Junior Doctors Contract

Philippa Whitford Excerpts

Wednesday 6th July 2016 Commons Chamber

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

I, too, am disappointed by the outcome of the ballot yesterday. It has to be recognised that it reflects a real desperation and unhappiness among junior doctors, who are dealing with increased demand and pressure. They have felt that, at times, the tone of the negotiations has left a lot to be desired. The threat of imposition was there from the start, and they felt that hanging over them.

I welcome several things in the statement, and I absolutely welcome its very measured tone. I welcome the attempt to tackle the gender pay gap, to deal with unhappy foundationers and to limit hours. I would say that junior doctors’ biggest concern is rota gaps. In some specialties, the rate is as high as one in four, so one doctor covers the role of two. That is a real patient safety issue, and patient safety is meant to be the whole point of the contract. I welcome the fact that the contract will be phased in, and I call on the Secretary of State to ensure absolutely that, as this goes forward, he will learn, because junior doctors’ concern is about how we spread a short-staffed workforce across more days. I called for the contract to be phased in through a trial, and it is being phased in, but in a different way. We need to recognise the pain that the vote represents.

[Mr Hunt]

I thank the hon. Lady for her constructive comments, which are born of her NHS experience. She is right: we are phasing in the contract carefully to make sure that we learn lessons. She is absolutely right to talk about rota gaps. Unfortunately, the problem of rota gaps cannot be solved at a stroke on signing a contract; it has to do with making sure that we have a big enough supply of doctors in the NHS to fill those rota gaps. We now have much greater transparency about the safety levels that are appropriate in different hospitals; that is one of the lessons that we learned post Mid Staffs. We are investing more in the NHS in this Parliament. We recruited an extra 9,300 doctors in the last Parliament and we are increasing our investment in the NHS in this Parliament, so that we can continue to boost the doctor workforce in the NHS. In the long run, that is how we will deal with the rota gap issue; but unfortunately, that cannot be done overnight.

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 5th July 2016 Commons Chamber

[Ben Gummer]

The Home Secretary is well aware of the enormous contribution that EU nationals make to the NHS. We all have a duty to undo the damage done during the referendum campaign and the poisonous atmosphere that exists in some parts of our communities and to thank personally—I will be doing so myself—EU nationals working in the NHS for their hard work and dedication so that they feel valued by each and every one of us.

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

There has been a 27% surge in trainee applications to NHS Scotland because of the conflict around the junior doctors contract in England, and now doctors and academics from the EU are not taking up posts here because of the Brexit vote. With a one-in-four rota gap in many specialties, how does the Minister plan to sustain the current service, let alone extend it?

[Ben Gummer]

As much as I admire and like the hon. Lady, my opposite number on the Scottish National party Benches, I think that the behaviour of some of her colleagues in Scotland during the junior doctors dispute was not in the spirit of concord by which we try to establish relations with the devolved Administrations. I do not recognise the figures she quoted about junior doctors—I am glad that we have recruited well in this country during this difficult period—but I know that she will want to thank the British Medical Association for its work in bringing the dispute to an end. I hope that in the next few days we will come to a conclusion suitable for everyone.

[Dr Whitford]

I thank the Minister for that and for his welcome to EU nationals here, but with the Secretary of State merely repeating what the Immigration Minister said yesterday and given what the Home Secretary has said, does he not understand the urgent situation facing EU nationals working here? With more than 100,000 of them, do we not want to give them security of residency now to avoid haemorrhaging vital staff from the NHS?

[Ben Gummer]

The Home Secretary said she was confident we could get a deal ensuring that they could stay, but we need a new Prime Minister able to start the negotiations caused by the decision of the British people on 23 June. I say in my capacity as a Health Minister— the House has heard from other Members, including the Secretary of State—that we have full confidence in the EU nationals working in the NHS and wish to praise their contribution, which makes the NHS a better organisation.

Carers

Philippa Whitford Excerpts

Thursday 9th June 2016 Commons Chamber

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

I pay tribute to the hon. Member for Eastleigh (Mims Davies) for securing this debate in carers week. Frankly, one week in the year is not enough; carers care for more than just one week in the year. I will talk predominantly about informal carers—the people who are looking after family—but we should also remember the people who work in the care industry, because they support the carers and the people who need caring for. We have problems getting high-quality care because we do not value those people. We pay them very poorly. They work for companies that often treat them badly. Pay for travel time may not be included, and they may be doing 15-minute visits. These jobs are therefore short term and temporary, and people get out of them as soon as they have the opportunity. Unless we turn this into a profession that is valued and respected and includes development—as we have done with nursing, over the years—our relatives and loved ones will not be cared for by people who actually want to do the job. I would just like to open with that.

We have heard a lot of detailed statistics about informal carers. Across the UK, 10% of people—6.5 million—are involved in caring. In Scotland, the proportion is higher, at 17%. People often do not identify themselves. Those carers are not always the same people, because there is a turnover—a change—every year of one third, or 2.1 million people. Some of them, as the hon. Member for Strangford (Jim Shannon) mentioned, will be people caring for loved ones at the end of their life. When we lose that loved one, although we may face other challenges, we leave the informal care group, but other people take up that role. The same number of people—more than 2 million—enter and leave the role of informal carer each year.

We have heard about the cost that informal carers save the state. If we were to replace them with professional staff, the cost would be almost greater than that of the NHS, but how do we treat the people who deliver that care? A third of them live in poverty. That is because we have tangled things up so much around carer’s allowance, and we never seem to have a “health in all policies” view, so on different days of the week we make decisions that absolutely counteract each other.

My hon. Friend the Member for Ayr, Carrick and Cumnock (Corri Wilson)—I hope I got that right—mentioned some of the changes that have been made, including to the personal independence payment and the employment and support allowance work-related activity group. Perhaps the Government think that those changes send people back to work, but the reality is that many of the people affected, particularly where mental health or waxing and waning illnesses are involved, will not get back to work. That household will simply become more impoverished. We need to realise that that has an impact. If someone cannot afford to do things, their quality of life goes down. People who are caring— 1.3 million of them for more than 50 hours a week—already have a pretty tough life without having to deal with poverty on top of everything else.

