NHS Long-Term Plan: Implementation

Peter Bottomley Excerpts

Monday 1st July 2019 Commons Chamber

[Matt Hancock]

I picked out three of the 20 areas that we are particularly focused on in this implementation framework, one of which is the number of GPs and the broader primary care workforce, because it is not just about GPs but about all those who also support primary care across the board. We have a clear target of 5,000 more GPs, based on the 2015 baseline. We have a record number of GPs in training. Last month, the Minister for Health, my hon. Friend the Member for Wimbledon (Stephen Hammond), announced the consultation on changes to the pension to remove some of the unintended consequences of pension tax changes for GPs to ensure that we retain our highly trained, highly qualified GPs. There is a whole load of work in the people plan being led by Baroness Dido Harding to make sure that we have the number of GPs that we need and the wider primary care health workforce that is necessary.

[Sir Peter Bottomley (Worthing West) (Con)]

As my right hon. Friend said, the first Minister of Health was Christopher Addison, then a Liberal, who abolished his position as President of the Local Government Board to succeed himself as the first Minister of Health in 1919, but the first Secretary of State to hold up a White Paper saying “national health service” was the Conservative Sir Henry Willink in 1944. We must give credit to the Labour party for bringing in the health service, agreed by the coalition Government, in 1948, although we have to recognise that Aneurin Bevan decided to nationalise the hospitals and not the GPs, when most people expected it to be the other way round.

In the experience of my wife, who did five years as Minister for Health and Secretary of State for Health, we should be praising all those who support the clinicians—the support workers, administrators and others who help doctors, nurses and other professionals—to look after us at all stages of our lives. We must have the extra money. I am glad that we have gone beyond the Labour party’s ambitious targets to meet our own ambitious targets, and that we can look forward to doing more, because we have to recognise that health will require a greater proportion of our wealth as we live longer and want better services.

[Matt Hancock]

I wholeheartedly agree with the entirety of what my hon. Friend said. It is true that for the majority of its 71-year history—71 this week—the NHS has been run by Conservative Secretaries of State, and the largest cash injections have come from this party. It is a truly national institution that we should all support, and we have to support not only the doctors, who lead many parts of the NHS, and the nurses, but all the health service staff, because it is a true team effort.

Listeria: Contaminated Sandwiches

Peter Bottomley Excerpts

Monday 17th June 2019 Commons Chamber

[Matt Hancock]

I agree with the hon. Lady on the need for food to be produced in-house whenever possible, especially as the evidence from some of the best hospitals in the country is that it is also very good value for money. There really is no case for not doing that and I look forward to best practice spreading across the NHS. I will, like her, do what I can to make that happen. She asks about transparency. I made it clear that there are hospitals trusts where further information needs to be published. There is a need to tell patients first, which is why the information has come out at the pace that is has. That duty of candour is important, but of course the review will lead to full transparency. All that everybody wants to do is get to the bottom of this and learn lessons for the future.

[Sir Peter Bottomley (Worthing West) (Con)]

May I join those who have praised Public Health England? Not every hospital involved has necessarily had fatalities or major problems, but it was very important that Public Health England notified all those who might have been supplied by the same people. May I put it to the Secretary of State that we should not just think that there was one cause of listeriosis? It can come from processed vegetables, processed meats, ice cream and other things. May I ask him to recommend to everyone that people try to ensure there is safe handling, safe cooking and safe consumption to reduce the risk of cross-contamination? When an outbreak happens, that is the way, as well as through the work of Public Health England, that people can help to ensure it does not affect them.

[Matt Hancock]

I agree wholeheartedly with the wise words of my hon. Friend.

Tessa Jowell Brain Cancer Mission

Peter Bottomley Excerpts

Monday 13th May 2019 Commons Chamber

[Matt Hancock]

Baroness Jowell’s successor in her parliamentary seat speaks very powerfully and the hon. Lady is right to highlight the role of King’s in this research. King’s has been developing this treatment for years, and as a result of its work, it can now be rolled out nationally. It is a hospital that, as the hon. Lady says, needs to address some of its local challenges, but we should not take away from some of the globally cutting-edge work that it does and the positive impact it has: potentially 2,000 people alive each year who would otherwise die. That is testament to the importance of this research.

