampshire (Kit Malthouse) to consider not pressing it.

[Kevin Foster]

I am conscious of the time, so I shall be careful not to be either repetitive or irrelevant, and to confine my remarks to the amendments. I should make it clear at the outset that, while I respect the points of passion—and fashion—that have been made in support of them, I do not think that any of them would enhance the Bill.

Amendment 4 deals with public consultation. We surely do not want to ask people to comment on a matter that has already been decided, or in circumstances in which a response to a consultation will not make any real difference to the outcome—other than, as was pointed out by my hon. Friend the Member for South East Cornwall (Mrs Murray), potentially helping to take funds away from either the charity and its objectives or the Department of Health, which is paying for the consultation.

As several Members said, nothing is more likely to build public cynicism about politics than the idea that people have been asked to comment on something and their comments will then be virtually ignored. I can think of an example in local government. A council wanted to reduce free weekend parking, because that had been a manifesto commitment and the council had been returned with a majority. However, it then had to engage in a legal public consultation to find out whether motorists objected to the idea of free parking at the weekend, as opposed to the idea of paying for it. That was absolute nonsense. Several thousand pounds were wasted on advertising in the local press with public notices, and, funnily enough, no motorist wrote in saying, “Do you know what, I would actually like to pay two quid next time I park.”

We should not introduce measures that will engender cynicism. We should not say that a measure has been decided on and announced, but will be subject to a consultation; nor should we provide for a consultation on a matter that is highly technical, and with which very few people will be able to engage. When I was preparing for the Second Reading debate and for today’s Report stage, I found myself burrowing into a huge amount of detail. I do not see how a consultation would be effective.

[Mrs Sheryll Murray]

With individual consultations as well, there is no guarantee we are going to reach everyone. I remember when a consultation was entered into on whether Cornwall should have a unitary council, and the company used admitted in the end that it had not reached all the households concerned, so a lot of people were missed. This is one of the downsides of consulting on individual things.

[Kevin Foster]

My hon. Friend makes excellent points about the difficulties in reaching everyone. In the consultation that created Cornwall Council, there was a major discussion to be had on, I believe, six district councils and one county council being merged into one. There was significant media coverage on, for instance, BBC “Spotlight” and BBC Radio Cornwall, but still, even after all that, some people will have said, “I didn’t know the consultation was going on,” or “I didn’t know exactly what the nature of the consultation was.”

I sat through discussions about future local government structures, including referendums on an elected mayor, during my time in the midlands. People could, I think, engage with some things—for example, planning decisions or social services decisions—but in terms of how a local charity board is structured at the local hospital, and who can make appointments, how they are structured and the process gone through to make them, I cannot see many people saying, “I want to go out to talk about that on a Tuesday night in mid-February.”

If we are having consultations, they should be meaningful. On the question of what is “appropriate”, we should be asking what the appropriate stage is of decision making for each item. As I have argued in the Chamber before, on major constitutional change—the voting system for this House, for instance, or whether we abolish, or significantly change, the other place—we would probably at least need a manifesto commitment, and without that people should be directly asked for their consent to make that change. In terms of the fundamental constitution, it should have the direct consent of the people, therefore. At the other end of the spectrum, however, none of us would argue that the things that this House deals with through secondary legislation would be appropriate subjects for public referendums.

We should ask what the appropriate process is, and in this case the appropriate level of consultation would more be along these lines: “Yes, the charities should talk to each other and, yes, they should go through the normal process to appoint trustees by speaking to their members, but they do not necessarily have to host a public meeting to discuss that.” If this amendment were passed, there would be the nonsense that these particular charities would be required to go through a public consultation, yet the vast majority of charities in this country, who are regulated under the normal method for charities, would not have to do so. I recognise the intention of my hon. Friends the Members for Erewash (Maggie Throup) and for Mid Dorset and North Poole (Michael Tomlinson) in wanting people to be able to engage with the NHS and its services, but this amendment is not the right way of going about it.

On amendments 1, 3 and 2, tabled by my hon. Friend the Member for North West Hampshire (Kit Malthouse), I found the level of doom and disaster that was presented as possibly affecting these particular NHS charities quite interesting. If anyone listening is thinking of becoming a trustee, they might be slightly put off from doing so when they hear all the things that could possibly happen to them as a member of the board of trustees of one of these charities. I am not at all convinced that we need special provision in this Bill for these charities, rather than the wealth of charitable legislation that we already have, including a Bill currently before this House to change that legislation.

