Childhood Obesity
Nadine Dorries Excerpts(13 years, 5 months ago)
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The Parliamentary Under-Secretary of State for Health (Anne Milton)
May I say what a pleasure it is to serve under your chairmanship, Ms Dorries? I have not had the pleasure before. I congratulate my hon. Friend the Member for Brentford and Isleworth (Mary Macleod) on securing the debate. I thank her and other Members for their contributions. I noticed that the hon. Member for West Ham (Lyn Brown) stayed on from the previous debate because she was so riveted by my hon. Friend’s contribution. It is good to see that, because we perhaps do not see it as much as we would like in this Chamber.
My hon. Friend eloquently highlighted not only the scale of the problem and its costs in her constituency, but the individual consequences and the health impact. She was absolutely right, however, to say that this is not just a health issue, and if we need to get one thing across today, it is that. The Prime Minister set up a Cabinet Sub-Committee on Public Health because we need sign-up from all Departments. This is everybody’s business; it is about local government, education, transport and the Department for Culture, Media and Sport, and it requires action on every level.
I was not in the country for the royal wedding on Friday, sadly, because I was attending a World Health Organisation conference in Moscow on non-communicable diseases. Along with smoking, alcohol and lack of exercise, obesity is one of the major issues facing the world, and it was interesting to hear some of the interesting ideas that are coming forward.
There is no doubt that tackling the problem of obesity, particularly in children, is key. The hon. Member for Hackney North and Stoke Newington (Ms Abbott) was right to raise the associations between obesity and deprivation. Obesity was, and still is in some developing countries, a problem for wealthier people, but we are now seeing a switch, with obesity now being associated with deprivation.
My hon. Friend and other Members mentioned MEND. She also mentioned the importance of the Olympic legacy and food labelling, and I will deal with those points in my remarks.
As Members are aware, the Government published their public health White Paper last year. It set out the scale of the public health challenge ahead of us and the Government’s approach to improving health and well-being.
The hon. Member for Hackney North and Stoke Newington mentioned parenting, which involves some really complex issues. There is the issue of what constitutes a good parent. Am I not a good parent if my fridge is not full? The hon. Lady rightly touched on that. Am I not a good parent if I do not make my children clean their plate at every meal? My generation was brought up on the idea that what children do not eat one day, they have cold in their sandwiches for tea the next day. We need to approach such attitudes.
The White Paper signalled the Government’s commitment to addressing the current trend. This is not about just the governmental costs, but the social costs and the burden of disease. The latest figures show that 61% of adults and 28% of children aged between two and 10 in England are overweight or obese. Those figures are enormous. My hon. Friend the Member for Brentford and Isleworth mentioned the publication of a report by the London assembly. We know that in her area nearly a quarter of children in year 6 are obese—one quarter, one out of every four children, is obese. The risks of being overweight include the increase of a range of diseases, such as heart disease and type 2 diabetes.
An analysis by the National Heart Forum has predicted that, by 2050, the number of people getting diabetes because of their weight will nearly double, and that those with heart disease caused by obesity will rise by 44%. Obese and overweight people place a significant burden on the NHS and the direct costs are estimated to be £4.2 billion. However, the indirect costs are massive, such as the impact of early death on families, poverty due to not being able to work, and so on.
The White Paper sets out our vision and general approach. There are three underlying principles. First is individual responsibility: we want to encourage people to take responsibility for their own health. My hon. Friend the Member for Bosworth (David Tredinnick) commented on an anecdote about losing weight by eating less. That is old-fashioned and simple, but a message that we need to get across. It is about individual responsibility.
The second principle is working together, to which I have referred. That is about the problem being everybody’s business—every part of society, focusing on developing partnerships across the board, with third sector organisations, social enterprises and business. Everybody has a role to play. The third aspect is the role of local communities, about which we heard a lot from my hon. Friend the Member for North Swindon (Justin Tomlinson), who talked about local initiatives and what can be done at that level.
We will publish before the summer a document on obesity, which will set out how we will tackle the matter in the new public health and NHS systems, and the role of key partners. The Department has recently held two events with key organisations involved in reducing obesity, to help develop the document. We will also consider comments from the consultation exercise on proposals for a public health outcomes framework, which has just come to an end. That framework includes two possible indicators relating to adults and children, to measure progress relating to obesity.
Experts from the Foresight team described the UK as having an “obesogenic environment”. That is probably right in many ways. There are a number of factors that drive people towards overweight and obesity. As I have said, it is clear that too many people eat too much and exercise too little, and are storing up big health problems. We all need to play our part. It is for local and central Government, business and other partners to make it easier for people, and remove the sort of barriers—mentioned by my hon. Friend the Member for North Swindon—which include irritating matters such as insuring minibuses to get people to sporting events.
The Government cannot compel people to eat less food. We can encourage people and make it easier for them to make better choices. There is already a lot of action under way to do that. Many products in the UK voluntarily provide front-of-pack nutrition labelling, which provides more information. The regulations surrounding front-of-pack labelling are an EU competence. The EU is not dragging its feet, but it is incredibly complicated to get all member states to sign.
We would like to see as light a regulatory burden as possible, to allow different member states to have different front-of-pack labels, because, as a number of hon. Members have said, all systems—guideline daily allowances are one example, traffic lights another—have upsides and downsides. Some can be difficult to understand and some can be misleading. We have all seen claims on the front of packets indicating low fat, but the sugar content is another problem staring one in the face. Indicating calories is attractive to some people but is a problem for those with an eating disorder and are underweight. We need maximum flexibility. Discussions are very active in the EU at the moment and we will start to see some suggestions coming forward.
The Change4Life programme is encouraging people to make simple changes: eating more fruit and vegetables, cutting down on fatty and sugary food and being more active. The national child measurement programme, started under the previous Government, provides feedback to parents about the weight status of their children, enabling them to take action where necessary. My hon. Friend the Member for Bosworth mentioned clothes sizing, which indicates that being fatter has become the norm. The child measurement programme is an important part of giving information to parents.