We have heard that carer’s allowance is some £62 a week; it is pretty insulting that that is less than jobseeker’s allowance. People tend to spend six or nine months on jobseeker’s allowance, but they may depend on carer’s allowance, along with other benefits, for much longer than that. To pay someone, in essence, £62 a week for the hours that they put in is derisory. In Scotland, if I may correct the hon. Member for Strangford, we are not just considering raising carer’s allowance to £72 a week; that is a commitment. It will become the same as jobseeker’s allowance. Even that is very much a baseline. It does not recognise what those people need.

Of course, there are people in caring situations for whom money is not an issue, because they have a pension or large amounts of savings, but they are not the generality of cases, if a third of carers are in poverty. Half of them have used up all their savings and have had to borrow. A quarter of them have had to re-mortgage their home. That all adds stress to people who contribute massively to society.

We have well over a million older carers, as the hon. Member for Bexhill and Battle (Huw Merriman) mentioned. What has not been mentioned in this debate is that people on retirement pension do not qualify for carer’s allowance. That seems bizarre, because one of the biggest groups of carers is people who are retired. In the past, people would have been caring for a partner as they became more frail, but as people are living longer, we are retiring people who are caring for a parent, or for a parent and a partner. The hon. Member for Eastleigh spoke of caring for little ones and older ones, but we actually have people who are caring for older ones and much older ones. That is massively challenging.

At the other end, we have heard mention of young carers, who are defined as those under the age of 16. They are completely excluded from carer’s allowance as it starts only at the age of 16, yet those children again play a major role and suffer major detriment. They will often be in a poor household, because the parent—as it usually is—for whom they are caring will have suffered from the various cuts to support. Their parent may have a physical or mental illness, may suffer from addiction, or may in other ways not be the parent in the family. If 12 and 13-year-olds are carrying that burden, and cannot afford to go on a school trip, and do not have time to do the little Saturday job or paper round that allowed the rest of us to invest in the height of fashion, we are allowing their quality of life to be lowered still further.

Young adult carers are defined as being 16 to 25. If they are students, they are automatically excluded from carer’s allowance, regardless of the fact that a quarter of them work more than 20 hours a week. If they work less than 35 hours a week, they do not qualify for anything. If they are official students, they qualify for nothing.

We have all these pockets of people who are working really hard, yet we as a state are offering no support to them. That is the minimum that we should be doing. They will still be doing a hard job and putting in long hours that save the country masses of money. We should all feel ashamed that they can have to choose between eating and heating, and that there are young people who have no opportunities and know that their job opportunities will be limited by going through that. Obviously, given my health background, I have looked at the health of these people, and they are twice as likely to be ill. Indeed, 8% of them are on disability living allowance as was, so we have someone who has frailty caring for someone else who has frailty.

One fifth of the people who are putting in more than 50 hours a week are not getting any services because, as has been mentioned, they do not identify themselves as carers, no one else identifies them as carers, and they have no idea where they should go to get help. I back the call that this should be part of the health service’s duty. If a doctor diagnoses someone with advanced cancer or dementia, or a child with disability, they should ask, “Who are the carers here?”. That is part of the primary care role in Scotland, but I am not sure what the roles are in England. Certainly, as part of the quality framework in Scotland, there must be that discussion. There is still room for improvement in our communities on that. People simply see themselves as looking after their family, but actually, they are looking after all of us.

We know that the ageing population will increase. We already have 800,000 people with dementia, who are being looked after by 670,000 carers. At the moment, 60% of us will be carers at some point. As the numbers increase, all of us must expect to spend a portion of our lives as a carer. If that always causes massive detriment to our work, our ability to do anything and our quality of life, we will have allowed the quality of life of everyone to deteriorate.

For women, there is a disproportionate hit, because 60% of carers are women, and one in four of those women will end up giving up work. As was mentioned, they end up in part-time, low-quality, low-paid jobs, and they do not get promotion. Right at the end, they get a rubbish pension, which, as we have heard in many debates in this Chamber, may be plucked out from underneath them. That is the last slap in the face. With modern technology, we should be able to have more home working and flexible working to allow people with talent and skill to remain active and have a career, even if they face a few years of having to commit to caring for someone. As we go into the future, whether we are carers or not, as politicians we need to make sure that we provide the basic funding and services to support carers as they support those who need help.

As individuals, we need to do more in our communities. We have heard mention of carer-friendly communities. I was honoured last Saturday to be part of the launch of one of my local towns, Prestwick, as a dementia-friendly community. It was a fantastic event, and the turnout of the community at the market cross for music, food, cupcakes, fiddling and singing by the wonderful Musical Minds choir, which is made up of people with dementia, was fantastic. The community is already coming forward, and local businesses have undergone training.

Within that, we have a group called Crossroads, which supports carers and allows them little informal breaks, so that they can try to keep some of themselves. Women are used to being recognised as somebody or other’s wife and somebody or other’s mother once they have got past being so-and-so’s daughter. The problem for somebody facing this intensity of care is that they can feel like they disappear altogether—that they as a person have no outside view at all. Their hobbies are gone and, as was mentioned earlier, their friends are gone.

It is important, not just as politicians and people in families, but as members of our communities, that we value and recognise carers if they are out and about, and accept the person they are caring for, no matter if they are a bit loud, if their wheelchair gets in the way, or if they need time to get on the bus. If we accept the person they are caring for, the carer will also feel more accepted in our communities. Basically, I call on everybody, because we all have a role to play.

[Mark Durkan (Foyle) (SDLP)]

Just as we must not lose our recognition of people, or identify them just by their disability, the fact that they need care or the fact that they are carers, it is important that we recruit carers to contribute to thinking on public policy—and not just when it relates to care issues; often, carers are disfranchised and disconnected from society because of their caring commitments. All of us at all political levels need to do more to engage carers, so that they contribute to a range of public policies.

[Dr Whitford]

I thank the hon. Gentleman for his contribution. I refer him back to the comments of my hon. Friend the Member for Paisley and Renfrewshire North (Gavin Newlands) about the Carers Parliament in Scotland, which looks at young carers, young adult carers and older carers. When they consult, the Scottish Government make great efforts to pluck people out of the voluntary world to come and tell them how it really is, because unless we hear how it really is, we are not going to fix it.

