Contaminated Blood

Norman Lamb Excerpts

Tuesday 12th April 2016 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

I, too, pay tribute to the hon. Member for Kingston upon Hull North (Diana Johnson) for her amazing campaigning work, and indeed to the other hon. Members who helped secure this debate. I also pay tribute to the organisations Tainted Blood, the Contaminated Blood Campaign and the Haemophilia Society, which have campaigned for years to get justice for so many people. We should also pay tribute to the many individuals who have fought on and on for justice, often in very difficult circumstances.

The Minister should reflect on the extraordinary unanimity of view in this debate, on the reflections in the consultation, on the proposals that the Government have put forward and on the need to think again. This is not a party political issue, because all Governments are to some extent culpable—Labour Governments, Conservative Governments and, indeed, the coalition Government. This is a moral imperative—there is no doubt about that. We have to offer these people justice, and the Government must accept that.

The Government set out the principle right at the start, in their introduction to the consultation, by stating that they accept and recognise their responsibility to everyone infected as a result of NHS treatment, but that leaves out those people affected. This is about not only those infected, but those affected. What about all the loved ones, the children, the spouses and the partners bereaved as a result of loss of life? The Government should accept responsibility for them as well. They have to accept that when they respond to this consultation exercise.

Serious concerns have been raised about this set of proposals. The Prime Minister said—his words were very clear—that:

“We will help them more”—[Official Report, 11 March 2015; Vol. 594, C. 289.]

Yet the proposals, when we see the detail, include a proposal to cut the amount of money that individuals receive. That is not consistent with what the Prime Minister said, so surely the Government must think again. It is surely unconscionable that people in very real need will lose out financially as a result of these proposals. What assessment have the Government made of the winners and the losers? How much will some people lose? It is really important that the Government are open about that. If the Minister cannot respond today, I would be grateful if she wrote to hon. Members to set out the assessment of the amount some people will lose, and of how many people are likely to lose, as a result of these proposals.

As my right hon. Friend the Member for Orkney and Shetland (Mr Carmichael) and others have said, it is surely not right that people in Scotland benefit more than people in England. Surely everyone should be treated exactly the same as a result of this scandal.

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

Will the right hon. Gentleman give way?

[Norman Lamb]

I will not, because I am concerned about the time.

Ending inflation-proofing actually means that we plan a cut to what people are paid every year for as long as there is inflation. Surely we cannot begin to justify that.

I have a problem with the principle of funding new medical treatments at an early stage by taking money from people’s financial support. That surely confuses two principles. We should leave intact the money that is available for people’s financial security.

I am concerned that the money will come from the Department of Health. The impact assessment talks about the other things that cannot be done as a result. Surely the money should come from the Treasury. In the Budget, the Government cut capital gains tax. I heard recently of one individual who will benefit to the tune of nearly £1 million as a result. These are political choices. Do we as a country want to cut capital gains tax and give large sums to very wealthy people at the same time as cutting financial support for people who have lost out as a result of a national scandal? That is surely unacceptable.

I therefore say to the Minister: accept what the Haemophilia Society says, withdraw these proposals and think again.

--- Later in debate ---

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

We have paid tribute to many of the people who have come from across the UK to listen to today’s debate, but there is one group missing: members of Haemophilia Scotland, who are in Tayside attending a funeral of one of their members, the second of three brothers who have haemophilia. The remaining brother has had a transplant because of liver damage. I expect that everyone here would want to send their condolences to the family.

Let us recall that this scandal has been going on for over 40 years. People have been dying without being recognised and without being looked after for all that time. It really is a disgrace. We talk about not accepting liability. I have my specs on because I want to read out some quotations, which, as Members know, I do not normally do. I have a letter here. According to a leading doctor in the Food and Drug Administration in America, in May 1985, heat treatment of blood products had been available for some time, but non-heat-treated blood could continue to be produced with the current licences because the FDA was not going to do anything about it. It could have regulated the practice out, but it wanted things to be tidied up quietly. The doctor explained that although the FDA could revoke the licences through regulatory process, it did not want any attention to be paid to the fact that the practice had been allowed to continue for so long; it wanted the issue to be

“quietly solved without alerting the Congress, the medical community and the public.”

I have a copy of a letter from John Major, the former Prime Minister, who was at the time Chief Secretary to the Treasury. In 1997, he wrote to Tony Newton, then a Health Minister, raising the possible consequences of a sympathetic response to the Haemophilia Society:

“It could lead to an open-ended commitment of huge dimensions

and

“give rise to court action against the Government because of the implication of negligence”.

He asked Tony Newton to “consider the points” made by the society, but

“with no implication that the Government will take action.”

Here we are, nearly 30 years on, in almost exactly the same situation.

As has frequently been mentioned, this is the biggest treatment disaster in the NHS, and it happened because we were importing American coagulation products and American blood—blood taken from prisoners, or units of blood that were sold. Who sells their blood for donation? People living on the streets; people who are drug addicts. The main reason haemophiliacs and others are suffering is that making factor VIII meant using the blood products of multiple donors, which meant an increase in the risk of a positive result. Moreover, the haemophiliacs received those products over and over again.

Here we are, all these years on. When I graduated in 1982, and when I worked as a young surgeon throughout the 1980s, this was just beginning to emerge and be discovered. It certainly left me, as a surgeon, with an absolute fear of transfusing blood. I used to go to great lengths to use electrocautery and other techniques to avoid shedding blood in elective cases, because we did not know what other problems were there.

Some of my colleagues have drawn attention to the exact terms of the Scottish settlement, but the first three can be summarised thus. People who are suffering from hepatitis C, HIV or co-infection will receive more money, allowing them to receive at least the equivalent of an average income of £27,000. People with stage 1 hepatitis C will receive £50,000 instead of £20,000, and those who have received compensation of £20,000 in the past will be eligible for £30,000 now. It is totally accepted by the Scottish Government that focusing solely on cirrhosis is a rather bizarre way of assessing people, and they are entirely open to an evidence-based piece of work in the future looking into how people should really be assessed.

I think that one of the biggest differences in Scotland is the recognition of the bereaved families. They will receive the money for another year, and will then receive a lifelong pension of 75%. Our flexible fund will continue to be topped up to the point of £1 million a year. As has already been said, that will not give people back their lives, but it can allow them to live with dignity.

The right hon. Member for Orkney and Shetland (Mr Carmichael) and the right hon. Member for North Norfolk (Norman Lamb) suggested, with a degree of criticism, that Scotland had gone ahead rather than seeking a United Kingdom solution. How long should we wait? Scotland was criticised because although we were ready to screen blood in 1990, we waited until 1991 so that there would be UK screening of blood donations. We made that mistake then, and we cannot make it again now.

[Norman Lamb]

Will the hon. Lady give way?

[Dr Whitford]

I am sorry, but I do not have enough time.

I do not think that we would be debating this matter with the same urgency if there were not the contrast with what Scotland is doing. This is not just about financial support and recognition. All patients in Scotland with hepatitis C for whom Sofosbuvir is appropriate can receive it. I find it shocking that people in England who have been infected with contaminated blood should have to use any of their funding to buy a drug that can increase their quality of life and reduce the risk of giving the condition to their family. We are doing this not just for those patients but as a public health measure. If we reduce the burden of virus in the community, we will reduce the number of new cases.

A year ago, the Prime Minister and our First Minister responded to the Penrose inquiry. That inquiry was carried out in Scotland; the UK has never had a public inquiry on this matter. Both of them apologised, and our First Minister has used this first year to set up a group to look into changing support, and ensuring that people can access treatment and that families are recognised. I call on the Prime Minister to honour his apology and to ensure that patients in the rest of the UK receive the same treatment.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I thank the shadow Minister and the hon. Member for Central Ayrshire (Dr Whitford), the SNP spokeswoman, for granting me a little of their time to respond to many of the points made during this excellent debate. I congratulate members of the all-party parliamentary group on haemophilia and contaminated blood, in particular the hon. Member for Kingston upon Hull North (Diana Johnson), on securing the debate and on their campaigning work, to which tributes have rightly been paid. I also wish to thank those who have taken considerable time and trouble, and made considerable efforts, to travel down to London today to express their feelings to their Members of Parliament; some have been able to stay to listen to the debate. I am going to spend as much of my time as possible responding to as many of the factual questions I have been asked as I can, so let me move swiftly on to that.

The consultation on infected blood scheme reform seeks views on what a reformed scheme should look like. This is the first public consultation on this matter by a Government, although there have been other consultations led by parliamentarians. Obviously, it has attracted a lot of interest from Members, as indicated by the presence of those contributing today. I know that many Members, myself included, have had personal frustrations and concerns expressed to them over many years by constituents.

Members will appreciate that, as the consultation is still open, I am not in a position to give any commitments or guarantees on the shape of scheme reform today. Indeed, I want to reassure the House that no decisions on scheme reform will be made until the consultation has closed and all the responses have been carefully analysed. I have listened with keen interest to the various points that have been made and I will carefully consider the contents of this debate, alongside the responses to the consultation.

None the less, I am aware that there are some concerns—they have been expressed today—about the consultation and some of the proposals, and I will try to address those today. First, let me deal with any lack of clarity on the additional funding committed. To be clear, when I launched the consultation I announced £100 million of new funding for the scheme. That is in addition to the current spend of about £22 million per year and the £25 million announced by the Prime Minister in March 2015, so it will more than double our annual spend on the scheme in England over the next five years.

To date, we have spent more than £390 million on support for those affected, and the additional funds I have announced bring the budget for the next five years to £237 million. That means that, over the lifetime of the schemes, we project that more than £1 billion will be spent on support for those affected. The money comes from the Department of Health budget—I hear the points that have been made about where people think the money should come from, but that is where it is coming from and that is the funding we have been able to identify. We are more than doubling the budget for the next five years. This financial assistance is voluntarily provided by Government to help those infected and their dependants. I wish to ensure, and the key aim of the scheme is to ensure, that the money is distributed in a fair and equitable way within that budget envelope and within the legal framework within which I am working, in a way that is also sustainable for the future.

With that in mind, I want to emphasise to Members and to the House that this is a truly open consultation; I genuinely want to hear from all those who have been affected. It has been very useful for me to hear the points made in this debate. I want to hear what support would be most beneficial within the parameters I have set out.

To give some idea of how widely we reached to try to get responses to the consultation, I should say that letters have been sent to all 3,482 registrants of the existing schemes to make them aware of the consultation and provide them with details of how to access it. Letters were also sent to almost 180 Members who have at various times, by various means, contacted us on behalf of constituents over the past year or so, and they have been urged to respond, too. We have already received more than 1,200 responses to the consultation, and I hope that reassures some Members, including the hon. Member for Hammersmith (Andy Slaughter), who were worried that people might have found the consultation difficult to respond to. That is a very good level of response and it is enormously helpful. I am very pleased that so many people have taken the time to feed their views into the process. It might be helpful and, I hope, reassuring for Members to know that a specific team in the Department has been established to ensure that every response is read in full and captured in the analysis, and given that respectful hearing to which one Member referred.