The Department has also been working with the Association of Convenience Stores to increase the availability of fresh fruit and vegetables in convenience stores across the country. That initiative has been expanding incredibly quickly. I recently had the pleasure of visiting a scheme. This development is particularly important for areas of high deprivation; convenience stores are often the first port of call for many to do their shopping. Some participating stores have seen a dramatic 47% increase in sales of fruit and vegetables.
As part of the public health responsibility deal, a number of organisations have made a series of pledges, which will provide better information to consumers about food. Let me make it clear that the Government are the only people to decide Government policy. However, the responsibility deal currently involves 180 organisations and businesses, and there are 19 collective pledges available online, which I urge hon. Members to view. The idea is to capitalise on the reach of many of these organisations—both businesses and voluntary bodies—so that we can tap into the unrealised potential of a wide range of resources that can promote healthier lifestyles and give people information.
Calorie labelling in out-of-home venues is intended to give information and has been quite successful. We have talked about the half-pint latte and a muffin. It is dramatic and astounding to discover that one has probably had the daily allowance just in a snack on the way to work.
We talked about physical activity. We are currently reviewing the chief medical officer’s guidelines, and are looking at evidence in relation to the health benefits of physical activity. There is also an important psychological benefit, because it makes one consider how one feels and what one is eating and doing, and to be more conscious of overall general physical and mental health.
While much of the focus is on preventing problems from arising, we are also working to meet the needs of those at most risk of becoming obese, including those who are already overweight. Weight management providers will continue to play a role in tackling obesity. In future, the move of public health into local councils is going to be an important and significant step.
I think it was my hon. Friend the Member for North Swindon who mentioned playing in the street and street parties. Interestingly, when I was in Moscow last week, the Minister of Health for Columbia talked about a scheme they have there. On Sundays they close certain streets so that everybody can play in them. That is an outstanding idea. Before constituents e-mail to complain about their streets closing, I should say that I accept it would not work everywhere. It could, however, work in some places.
We have heard today of the huge opportunity for local action; we cannot work in silos any more. Government cannot tackle obesity alone and we want to work with the widest range of providers. Government can and must do their part, but we rely on the compliance of the public as individuals. We have to facilitate and help more people to want to lose weight and stay at a healthy weight. The truth is that no single solution will make a difference; the issue is about using all the ideas raised in this debate to turn round the supertanker. There is a tendency to refer to an epidemic, to suggest that it is something that happens to us. We are like—
NHS Reorganisation
Nadine Dorries Excerpts(13 years, 6 months ago)
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Debbie Abrahams (Oldham East and Saddleworth) (Lab)
This costly reorganisation of the NHS has no mandate from the British people, and no support from health professionals or, apparently, the Liberal Democrats. It will be the end of the NHS that we know and love. As I have said before, the NHS is not just an organisation that plans and provides our health services; it also represents the values of our society by which this country sets much store. Contrary to the assertions from the Government Front Bench, the NHS reorganisation defined in the Health and Social Care Bill will wipe out the founding principles of the NHS in one fell swoop.
For the first time since the NHS was established in 1948, the Secretary of State for Health will not have a duty to provide a comprehensive health service. I will let that sink in. Instead, it is to be replaced with duties to “promote” and to
“act with a view to securing”
health services—weasel words that beggar belief. The original duty is fundamental to protecting the provision of a universal, comprehensive health service. It is the foundation on which the NHS was established. Without it, we will no longer be sure that a comprehensive national health service will be provided, and Members of Parliament will no longer be able to hold the Secretary of State to account on behalf of the constituents who elected them.
Rather embarrassingly for the Secretary of State, he might recall that, when he presented evidence to the Health and Social Care Bill Committee, I questioned him on this and asked him why he was repealing that fundamental duty. He said that he was not. However, it is absolutely clear from the Bill’s explanatory notes that that is exactly what will happen. Paragraph 64 states that clause 1
“removes the current duty on the Secretary of State in subsection (2) of section 1 to provide or secure the provision of services for the purposes of the health service.”
That duty is absolutely core: the NHS was established to provide a universal, comprehensive health service, but that will soon be gone. It is worrying that the Secretary of State did not appear to understand the implications of competition law, or to know what was being repealed in his own Bill.
The Government have suggested that these functions will now be the duty of the NHS commissioning board and the GP consortia, but the exercise of the functions will be discretionary. There will be no requirement to provide those services. So I repeat that the Bill will take away the duty to provide a comprehensive, universal health service.
Debbie Abrahams
No, I am sorry, I am going to make progress so that everyone gets a chance to speak.
The Government have also said that the NHS commissioning board will ensure that NHS delivery is free from political control, but I am not so sure about that. The Bill contains a variety of contradictions, particularly in relation to the Secretary of State’s appointments to the various quangos. Another of the founding principles under threat from this Government is that treatment should be based on clinical need and not the ability to pay. We heard the Secretary of State say that that would be protected, but the Government’s reorganisation of the NHS will result in opening up that fundamental principle. The NHS commissioning board and the GP consortia will have the power to generate income, perhaps by charging for non-designated services. What constitutes designated and non-designated services has yet to be defined, however. My hon. Friend the Member for Leicester West (Liz Kendall) tried to get some elucidation on that, but none was forthcoming.
John Pugh (Southport) (LD)
I am glad to be called to speak. I had a hand in drafting both amendments and the motion in that it is taken from the Liberal Democrat conference. I appear to be responsible for the lot, so I may be a parliamentary first.
I begin by stating the blindingly obvious: the Health and Social Care Bill is in trouble. There is hostility to it from the professions, anxiety about it among the public, concern in the Cabinet and an unease that can be felt spreading in all sections and all parties in this House and the other place. That is just a fact, and it matters more than the political knockabout here or any loss of face, because the effects of the policy—for good or ill, for better or worse—announced with unseemly and misguided haste last June are going to be felt in every home in the country.
Nadine Dorries
I thank the hon. Gentleman for having the good grace to give way. Would he describe the 5,000 GPs who agreed to be part of the pathfinder consortia as “uneasy”? It appears to me that they are incredibly enthusiastic to get going.