We all have a duty, including the Government, to look more at health in all policies. We cannot fix everything, but we should not be adding poverty on top of all carers’ other challenges.

NHS Commissioning (Pre-Exposure Prophylaxis)

Philippa Whitford Excerpts

Tuesday 7th June 2016 Commons Chamber

[Jane Ellison]

I thank my hon. Friend for his kind words. I take this issue extremely seriously. He is right to say that we face a challenge in relation to HIV rates, and particularly, as I said, STI rates in the high-risk MSM community. I stress again that while it will no doubt have an important part to play, PrEP is not a silver bullet for sexual infections, particularly in some of those high-risk groups. It is important to understand that. We have to continue to look at a whole range of measures. When I recently met the chief executive of the Terrence Higgins Trust, we touched on this.

As my hon. Friend says, we have a meeting coming up. I apologise for not responding to the shadow Minister’s question about meeting stakeholder groups. Of course I will meet all the key stakeholder groups. I have already had some formal and some informal discussions on this, but of course I am very open to having further such discussions. Stakeholders were involved in the process that NHS England has been involved in. NHS England has made its position clear, and there is a matter due to go before the courts on which I will not comment further. Yes, I will engage on this. Yes, of course I accept that we need to do more, and of course we all share the concerns about rising HIV infection rates, particularly among the MSM community. I too lost friends to the AIDS epidemic that my hon. Friend mentions. I take this issue extremely seriously, but we have to follow a sensible process, and that is what the Government are doing.

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

Anyone in this House will be glad to see the results of the PROUD study and the 85% reduction in new infections. However, there is more to understand, in that we did not see a good response in heterosexual women. While over 40,000 HIV sufferers in the UK are men who have sex with men, 60,000 are heterosexual or bisexual, predominantly of African origin, and we need to think of them in this regard.

My main complaint is on the failure to go through a process of looking at clinical evidence and cost-effectiveness and then making a decision. Why was the company not encouraged to get through this earlier and go to NICE? I do not understand why we are only going to NICE now, because that gives the answer that we need. It is relatively poor of NHS England to have made the decision on the basis of, “It’s not our job—it’s your job.” That is the most insulting bit for the community. In Scotland, our Cabinet Secretary asked it to go through the European Medicines Agency, which it applied for in February, and then the Scottish Medicines Consortium. It is on the right path now, but that is where we should have gone first.

[Jane Ellison]

It is probably worth clarifying that we asked NICE to undertake an evidence review, not a technology assessment. What drugs are licensed for are matters for drug companies to address. The Government do not initiate the process on whether a drug is licensed— the drug company must initiate it. It also worth noting that when a drug is licensed for a new purpose, as would be the case for Truvada in PrEP, the company could apply for the patent to be extended to cover this new use. Again, that is something that the drug company would do.

On the hon. Lady’s first point, I agree that we need to consider the impact on women in the circumstances she described. That is one of the arguments for carefully planning this pilot programme and taking those sorts of factors into account.

Junior Doctors Contract

Philippa Whitford Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

First, I very much agree with my hon. Friend in her thanks to Professor Dame Sue Bailey for the leadership that the Academy of Medical Royal Colleges has shown in the initiative that, in the end, made these talks and this agreement possible. I know it has been a very difficult and challenging time for the royal colleges, but Professor Bailey has shown real leadership in her initiative.

I also very much agree with my hon. Friend about the need to sort out some of the issues that have been frustrations for junior doctors—not just in the last few years, but going back decades—in terms of the way their training works and the flexibility of the system of six-month rotations that they work in. This is an opportunity to look at those wider issues. We started to look at some of them yesterday. I think there is more that we can do.

It is important that this is seen not as one side winning and the other side losing, but as a win-win. What the last 10 days show is that if we sit round the table, we can make real progress, with a better deal for patients and a better deal for doctors. That is the spirit that we want to go forward in.

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

I absolutely welcome this agreement, and I pay tribute to the Academy of Medical Royal Colleges for bringing it about. I do wish there had been some response to the letter that I and other Members sent before the all-out strike, because it was a genuine attempt to create a space that both sides could step into. However, I am glad that we have got to that stage now.

I welcome the recognition of the equality issues, which, to us and to many junior doctors, appeared to have been dismissed in the impact assessment. On the idea of flexible training champions in each trust, I myself was a flexible training senior surgeon—indeed, the first one in Scotland—and the idea of accelerated training is important. However, one concern I have is about childcare. If women junior doctors are going to be working longer, more antisocial shifts—I remember what I had to fork out for childcare—I would like to know whether the NHS will respond to that. Will that be in the form of crèche hours or support?

I welcome the fact that the hours guardian will be linked to the director of medical education and that there will be an elected junior doctors forum. One concern of junior doctors was that they would have no voice in relation to the guardian.

I also welcome the idea of using modern technology in rota-ing. At the moment, rotas are sheets of paper, and often no one looks at the shoulder from one rota to the next, so people can end up with the very long periods on call. However, one concern that remains is rota gaps. We do not have enough junior doctors, and we do not have enough junior doctors in the most acute specialties. How is the Secretary of State planning to re-establish a relationship? How is he going to recruit people to fill that gap? That was the core fear of junior doctors: a lack of doctors, with doctors simply being spread further. How are we going to recruit and retain doctors after the painful clash that has been going on for the last year?

[Mr Hunt]

I welcome the tone of the hon. Lady’s comments; we might have wished for a similar tone from the shadow Health Secretary. Let me address the comments of the hon. Member for Central Ayrshire (Dr Whitford) as constructively as she made them to me. She is right about flexible training. We have to recognise that the junior doctor workforce is now majority female, and that a number of family and caring pressures need to be taken account of. We need to do that for the NHS not only because it is the right thing to do, but because we will lose people if we do not. Those people will simply leave medicine, even though they have been through very extensive and expensive training.