[Sir Peter Bottomley (Worthing West) (Con)]

The first person I know who had a brain tumour and cancer and died was John Davies, who had been the MP for Knutsford shortly after I was first elected.

The NHS website is very good about the possible symptoms of brain tumours. May I strongly recommend that everyone who thinks they may have a worry consult their medical practitioners so that either they can be cleared or they can get early treatment, and is it not right that early diagnosis is the best way forward for those who may have the condition?

[Matt Hancock]

My hon. Friend is absolutely right about that: early diagnosis is critical to improving the proportion of people who survive cancers, because of course it is easier to treat people if diagnosis is early. We are reviewing all cancer screening programmes because they are not working well enough; the National Audit Office set that out in some detail recently, and we accept those findings. We want to get early diagnosis and screening right, and it is a top priority for the new Public Health Minister, my hon. Friend the Member for South Ribble (Seema Kennedy), to make sure we do so that more people can survive.

Government Mandate for the NHS

Peter Bottomley Excerpts

Thursday 25th April 2019 Commons Chamber

[Stephen Hammond]

There are all sorts of lines I could follow that with, Mr Speaker.

It is clear that it is this side of the House that is putting in the funding to make sure that the NHS can deliver for the patients, staff and families.

[Sir Peter Bottomley (Worthing West) (Con)]

Most of us will remember that the NHS Confederation said four years ago that it wanted

“a manageable number of objectives, which…focus on long-term outcomes for patients and populations rather than measures of how services are delivered”—

and—

“encourage collective responsibility for patient outcomes rather than silo working – particularly the expected outcomes from integrated care”.

Most people in the NHS will welcome the short delay if the result is that it makes it more possible for them to achieve the objective of the NHS, which is serving patients together.

Mental Capacity (Amendment) Bill [Lords]

Peter Bottomley Excerpts

Ping Pong: House of Commons
Tuesday 2nd April 2019 Commons Chamber

[Caroline Dinenage]

We now have an opportunity to deliver reforms that will provide quicker and fuller access to protections for the 125,000 people who are not currently receiving them. That is 125,000 vulnerable people without the legal protection that they deserve, whose families do not have peace of mind, and whose care providers have no legal cover for supporting them. We now have an opportunity to rectify this situation.

In February, the other place considered the 56 amendments made to the Bill by the House of Commons, the vast majority of which were agreed with. However, the Lords tabled alternatives to two of the Commons amendments, and they are the focus of our discussions.

[Sir Peter Bottomley (Worthing West) (Con)]

The Minister has rightly pointed out that the Bill will provide a great advantage to those who are directly affected. I do not want to be a total patsy for my local authority, but will she explain what the benefit will be for local authorities, which are responsible for trying to protect people’s welfare and safety?

[Caroline Dinenage]

My hon. Friend makes an incredibly important point. This issue has been a huge burden for local authorities: they have had to carry out multiple deprivation of liberty safeguards often for the same people and often when those people move from one setting to another. That involves a huge amount of bureaucracy and does not offer any better protection for the individuals concerned. The new service will enable local authorities to do this in a much more streamlined and efficient way. It will save them money and, at the same time, offer better protection for the individuals about whom we all care.

Lords amendment 1B was tabled by Baroness Tyler of Enfield to set out the meaning of a deprivation of liberty positively, rather than by using the exclusionary approach set out by the Government. Noble lords are, of course, absolutely right to want to ensure that any definition is understood by people and practitioners. However, a positive definition of a deprivation of liberty is likely to be subject to a legal challenge as article 5 case law evolves, and it would become unfit for purpose incredibly quickly. This is a view not only shared by the Government, but highlighted beautifully in the other place by the esteemed legal experts Lord Mackay and Lord Hope.