John Pugh
I think it is Hobson’s choice.
This is not the first health reform—the last Government introduced more “step changes” than could fill an episode of “Strictly Come Dancing”—but it is certainly the biggest, the most expensive and possibly the most risky. The Secretary of State seems to have chosen for himself a path on which future generations will either put up statues to him or burn him in effigy. However, it is no longer his Bill; it is our Bill. No Secretary of State currently commands a majority in this House.
This Parliament may act like all the others hitherto—and, sadly, it usually does, as it has largely done today—but it is not like any other Parliament. There is no party in this House with a majority, so we should dump the tribalism, the point scoring and the political games. We can get round to doing what we have to do and what we need to do. We have the chance to scrutinise, to seek to amend and improve—and, if unsatisfied, the chance to reject the Bill on Third Reading. That applies to Members of all parties. It is not just “top-down reorganisation” of the health service that we should have dropped with the coalition; we should have dropped “top-down legislation”, whereby MPs simply become pawns in a wider political game, and conviction takes second place to coercion.
There has never been a Secretary of State who has looked at the NHS and found it to be perfect and incapable of improvement. That is largely because we demand so many incompatible things of it that any incarnation is unlikely to satisfy all. Each successive Secretary of State suggests proposals for reform, rather like the Flying Dutchman in a hopeless and sadly doomed pursuit of the ideal format for the NHS. I have to say that the current Secretary of State is probably better equipped for this eternal task than any others: he is committed, passionate, well informed—probably the best informed Secretary of State we have had for some time—and he is brave. He voyages on, undeterred by the siren voices of think-tanks from right and left and the warnings about costs and practical difficulties, and unfazed by the lack of enthusiasm, if the polls are to be believed, among the NHS crew and staff. Of course, as a Liberal Democrat I am disinclined to believe polls at the moment. He carries on, unmindful of the uncharted nature of the course he has set. In Committee, we found real gaps in the understanding of how things will proceed. It is not that he is unaware of the possible danger, but the big danger is that any potential shipwreck will cause us all to be engulfed if costs overrun, if productivity falls, if hospitals close, if waiting lists grow, if morale declines, or if the NHS appears to be denatured, privatised, and not safe in our hands. That is why Parliament’s role is so important in this context, and why good argument rather than the Government machine must prevail.
Karl Turner (Kingston upon Hull East) (Lab)
It is a privilege to follow the hon. Member for Southport (John Pugh). Like him, I am a member of the Public Bill Committee considering the Health and Social Care Bill, and I always listen intently to his well-informed and reasoned speeches. I think that many Opposition Members, at least, will agree with what he has said today.
The Government’s proposed changes will fundamentally alter the nature of the health care system for the worse. That opinion is held not only by Opposition Members but by numerous experts, including the British Medical Association, the Royal College of Nursing and the Royal College of Surgeons, to name but a few. I am pleased to say that we now know that the Liberal Democrats agree with us on this issue, but it is not enough for them to talk tough. They must do what they say they can do. They should not just sit on the fence. They have a real opportunity to prove to the electorate that they can change Government policy when it is damaging and destructive to their constituents.
The damage that this policy will do is, in my view, irrevocable. Let us make no mistake: the Government are ripping the N from the NHS. They are planning, by stealth, a wholesale change in the structure of our health service system. The plans are damaging and, without question, revolutionary rather than evolutionary.
Karl Turner
Not at the moment.
The Government Front-Bench team and its Lib Dem colleagues can argue against what I say until they are blue in the face, but we know what the reality is. The chief executive of the NHS, Sir David Nicholson, says:
“The scale of the change is enormous—beyond anything that anybody from the public or private sector has witnessed”.
When we bear in mind the context of the plans, the destruction to the NHS becomes very apparent. The plans are to be implemented at a time when the NHS is to make £20 billion in efficiency savings. This is a costly, unnecessary and reckless top-down reorganisation of the NHS, and it is without any real mandate. The coalition agreement clearly states that the new Government will stop the top-down reorganisation of the NHS. Instead, we are faced with a reorganisation that is described as being so big
“you can see it from space.”
Paul Blomfield
No. I have said it once: I have given way, and will not give way again, because I want to make progress.
The Government’s plans mean that as we return to the days of long waiting lists, in will step the health insurance companies, perhaps with their links to new commissioning bodies, which will pitch to those who understandably want the assurance of prompt treatment when they need it. There would be a self-reinforcing cycle: more patients would go private to escape worsening NHS services, and NHS providers would then prioritise private patients, worsening services further. Before long, the NHS would be changed beyond recognition. Its founding principles of free and equal treatment for all who need it would be fundamentally undone. No wonder that the chair of the Royal College of General Practitioners has attacked the plans as
“the end of the NHS as we currently know it”,
or that the Royal College of Midwives has said that
“this could accelerate the development of a two-tier service within foundation trusts, with resources directed towards developing private patient care service at the expense of NHS patients.”
Helen Jones
I am sorry—I have not got time. [Interruption.] Other Members are waiting to speak and I will not give way.
The market, not the patient will be king. That is being done under the cloak of localism—the Government’s current buzz word. Remove the cloak and we will see the realities: an NHS driven by the market, run by a vast, unelected and unaccountable bureaucracy, with accountability to Parliament greatly reduced.
The Government plan to give all commissioning to GPs. They conveniently ignore the fact that if GPs wanted to be managers, they would have taken MBAs rather than medical degrees. They will bring in other companies—mostly private—to do the managing.
Helen Jones
I have said no. The hon. Lady was not even here for the beginning of the debate.
It is not sufficient for the Government to ensure that private companies determine our health care; they will also introduce EU competition law into the NHS. That means that the private health companies that are currently hovering over the NHS like a bunch of vultures will threaten legal action if services are not put out to tender. They will then cherry-pick the services in which they can make the most money—they do not want to do geriatric care, paediatrics or A and E. That will fatally wound and undermine local hospitals and some, no doubt, will go to the wall. It is no surprise that the Health and Social Care Bill includes detailed insolvency provisions.