We have to look particularly at the responsibilities of doctors with young children. One of the things that we announced yesterday was an obligation on trusts to take account of caring responsibilities. If, for example, a doctor wanted to work fewer hours in school holidays and more hours in term time, we cannot guarantee that a hospital would always be able meet those needs—the needs of patients always have to come first—but they could at least be taken account of, in the same way as they are in many other industries that operate 24/7. The hon. Lady is absolutely right to say that modern technology is key to that. An air steward or a pilot who works for British Airways can go on to an electronic system and choose the shifts and hours that they want to work. Because we have failed to modernise the NHS, we have seen a huge growth in agency and locum work, which is partly driven by the fact that it offers precisely the flexibilities that people need. These are important changes, and we intend to take them forward.

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 10th May 2016 Commons Chamber

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

I too am glad that the Secretary of State has reopened talks with the junior doctors, but I am a little concerned by the claim that the only issue is Saturday pay, whereas the doctors tell me that they fear the danger of exhaustion. Has he seen the analysis by Cass Business School suggesting that it is impossible to avoid high levels of fatigue under the new contract?

[Mr Hunt]

What I have done in the new contract is precisely to try to address those issues by reducing the maximum number of hours that junior doctors can be asked to work every week from 91 to 72 and by stopping junior doctors being asked to work six nights in a row or seven long days in a row. These are important steps forward, and the hon Lady may want to look at Channel 4 FactCheck and other independent analysis of the safety aspects of the new contract which say that this contract is a safer contract.

[Dr Whitford]

I would just say that stating it does not make it happen. Junior doctors have looked at the rotas that have been put out as exemplars, and they will not be able to avoid high levels of fatigue. Does the Secretary of State not recognise that, now that we have more data suggesting that the weekend effect may just be statistical, we actually require clinical research because he does not know exactly what the problem is that he is trying to fix?

[Mr Hunt]

The new data that the hon. Lady has talked about have been heavily contested this week by some of the most distinguished experts on mortality rates in the country. Academics do sometimes disagree, but Ministers have to decide. The fact is that the overwhelming evidence—whether it is on cancer, cardiac arrests, maternity or emergency surgery, and whether it is in big studies, small studies, UK studies or international studies—is that there is a weekend effect. This Government are determined to do something about it, and I gently say to the hon. Lady that she might consider whether something similar should be done in Scotland.

World Autism Awareness Week

Philippa Whitford Excerpts

Thursday 28th April 2016 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I congratulate the Backbench Business Committee on granting this debate, and the right hon. Member for Chesham and Amersham (Mrs Gillan) on securing it and on being an autism champion. As a clinical psychologist I have worked with many people who have autistic spectrum disorder. I put on the record that it is a privilege to be a member of the all-party parliamentary group on autism and to be a co-sponsor of the debate.

Autistic spectrum disorder is a pervasive lifelong developmental disorder that affects people’s social interactions. It impacts on how people communicate with others, how they relate to people and how they experience the world around them. Being a professional is one thing, but the key lesson we must learn is that the greatest insights come from those who have autistic spectrum disorder and their families. We must listen very carefully to what they tell us.

We know that how we interact with individuals with ASD and their families can have a huge impact on their quality of life. Negative public reactions can encourage people and their families to avoid situations and social contact, leading to their becoming socially isolated and experiencing mental health difficulties.

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

The debate has covered a lot of the structural and supportive things that need to be done, but does it not also throw down the gauntlet to us about the need to change our view? We think of people with autism as finding it difficult to see the world as we see it. We actually need to see the world as they see it.

[Dr Cameron]

As usual, my hon. Friend makes an excellent point. We must focus not on the difficulties faced by those with autistic spectrum disorders but on their full potential, and we should have greater awareness of the world as they view it.

Research indicates that 66% of autistic people, and 68% of their families, have reported feeling socially isolated, and 70% of autistic individuals are reported to have mental health disorders such as anxiety or depression. Autistic adults have been reported to be nine times more likely to die from suicide. There is a clear need to address comorbidity, and particularly mental health difficulties.

One constituent who contacted me advised that the “Too Much Information” video and campaign, which must be commended, had resonated with her. Her eight-year-old daughter has autism, and she shared with me some of her personal experiences. Her daughter is extremely vulnerable and sensitive to everyday sights, sounds, touches and smells, which cause her anxiety, panic or obsessive worries and despair. She cannot cope with changes to her environment, and she is prone to becoming distressed in public. As a result, she has experienced negative community responses, including from school peers. Her reaction has been reluctance to go back to school, and withdrawal from her extracurricular activities. Sadly, that means that she is at risk of becoming further isolated, and it is clear from this story—such stories were common among those who contacted me—that we all need to do more in many areas.

I recently attended Milton Primary School in my constituency, where the lack of understanding about pupils with autism among peers and their parents was highlighted to me. The headteacher is now engaged in good work to increase understanding through planned awareness sessions, and I commend her on that fantastic local development. Again, that highlights how teacher training and awareness in schools is key.

As has been mentioned, we must raise awareness and understanding among employers to help support people with autism into employment. Having a job is about earning a living, but it also contributes to psychological wellbeing. It can provide people with a sense of belonging and purpose, and build confidence and self-esteem. The autism employment gap is even bigger than the general disability employment gap, and only 15% of autistic adults in the UK are in full-time work. The Association of Graduate Careers Advisory Services has reported that 26% of graduates on the autistic spectrum are unemployed. Mainstream employment programmes currently on offer are failing to capitalise on the potential of those with autism. I urge the Minister to ensure appropriate support for people with autism, and for that to be covered by proposals in the disability and employment White Paper.

In 2011 the SNP Scottish Government launched the Scottish strategy for autism, and declared that autism is a national priority. That strategy attempts to improve diagnosis and assessment, and to create consistent service standards. It also helped to establish one-stop shops. We must continue to support that issue, and I offer my full co-operation and involvement with my hon. Friend the Member for Motherwell and Wishaw (Marion Fellows) to save our local one-stop shop.

We must all be champions of autism, and I ask the Minister to support an awareness campaign, promote training for teachers and local authority staff, tackle issues raised in the White Paper, ensure that more clinicians are trained, and consider waiting time guidelines. Society must not continue to fail people with autistic spectrum disorder, so let us do all that we can together to ensure that we succeed.