Lords amendment 1B does not link the definition of a deprivation of liberty to article 5 of the European convention on human rights, so creating a risk of the definition set out in statute diverging from the convention. This would mean that people who fall outside Parliament’s concept of deprivation of liberty but within the article 5 definition could not have their deprivation of liberty authorised under the Mental Capacity Act 2005. For those people, only the High Court would be available to authorise such a deprivation of liberty, which, in turn, would give rise to excessive delays in accessing vital safeguards.

That is precisely the situation that this piece of legislation looks to address—there are already too many people subject to delays when accessing safeguards, and we cannot introduce a provision that would further risk this.

Given that the Government have these concerns, we cannot agree with the noble lords in their amendment 1B. However, we know that concerns in the other place are reflected by many across the sector and we have taken that on board. We have listened carefully to the views of MPs, peers and other stakeholders and decided not to insist on amendment 1. Instead, I propose that the meaning of a deprivation of liberty will still be as defined under article 5 of the convention, as it is under section 64(5) of the Mental Capacity Act, but there will not be a clarification of the meaning of a deprivation of liberty in the Bill. The Bill will work alongside the rest of the Mental Capacity Act, so it does not impact on the existing definition.

I reassure the House that the Government are still absolutely committed to providing clarification regarding the meaning of a deprivation of liberty for both people and practitioners. We will use the code of practice to lay out in very clear terms and provide details of when a deprivation of liberty is and is not occurring, and this guidance will reflect existing case law. We will set out the meaning of a deprivation of liberty in a positive framing and in a way that is clearer for people and practitioners. We will also include case studies in the code to help bring this to life. Government amendment (a) in lieu of Lords amendment 1B will prescribe that the code of practice must contain guidance on what kind of arrangements amount to a deprivation of liberty.

NHS Long-Term Plan

Peter Bottomley Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

With respect, this is a huge increase in NHS funding, the like of which I am not aware that the Liberal Democrats were proposing at the last election. Although I am grateful to the right hon. Gentleman for welcoming the settlement, for him to stand up and say that it is not enough is not a satisfactory response. As he knows, we have actually put our money where our mouth is and demonstrated that we are committed to the NHS, with one of the biggest single injections of cash in the history of the NHS.

[Sir Peter Bottomley (Worthing West) (Con)]

I am glad that both my right hon. Friend and the Prime Minister have welcomed the fact that all parties have supported the health service: the Liberals first with Christopher Addison, for whom my father once worked, in 1919; Henry Willink, a Conservative member of the coalition Government, in 1944; and Aneurin Bevan, who made some changes and nationalised the hospitals, rather than the family doctors. Both the resources and the reform are needed, and future generations will be grateful to this Government—hopefully with the support of other parties—for taking this forward.

[Mr Hunt]

I thank my hon. Friend for that comment. If there is ever a memorial built to Sir Henry Willink for his role in the White Paper that critically announced to this House that we were going to have a national health service, my hon. Friend should certainly be the person to unveil it because he has done a huge amount to make the point that, although Nye Bevan’s role was absolutely critical, other people in other parties also played a vital role.

NHS 70th Anniversary

Peter Bottomley Excerpts

Wednesday 16th May 2018 Westminster Hall

[Bill Grant (Ayr, Carrick and Cumnock) (Con)]

It is a pleasure to serve under your chairmanship this morning, Mr Hosie. I congratulate the hon. Member for Blaenau Gwent (Nick Smith) on securing this important celebratory debate.

On 5 July this year we will mark 70 years of the NHS across the whole of the United Kingdom. Although now a devolved matter, the same core principle of safe, effective, person-centred care applies and it remains free at the point of delivery throughout the United Kingdom. I have no doubt that, no matter where we live on these islands, the NHS is the British institution most loved and valued by the public.

For the past seven decades, millions in the United Kingdom have known that they can rely on the NHS in their hour of need, to treat them when they are sick or injured and help them keep fit and healthy—most importantly, without discrimination. That principle has worked well for 70 years because of the dedication of generations of hard-working NHS staff. In this anniversary year, it is only right that we should thank all NHS staff, past and present, in Scotland and across the United Kingdom for their dedication and service. Mr Hosie, I should have declared an interest. I have two daughters who are nursing professionals in NHS Ayrshire and Arran.

