UK Ebola Preparedness

Sarah Wollaston Excerpts

Monday 5th January 2015 Commons Chamber

[Mr Hunt]

May I first thank the right hon. Gentleman for the constructive tone of his comments and the official Opposition’s willingness to work closely with us on this very important issue? Let me cover some of the important points that he made.

The right hon. Gentleman is right that the disease is continuing to progress in those countries. We now have a total of 7,905 reported deaths, and there are 20,206 reported cases, which is likely to be an underestimate. There are some early—I stress, early—signs that the rate at which the disease is reproducing itself is beginning to fall to about the level where it is stabilising. However, those are early signs, and the truth is that we still need to do a huge amount of work to bring the disease under control.

We think that it is absolutely vital to proceed as quickly as possible with the vaccine that the right hon. Gentleman mentioned, and I can tell him that we currently have three vaccines in the first phase of clinical trials. We have made some changes to speed up the process by which they can be used in the field, and DFID has put in £1.34 million to establish a joint research fund with the Wellcome Trust, so we are making progress on that front.

It has been impossible to get supplies of ZMapp—the drug given to the other Ebola patient treated in the UK, Will Pooley—because it is grown using genetically modified tobacco plants, so there is a time constraint. Clinically, we do not yet know whether it was significant in Will Pooley’s recovery. We have tried other experimental treatments on Pauline Cafferkey, including using some of the plasma from Will Pooley, and we hope that will have an effect.

The review by Save the Children is being conducted in conjunction with Public Health England staff in Sierra Leone, and I hope that it will report in the next few days. We are obviously keen for them to report as quickly as possible, but we do not want to put them under pressure not to do a thorough report. I am satisfied with current protective arrangements on the basis of our clinical evidence, but as we saw with the screening arrangements, with a disease such as Ebola we must constantly keep an open mind about the best ways of dealing with things, and we will look carefully at what Save the Children recommends. I am satisfied with the protections in place for NHS workers in the UK on the basis of advice from the chief medical officer, and we will obviously also look at what happened in the US. At the moment we do not believe that the personal protective equipment suits have been breached, but we must keep an open mind and see what other evidence comes forward.

On the screening procedure, our clinical protocols were followed when Pauline Cafferkey arrived, but organisationally I do not think that it was as smooth as it needed to be. There were a lot of people to deal with, and because it was over the Christmas period we probably did not have as many people to do that as we needed, which meant that those coming for screening needed to wait longer than we would have liked. However, on the basis of revised protocols, and to ensure that we do not repeat this situation—nine more volunteers are coming back this Sunday and 60 more the following Sunday—the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), and the chief medical officer have been to inspect what is happening, to ensure that we learn the necessary lessons. Other volunteers have said that they think the screening procedure is working smoothly. This was a relatively isolated incident, but we must learn the lessons.

On expanding screening to other airports, I will look into whether Glasgow airport was informed and let the right hon. Gentleman know, but we have obviously learned from this event the importance of close working with the Scottish Government, and that has worked very well.

Finally, the right hon. Gentleman mentioned the active monitoring of people who come back, and I think that we have the best system. We are not only actively monitoring those who have been tested for having contracted the disease, but actively monitoring anyone in the high-risk groups. Of the 2,495 people who have been screened since we set up the process, 54 have been identified as having had direct contact with Ebola patients and as being in the high-risk group, and we have an enhanced monitoring process for them. Everyone else is informed exactly what to do if they develop feverish symptoms, which is what happened with Pauline Cafferkey.

I again thank the right hon. Gentleman for his constructive approach to this issue.

[Dr Sarah Wollaston (Totnes) (Con)]

I join the Secretary of State in paying tribute to Pauline Cafferkey and all NHS volunteers, aid workers, staff at DFID and Public Health England for the work they are doing to keep us safe in the UK by fighting Ebola on the front line in west Africa at great personal risk. I also thank him for updating the House so succinctly on the improvements to the screening protocols, so that everyone will be screened if they have symptoms, not just a temperature. Will he update the House on the vaccines and say whether there has been any progress on the provision of rapid screening for Ebola? Will he reassure us that he will not follow the knee-jerk response that we have heard calls for from some quarters, which is to quarantine all NHS staff, because of the unintended consequences of such an approach?

[Mr Hunt]

I thank my hon. Friend for her constructive comments and I agree with what she has said on this issue. Some 678 health care workers have contracted Ebola since the outbreak of the disease, and of those nearly 400 have died, the vast majority African. That shows how incredibly brave front-line workers are, and perhaps the fact that—tragically—we have someone in this country who has contracted Ebola is a good way of reminding ourselves that many hundreds of other people have already been in this situation. They are all incredibly brave. We are proceeding as quickly as we can with the possibility of having a much speedier Ebola test, which would obviously be helpful for the screening process.