Some hospitals will bring in more private patients to fill the gap, because the Bill lifts the cap on private patients. We will therefore have the absurd situation of private companies making decisions on health care, and of NHS staff and facilities being used not for those most in need, but for those with the ability to pay. There is a word for that and it is not often used in this House: it is quite simply immoral. It is also indefensible.
At the same time, these plans will undermine our ability to deal with long-term conditions. Progress has been made on conditions such as stroke through co-operation, not competition. It has been made through stroke networks, by sharing expertise and by reconfiguring services to get the best deal. All the expertise in primary care trusts on delivering those services will be swept away.
Oral Answers to Questions
Nadine Dorries Excerpts(13 years, 6 months ago)
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Mr Lansley
In the public health White Paper, which was just mentioned, the Government committed to publish a tobacco control plan, and we will present that to the House shortly.
Nadine Dorries (Mid Bedfordshire) (Con)
A public health function which is funded by the Department of Health is carried out by the charity Marie Stopes. The last accounts available for this registered charity are from 2009 and, upon inquiry, it appears that no further accounts will be available for scrutiny until October 2011. Does the Secretary of State think that that is transparent? Is it good enough?
Mr Lansley
I am grateful to my hon. Friend for her question. As a registered charity, Marie Stopes is of course under an obligation to follow the rules and guidelines established by the Charity Commission on such matters. To that extent, these are not directly matters for me.
Health and Social Care Bill
Nadine Dorries Excerpts(13 years, 8 months ago)
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Mr Lansley
First, I have just answered the point about John Appleby. It is true in a number of respects, as I have made clear, that although there have often been improvements in the NHS, they have not been what they ought to have been. It was a Labour Prime Minister, back in 2001, who said that we must raise resources for the NHS to the European average, but he did not achieve results that compared with the European average.
Let me give the hon. Gentleman some examples. A recent National Audit Office report showed that as many as 600 lives a year could be saved in England if trauma care were managed more effectively. Too often, the latest interventions, which are routine in other countries, take too long to happen here. John Appleby used heart disease to illustrate his point. Primary PCI— percutaneous coronary intervention—using a balloon and stent as a primary intervention to respond to heart attack was proven to be a better first response years ago. I knew that because cardiologists across the country told me so several years ago. I remember a cardiologist at Charing Cross telling me, “I have a Czech registrar working for me who says that in the Czech Republic PCI as a response to a heart attack is routine, but it hardly ever happens in this country.” Since then, it has been better implemented in this country, but that started to happen only when the Department of Health gave permission for its adoption.
The same was true of thrombolysis for stroke. That happened too late in this country, after such changes had taken place in other countries, because health care professionals there were empowered to apply innovation to the best interests of patients earlier.
Nadine Dorries (Mid Bedfordshire) (Con)
Does my right hon. Friend agree that, given the disparity in survival rates in trauma care and in many illnesses, including cancer care and heart attacks—citizens in this country are twice as likely to die of a heart attack as those in France—the NHS is in desperate need of modernisation?
Mr Lansley
My hon. Friend is right. We need not only to match European spending, as we do now, but to ensure that we achieve European-level results. It is not just about benchmarking, which we know we must do. We must benchmark ourselves against the best in the world if we are to deliver the best results for patients. We must also constantly make sure that we achieve a modernised health service that delivers the best possible care—sometimes going ahead of what others achieve, and applying innovation more quickly.
In some ways, as we know—for example, in mortality rates from accidents and from self-harm, and in equity of access to health care—the NHS leads the world, but our doctors and nurses are regularly hobbled by a system that treats equality as sufficient, when what we need is both equity and excellence.
Jim Dowd (Lewisham West and Penge) (Lab)
It is a pleasure to follow the hon. Member for Boston and Skegness (Mark Simmonds). Although I do not agree with much of what he said—I certainly do not agree with his rationale for supporting the Bill—he made a few genuine points that, in the calmer atmosphere of a Committee, could be looked at in detail.
I agree with the hon. Gentleman that the difference between the two Front Benches could hardly be starker. This is about the view of what the national health service should be. I am not disappointed for one moment that the view of the Labour party is different from that of the Conservative party and its followers from the Liberal camp. Much has been made of that great event on 5 July 1948, when the national health service came into being. Of course, at the time, it was ferociously opposed by the Conservative party. At the beginning, it was also opposed by large parts, although not all, of the medical profession.
Jim Dowd
I will not give way, for one good reason: I might get injury time for it, but others would lose out.
The medical profession has changed its view, as has the Conservative party. The Conservative party has changed its view largely because the NHS and the principles that underpin it resound so clearly with the British people. This has been a difficulty for the Conservative party over the years.
I have seen a few Conservative party reorganisations of the health service. Thirty-five years ago, I was appointed to the Lambeth, Southwark and Lewisham area health authority, which included such hospitals as our local one over the river, St Thomas’s, Guy’s, King’s College and Lewisham. The AHAs were set up as a consequence of the Heath Government’s reforms in the early ’70s. They were abolished, but not before Lord Jenkin suspended the Lambeth, Southwark and Lewisham AHA for refusing to accept the cuts in the budgets that the then Government were trying to inflict.
The Tories reorganised the health service again and brought in district health authorities. I served on Lewisham and North Southwark district health authority for some time, until in 1990 I was thrown off for having the temerity to be a local councillor. I am sure that there are others around the Chamber who suffered similarly. Who engineered that amazing transformation? It was none other than the current Secretary of State for Justice. I think that he just sacked anybody who was not on his Christmas card list, quite frankly, because nothing in that reform of the health service did anything to improve its accountability or performance. It did hand over the health service, more than ever, to central control and direction, which, we are asked to believe, the Conservative party today decries so readily.
The Conservative party, of course, contains members who believe—and who go on foreign broadcasting stations to announce—that the national health service is a 60-year-old mistake. That is what was said by an MEP who was advising Republicans in the United States to oppose the Obama reforms. He was slapped down quite quickly, unsurprisingly. It is the great embarrassment of the Conservative party that it cannot reconcile its atavistic feelings towards the health service and belief in the free market with the feelings of the vast majority of the British people.