I do not think these amendments would tackle the issues, and worst of all they still give the idea that the Secretary of State is in control of a charity. As I said on Second Reading, at the heart of this Bill is independence. It is about these charities not being seen as an arm’s length part of the Department of Health—not being seen as government by the back door.

[Wendy Morton]

Does my hon. Friend therefore agree that these amendments on trustees, which seek to re-establish the powers that my Bill wishes to remove, represent a regressive step, rather than the progressive step the Bill seeks to deliver?

[Kevin Foster]

My hon. Friend is right. The whole point of the Bill is to free these charities from being, in effect, arm’s length parts of the Government. If we say, “We want to free you, but now we want to pop back in the Secretary of State having specific powers that do not apply to any other charities”, that is not a coherent argument and it would not produce coherent legislation. Hon. Members may have concerns about how charities are regulated and whether someone can go off to the Seychelles with the money, but that is a debate about the wider system of charity regulation in this country. They should not seek to put something specific into this Bill that adds another layer of bureaucracy for the charities involved, given that the whole point of the Bill is to get shot of such bureaucracy. I am not persuaded by those amendments.

Amendment 9 deals with the NHS logo. It was put forward eloquently by my hon. Friend the Member for North East Somerset (Mr Rees-Mogg), but, sadly, I will not be joining in the fashion of supporting it. I appreciate that the bodies it deals with are working closely with the NHS, but so, too, do other charities. For example, the Torbay Hospital League of Friends has its own logo and it successfully raises money for Torbay hospital. The name makes it obvious what it is linked with.

[Mrs Sheryll Murray]

We could extend that point even further. A lot of the surgeries in my constituency have “friends of the surgery” organisations. Are we saying that they should be allowed to use the NHS logo, too? Where does this end?

[Kevin Foster]

I thank my hon. Friend for that good point. Once we start on the principle of these changes, where do we stop? Karing, a charity in my constituency—it is in Preston, in Paignton—is very closely linked with a local doctor’s surgery, and it was lucky enough recently to have had its new base opened by Esther Rantzen. It is not, however, part of that surgery. Clearly, the two work together, with Karing supporting and providing great services, giving real benefits to local people, but, crucially, it is not part of the business that is the surgery, nor is it part of the business that is the NHS. That is where the logo point comes in.

[Tom Tugendhat]

My hon. Friend is making a strong, clear point. In my constituency, Edenbridge hospital has a league of friends, which is there not only to support the hospital—it does that incredibly impressively—but to support the needs of the community and to advocate when the hospital gets it wrong, which, occasionally, it may have done. Keeping that independence is essential so that the charity can actually do its job and not merely be an adjunct to the hospital.

[Kevin Foster]

My hon. Friend makes the excellent point that many people will see a league of friends at a local hospital as not just having a function of holding some money in an account, but as also being a stakeholder in the process, able to speak independently and fearlessly about the local hospital and the charities. It needs to be seen as neutral and independent. As we have mentioned, the Public Accounts Committee looked in depth this week at the financial sustainability of NHS trusts. There are concerns about that, and we have seen examples where NHS trusts have gone badly wrong. Thankfully, this Government have been far more prepared to talk about that and deal with it than previous Governments have been. If the charity is seen to be part of the trust, we go back to the idea that the charity is not bringing in additionality. People will think, “I am not donating money so that there is something extra; I am donating money that could or should have been provided by the Government or by the trust.”

If we start spreading the logo around, we open up other debates that are not particularly helpful, as we set a precedent. That was touched on briefly in the intervention by my hon. Friend the Member for South East Cornwall. People are very precious about the NHS—it is a symbol of the public sector, delivered by the public sector. That is a very important point. If we start extending use of the logo to charities, what do we do about other bodies that might wish to start using it? For example, we regularly see the NHS logo used alongside “in partnership”, for example with a foundation trust or the Department of Health, but we do not see groups such as my local league of friends abandoning their long-established and very well-recognised brand within the local area to say that they are collecting for the NHS. The Torbay Hospital League of Friends is doing a great job with its “This is Critical” campaign to get money to help equip the new critical care unit of the hospital, but it is not the NHS, and the essence of that approach is that what it provides is additional and that it is independent. That is why, for me, the amendment would go against the whole spirit of the Bill, which is about independent charities and independent trusts. For me, amendment 9 does not make sense and I will not be supporting it. I hope that my hon. Friend the Member for North East Somerset will not press it to a vote.