This is indeed a time to reflect on the progress that the NHS has made since 1948 and consider what steps we should take over the next seven decades to ensure that the national health service continues to provide the best possible service to the British public, who very much rely on it.

In 1948, the newly created NHS was more concerned with childhood malnutrition than with obesity. Penicillin, discovered by Sir Alexander Fleming, physician and Nobel prize winner, who was born in Ayrshire in Scotland in 1881, was a relatively new and revolutionary treatment. Polio, tuberculosis and rickets were of major concern as opposed to dementia, the diabetes that was mentioned earlier, and the cancer conditions experienced today.

It is worth noting the progress that the NHS and society in general have made in recent years in recognising the need for improved mental health provision. Health is health, whether we categorise it as mental or physical. The UK Government’s introduction of parity between mental and physical health was a vital and important step forward, and I am glad that the Scottish Government have followed suit.

As our population ages—I fall into that category—and our society changes, the challenges that the NHS faces in health promotion and health and wellbeing will continue to evolve. We need an NHS that is adaptable and committed to embracing new technologies such as genomics wherever possible, and it must be well resourced to meet the increase in demand. I mentioned earlier the dedication of the staff, but it is crucial that there are enough skilled staff to meet today’s demanding and changing workload. Sadly, today’s national health service as a whole has vacancies and challenges in recruiting across the spectrum, whether nurses, allied health professionals or medics. There are too many gaps in the system, which has led to significant funds being paid on overtime and expensive agency nurses. We need to resolve the long-standing UK-wide conundrum of delayed discharges from acute care beds by ensuring that patients are cared for safely in the most appropriate, supported environment.

Over the past 70 years the NHS has been a great success based on a great principle. We are living longer and healthier lives as a result. May I commend the Labour Government who, 70 years ago, in the dark days of a post-war Britain, had the courage and foresight to create the national health service, and also successive Governments, including, dare I say, Conservative Governments, who have supported the service that we all continue to value so much?

[Sir Peter Bottomley (Worthing West) (Con)]

If I were able to make a speech, which I cannot, I would talk about public health even before the health service. However, let me remind everyone that on the creation of the national health service, in January 1944, Henry Willink, a Conservative Minister in the coalition Government, held up the first White Paper that said, “national health service”.

HPV Vaccination for Boys

Peter Bottomley Excerpts

Wednesday 2nd May 2018 Westminster Hall

[Sir Peter Bottomley (Worthing West) (Con)]

I congratulate my hon. Friend the Member for North Thanet (Sir Roger Gale) on his address and on securing this debate. We have to remember two things. First, celibacy is about the only thing we cannot inherit from our parents. Sex may be adopted or forced on you, but it cannot be inherited, unless one is conceived in a glass dish, which most of us were not. Secondly, HPV is a vector. It goes from male to female and from female to male. If I was to alter my hon. Friend’s speech, I would say that the female, from whom the male may get the virus, probably got it from a male in the first place. We have to regard this as an almost endless chain of sexual engagement and the vector going on.

When I was involved in the HPV issue, it was to try to get the Government to bring in genital warts protection for females and to have that added to the cervical cancer vaccination. As it happened, the pharmaceutical company in the town I represent was making the vaccination that did not include it. Somebody came along and pointed out that this might mean a loss of trade for the particular business. I explained that the role and responsibility of a Member of Parliament—of the Government also—is not to put their constituency interest first, but to put the national interest first. My hon. Friend the Minister will not need any reminding that public health first means prevention of illness, then curing illness and then caring for those who cannot be cured. This issue is about prevention. The introductory speech should convince those behind the Minister to get things moving.

The arguments for delaying the addition of the HPV protection to the cervical cancer protection were scandalous. Adding to what my hon. Friend the Member for North Thanet said, if we are looking for herd immunity, we should note that, as has been discovered in Australia, it comes twice as fast if young males are offered the protection at the same time as young females. There is the extreme case of those males who only have sex with males—the herd immunity will not get through to them, and that leads to 400 avoidable deaths a year.

