PIP Breast Implants and Regulation of Cosmetic Interventions

Lord Lansley Excerpts

Tuesday 24th January 2012 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

In my oral statement to the House of 11 January 2012, Official Report, columns 181-183, I described the immediate action which the Government are taking to address the concerns of women who have received breast implants made by the company Poly Implant Prothèse (PIP). I said that, in the light of these events, we needed both to review the lessons that could be learnt, and to consider the wider issues of ensuring the safety of people who are considering cosmetic surgery and similar treatments. I therefore announced two reviews, one to be led by my noble Friend the Parliamentary Under Secretary of State (Earl Howe) which will look at what happened in the United Kingdom in relation to PIP implants; and the second, to be led by the NHS Medical Director, Sir Bruce Keogh, to look at the wider issues of clinical safety and regulation.

The review to be carried out by Earl Howe will report by the end of March 2012 and the terms of reference are:

Review of actions of the MHRA and wider Department of Health

“In the context of current EC directives on the regulation of medical devices and the information generally available at the time on the risks associated with breast implants, to review:

1. what information about PIP implants was available from routine adverse reporting systems;

2. what external concerns about PIP implants were brought to the attention of the MHRA or the wider Department of Health, and when;

3. how these concerns and any related information were handled;

4. what advice was sought and from whom;

5. what information was shared between MHRA and its counterparts in other countries in the EU and elsewhere;

6. how decisions were taken, and who was involved in this process;

7. what action was taken to safeguard and advise patients;

8. whether action was sufficiently prompt and appropriate

The review will advise the Secretary of State on what lessons can be learned for application should similar circumstances arise in the future, and on implications for UK input to the ongoing review of the European Medical Devices Directives.”

The review to be carried out by Sir Bruce Keogh will begin in March 2012 and will report within 9-12 months, that is, at the latest by March 2013, and the terms of reference are:

Review of regulation of cosmetic interventions

“Taking into account the Government’s Better Regulation framework and the concurrent review by the EU of current arrangements for the regulation of medical devices:

1. To review the current arrangements for ensuring the quality and safety of cosmetic interventions posing a potential risk to physical or psychological health, and in particular to consider:

i. whether the regulation of the products used in such interventions is appropriate;

ii. how best to assure patients and consumers that the people who carry out procedures have the skills to do so;

iii. how to ensure that the organisations which deliver such procedures have the clinical governance systems to assure the care and welfare of people who use their services;

iv. how to ensure that people considering such interventions are given the information, advice and time for reflection to make an informed choice;

v. whether there should be a statutory requirement for such organisations to offer redress in the event of harm, and if so how this could be funded;

vi. what improvements are needed in systems for reporting patient outcomes, including adverse events, for central analysis and surveillance.

The review will consider issues of governance, data quality, record keeping and surveillance, as well as ensuring that sufficient information is provided to secure patients’ informed consent. It will include consideration of the feasibility of an outcomes-based register of commonly implanted devices.

2. To make recommendations to Ministers, including interim recommendations if appropriate, and to inform the UK contribution to the EU review.

The interventions to be considered for the purpose of this review could potentially include:

a. the surgical insertion of a medical device or prosthesis, or other surgery intended to change the appearance of the body

b. injection with any product, whether medicinal or otherwise

c. any other form of intervention at the discretion of the review team where the intervention is not clinically indicated to safeguard or improve the physical health of the recipient.”

NHS (Private Sector)

Lord Lansley Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

May I refer the hon. Gentleman to the motion? Its request to the Government is not unreasonable; it asks them “to revise significantly downwards” the cap they have proposed.

[The Secretary of State for Health (Mr Andrew Lansley)]

To what?

[Andy Burnham]

I remind the Health Secretary that he is the Secretary of State, not me. It is for him to bring forward proposals. Forty-nine per cent: in that proposal he is saying that NHS hospitals can give equal priority to the treatment of private patients—that it can be as legitimate an objective for an NHS facility, paid for by the taxpayers, to be used equally for the treatment of private and NHS patients. I put it to the hon. Member for Kingswood (Chris Skidmore) that I am not prepared to accept a cap on that scale. It could lead to an explosion of private sector work in NHS facilities and I do not think that is in the best interests of NHS patients. I would be prepared to accept the Government’s bringing forward proposals that fulfilled a modest loosening of the cap, to give the NHS more freedom at this difficult time, but I am talking in single figures. I am not talking about a doubt-digit, 50% cap—a recommendation that hospitals devote half their resources to private patients.

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[Andy Burnham]

My hon. Friend is absolutely right: this proposal brings that conflict right to the heart of the NHS. At the moment, NHS hospitals have a paramount and overriding duty to the treatment of NHS patients, but considering a health care system whereby services would be delivered through a series of commercial contracts brings that conflict of interest into the health care system—shareholders on the one hand, patients on the other. That is why there is such deep disquiet among health professions about these proposals. It is why those professions applied so much pressure last year, and the pause was ordered. It is why, I am afraid, they are still unhappy today—the Government have not addressed their concerns.

[Mr Lansley]

Before the right hon. Gentleman continues with this wholly erroneous line of discussion, will he reflect on the fact that the Bill introduces, for the first time, a transparency in accounting between NHS activity and any private income in any foundation trust, which he did not put into legislation? The Bill introduces a transparency that there can be no cross-subsidisation between NHS resources and any private activity. It introduces a legal requirement for any foundation trust to explain to the public at its annual meeting how it has used any private income to the benefit of NHS patients. Will he reflect on the fact that the primary purpose of a foundation trust is to provide NHS services? For it to do anything that was to the detriment of NHS patients, involving private patients, would be contrary to its primary purpose and unlawful.

[Andy Burnham]

There are a lot of questions there. The Secretary of State discusses the safeguards, but he has introduced them precisely because he has made a major break with 63 years of NHS history. He needs them because he wants a different health care system in this country, in which much more work is done by private providers and in which the commissioning of services is largely handed over to the private sector. That is why he has had to introduce those safeguards. We had a health service that was planned, managed and publicly accountable, but he is throwing all of that away.

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[The Secretary of State for Health (Mr Andrew Lansley)]

We start 2012, and what is the Labour party’s priority? Is it to welcome the NHS improvements in performance, as reported before Christmas—that waiting times are low and stable, that there are now 90% fewer breaches of mixed-sex accommodation standards than at the same time last year, that hospital infections are at their lowest ever levels, or that there are more doctors and fewer managers in the NHS than at the election? No, none of those was Labour’s priority. Was it to welcome the increase next year announced just before Christmas in NHS funding for primary care trusts, or since Christmas an increase in the funding available this year direct to clinical commissioning groups to enable them to meet the needs of their patients? No, it was not that.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I know that the Secretary of State was at Salford Royal hospital last week, where the abundance that he is describing does not seem to be around. That hospital—he went there to talk about nursing—will have to lose many hundreds of its nurses. It seems strange to us that we do not seem to see the abundance that he talks about and it certainly was not apparent at Salford Royal.

[Mr Lansley]

That is exactly the same question that the hon. Lady asked during oral questions. The Prime Minister and I did indeed go to Salford Royal hospital and we were tremendously impressed by what is being done there but, like other hospitals across the NHS, as part of a process of using resources more effectively and as part of the consequences of a transfer to supporting patients more in the community than in the acute sector, that hospital is changing the way it manages its services, and it is delivering cost improvements. We make no bones about that.

We delivered £4.3 billion of cost improvement in the NHS in the last financial year. We are aiming to do more this year. We delivered £2.5 billion, according to the deputy chief executive of the NHS, in the first two quarters. Every penny saved by reducing costs in the NHS is available to be reinvested in the NHS. That is why we are in a position to improve the performance. The hon. Lady did not talk about how that funding is becoming available through savings on central costs—for example, £150 million extra funding this year announced since Christmas for support for the integration of health and social care.

Was that Labour’s priority? No. Did Labour come to the House and say, “We want to welcome the way the NHS has achieved an increase in the flu vaccine uptake,” or the simple fact that flu activity at this stage is at its lowest level for the past 20 years? No, none of that. The hon. Lady talked about Salford Royal and the way nurses are engaging in some best practice—

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

Will the Secretary of State give way?

[Mr Lansley]

No. I am still answering the previous intervention. Nurses are engaging in best practice to improve the quality of care for patients in Salford Royal. Was that the basis upon which the right hon. Member for Leigh (Andy Burnham) chose to come to the House to talk about the things that matter to patients—the quality of care being delivered to patients? No, it was none of those things.

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Lansley]

No. I answered the hon. Lady’s question.

Labour Members came to the House not to pursue the priorities of patients or of those who work in the NHS, but to pursue Labour’s priorities. They are not in 2012; they are not even in the 21st century. They are back in the past. Talking of the past and somebody who lives in the past, let us listen to the hon. Member for Easington (Grahame M. Morris).

[Grahame M. Morris]

The Secretary of State has quoted a series of statistics. Does he welcome the 29% increase in patients waiting more than 18 weeks since May 2010 as a result of dropping targets?

[Mr Lansley]

Let me explain to the hon. Gentleman. The average time that patients waited for in-patient elective procedures in the NHS according to the latest data was 8.4 weeks, which is exactly the same as at the time of the last general election. For out-patients it was 3.9 weeks, compared to 4.3 weeks at the election. For diagnostic tests, despite the fact that the NHS has performed 440,000 more diagnostic tests, the average waiting time is 1.8 weeks, the same as at the election. Long waits? The hon. Gentleman did not say that according to the latest data published the number of patients waiting more than a year for their treatment went down 40%, compared with what we inherited from the Government at the time of the last election.

The motion is all about Labour’s going back to the past. I am staggered. It is almost like revisiting Barbara Castle’s antipathy towards the private sector, or that of the right hon. Member for Holborn and St Pancras (Frank Dobson), the only former Labour Secretary of State now, even including himself, that the right hon. Member for Leigh seems to agree with.

I will ask the House to reject the motion, but in a way I am asking the House to reject those sentiments all over again, because we have been here before with this debate. Far from the House not having had an opportunity to consider issues including the private income cap, I remember having exactly this debate on Report. We were very clear about that. We discussed it when the White Paper was published, we discussed it when the Bill was debated on Second Reading, when it was in Committee and on Report, and it has been debated again in another place. I hope to use this opportunity to trample on some of the myths that the right hon. Member for Leigh and his friends are propagating about the Bill.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

I have received information from inside King’s College Hospital NHS Foundation Trust that priority is being given to private cancer patients in both diagnosis and treatment. Will the Secretary of State either confirm or deny that that is a fact?

[Mr Lansley]

If the right hon. Lady has any such evidence, she should give it to me. Let me explain that at the moment any individual member of NHS staff would be acting contrary to the NHS staff code of conduct if they saw a conflict between private sector and NHS activity and gave priority to private patients to the detriment of NHS patients. Technically speaking, under the legislation we inherited it is not explicitly unlawful for a foundation trust to do that but, as I explained to the right hon. Member for Leigh, a whole series of specific safeguards relating to the relationship between private and NHS activities was introduced into the Bill in another place. It makes it clear that the principal purpose of a foundation trust is to benefit NHS patients and NHS services. To do anything that is to the detriment of NHS patients will be unlawful. There are specific safeguards stating that foundation trusts cannot cross-subsidise between NHS activities and services and private services. If the right hon. Lady has information of a particular instance, she might as well give it to me.

[Dame Joan Ruddock]

I am grateful to the Secretary of State for giving way again. Does he not understand that a person who has this information is terrified of putting it into the public domain—[Interruption.] I am sorry, but he is wrong. We are talking about someone’s job and livelihood. I simply asked him whether this is correct or not. Does he know?

[Mr Lansley]

I have no knowledge of what the right hon. Lady describes. Let me remind her that those working in the NHS have a responsibility to disclose anything that that they think is to the detriment of their patients’ interests, and under legislation on public interest disclosure they have protection. I announced just before Christmas that in the latest contract for an enhanced advice line there should be a whistleblower advice line.

[Kate Green]

I note what the Secretary of State says about staff who have concerns being encouraged to express them, but in the case of Trafford Healthcare NHS Trust, where a private company has just been commissioned to provide orthopaedic pain relief services, the staff had absolutely no knowledge that that commissioning was going on. How can he be sure that staff will be able to raise concerns when there is such a lack of transparency?

[Mr Lansley]

What the hon. Lady describes is precisely what has happened time and again under the legislation we inherited, which is not transparent. Primary care trusts were not accountable or transparent and an enormous amount of activity went on with tenders that involved the private sector and was not conducted in the way that we want, which is on the basis of a tariff and on the basis of which provider is best able to deliver the highest quality.

Let me deal with the first of the myths propagated by the right hon. Member for Leigh: that we have some kind of privatisation agenda. We do not. As I recollect, the only time any Government had a specific objective to increase the role of the private sector in the NHS was when he was a Minister, his hon. Friend the Member for Leicester West (Liz Kendall) was a special adviser to the Department for Health and Patricia Hewitt was Secretary of State. That was when they were saying they wanted to increase the role of the private sector to 10% or 15%, and the Health and Social Care Bill contains specific provision not to allow such discrimination in favour of private providers in future.