It has been very valuable in the contributions to the consultation we have already received to hear from the quieter voices in the affected community that I have spoken of before. Indeed, I have been struck—in some ways shocked—by the number of affected individuals who were not aware of some of the support potentially available to them, such as the discretionary financial support and non-financial support provided by the three charitable scheme bodies. That has reinforced my sense, which I think is shared across the House—I say that especially in the light of today’s debate—that scheme reform is necessary, especially with a view to simplification and transparency. That point was put very ably by the hon. Member for Heywood and Middleton (Liz McInnes). There are still a few days left in which to submit responses, and I encourage anyone who has not responded but would like to do so to respond before midnight on 15 April.

Let me turn to some of the proposals in the consultation. I know that some of the charitable scheme bodies wrote to their beneficiaries to help clarify the consultation proposals, but some of the nuances were lost in the letters. A number of speakers, including my hon. Friend the Member for South East Cornwall (Mrs Murray), have reinforced that point. Let me confirm that the crux of the consultation is the proposal that every chronically infected individual would, for the first time, receive an annual payment under a reformed scheme. At the moment, those who are registered with the Skipton Fund at hepatitis C stage 1—that is 2,424 people, which is more than 70% of the total number of infected registrants—are not eligible for annual financial support. We are proposing a new annual payment for everyone in that group, reflective of the level of ill health they experience. Should the proposal be taken forward, we anticipate that a large proportion of the additional money committed will be used to provide these new payments.

The proposed reforms would continue annual payments to those who currently receive them, which is, approximately 840 people. Those who are currently registered with the Skipton Fund at hepatitis C stage 2, and those with HIV registered with MFET Ltd would have their payments increased to a rate of £15,000 annually, and those co-infected with HIV and hep C would benefit from an uplift to £30,000. That means that, over the next 10 years, someone with hepatitis C stage 2 would receive £150,000 in addition to any payments they have received to date. Someone co-infected would receive £300,000 in addition to the support they have already received. None of those payments is taxable, nor does it affect a person’s entitlement to any state benefits.

There has been mention of the link to the consumer prices index. I know that there is some concern about the proposal to remove the linkage to CPI. CPI linkage can result in an annual increase or, in theory at least, a decrease in payments. This year, CPI was negative, but we decided to freeze payments to ensure that support for infected individuals did not decrease as a result. Fixing the payments at a set rate would provide more financial certainty over this spending review period for those receiving annual payments. However, I will take very careful account of the concerns that have been raised in response to the consultation when making my final decision on this matter.

[Norman Lamb]

rose—

[Jane Ellison]

I will give way if the right hon. Gentleman is really brief.

[Norman Lamb]

The Minister has explained that many people will benefit, but will there also be losers? If there are, will she write to confirm how much they will lose by and how many people will be involved?

[Jane Ellison]

I cannot give the right hon. Gentleman that clarity today, and there is a specific reason for that.

I will move on to discretionary support for infected individuals. Obviously, I have heard the concerns—I have had a number of letters and held a number of meetings. Some people came to the surgery that I organised. The hon. Member for Kingston upon Hull North was not able to make it, but other Members came and talked about this point. In the consultation, we did propose providing discretionary payments only for travel and accommodation costs. We addressed this issue because, prior to launching the consultation, one of the main criticisms of the current system raised by different groups of beneficiaries and their MPs and by the all-party group was that discretionary grants and the process of applying for them was “demeaning”.

However, I am aware that, through the consultation responses, a number of beneficiaries are troubled by the consultation question on discretionary payment, and those voices have been heard today. In principle, discretionary support should be means-tested, which means that it will vary with circumstances over time. However, it has become clear that, through the independent charitable schemes, a relatively small number of individuals are receiving regular and significant levels of discretionary—as opposed to regular—support. I encourage anyone who feels that they are in this position, or would lose out as a result of the consultation proposals on discretionary support, to reply to the consultation explaining that. No decisions have been made about some of the other discretionary elements on which Members have touched. I hope that clarifies the distinction between our assessment of the impact of annual payments and the impact of discretionary payments, some of which could not be known to us because they were put out through independent charitable schemes.

I welcome any suggestions that respondents may have in relation to the proposals and what would be of benefit to them. This, along with the rest of the consultation responses, will help us to decide what we might be able to do within the budget. We are well aware that some of the non-financial elements of support, which are currently provided by the charitable schemes, are valued. I want to reassure colleagues that we are entirely open-minded about this provision. As I have emphasised previously, it is up to people to tell us through the consultation what they most value in that non-financial support.

Let me touch on the Scottish reforms. Clearly, that has been quite a key theme today. I have been asked to consider matching the recent reforms. The Scottish Government established a financial review group, as we heard, and they announced their plans on 18 March. The package announced by the Scottish Government differs from the proposals on which the Department is consulting. One major difference is in relation to annual payments provided to infected individuals. The Department of Health proposals for England are intended to ensure long-term stability and security to all infected individuals. The hon. Member for Newport East (Jessica Morden) made a point about long-term security and sustainability. To reiterate, in England, there are about 2,400 individuals with hepatitis C stage 1 who do not receive any annual payment. Our proposal is to provide a new ongoing payment to all those individuals that reflects the level of ill health that they experience. The Scottish Government have chosen to provide a lump sum payment.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

I was delighted that Paul Farmer’s taskforce report endorsed the plan first proposed by the Secretary of State and myself in 2014 to have comprehensive maximum waiting times in mental health by 2020 so that people with mental ill health have exactly the same right to treatment on time as others. I was delighted that the Government endorsed the whole plan, but dismayed that Simon Stevens then confirmed that there was no money to implement it. How will the Minister ensure that the comprehensive waiting time standards are implemented by 2020?

[Mr Speaker]

If anything, questions are getting longer, not shorter. I say with great courtesy to the right hon. Gentleman, whom I hold in the highest esteem and whose track record is greatly respected across the House, that his question was far too long.

NHS: Learning from Mistakes

Norman Lamb Excerpts

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

I shall do my best for my right hon. and learned—and eminent—Friend. We do not want to affect the legal rights of anyone who wishes to litigate against the NHS because they feel they have been treated badly. Those rights must remain, and we will protect them, but we want to make it easier to get to the truth of what happened so that we can learn from mistakes. The information uncovered by a healthcare safety investigation branch investigation could not be used in litigation proceedings without a court order. However, my belief is that having those investigations carried out by the branch is quite likely to speed up court processes, because I think it will establish on all sides, in greater likelihood, agreement about what actually happened in any particular situation. I hope that that will be beneficial, but if anyone wants to use the evidence in litigation, they will have to re-gather it, because we are concerned that, if doctors are worried that anything that they say could be used in litigation, they may be hesitant about speaking openly, and that represents the defensive culture that we are trying to change.

[Norman Lamb (North Norfolk) (LD)]

I welcome the measures set out in the statement. The Secretary of State will not be surprised to hear that I want to focus on safety in mental health. The statement seems to be quite focused on acute hospitals. At the summit taking place today, will there be a specialist focus on safety in mental health? The Secretary of State will remember that the Government announced last February an ambition to achieve zero suicide, but he will be aware that there has been a significant increase in serious incidents and in the reporting of unexpected deaths and suicides. I do not know where that project has got to, but would he be prepared to meet me to discuss how we can develop the zero-suicide ambition, which has achieved such a reduction in deaths in the city of Detroit in the United States? The same can happen here if we have the same focus and ambition.

[Several hon. Members rose—]

Junior Doctors’ Contract Negotiations

Norman Lamb Excerpts

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

No, it is not.

[Norman Lamb (North Norfolk) (LD)]

Does the Minister ever wonder whether he has chosen the wrong target? He bases his entire argument on safety—and rightly so—yet chairs and chief executives of hospitals constantly tell me that they have no difficulty staffing their hospitals with junior doctors over weekends. At the same time, however, our GP out-of-hours services are under incredible strain and cover is threadbare in many parts of the country. That, surely, is where the real safety concerns lie.

NHS Trusts: Finances

Norman Lamb Excerpts

Monday 1st February 2016 Commons Chamber

[Ben Gummer]

My hon. Friend should know that that review is already taking place in the Department of Health. We are looking again at the PFI deals that were signed by a previous Administration, who went around the country claiming to be building new hospitals without telling people that they had all been put on the credit card and that the bill would be paid by future generations and, in part, by the NHS itself. That is a great shame, and it has created a great deal of uncertainty for many trusts. I know that my hon. Friend has specific issues in Huddersfield, and we will answer them tomorrow in Westminster Hall.

[Norman Lamb (North Norfolk) (LD)]

Will the Minister make it very clear whether he accepts the view of Simon Stevens that if there is a funding gap in social care, which is projected to be the case in 2020 and before, it will simply increase the deficit in the NHS; and that the funding of social care remains “unfinished business”? Does he accept that case?

[Ben Gummer]

I accept the case for the “Five Year Forward View”. Simon Stevens was very clear that the relationship between social care and the NHS needs to be transformed. That called for an additional £8 billion into the NHS, which we have provided, and it required additional money for social care. We have provided that in the better care fund and the council tax precept.

NHS and Social Care Commission

Norman Lamb Excerpts

Thursday 28th January 2016 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House calls for the establishment of an independent, non-partisan Commission on the future of the NHS and social care which would engage with the public, the NHS and care workforces, experts and civic society, sitting for a defined period with the aim of establishing a long-term settlement for the NHS and social care.

May I take this opportunity to thank the Backbench Business Committee for granting this debate and Members on both sides of the House for expressing interest in, and support for, the motion? I tabled the motion alongside the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who sadly cannot be here because of a family illness, and the hon. Member for Leicester West (Liz Kendall). I want to be clear that I am making this case on a cross-party basis, because I believe that it absolutely transcends narrow party politics. I sought the support of, and have been working alongside, Steven Dorrell, the respected former Conservative Health Secretary, and Alan Milburn, the former Labour Health Secretary.

I have felt for a long time now that the NHS and the care system face a very real existential threat, and we have been drifting in that direction for many years. We have to get to grips with this before seriously unattractive things start happening to some of the most vulnerable people in our country. The motion obviously addresses the situation in England, but the position in Scotland, Wales and Northern Ireland is essentially the same; we are all facing the same demographic challenges and the same need to ensure that our health and care systems meet the needs of our communities today, rather than those of 1948.

There is an enormous belief in the NHS in this country, and it is a belief that I share very strongly. It engenders a sense of solidarity and the sense of the decency of this country that we all commit together to ensuring that people can access care when they need it, regardless of their ability to pay. That is a founding principle that has stood the test of time and should be sustained. That is what this debate is all about.

It was a great Liberal, William Beveridge, who put forward the proposition that there should be a national health service, and it was a great socialist, Nye Bevan, who then implemented it as Minister of State for Health. It is also fair to say that Conservative Governments since have sustained the NHS. We have always had our battles about funding levels, reorganisations, structural reforms and so forth, but the NHS has been sustained, with cross-party support, and it is very important that that continues.