Meningitis B Vaccine

Philippa Whitford Excerpts

Monday 25th April 2016 Westminster Hall

[Geoffrey Clifton-Brown]

I could not agree more. That is why the CEMIPP group study should look at not only the medical costs but the educational costs, the cost of carers and so on. There are considerable costs to the public purse. We tend, under our democratic system, to be quite short-termist in our view of such matters. I am involved at the moment in work on drugs for cystic fibrosis, to which exactly the same issues apply. After the considerable cost at the outset, there is a lifelong benefit to babies from getting such drugs. If we are going to carry out a cost-benefit analysis for the meningitisusb B vaccination, that is what we should consider.

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

I agree with the vast majority of what the hon. Gentleman says. In actual fact, it was not possible to trial Bexsero in humans because this is such a rare condition, and therefore we do not yet know whether the immunity will be for life.

[Geoffrey Clifton-Brown]

I am extremely grateful to the hon. Lady. The benefit of these debates is that we always have a professional on hand who can give us the last word on the subject. My sister is a GP and would no doubt have given me that same advice.

I am grateful for the chance to speak in this debate. This is a tragic disease with tragic consequences. I urge the Minister to go further, and faster in rolling out a good, safe vaccine that will give immunity to a larger section of the population.

--- Later in debate ---

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

I apologise to the Chamber for being late; that was due to the health statement earlier. I, too, begin by paying tribute to the families who attended the combined Petitions and Health Committees last month. Their bravery in going through their experience again was incredible, and it was obviously very moving for us to listen to.

Funnily enough, this is World Immunisation Week, so the debate could not have been timed any better. Just think of the lethal diseases and conditions that we have tackled across the world because of immunisation. The hon. Member for Totnes (Dr Wollaston) referred to polio; we have not beaten that yet, but we are on the way.

Meningitis is an inflammation of the meninges, the covering of the brain, and that can happen with other diseases, not just meningitis B or any of the meningococcal diseases, but they are the most serious; they are the ones that result in the biggest harm. There is A, B, C, W and Y. When I was a younger doctor, which was a wee while ago, meningitis C was the big concern. It was very common in teenagers as well as in children, and there was always a big peak when people went off to university, but in 1999 the vaccine for that was introduced. It was given to those right up to the age of 18, and 90% of those cases are now prevented, which is a real transformation.

That leaves meningitis B, which is the most lethal type and affects people very quickly. We have heard that from the families and from hon. Members in the debate. There are not many conditions whereby someone will go from being slightly off-colour to either death or permanent disability in less than 12 hours. Having worked in a paediatric hospital and dealt with children with meningitis, I can tell hon. Members that for a doctor, it is terrifying. As was talked about in the Committee, it is not that doctors think, “Och, no, it won’t be that; I’ll ignore it.” It is simply that it is so hard to pick out that child. When they are a little bit hingy, as we would say in Scotland—a little bit off—it is not obvious, but there are signs that people should be looking for.

As the hon. Member for Faversham and Mid Kent (Helen Whately) said, do not wait for the rash. I was delighted to see in the Meningitis Now advice that that is written in big red letters: “Don’t wait for a rash”. Do not wait for the rash if the child is quiet, not reacting normally and very feverish. As a doctor, what I would say is of real concern is cold hands and feet. If a child has a fever, yet has cold hands and feet, that to me is a sign of septicaemia—a sign that the blood supply to the extremities is beginning to shut down. That should be a warning sign long before we get to the rash. Reading the testimony produced by the families and the petitions group is absolutely heartbreaking. In case after case, the first warning sign that the parents or the medical professionals recognised was that horrible rash.

It is important that we take account of the long-term disability. One in 10 of these children will not survive. One in three of them will be left with a severe disability. That includes brain damage, cognitive and sensory impairment and, as we have heard, limb amputation. That is horrific to think of in little children. I can tell hon. Members as a doctor that this impinges on doctors as well. If someone has seen a child and not spotted meningitis, or seen a child and watched them just slip through their fingers, that is absolutely horrific. Meningitis moves so fast that vaccination has always been the holy grail. We now have it, but we probably have not rolled it out widely enough, because of the cost-benefit analysis.

I will echo the hon. Member for Totnes: there is no question but that the decision should not be made in this House. It is not a political decision; it must be made in the cold light of evidence of benefit, but that is not just cost-benefit; it is also risk-benefit. We spend a lot of our time being lobbied by constituents who are against vaccination. Think of the saga we have been through with the measles, mumps and rubella vaccine in the last decade, and here we are with a movie reigniting all of that.

There was no trial with Bexsero, so we are still gathering the data through this year. I am talking about the efficacy, safety, side effects and, crucially, as I mentioned earlier, whether people have permanent protection. We do not know that yet, but questions on those points have to be answered, so it is crucial that the body responsible is the JCVI . On my reading, the key problem has been in the discounting. Of course if people invest money in any treatment, they want a quick return. That is what the City of London would look for as well. But we are talking about preventing things—preventing damage that will be with someone for their whole life. A child’s life is written off, before they are 28, as really not having any additional value in being saved. A discounting of 3.5% means that that value is gone at that age, even though we have perhaps saved 70 years of life. In particular, if the child never got ill in the first place, we would have saved a disabled life; we would have saved a life of suffering, and the cost to society and the family of looking after a child who perhaps faces incredible disabilities and suffering.

Every year, that life is discounted at 3.5% until we reach zero, yet we accept that public health measures, such as smoking cessation, take a long time to give us a return. Having seen the results of people smoking, I am not quite ready to say that we should give up on those public health measures. We need people to stop smoking as that will save us money in the long term. However, we should be using the same rate, because if we were discounting at 1.5% a year, the catch-up up to the age of five would have been considered cost-effective. It is not that the rate should not be down to the JCVI, or that it should not be based on proper medical evidence. The issue is the tool that was given by the National Institute for Health and Care Excellence, based on the Treasury figure of 3.5%, although appraisal committees can consider anything between zero and 6%. The key thing is to ask for that evidence to be looked at—specifically the long-term costs of major disability—and to look at the impact on the decisions of using that lower discount rate.