[Andy Burnham]

The Secretary of State says that he has no proposals to increase privatisation. Will he confirm that he has sent a letter through the Department asking clinical commissioning groups to identify three community services that will be subject to a compulsory competitive tender?

[Mr Lansley]

No, because it is not compulsory competitive tendering. It will extend access to any qualified provider—

[Andy Burnham]

That is the same thing.

[Mr Lansley]

It is not. The right hon. Gentleman, having been Secretary of State, ought to understand the difference between compulsory competitive tendering and any qualified provider. Under compulsory competitive tendering, it is the primary care trust that gets to choose who provides the service, but under any qualified provider it is patients who get to choose. One example is access to wheelchair services. Voluntary sector organisations, such as Whizz-Kidz, are setting out to provide a better service. From its point of view, that is not competitive tendering. Wherever Whizz-Kidz provides the service, patients in that area—[Interruption.] If he wants to have a conversation with other Members, he may by all means do so, but I will sit down.

I answered the right hon. Gentleman’s point and I am afraid that it proceeds from a fundamental misunderstanding of the difference between competitive tendering processes, which have been the stuff of primary care trusts—in the past it was they that decided who should provide services—and giving patients access to choice so that they can drive quality. Unlike competitive tendering, which was generally price-based tendering decided on cost and volume, under any qualified provider it is not about price, but about quality.

[Charlie Elphicke]

My right hon. Friend mentioned the provision of wheelchair services, which we have been looking at in Kent when considering how commissioning can be taken forward. Whizz-Kidz offers really great and radical ideas. Is it not the case that the Labour party would have condemned disabled people to the same standard-issue NHS wheelchairs rather than allowing them real choice across the spectrum?

[Mr Lansley]

My hon. Friend is absolutely right. That is precisely why on that basis, using the any qualified provider approach, the chief executive of the NHS can set out the ambition that a child who needs a wheelchair should get it in a day. In the past they would have to wait and then would not necessarily get the wheelchair they wanted, or in any reasonable time scale. This is about driving improvement and quality. Many NHS providers will respond positively to that and deliver the quality, but if they do not we ought to be in a position to believe that what really matters in the NHS is the quality of the service provided to patients. That used to be what the Labour party believed in, which I suppose was why its last manifesto, written when the right hon. Gentleman was Secretary of State, stated:

“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”

That is a complete description of what we are setting out to do. It is a description of the any qualified provider policy and something that he has now completely abandoned, and he has abandoned patients in the process. It is absurd.

The objective of the Bill and of the Government is simple: continuously to improve care for patients and the health and well-being of people in this country, and that includes improving the health of the poorest fastest, and to ensure that everyone, regardless of who or where they are, enjoys health outcomes that are as good as the very best in the world. That is what we are setting out to do.

The motion states that the private sector already plays an important role in providing that care. Indeed, once upon a time the Labour party was in favour of it. The right hon. Gentleman said in May 2007:

“Now the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”

Like my hon. Friends, I do not understand where he is coming from. The motion tries to face both ways, stating that Labour agrees with the private sector but also wants to have less of it. It agrees that the private sector can make a valuable contribution, but wants to stop it doing so. What matters to patients is the quality of care they receive, the experience of their care and the dignity and respect with which they are treated. Whether the hospital or community provider is operated by the NHS, a charity, a private company or a social enterprise is not the issue from the patient’s point of view. From our point of view, we should not make that the issue. The reason it will not matter is that, whoever is the provider of care, the values of the NHS—universal health care, paid for through general taxation, free and based on need, not ability to pay—will remain unchanged. No NHS patient pays for their care today; no patient will pay for their care in future under this Government. On that basis, I can absolutely restate what the Prime Minister said: under this Government and on our watch the NHS will not be privatised.

[Tom Blenkinsop]

With all due respect to the Secretary of State, I am afraid he cannot say that. We heard the excellent example of Whizz-Kidz, which is a fantastic organisation, but he cannot guarantee that it will get the contract, because Monitor, as we all know from the Bill, has primary control over who gets the service, and it will apply competition law, purely and simply. There is absolutely no guarantee that the third sector or co-operatives will get in, and in any case there is no guarantee that care quality will be applied in the decision.

[Mr Lansley]

Forgive me, Mr Deputy Speaker, but I hardly know where to start, given the degree of ignorance associated with that point. Monitor does not decide who gets the service; patients and commissioners do, and the clinical commissioning groups determine how they commission the services. Quality is absolutely at the heart of the Bill, and at the heart of how we structure the statutory duties of all organisations concerned, but the hon. Gentleman goes on about the application of competition law. Actually, there is no extension of competition law in the NHS and no extension of EU competition law as a consequence of the Bill; it simply enables the NHS to have a health-specific regulator so that the application of competition law and EU competition rules, in so far as they apply because the Bill does not change their application at all, is carried out by a health sector regulator.

Myth No. 2 is that the impact of a wider range of providers in the NHS will drive down the quality of care, but we will give patients more choice and more control over their health care. If people are given clear information about the quality of different providers, they will, with their doctors and nurses helping as their commissioners, choose the provider that is best for them, and the Health and Social Care Bill means that all providers will compete on the quality of their services, not on the prices that they charge.

There will be no incentive for doctors to encourage their patients to opt for the cheapest option, because there will be no cheapest option; there will only be the best-quality option.

[Tom Blenkinsop]

It will be Monitor’s option.

[Mr Lansley]

No, it is nothing to do with Monitor in those circumstances; those whom I have mentioned will make the choice.

The more choice there is, the more innovation there is, the more new ideas there are and the more pressure there is on all providers from all sectors constantly to raise their game for patients. The evidence supports that.

[Andy Burnham]

I have been listening to the right hon. Gentleman very carefully, and he made a statement a moment ago about there being no privatisation—that privatisation will not result from the Bill. Is he saying to us that his Health and Social Care Bill will lead to no additional privatisation of commissioning or provision in the national health service? It is a very clear question.

[Mr Lansley]

There will not be any transfer of responsibility for services from the NHS to the private sector; the NHS will continue to be responsible. The balance in the NHS—[Interruption.] No, I shall answer the right hon. Gentleman’s point. He is trying to interpret “privatisation” as every service currently provided by an NHS provider being provided by an NHS provider in the future, but whether services are provided by the NHS or by a private enterprise, a social enterprise or a charity will be determined by patients choosing who is the best-quality provider. So that is not privatisation; the service remains free, and it remains an NHS service. It is guaranteed to patients in exactly the same way, and there is no presumption in the legislation—in fact, it excludes any presumption—in favour of a private sector provider as against an NHS provider.

The right hon. Gentleman is in absolutely no position to make any criticism of that, because he served in a Government who introduced independent sector treatment centres. They went through the process of giving the private sector contracts that were not available to the NHS, with an 11% higher price on average and a guarantee that they would be paid even if they did not necessarily provide the treatment. The net result was £297 million spent on operations that never took place, and the private sector walked away with that money, so he is in absolutely no position to make any criticism, because we are going to exclude such practices. The contracts that the Labour party gave to the private sector when he was a Minister are exactly the contracts that our legislation will exclude.

[Henry Smith]

Will the Secretary of State confirm that, under the previous Administration, private sector involvement in the NHS went up by 78%?

[Mr Lansley]

Interestingly, under the so-called extended choice network that the Labour Government introduced, the number of elective operations conducted in the private sector went from, I think, 16,000 in 2005-06 to 208,000 in 2009-10—an enormous increase. From the right hon. Gentleman’s point of view, it was marginal capacity that did not really matter, but the point is that patients said that they thought it provided good quality care. In a Care Quality Commission survey, some 96% of NHS patients using independent facilities said that the elective surgery they received was “excellent” or “very good”. The figure for NHS facilities was 79%. On the NHS Choices website, nine of the top 20 highest-rated NHS-funded providers were run by the independent sector; there were no independent-sector hospitals in the bottom 20. The general proposition is that the private sector is worse in the NHS, but there is no evidence to support that.

The right hon. Gentleman will recall that the Royal College of Surgeons conducted a study of the quality of care, and its general conclusion was that the quality of clinical care offered to NHS patients by private sector providers was as good as the care offered by the NHS. So what is his point? He used the private sector, patients used the private sector and patients were happy. What is his point?

[Andy Burnham]

We did, and I have celebrated it already, because it delivered the lowest-ever NHS waiting lists, which I celebrate again. But I am listening to the right hon. Gentleman, and I get the impression that he is completely confused. He cannot admit that his Bill will lead to more privatisation, but that is at its core, and people listening to this debate would have more respect for him if he came to the Dispatch Box and made an argument for what he is trying to do—to create a market in health care. Is he just floundering around? He is no longer able to say what the Bill is really about. It is about more privatisation, so why does he not try to make an argument for what he is trying to do, instead of avoiding the issue?

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[Mr Lansley]

When the right hon. Gentleman finds that his argument is not working, he resorts to abuse. It is very simple: the Bill is not about privatisation. Patients will have access to NHS-funded services; the commissioners of those services will be NHS commissioners who are accountable to the NHS through statutory bodies, and they will not be able to transfer that responsibility to the private sector. Provision will be determined by the choices that patients and their doctors and nurses make about who is the best-qualified provider, and that choice will be made on quality, not on any other basis.

On the simple fact that we are looking to use competition within a tariff system, studies from Imperial college and the university of Bristol have recently shown that when it is introduced quality increases. Indeed, research from the university of York’s centre for health economics suggests that, if anything, the use of such competition has tended to support a reduction in the inequalities of access and care, rather than to lead to greater inequalities.

Let me provide some examples, bearing in mind the path that the Labour party is looking to go down. The Eastbourne Wound Healing Centre, a social enterprise set up by a nurse and an occupational therapist, specialises in wound healing. Patients who go to their clinic often have wounds that have not healed over three years, but more than eight out of every 10 of them have those wounds healed in just six weeks. Should we prevent patients being seen there because it is not actually owned by the NHS?

The City Health Care Partnership in Hull provides palliative care at home for patients and does not put profit before patients. One carer said that

“this clinic is so different, the focus is about how the illness is affecting you and what can be done to support you through it.”

Should we stop it doing that?

Another example is Inclusion Healthcare, a social enterprise in Leicester, which the hon. Member for Leicester West might know. It provides specialist health care to the homeless. Jane Gray, its director of nursing and development, stated:

“We’re providing a better service than we did in the NHS. We’re able to innovate and shape our services without constraint.”

Should we shut it down? Would that reduce inequalities? No, it would make them worse.

[Andrew George (St Ives) (LD)]

I endorse entirely the Secretary of State’s criticism of the previous Government’s bias towards the private sector. I would be grateful if he clarified an issue in respect of the integration of health services. Does he agree that, particularly at the secondary and tertiary level, the question is not so much about privatisation because if the NHS was to lose its preferred provider status, the gradual loss of many aspects of secondary and tertiary services in, for example, an acute general hospital might undermine the viability of the hospital?

[Mr Lansley]

The position is very clear, as the hon. Gentleman should know from the debates that we have had. Continuity of access to services through the NHS is one of the central responsibilities of commissioners and of Monitor. If there is any threat to the continuity of those services, they can step in and take measures to ensure that the services continue, including by agreeing funding beyond the tariff to make that happen. If the extension of any qualified provider could lead directly to the loss of access to essential services for patients, the commissioners and Monitor do not have to go down that path. They can make those judgments.

I caution the hon. Member for St Ives (Andrew George) about hanging his hat on the NHS as preferred provider. Before the last election, the right hon. Member for Leigh said that the NHS should be the preferred provider. His philosophy said that the NHS should be allowed to get it wrong twice before the private sector gets a look in. From the patient’s point of view it is, of course, a very cheerful thought that they will be surrendered to the policy of NHS as preferred provider.

Curiously, in March 2010, before the election and at the same time as he said that his policy was the NHS as preferred provider, the right hon. Gentleman published the “Principles and rules for cooperation and competition”, which he seems to be very fond of and which we are maintaining. That document stated:

“Commissioners must commission services from providers who are best placed to deliver the needs of their patients.”

It also stated:

“Commissioners and providers must not take any actions which restrict choice against patients’ and taxpayers’ interests.”

The reason that the right hon. Gentleman published that document was that he knew that the policy of NHS as preferred provider was already going to be the subject of a legal challenge and that it would not survive that challenge. That is why he restated exactly the principles of co-operation and competition that we intend to incorporate directly and without amendment into the way in which Monitor does its job.

[Tom Blenkinsop]

Will the Secretary of State give way?

[Mr Lansley]

No, I am going to move on. There has to be time for people to contribute to the debate, so I do not want to go on for too long.

The Health and Social Care Bill will, for the first time, ensure that private and voluntary sector organisations have to meet the same exacting standards and be regulated in exactly the same way as NHS organisations when they provide NHS services. Because that extends to any organisation providing NHS services, whether it be private or voluntary, it is disingenuous at best and possibly disreputable for the right hon. Member for Leigh to draw any comparison with the PIP breast implants scandal. There is no comparison between the position of a private company working in the private sector providing private services and the role of a private company operating inside the NHS under NHS controls. He knows that there is no comparison. In the NHS, the patient will be wholly protected. It is our intention to ensure for the first time—this did not happen under the Labour Government—that when a private sector provider operates in the NHS, it has to provide equivalent indemnities to its patients as would be provided through the NHS. That did not happen when the independent sector treatment centres and other things were brought in. There will be better protection. The private sector operating outside the NHS is a different matter.