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[Jeremy Quin]

I am grateful to my hon. Friend for clarifying his views. I have no problem with paying for consultations when they are necessary and appropriate, but I do not believe that the circumstances likely to pertain to the Bill will be in that category. Issues worthy of consultation are those described by my hon. Friends the Members for Torbay and for North West Hampshire, and the local issues to which I referred.

On amendment 2 tabled by my hon. Friend the Member for North West Hampshire, I hope he will not be upset if I refer to it as the magic circle amendment—now you see it in the Bill, now you don’t—hey presto. With one stroke, his amendment would remove a power that is at the core of the Bill, as it creates clarity for the charities concerned. I know that every hon. Member who has tabled an amendment today is a passionate supporter of those charities, as are we all. The benefit of the Bill is that it provides clarity to the charities. Under the Bill, trustees will become fully independent. They are left in no doubt about who is responsible for the conduct of the charity and about their own corporate governance. That is a good thing, which empowers them and encourages responsibility.

[Kevin Foster]

My hon. Friend has made some excellent points. Does he agree that the point of the Bill is to make these charities independent and regulated like others? This is the Peter Pan Bill, but the tale of disaster behind the amendments will make them the Tinker Bell amendments.

[Jeremy Quin]

I am grateful for my hon. Friend’s knowledge of pantomimes. No doubt Captain Hook is in there somewhere. I certainly accept the pith of his remarks. By making the charities fully independent, we provide clarity not only to the trustees by empowering them, but to donors, who will know that their generous gifts to the charities will be looked after by independent trustees.

My hon. Friend the Member for South Ribble (Seema Kennedy) referred to the sad state of current polling on Government Ministers. I think we would all agree in this House that those who fulfil the functions of charity trustees are good people doing a good task, and are recognised as such. They are the people whom the generous donors to these charities want to be in command of the assets that they transfer, rather than any other body. That is why I oppose the amendment.

Amendment 7, which stands in the name of my hon. and fashionable Friend the Member for North East Somerset, would merely add to complexity and cost, neither of which is required. In particular, a report from the Comptroller and Auditor General is an unnecessarily bureaucratic step.

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[Jane Ellison]

My hon. Friend is absolutely right. Several hon. Members have mentioned charities in their area that are doing great work to increase the public availability of defibrillators. Perhaps I may take a moment to update the House on that matter. The Government were delighted, in partnership with the British Heart Foundation, to provide £1 million for defibrillators, meaning that this life-saving equipment will be given to communities right across the country—we have heard about several examples this morning, and my hon. Friend has mentioned another great example in Derbyshire—and that more people can be trained in cardiopulmonary resuscitation. That will make it easier for people to act in an emergency, and ultimately it will of course save lives.

I can update the House by saying that applications opened last October and interest was very high. The British Heart Foundation allocated funding to applicants who could demonstrate that the criteria had been met, and the application process has now closed. We look forward to hearing more about all the places around the country—I am sure that some of them will be in constituencies of hon. Members in the Chamber—where such life-saving work will be enabled.

[Kevin Foster]

I am interested to hear the Minister’s remarks. Given the slightly negative perceptions of charitable work and the descriptions of things that could go wrong that we heard earlier, would she like to comment on the things that are going very well? Will she put on the record her thanks, on behalf of Her Majesty’s Government, to the Torbay Hospital League of Friends? Over 62 years, it has raised millions of pounds to support local people and it is currently running its “This Is Critical” campaign to provide equipment for the new critical care unit that is under construction at Torbay hospital.

[Jane Ellison]

My hon. Friend is exactly right. At times, the debate has moved into rather gloomy territory. He used the “EastEnders” analogy. During the contribution of my hon. Friend the Member for North West Hampshire (Kit Malthouse), I began to think he was speaking to the Private Frazer amendment—the “We’re doomed!” amendment.

My hon. Friend the Member for Torbay (Kevin Foster) is right to bring us back to the great work that is being done. My experience of a local league of friends is similarly positive. Often, in the cut and thrust of our debates on legislation from Monday to Thursday we do not have time to put on the record the thanks of Parliament and the Government for the efforts of groups like his league of friends. It is welcome that this morning, when we have a little more time, we are able to put on the record our thanks to people who are not in the spotlight, but who are doing wonderful work in all our constituencies. I congratulate him on doing that and join him in praising the Torbay Hospital League of Friends.