The other thing mentioned was a study of adolescents. In meningitis C, we were particularly after the adolescents. Babies do not carry meningococcal meningitis; teenagers do. When we vaccinate little children, it is for the individual protection of that child. The protection that is given by teenagers is herd immunity. When they stop carrying it, babies will catch it less. We do not know whether that will happen with Bexsero as it is such a different vaccine. As the hon. Member for Totnes mentioned, the whole structure is totally different. Normally, we are looking at the sugars on the surface of bacteria. Bexsero was done through genomics—identifying protein to create antigens and antibodies. It is so expensive because it has been done in a totally different and novel way.

We need to do a study on adolescents. There seem to have been a couple of years of talking about doing it, yet we have not even started or laid out the terms and parameters. It is really important that we answer the questions with evidence, not just by thinking that we would quite like to splash the vaccine around. The case for extending the catch-up to five years is stronger as half the cases will happen before the age of two and the majority will happen before the age of five. The cost burden for a child who requires 24/7 care for their entire life—particularly when they are older and their parents are no longer looking after them—including the burden on their family, friends and society, is enormous. I find it hard to believe that it would not be cost-effective to prevent that.

For me, as a doctor, vaccination is almost the only way. The one thing I do not recognise in the cost-effectiveness balance is the talk about peace of mind. As we explored with families in Committee hearings, peace of mind caused some of the problem, because some parents thought, “My child is vaccinated against meningitis.” We cannot cast that up. A simple change in the discounting method and the inclusion of long-term social care costs are the most important things.

Even if we roll the vaccination out, we must remember that there are other types of meningitis, and that there is more than one strain of meningitis B. We need to get that great little Meningitis Now card out to families and parents as widely as possible, but we also need to get this message to doctors: do not wait for the rash. Look at the child, listen to the parents, and, as I said earlier, think about cold hands and feet. We have the potential to stop the damage of this absolutely horrific disease, and I hope that we take the issue back to the JCVI.

--- Later in debate ---

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

I thank all hon. Members who have spoken in this important debate. As others did, I start by offering my condolences to the family of Faye Burdett, whose tragic death sparked such interest in the e-petition that led to this debate, and to all the other parents. Their powerful testimony on their personal family tragedies has led us and their Members of Parliament here today, and they have helped to stimulate interest in the petition, which has huge support, with more than 820,000 signatures. The petition goes right to the heart of the concern that parents and the public have about meningitis.

I have listened to the many hon. Members who have spoken this afternoon and, like everyone in the Chamber, I have been moved by the stories we have heard of how both meningitis and septicaemia have affected families and, in some cases, have tragically changed their lives forever. As has been made clear, meningococcal meningitis—the infection and inflammation of the lining of the brain—and meningococcal septicaemia, or blood poisoning, which for simplicity I will refer to as meningitis, are very serious infections that can be severely disabling and even fatal, as has been movingly and, in some cases, starkly demonstrated by hon. Members today. It is right that we should have robust arrangements in place to protect against this disease. In fact, we are the only country in the world with a vaccination programme for all the major causes of meningitis, and it is clear from the strength of feeling today that hon. Members fully support the meningitis and other world-class vaccination programmes that we have in place to protect individuals, particularly children, and the community as a whole by vaccinating against preventable diseases.

For 35 years successive Governments have based decisions on vaccination programmes on independent expert advice from the Joint Committee on Vaccination and Immunisation, and it will help to answer one or two points that have been raised if I clarify the JCVI’s legal basis. Since 1 April 2009, the Health Protection (Vaccination) Regulations 2009 have placed a duty on the Secretary of State for Health in England

“to ensure, so far as is reasonably practicable, that the recommendation of the JCVI is implemented”

where certain conditions are met, including that the recommendation is

“in response to a question referred to the JCVI by the Secretary of State”

and that it is

“based on an assessment which demonstrates cost-effectiveness”.

That is the basis on which the JCVI was constructed and under which it operates.

At the recommendation of the JCVI, as the House knows, we introduced in September 2015 a men B programme, using the vaccine Bexsero, for babies born on or after 1 July 2015. The babies receive a dose of vaccine at two months, with a further dose at four months and a booster at 12 months. To ensure that we have protected as many infants born in 2015 as possible from men B before the usual winter peak in cases, we also offered the vaccine to babies born in May and June 2015 as part of a one-off catch-up programme, which was possible because the vaccinations could take place when the babies were due to attend their routine immunisation appointments at three and four months.

By May 2016, all infants under one will have become eligible for the men B vaccine, and by May 2017 all children under two will have become eligible for vaccination, which clarifies the points made by my hon. Friends the Members for Erewash (Maggie Throup) and, in particular, for The Cotswolds (Geoffrey Clifton-Brown). Obviously, much of today’s debate has focused on extending the men B vaccination programme, and hon. Members and those who signed the e-petition want us to go further, which I absolutely understand. The term “meningitis” strikes fear into the heart of any parent. Public Health England surveys parental attitudes, and its surveys regularly show that meningitis is the disease that parents fear the most. When we hear sad stories and see utterly heart-breaking pictures of children such as Faye, of course it adds to parents’ fear and worry. They want what is best for their children, which includes protecting them from meningitis if there is a means available to do so.

The Government feel the same, which is why we became the first country in the world to introduce a programme using Bexsero. However, although meningitis is a much-feared disease, it is now much rarer, thanks in large part to the success of this country’s immunisation programmes. Cases are currently at their lowest numbers in more than two decades. To give the House an example drawn on by the hon. Member for Central Ayrshire (Dr Whitford), who spoke for the Scottish National party, cases of meningitis C have dropped from a peak of around 900 in 1998-99 to about 30 cases in 2014-15. Very few children will get meningitis, and thankfully, deaths are uncommon, although no less tragic.