Myth No. 3 is that raising the cap on private income will lead to a worse deal for patients. The paradigm example is the Royal Marsden NHS Foundation Trust. Its private patient cap is set at 31%. That is because in 2002, 31% of its income was derived from private sources and that was the basis on which it became a foundation trust in 2004. Its current private patient income is 25.8% of its total income. The fact that it has a cap does not mean that it goes up to it. In fact, its private patient level has come down slightly. The effect of setting the cap at 10%, as suggested by the right hon. Member for Leigh, would be to take about a fifth out of the income of the Royal Marsden. The Royal Marsden, like Great Ormond Street, is a classic example of how having a thriving private income from research, joint ventures and patients coming from overseas can get a hospital to a place where it can also consistently be recorded as one of the most excellent hospitals in the NHS, where NHS patients get the best care. It has on one hand the highest level of private patient activity—or, strictly speaking, private income—and on the other hand the highest standard of NHS care. The two things are entirely compatible.

[Andy Burnham]

May I just ask the Secretary of State to correct what he has said about the statements that I made? I did not say that I would reduce the Marsden’s cap. I said that we would allow a small increase on the existing cap that is linked to trusts’ own historical levels of private work. It would help the debate if he would be careful to get my position right. I was not talking about an across-the-board, blanket 10% cap, I simply said that some trusts with a much tighter cap of 1% or 2% were asking for a little extra leeway, which I said should be provided. I am not proposing a 10% cap across the board.

[Mr Lansley]

I think I could be forgiven for not understanding what on earth the right hon. Gentleman was talking about, since he did not put it in his motion and my colleagues had to ask him three or four times before they got anything close to an answer—he was saying “10%, or in single figures, we’re not quite sure what it would be”.

We have always been clear that there is an inherent unfairness in some foundation trusts having a cap set at the maximum 31% and others having it set at 1.5%, as all mental health trusts did when they were allowed to become foundation trusts. Technically, all NHS trusts have no cap at all, and some of them use that flexibility. Great Ormond Street, for example, is an NHS trust, not a foundation trust, and it uses that freedom, mainly to treat patients from overseas. Are we to stop that happening? I ask the right hon. Gentleman where he would set the cap for Great Ormond Street. I will give way to him if he will tell me.

[Andy Burnham]

I am not defending the existing policy. The cap was set for each trust individually to reflect historical levels. The reason trusts such as the Marsden and Great Ormond Street have a more generous cap is the large amounts of private work that they carry out. [Interruption.] Yes, but if and when they become foundation trusts under the Secretary of State’s policy, they will have caps reflecting their historical levels of work if he adopts my suggestion. I have proposed that each individual cap be modestly loosened, but he proposes an across-the-board 49% cap applying to all NHS hospitals, effectively meaning that every NHS hospital could devote half their beds to the treatment of private patients. Will he confirm that that is the effect of the policy that he is bringing forward?

[Mr Lansley]

Answer came there none. The truth is, we are doing exactly what the right hon. Gentleman and his party intended to do. At the election, Labour said in its manifesto:

“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services—where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS”.

That is what we are doing.

[Karl Turner (Kingston upon Hull East) (Lab)]

Will the Secretary of State give way?

[Mr Lansley]

No.

We are giving foundation trusts freedom to generate revenue from other sources that can be invested directly into the NHS. When Moorfields, for example, sets up a clinic in the middle east in a joint venture, should we say, “No, you’re not allowed to do that, because it might imperil your ability to support NHS patients”? Actually, it will help their ability to do so, with NHS Global encouraging the NHS.

I believe in the NHS and in the ability of NHS hospitals and providers, which in the past have had their horizons limited, to move beyond those horizons and deliver much better care. That can include turning them into international providers of choice in joint ventures across the world, and even joint ventures in this country, whether in research or the provision of additional services. However, as I explained to the right hon. Member for Leigh in an intervention, under the Health and Social Care Bill the principal purpose of any foundation trust will be the provision of NHS services. Doing anything that would be to the detriment of its provision of NHS services would be unlawful. Foundation trusts cannot cross-subsidise from NHS services into private services.

[Tom Blenkinsop]

Will the Secretary of State give way?

[Mr Lansley]

No.

Individual staff in the NHS have a duty not to allow their private activity to be to the detriment of their NHS activity. Foundation trusts will have an obligation to be transparent in accounting for the two sources of income, and they will have an obligation to report at their general meeting how they have used their private income to benefit their NHS patients.

I am afraid that what the right hon. Member for Leigh says is a tissue of nonsense. The 49% amendment was introduced only to make it abundantly clear that if the principal purpose of a foundation trust is the provision of NHS services, by extension that would not be consistent with the balance of its activity being private rather than NHS activity—hence 49%. There is no specific intention that NHS foundation trusts should increase their private income to any specific degree.

[Sarah Newton (Truro and Falmouth) (Con)]

Is it not true that the cap is “up to” 49%? Does my right hon. Friend agree that the best decisions are made not at the Dispatch Box by plucking numbers out of the air, but by patients, clinicians and hospital trusts?

[Mr Lansley]

My hon. Friend is absolutely right. The Labour party appears to be going backwards. Its 2010 manifesto said:

“We will support an active role for the independent sector working alongside the NHS in the provision of care”,

but tonight’s motion says that Labour has abandoned that policy. I quoted earlier the Labour party’s commitment to giving patients the choice of the best available provider. Its policy tonight is to abandon patients, including the 81% who told a survey that they want to exercise choice. Labour’s manifesto said it would give foundation trusts freedom to expand and increase their private services. It has now abandoned that policy.

Why does Labour do that? Why did it abandon those policies? Perhaps it is because the Labour party is a wholly owned subsidiary of the trade unions. Labour is interested not in patients or the NHS, but in the trade unions, because its policy is all about the protection of trade union interests—vested interests. The guarding of the vested interests is the remaining activity of the Labour party, but it will diminish over time.

Let me tell the shadow Health Secretary very simply what we are setting out to do. Under this Government, the power to choose will increasingly lie in the hands of patients, doctors and nurses, and incentives will encourage all providers to integrate their care and improve the quality of their care. The result is not a fragmentation of the NHS or inequalities, but better, higher-quality care, and integrated NHS care that offers everyone the very best care available. We will use choice—patients’, doctors’ and nurses’ interests in delivering that choice—and the best quality provision to deliver better outcomes for patients. That is why I urge the House to reject the Opposition motion.

[Several hon. Members]

rose—

Breast Implants

Lord Lansley Excerpts

Wednesday 11th January 2012 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

With permission, Mr Speaker, I would like to make a statement about PIP breast implants. The House will be aware that approximately 40,000 women in this country have had implants manufactured by the French company Poly Implant Prothese, and that these implants could have been made of a non-medical grade silicone gel. My concern throughout has been for the safety and well-being of all these women. I wish now to update the House on what happened; how we are looking after the women concerned; and the further actions required.

In 1997, PIP received a European CE mark for its silicone breast implants. The CE mark was overseen by the German notified body, TUV Rheinland. The Medicines and Healthcare products Regulatory Agency adverse incident centre received a number of reports annually about PIP implants. Based on such reports, in 2008, the MHRA raised its concerns with the German regulatory authorities and the manufacturer. The MHRA was reassured by the notified body that the number of adverse reports was adequately explained by changes in the company’s reporting practices and by the increasing number of implants sold.

However, in March 2010, the French regulator discovered that rather than using medical grade silicone gel in the implants, PIP had in fact been using unauthorised silicone gel. This is in clear violation of the CE mark. The mark was promptly withdrawn and all EU member states immediately alerted. The MHRA immediately issued advice to stop using PIP breast implants in the UK. The French authorities are currently investigating this as a criminal matter, and the UK Government will help in any way we can with their investigation.

Initial toxicology tests in both France and the UK found no significant health risk to women with the implants. Also the MHRA could find no evidence of an increased risk of cancer. However, on 23 December 2011, following an increase in the number of reported ruptures, the French Ministry of Health announced that it was advising women, as a non-urgent precautionary measure, to consider having their PIP implants removed. The MHRA’s advice was that there was no scientific basis for recommending routine removal of implants in the absence of symptoms.

The available data, however, were incomplete. For this reason, I asked Sir Bruce Keogh, the NHS medical director, to form an expert group and to review the available data, including information from the French authorities, and to offer more definitive advice. I received the group’s interim report on Friday 6 January and a copy has been placed in the Library. I would like to thank the experts and members of the profession for their hard work and commitment in producing this rapid report.

The main findings of the expert group were, first, that there is no causal link between these implants and breast cancer. Secondly, the evidence on the rate of ruptures for PIP implants compared with other implants is incomplete and so this risk cannot be assessed definitively. Thirdly, although the rupture of implants or leakage of material can result in inflammation, there is no clear evidence that these problems are more serious in relation to PIP implants than other implants, or that they result in increased long-term health risks. Therefore, they have not recommended routine removal of the implants. Fourthly, there are risks inherent in the removal of breast implants, just as with any surgery, and these risks should be taken into account when taking any clinical decisions. However, for this particular group of women the risk is very low. Fifthly, the expert group recognises, as we have throughout, that women with PIP implants will be understandably concerned that they did not have the character of implant that they thought they did. The expert group advises, as we have, that we should give every woman an opportunity to secure advice, investigation and remedy.

The women who received the implants did so on the understanding that the implants met the requirements of the CE mark and were safe. That was not the case, and every provider has a responsibility to put things right. Although the majority of women will have received their implants privately, some—such as those who have had reconstructive surgery following mastectomy—will have received PIP implants through the NHS. All those patients will receive the highest possible standard of care. First, they will be contacted to inform them and give them all the relevant information and advice. Women who wish to will be able to speak to their GP or the surgical team that carried out the original implant to get advice on the best way forward for them. If the woman chooses, that could include an examination by imaging. If, when informed by an assessment of clinical need of the risks involved and the impact of any unresolved concerns, a woman decides with her doctor that it is right to do so, the NHS will remove and replace the implants, if the original operation was done by the NHS. Last week the NHS chief executive wrote to the service, and Dame Sally Davies, the chief medical officer, wrote to GPs and relevant health professionals. Copies of those letters are available in the Library.

It is right that those who received their care privately should also receive a similar level of service and reassurance from their care provider. However, I do not think it fair to the taxpayer for the NHS to foot the bill for patients who had their operation privately. Eight private health care companies, including Nuffield Health, Spire Healthcare and BMI, have confirmed that they will follow the same guidelines as those that I have set out for NHS patients. However, I want to be absolutely clear that the NHS will continue to be there to support any woman. If a clinic that implanted PIP implants no longer exists or refuses to remove the breast implants, where that patient is entitled to NHS services, the NHS will, in consultation with their doctor, support the removal of PIP implants in line with the guidance that I have just outlined. Any NHS service in that instance would cover only the removal of the implant, which would not include the replacement of private cosmetic implants. In such cases the Government would pursue private clinics to seek recovery of our costs.

These events highlight the need to ensure the safety of people having cosmetic interventions. It is clear from the information that we have received from the industry that the safety information that it collects and provides to the regulator is of variable quality. Without good data, we have no way of knowing when problems arise. I believe that there are a number of things that we now need to do. First, lessons need to be learned from this case and incorporated into the ongoing review of the EU medical devices directive. I spoke to Commissioner Dalli yesterday, and can confirm that this European work is under way. We also need to understand what happened in this instance in the United Kingdom. A review for that purpose will be led by the Minister for Quality, Earl Howe, with expert advice, and will shortly put its terms of reference in the Library. That review will investigate and report rapidly. The blame for what happened lies with PIP, but the review will enable us to learn lessons to improve future regulatory effectiveness and will feed into the Commission’s review.

In addition, the Care Quality Commission will conduct a swift review of private clinics. That review will look at evidence of compliance, patient safety and clinical quality, and the information and support given to their patients. Where a provider does not meet those requirements, the CQC has a wide range of enforcement powers that it can use to protect the safety of patients. The findings of that review will be published before the end of March.

Looking to wider issues of clinical safety and regulation, I have also asked Sir Bruce Keogh to reconstitute his expert group to look at how the safety of patients considering cosmetic interventions can be better ensured in the future. That will include treatments such as cosmetic surgery and dermal fillers. I expect his review to consider whether cosmetic products and interventions are appropriately regulated and have strong clinical governance; whether patients and consumers can be confident that the people who carry out procedures have the skills to do so; and whether the settings in which such procedures take place are able to ensure the care and welfare of people who use their services. That review will consider issues of governance, data quality, record keeping and surveillance, as well as ensuring that proper information is provided to secure patients’ informed consent.

I expect the review also to include consideration of an outcomes-based register of frequently implanted devices, covering everything from breast implants to heart valves and replacement joints, in order to provide the United Kingdom with a valuable asset for further innovation and safety improvement. There is already considerable clinical support for such a comprehensive register. The Government’s commitment is to provide effective reassurance and remedy for women with these implants, and also to learn the lessons to deliver safety and quality for the future. I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Health Secretary for his statement, and for the steps that he is taking to help the thousands of women who have found themselves in this worrying situation. We welcome much of what he has just announced, including the further reviews that he has commissioned. I assure him that we will support him in his efforts to reach a resolution as quickly as possible for all those people who are affected, but I have to tell him that he has a lot of work to do, and a lot of ground to recover, as his response to date has not helped to build those people’s confidence.