As I have said, that principle has stood the test of time. The Commonwealth Fund concluded back in 2014 that, among the major economies it looked at, the NHS was essentially the best system globally, although it is worth noting that it did not score so well on outcomes or on premature mortality—those are, after all, quite important measures that we should not be complacent about. I have made the case that there is an existential challenge to the system, and I believe that it is time for what I call a new Beveridge report for the 21st century.

[Mr Andrew Mitchell (Sutton Coldfield) (Con)]

Is not the key point that the right hon. Gentleman has made, and that the House should consider today, that all parties support the NHS and that, therefore, it simply will not work to have one party chart the future? It would be much better, therefore—this is why I support his motion—to have a cross-party commission, although not a royal commission that would kick it into touch for three years, to try to bring everyone together to face what he rightly describes as an existential challenge to health in this country for the future?

[Norman Lamb]

I am grateful to the right hon. Gentleman for that intervention; he absolutely makes the case. Incidentally, I think that it is massively in the Government’s interests to respond positively, because any solution has to carry public support and support across the political spectrum.

Consider these points. Does it still make sense to maintain the divide that was originally put in place in 1948 between the NHS and the social care system? Is that serving patients effectively, particularly given that the big challenge of this century will be people living with long-term, chronic conditions, often multiple conditions, and often a mix of mental and physical health conditions? For those people, a divide between different organisations with different pools of money and different commissioning arrangements does not seem to make much sense. I think that that needs to be looked at.

Too often, the system gives the impression of being rather dysfunctional. For example, last October there were 160,000 bed days resulting from people whose discharges were delayed. These are predominantly older people, often with dementia, who remain stuck in hospital long after they are ready to go home or somewhere closer to home. This is not good care. We are letting people down by keeping them in hospital for longer than they need to be, which also makes it harder for them to become independent again. The figure went down a little in November, but it is still the second highest since the data on delayed discharges started to be recorded.

[Helen Whately (Faversham and Mid Kent) (Con)]

The right hon. Gentleman mentions the relationship between the NHS and social care and the problem with their being separate. Does he acknowledge that the “Five Year Forward View” contains several approaches to bringing them together, and that parts of the country are already working on further integrating them? Is it not important to press on with those approaches so that we can see how they work and move as quickly as possible on this?

[Norman Lamb]

I totally agree with the hon. Lady. I have always been a strong supporter of the forward view. Simon Stevens is a good leader of the NHS. He has a vision, and he recognises that the solutions to this challenge often lie beyond the NHS. Some of the models that are being trialled across the country are very interesting. I do not want what I am saying to be seen in any way as undermining the very good work that is under way in the so-called vanguards around the country.

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

On bed blocking, when I was leader of Croydon Council it cost £300 a night to keep someone in Mayday hospital and £100 a night for us to provide a bed as a local authority. We had no money, so I asked the health authority to pay for our beds and save £200, and it did. However, that was an ad hoc strategy, and surely we want a holistic, integrated approach, as the right hon. Gentleman is so eloquently explaining.

[Norman Lamb]

I totally agree with the hon. Gentleman’s last point, but also his substantive point. The problem is that these are all ad hoc arrangements that are about good leaders doing something despite the system, not because of it. We have to mainstream this and align the incentives throughout the healthcare system so that everyone is focused on preventing ill health, preventing deterioration of health, and getting people better as quickly as possible.

Let me give an example of the pressure that the system is facing. It is fair to say, as a gentle challenge to the Government, that this year we are not seeing the data on accident and emergency pressures over the winter period, so the situation is slightly hidden from view. However, I heard that on Tuesday this week all the hospitals in Hertfordshire, north London, Bedfordshire, Northamptonshire and Leicestershire were on black alert, which occurs, in essence, when hospitals are completely full and under enormous pressure. One of the key system leaders in that area said that he had not seen anything like it for 20 years. This is happening at a time when there is no flu epidemic, and certainly no severe weather. This is one of the mildest winters on record, and yet we are seeing hospitals placed under impossible pressure.

[Chris Davies (Brecon and Radnorshire) (Con)]

I commend you for trying to bring the parties together to have a commission to look into the matter of the NHS, but we are now living in a devolved Great Britain. It is great to get the parties together in England, but how do you propose to get Wales, Scotland and Northern Ireland together? I will give an example. My wife works for the NHS. She worked for the NHS for 18 years in Wales. She gets treated by the NHS in Wales because we live in Wales, but she works for NHS England. Given that there are so many cross-border issues, especially in Brecon and Radnorshire, how do you propose to get the whole of Great Britain to work with this plan?

[Norman Lamb]

I said at the start that I am primarily focused on England because health is a devolved responsibility, but I also said that the same pressures apply everywhere, and so the case for a process of this sort in Wales, in Scotland and in Northern Ireland is just as strong as it is England. I would encourage this debate to take place in Wales as well. We must overcome the clashes between the parties to recognise that something bigger is going on and we need to work together.

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

I want to return to the right hon. Gentleman’s point about the data. Last June, we had a debate about moving from weekly to monthly data, and we were told that the NHS would still know what was going on. We now have a six-week delay in the publication of those monthly data, which results in a total of 10 weeks. Having asked about this at the most recent Health questions, I understand that people within the NHS can access the data, so why are they not being shared with this place? The last data we had was in November.

--- Later in debate ---

[Norman Lamb]

I thank the hon. Lady—that is a very good point. I fundamentally believe in openness. It is much better if everyone understands what is going on, and then there can be a much more informed debate.

One of my big concerns is that despite some of the very good policy positions that have been taken nationally, too often, across the country, crisis management prevails. Because areas are so focused on propping up acute hospitals that are under the intense pressure I described, more and more money ends up being pumped into those hospitals while the preventive parts of the system are losing out and being cut further. It becomes a vicious circle, because the more we cut back on preventive care within NHS community services, general practice and social care, the more pressure we end up putting on hospitals. We cannot escape from this, and that is why we need the long-term solution that I have talked about.

In health and social care, demand keeps rising. This is unusual in public service terms when compared with, say, police and schools. Demand has risen at 4% a year throughout the post-war period. We all know the causes: we are living longer, new medicines and new technologies come on stream, we face challenges like obesity, and so forth. The cost pressures just keep going up. It is a well-established position that by 2020 there will be a £30 billion gap in NHS funding. The Health Foundation has said that in social care the gap will be £6 billion. Those are enormous figures, and they take no account of the £1 billion additional cost from increasing the minimum wage. In responding, the Government have identified an extra £10 billion for the NHS, but that leaves a £20 billion shortfall. This is based on scenarios set out in the forward view. However, the scenario of a £20 billion shortfall involves efficiency savings that are completely unheard of in the whole history of the NHS. Virtually everyone one speaks to—not just people who refuse to accept the need for efficiencies—says that achieving efficiency savings of 2%, rising to 3%, is unachievable between now and 2020.

[Mr Mitchell]

Is it not the case—I think this is a cross-party point—that although the NHS is under very great financial pressure, and we are trying, in effect, to get a quart out of a pint pot and have been doing so for many years, the people who work in the service are also under very great pressure? Whatever one thinks about the junior doctors’ situation, the information that has come out from across the service, and from across the junior doctors, is testament to the fact that they work under enormous pressure. This is not just a financial issue; it is also about the fact that the staff in the NHS are under unprecedented pressure that is not set to get any easier.

[Norman Lamb]

The right hon. Gentleman makes a very powerful point. Indeed, the staff are working under impossible pressure.

Incidentally, the assumptions about the funding gap by 2020 do not take into account the work that the right hon. Gentleman and I have done together to make the case for equality of access for people who suffer from mental ill health. This is about a historical injustice that has to be dealt with. Paul Farmer, who has led a taskforce for NHS England, has concluded that mental health will require an extra £1.2 billion a year by 2020 in order to ensure equal rights of access with everyone else. It is very hard to deny the justice of that cause and the right of people to get access to social care in the same way as everyone else.

[Geraint Davies]

rose—

[Norman Lamb]

I am conscious that you may start to get slightly irritated with me, Madam Deputy Speaker —

[Madam Deputy Speaker (Mrs Eleanor Laing)]

On a point of clarification, the right hon. Gentleman is doing just fine on timing. I appreciate that he has taken a lot of interventions, and people who intervene know that, later in the debate, their speeches will be shorter as a result of their interventions. He is doing nothing wrong, and he may proceed.

[Norman Lamb]

I am relieved. I sensed that I might be getting into trouble. I will give way to the hon. Gentleman.

[Geraint Davies]

Very briefly, in terms of aggregating the expenditure of health and social care, which, incidentally, is higher in Wales where there is an attempt to have a more integrated approach, the cutting of social care will increase the total amount, as undue pressure will be put on the NHS, which then cannot release beds, and it costs more per night to keep someone in a hospital.

[Norman Lamb]

The hon. Gentleman is absolutely right. Simon Stevens has made the point that if we cut social care, the £30 billion gap widens. There is no escaping from that. The brutal truth is that the whole system is under very substantial pressure. Analysis by the Office for Budget Responsibility, which is independent of Government, shows that between now and 2020, we are planning to spend a reducing percentage of our GDP on health. At a time when demand is increasing so dramatically, does that decision make any sense at all? Back in 2013, the OECD did an analysis of all OECD countries in the European Union. Only five were spending a lower proportion of their GDP on health than we do. The NHS is very good value for money, but it is under extraordinary pressure.

[Anne Marie Morris (Newton Abbot) (Con)]

The right hon. Gentleman is being very generous with his time. The picture that he is painting is one of a very reactive approach to the growing problems. I entirely support his call for this review. As a responsible society, we need to have a holistic, forward-looking, proactive approach, particularly with regard to social care. The Barker commission made a number of good proposals, some of which I agreed with and some I did not. To what extent does he agree with me on that point?

[Norman Lamb]

I totally agree with the hon. Lady. In fact, I think that I have agreed with every intervention so far. We will probably all just agree with each other. She is absolutely right and it goes to my point about crisis management. We are at risk of lurching from crisis to crisis, as we prop up a system that is under unsustainable pressure. Of course we always end up spending money at the repair end of the spectrum, rather than on preventing ill health.

There are some great initiatives in the west country, where volunteers, working with GPs, try to address the problems of loneliness, and that is helping to keep people out of hospital. That sort of thinking needs to be much more widespread.

[Tom Brake (Carshalton and Wallington) (LD)]

My right hon. Friend may be coming on to this point, but what I want to understand is how the commission, and the output of that commission, can help with some of the very difficult hospital reorganisations that we all face in our constituencies—mine being St Helier hospital—and how we can ensure that we strike the right balance between acute services and care in the community. How will the commission help with that?

[Norman Lamb]

My right hon. Friend comes to the central point. As someone once said, the NHS has the status of a national religion. In this partisan atmosphere in which we all work, there is a danger that anyone who proposes a change to the NHS will get condemned from on high, because of the political points that can be scored in so doing. If we are to think about what we need from a modern health and care system that focuses on prevention, and to make changes in a rational way, we must give Government the space to think afresh about how we can sustain the system and guarantee care for those who need it. We have a choice now: we continue to drift until, ultimately, the system crashes, or we grasp the nettle and come up with a long-term solution.