In recent years, as my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) pointed out, waiting times for most specialisms have come down almost to the point where they are no longer a consideration. I will tell the House briefly about the experience I had towards the end of 2009. I suffered chest pains of various kinds. I went to A and E at Lewisham hospital on 28 July. I was referred to the chest pain clinic at the same hospital the following week. I went for an angiogram at King’s College hospital two weeks after that, where the consultant advised me that I needed bypass surgery. I asked how long it would take—I did not mean the operation, obviously, but the wait. He said, “When can you come in?” I could not make the first date that I was offered, so I had to put it back. My experience was repeated millions of times across this country when the Labour party had stewardship of the NHS. It is that relationship that is so critically under attack.
The NHS is about patients—of course it is. Everybody knows that patients come first and that it must be patient-centred. Those things are meaningless clichés. Patient care and patient choice matter, but what matters more is patient trust. Patients must trust that any therapy, drug or treatment that is suggested by their clinicians and medical advisers is what is best for them—not what is cheapest or what has been contracted for. It is that critical, basic relationship in the national health service that is most under threat from this Bill and that Government.
Nadine Dorries (Mid Bedfordshire) (Con)
I rise to support a Bill that I believe is perhaps one of the most exciting, if controversial, Bills to have been put before Parliament in the 62 years since the NHS was established. It is a fact that a resident in this country today is twice as likely to die from a heart attack as a resident in France. In this country, we also fail to reach European averages for stroke care. In fact, 4,000 stroke victims a year lose their lives because our NHS is not up to European standards in stroke care. If we delivered trauma care slightly differently, we could also save 600 more lives a year, but we do not. Those figures alone show that it is now time, 62 years since it was established, for the NHS to be modernised.
In those 62 years, drug research and development have advanced hugely. Medical technologies have advanced in a way that could not even have been imagined 62 years ago. As a result of the internet and the information now available, patients expect and demand to have a say in how their condition is managed. They want more information and they want to discuss their care with their GPs. The Bill will put the patient right at the heart of the NHS, and that is why I so passionately support it. The central tenet of the Bill is: “No decision about me without me”. It will ensure that, for the first time, each and every patient can almost become their own lobbyist, sitting in front of their GP and discussing their condition and treatment in an open way, where they have information and the GP will have to engage with them. That does not happen today, and certainly not in hospitals.
I would like to give an example—something that I heard about this weekend from a patient—that clearly epitomises why the patient has become invisible in the NHS today. That patient was in hospital at the weekend when a doctor walked up to him, lifted his arm, took blood, put his arm back down and walked away without saying a single word to him.
Catherine McKinnell
It strikes me that despite what the hon. Lady is saying about the patient becoming the heart of the NHS, it will instead be the GP who becomes the heart of the NHS. Is she suggesting that the GP will be in the hospital with that patient to hold their hand at every stage of their treatment?
Nadine Dorries
I wish that that had been a more sensible question, because then I would have been delighted to give the hon. Lady an answer.
That patient was in hospital when the doctor walked up, took blood and put his arm back down without even a word of acknowledgment. A nurse then came and put his tray of food at the end of the bed. The patient was attached to a heart monitor and a drip, and could not reach the food. The patient was distressed, vulnerable and in pain, yet he was invisible to the health care professionals who were treating him. He was invisible because what is important in today’s NHS is the process—the management, not the patient. The humanity of the patient has almost been lost, and there is no way to put it back into the NHS other than to tip the understanding of who is important in the NHS on its head. The Bill does that in a way that has never been done before and which is now needed.
Anne Marie Morris (Newton Abbot) (Con)
One of the concerns that I have come across is from health professionals who would be delighted to see red tape removed. I have spoken to directors of nursing who spend more time on red tape than they do with their patients, and they are deeply frustrated. Does my hon. Friend agree?
Nadine Dorries
Absolutely, and the Bill will address that, in as much as care will be more easily accessed by the GP and the patient, in a much more streamlined process.
When nurses sat their medical exams 62 years ago, when the NHS was first established, the answer to each question had to begin and end with the words: “Reassure the patient”. It did not matter what someone said in the answer; if they did not emphasise the fact that the patient had to be reassured, they failed. That has gone. That demonstrates exactly how the patient has become invisible in today’s NHS.
I support the Bill because I support GPs working in consortia. A common myth—an urban myth—that we have heard in the few weeks leading up to this debate, and which has been thrown at us from the Opposition Benches, is that GPs are simply not up to the task of becoming business managers. The truth is that they already are business managers, because they all manage their own businesses. They will not be working as individuals or in individual practices; they will be working as part of a consortium, which is quite different from the impression given by the Opposition. Right now, 141 pathfinder consortia are demonstrating that they are ready and able to take on commissioning, and that they endorse patient involvement in the decision-making process. As a result of the “any willing provider” provisions, there will be a genuinely wider choice of care options available to the GP and the patient.
I would like to rebut the argument that the private sector will come in and undercut the NHS. That is complete nonsense. There will be no undercutting of the NHS whatever. Services will be—[Interruption.] I can only say that Opposition Members have not read the Bill, because there will be a tariff. Charities and the private sector will be able to provide services, but with a tariff. I shall give an example. If a patient requires a surgical procedure, which they discuss with their GP, and the local hospital has no bed available for six weeks, two months or however long, but if the local private hospital can provide a bed the next morning at the same price, are the Opposition really saying that an ideological obstruction should be put in the way of that patient being admitted to that private bed for that procedure the following day?
Nadine Dorries
I cannot, because I have given way twice and I have no more time.
If that patient were in pain, why should they not be admitted into that bed if it were available? That is how the market will be opened up by GPs, to the benefit of patients.