I agree with my hon. Friend that we do not want a knee-jerk response on quarantining people who come back. The contribution of NHS volunteers and health care workers from western countries in fighting the disease in Sierra Leone, Guinea and Liberia is critical. Some 1,500 people from the NHS have volunteered, but they volunteer on the basis that we will follow proper clinical protocols, meaning quarantining people when it is clinically necessary to do so, but not doing so when it is not necessary. If we are to keep their confidence, we must be proportionate in our response.

Patient Safety and Medical Innovation

Sarah Wollaston Excerpts

Tuesday 9th December 2014 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

Like books, one should never judge a Bill by its cover. Later this week, the Medical Innovation Bill reaches Report stage in the House of Lords, but I would like to demonstrate that it is fundamentally flawed in its premise, it is unnecessary, it removes essential protections for patients, and it increases the risks of their exposure to maverick doctors. I believe it will undermine not only patient safety but medical innovation and so will have precisely the opposite effect to that intended.

Under current law, a doctor is negligent if he or she acts in a way which no responsible body of medical opinion would support, or which is irrational or illogical—the so-called Bolam test, as refined in the case of Bolitho. The Bill would rewrite the law on clinical negligence and a doctor whose decision to treat would not be supported by any responsible body of medical opinion, or was illogical or irrational, would be able to call on a new Saatchi defence if they fulfilled the procedural requirements of the Bill. That is important: the Bill’s protection of doctors applies if the procedural requirements are met. The Bill states:

“For the purposes of taking a responsible decision to depart from the existing range of accepted medical treatments for a condition, the doctor must…obtain the views of one or more appropriately qualified doctors in relation to the proposed treatment”.

There is no requirement for the second doctor to have seen the patient or even read their notes, and no requirement for them to be independent. They could be working at the same private clinic. It is of little reassurance that the treating doctor must

“take full account of the views”

of the second doctor if the second doctor is in collusion with the first in that treatment, which may be unreasonable.

If the Bill is passed, we will put patient safety at risk and we will no doubt have to return to amend the legislation subsequently. Let me quote from a letter forwarded to me by a constituent who had met a visitor to my constituency who managed to convince him utterly that this individual’s company had found a cure—a miraculous treatment—for cancer, but was being obstructed by a vast conspiracy in the medical community. In the letter, David Noakes, who describes himself as the chief executive of a biotechnology company, refers to a compound he calls GcMAF, which he describes as

“a human protein, present in 5 billion healthy people, that removes a number of diseases, including terminal stage 4 cancer. It has no side effects.”

He attaches a couple of scientific-y looking papers, which have no bearing on proving its clinical effectiveness. Mr Noakes continues:

“It’s always difficult to get feedback, but we have hundreds of superb results. In Guernsey, we treat over 100 people and…have 50 successes including 10 excellent cancer results. We have perfect feedback in our German and Swiss clinics, where our 7 doctors reduce tumours at the rate of 25% a week”.

He says that he cannot do it in the UK

“because the law is so destructive.”

Here is the bit that really worries me. Mr Noakes states:

“But we state that if you have terminal stage 4…cancer, have not had chemotherapy, and you do the”

so-called

“GcMAF protocol, you have an 80% chance of being cancer free in a year.”

In other words, what the company is specifically saying to people is that they can look forward to that result if they do not have chemotherapy—it is actively encouraging people not to have evidence-based treatment and promising that it has a cure for cancer.

Mr Noakes says that

“The pharmaceutical industry is not interested in”

this treatment, because there is no profit in it—

“it is too cheap, and can’t be patented”.

He says:

“The chemo lobby is so powerful it has changed British law so that doctors are only allowed to prescribe the poison of chemo for cancer when there are…better treatments.”

He adds, specifically:

“Lord Maurice Saatchi is trying to get that law changed with his Medical Innovation bill, but against so powerful a lobby”—

and so on. In other words, for this individual and the seven doctors to whom he refers, the Bill would be carte blanche. They see it as a Bill that would provide them with protections. The Bill specifically refers to medical practitioners and doctors as the people who can take this forward—not homeopaths or unregistered doctors. He says that he has seven doctors in his company. If one of those seven consulted another doctor in the clinic, it is highly likely that they would agree that this was an eminently sensible treatment.

[Dr Julian Huppert (Cambridge) (LD)]

I thank my hon. Friend for giving way and for securing this debate on an important subject. It is a shame that more people are not in the Chamber to discuss it. There are some very real concerns. Does she agree that people who are terminally ill may be desperate for treatment, and that simply makes them prey to people who may be unethical, who may be trying to push the envelope, and who may be doing things that would harm them but that sound quite good?