Over the Christmas break, the mixed messages coming from the Government did not go unnoticed. They only added uncertainty in what has been an anxious time for many people. The Health Secretary has gone from downplaying the dangers on 23 December to announcing an urgent review on new year’s eve, then giving an inconclusive statement late last Friday evening. This has left the people affected struggling to make sense of what it means. For the vast majority whose implants were fitted privately, there was precious little practical advice or help from the Department of Health as they began approaching their private providers. Many women were unable to access their records or told that long delays would be involved. Others have been asked to pay large fees to access their records. Many have simply hit a brick wall when they have sought medical advice or removal, even where there is evidence of rupture.

What people needed at the earliest stages was a strong statement from the Government of what was expected of all private providers—namely, that records should be provided without delay and without charge; that consultations should be arranged when people were worried; and that removal should be arranged urgently when there was evidence of rupture. The reality is that the Government’s failure to provide that leadership from the outset has left people fending for themselves in the face of a self-serving and unaccountable industry.

The Health Secretary was right, however, to establish an urgent review of the evidence by the NHS medical director, Professor Sir Bruce Keogh. We welcome the speed with which that review was conducted, and we echo the Health Secretary’s thanks to the members of the review panel. We accept the Government’s judgment on the advice to women regarding the removal of implants on the basis of the data that they have seen, but what confidence can we have in the evidence and data on which those decisions were reached?

We note the Secretary of State’s public comments about the industry’s failure to provide quality information in a timely fashion, and the interim report’s finding that the evidence is subject to “considerable uncertainty”. The review concludes that it should reconvene in “about four weeks time” to examine any new evidence, and to consider whether to update its recommendation on removal. I have to tell the Health Secretary, however, that that feels way too vague and ad hoc. May I press him to give a clearer timetable for this further process of review on whether to change the recommendation on removal? People need absolute clarity on when further statements will be made, so that they can make informed decisions. This is of course a separate matter from the long-term reviews that he has announced today.

This is particularly important in the light of the different decisions that other Governments are beginning to make in response to the situation. Yesterday, the Welsh Government announced that all women who received PIP implants, including those treated privately, will be offered replacement implants on the NHS. That is of course different from what the Health Secretary has announced today. What discussions did he have with his counterpart Minister in the Welsh Assembly Government before their announcement was made? Will he assure the House today that all the data that were available to Welsh Ministers and officials were also available to, and considered by, the Keogh review? Governments around Europe have responded sooner, more decisively and with greater clarity than the coalition has done. By contrast, people here have found the Government’s statements in response to be both inconclusive and ambiguous.

We support the decision to help NHS patients to have PIP implants removed and replaced, but does the Secretary of State appreciate how that decision has added to the confusion that many people feel and was interpreted as contradictory to the review’s overall finding? The clear implication of the Keogh review is that the best course of action is, in fact, to have the implants removed, but again no practical help was offered beyond the statements of expectation for private providers to match the support on offer from the NHS and the reference made to “moral duty”.

I, too, commend the private providers, such as Nuffield, Spire and BMI, that have done the right thing by their patients, but in recent days we have heard how some of the leading cosmetic surgery clinics have simply ignored the Health Secretary’s appeal. Transform, which used PIP implants on over 4,000 patients, has said that all women affected will have to pay £2,800 for removal, while the Harley Medical Group, which has 13,900 patients with PIP implants, has offered to pay for the cost of the new implant, but only if the NHS pays the far greater bill for the surgery. I am sure the whole House will agree that this is an appalling response to this situation, and that the failure of these companies to face up to their duty of care for their patients leaves everybody, including the Government, in a difficult position. It is simply unacceptable for any woman in England to be left in a position where she is worrying about her health and thus has no peace of mind, but is unable to afford to do anything about it.

I appreciate what the Health Secretary has said today about helping people out of this predicament. I agree with his decision where private clinics no longer exist, but in accepting that the NHS will provide private treatment where private providers refuse to, is he not in danger of letting those providers off the hook? May I remind him that most people will not accept that the NHS should subsidise the failures of private companies, and will look to him to pursue them to the nth degree to get any costs back? For instance, has he fully explored the insurance position of these private providers as a means of recovering costs? He says he will pursue them, but what assumptions has the Department of Health made about the likelihood of his success, and how much money is expected to be recovered? Has he fully explored the position of the French Government and considered whether there is any residual liability on the device manufacturer in that company?

Let me turn briefly to questions of regulation. Can we support what the Secretary of State said today about the wider review of regulation of the cosmetic surgery industry? If there are any loopholes, we will support him in closing them down.

Finally, the right hon. Gentleman’s Health and Social Care Bill envisages a much expanded role for the private sector in the delivery of health care. I make no comment about that, but has he reflected on the Bill and revisited the assumptions behind it? Will he assure us that issues of quality and safety will be safeguarded in the NHS that he seeks to create? We want to be assured that he is giving careful consideration to all these issues, as he considers his response to this worrying situation.

--- Later in debate ---

[Mr Lansley]

I am grateful to the shadow Health Secretary for his welcome of my statement and the principles behind what we are setting out to do to look after the women affected by these implants.

I do not share the right hon. Gentleman’s view that there were any mixed messages. I am sure he would have been the first to complain if I had not identified the lack of available and consistent data and not asked an expert group to look into this. As we look at countries across the world, we can be confident that we have set an exemplary standard in looking after women through the NHS and in bringing together an expert panel fully to understand what would be the best advice for women. The advice that no identified specific safety concern justified the “routine removal” of these implants was true on 23 December and it remains true today. As we have recognised from the outset and as I said on 23 December, if women are worried or concerned about the possibility of not having the implant they thought they had, that provides a perfectly reasonable basis on which to seek advice and investigation. It would be right for some women to ask for removal, but we should not assume that women are choosing to have these implants removed on the basis of clinical advice—even in France.

The chief medical officer spoke to a clinical counterpart in the Welsh Assembly Government before the publication of the expert group’s work. I have made sure that they are informed, but I have to say that the Welsh Government made an announcement yesterday without previously informing us.

[Paul Flynn (Newport West) (Lab)]

It’s called devolution.

[Mr Lansley]

It may be called devolution. I respect the devolved Administrations and always inform them of what I am doing, where it is relevant to them. We do not recognise the advice that Wales received. Sir Bruce Keogh’s expert group, which included some of the foremost experts in plastic surgery, made clear recommendations last week for patients in England and concluded that there was no significant increased clinical risk in cases where implants are not replaced.

If the shadow Secretary of State commends what the Welsh Government have done—[Interruption.] Perhaps he did not, but if he or anyone were to commend it, they would need to recognise that it runs the risk of letting the private providers off the hook. I am very clear that they should provide an equivalent standard of care. As the right hon. Gentleman made clear, there are limitations on what can be done. I do not have powers and I did not inherit powers to control what the private providers do in the private sector. I have to tell the right hon. Gentleman, however, that I have reflected on the Health and Social Care Bill, which is a positive legislative step forward. Just as it allows Monitor as a health and social care sector regulator, on which we are consulting, to look at the prudential regulation of private providers in social care, so it would allow us to consider the role of Monitor as a health sector regulator in licensing private providers of private health care. It is thus a positive not a negative step forward. There is no comparison, as the right hon. Gentleman will recognise, between the role of the private sector providing private care and the private sector in the NHS, which is subject to the same duties and obligations as an NHS provider. The Bill does not lead to an increase in private sector provision, but in so far as there are private sector providers, they will be properly regulated in the NHS.

On the role of private providers, they may be insured and there may be warranties relating to these implants. We do not have data on this aspect, but I am clear that these providers have legal and, indeed, moral obligations. I particularly commend a letter issued this morning by the leaders of the profession—the two principal professional associations—to their surgical colleagues. Having talked about the standard of care in the NHS, the letter went on to say:

“Those working in the private sector are urged to support in similar fashion. We would hope that implanting surgeons would honour requests for replacement surgery free of surgical charge”.

The private providers that have not made this offer to the women for whom they are responsible can see that their surgical associates are willing to carry this out free of surgical charge, so I see no reason why they should not now step up and deliver the standard of care that women have a right to expect.

[Mr Stephen Dorrell (Charnwood) (Con)]

May I welcome my right hon. Friend’s statement and the prompt action he has taken over the last few weeks to address this issue? Does he agree that the first priority when these concerns came to light was to ensure that the women who have had these implants had clear, authoritative advice based on the evidence of the right way to treat them, and that the process he established under Sir Bruce Keogh has provided and will continue to provide exactly that authoritative evidence-based advice? Does he further agree that there are some longer-term policy issues around the regulation of this industry that need to be addressed, but in a more considered way and not tied up in the emotions of this immediate concern?

[Mr Lansley]

I am grateful to my right hon. Friend and agree with all his points. I would add that when the French Government informed us of their prospective announcement—I spoke to the French Health Minister the day before it—we gave the best advice to date, based on the MHRA’s knowledge of the toxicology tests and its discussions with the French regulator. What we have to do is to establish the extent to which surveillance of these implants over a number of years should have led to any different conclusion. It remains true, however, that there is no evidence of long-term health effects that would give rise—and would have given rise at that time—to a different recommendation from the one that we made.

[Ann Clwyd (Cynon Valley) (Lab)]

This is not a new issue, as the Secretary of State must know. Twenty years ago I raised the case of a constituent who had to have a double mastectomy because silicon implants had leaked in her body. As a result, we set up an organisation called SOS—Survivors of Silicon. We worked with Which? magazine and the Department of Health, and we helped to set up the register of implants, which was unfortunately not made compulsory. That is why the data are missing.

This is part of a wider issue, of the proper regulation of the cosmetic surgery industry, 70% of which is virtually unregulated. I hope that the Secretary of State will insert an amendment into the Health and Social Care Bill to ensure that there is proper regulation of the whole industry.

--- Later in debate ---

[Mr Lansley]

I completely understand the right hon. Lady’s point, but this activity is not unregulated. For example, the Care Quality Commission is responsible for the registration of providers, and for ensuring that they meet essential standards of safety and quality. However, for precisely the reasons cited by the right hon. Lady, I am asking Sir Bruce Keogh’s group to consider wider issues relating to the regulation of cosmetic surgery and cosmetic interventions.

The registry to which the right hon. Lady referred was discontinued in 2004 because a substantial number of women were not consenting to the addition of their names to the register. I believe that, given the positive experience that has followed the establishment of the National Joint Registry, we can reassure women that their data can be entered without prejudicing their patient confidentiality.

I should make it clear that as yet we have no evidence demonstrating any significant difference between the rupture and leakage rates of PIP breast implants and those of other implants. Last June the American Food and Drug Administration published the findings of a study of normal implants, two of which had a 10% to 13% rupture rate over a 10-year period. It is important to appreciate that implants in themselves pose a distinct risk of rupture and leakage.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the clear commitment to putting women’s health needs first in this context, but is not the heart of the problem the obvious conflict of interests for private clinics when it comes to the provision of long-term safety statistics? Will my right hon. Friend ensure that any future system allows women to self-report to the registry—albeit with a follow-up from specialists for confirmation purposes—so that we can have a complete picture of the long-term complications caused by devices of this kind?

[Mr Lansley]

My hon. Friend is right. When Sir Bruce and his colleagues are considering the establishment of a wider registry, they will consider not only the possibility of self-registration but the possibility of making clinical professionals responsible for the publication of such data. The responsibility should not rest solely on providers or manufacturers.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I understand that a number of private clinics will not even scan a patient with PIP implants without charging. However, these goods were counterfeit. They were not of a medical standard, and they could be injurious to health. Should not the NHS be prepared to help women who must be worried sick, and perhaps cannot even afford to have a scan to reassure them? I cannot believe that the NHS would turn its back on a patient who was suffering after drinking counterfeit vodka, so why should it turn its back on these patients?

[Mr Lansley]

I am sorry that the hon. Lady framed her question in that way, because I thought I had made it clear that the NHS would always be there to support women. We will seek to recover the cost to the NHS if the original provider was a private provider: that approach has been adopted for years, and I am sure that it would have been adopted by my predecessors. No woman should have to feel that she will not be looked after, but I am making a different point—namely that, in the first instance, women should be looked after by the original providers, who have a continuing duty of care. They also have legal obligations—as well as the moral obligations to which I have referred—but it is not for me to advise on those.

[John Pugh (Southport) (LD)]

If the Government are paying for something that is needed, it is logical to assume that some private firms must be dodging their responsibilities. If those firms are not indemnified against the risks of surgery or willing to accept responsibility for its consequences, why on earth do we allow them to practise? Does the remedy not lie in our hands?

[Mr Lansley]

I entirely understand my hon. Friend’s point. The position we have inherited is that I have no powers in relation to the provision of private health care by private companies. As I said to the right hon. Member for Leigh (Andy Burnham), the Health and Social Care Bill provides for the establishment of Monitor as a health sector regulator that will license such providers. I am not making any judgment at this point on whether it would be appropriate for conditions to be attached to such licences in relation to the continuity of service to patients, but it is one option that we can consider.