The key point is to get herd immunity for everyone far faster. It seems to me blindingly obvious, in medical terms, public terms and cost terms, that the sooner that happens, the better. If there is some problem about the run-on of the existing contract only being for a certain number, I say to the Minister that no pharmaceutical company that I know supplying the national health service would object to having its order doubled, so that young males were included with young females.

We look forward to hearing that the Minister is persuaded and that he will give a strong nudge to the Joint Committee. We look forward, in time, to being able to congratulate my hon. Friend on achieving—with Government, the medical profession, the nursing profession and the affected communities—this progress, which has been too long delayed.

--- Later in debate ---

[Steve Brine]

Not wishing to mislead the House, my honest answer is that I am not aware of that paper. Whether my officials are aware of it is another matter—I will ask them. I know that the hon. Gentleman will not be shy about putting a copy in my hand after the debate.

The good news is that HPV vaccination of girls also provides some—I emphasise “some”—indirect protection for boys. When the vaccination uptake rates are high, as they are in England, there are fewer HPV infections in heterosexual males, because the spread of HPV infection between girls and boys is reduced. There is evidence to back that up; it is not just words. For instance, diagnosis of first-episode genital warts in young heterosexual men between the ages of 15 and 17 declined by 62% between 2009 and 2016. That suggests that there is some—again, I emphasise “some”—herd protection from the existing HPV vaccination programme. However, that is not the start of the story, and neither is it the end, and I have to put it on the record that nobody in Government has ever said that it was. Nevertheless, I take the points that have been made today about herd immunity; it is only part of the story.

Of course, it will take much longer to see the impact that the girls programme has on HPV-related cancers, but we should not wait for those results before considering whether more needs to be done now for boys. As my hon. Friend the Member for North Thanet said, this is a slow-burn problem.

[Sir Peter Bottomley]

It is just a matter of pure mathematics. If 100%, or nearly 100%, of any age cohort —male and female—gets the vaccination, the herd immunity develops much faster than just relying on vaccinating up to 50% of that cohort.

[Steve Brine]

I think that my hon. Friend is stating facts, and I know that the JCVI officials who are here today will have heard him.

The JCVI keeps all vaccination programmes under review, as it should, and it keeps Ministers informed of any reviews. As my hon. Friend the Member for North Thanet is aware, given the increasing evidence about the link between HPV infection and oral, throat, anal and penile cancers, alongside the incidence of genital warts, the JCVI has considered whether HPV vaccination is now needed for males.

I understand the point that the hon. Member for West Dunbartonshire (Martin Docherty-Hughes) made about the surprise about penile cancer. He has more experience of the subject than I do, but it is not a surprise to me. I work with a very good charity called Orchid Cancer, some of whose staff attend my cancer roundtable regularly. It deals with male cancers and is trying to raise awareness of penile cancer as a challenge in society today. It is an issue that is difficult for society, let alone for men, to talk about. I thank the hon. Gentleman for what he has said today.

The JCVI considered its current piece of work in two parts: first, whether the HPV vaccination should be introduced for men who have sex with men—MSM—and secondly, whether it should be introduced for adolescent boys. MSM, as we know, are a group at high risk of HPV infection. Unlike heterosexual men, of course, they are unlikely to receive much, if any, indirect protection from the HPV vaccination programme for girls. The JCVI advised us that a targeted HPV vaccination programme should be introduced for MSM up to the age of 45 who attend genitourinary medicine clinics or HIV clinics. Following a successful pilot in 42 clinics that was led by Public Health England, we announced in February that the programme would roll out across the country from April, and it is now being rolled out. That programme is welcome, but again I fully appreciate that it is not the start and it is certainly not the end of the story, for some of the reasons that the hon. Member for Washington and Sunderland West set out in her very coherent remarks.

Let me turn to the issue of adolescent boys. Of the non-cervical HPV-associated cancers, not all cases are caused by HPV—indeed, the percentage of cases that are attributable to HPV is widely debated. My hon. Friend the Member for North Thanet mentioned The Swallows, which I do not have much contact with, although I have heard of it. I passed a note to my officials asking them to get in touch with the charity as a result of this debate, so it should look out for that. For head and neck cancers, alcohol is an important risk factor to take into account, but HPV does play a role, and that is why the JCVI is considering whether vaccination for boys should be introduced.