--- Later in debate ---

[Kevin Foster]

It is a delight to be called to speak in this Third Reading debate. I will keep my remarks relatively short, given the time.

It is a delight to speak again about the “Peter Pan” Bill promoted by Wendy. Although it is amusing to allude to “Peter Pan”, this debate is backed up by the serious work done by the charities affected. Securing the royalties for the future will ensure that one of the world’s best places for treating sick children—a place that does groundbreaking work and allows people who would otherwise not have survived to see their adult years, not to mention to have a full chance in life—will be able to continue. That is so important, which is why I am pleased to support the Bill.

The Bill also sends a powerful message about the independence of charities. The charities affected will not be seen as arm’s length parts of Government, but as independent organisations that offer something additional to what the NHS provides. I opposed a number of amendments because they were not in keeping with the Bill’s golden thread: the idea that NHS charities are independent organisations that add extra to the NHS, not arm’s length Government bodies trying to collect donations to do what many people feel the NHS should either be doing already or looking to be doing in the future.

I know from my experience of working with charities that work closely with the NHS—I touched on that earlier—that some of the fears associated with the independent status of the charities are false. Many charities work very well in collaboration with local authorities, the NHS and other public sector bodies to deliver services and make a difference in their communities. That is what this Bill will fundamentally allow such charities to do.

It has absolutely been worth while giving the Bill the level of scrutiny it has received today, given that the Committee was truncated by the Syria debate. It is important to send to the other place a very strong message about our support for the Bill, the fact that it makes sense to enact it, and the fact that it should not head off into the Neverland of endless debate, but should in due course receive Royal Assent.

The Bill is the right step to take with regard to monitoring NHS charities. It frees them from being part of the Government, but not from the overall provisions regulating charities, or from the overall duties of trustees under laws passed in Parliament. The charities will still have to follow those laws and are not free to do anything they want, but they can say to someone who is honestly thinking of making a donation, “We are not part of the Government or an arm’s length part of an NHS organisation; we are an independent charity that provides extra services to support the work of the NHS and the local hospital to which we are affiliated.” What the Torbay Hospital League of Friends does in my constituency should be done across the whole country.

It has been a pleasure to be in the Chamber today, and to speak on Third Reading. I hope that it will not be necessary to have a Division, but that the Bill will receive unanimous support from all parts of the House.

Oral Answers to Questions

Kevin Foster Excerpts

Tuesday 5th January 2016 Commons Chamber

[Alistair Burt]

Absolutely, and a number of the pilots and pioneer programmes are doing just that. Early results from the living well programme in Penwith in Cornwall show a 49% reduction in non-elective admissions to hospital and a 36% reduction in emergency admissions to hospital. So the hon. Gentleman is right: better social care and better integration may have, and should have, an impact on hospital admissions and make sure people are receiving the most appropriate care in the most appropriate place.

[Kevin Foster (Torbay) (Con)]

I was pleased to hear the Minister’s reference to the integrated care organisation that is being created in my constituency. Given the increasing challenge of providing social care to those in the later stages of life, does he agree that this is a model that needs to be looked at, and will he give it as much support as he can?

[Alistair Burt]

Indeed; the ability to see how these pilot projects respond to the different demographics in different areas enables one area to learn from another. Torbay has come up frequently in this context, and I am pleased to be able to praise it again. While I am on my feet, I should also like to point out that many of those involved in adult social care were greatly affected by the recent flooding in the north of England and that they were looking after vulnerable people and working beyond the front line. That work was very important, and I am grateful to Ray James of the Association of Directors of Adult Social Services and to all those working in local authorities in the affected areas who contributed so well to looking after vulnerable people during that period.

Victims of Contaminated Blood: Support

Kevin Foster Excerpts

Wednesday 16th December 2015 Commons Chamber

[Jane Ellison]

My officials are working closely with their opposite numbers in all the devolved Administrations. As we move towards publication of the consultation, I will look to communicate directly with my opposite numbers in the devolved Administrations and pick up all these points.

[Kevin Foster (Torbay) (Con)]

I know from her statement that the Minister will appreciate the frustration that my constituents, some of whom have been waiting for an outcome for some decades, will feel at another delay. Given her comments on the carrying over of transitional funding, will she give me a clear idea of when she expects the new system to be in place?

[Jane Ellison]

We aim to consult, and we want to make sure that the final shape of the reformed scheme is informed by that consultation. As I have said, we look to start transitioning to a reformed scheme in the spring. At this stage, however, it is a little difficult to be more precise. We are working hard to ensure that aspects of the transition are being planned and thought about, and this will be informed by the final outcome of the consultation.