The hon. Member for Central Ayrshire also mentioned teenagers. As I have enough time, I will draw the House’s attention to the men ACWY programme that we have introduced. Men W is the strain of meningitis that has increased; cases have been increasing since 2009. There were about 50 cases in 2012-13, about 100 in 2013-14 and around 180 in 2014-15. We rapidly introduced a vaccination programme this year as part of an emergency response to control the national outbreak of group W meningococcal disease. Provisional data show men ACWY vaccine uptake at around 34% in the urgent catch-up cohort aged 17 to 18 in 2014-15. I say that to enlist the help of hon. Members when we try to increase awareness of the men W campaign again this year. We need any help that can be given in publicising it. As I remarked with one colleague before the debate, it is considerably harder to get teenagers to the GP than small infants. It is an important campaign involving a very dangerous strain of meningitis that we must continue to bear down on.

However, the petition is about men B. It calls for the men B programme to be extended to children up to 11 years, although several hon. Members have suggested that up to five years may be a compromise. I fully understand why parents and the public want the extension, but as we have begun to explore in this debate, it is not a simple matter; I hope that hon. Members agree. Some of the reasons for that have been teased out, and I will say a little more about them.

Any Government must make the best use of the resources that they have to ensure that they deliver the maximum health benefit to the population. The greatest burden of meningitis B falls on the under-ones, who have therefore been our focus, on expert advice. As we have heard, such judgments are based on NICE’s rules on cost-effectiveness, which have helped successive generations of Ministers to make difficult decisions that are none the less fair and justifiable and reflect, as the Chair of the Health Committee said, the many challenges across our healthcare system.

I have spoken in detail to Professor Andy Pollard, the chair of the JCVI, to understand what process the committee went through when considering the men B vaccination and to be assured that the committee’s recommendation is robust. I have been reassured that the programme we have is the right one, targeting the group of children at highest risk of disease and death. Professor Pollard confirmed that a catch-up programme for one to four-year-olds would not be cost-effective at a realistic vaccine price. Also, the disease is so rare in those aged five to 11 that a programme for that age group would not be cost-effective, and the JCVI could not recommend it.

[Dr Whitford]

Is it not the case that the JCVI did a cost-effectiveness analysis using a 1.5% discount, which is the same as in public health, and at that level a catch-up programme for one to five-year-olds would be cost-effective?

[Jane Ellison]

I am coming to that point, but I thank the hon. Lady for her intervention.

As it stands, on the evidence and advice that I have received, I cannot support extending the men B vaccination programme to older children, but I emphasise that the JCVI keeps under review the evidence relating to all vaccination programmes, and I know that it will consider all the points made in this important debate. If the committee’s advice changes, I will consider it as a priority. The JCVI also keeps the eligibility criteria under review. I wrote to the chair on 17 March this year, following the evidence session with parents, asking the committee to review the cost-effectiveness evidence for one to two-year-olds, which Professor Pollard mentioned in his evidence to the committees. I await formal advice on that. Again, if the JCVI’s advice changes, I will consider it as a priority.

Many of the contributions made by hon. Members in this debate have queried whether the cost-effectiveness methodology used by our experts is right for immunisation programmes. The shadow Minister drew out that point, as did others, including my hon. Friend the Member for Bath (Ben Howlett), who led the debate on behalf of the committees. As some hon. Members said, an independent expert group—the Chair of the Health Committee gave it its full title, but I will call it CEMIPP for ease—is considering the cost-effectiveness methodology for immunisation generally. It includes factors such as peace of mind, cost of long-term social care for surviving children and how prevention is taken into account, all of which have been mentioned in this debate, as well as the issue of discounting.

The CEMIPP review is considering whether current discount rates are appropriate for vaccination in general, and it will report in the summer. I will consider any recommendations on that, although obviously I cannot pre-empt decisions in this debate. As I indicated to the Chair of the Health Committee when she made her contribution, I look forward to receiving the report in the summer. I have committed to publishing the report, and I do so again. If it is of interest, I will also provide the Petitions and Health Committees with a written briefing summarising the report and the Government’s proposed next steps when we get it.

Several hon. Members have expressed concern about whether the research requested by JCVI into whether a men B vaccination programme for adolescents would be cost-effective will take place and how long it might take. I can confirm that a preliminary study of the meningococcal strains carried by teenagers is now under way and will report in February 2017. It will inform a larger study of the effect of men B vaccination in that group. As the Chair of the Health Committee said, it is about exactly how the impact of the larger group would bed down on the impact of the disease in smaller children. I commit to the House to commission the second, wider study following on from the preliminary study now under way on strains.

I recognise that Members have concerns—again, the hon. Member for Central Ayrshire mentioned this issue—about how long the research is taking. I have had extensive discussions about that, because like hon. Members, I want quick answers. However, things are sometimes difficult to weigh in the balance. Robust scientific studies on which long-lasting and important decisions can be taken take time. My scientific advisers have told me that this is a particularly complex study, and that a previous study had inconclusive findings. We want to get this one right and ensure that we have a definitive answer. I am hopeful that this study could start in December 2017. The House has my complete assurance that we will always go with as much speed as we can while maintaining important robustness, so that we reach answers on which evidence-based policies can be made.

Much has been made about the importance of raising awareness and ensuring quick treatment. As many have said, no matter what the nature of the vaccination programme, there will still be cases, and we need to bear that in mind. Many Members have spoken of the reassurance that vaccinations offer and how they set minds at rest; it came out particularly in some of the evidence sessions. Although it is important that it reassures parents, I take this opportunity to underline and stress that vaccination is not a silver bullet. Even with a vaccination programme up to the age of 11, there would still be men B cases in under-11s, as we think that the vaccine covers only about three quarters of all men B strains and no vaccine is 100% effective.

A number of people have made the point, including the hon. Member for Central Ayrshire in an earlier intervention, about understanding the impact of the programme. No other country has introduced a free vaccination programme.

There is as yet no evidence regarding the real-world effectiveness of Bexsero in preventing meningococcal disease in a population—that is different from the safety issue—because, as has been said, incidence is too low for clinical trials to provide a reliable measure of effectiveness.

In response to points made by my hon. Friend the Member for The Cotswolds, I will say that we should have some indication later in 2016 of how effective the vaccine has been. However, establishing an accurate measure of how effective the vaccine is, how long the protection lasts and what proportion of strains it will prevent will take many years of detailed observation by Public Health England, and that clearly will feed into the ongoing review and the important decision-making process that we have. It is worth making that point.