We recently heard from my right hon. Friend the Prime Minister about an extra £60 million that will be available to fund the latest bowel cancer screening technology, with wider deployment of the flexible sigmoidoscope. That does not need to be provided in secondary care in a hospital; it could be provided in the GP practice under the “any willing provider” provisions, perhaps via charities with specialised trained technicians. The Bill will ensure a new approach to providing services to the patient. “Any willing provider” will give patients the choice that they have not had for 62 years, empowering them to make decisions over that choice and opening up health care that patients in this country have not had, certainly for the past 15 years. With new technologies coming on stream and new ways of delivering care, both in the patient’s home and in the GP practice, that has to be welcomed. The Bill has to be welcomed, and Government Members will vote for it because the most important person in the Bill is the patient. That is why I support it wholeheartedly.
Umbilical Cord Blood
Nadine Dorries Excerpts(13 years, 8 months ago)
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Mr Burrowes
We often talk about investing to save, but this is an area in which investment would save both money and lives. I shall go into that in more detail.
A report on transplantation by the UK Stem Cell Strategic Forum, ably chaired by Professor Charles Craddock, was published in December 2010 by NHS Blood and Transplant. The Minister discussed the report, which makes important recommendations, with the all-party group on the day of its publication. The report recommended, first, investing in expanding Britain’s cord blood bank capacity to 50,000 units. Those proposals have been properly costed and the costs have been balanced against effectiveness by NHS Blood and Transplant. For an investment of £50 million, spread over five years, Britain could have that 50,000-unit cord blood bank.
Nadine Dorries (Mid Bedfordshire) (Con)
I thank my hon. Friend for giving way. I want to congratulate him on the work that he has consistently put into this issue over the past three years, which is to be commended. Would he endorse the proposal that certain hospitals or regions could be piloted or allocated as regions to collect and donate the necessary 50,000 units? Rather than having routine testing across the country, it could be just in specific regions or units.
Mr Burrowes
I am grateful to my hon. Friend for making that point. There has been some progress on the areas that could retrieve unit cords, particularly from members of BME communities who lack those matches, but we also need to look further at matching that up with regional centres of excellence. I shall return to that point.
First, let me deal with the money issue, which we cannot ignore in this area of health. For an investment of £50 million over five years, we could get that 50,000-unit blood bank. Although it would be difficult to find £10 million a year for five years in these austere times, the financial benefits make sense. The blood bank would provide economies of scale that would reduce the cost to the NHS of every treatment and would radically reduce the need to import expensive stem cell units from abroad, which is, sadly, too common a practice today. The saving that would bring to the NHS has been calculated at £6 million a year in perpetuity. Within 10 years, the entire investment would have been repaid and the programme would save the NHS money for the foreseeable future—and then there are the 200 lives we can choose to save each year by taking that step. So, it would save £6 million and 200 lives a year, and those figures are with currently available treatments at success rates that are currently being achieved.
Oral Answers to Questions
Nadine Dorries Excerpts(13 years, 9 months ago)
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Paul Burstow
Let me start with the point of agreement: this is about more than just the work of GPs. That is why the Government are proposing the establishment of health and well-being boards in local authorities to drive the integration that was never delivered under the Labour party. Services were not integrated and, for many people, services did not fit around their lives as a consequence. This Government will change that. It seems that the hon. Gentleman is putting forward the campaign slogan, “Save the PCT; don’t trust your GP.” That is not a good campaign slogan.
Nadine Dorries (Mid Bedfordshire) (Con)
Will there be £2 billion going into two pots—one for public health and one for social care? What element of that budget will local authorities be able to use for preventive care? Some reports say that the budget is ring-fenced and some say that it is not, so some clarity would be appreciated.
Public Health White Paper
Nadine Dorries Excerpts(13 years, 10 months ago)
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Mr Lansley
I am afraid the right hon. Gentleman is simply wrong about that: we have made no announcement, and I have said we are considering it. More to the point, I have said we are also considering the question of plain packaging of cigarettes, which is being pursued by a Labour Administration in Australia, and which his Administration did not pursue.
Nadine Dorries (Mid Bedfordshire) (Con)
The White Paper states that we are going to provide easy access to confidential non-judgmental sexual health services. Will that include better counselling for women seeking an abortion, and will that counselling include the information that has so far been withheld from women seeking a termination?
Mr Lansley
The support for women seeking the termination of a pregnancy should include the fullest possible information about the nature of that procedure and its consequences. Consent should always be fully informed.
Termination of Pregnancy (Information Provided)
Nadine Dorries Excerpts(13 years, 11 months ago)
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Nadine Dorries (Mid Bedfordshire) (Con)
Although the abortion figures for last year were slightly reduced by 3.2%, there were still 200,000 abortions carried out in the UK last year—572 per day. Abortion in this country is an industry from which a small number of organisations and individuals make vast amounts of money. No sensible person would condone this. In examining the legislative abortion procedures of European countries with far lower numbers than ours, it occurred to me that for those countries in which informed consent before an abortion takes place is enshrined in law—Germany, France, Belgium, Finland and others—the abortion rate was much lower. I have deliberately excluded countries with religious and cultural influences, such as Italy, Spain and Portugal from that analysis. It also appears to me that in those countries, the abortion procedure is a far kinder one, which takes much more account of the vulnerable position a woman might be in at the time of her request for an abortion and provides her with alternatives to consider and a cooling-down time in order to think, breathe and take stock of what is happening.
All those countries with good informed consent legislation had significantly lower than average daily abortion rates than the countries that do not have such informed consent legislation. Although a causal link is impossible to prove, these figures suggest that informed consent legislation might prove a good way of reducing Britain’s abortion figures. I think that all Members of all parties are agreed that we want to see that happen.
In this country, if a woman requests a termination from her GP, no questions are asked. I have spoken to numerous GPs and posed this question to them: “When a woman sits in your surgery and asks for a termination, what do you say?” The answer I frequently receive is that the GP does not say anything, but writes a referral letter. That is the process at the GP stage. A referral is made to a hospital or clinic and the abortion is performed, for the woman’s sake, as quickly as possible and without fuss.