[Chris Bryant (Rhondda) (Lab)]

May I suggest to the Secretary of State that the problems in the cosmetic intervention industry may be far more extensive than we have known thus far? A few years ago, I had my eyes lasered. I visited five clinics, four of which seemed to be trying to sell me an intervention rather than trying to do anything that would be in my general health interest. Will the Secretary of State add laser surgery clinics to his list, and also private dentists, many of which are encouraging patients to undergo operations that they certainly do not need?

[Mr Lansley]

I will reserve my position on dentistry, because there is a very wide range and cosmetic intervention constitutes a substantial proportion of overall dentistry activity, but I will happily consider whether there is an issue to be dealt with. As for laser eye surgery, I will ask Sir Bruce’s group to consider not only the establishment of a registry in relation to implants and devices, but cosmetic interventions more generally. I hope that we shall be able to reassure the hon. Gentleman when we publish the terms of reference.

[Several hon. Members]

rose—

[Margot James (Stourbridge) (Con)]

I commend the Black Country Partnership NHS Foundation Trust on conducting 517 breast implant operations in the decade before 2008 without the use of a single PIP implant.

What this furore has revealed to me is the existence of a growing private sector offering a vast array of cosmetic surgery that extends well beyond breast implants. I fear that the need for tighter regulation of the industry will prove widespread, and I therefore welcome the Government’s commitment to a review. Does my right hon. Friend expect to be able to charge the private sector for the costs of any additional regulation that the review group may deem necessary?

[Mr Lansley]

I am grateful to my hon. Friend for what she said about the NHS. I think that before considering whether there is a cost associated with regulation and how it might appropriately be met, we should consider what is necessary to assure patients of safety and quality.

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

I welcome the statement, but may I caution the Secretary of State against placing additional burdens on the Care Quality Commission without providing it with additional resources? May I also urge him to heed the advice of my right hon. Friend the Member for Leigh (Andy Burnham), and pause to listen and reflect on what lessons can be learned and what safeguards can be provided for the future? I am thinking both of the protection of patients’ safety and of future NHS liabilities when surgical procedures or treatments are carried out by the private sector, which is likely to become more frequent as the privatisation provisions of the Health and Social Care Bill are implemented.

[Mr Lansley]

For reasons that I have already explained, the hon. Gentleman is simply wrong about that. It is nonsensical to attempt—as the editor of The Lancet did this morning—to compare the regulation of private providers of private care with that of private providers of NHS care. There is no comparison at all.

The CQC will inspect a sample of providers of cosmetic surgery to check that they are meeting registration requirements, and will undertake a number of unannounced inspections as part of that. We expect the inspections to be completed by the end of the month, and expect the CQC to have published its report by the end of March. It has confirmed that it has enough resources to undertake the inspections within its existing budget.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I add my support and thanks to the Secretary of State for what he is doing on this very important issue which has caused so much distress to so many women. Does he agree that this episode flags up a wider issue in the cosmetic surgery industry, in that some practitioners performing medical procedures do not have any medical qualifications or knowledge of anatomy? Does he also agree that it is a problem that there is no psychological counselling and that a holistic look at patients is not taken, as this is an on-demand industry? Finally, does he agree that there must be a proper paper trail and record system in the industry, so that we can consider what is in the best interests of patients and so that there is proper accountability for all providers?

[Mr Lansley]

My hon. Friend makes a number of important and perceptive points. It is, and will continue to be, one aspect of NHS advice that psychological assessment can form an important part in the management of patients referred for low-priority procedures, including cosmetic surgery. However, although we will look at cosmetic interventions and their regulation more widely, we must recognise that the issue in this instance related to what was a criminal act—seeking to adulterate the material in the implants. Many private providers were using what they regarded as properly certified implants for a perfectly proper procedure. To that extent, they were not engaging in any improper behaviour. However, they have legal and moral obligations to their patients, and I am asking them to discharge those obligations.

[Fiona Mactaggart (Slough) (Lab)]

It saddens me that, despite previous reports recommending more effective regulation of the cosmetic surgery industry, it has taken this crisis, causing so much distress to so many women, for the issue to be taken seriously. I am nevertheless glad that it is being taken seriously. Will the Secretary of State consider ensuring that people seeking cosmetic procedures must have independent counselling and advice from a body that will not make a profit from that procedure, and whose whole concern is the health of the patient?

[Mr Lansley]

I am grateful to the hon. Lady for that suggestion, and I will ask Sir Bruce’s group to consider it.

[Penny Mordaunt (Portsmouth North) (Con)]

I welcome the statement. What has the Secretary of State learned from this episode about the quality and take-up of routine insurance products offered by private companies to protect both patients and providers when cosmetic surgery goes wrong?

[Mr Lansley]

I am grateful to my hon. Friend for her welcome for the statement. Those seeking cosmetic interventions must ask serious questions about not only the nature of the procedure but the quality and reputation of the provider organisation, and ask it how it would protect their interests if things went wrong.

[Sheila Gilmore (Edinburgh East) (Lab)]

The Secretary of State referred in his statement to the possibility that an organisation that had carried out operations had gone out of business. As there are long-term implications from such surgical interventions, has the Secretary of State considered instituting some form of levy or fund that would have to be paid into—nor do I want to let the private sector off the hook—so that if organisations go out business there would be a sum of money from which people could claim?

[Mr Lansley]

As I hope the hon. Lady will appreciate from what I said to the right hon. Member for Leigh (Andy Burnham), the Health and Social Care Bill introduces for the first time a comprehensive continuity of service regime for the NHS, and it also creates, through the health sector regulator, the potential for us to consider whether such continuity of service needs to be extended beyond the NHS.

[Ian Swales (Redcar) (LD)]

If the NHS stands behind private providers in such cases, it is effectively providing free indemnity insurance. Will the Secretary of State look at the insurance position of providers of such services and ensure that the taxpayer does not face open-ended liabilities?

[Mr Lansley]

As my hon. Friend points out, to that extent the NHS has always stood behind the private sector provision of health care. If things go wrong, people have the right to access NHS treatment as they must be looked after on the basis of clinical need. Referring back to points I made earlier, the Health and Social Care Bill gives us an opportunity to look more systematically at continuity of care for patients both in the NHS and the private sector and at the responsibilities of providers under their licence.

[Valerie Vaz (Walsall South) (Lab)]

I thank the Secretary of State for coming to the House and making this statement. How many clinics will the CQC be reviewing, and what will happens in respect of any clinics that are no longer practising? Presumably the CQC will not have access to their records.

[Mr Lansley]

I cannot tell the hon. Lady how many clinics the CQC will visit, but it will be a sample of providers, not all of them. As she may know from the material we published last Friday, there were 93 private providers. The operations were heavily concentrated in that a lot of them were carried out by a small proportion of providers, but about 87 other small providers, or even single-handed providers, are involved and accessing data from all of them will be difficult. I also recognise that, as the hon. Member for Edinburgh East (Sheila Gilmore) said, some may not be in business any longer, or there may be surgeons who have retired.

[Paul Uppal (Wolverhampton South West) (Con)]

I also thank the Secretary of State for making the statement. Following on from a vein of questioning that has already been explored, will he elaborate on the point about the Government pursuing firms to recover costs and explain what mechanisms are available to the Secretary of State to recover costs?

[Mr Lansley]

I will do so to an extent. It depends on the nature of the legal contract between a woman and her private provider. I hope that in many cases the legal obligations derived under that contract or under sale of goods and services legislation will clearly mean that the woman will get redress from her private providers or her insurers. If the NHS becomes involved, there may be compensation through the injury costs recovery scheme, so if the NHS incurs costs, we can go on to seek to recover them.

[Yasmin Qureshi (Bolton South East) (Lab)]

I thank the Secretary of State for his statement. As has been said, most of the cosmetic surgery industry is not regulated. What time frame are he and his staff working towards?

[Mr Lansley]

Given the nature of the work I am asking Sir Bruce Keogh and his group to undertake, it will take them some time to look at the range of cosmetic interventions and make any recommendations. They are coming together as rapidly as they can. Many of them have given up a great deal of time over the past two weeks to help us in this work. We must recognise that there are things we need to do rapidly to ensure that there is support and reassurance for any woman affected by PIP implants, and we are acting rapidly. There are lessons and wider implications to be learned. This particular area of cosmetic surgery was not without regulation. The question is to what extent things were properly regulated with surveillance and enforcement over a number of years.

[Steve Brine (Winchester) (Con)]

I welcome the Secretary of State’s statement. As he knows, I co-chair the all-party group on breast cancer and we will want to monitor how women are treated by the NHS and private providers, and we will certainly feed that into the Department. For women who have fought breast cancer and been through the trauma of reconstructive surgery, this will bring it all back and be tremendously upsetting. Does the Secretary of State therefore agree that speed is of the essence in respect of replacement surgery where it is wanted, so that those women can again put this nightmare behind them?

[Mr Lansley]

I am grateful to my hon. Friend and I completely recognise the points he makes. As he will know, the overwhelming majority of the approximately 3,000 women who had PIP implants through the NHS will have had them as breast reconstruction surgery following mastectomy. From day one, we were clear that we wanted all those women to be able to get advice, investigation and remedy, and removal and replacement, should they wish. If the NHS was responsible for the original operation, we will be responsible for the replacement with new implants, if that is what is wanted.

The NHS is very clear about this issue in the advice that was presented. I welcome the fact that my professional colleagues in the associations are making it clear that, through the NHS, replacement procedures for these women should be possible rapidly, but it should not prejudice the availability of urgent referral for cancer, which will continue to be an operational requirement in the NHS.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

The question arises of access to records in both the private and NHS sectors. Is it not time to look again at who is the keeper of medical records? Should it not be the patient—therefore bringing together the NHS and private provision, where applicable—rather than the institutions?

[Mr Lansley]

Of course, as the hon. Lady knows, we have been thinking hard about precisely this issue. The NHS Future Forum made further recommendations to us only yesterday about achieving access for patients to their own records by 2015 across the NHS. The NHS should keep records, but the patients themselves should have access to them. We will pursue that issue in the NHS, although frankly, I am not in a position to mandate that in the private sector. However, any patient would be well advised to say, “Why can’t I hold my own record from a private provider?”

[Bob Blackman (Harrow East) (Con)]

I welcome the Secretary of State’s statement, but PIP is not the sole supplier of breast implants across the industry. What assurances has he received from the industry that no other company has embarked on the practice of using non-medical grade silicon in its breast implants, so that women who have had such implants can feel safe?

[Mr Lansley]

I have no evidence of such behaviour on the part of other companies. My hon. Friend is right: PIP is only one of a number of suppliers, and in this country probably only one in seven breast implants were PIP implants. Other countries have looked at this, and across Europe the regulatory process should ensure the scrutiny of these implants, including proper testing. The European review must look at whether that surveillance, including unannounced inspections and appropriate testing, gives us the assurance we are looking for.

[Heidi Alexander (Lewisham East) (Lab)]

Yesterday, I was contacted by a constituent who had PIP implants inserted by the Harley Medical Group in 2006. She said:

“There is so much conflicting information at the moment, I feel as though I’m being pushed from pillar to post. To add absolute insult to injury nobody is keen on helping us, they are saying the NHS should help…or they say they will perform the procedures on us for an extra fee.”

Can the Secretary of State tell me precisely what further representations he will be making to private providers to ensure that all women get access to the advice and treatment they need?

[Mr Lansley]

We have been very clear about the advice we have given to women, and I hope that, through the NHS, any woman in those circumstances would go and see their general practitioner, who will have full access, from the chief medical officer, to the expert advice we have disseminated. I know that the Harley Medical Group has not shared with others the view that it can match the NHS’s standard of care; but given that, the professions are suggesting to surgeons that they should honour requests for replacement surgery free of surgical charge. I hope that gives a basis on which more of the private providers will now meet their full obligation of a duty of care.

[Mr Philip Hollobone (Kettering) (Con)]

What is the Department of Health’s central estimate of the number of women who have had breast implants through private clinics who will seek their removal through the NHS?

[Mr Lansley]

I am sorry to disappoint my hon. Friend but I cannot offer him such an estimate. We know that some 37,000 women had PIP breast implants. Clearly, not all those will necessarily want removal, and on advice, it might be any proportion of those; I cannot tell him what that figure would be. As we see in France, recommending the removal of implants does not mean that all women will have them removed.

[Mark Durkan (Foyle) (SDLP)]

I acknowledge the Secretary of State’s commitment to engaging proactively with the devolved Administrations on this issue. However, in his statement he used somewhat clumsy language regarding the third main finding of the expert group, saying that “there is no clear evidence that these problems are more serious in relation to PIP implants than other implants, or that they result in increased long-term health risks.” Is he not concerned that, put so clumsily, that will not only fail to reassure those with PIP implants but extend concern and alarm to those who have received other implants?

[Mr Lansley]

I am afraid that absence of evidence does not mean evidence of absence. We can be very clear, on expert advice, that there are no specific safety concerns that routinely require the removal of these implants, nor identification of any increased long-term health risks, in precisely the way I have described. I cannot go further and provide, on advice, absolute assurance, and the expert group was clear about that. That is why the French Health Minister, whom I was talking to last week, and I were clear that we should undertake additional toxicology tests on implants when they are explanted, in cases where they were implanted over a period of time, to begin to understand the extent to which they had adulterated filler material and what was in it.