All parties should commit to the proposal. If we want a good example, we should look at the commission of Adair Turner, which was established by the Labour Government to look at the long-term sustainability of pensions in this country. He managed to secure cross-party buy-in. He came up with proposals that led to change and reform. It was a process that gave people the space to look at a very difficult challenge and to come up with solutions. That is one model we could follow. It should be strictly time-limited. Somebody made the point that we are talking about not a royal commission, which goes into the long grass for three or four years, but a time-limited commission of up to one year with the aim of coming up with solutions that are then implemented. It should engage with the public, with patient groups and, critically, with staff, who, as the right hon. Member for Sutton Coldfield (Mr Mitchell) said, often feel that they are under intense pressure and that they are not listened to by Governments of all political persuasions. They, together with unions and civic society, should be centrally engaged with this commission. At the end of the process, we should seek to come up with recommendations that can then be implemented and can give everyone in this country the assurance that there is a long-term settlement for the NHS and for care.

Finally, let me raise one or two things that the commission needs to consider. It needs to look at the divide between the NHS and social care and at the adequacy of funding. How much as a society are we prepared to pay to ensure that we have a good, well-functioning health and care system? At the moment, funding for our health and care system comes through three different channels: the NHS, local authorities and the benefit system. Does that make sense? Should we look again at that system?

We also need to look at how we, as a country, are spending money on our older people. Are we spending it effectively enough? Are we targeting it at those older people who most need Government help? We need to look at intergenerational fairness and at where the money comes from—a point very well made in a recent book by the respected former Cabinet Minister, David Willetts. We also need to consider how we can give power to people to help them to self-care. David Wanless, when he reported for the Labour Government, made the point that his projections about how much extra money the system would need was based on people being engaged in their health—I am talking about self-caring more effectively. That has not happened in the way that he proposed.

We also need to consider the case for a dedicated health and care tax, which can be varied locally. Even protecting NHS spending results in disproportionate cuts in other areas of Government spending, distorting sensible, rational decisions. As this is an area on which spending inexorably rises, there is a case for carving out such a tax.

[Helen Whately]

rose—

[Norman Lamb]

I am sorry, but I want to conclude my remarks now to give other Members a chance to speak.

This proposal has had very significant support. NHS Survival, which now encompasses 8,000 members—junior doctors, patient groups and so on—has strongly argued for such a tax. Forty chief executives of care organisations wrote to the Prime Minister to support the case. The chief executive of the King’s Fund, Chris Ham, has written a very helpful blog, making the case. Royal colleges of surgeons, pathologists and anaesthetists have all supported the call. I urge the Government to respond positively. They should stop and think for a moment before rejecting our proposal, because it might be an enormous help to the Government in resolving an intractable problem. This is the time for a 21st-century Beveridge report to come up with a long-term settlement for the NHS and for social care.

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[Dr Wollaston]

In this place, we sometimes push issues into commissions, which debate them endlessly and come to no agreement. I would say the urgency of this issue demands that the leaders of all political parties sit down together and agree.

[Norman Lamb]

I am very grateful to the hon. Lady for giving way, and I promise not to keep intervening. I feel that there needs to be a process to which everybody is committed. If there is just a desire for the party leaders to co-operate, the temptation to score political points when a crisis comes along will be too great and it just will not happen. We need to bind people into such a process, and they must be prepared to commit to it.

[Dr Wollaston]

I thank the right hon. Gentleman for his clarification. I agree that we are looking for a process to which everyone can commit. We are not looking for a commission that will go away and examine the problems. We know the issues, which have been set out in very stark terms. The King’s Fund’s excellent independent Barker commission set out the whole range of options. What we have always lacked is the political buy-in and determination to move forward. I would join in making a request for any process that will make that happen, but not for something that pushes it away for three years, because, as we all know, the closer we get to a general election, the more challenging it will be to have a genuine political agreement. It therefore needs to happen as rapidly as possible.

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[Valerie Vaz (Walsall South) (Lab)]

It is always a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy), who is a great defender of the NHS, both locally and nationally. I congratulate the right hon. Member for North Norfolk (Norman Lamb), who was a very assiduous Minister; my hon. Friend the Member for Leicester West (Liz Kendall), who is not in her place but who was an assiduous shadow Minister; and the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who unfortunately cannot be here but who was also an assiduous Minister and a member of the Health Committee.

It is with great difficulty and a bit of sadness that I say that I do not support the motion. I know that it comes with great heavyweight backing from public figures—MPs and former Ministers—but I do not think that it will take the debate forward. When we set up a commission, it can feel like we are kicking something into the long grass, and that is what it feels like we are doing today. This issue has been going on for a long time, and it is, I feel, a lack of political will that is failing to drive the changes forward.

We have had the evidence. There has been a pilot scheme, which was set up by my right hon. Friend the Member for Leigh (Andy Burnham) in Torbay in 2009. The integrated care trust is operating. A former Secretary of State for Health, Stephen Dorrell, who was a very good Chair of the Select Committee on which I served, gave an interview on 22 January in The House magazine in which he recalls asking an adviser:

“What is the oldest quote from a health minister saying how important it is to join up health and care services?”

This answer came back:

“Dick Crossman, the Health Secretary in the late 1960s.”

That is how long this issue has been going on, and it has cross-party support.

I want to touch on what some hon. Members have been saying about cross-party support. Perhaps I have been on a different planet, or perhaps, a bit like Bobby in “Dallas”, I have woken up and it is all a dream, but I recall being on a cross-party Health Committee, ably chaired by Stephen Dorrell, that produced many reports, but never a minority report. We came up with a number of conclusions that Members are now saying that we should consider.

In our report on public expenditure, we said that very little of the money spent by the NHS on people with long-term conditions was spent in an integrated way, which meant that significant amounts of money were wasted. In our report on commissioning, we said the NHS Commissioning Board should work closely with local commissioning bodies

“to facilitate budget pooling and service integration to reflect patient priorities.”

In our 12th report of the 2010-12 Session on social care, we said that efficiency savings would not be possible without further integration between health and social care. That has been an aim of successive Governments, but has not been properly achieved.

In our 11th report of the 2012-13 Session, “Public Expenditure of Health and Social Care”, we said that

“health and wellbeing boards and clinical commissioning groups should be placed under a duty to demonstrate how they intend to deliver a commissioning process which provides integrated health, social care and social housing services in their area”

and that there was

“evidence, for example, that 30% of admissions to the acute sector are unnecessary or could have been avoided if the conditions had been detected and treated earlier through an integrated health and care system.”

In our seventh report of the 2013-14 Session, “Public Expenditure on Health and Social Care”, we said that

“fragmented commissioning structures significantly inhibit the growth of truly integrated services.”

In our second report of the 2014-15 Session, “Managing the care of people with long-term conditions”, we said that

“in many cases commissioning of services for LTCs remains fragmented and that care centred on the person is remote from the experience of many”

and that an integrated approach was necessary to relieve pressure on acute care.

Members of the Health Committee, including the hon. Member for Totnes (Dr Wollaston) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who unfortunately had to leave this debate to go to a young carers’ meeting in her constituency, have all sat through that evidence. I know it is real, because it will be on the website of the Health Committee. There are pages and pages of evidence on where we can get things right.

In particular, our report on “Social Care” said:

“Although the Government has ‘signed-up’ to the idea of integration, little action has taken place... The Committee does not believe that the proposals in the Health and Social Care Bill will simplify this process.”

We called for a single commissioner with a single pot of money who would bring together the different pots of money and decide how resources would be deployed.

One thing we did as part of our inquiry into health and social care was to visit Torbay, which has not been mentioned today, where we saw integrated care in action. Mrs Smith, who is fictitious but could be any one of our constituents, has one point of contact: she only has to make one phone call. Mrs Smith has seamless social care up to the health service and back again. The health service workers have been upskilled and can help her through the whole system. The local authority and the local hospital worked together so that when Mrs Smith is unwell and has to go to hospital, she can be tracked through the whole system. That is integrated care in action in Torbay. One concern was what would happen and whether such integrated systems would work under the Health and Social Care Act 2012, but I have seen it working.

There is another interesting area where integrated care is working. Another visit we made was to look at integrated care in Denmark and Sweden. In Denmark, we saw the most fabulous building in which elderly people could be cared for, and where they could be visited by GPs. It looked more like a hotel than a home. We were told, “We are looking at your system. We are looking at Mrs Smith.” At that point, we nearly fell off our chairs, because we had come to Denmark to find out how its system works.

[Norman Lamb]

I appreciate the hon. Lady’s kind words. She is talking about all the various initiatives and the need for political will, but the conclusion is that none of those things has happened. There has not been the political will because of the acutely partisan environment in which we all work. Does that not make the case for a process—which the Government could buy into and all the parties could commit to—that will deliver change in a defined period?

[Valerie Vaz]

I think that the Health Committee structure has such a purpose.

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[Norman Lamb]

The Government have not bought into it.

[Valerie Vaz]

Well, they have. The Government have a responsibility to respond to the Health Committee. If the right hon. Gentleman waits until the end of the speech, he will see where I am heading. I agree with his idea that something needs to be put together. I do not like knocking good ideas on the head; I like to see such things taken forward. As the hon. Member for Stafford (Jeremy Lefroy) said, it is either “a commission or whatever”. It may be that the right hon. Member for North Norfolk has a good role to play in pulling all this together and taking forward the idea somehow, but at the end of the day, it is a political decision for the Government of the day to consider.

I want to move on to discuss my local hospital, Manor hospital, and the local authority. In Walsall, we are lucky to have a settled community, and we have one local authority dealing with the local hospital. Work is carried out by the local authority and the hospital together, and they can talk things through. When difficulties arose at the hospital in Stafford—the A&E closed, and we had to take on extra maternity services—it was much more difficult, taking on patients from different areas, to deal with local authorities in different areas. Such relationships had not been built up, but they can be built up and, with the best will in the world, I am sure they will be. We know that workers in the health service work very hard and extremely well together to ensure that such relationships exist. If that works for one local authority, I am sure it can work for other neighbouring authorities.

Interestingly, the right hon. Member for North Norfolk has involved two former Secretaries of State for Health, Alan Milburn and Stephen Dorrell, in his commission. If I was really cruel, I might say that they were Secretaries of State for Health, so why did they not do something about it then and why do they think they can do something about it now? As I have said, there is a way forward. Many Members have alluded to the myriad reports. The King’s Fund has produced a report, the Nuffield Trust has produced one and many universities have produced reports. There have been lots of words, but we need a little more action.

My only difficulty with the proposed commission is the accountability structure. I am not sure who it would report to and there would be no obligation on the Government to respond to it in the way that they have to respond to the Health Committee.