Minimal counselling or no counselling is provided in some NHS hospitals and some clinics. Minimal counselling is provided by BPAS—the British Pregnancy Advisory Service—which carries out a large number of abortions on behalf of the NHS. However, BPAS carries out some counselling, but also carries out the abortion, so there is a clear conflict of interest there.
Andrew Selous (South West Bedfordshire) (Con)
I understand that the counselling provided by abortion providers is Government funded only if the abortion goes ahead. Does my hon. Friend share my concern about that?
Nadine Dorries
I am going to come to that very point a little later in my speech. It is one of the main concerns, mainly because no alternative counselling is provided to negate that option.
We all know that when it comes to abortion, the law is indeed an ass. It has no application whatever. We know that the law prohibits social termination—two doctors’ signatures are required—but none of that is ever taken into account. Abortion clinics freely admit that consent forms pile up in their offices, waiting for the second signature, long after the event has taken place.
A woman has an assumed right to choose. However, she apparently has no right whatever to any information on which to make that choice. If any of us were referred to a hospital today for a minor procedure such as an operation for an in-growing toenail, the procedure would be explained to us in detail. We would be made aware of the level of pain we might experience; we would be told exactly what would happen while we were under the anaesthetic; we would be given follow-up appointments to check on the progress of our healing; we would have our dressings changed and have checks for infection. A woman who has an abortion has none of that.
At the end of the day, the woman is discharged out on to the street and left to come to terms with the rollercoaster emotional journey of which she will still be in the midst. Before the woman received the procedure, she might have felt coerced, pressurised or bullied into the abortion. To her, it might have been a life or the beginning of a life—depending on her perspective. She might have had a seed of doubt, but once she was on the conveyor belt to the clinic, she might have felt helpless and unable to step off.
Make no mistake: abortion is not a medical procedure. It is not an in-growing toenail. Abortion is about the ending of a life, or a potential life. It is about a death which is final, and from which there is no going back. The abortion of a baby does not abort the seed of doubt or misgivings that may have been present at the time; that still remains.
Many consultant psychiatrists from the Royal College of Psychiatrists are becoming increasingly concerned about the number of women who are presenting with mental health issues directly linked to previous abortions. A major longitudinal 30-year survey published in The British Journal of Psychiatry in 2008 showed clearly—after adjustment for confounding variables—that women who had had abortions had rates of mental disorder 30% higher than women who had not. The Royal College of Psychiatrists said that, following its position statement on abortion and mental health,
“healthcare professionals who assess or refer women who are requesting an abortion should assess for mental health disorder and for risk factors that may be associated with its subsequent development”.
Nothing remotely like that happens. No consideration whatsoever is taken of the state of a mother’s mental health when she asks for an abortion. If she asks for an abortion, she is given one.
Given the disregard that we have for women seeking this procedure, I am surprised that that figure stands at only 30%. We push vulnerable women through a clinical procedure at great speed to end a life—or, as I said, a potential life—that is growing within them, and we wonder why only 30% have problems in later life. Those are the women who are diagnosed. They are the women who seek help, and whom we know about. We do not know about the others. Is it not time that we started to treat women a little better than this?
Daniel Kawczynski (Shrewsbury and Atcham) (Con)
I am very pleased that my hon. Friend has raised the issue of the rights of women in this context, but what about the fathers? I hope she agrees with me that the law needs to be examined to ensure that the rights of the potential father are taken into consideration.
Nadine Dorries
I thank my hon. Friend for his contribution, but I am afraid that I must stick to the point of the debate, because otherwise we shall run out of time.
Does not the way in which abortions are carried out in this country today almost amount to abuse? We need to take lessons from our European neighbours. In Germany, women are offered counselling and a cooling-off period. That gives them a chance to breathe and think. It gives them support. They are informed about the procedure, and of the possible consequences. They are provided with alternative routes other than the surgical removal of a life. They are given information about adoption—and yes, I know that people throw up their hands in horror when that is mentioned, but it is not our pregnancy, and it is not our baby.
We have no right to institutionalise and frame a decision-making process that is void of choice for the women who seek information. It is a woman’s right to choose, and women should have the right to be given every shred of information that we have and every alternative option. If a woman wants to continue with her pregnancy and deliver her baby for adoption, she should have the right to choose to do so. If she does not, at least she can emerge from the abortion process feeling that she made an informed decision. She can emerge feeling that she went in empowered and not helpless, strong and not vulnerable, and believing that she did the best thing because she knew exactly what she was doing and had full knowledge of every available option. She will be able to draw strength from that in future.
Women are entitled to an option. They are entitled to give informed consent, which should be explicitly supported by pro-choice and pro-life campaigners. When it comes to a decision of such magnitude, it is vital for women to receive information that is absolutely accurate and is given calmly, without coercion or a principled bias and, in particular, without political ideology. Last month ComRes, the pollsters, revealed after an extensive survey that 89% of people agreed with that. They think that women should be entitled to have more information when requesting an abortion. Given that overwhelmingly high figure, it is time that this House paid some attention. I hope the Minister agrees that it is time that we took a little more care of women undergoing such a procedure. It is time that we introduced a statutory process of informed consent and a cooling-off period. The European evidence shows that that could provide us with a considerable reduction in the number of abortions, and everyone would surely welcome that.
I shall finish by mentioning a book which is to be launched this month. It is published by the charity Forsaken, which is neither pro-life nor pro-choice: it is pro-women. For two years, the charity has put together the stories of women suffering from post-abortion syndrome. Reading the book is so heart-wrenching that we just want to reach out and take their pain away, but we cannot. There is no going back. We cannot make it better; abortion is a procedure to end life—it is final.
The women interviewed for this book feel that talking about abortion is taboo. That forces them into silence, leaving them unable to express their suffering. Abortion really is a taboo subject. We will never see an abortion filmed on television; we will never see that screened. It is still the taboo subject that we do not talk about.
One woman in the book describes how even when she told the anaesthetist that she was changing her mind and was having doubts, he pushed her to go ahead. He did so because, if she changed her mind, he would not have been paid. There is the same process as for the counselling. If the woman does not go ahead with the abortion, the clinics are not paid for the counselling, and therefore they need to know that she is going ahead before she is given the counselling—and we can imagine the process that ensues.