[Andrew George (St Ives) (LD)]

I commend my right hon. Friend’s initiative. However, he said the following, which may have been sloppy wording: “those who have had reconstructive surgery following a mastectomy, will have received PIP implants through the NHS.” Of course, the majority will not have done so, and I have confirmed with surgeons in Cornwall that PIP implants have never been used in the NHS in Cornwall. Given that the Medicines and Healthcare products Regulatory Agency issued advice to stop using PIP implants in the UK in March 2010, can the Secretary of State confirm that this advice was acted on, no doubt within the NHS but across private clinics as well?

[Mr Lansley]

I hope I did not say what the hon. Gentleman ascribes to me. Some 3,000 women, we think, had PIP implants, and of course, that is only a fraction of the number having breast reconstruction surgery. I think I can offer him reassurance. The MHRA withdrew authorisation in March 2010, and given that there was only one distributor of these implants in this country—Cloverleaf—they will not have been distributed for use after that date.

[Toby Perkins (Chesterfield) (Lab)]

A constituent in Chesterfield contacted me who is at her wits’ end. She has been in considerable pain since having a PIP implant fitted, and has been told by the private provider that she will have to pay £3,600 to have it replaced. What more can the Secretary of State do to ensure that her private provider follows the example of the other eight providers that are doing this free of charge? Let us put some pressure on these companies to make sure that all of them do the same as the NHS and replace the products they have fitted.

[Mr Lansley]

I think I have made it clear that not only the Government but, helpfully, the professional associations are looking to give no reason why private providers should not match that standard of care, especially if the implanting surgeons are willing to offer replacement surgery free of surgical charge themselves. It would be very helpful if the hon. Gentleman and other Members gave us details of such cases on behalf of their constituents. Clearly, his constituent will have had that implant before March 2010. The adverse incident centre has had 478 reports of ruptures over the whole period, which extends back many years. One of the things we want to understand as part of our review is why, if there were ruptures and, more to the point, adverse health effects associated with these implants, they were not disclosed to the adverse incident centre. As yet, we have not seen a range of health effects over a period of time that, in themselves, distinguish these implants from other, normal implants.

[Mr Marcus Jones (Nuneaton) (Con)]

I contacted the Harley Medical Group on behalf of a concerned constituent this morning and was told that it would be making a decision on its response to this issue by Friday, although that is somewhat contradicted by the comments made by the shadow Secretary of State. Regardless of that, does my right hon. Friend not agree that the Harley Medical Group, or any other company, should step up to the plate, take full responsibility and work to make sure that it gives the people involved complete satisfaction, without any cost to the individual concerned?

[Mr Lansley]

My hon. Friend will understand that I cannot speak about the precise details of the situation with the Harley Medical Group. All I can say is that the group has told the media that it does not feel it can offer that standard of care completely, but that will have been before the professional associations wrote to their members asking them to support replacement surgery free of surgical charge. I know that the group has told members of the media that it is willing to offer to the Government that if we are responsible for the removal of implants, it will pay for implants to be available for replacement purposes. Frankly, if surgeons are willing to waive the surgical charge and the group is willing to pay for the implants, it is not too much to ask for it to be responsible for removal and replacement, where it is in the woman’s best interests to do that.

[Paul Flynn (Newport West) (Lab)]

Does the Secretary of State not regret failing to react to the call made last May for British patients to have the same protection against failures of all medical devices as that enjoyed in the United States? Is not the real scandal here, again, the chronic under-reporting by the industry and the MHRA of failures of devices and drugs? Is not the answer for this probe to look into the possibility of having a genuinely independent regulatory authority, instead of one that is entirely funded by the industry, because self-regulation is often no regulation?

[Mr Lansley]

The hon. Gentleman says that this body is entirely funded by the industry. It is true that in relation to pharmaceuticals the MHRA is funded by levies on the pharmaceutical industry, but much of the cost of the regulation of medical devices is actually met by the taxpayer. I regard the MHRA as operating in an independent fashion and its expert and scientific advice as independent from Ministers. None the less, as he says, the review that Earl Howe will lead will examine the lessons to be learned, including those about the effectiveness of regulatory surveillance and enforcement in this country, albeit that the regulatory failure occurred, in essence, in Germany, in the first instance, and in France.

[Richard Burden (Birmingham, Northfield) (Lab)]

The uncertainty that many women face relates to not only the level of risk associated with PIP implants, but whether the implants they had fitted were PIP implants. I accept what other hon. Members have said about problems with record keeping in the private sector, and that needs to be taken up. The Secretary of State said that the estimated 3,000 NHS patients will be written to. If they are to receive such a letter, will he reassure them about when that will be?

[Mr Lansley]

The chief executive of the NHS wrote to the NHS bodies last week. As the hon. Gentleman will realise, the numbers concerned in each organisation will not be very large, so I am looking for what he describes to happen rapidly.

[Mr Denis MacShane (Rotherham) (Lab)]

Will the Secretary of State send officials to investigate the Birkdale clinic in Rotherham and its executive, Mr Promod Bhatnagar? Scores of women have had PIP implants at the clinic and are now being told that they have to pay £2,900, in cash, to be screened and looked at again. Mr Bhatnagar has threatened groups in south Yorkshire with “unimaginable consequences” if they raise this issue. After his very unclear statement, will the Secretary of State finish by saying that as in every other European country, and standing with the women of Britain, taxpayers do not mind paying for a few hundred women to be properly investigated? My constituents have contacted me saying that the women of south Yorkshire should be able to go to their general practitioner, go straight into hospital and be seen to, and we should clear up all the fuss about bills afterwards.

[Mr Lansley]

I think I have been absolutely clear about what I expect to happen, in relation both to women treated through the NHS and what I expect of private providers. I have also made it clear that if private providers will not or are unable to meet that standard of care, the NHS is available to support women. It is absolutely wrong to say that we are somehow responding to women differently from other European countries, because across Europe countries affected by this are taking exactly the same view that we take.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement and I again highlight the concerns that a great many ladies have. Just today, I have been made aware that constituents of mine, as well as those from other regions of the United Kingdom, have had PIP breast implants carried out privately in the Republic of Ireland. When they contacted the firm, they found that it had gone bust, so what help can he give ladies, both financially and physically, who were NHS patients in the United Kingdom but had operations carried out outside the United Kingdom, specifically in the Republic of Ireland?

--- Later in debate ---

[Mr Lansley]

I refer the hon. Gentleman to what I said in my statement: if women are entitled to NHS treatment in those sorts of circumstances, they should come to the NHS and we will provide the standard of care that I outlined.

[Ian Mearns (Gateshead) (Lab)]

The Secretary of State has demonstrated his obvious concern for the women affected by this situation. Does he accept that they are gravely concerned about the difference of opinion that is emerging between Governments in the countries where these implants have been used, in particular, the difference between our Government’s advice and that of the country where the implants were manufactured, France? Will he also reflect on whether companies in the private sector that are giving either cosmetic or other treatments of this nature to women are properly insured, so that even if they go out of business the insurer will cover women for future treatments should something go wrong?

[Mr Lansley]

On the hon. Gentleman’s final point, I refer him to what I said earlier about how we might deal with that in the future. On the point about other countries, I have spoken to Commissioner Dalli and I have spoken to my French counterpart twice. What I want to be clear about is that the French authorities did recommend routine removal of implants, but from any individual woman’s point of view we are, in effect, recommending that the same thing should happen: any individual woman should see the clinician responsible, should be examined—by imaging, if necessary—and should consider, in the light of that and in a clinical decision with her adviser, what is right for her. That will be true in France and in Britain. I wish to emphasise that we have not seen, on advice, scientific evidence that justifies the recommendation of the routine removal of these implants. We are not saying to women that we think they should have them removed; we are saying that women should have access to imaging. Clearly, women with symptoms, or women for whom evidence of rupture or leakage has been provided through imaging, may well choose to have the implants removed, and we would support that.

Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 10th January 2012 Commons Chamber

[Graham Evans (Weaver Vale) (Con)]

2. What recent representations he has received on access by NHS patients to drugs invented and developed in UK laboratories; and if he will make a statement.

[The Secretary of State for Health (Mr Andrew Lansley)]

Representations received have strongly supported the Government’s “Strategy for UK Life Sciences”, which was published on 5 September. Speeding up clinical trials approval, enabling the unique NHS clinical databanks to support research, the early adoption of new medicines and other initiatives will bring NHS patients the fullest benefit from innovation and will promote growth in UK biosciences.

[Graham Evans]

What steps are being taken towards closer collaboration between the NHS, industry and our world-class universities to drive improvement and innovation in the NHS for the benefit of current and future NHS patients?

[Mr Lansley]

I am grateful to my hon. Friend. He rightly highlights an area where we are clear that innovation can be considerably supported, and not only by the academic health science centres, which were established under the last Government. As the life sciences strategy set out in early September made clear, we want to create academic health science networks across the NHS so that higher education, industry and the NHS can work together to bring about the greatest possible innovation to the benefit of patients.

[Mr Kevin Barron (Rother Valley) (Lab)]

The current pharmaceutical price regulation scheme is able to recognise the fact that pharmaceutical companies based here and developing drugs here should be paid a little bit more for their drugs by the NHS on the basis of their worth for the general economy. Will the Secretary of State tell us whether his proposals for value-based prices will affect that?

[Mr Lansley]

The right hon. Gentleman will be aware that the existing PPRS does not in any sense directly fund innovation in the United Kingdom. Although it takes account of expenditure on innovation, it cannot identify that expenditure in the United Kingdom as a beneficiary through pharmaceutical pricing. As the right hon. Gentleman knows, we are continuing to discuss with the industry the shape of value-based pricing from January 2014, the purpose being to ensure that we fund the value associated with new medicines: the therapeutic value to patients, the innovative value—which will highlight the UK as a base for research and development—and the societal value.

[Jason McCartney (Colne Valley) (Con)]

3. If he will take steps to ensure that the safe and sustainable review of paediatric cardiac services is fully inclusive.

--- Later in debate ---

[Mr David Evennett (Bexleyheath and Crayford) (Con)]

4. What recent representations he has received on access to the cancer drugs fund; and if he will make a statement.

[The Secretary of State for Health (Mr Andrew Lansley)]

We have received a number of supportive representations regarding the cancer drugs fund. Indeed, the Rarer Cancers Foundation recently praised the fund for making additional cancer drugs available to almost 10,000 patients in England since October 2010. It contrasted that access to medicines in England with the lack of such access in Wales.

[Mr Evennett]

My right hon. Friend has cited the view of the Rarer Cancers Foundation. Does he agree that this policy has put patients and doctors back at the heart of decision making, and has transformed the ability of cancer patients to obtain clinically effective treatment so that they can gain precious extra time with their families?

[Mr Lansley]

My hon. Friend is absolutely right. In the summer of 2010, we learnt from Sir Mike Richards’s review that patients in this country were less likely to have access to the latest cancer medicines within five years of their introduction than those in many other European countries. I am proud that so far the coalition Government have been able, through the cancer drugs fund, to help 10,000 patients to gain access to the latest cancer medicines.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for that response. Last year, Cancer Research UK revealed that cancer deaths were down 20% since 1985 and survival rates have doubled in the last 40 years. Does the Minister agree that we must continue to research proactively and thereby continue to reduce deaths and ensure continuity of life?

[Mr Lansley]

I am grateful to the hon. Gentleman, and he is absolutely right about that, of course. He will also be aware that Cancer Research UK highlighted not only the progress that had been made, but the variation in progress on different cancers. Harking back to the earlier point about innovation, we must focus on how some of these innovations will enable us to deliver improved survival rates for specific cancers, and I announced last month that we would be funding additional scanner facilities in this country—proton beam therapy scanning interventions—in order to enable some of the most difficult cancers, such as brain cancers in children, to be treated in this country effectively.

[Duncan Hames (Chippenham) (LD)]

A cancer patient in my constituency faces an avoidable further round of chemotherapy having waited for the strategic health authority to make an individual funding request decision on the drug Plerixafor, which is not included in the cancer drugs fund. Will the Minister consider broadening the scope of the cancer drugs fund to include such drugs that are critical in cancer patients’ care, in addition to their other uses?

[Mr Lansley]

I should be grateful if my hon. Friend would write to me about that. The cancer drugs fund is focused on an identified lack of access to cancer medicines, but if a drug is of particular benefit to a cancer patient, such as in the instance he describes, it should be possible for SHA panels to include it within the scope of the fund.

[Valerie Vaz (Walsall South) (Lab)]

Will the Secretary of State confirm whether those receiving treatment under the cancer drugs fund will also be guaranteed treatment under the new scheme?

[Mr Lansley]

The intention is that from January 2014 as new medicines are introduced through the value-based pricing system, the reimbursement price in the NHS will reflect their value and therefore, by extension, they will all be available through the NHS.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

5. What steps he is taking to ensure drugs approved by the National Institute for Health and Clinical Excellence are made available to all patients in the NHS.