I want to touch on the issue of money. We had a reorganisation of the health service that cost £2 billion and counting. If the Government can sit down with a company to reduce its tax liability and, hence, what flows into the coffers of the Treasury, that has an enormous impact on the Mrs Smiths of this world and on all of us. That is why, as our second report of 2014-15 stated, the Government said in evidence to the Select Committee that

“the ambition of achieving integrated health and care services by 2017 had been given ‘quite a turbo charge’ by the introduction of the Better Care Fund”.

The then Minister of State, the right hon. Member for North Norfolk, said that

“by 2015 the whole country will be starting to see a significant change.”

That may be something that the Health Committee could look at and produce a report on or even that the “commission”—in inverted commas—or whatever it is that the right hon. Gentleman and his colleagues extract from the Government could consider.

We have the evidence—we have the care trust and the pilot—and, in the Government’s own turbo-charged words, we have the will, hopefully. Finally, I am not persuaded that a commission will bring about the change that all of us so desperately need.

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[Helen Whately]

I agree with the right hon. Lady that it is difficult in our election cycle to think further ahead, but it is not impossible. During the last Parliament, the NHS came up with the “Five Year Forward View”, which at the time was supported by all major political parties. With that experience behind us, it is possible to go ahead and come up with further long-term views. As I said, a debate, rather than aiming for a consensus, would be helpful. That is exactly the sort of thing that think-tanks, researchers and all sorts of organisations can, are and should look into.

I want to highlight the fact that this issue is political. The right hon. Member for North Norfolk mentioned an organisation called NHS Survival. I saw on its website that lots of clinicians are involved with it. It is fabulous that clinicians are involved in this discussion about the future of the NHS. That said, the founder of the organisation was also, according to its website, the person who initiated a petition calling on the Secretary of State for Health to resign. The right hon. Gentleman called on NHS Survival as an example of a body lobbying for a commission, but it is clearly very political. There is no way of taking the politics out of this.

[Norman Lamb]

I totally share the hon. Lady’s view that the politics should not be taken out of health. As others have said, we spend such a substantial amount of public money on the NHS and social care that it is absolutely right it should be subject to political debate. However, as others have said, in particular the hon. Member for Leicester West (Liz Kendall) and the right hon. Member for Don Valley (Caroline Flint), we do not ultimately, in the partisan environment we work in, confront the really difficult issues. They keep being put off. This is the whole problem. However much in theory she describes a perfect democratic situation in which these issues are debated and resolved, they are not resolved. We remain drifting into crisis because we are not confronting it.

[Helen Whately]

The right hon. Gentleman makes an important point about the need to look at and confront the long-term future funding settlement. I just do not think a commission is necessarily the right way to do it. The fact that we are having a conversation about it now, here in this House, is in its own right a good thing.

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[Debbie Abrahams]

We come from completely different perspectives, as I have just mentioned to my right hon. Friend the Member for Don Valley (Caroline Flint). My hon. Friend the Member for Walsall South said this had been mooted back in the ’60s, but if we think that now, just a few months after our debate on the Health and Social Care Act, something has suddenly changed, I would respectfully ask, what has changed?

Again, a commission would be a distraction from what we really need to have our eye on: what is happening in health and social care at the moment. We know that the decisions made about staffing and training, for example, have put our workforce plans in jeopardy. One reason why we have financial problems is that three out of four trusts are now in deficit—currently a deficit total of about £840 million, which will run up to £1 billion by the end of the year.

[Norman Lamb]

Is there not a danger with the approach that the hon. Lady advocates? We can continue to have a go at the Government and say how awful the pressure on staff and the deterioration of services are—I accept that a lot of that is happening—but is it not better to try to achieve a solution rather than wait in the hope that at some point in the future, a Government might take a decision to provide the necessary funding and other necessary changes?

[Debbie Abrahams]

As I teased the right hon. Gentleman last week at a Radio 5 Live interview, “so says the former Minister who was saying something quite different just a few months ago”! I do not want anyone to be under any illusion about this. I am not saying that we should not be planning for 30 and 40 years hence. I am saying that, given the vastly different ideological perspectives —I have provided one example, showing how much we disagree about the Health and Social Care Act 2012—trying to pretend that we can agree is naive.

In the last Parliament, I was chair of the parliamentary Labour party’s health committee, and we undertook an inquiry that looked into the effectiveness of international health systems—it is published on my website for everyone to have a look at. We were particularly concerned about quality and equity in access and outcomes, because we knew there was a vast difference in both those respects. The inquiry showed quite conclusively that where there was competition, privatisation or marketisation in the health system, health equities worsened. It revealed that there was no compelling evidence to show that competition, privatisation or marketisation improves healthcare quality. In fact, there is some evidence to show that it impedes quality and increases hospitalisation rates and mortality. This was peer-reviewed evidence—a review of a review of evidence—not one-off studies. It was the strongest type of evidence showing that marketisation and privatisation worsen health equity and worsen the quality of care.

We need to take a forward view, 30 or 40 years hence, about how to continue to fund the NHS and social care. This is a distraction, however, from the crisis that we have right now. We have seen A&E waits up 34% since 2015, failure to meet cancer 62-day treatment standards up 14%, and diagnostics up 36%. It goes on and on. Mental health cuts in 2014 meant the equivalent of £600 million-worth of cuts to mental health trusts. What has changed in the last few months? Delayed discharges reflect the care crisis, with £3.6 billion taken out of the budget for social care in the last Parliament. There is supposed to be £4.3 billion and a 2% precept, but it has been rightly said that it will not make up the difference. As my hon. Friend the Member for Leicester West said, since 2010, half a million fewer older and disabled people have received state-funded support.

In my constituency, I was doing my regular door knocks when I encountered an elderly lady in her 70s. She opened the door and presented me with a bubble pack of medicines and told me that she did not know what she had to do. She had never met me before. She was dishevelled and wearing a dressing-gown in the middle of the afternoon. This was a woman who clearly needed our help and needed support. She was all on her own and did not know what the medications were. I managed to get somebody there. I wonder, though, how much more this is likely to be happening up and down the country. The system is in a crisis, which is a real concern.

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

I, too, attended the debate on 2 June last year, and I remember expressing my shock at the violence that was taking place between the Dispatch Boxes. I considered leaving the Chamber, because it did not seem to be a very useful debate and I did not see the point of taking part in it, but then I thought “No, let us get in and tackle this”, and I did make a comment. I said that, regardless of the differences in the way in which politicians would “do” the NHS, the public absolutely believed in it. We have had a fantastic debate today, because people have expressed different views and different outlooks, but have done so calmly.

As was mentioned by the right hon. Member for North Norfolk (Norman Lamb), the challenges of increasing demand caused by age and multi-morbidity are found not just north and south of the border, but throughout the developed world. We also face the challenge of not having enough doctors, in both primary and secondary care. That, too, applies throughout the nations of the United Kingdom.

There are some challenges that we do not face in Scotland. We have not experienced the fragmentation that resulted from the Health and Social Care Act 2012. Indeed, we got rid of hospital trusts back in 2004. We have gone, therefore, to geographical boards—we just have health boards—so there is no barrier between primary and secondary care, which people used to pitch across. Since April of last year our joint integration boards have become active. They ran in a theoretical way for about a year, but the vast majority of them went live last year and the last one will go live in April this year. That is putting the pot of money into a joint space where health and social care work together, break down the barriers and realise there is no benefit in sticking a person in a bed and then looking to see who should pay for it. What purse the money is in has often been the biggest problem.

We cannot develop integration if what we are actually developing is fragmentation and competition. That is why we have not gone down the route of outsourcing to private providers. It wastes a lot money and effort, and people are competing instead of co-operating.

We obviously have different systems in Scotland. We have free personal care, the level of which has been increased to allow us to keep at home people with more complicated conditions. That is important. Since June of last year we have been going through a national conversation. Whether we have a commission, a committee or whatever, it is important that the public and the staff are involved, as well as the people who have written all the reports—Marmot, Wanless, Barker, the King’s Fund, the Nuffield Trust. There must be a way of bringing these together and picking out the good bits to get a shape. Our piece of work is looking towards 2030; that is what we are working on at the moment.

We did a piece of work that started in 2011-12 called “2020 Vision”. It was very like “Five Year Forward View” and addressed where we wanted to be and what shape we wanted. That identified that the No. 1 thing was integrating health and social care.

Talking about the money for this and where it comes from is always going to be political. At the moment national insurance is bizarre; it starts when people earn £7,000 when we would not tax them, and it stops when people retire, although they might be incredibly wealthy. I do not think people see it as national health insurance, which is how it started. Where the money comes from and what it is put towards is a political decision.

To get some kind of shared view of where NHS England and indeed the NHS in all the nations want to be in 2030 could be a useful piece of work. I totally agree with the hon. Members who have expressed anxiety about kicking this into the long grass. I certainly do not think it needs to stop any piece of work going forward. To me, this provides a place where that can come. One of the features in Scotland in developing quality measures is bringing groups of people together for an annual conference; I am a great believer in getting people into a room—maybe not always a room like this one; maybe a more co-operative room—so that people can say “This is what we found difficult. This is how we fixed it. This is where we are stuck. I see you solved that.”

One of the projects that Nicola Sturgeon has taken forward is called “once for Scotland”. It is not eternally going through local projects and experiments that never get shared with anybody, and everyone reinvents the wheel. That is a huge waste of energy.

Obviously the Government have committed to the £10 billion and that has been welcomed, but more than £2 billion of that is already gone in the deficits. That increase is focused purely on NHS England, whereas normally funding is described in all the Department of Health responsibilities. The other responsibilities are facing a cut that is described as approximately £3 billion. The King’s Fund, the Nuffield Trust and the Health Foundation identify the increase as in fact about £4.5 billion—so not exactly the headline figure.

The “Five Year Forward View” has been mentioned, and that asks for £8 billion but it also identified £22 billion that had to be found. That is fairly eye-watering. Let us think about two of the things that were identified within that. One was a change in how people worked.

[Norman Lamb]

The hon. Lady is talking a lot of sense, as she always does. The “Five Year Forward View” set out three scenarios, but it did not ask for £8 billion; that is just the narrative that has developed. The efficiency assumptions on which the £8 billion—or £10 billion, or whatever we want to call it—is based are unimaginable. They are at least 2% to 3% throughout the period between now and 2020, and everyone knows that that is not going to be delivered.

[Dr Whitford]

I thank the right hon. Gentleman for his intervention. Even without recognising that no one has ever achieved those levels of efficiency savings, we need to acknowledge that a big chunk of this is about prevention. More than £5 billion of the £22 billion has been identified as relating to people not going into hospital and not getting sick, yet public health expenditure has been cut by £200 million in-year, with another £600 million to go. That amounts to a 3.9% cut. Lots of people will think that that just means less smoking cessation and less preventive work around alcohol, but public health should be much bigger than that.

I understand that there used to be a Cabinet Committee on public health in this place. Public health should be feeding into all the decisions that are made here. We also need to ensure that our directors of public health are strategically involved in local government, because the shape of our town centres will determine whether we have car-based or active transport, how we design our schools and whether we flog off our playing fields. All those things will interact with health.