Mental Health: Out-of-Area Placements

Kevin Foster Excerpts

Thursday 3rd December 2015 Commons Chamber

[Norman Lamb]

That is a shocking practice. I applaud my hon. Friend for the work that he has done on it in his area. The idea of putting someone who is suffering an acute mental illness into a police cell, which is defined in the legislation, unbelievably, as “a place of safety”, is bizarre and ought not to be tolerated. I am pleased that the Government have indicated an intention to legislate, in effect to eradicate the problem completely for under-18s and to make it an exception for adults. We managed to reduce the numbers in England by 50% in the past two years, which was considerable progress, but we need to go much further and bring an end to an unacceptable practice.

It is interesting that where local passion and drive exist, amazing things are possible. In our capital city, London, last year around 20 people in total ended up in a police cell, whereas in Sussex the number was over 400. That demonstrates that with real drive from both police and mental health services, practices can be changed and people’s lives can be made better. My hon. Friend is right to persist with the issue in Wales, just as I have tried to do in England.

[Kevin Foster (Torbay) (Con)]

I congratulate the right hon. Gentleman on securing the debate and on the work that he has done to bring the issue to the fore. A police cell should be for someone charged with a crime, not for someone who is unwell. Does he agree that to some extent the problem could be overcome with better co-ordination? I had a case in my constituency where a local treatment unit was full so a person was placed in Maidenhead. We then discovered that there was someone from Maidenhead in the local treatment unit in Torbay and arranged a swap.

[Norman Lamb]

Such a story makes one weep and leaves one feeling that there is a degree of incompetence somewhere. I will come to that point. Much of what I want to see happen can be done by better organisation, rather than by providing more money. I strongly believe that we need more investment in mental health services, but a lot can be done just by organising things much better.

--- Later in debate ---

[Norman Lamb]

We do not have that information—the data are very basic—but that matter is crucial. I imagine that communications often fall down when urgent referrals to another location take place.

I would raise another issue about families. If they have to visit a loved one 50 km or 100 km from home, just imagine the cost involved. Members in the Chamber— any of us could be in this situation—can afford to visit a loved one, but many people cannot do so. That is another reason why the situation is intolerable.

[Kevin Foster]

It is very interesting to hear the right hon. Gentleman’s statistics on my own area of Devon. It is important to get to grips with the issue for the reasons he has mentioned. He raised the point about communications in the example of the expensive round trip from Devon to Maidenhead. In many cases, families may know where their loved one will go, but the reality is they are presented with a choice: “Your loved one needs treatment—this is where it’s going to be. There is not much you can do, other than trying to mitigate all the impacts in the best way you can.”

[Norman Lamb]

Such a situation leaves the family feeling desperate, guilty that they can do nothing to help their child or loved one, and powerless to do anything. That is similar to the case of Josh Wills, a little boy with autism, who lives in Cornwall. He was placed in a specialist unit in Birmingham, so we can imagine the journey his parents had to make every week. He was there for more than three years, and when I was the Minister, I had to intervene personally to get the commissioners to London to try to sort out the case. Josh is now back in Cornwall, but it took far too long for that to happen. Such cases must put families under intolerable pressure and strain.

I should mention the areas where the problem is at its worst. In the Lancashire Care NHS Foundation Trust, there were 30 cases in August. Again, that is one a day. In the Kent and Medway NHS and Social Care Partnership Trust the figure was 30, in West London Mental Health NHS Trust it was 25 and in Birmingham and Solihull Mental Health NHS Foundation Trust it was 25. Again, there is the caveat that we do not know where the responsibility lies, but we should all accept that the practice is not acceptable and has to be brought to an end.

The data focus on non-specialist beds. There will be cases, just as with physical health problems, where a patient needs specialist input and where a referral to a specialist hospital, such as Papworth in the case of a heart condition, is appropriate. However, non-specialist beds and services should surely be provided closer to home. So we got these data together and they now allow us to hold the system to account. As well as establishing the dataset, we got Monitor and the Trust Development Authority to do, to use the jargon, deep dives into a number of organisations, both good organisations and those with a bad record of out-of-area placements, to get a better understanding of what was going on. When they reported back to me, their conclusion was that this problem ought to be solvable.