[The Secretary of State for Health (Mr Andrew Lansley)]

The NHS is required to fund drugs and technologies recommended in NICE technology appraisals, in line with the NHS constitution. The NHS chief executive’s report “Innovation, Health and Wealth” sets out plans for the introduction of a compliance regime to ensure rapid and consistent implementation of NICE technology appraisal recommendations throughout the NHS.

[Stephen Metcalfe]

I greatly welcome the Government’s recent announcement on swift and proper implementation of NICE guidance that allows patients access to innovative treatments. In order for cost-effective treatments to secure NICE guidance approval, in the first instance will the Secretary of State ensure that NICE’s methodology review reinforces the importance of appraisal appropriately reflecting clinical practice when assessing new treatments?

[Mr Lansley]

I am grateful to my hon. Friend, who clearly understands that NICE is responsible for the methods it uses in the development of its guidance and that it is undertaking a review of its appraisal methods. I expect that that will be published for consultation this year. NICE should issue final guidance only after careful consideration of the evidence and public consultation with stakeholders, including patient and professional groups.

[John Healey (Wentworth and Dearne) (Lab)]

It is sometimes hard to follow the Secretary of State as he can get lost in his own jargon. Just to be clear: if NICE says that a drug should be available to patients on the NHS wherever they live and whatever their clinical commissioning group, will they get it? Can he give that guarantee today?

[Mr Lansley]

The right hon. Gentleman knows perfectly well that that did not happen under the last Government. The NHS chief executive’s innovation report of early December made it clear that we will make certain that when NICE gives a positive appraisal for a medicine, it is automatically included in formularies, and also that we will establish an effective compliance regime in respect of NICE appraisals and establish a new NICE implementation collaborative to make it happen. As the right hon. Gentleman knows perfectly well, the legislation is clear: when NICE gives a positive appraisal, a medicine should be available across the NHS. That was not achieved under his Government. We will achieve that, and the NHS chief executive is setting out to show how that will happen in the future.

[Mr Marcus Jones (Nuneaton) (Con)]

Under the current regime of primary care trust commissioning, my constituents in Warwickshire often complain to me that drugs approved by NICE are not always available locally but are available in neighbouring commissioning areas. What steps are being taken to ensure that new NHS commissioning boards and local commissioning groups promote the NHS constitution and the right of patients to access NICE-approved drugs?

[Mr Lansley]

My hon. Friend makes exactly the right point, in that what the last Government said happened did not happen: such medicines were not available, and there was a postcode lottery in accessing many of them. That, among other reasons, is why the chief executive of the NHS published his report, which will introduce the NICE compliance strategy. We will require all NICE technology appraisals to be incorporated automatically in the local drug formularies, and the NICE implementation collaboration will support the prompt implementation of NICE guidance.

[Fiona Mactaggart (Slough) (Lab)]

Last week in my constituency, a community pharmacist refused to issue a blind patient with dosage packs unless they paid an additional fee. What redress will such patients have in the newly reorganised NHS regarding actions such as this by community pharmacists, which in my view are against the Disability Discrimination Act?

[Mr Lansley]

I should be grateful if the hon. Lady wrote to me about that case and gave me the opportunity to look at it, which I would be pleased to do. From my point of view, we do not countenance such requirements, through charging, denying patients access to any NHS treatment.

[David Tredinnick (Bosworth) (Con)]

In addition to approving drugs, NICE has also approved acupuncture for lower back pain. Should this not be widely available on the health service now?

[Mr Lansley]

Of course, my hon. Friend will know very well that choice of treatment is a shared decision between patients and their clinicians. NICE appraisals are about whether treatments are available in the NHS and giving information to clinicians about their relative clinical and cost-effectiveness, not prescribing that treatments should be available in specific circumstances.

--- Later in debate ---

[Fiona Bruce (Congleton) (Con)]

8. When he expects residents in Congleton constituency to benefit from investment in telehealth and telecare services by the NHS.

[The Secretary of State for Health (Mr Andrew Lansley)]

I am pleased to say that patients in Congleton who have health conditions such as heart failure or chronic respiratory disease can already benefit from these technologies. I am committed to supporting the use of telehealth and telecare services by working with industry to improve the lives of 3 million people across the country who are living at home with long-term conditions.

[Fiona Bruce]

I thank the Secretary of State for that reply, and indeed innovative schemes in my constituency and across the Cheshire East council area, such as DemenShare, are already using this technology. But what other schemes and advances will the Government introduce for an area that has the highest level of elderly people per population head in the north-west of England and where the number of over-65s will grow by 50% and the number of over-85s is set to more than double by 2025?

[Mr Lansley]

I am grateful to my hon. Friend for her question. She rightly talks about this increasing number of older people in the community and rightly says that we want to support them to be independent and to improve their quality of life.

The whole system demonstrator programme was the largest trial of telehealth systems anywhere in the world. In the three pilot areas of Kent, Cornwall and Newham, it demonstrated a reduction in mortality among older people of 45%; a 21% reduction in emergency admissions; a 24% reduction in planned admissions to hospital; and a 15% reduction in emergency department visits. Those are dramatic benefits, which is why we are so determined to ensure, over the next five years, that we reach out to older people who are living at home with long-term conditions and improve their quality of life in this way.

[Mr Philip Hollobone (Kettering) (Con)]

9. If he will consider proposals to introduce a national screening programme to detect group B streptococcus in pregnant women.

--- Later in debate ---

[Margot James (Stourbridge) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Andrew Lansley)]

My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care, which supports and protects vulnerable people.

[Margot James]

My right hon. Friend will be aware that a significant number of private clinics that fitted women with Poly Implant Prothese breast implants are no longer in business. Will he advise the House on how he plans to strengthen not just the regulation of clinics offering cosmetic surgery, but the products that they use?

[Mr Lansley]

I am grateful to my hon. Friend. I not only laid before the House a written statement this morning, but will, with permission, make a statement on the subject tomorrow. We have been very clear about the support the NHS will give to women who have had implants through the NHS, and we expect private companies to do the same. Not all will do so, and to that extent I make it clear that the NHS is there to support women in their clinical needs, whatever their circumstances.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Secretary of State will be aware that thousands of women are worried and frightened about this issue. The statements he has made are welcome, but what practical help can he offer women whose private providers have not yet committed to offering free replacements?

[Mr Lansley]

This is important, as the hon. Lady says. All the way through we have wanted to be absolutely clear that any woman who is worried should be able to go to her general practitioner. The NHS is there to support any women in their clinical needs, whatever their circumstances. I have made it clear that I expect private providers to match the NHS support through information and access to specialist advice, imaging and investigation, as necessary, and through the removal of implants if it is decided that that is necessary. If private providers will not do that, let me be clear, as I will explain further tomorrow, that the NHS remains available to support women in their clinical needs.

[Karl MᶜCartney (Lincoln) (Con)]

T5. Does my hon. Friend the Minister believe that the Government’s aim of stopping people smoking is in any way helped by the chairman of the all-party group on smoking and health, the hon. Member for Bristol West (Stephen Williams), using a private letter that I sent to him, and copied to the Minister, to castigate me and make untrue allegations in my local newspaper last Thursday?

--- Later in debate ---

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

T2. The people of Newcastle are more likely to die early from cancer, health disease and stroke. On average, a child born in Newcastle today is expected to die five years before a child born in the Secretary of State’s constituency, so why is he changing the health funding formula so that in Newcastle we will lose 2.5% of our funding, whereas his constituency will see a rise of 2.1%?

[Mr Lansley]

Let me remind the hon. Lady—she might not have noticed this—that before the Christmas recess I announced funding for the next financial year for all primary care trusts in England, and the increase for all primary care trusts is 2.8%. In contrast to the previous Government, we are setting out to reduce health inequalities, not least by focusing resources on public health on the basis of an objective measurement of disparities in health outcomes.

[Robert Halfon (Harlow) (Con)]

A BBC Essex investigation into Rushcliffe’s Partridge care home in my constituency has uncovered shocking allegations of abuse and neglect. Will the Minister urge the Care Quality Commission to step in now with an inquiry and take whatever legal action is necessary to protect the elderly residents? Will he meet me and my constituent Lesley Minchin who has a relative who has suffered as a result of what has been going on in the care home?

--- Later in debate ---

[Mr Lansley]

I do indeed agree with the Prime Minister, but I would not characterise what he said in the way that the hon. Gentleman does. I was very interested to see a number of letters in The Times just this morning that highlighted that in the past, under patient and public involvement forums and community health councils, there was a direct public interest in seeing what happened in hospitals and in inspection. Through the Health and Social Care Bill and the establishment of HealthWatch, we will enable the public—representatives of patients—to be involved directly in assessing the quality of the environment in which patients are looked after. They will not supervise nurses. Nurses will be responsible for the experience and care of patients, but the public have a right to be participants in inspection—

[Mr Speaker]

Order. I am grateful to the Secretary of State.

[Andrew George (St Ives) (LD)]

When the Government introduced the Health and Social Care Bill a year ago, they did so with the claim that the NHS fails in comparison with its European counterparts with regard to patient outcomes. Now we know that that is not the case, will the Government withdraw the Bill?

[Mr Lansley]

I do not agree with that characterisation of why we instituted the Health and Social Care Bill or of the current situation. For example, the OECD published in October its latest assessment of health in a number of countries. In too many respects—for example, in relation to serious respiratory disease—we have very poor outcomes relative to other countries. What we are setting out to do in any case is to deliver continuously improving outcomes and to get among the best in the world. In too many respects we are not yet among the best in the world.

[Karl Turner (Kingston upon Hull East) (Lab)]

T4. If the Prime Minister really wants to help nurses to focus on patient care, should the Secretary of State not listen to those nurses and drop this barmy, unnecessary Health and Social Care Bill?

[Mr Lansley]

It is precisely because the Prime Minister and I listen to nurses that we met them and made it clear that we will support best practice. The hon. Gentleman and his colleagues should support nurse leadership on the wards. Nurses can see—through best practice, if they talk to patients about their experience every hour—that they can deliver better care. We will support nurses to deliver better care; he should support us in doing so.

[Dr Sarah Wollaston (Totnes) (Con)]

I know the Secretary of State cares deeply about outcomes in health. Will he add his support to the campaign for a minimum price for alcohol in England and Wales?

[Mr Lansley]

The Government will shortly publish our alcohol strategy, which will set out how we hope to deliver continuing success in the reduction of alcohol consumption and abuse.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

T6. In a written answer on 12 December, the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who has responsibility for care services, told me that the Government felt that:“Local community hospitals provide a vital community resource to support patients in need of rehabilitation, recuperation and respite care”—[Official Report, 12 December 2011; Vol. 537, c. 560W.]What steps will the Government take to prevent the closure of the Chaloner Ward at Guisborough hospital and financially secure that hospital’s vital future?

[Mr Lansley]

I am grateful for that question. I will certainly be happy to write to the hon. Gentleman on Guisborough hospital—I will not delay the House with the detail. I have those details, and will be happy to correspond with him.

[Andrew Bridgen (North West Leicestershire) (Con)]

The Prime Minister speaks of the “health and safety monster”; does the Minister believe it is right that advertising for personal injury lawyers should be displayed in hospital A and E departments, which many might think would feed the monster and make it bigger?

[Jim McGovern (Dundee West) (Lab)]

T8. Yesterday, I had a meeting with Patricia Osborne, the chief executive of the Brittle Bone Society, a UK-wide organisation that is headquartered in my constituency. It was made clear to me that given the current funding squeeze across the voluntary sector, the society is concerned about its ability to provide the vital services that it currently provides. Also troubling the society is the lack of support for adult sufferers of osteogenesis imperfecta. What can the Secretary of State tell me about the Government continuing to support that important society, and what more can they do to support adults with that condition?

[Mr Lansley]

The hon. Gentleman will know that the Department of Health continues to support the voluntary sector considerably through section 64 funding and related support. If he wishes to write to me about the specific circumstances of the Brittle Bone Society, I will be glad to reply to him.

[Chris Skidmore (Kingswood) (Con)]

I recently made a freedom of information request to all 170 acute trusts asking for the estimated total cost of missed out-patient and surgery appointments. So far, 61 have come back to me, and the cost is already over £1 billion. Will the Secretary of State seriously consider what we can do to tackle the enormous cost of missed appointments in the NHS?

[Mr Lansley]

Yes. My hon. Friend makes an important point, and it is something the NHS must focus on. There are considerable opportunities through new technologies substantially to reduce the extent of missed appointments, including through things such as text messaging. What is frustrating is that, sometimes, appointments are missed because patients have not been adequately contacted by hospitals. As for people who abuse the NHS, I hope we will give them no excuses for not meeting their obligation to attend appointments.

[Mike Gapes (Ilford South) (Lab/Co-op)]

Can the Secretary of State intervene with those involved with the health for outer north-east London programme to get them to allow the Barking, Havering and Redbridge University Hospitals NHS Trust to use the births and maternity capacity at King George hospital to take pressure off Queen’s?

[Mr Lansley]

As the hon. Gentleman knows, following the independent reconfiguration panel report, which I accepted in full, the Barking, Havering and Redbridge Trust is looking to manage safely its maternity services, while improving the quality at Queen’s. It is doing that in close co-operation with NHS London and, indeed, with the advice of the Care Quality Commission, following the commission’s inspections. I will continue to be closely involved in that, and we will continue to support the Barking, Havering and Redbridge Trust in improving services for the hon. Gentleman’s constituents and others.