I will conclude by reading a paragraph from the book, giving a young girl’s account:
“An uncle dropped me off at the clinic with a letter to give to them. I don’t know what that letter was. At this point, I was holding onto the thought that they were only checking me. The staff at the clinic were very nice there, seemingly courteous and kind. It was not my usual surgery, I did not realise it was an abortion clinic until I was shown into a counsellor’s room. When I went to the counsellor’s room, I was asked: ‘Why don’t you want to keep this pregnancy?’
‘I want it but my family don’t want it,’ I replied, and promptly burst into tears. ‘They won’t support me and I can’t look after it myself.’
Nothing more was said that I remember...I was given a bed—there must have been 20 of us crowded into that ward. I was the first in line. As I waited, I scanned the corridors for some means of escape, but I was already wearing my hospital gown and no underwear. It wasn’t long before a man brought a wheelchair to take me to the operating theatre. For a brief moment I wondered if I had the strength to run away, but instead I sat obediently into the chair.”
That is a story of loneliness, suffering, emptiness and loss that many thousands of women live with day after day. It is they who become the 30%.
It is time for the UK to catch up with the rest of Europe and introduce informed consent in an attempt to ensure that stories like this become a rare exception. It is time for this country to start looking after our young girls and women at the most vulnerable time in their lives and treat them with some respect.
Contaminated Blood and Blood Products
Nadine Dorries Excerpts(13 years, 11 months ago)
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Nadine Dorries (Mid Bedfordshire) (Con)
I welcome the Government’s intention to review the Archer report, for this simple reason: its last recommendation, which to many sufferers was the most important, was to review the nursing, caring and other services that are available. This debate has been very much focused on money, but regardless of whether the figures are correct, the problems that many sufferers have had to experience throughout their lives, from the moment of infection, have been compounded by the years in which they have had to deal with these problems alone.
I would like to give the House a couple of examples, because I do not think that any of us, although we speak here on behalf of our constituents, can fully understand some of the problems that these people have had to deal with. I would like to speak on behalf of a constituent of my hon. Friend the Member for North East Bedfordshire (Alistair Burt) and a constituent of my own, and cite some of the things that they have told us. What they said to us is powerful, and we must recognise the bravery that it takes for people to go and sit in front of their MP and talk about the problems that they experience, which is not an easy thing to do. Some of those constituents are here today.
My constituent was infected with HIV from contaminated blood at the age of 12, when he was told: “This is what you now have. You must never tell anybody at all, ever. You must never tell friends in school, because if you do you will be bullied and hounded out of your school, and we will be hounded out of our home and have to move away.” It is enough to have suffered with haemophilia, but then, at the age of 12, they are told not only that they have a socially unacceptable disease, as it was at that time, but, at an age when they fully understand, that they are soon going to die from it.
He got that message more powerfully than by words alone. As a haemophiliac before his diagnosis of HIV, he was never allowed to have a bike of his own, so he was always asking to hitch a ride on somebody else’s. The Christmas after his diagnosis, his Christmas present was a bike of his own. He knew, from the statements by his parents and the look in his father’s eyes, that it did not matter any more—that he may as well have his own bike, because at that point in the ’80s nobody knew whether he had a month, a year or years to live. For a child to have had to live with being a social pariah, and to have had to keep a secret that they know they will die from, brings with it psychological problems that we cannot even begin to imagine. Their childhood is taken away and they have to live with that secret all their life.
I welcome the report, because these people need counselling. They need to be able to know that they can speak about the vitally important conditions that they suffer from, and how to deal with them. To use the words of one of our constituents, he felt that he had been born to bleed but did not realise he would have to pay the death penalty for it, and every day he feels ungrateful to be alive. The figures may be wrong or right, but other issues are just as important as the financial compensation that some of the people who have been infected are looking for.
There was a huge stigma surrounding HIV in the ’80s. We know in this place, and many other people know now, that there are only two ways to catch HIV—via sexual intercourse or contaminated blood. Perhaps it is time for us to start doing our bit to let people know that that stigma should not be there any more and that these people should not be afraid to talk about what they have suffered.
Mr Robinson
On a point of order, Mr Deputy Speaker. We are conducting a Back-Bench debate that is being coloured by a figure in an amendment that the Government have tabled, which has not been selected. It suggests that £3 billion would be the cost of what my motion proposes. If the exact figure is in the order of 1% of that, or £300 million, as I think the hon. Member for Bracknell (Dr Lee), a medical doctor, suggested—[Hon. Members: “No, £1 billion.”] Does it come to £1 billion? I think that ought to be clarified before we go further in the debate.
NHS White Paper
Nadine Dorries Excerpts(14 years, 2 months ago)
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Mr Lansley
The White Paper makes it clear that the NHS commissioning board will be required to allocate resources across the NHS in England on the basis, as far as possible, of seeking to secure equivalent access to NHS services. That will clearly be relative to the prospective burden of disease. In tackling health inequalities, the right hon. Lady will know that we need separately to allocate resources to local health improvement plans, which will be led through local authorities, and which will enable them to create local public health strategies to secure improvements in health outcomes and to reduce health inequalities.
Nadine Dorries (Mid Bedfordshire) (Con)
May I congratulate the Secretary of State on what is a truly exciting White Paper? Will he confirm that in addition to GPs having responsibility for commissioning, there will be the opportunity for them to become actively involved in the provision of care and deciding what care is allocated to which patients?
Mr Lansley
Yes, my hon. Friend understands that GPs are often providers beyond their primary medical services responsibilities. One of the difficulties with fundholding was that there was an opportunity for that conflict of interest to arise and not be properly resolved, so we have made it clear that, in the commissioning framework that we will publish, we will set out consultation proposals on how we ensure that that conflict of interest is not allowed to arise. Where GPs wish to be providers, we do not constrain them, but how that contract is arrived at is transparent and open.