It has been said that secondary care always gets the bigger bite of the cherry. We talk about fixing the roof while the sun is shining, but in fact, when the window has just come in or the door has just come off its hinges, that is what we fix first. That is very similar to secondary care, which is actually the national illness service. It responds to people who are already ill. We are developing more complex and expensive treatments that allow us to keep people alive, and we need to recognise that. People talk about the catastrophe of ageing, but I would like Members to focus on what the alternative is. People used to say, “Age does not come alone, and it is terrible.” In the field I worked in, however, not everyone gets old. Age is something that we should value, because wisdom and a sense of community come with it.

However, we need to be ready to develop the services around older people, and that means not always just patching things up at the end. We need more intermediate care to allow step-up and step-down beds, and we are working on that in Scotland. In particular, we need to focus on primary care, as the hon. Member for Stafford (Jeremy Lefroy) said. That is the real generalism. The GP is the person who is able to make a diagnosis because they have known the patient linearly over many years. However, GPs are on their knees and that is a UK-wide problem. They are under huge pressure because of the demand and the complexity. Within that, of course, we must talk about the lack of mental health services. They have been ignored for a long time, but that is beginning to change. In Scotland, we have a waiting time target for child and adolescent mental health services. Unfortunately, it is proving very challenging to meet that target, but we have doubled the number of staff in those services and we hope eventually to see improvements.

We need to be looking at these issues more broadly. The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) and I—I am not very good at learning constituencies that have two names; I find one name a challenge with 650 people here—are members of the all-party parliamentary group on health in all policies. We have been taking evidence on the health impacts of increasing child poverty, of which we are going to see even more. We need to recognise that every decision we make feeds into whether our citizens are healthier, physically and mentally, or less healthy. That is about welfare. It is particularly about housing, which has one of the biggest impacts on health. The hon. Member for Stafford mentioned those impacts in our debate yesterday on supported care. If we lose supported care in the community, we are never going to get people out of hospital. I want to make the plea, as I did in my maiden speech, that we in this place should put health and wellbeing—meaning mental health—across all our policies and measure our decisions against those factors. Far too many decisions are made in a broken up, narrow way without looking at the ramifications for everything else.

--- Later in debate ---

[The Minister for Community and Social Care (Alistair Burt)]

This has been a really great afternoon. I have thoroughly enjoyed listening to all the speeches. It has been the sort of debate that I think people outside this place appreciate. I thank the right hon. Member for North Norfolk (Norman Lamb) and his colleagues for securing the debate. I also thank him, as always, for the contribution he made when he was in the role I am now in. I thank all right hon. and hon. Members for their contributions, not least those with a medical background. We encourage them to remain in active medicine, because it brings an extra dimension to these debates. If I have time, I will address the comments from each Member. I will first respond briefly to the nub of the debate before responding to colleagues’ remarks and making some comments on the structure.

The sustainability of the NHS and social care system, whether financial or operational, is a key commitment of this Government. However, we do not believe that there is a need to launch an independent commission into its future. The NHS and wider health system has already examined what needs to be done to ensure the sustainability of the health and care system. Part of the purpose of making NHS England independent was to allow it to examine the circumstances of its finances and project into the future. It did so independently and came up with a figure. The Conservative party, uniquely, met that commitment at the last election and was able to carry it into government. It is important for the House to recognise that right at the beginning.

[Norman Lamb]

I just want to challenge the Minister on the suggestion that NHS England came up with the figure and the Government met it, because that is not actually what happened. NHS England and Simon Stevens painted three scenarios. The scenario that the Government have met, and on which both my party and his party stood at the election, is based on assumptions that are heroic in their scale and have never been met in the history of the NHS.

[Alistair Burt]

If I may say so, Simon Stevens said, “Look, it needs £8 billion.” It also needs £22 billion in efficiencies. We have met the challenge and put in even more than £8 billion—by 2020 it will be £10 billion. I understand the pressures in the system and fully appreciate the right hon. Gentleman’s remarks. The King’s Fund stated in its 2015 report:

“‘Business as usual’ is not sustainable. But that does not mean the NHS is fundamentally unsustainable.”

Simon Stevens recently said:

“The NHS has a huge job of work to do ensuring an already lean health service is as efficient as it can be—which, in my assessment, people are entirely up for.”

He recently told the Health Committee, “In headline terms, £22 billion is a big number, but when you think about the practical examples and do the economic analysis, we have some pretty big opportunities in front of us.” We know that the challenge is there; nobody denies that. However, NHS England put its assessment of what it needs to the political parties at the last election. We met that challenge and were elected.

We have spoken about a process, and I will return to that in a moment. What NHS England produced was developed by it, along with Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority. The Government back the plan, but we need a strong economy to be able to do that, as a number of colleagues have said. Without trespassing too much into other areas, that is the meat of political debate in this country. The public are not just asked to make a judgment on the delivery of one particular service, however precious it is. It is about whether they think that those who are promoting their view of a particular service have the economic background to deliver it. That question was also comprehensively answered at the general election. We now have responsibility for carrying that forward. People believed that we could put the money into it, and we have done so.

--- Later in debate ---

[Norman Lamb]

After your intervention on the Minister, Mr Deputy Speaker, I will ensure that I keep my remarks extremely brief. For those who have been here throughout the duration of the debate, it is probably time to have something to eat.

This has been an extraordinarily good debate and we have heard very well informed contributions. I absolutely agree with the hon. Member for South West Wiltshire (Dr Murrison) that we should be ambitious and that we should have the mindset that what happens at the moment is not good enough. We should aspire to have the best health and care system imaginable and in comparison with other European countries.

I suppose that what is behind my plea for a commission, which I will continue to make, is the brutal truth that our political process has let people down. The hon. Member for Leicester West (Liz Kendall) made the point that an elderly person who does not get the care they need suffers when the political process fails. In a way, partisan politics has ducked the big issues, despite what some hon. Members have said about big political issues being determined in a partisan way. That has failed and let the people of this country down.

The shadow Secretary of State, the hon. Member for Lewisham East (Heidi Alexander), in many ways gave a thoughtful speech, much of which I completely agreed with. She had a little go at me about social care funding, but the truth is that none of the political parties confronted the funding needs of social care at the general election. There was a bit of a race over health funding, but social care was neglected, as it has been again and again. Until we confront that, people in this country will continue to be let down.

Opposition Members can choose to say, “It is all the Government’s responsibility.” The Minister clearly wants to keep it that way, and we could just attack for the next five years. When things get really difficult, we can go for the failures of the system. Alternatively, we could adopt a different approach and recognise that these are profound issues that, in a way, have not been thought about comprehensively since the foundation of the system back in 1948. In ’48, there was a process that garnered cross-party support, despite what the shadow Secretary of State said about that being impossible.

Sometimes, this country needs to reach big decisions together, whether it is about pensions or climate change, as my right hon. Friend the Member for Sheffield, Hallam (Mr Clegg) was saying, or about how we cope with an ageing population. I believe that this is the moment when it is necessary for us to come together to confront those issues. It is in the Government’s interest to think again and embrace the proposal. It is foolhardy to reject it, because I suspect that, with the projections that we all know about, during this Parliament, things will get very messy.

I will continue to campaign and I am very grateful to Members on both sides of the House for supporting that proposition. I thank all hon. Members for their contributions to the debate this afternoon.

Question put and agreed to.

Resolved,

That this House calls for the establishment of an independent, non-partisan Commission on the future of the NHS and social care which would engage with the public, the NHS and care workforces, experts and civic society, sitting for a defined period with the aim of establishing a long-term settlement for the NHS and social care.

[Mary Creagh (Wakefield) (Lab)]

On a point of order, Mr Deputy Speaker. In the past hour, we have had the news that the Lord Chancellor has scrapped the Government’s proposed legal aid reforms, which had drawn such huge protests from criminal solicitors across the country, including in my constituency. We had a debate on prison and justice issues for three hours yesterday, which would have given him ample opportunity to tell the House of the news. May I use your good offices, Mr Deputy Speaker, to ask whether it would be appropriate for the Lord Chancellor to come and make a statement to the House tomorrow, which is a sitting Friday?

Infected Blood

Norman Lamb Excerpts

Thursday 21st January 2016 Commons Chamber

[Jane Ellison]

I thank my hon. Friend for what she has said. I am glad that she feels that we are making progress.

The NHS is just beginning to roll out many of the new hepatitis C drugs, although some people have already been treated, and obviously many more will be treated in the future. One of the benefits of individual health assessments for everyone in stage 1 of the scheme is that we shall be able to understand not just clinical need, but problems such as those described by my hon. Friend. The consultation may help us to establish whether help with navigating the health system is one of the non-financial aspects of support that people might seek.

[Norman Lamb (North Norfolk) (LD)]

I thank the Minister for her statement, and welcome the consultation. It is an important step forward.

The individual health assessment clearly marks quite an important moment for people with hepatitis C—a condition that other Members have raised—because the Minister has talked about linking it to payments. Does she envisage an entirely discretionary payment linked to the assessment, or a system involving payment bands? How will the scheme work, and will there be a right of challenge? What does the Minister mean by “enhanced” access to treatment? Is there still a risk that some people will not have immediate access to it?

[Jane Ellison]

As have I said, we will ask an expert advisory group to consider what the criteria for the health assessments should be, and we expect people’s own clinicians to be involved. Broadly speaking, we probably envisage payment bands, but that too will be subject to the consultation. We want to be able to combine speed and fairness.

People with hepatitis C are receiving NHS treatment based on NICE guidelines, but we understand that there will always be people who fall a little short of that at any one time, and we hope to be able to offer treatment to them within the scheme. Within the overall envelope of funding, however, we will not know exactly what the balance is until after the consultation. I do not know what affected individuals’ views are about the balance between treatment and some of the other options in the consultation. I genuinely want to see what they think, and how attractive the treatment offer is to them, before we reach our final conclusions.

Childhood Obesity Strategy

Norman Lamb Excerpts

Thursday 21st January 2016 Commons Chamber

[Dr Wollaston]

I thank my hon. Friend for mentioning that. I was going to come on to that point and he has saved me from doing so. I completely agree that we must not forget the impact of sugar on children’s teeth. He will recognise that there are great health inequalities relating to that issue as well.

So how should we tackle this? I have spoken many times about a sugary drinks tax, but I recognise that that is not where the greatest gain lies when it comes to tackling childhood obesity. As the Minister will recognise from the evidence presented by Public Health England, price promotions will need to form an extraordinarily important part of the childhood obesity strategy if it is to be effective. It is a staggering fact that around 40% of what we spend on our consumption of food and drink at home is spent on price promotions. Unfortunately, however, they do not save us as much money as we assume. They encourage us to consume more. In British supermarkets, a huge number of those promotions relate to sugary and other unhealthy products. I call on the Government to tackle that as part of their strategy. We need a level playing field as we seek to rebalance price promotions, but that has to be done in a way that does not simply drive us towards promoting other products such as alcohol. We need to take a careful, evidence-based look at all this.