The JCVI issued interim advice on HPV last July. As Members know, that was subject to consultation. It is reviewing the evidence ahead of finalising its advice to Ministers. Its members are the experts, and they are best placed to consider the evidence and provide advice to Ministers. That is the system that Parliament has mandated. Parliament could change it, but that is our system.

[Sir Peter Bottomley]

When the Minister sends a report of this debate to the JCVI, it might be worth him respectfully saying that some of us here are aware of how long it took it to agree to bring in HPV protection even for females. It might want to consider whether postponing that decision was right or wrong. In my view, it was wrong. The people at the British Association for Sexual Health and HIV knew that it was wrong, and it took an awfully long time for them to change their minds. Can we please ask them respectfully not to make the same mistake again?

[Steve Brine]

Those people are nearer to my hon. Friend than he knows, and they will have heard his point.

In his opening remarks, my hon. Friend the Member for North Thanet asked the JCVI to take the long view, and I hope that I can reassure him somewhat on that point. Some examples of what the JCVI is taking into account in its considerations include: the projected future number of HPV cancers resulting from the current incidence of HPV infection; the potential savings as a result of preventing future cancers, which a number of Members have mentioned; the potential savings from preventing genital warts; and, crucially for my hon. Friend’s point, the long-term impact of HPV infection up to 100 years into the future, which will outlive even him.

The JCVI’s interim advice indicated that to vaccinate boys would be

“highly unlikely to be cost-effective in the UK, where uptake in adolescent girls is consistently high”.

It is true that the UK has achieved high uptake for the girls HPV immunisation programme for the past 10 years. In 2016-17, 83.1% of girls completed the current two-dose course, including the daughter of the hon. Member for Washington and Sunderland West. I have two young children—one of each—and of course those of us who are parents want what is best for our children. Somehow arguments about cost-effectiveness do not feel right. Cost-effectiveness is important, however, because it is about how to fairly, consistently and robustly assess which interventions and treatments should be funded in what we must remember is a publicly funded health system. We need to deliver value for money for the taxpayer and deliver the most health benefit possible to all patients. That is our system.

Contaminated Blood

Peter Bottomley Excerpts

Thursday 20th July 2017 Commons Chamber

[Jackie Doyle-Price]

I understand the right hon. Lady’s point and I repeat that the Cabinet Office is closely involved with this at this stage. I think she would consider it most remiss of me were I not to take a close interest as this consultation is taken forward. I cannot say this enough: it is essential that the way in which the inquiry is established inspires confidence in the people affected, and that is what we are trying to achieve through the consultation. As I say, we want to hear from them and we are completely open-minded as to which Department takes responsibility. For now, I want to have those conversations because I want to understand their concerns with what has happened with the Department of Health. As a Minister, I need to give that challenge.

[Sir Peter Bottomley (Worthing West) (Con)]

The letter from the hon. Member for Kingston upon Hull North (Diana Johnson) started by expressing gratitude to the Government for the progress made so far. That would have been welcome decades ago, but it is right to acknowledge it now. The letter included three practical points that it put perhaps slightly better than the shadow Minister. The machinery of government cannot work overnight normally and the questions and answers today will help the Government and the Prime Minister decide whether the right solution is, as has been suggested, having another Department or the Cabinet Office take on the consultation with the Department of Health helping as far as it can. The one point for the Department of Health now is whether it can guarantee the third point in the hon. Lady’s letter, which is that no records will be destroyed and that they will all be available to the inquiry.

[Jackie Doyle-Price]

I can certainly give my hon. Friend that commitment. Let me reiterate that we have made many documents available in public, all published, and I can give him every assurance that nothing will be destroyed. Having now taken the decision to hold an inquiry, we must get it right. I am happy to hear from hon. Members at any time if they have any specific concerns about whether they think evidence is being withheld, so that I can satisfy myself that that is not the case.