Junior Doctors Contracts

Philippa Whitford Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

My hon. Friend has spoken very wisely. She recently wrote, in The Guardian, something with which I profoundly agree: she wrote that there could have been a solution to this problem back in February, when a very fair compromise was put on the table in relation to the one outstanding issue of substance, Saturday pay.

I understand that this is a very emotive issue. The Government initially wanted there to be no premium pay on Saturdays, but in the end we agreed to premium pay for anyone who works one Saturday a month or more. That will cover more than half the number of junior doctors working on Saturdays. It was a fair compromise, and there was an opportunity to settle the dispute, but unfortunately the BMA negotiators were not willing to take that opportunity. I, too, urge them, whatever their differences with me and whatever their differences with the Government, to think about patients tomorrow. It would be an absolute tragedy for the NHS if something went wrong in the next couple of days, and they have a duty to make sure that it does not.

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

I welcome the absolute commitment that the Secretary of State has given today that this is only about seven-day emergency care, because in the past he has often seemed to move between elective and emergency care. However, Sir Bruce Keogh has criticised the imposition of the contract, and has said that what has lost consensus across the profession has been the conflation of the need for a robust emergency service over seven days with the junior doctors’ contract, when junior doctors already work seven days.

I think that people have also been upset by the use of statistics without analysis. It is not a case of extra deaths at the weekend, which suggests poor care, but a case of extra deaths among people who were admitted at weekends within 30 days. That is quite an odd formula, but we can think of factors that might contribute.

I support the four standards that the Secretary of State mentioned, but none of them relates to junior doctors. Number one is probably access to diagnosis: people lie in hospital over the weekend with no access to scans, and their whole pathway is delayed. When we conducted an in-depth audit of surgical mortality in Scotland, it identified issues such as the insufficient seniority of an operating surgeon and, later, the insufficient seniority of an operating anaesthetist. However, part of the problem is that we have not worked out what the problem is. The Secretary of State may go on about the four standards—about a senior review, 24/7 access to interventional care, and access to diagnostics—but that will not be changed by the junior doctors’ contract.

The Secretary of State calls on the BMA to listen to leaders. What about the 11 royal colleges that have written to him? In his letter to the leader of the BMA over the weekend, he highlighted the things that still need to be sorted out, and that means that there is a need to talk. There has been no talking for five weeks. Surely we should stop the imposition, get rid of the strike, go back to the table, and complete the talking.

[Mr Hunt]

I agree with the hon. Lady on one point: it is a total tragedy when the Health Secretary ends up with no other choice but to impose. Had we had sensible negotiations, that would have not have been necessary. She talked about the royal colleges. They say that the withdrawal of emergency care should not happen. Clare Marx, the president of the Royal College of Surgeons, has said that she personally would not and could not strike. I have tried to be very clear this afternoon about exactly what we are trying to do, and we have been clear on many occasions that this does not apply to elective care.

If the hon. Lady is concerned about the statistics, I would encourage her to read some of the 15 international studies covering stroke, cancer, emergency surgery and paediatric care, including the very thorough Fremantle study published last September. She is right to suggest that many of them talk about senior decision-makers being present. That could be a consultant, but it could also be an experienced junior doctor. As she knows, the term “junior doctor” is something of a misnomer because someone could have been a doctor for seven years and still be a junior doctor.

The hon. Lady also asked about the link with the junior doctor contract. The single outstanding issue is Saturday pay rates, as the BMA has confirmed in private emails that it has sent out. We need to make it possible for doctors to roster more people at weekends, and Saturday pay rates are obviously connected to that. What I have tried to do today is to show that the supply of trained doctors into the NHS will be going up during this Parliament, so we will not be depending on the current workforce to supply the additional Saturday cover in its entirety. There will be more doctors going into the NHS, which will spread the burden, and that is the way that we will get the safe NHS that we want.

Junior Doctors Contracts

Philippa Whitford Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

My right hon. and learned Friend speaks with huge wisdom and experience. He makes a point about what happened under previous Labour Governments. He might also have said that those were the same Governments that gave us the current badly flawed contracts. Because those previous Labour Governments did not stand up to the BMA and because they ducked difficult decisions, we saw the pay bill balloon and some shocking failures of care. Leadership is not just about talking and negotiating; it is also about acting. That is what Ministers have to do, and in this situation we have a very simple decision to make after three years of talks: do we proceed with the measures necessary to deliver a seven-day NHS and better care for patients, or do we duck those decisions? This Government choose to act.

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

Yet again, I must pull up the Secretary of State. It is not a case of excess deaths at weekends; it is a case of people admitted at weekends dying within 30 days. He said the same thing again today, and it is being repeated over and over.

The Secretary of State has described, within the same pay envelope, having more doctors at weekends, not fewer during the week, and reducing a maximum of 91 hours to 72 hours. I do not see how the maths of that can possibly add up. We are not managing to cover the rotas that we have, and those rota gaps pose a danger to patients.

I was very disappointed that the equality impact assessment dismissed the impact on women and other people who train less than full-time as acceptable collateral damage. We are facing the first ever all-out strike next week, and I cannot believe that we are not in negotiations. We should be at the table trying to prevent that strike. May I ask the Secretary of State how he plans to get us out of this? He should come back to the table, because that is the only way in which an impasse can ever end.

[Mr Hunt]

Let me gently ask the hon. Lady how long she expects us to sit round the table. We have been trying to discuss this for three years. She asked how the maths added up. I will tell her how the maths adds up. It adds up because we are putting an extra £10 billion, in real terms, into the NHS over the course of this Parliament. Conservatives put money into the NHS. The Scottish National party, incidentally, takes money out of the NHS.

The hon. Lady referred to the equality impact assessment selectively. She normally pays very good attention to detail, but the paragraphs from which she quoted related to changes that were agreed to by the BMA. What she did not quote was paragraph 95, which says that the overall assessment of the new contract is that it is “fair and justified” and will promote “equality of opportunity”. Why is that? Because shorter hours, fewer consecutive nights and fewer consecutive weekends make this a pro-women contract that will help people who are juggling important home and work responsibilities.