[Norman Lamb (North Norfolk) (LD)]

I am delighted that the hon. Lady is pursuing this issue. Has she looked at whether there could be a tax on the ingredient “sugar” in products, so that we create an incentive to reformulate, in order to reduce sugar content not just in fizzy drinks but across foods and drinks generally? Could that be a way to get the industry to start to think about the content of its food?

[Dr Wollaston]

I thank the right hon. Gentleman for his point, which prompts me to address the issue of a sugary drinks tax. We looked at examples of where taxation can be applied across sugar more broadly, perhaps to incentivise reductions within reformulation, as some countries have done. However, we wanted to address the single biggest component of sugar in children’s diets, which is sugary drinks. The Committee recommended a sugary drinks tax rather than a wider sugar tax, and there are several reasons for doing that. First, we know that it works. Secondly, it addresses that point about health inequality.

Mexico introduced a 1 peso per litre tax on sugary drinks and by the end of the year the greatest reduction in use—17% by the end of the year—was among the highest consumers of sugary drinks. The tax drove a change in behaviour. The whole point of this sugary drinks tax is that nobody should have to pay it at all. To those who say it is regressive, I say no it is not; the regressive situation is the current one, where the greatest harms fall on the least advantaged in society. As we have seen with the plastic bag tax, the tax aims to nudge a change in behaviour among parents, with a simple price differential between a product that is full of sugar, and causes all the harms that we have heard about, including to children’s teeth, and an identical but sugar-free product—or, better still, water.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 5th January 2016 Commons Chamber

[George Freeman]

My hon. Friend makes an excellent point. We hear very little from the Labour party about Wales, where it is responsible for the health service, and an awful lot of questions about England, where fortunately it is not responsible. If we want to get pressure on A&E down, we need to integrate and invest as we are doing in prevention and in keeping people out of unnecessary A&E admission.

[Norman Lamb (North Norfolk) (LD)]

23. The Health Foundation estimates that the gap in social care funding by 2020 will be £6 billion, not taking into account the increase in the minimum wage, so although the spending review narrows the gap, it still leaves an enormous gap which will result in further cuts in social care. How will the Government avoid the totally unacceptable situation in which those with money will still get good care and those without money will get substandard care or no care at all?

[George Freeman]

I pay tribute to the right hon. Gentleman. He is a Norfolk colleague and as Minister did a lot of work in this area. He raises an important point that as a society we need to think profoundly about how we integrate health and social care. As I say, the Government have made a £3.5 billion commitment from the new precept and the better care fund is a significant commitment, but he is right—we will have to go further. Through the devolution programme and the integration programme, we will have to develop more powers so that local health leaders and care council leaders can better integrate services to reduce unnecessary pressure.

Tobacco Control Strategy

Norman Lamb Excerpts

Thursday 17th December 2015 Westminster Hall

[Kevin Barron (Rother Valley) (Lab)]

I beg to move,

That this House has considered a new tobacco control strategy.

I am pleased to speak in this debate with you in the Chair, Mr Betts, because we are not talking about football today—our teams are doing different things in the league at the moment. I ought to declare that I am the vice-chair of the all-party group on smoking and health, and have been an officer of sorts for it for some 20 years. I am sure Members are aware that the group’s secretariat has been the Action on Smoking and Health charity for many years.

My commitment to tobacco control is well known in this House. For the more than 20 years that I have been involved in this issue, I have had great support from Action on Smoking and Health, as I know Governments have from time to time. My commitment was an individual one at one stage, going back a couple of decades, so I am pleased that in recent years we have seen a growth in cross-party support for tobacco control, as people recognise that it is a key area of public health.

The Minister has played a key leadership role in guiding through the House measures such as standard packaging and the prohibition on smoking in cars with children. She has been helped by the strong support for these measures across Parliament, both here and in the other place. We have moved on in leaps and bounds on this major public health issue in the past decade. Measures to tackle the harm caused by smoking are strongly supported by the public, three quarters of whom supported Government action to limit smoking in a YouGov poll conducted for ASH, and around half of whom think the Government could do more.

In recent years, a great deal has been achieved with the support of the public and all political parties, starting with the Labour Government introducing the first comprehensive tobacco control strategy in 1998; they subsequently introduced comprehensive smoke-free legislation with strong cross-party support. The coalition Government published as their first detailed public health strategy the tobacco control plan for England in 2011. Over the life of the current plan, a great deal has been achieved, and smoking prevalence rates in England have fallen significantly during the five years of the plan from some 20.2% in 2011 to 18% in 2014.

[Norman Lamb (North Norfolk) (LD)]

I am not sure whether the right hon. Gentleman will cover this, but I am particularly interested in smoking prevalence rates among those who suffer severe and enduring mental ill health. It appears to have been stubbornly more difficult to reduce smoking rates among that group. Given that people with mental ill health die earlier, and that smoking actually damages their mental health, does he agree that it is critical that the NHS ensures that those people get access to support services to help them give up smoking?

[Kevin Barron]

The right hon. Gentleman is absolutely right; there is a high incidence of smoking among people with mental health conditions, as there is among poorer households. I will go into that in more detail, but he is right to mention it.

Smoking rates have fallen among not only adults but, importantly, young people. Regular smoking among 15-year-olds has fallen even faster under the plan, from 11% in 2011 to just 6% in 2014. That is a great credit to the current plan, but it is about to come to an end, so we need a new strategy.

The reduction ambitions set out in the tobacco control plan for England have been achieved ahead of the end of the strategy. However, a great deal remains to be done. Smoking remains by far the single largest cause of preventable illness and premature deaths in the United Kingdom, causing about 100,000 premature deaths a year and killing more people than the next six causes put together, including obesity, alcohol and illegal drugs. The cost of smoking to the national health service in England is estimated to be about £2 billion a year.

My constituency, Rother Valley, sits in Rotherham borough. Just under one in five people smoke in Rotherham, which is about the same as the national average. That amounts to some 37,391 people. Nearly 500 people in Rotherham die from smoke-related diseases every year—primarily cancer, heart disease and respiratory diseases. An estimated 900 children in Rotherham start smoking every year, and it is important to remember that two thirds of smokers start before the age of 18. Of those who try smoking, between one third and one half will become regular smokers. The best way to prevent children taking up smoking is to encourage their parents to quit, because children are three times more likely to start smoking if their parents smoke.

Smoking rates are much higher among poor people. In 2014, 12% of adults in managerial and professional occupations smoked, compared with some 28% in routine and manual occupations. Almost all groups that experience disadvantage have higher smoking rates than the general population. For example, as the right hon. Member for North Norfolk (Norman Lamb) mentioned, people with mental health conditions are much more likely to smoke, and nearly eight out of 10 prisoners and people who are homeless smoke.

Poorer smokers also face financial hardship as a result of smoking. When their expenditure on smoking is taken into account, some 1.4 million households are below the poverty line—that is 27% of all households that include a smoker. In Rotherham alone, smoking is estimated to cost the national health service some £12.2 million. The current and ex-smokers who require social care in later life as a result of smoking-related diseases cost society in Rotherham an additional £5.7 million, £3.3 million of which is funded by the local authority through social care costs, and £2.4 million of which is self-funded.

Quitting smoking surveys show that about two thirds of smokers would like to stop smoking, but only around one third make a quit attempt in any given year. Continued Government and public sector action to cut smoking rates therefore remains necessary, and a new strategy is required to replace the expiring tobacco control plan.

The current Department of Health tobacco control plan will expire at the end of this month, as I understand it. I am delighted that the Minister with responsibility for public health has announced that there will be a new plan, and I look forward to her announcing when it will be published; we may hear something today. It is crucial that a new tobacco control plan be a public health priority, and it has to be comprehensive. The current strategy has been successful because it is comprehensive and, so far, properly funded.

The main elements of successful tobacco control, as implemented in the UK, are well understood and strongly backed by evidence. They are: price rises through taxation, intended to make tobacco less affordable and to help pay for tobacco control interventions; stopping the smuggling of tobacco, which allows children and young people easy access and reduces the incentives for adult smokers to quit; helping smokers to quit through evidence-based services, including support and, where appropriate, the prescription of nicotine replacement products; an end to tobacco advertising, marketing and promotion, including on the pack design; and mass-media campaigns and social marketing of anti-smoking messages. Legislating for smoke-free enclosed public places and vehicles to protect people from the harmful effects of second-hand smoke has been a great success. The new strategy will need to be comprehensive and ambitious, with tough new targets, and it has to be well funded.

I commend to the Minister the comprehensive set of measures set out in the ASH document, “Smoking Still Kills”, which has been endorsed by more than 120 public health-related organisations, including the British Heart Foundation, Cancer Research UK, medical royal colleges and the British Medical Association. The report calls on the Government to impose an annual levy on tobacco companies, proposes new targets for reducing smoking prevalence to make our country effectively tobacco-free by 2035, and makes a comprehensive set of recommendations for a renewed national strategy to accelerate the decline in smoking prevalence over the next decade.

Hon. Members will remember that at the launch of that report in June, the Minister committed the Government to publishing a new strategy to replace the current plan. Sustained funding is essential to the success of any new strategy, as it has been for Government strategies to date. Clear evidence from the UK and overseas shows that a reduction in spending on tobacco control, together with less emphasis on new policies and on enforcement of existing ones, is likely to slow, halt or even reverse the long-term reduction in the smoking prevalence rate.

Some measures, once implemented, either do not need funding—such as standardised packaging, and the ban on advertising, promotion and sponsorship—or are self-funded, such as tax increases and reductions in smuggling. Others continue to need to be properly funded, including mass-media campaigns, stop smoking services and enforcement to prevent children from being able to buy cigarettes.

I am deeply concerned that the cuts in funding to the Department of Health and local authority public health budgets, both in-year and announced in the spending review, threaten to undermine the ability of the planned new tobacco control plan for England, so that, unlike the current plan, it will not be effective. We are already seeing cuts to stop smoking services up and down the country, and to local authority investment in tobacco control, even before the spending review cuts are implemented. Will the Minister confirm that the new tobacco control plan will contain ambitious targets and be sustainably funded?

I want to focus on the importance of mass-media campaigns, which are highly cost-effective in encouraging smokers to quit and in discouraging young people from taking up smoking. When funding was cut to mass-media campaigning in 2010, when the coalition Government came in, there was a noticeable impact on quitting behaviour. There was a decrease of 98% in the amount of quit support packs. Quitline calls fell by 65% and hits on the website fell by 34%, but the evidence shows that such services are only effective if they are sufficiently well funded; in recent years, they have not been.

At the peak in 2009-10, nearly £25 million was spent by the Government on mass-media campaigns. However, last year, in monetary terms, not taking inflation into account, the amount had fallen to less than £7 million, and it is likely to fall again this year. Investment in mass-media campaigns is a crucial part of the mix of tobacco control interventions needed to drive down smoking rates, and the UK is seriously under-investing.