[Mr Philip Hollobone (Kettering) (Con)]

In north Northamptonshire in 2010-11, there were 6,164 alcohol-related hospital admissions. That is four times the number just eight years before. What more can be done to tackle this horrendous increase in booze drinking?

[Mr Lansley]

Time does not permit me to mention all the things that could be achieved, but let me just say that we are clear about the need, for example, to tackle below-cost selling of alcohol, and we are doing that; to stimulate more community alcohol partnerships, and we are doing that; and to accelerate public understanding of the consequences of alcohol abuse, and we are doing that, not least through Change4Life, additionally, during this year. There is more, but we will say much more in our alcohol strategy soon.

[Hazel Blears (Salford and Eccles) (Lab)]

When the Secretary of State, together with the Prime Minister, visited Salford Royal hospital last week to praise the nurse leadership, was he aware that the hospital has cut 200 posts this year and is about to cut a further 200 posts over the next two years as a result of having to take 15% out of its budget? Does he not agree that nurse leadership is important, but that we also need the nurses on the wards to be able to deliver effective patient care?

[Mr Lansley]

Of course I had an opportunity to talk to the chief executive, the nursing director and others at Salford Royal, and I was tremendously impressed, as was the Prime Minister, by the quality and leadership of the nursing, which demonstrated what he was saying about nursing—that there is best practice inside the NHS, and we need to spread it. The right hon. Lady is confusing a cost-improvement programme with a cut. I think Members on both sides of the House understand that the NHS is having to make efficiency savings, which involves shifting some resources from the acute sector and hospitals into the community. Right across the NHS, we have an increase of over £3 billion this year; next year, we have a 2.5% or 2.8% increase everywhere.

NHS Future Forum

Lord Lansley Excerpts

Tuesday 10th January 2012 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

The Department of Health commissioned the independent NHS Future Forum in the summer to conduct a second listening exercise on a series of key issues for health and care. The NHS Future Forum submitted its report to the Department on 20 December and it has been published today. The report contains a series of recommendations for Government and for key bodies in the system in the areas of:

integration;

information;

the NHS’s role in improving the public’s health; and

education and training.

The Department is pleased to be able to accept all the forum’s recommendations for Government and has today published its response to the report.

Also published today is “Liberating the NHS: Developing the Healthcare Workforce, From Design to Delivery”, which sets out the Government’s policy for a new education and training system, and details how the Government are addressing the forum’s recommendations on education and training.

All documents published have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

PIP Silicone Gel Breast Implants

Lord Lansley Excerpts

Tuesday 10th January 2012 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Approximately 40,000 women in the UK have had implants manufactured by the French manufacturer Poly Implant Prosthèse (PIP). These implants were made of a non-medical grade silicone gel, which was withdrawn from use across Europe on 30 March 2010 following investigations at the PIP plant in France.

The recommendation of the French Government on 23 December that these should be removed has caused understandable worry for women affected. My primary concern is for safety and well-being, which is why I asked the NHS medical director, Sir Bruce Keogh to convene an expert advisory group to review the available data on PIP implants.

My Department published the interim report of the expert advisory group on Friday 6 January 2012. It also published a letter from the NHS chief executive, Sir David Nicholson, to the chief executives of all NHS bodies and from the chief medical officer, Dame Sally Davies, to all general practitioners and other relevant health professionals.

Taken together, these documents provide authoritative advice to women and clinical professionals about the risks associated with PIP implants. The expert advisory group concluded that there is not enough evidence to recommend routine explantation of the implants, although they also recognised this is a worrying time for women with PIP implants. The documents therefore set out the model of care to be provided to NHS patients, and the expectation that the private sector would follow suit.

These documents have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. I will keep the House updated.

NHS Pension Scheme

Lord Lansley Excerpts

Tuesday 20th December 2011 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

On 2 November the Chief Secretary to the Treasury made a statement to the House setting out an improved offer on public service pensions to public sector workers (Cm 8214). This offer provided a more generous cost ceiling for scheme-specific discussions to work within, and protected all those within 10 years of their pension age from any further change. This generous offer was conditional on the Government and trade unions reaching agreement by the end of the year, including in the NHS pension scheme, bringing to a conclusion talks that have lasted since February 2011.

Since 2 November I have been engaged in detailed and intensive talks with the health trade unions and employer representatives. I can now report to the House on the heads of agreement on the scheme design for the NHS pension scheme to be reached in 2015, on which talks have concluded. The Government have made it clear this sets out their final position on the main elements of scheme design, which unions have agreed to take to their Executives as the best that can be achieved through negotiations. Further work on the remaining details will take place in the new year, and Executives will consult members as appropriate. This includes a commitment to suspend any further industrial action while the final details are resolved and unions are consulting their members.

The main parameters of the new scheme are set out below:

a. a pension scheme design based on career average ;

b. a provisional accrual rate of l/54^th of pensionable earnings each year, subject to further agreement on outstanding issues not covered by this agreement (see annex A);

c. revaluation of active members’ benefits in line with CPI plus 1.5% per annum;

d. a normal pension age equal to the state pension age, which applies both to active members and deferred members (new scheme service only). If a member’s SPA rises, then NPA will do so too for all post 2015 service. Those within 10 years of NPA are excluded and accrued rights will also be related to existing NPA;

e. pensions in payment to increase in line with prices index (currently CPI);

f. benefits to increase in any period of deferment in line with prices index (currently CPI);

g. average member contributions of 9.8%, with tiered contributions. Member contributions in year 1 to increase between 0% and 2.4% in year 1. There will be no increase in year 1 for staff with WTE pensionable pay less than £26,557. There will be further discussions on contribution rates and increases in years 2 and 3;

h. optional lump sum commutation at a rate of £12 of lump sum for every £1 per annum of pension foregone in accordance with HMRC limits and regulations;

i. early/late retirement factors on an actuarially neutral basis;

j. ill-health retirement pensions to be based on the current ill-health retirement arrangements but with enhancement for higher tier awards to be at the rate of 50% of prospective service to normal pension age;

k. spouse and partner pensions to continue to be based on an accrual rate of 1/160^th. For deaths in retirement spouse and partner pensions will remain based on pre-commuted pension;

l. an employer contribution cap as detailed in the heads of agreement.

There will be transitional protection:

all accrued rights are protected and those past benefits will be linked to final salary when members leave the scheme;

all active NHS pension scheme members who as of 1 April 2012, have 10 years or less to their current pension age, including MHOs and members of the special classes will see no change in when they can retire, nor any decrease in the amount of pension they receive at their current normal pension age. This will be achieved by allowing such members to remain in their current arrangements until they retire (for 2008 members until they have taken all their 2008 pension benefits);

members who are within a further 3.5 years of their normal pension age, ( i.e. up to 13.5 years from their NPA) will have limited protection with linear tapering so that for every month of age that they are beyond 10 years of their normal pension age, they lose two months of protection. At the end of the protected period, they will be transferred into the new pension arrangements; and

the costs associated with the protection outlined above sit outside the costs of the reference scheme.

On the basis that the scheme design within the heads of agreement is agreed, the Government agree to retain fair deal provision and extend access to public service pension schemes for transferring staff. This means that all staff whose employment is compulsorily transferred from the NHS under TUPE, including subsequent TUPE transfers, will still be able to retain membership of the NHS pension scheme when transferred. These arrangements will replace the current provisions for bulk transfers under fair deal, which will no longer apply. In addition, a partnership review of the implementation of the provisions set out in this paragraph for staff working in “Any Qualified Providers” (AQP) will be carried out.

The Government Actuary’s Department has confirmed that this scheme design does not exceed the cost ceiling set by the Government on 2 November. Copies of the heads of agreement and GAD verification have been placed in the Library.

Public Health System

Lord Lansley Excerpts

Tuesday 20th December 2011 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today I am publishing policy updates on the new public health system, covering local government’s new public health functions and the operating model for Public Health England (PHE). Subject to the passage of the Health and Social Care Bill, PHE will be established in April 2013.

The Government have an ambitious programme to improve public health through strengthening local action, supporting self-esteem and behavioural changes, promoting healthy choices and changing the environment to support healthier lives.

The updates define the Government’s plans, set out in the White Paper “Healthy Lives, Healthy People: Our strategy for public health in England”, in November 2010, to change the way public health is delivered nationally through establishing Public Health England as an executive agency and locally, through moving responsibility and accountability for public health to local government.

These reforms will see local authorities taking the lead for improving health and co-ordinating local efforts to protect the public’s health and well-being, and ensuring health services effectively promote population health. Local political leadership will be central to making this work.

In addition, a new executive agency, Public Health England will:

deliver services: health protection, public health information and intelligence, and services for the public through social marketing and behavioural insight activities;

lead for public health by encouraging transparency and accountability, building the evidence base, building relationships promoting public health; and

support the development of the specialist and wider public health work force by appointing directors of public health with local authorities, supporting excellence in public health practice and bringing together the wider range of public health professionals.

The NHS will continue to play a full role in providing care, tackling inequalities and ensuring every clinical contact counts.



In “Healthy Lives, Health People: update and way forward”, published in July 2011, we included commissioning of termination of pregnancies as one of the areas for which local authorities will be responsible. I have now reflected further on whether it would be appropriate for local authorities to be responsible for commissioning procedures that will involve surgical procedures and the associated need for strong clinical governance arrangements to ensure people receive a safe, legal service. I therefore intend to consult on whether commissioning termination of pregnancies should in the longer term be the responsibility of clinical commissioning groups or local authorities. In the interim, as a practical measure, CCGs will be responsible for commissioning these services for April 2013.

The update documents have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. The updates are also available at

http://healthandcare.dh.gov.uk/category/public-health.

Tobacco Control Legislation

Lord Lansley Excerpts

Thursday 15th December 2011 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

The Government will publish a consultation on the packaging of tobacco products in spring 2012.

In March 2011 the Government published “Healthy Lives, Healthy People: A Tobacco Control Plan for England” which set out how our comprehensive, evidence-based programme of tobacco control will be delivered within the context of the new public health system over the next five years.

The tobacco control plan included a commitment to explore options to reduce the promotional impact of tobacco packaging and to publish a consultation paper.

The Government take very seriously the need to reduce the number of young people who take up smoking. Each year, in England alone, around 330,000 children under 16 first try smoking and the majority of smokers start smoking regularly before they are 18 years old.

I am pleased to confirm that this consultation will be carried out on a UK-wide basis. Ministers in Scotland, Wales and Northern Ireland are also eager to gain a better understanding of whether the plain packaging of tobacco products could be effective in reducing the number of young people who take up smoking and in supporting adults who want to quit. Participating in this consultation will help them in making decisions about how they wish to take forward this matter in their own Administrations.

It is also important to create a supportive environment for adults who want to quit smoking. Most smokers report that it takes many attempts before they succeed in quitting. Removing sources of temptation that undermine quit attempts can be of great help.

The Government want to make it easier for people to make healthy choices. To do this, we need to understand whether there is evidence to demonstrate that the plain packaging of tobacco products would have an additional health benefit, over and above existing tobacco control initiatives. The Department of Health has, therefore, commissioned an independent academic review of the existing evidence relevant to the effects of tobacco packaging. This systematic evidence review will be peer reviewed and made available alongside the consultation.

Department of Health officials are also working with colleagues across Government to explore the implications and likely impacts of options for tobacco packaging.

This presents a complex series of issues and we will need to take all the relevant factors into account.

In view of these requirements, the consultation will not be available prior to the new year. The consultation will be published in spring 2012 and I would encourage all those with an interest to respond.

Revenue Allocations 2012-13 (Primary Care Trusts)

Lord Lansley Excerpts

Wednesday 14th December 2011 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today I am announcing revenue allocations to primary care trusts (PCTs) for 2012-13.

The PCT revenue allocations in 2012-13 will grow at 2.8%, which represents a real-terms increase, taking account of the Office for Budget Responsibility figure for the GDP deflator in 2012-13. This represents continued positive investment in front-line NHS services.

This means total investment in local NHS services in 2012-13 of £91.6 billion, an increase in excess of £2.5 billion in total allocations assigned in 2011-12. It puts the NHS in a strong position to deliver the Government’s national priorities set out in the 2012-13 operating framework published on 24 November.

To allow the NHS financial stability during a period of transition, the weighted capitation formula, normally used to determine PCTs fair shares of available resources, has not been applied to the allocations. For 2012-13, all PCTs will receive the same percentage uplift in their recurrent allocations.

This will be the last round of allocations made to PCTs as, subject to the passage of the Health and Social Care Bill, the NHS Commissioning Board would be responsible for the allocation of resources and pace of change policy to clinical commissioning groups (CCGs) from 2013-14.

In common with previous practice, I have today written to all hon. Members to inform them of the revenue allocations made to the PCTs covered by their constituencies.

Full details of all local allocations, including details of other, specific allocations (to support primary dental care, pharmaceutical services, general ophthalmic services and joint working between health and social care) have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. They can also be found at

www.dh.gov.uk/health/2011/12/pct-allocations.