That is the important point for the Minister. It is not that this problem is something we would all love to solve but find it impossible to do. It is achievable, but it requires drive, ambition and determination to see it through. If I may, as an ex-Minister, I will offer a bit of advice to the incumbent. It is no good saying that we need to make incremental progress to reduce the numbers. We need to establish the principle that this practice is not acceptable. Someone in a mental health crisis who does not require specialist care should not be sent away from home, full stop. This is not a difficult issue. It should become what in the NHS is known as a “never event”—it should never happen. If we know that there is a link between this practice and an increased risk of suicide, how can we tolerate it?

The Minister has to set the objective of ending this practice. I understand that it will take time. Back in March, I wanted to see it end by the end of this calendar year. I recognise that that is now not achievable, but I set the objective of ending it within 12 months. That is achievable, provided that there is drive, ambition and purpose to make it happen.

A related issue is that of money. I have made it clear that I totally sign up to the importance of doing things differently and making better use of resources to achieve good results for people. However, investment is needed in mental health. In the negotiations in the run-up to the March Budget, my right hon. Friend the Member for Sheffield, Hallam (Mr Clegg) secured £1.25 billion of extra investment in children and young people’s mental health services for the five-year period of this Parliament. In year 1, the amount that ought to have arrived on an equitable division of that £1.25 billion was £250 million. The amount that was made available was £143 million, which means there is a shortfall.

We were told that that was because we were part way through the year, we had had the general election and we needed to make sure that the money was spent effectively. I sort of accepted that explanation, but I have since heard from reliable sources that there was a land grab going on and that money was taken away from children and young people’s mental health services to prop up the finances of acute hospitals, for example. I urge the Government to make good the shortfall in future years.

On 13 October, the Minister helpfully reconfirmed that the full £1.25 billion would be spent in this Parliament. I call on him to repeat that commitment today. It is critical that the extra investment that was confirmed in the Budget in March is stuck to. It is a matter of good faith by the Government and I would like to hear that confirmation. I also think, incidentally, that we should make good the shortfall in year 2 because, just as with the rest of the NHS, frontloading the money to invest in change is the best way to use the resources that are available.

I will move towards the end of my contribution, which has been rather elongated owing to the additional time that is available. I will end by asking specific questions of the Minister. I would be grateful if he addressed each of them directly this afternoon. If he is unable answer any of those questions directly, I would be grateful if he wrote to me as soon as possible and responded to them directly.

First is the issue of principle. Does the Minister accept that this practice is intolerable? I am not talking about specialist beds; I am talking about non-specialist beds where someone at a moment of mental health crisis, or in other circumstances, is shunted around the country—a practice that would never be tolerated in physical health. Secondly, will he commit to ending that practice completely within 12 months, and effectively to make it a “never event”? Thirdly, will he personally drive that change, because I know from experience that that is necessary? He needs to be on the case constantly to ensure that the system responds to that moral imperative.

Fourthly, will he ensure that all providers provide the data that their contracts oblige them to provide to the information centre? Anything short of that is completely unacceptable. The data are still in experimental form, and information centre notes state that they provide a “reference point” for a more accurate measurement in the future. There must therefore be an evolution to get to a point where data around the country are completely accurate, so that providers and commissioners can be held to account. Will the Minister commit to ensuring that the experimental data are turned into final-form data that we can all rely on?

Finally, will the Minister reconfirm his total and absolute commitment to ensuring that £1.25 billion of additional investment is spent on children and young people’s mental health services this Parliament? Will he commit to sticking with the vision that we published in October last year and to introduce comprehensive maximum waiting time standards? I did that work—which led to the publication of that document—in collaboration with the Secretary of State, and he was incredibly helpful in supporting me to get that published. The vision was clear, and it recognised that until we have comprehensive waiting time standards for mental health, just as exist for physical health, we will not get equality of access to treatment. An essential principle in a publicly funded service is that all people must have the same right to receive evidence-based treatment on a timely basis. As I have said, will the Minister write to confirm any specific point that he feels unable to deal with this afternoon?

--- Later in debate ---

[Norman Lamb]

One of the recommendations from the taskforce that NHS England established to look at tier 4 services, at the number of beds required across the system and at the variability of the services was that treatment should always be contained within a region —in other words, that no child who lives in the south-west should ever go out of the south-west for treatment. I cannot remember where the child from Torbay had to go—

[Kevin Foster]

Berkshire.

[Norman Lamb]

Indeed. Is the Minister going to stick to that? Is he going to ensure that that is the objective, and will he monitor it to ensure that he meets it?