To give an international comparison, in the US, the Centres for Disease Control and Prevention’s best-practice recommendations for mass-reach health communications to reduce smoking is $1.69 per capita. Using 2014 population figures, that means that in England, we should be spending in the region of £57 million a year on mass-media campaigns for that to be evidence-based. We are spending eight times less than that.

The cut in spending is already having an impact. An early indicator of the effects of reductions in spending on tobacco control is given by the smoking toolkit study run by Professor Robert West, from University College London. Results for 2015 show that smoking prevalence has stopped declining and is beginning to go back up again for the first time in many years.

Smoking rates have increased from 18.5%—the lowest ever recorded—to 18.7% in recent months. There has also been a fall in the proportion of smokers who made an attempt to quit, from 37.3% in 2014 to 32.4% in 2015. There are lower success rates for quit attempts, from 19.1% in 2014 to 17.0% in 2015. That is going in the opposite way to how it should be going.

I want to move on to an area on which the public have contrasting views: the role of electronic cigarettes, which are perhaps badly named, and harm reduction. Over the last few decades, it has become increasingly clear that although population smoking rates had been declining, some groups—particularly the poor, the disadvantaged and those with mental health problems—were being left behind. Those are the groups with the highest levels of nicotine addiction, who find it hardest to quit.

At present, the most popular source of nicotine—the cigarette—is far and away the most hazardous and addictive. In response to that, tobacco harm reduction approaches have been developed in the UK to find ways of giving smokers who are unable to quit access to alternative, less harmful forms of nicotine. We are at the forefront in the world in developing such an approach. Current smoking cessation programmes use nicotine replacement therapy, but they also use non-nicotine approaches such as psychotherapy and other pharmaceutical products. Although there has clearly been success with those products, they predate the advent of electronic cigarettes as a major consumer product.

Electronic cigarettes are now widely on sale and have become the most popular tool used by smokers to help them quit. There is growing evidence that they are effective aids to quitting, and they are used by around 2.6 million smokers, primarily to help them quit or prevent them from relapsing back into smoking. Although concerns have been raised about their use by young people and never-smokers, this has not been found to be an issue. Indeed, use by adults who have never been regular smokers is very rare, and although a growing number of young people under 18 have experimented with electronic cigarettes, regular use is limited almost exclusively to young people who are current smokers or who have experimented with smoking in the past.

More worryingly, evidence from ASH indicates that the public increasingly have false perceptions of the harm from electronic cigarettes, and smokers who have not yet tried an electronic cigarette are much more likely than other smokers to believe they are as harmful as conventional cigarettes, or more harmful. That is certainly not the case. A recent groundbreaking review by Public Health England, which was published in August, found that they are 95% safer than smoking tobacco and recommended that health providers and stop smoking services take a more proactive approach in supporting smokers who want to use electronic cigarettes to quit smoking.

For 50 years we have known now that it is not the nicotine in cigarettes that does the damage to people, but the contaminants in the tobacco. However, some people, including in the medical field, are talking electronic cigarettes down as though they were as dangerous as cigarettes. That figure of 95% safer gives us 5% wriggle room, because I do not think that has been tested or proven at this stage. It could be far higher than that, but this product is a way of taking nicotine into the system that does not do the damage that tobacco does.

I believe a large part of the delay in the roll-out of electronic cigarettes has been due to the fact that they were not developed in the UK, or not through traditional methods in national health service labs. I just wish they had been, because then some medical practitioners in the NHS would have had a different attitude to them. The regulatory systems are not used to this sort of organic growth that comes in from outside. However, the Medicines and Healthcare Products Regulatory Agency’s new approach to licensing e-cigarettes is a welcome step. To my knowledge, the MHRA is the only medicines regulator in the world to licence an e-cigarette, as happened earlier this month. They will potentially become a major part of smoking cessation programmes.

Unfortunately, there are high costs to putting e-cigarettes through the MHRA, and from conversations with British suppliers it is clear that the licensing costs are prohibitive for smaller manufacturers if they want them to be a medicinal product. That is obviously a major block, and it is argued that only the tobacco companies are putting those products through the MHRA at the moment. That may be because they have the money to be able to put them through at this stage. I would prefer a tobacco company to spend money on putting these products through the MHRA, so that they can get into smoking cessation clinics, than to sell cigarettes, which prematurely kill 50% of the people who use them. We should take our head out of the sand and look at the potential of these products to get everyone off cigarettes, which are so damaging to their health.

I recently met someone who runs a small business in my constituency and has developed a product called E-Burn, which is an e-cigarette for use in prisons. It is currently used in the prison on Guernsey and is being adopted by the NHS for use in secure hospitals. That innovation is taking place out there. I have not tasted that product and I do not know it from any other, but when I was on the Select Committee on Health in 2005-06 and we did an inquiry on smoking in public places, one of the most difficult things was trying to convince people that those in prisons ought to have smoke-free workplaces as well.

[Norman Lamb]

It should also be mentioned that in mental health settings and in-patient wards, where no-smoking policies have been introduced and patients have been helped to escape from addiction to tobacco, a significant improvement in their mental wellbeing and mental health has been seen.

[Kevin Barron]

The product to which I referred comes from China, I understand, but is assembled in Rother Valley, and the person who runs that company wants to expand his business and create jobs. I want to encourage him on the basis that it creates better health if these products are used both in mental health institutions and in prison.

I mentioned the 2005-06 report. The Health Committee, which I chaired at the time, had great difficulty in convincing people who ran institutions that smoke-free workplaces should be as much for people inside prisons and secure hospitals as for anyone else. Various arguments were put to us at the time. The major issue was not just about taking people off cigarettes; it was about control in prisons. I now see that from 1 January we are banning smoking in all Welsh prisons and selected English prisons, which we could loosely call non-traditional environments. That has taken a long time. We were told when we were doing that inquiry in 2005-06 that the Prison Service would bring things forward within three months of our completing it. It has actually taken 10 years to get to this stage. I suspect that if e-cigarettes, no matter which ones they are, go into those institutions for people who are addicted to nicotine and cannot get off that addiction, it will help us get what some of us were arguing for 10 years ago.

Next year, the UK will implement the electronic cigarette provisions in the tobacco products directive, which will provide a regulatory framework for those products, giving users greater assurance about their safety and quality. However, e-cigarette users have raised concerns that the UK Government’s implementation of those provisions will force products that they use off the market and may cause them to revert to conventional smoking.

I accept entirely that it is essential that the directive be implemented proportionately. As I understand it, the MHRA will be responsible for that, although not for making all e-cigarettes medicinal product, which involves high expense. It will bring in a regime whereby it will look at the quality of e-cigarettes, and quite right too. We want to know, if people are buying e-cigarettes in shops on our high streets or wherever, that what the packet says is what is in the product. People should know exactly what they are using. I agree about that, but I hope the Government will ensure that the regulation of electronic cigarettes is proportionate and maximises the benefits to smokers while minimising the risks.

I want to finish by discussing our role in global tobacco policy. As reported by Public Health England, money has been found in the spending review for the Department of Health to support the international implementation of tobacco control. The UK, as a world leader in tobacco control and in supporting development internationally, has a key role to play in that area. I am pleased to see the Minister nodding. The UK is the first G7 country to meet the long-standing commitment to spend 0.7% of gross national income on official development assistance—a commitment that is enshrined in law, I am very pleased to say as a Member of the House. Building economic growth and creating jobs helps developing countries to lift themselves out of poverty, and we can justly be proud of our work in that area.

Key to effective development work going forward will be helping to deliver on the new sustainable development goals. One of those is to accelerate the implementation of the World Health Organisation framework convention on tobacco control. I hope, therefore, that our new tobacco control plan will be cross-Government and will include an ambitious international strategy to help countries with FCTC implementation.

The Addis Ababa declaration on financing for development, which backs up the sustainable development goals, says that parties, such as the UK, should strengthen implementation of the WHO FCTC and support mechanisms to raise awareness and mobilise resources for the convention. The UK, as a world leader both in development and in tobacco control, has a key role to play in helping to support FCTC implementation, particularly in low and middle-income countries.

The financing for development declaration goes further and states that

“price and tax measures on tobacco can be an effective and important means to reduce tobacco consumption and health-care costs, and represent a revenue stream for financing for development in many countries.”

Clearly the UK has expertise in tobacco taxation: we have some of the highest taxes in the world, combined with a comprehensive and effective strategy to tackle illicit trade. A 2014 study found that tripling tobacco taxes around the world could reduce the number of smokers by 433 million and prevent 200 million premature deaths from lung cancer and other smoking-related diseases. That would benefit UK plc, because increased tobacco taxes of necessity go hand in hand with enhanced anti-smuggling strategies, which we now have to deal with daily. Her Majesty’s Treasury, in collaboration with Her Majesty’s Revenue and Customs, is in the process of setting up a cross-departmental ministerial working group to tackle the illicit trade in tobacco and help HMRC to achieve its aims, which include:

“Creating a hostile global environment for tobacco fraud through intelligence sharing and policy change”.

If other Governments increase tobacco taxes and enhance their anti-smuggling strategies, that will help to create precisely that hostile global environment for tobacco fraud. HMRC is working on that at the moment.

Our international strategy also needs to include work to help countries protect their tobacco control public health policies from the commercial and vested interests of the tobacco industry, and to ensure that UK diplomatic posts do not help tobacco companies promote their deadly products around the world. It was rightly considered a scandal earlier this year when the British high commissioner to Pakistan was revealed to have attended a British American Tobacco meeting with the Government of Pakistan, at which BAT lobbied the Government not to implement tougher health warnings on cigarette packs—a campaign that was successful, sadly. In a recent BBC “Panorama” programme, it was alleged that BAT employees and contractors had been involved in making payments to officials and politicians in Africa in return for access to draft tobacco control legislation. Given the UK’s strong domestic record on tobacco control and our leading international role in promoting successful tobacco control policies, we need to remain vigilant and ensure that we all do everything we can to promote successful tobacco control around the world.

I had personal experience of what the tobacco companies do more than 20 years ago, when I was promoting a private Member’s Bill to ban tobacco advertising and promotion. A lot came out years later through the tobacco files about exactly what had taken place and the influence that those companies exerted to try to stop us doing what this country has now done. They tried to stop us putting this country on the map as a major force in tobacco control, as it is now. Will the Minister confirm that the international work to support the implementation of the WHO FCTC will be a key part of the new tobacco control plan, and that it will include supporting Governments in protecting their public health policies from the commercial and vested interests of the tobacco companies, in line with article 5.3 of the FCTC?

I thank you for your indulgence, Mr Betts—you will be pleased to know that I am about to sit down. The tobacco control strategies have been published, in recent history, about once every five years. They have been crucial to this country in saving the lives of many of our fellow citizens and in our getting a good evidence base for the same thing to happen throughout the world. The last thing I want is for this country to stop doing what it has been doing well. I have asked questions about funding and other things, but there is much that we can do that requires not money but good will and determination.