[Dr Wollaston]

I agree with my hon. Friend. In my constituency a medically qualified individual attempted to set up a cancer conference. It had to be pointed out that under the Cancer Act 1939 it is not legal to advertise cures for cancer. The Bill would allow people to circumvent the Cancer Act. How easy is it to get a reference to a miracle treatment planted into a magazine article, for example? This is the real danger here. While the Cancer Act protects people against blatant advertising, it does not provide protection against the back-door advertising that we already see. What is to stop individuals who are absolutely desperate—as my hon. Friend has said—going to doctors with articles saying, “This is a cure. I want you to refer me to this clinic.”

[Dr Huppert]

I will try to resist the temptation to intervene too often. Does my hon. Friend agree that this is not just about cancer? We have already had homeopathic doctors, who may practise medicine as well as homeopathy, claiming that they have powerful treatments for Ebola that the World Health Organisation will not let them work on. The Bill would open the door for all sorts of quacks who will do serious harm in the name of medical innovation.

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[Dr Wollaston]

I agree. I thank my hon. Friend for making the point that this is not just about cancer treatment but about a wide range of surgical treatments and therapies for any number of conditions.

If the Bill is about reducing medical litigation so that doctors are free to undertake innovative treatments, why do those who are involved in medical litigation say that there is no need for it? The Medical Defence Union, the Medical Protection Society, even the NHS Litigation Authority, are clear that the law, with the Bolam and Bolitho tests, is well established. They feel that the Bill could increase uncertainty. The MPS briefing says:

“Fundamentally, current law allows doctors acting responsibly to innovate, and this Bill is unnecessary. The time has come for the debate to shift towards improving education about the present law, rather than confusing the law through a new piece of legislation.”

That is another point that is worth bearing in mind.

Far from promoting medical innovation, the Bill could undermine recruitment to genuine clinical trials. If someone had been persuaded by the likes of the doctors in the letter that I read out that there was a miraculous treatment for their terminal cancer, why would they wish to be enrolled in a clinical trial and be part of a randomised trial? If they could circumvent that and go along to a private clinic, why would they do that? Medical research does not just answer the question about whether a treatment works; it also helps answer the question whether a therapy or procedure has serious side effects. The history of medicine is littered with good intentions and innovations that seemed like a good idea but turned out to have disastrous side effects. I think, for example, of the use of 100% oxygen for premature babies, which led to blindness, or the use of steroids after head injury, which might have seemed like a good idea at the time but led to many, many deaths until it was realised that it was a dangerous innovation. There is an assumption that all innovation must be good innovation, but much innovation can be dangerous.

The randomised double-blind trial has been one of the greatest advances in medical science and has provided enormous protection for people. I look back at my time in medicine. Fairly soon after I qualified in 1986, I was a junior doctor on the Hedley Atkins breast unit. The newly appointed consultant is now Professor Sir Mike Richards, who is one of the country’s foremost and respected experts in cancer, formerly the cancer czar. He does not think the Bill will protect patients. We need to listen to the opinion of those who have serious concerns about such Bills. When I was working on that cancer unit in the 1980s, very many of the patients who did not survive at the time would survive today going to the same unit with similar conditions. That is because we now know what the best treatments are. We know that not from a series of unlinked anecdotal treatments, but because of former patients who were enrolled in clinical trials.

The accusation sometimes made is, “Aren’t clinical trials just experimenting on people?” Far from it. There seems to be a benefit for everyone taking part in a clinical trial, even those who are not receiving a treatment that turns out to be more effective. If the Bill is passed and undermines enrolment in clinical trials, we will be doing a grave disservice to medical innovation, and it will be to our great shame to have done so. I would like the Minister to address that point when he responds.

That is a fundamental flaw in the Bill. There is also a fundamental flaw in the premise that separate anecdotal treatments can progress medical research. Interestingly, clause 1(5) states:

“Nothing in this section permits a doctor to carry out treatment for the purposes of research”.

In other words, it specifically precludes the treatments being linked in any way, so we will learn nothing from these treatments. Lord Saatchi’s premise is that his Bill will advance medical knowledge, but there is no evidence that it will advance medical knowledge an inch because we will not be able to answer that fundamental question about whether there are unintended harms from the treatments or any long-term benefits.

Where will the evidence be of benefit from those “innovative treatments”? Will the Minister look carefully at that, and be clear in responding? The list of bodies opposed to the Medical Innovation Bill is very long—the Academy for Healthcare Science, the Academy of Medical Royal Colleges, the Academy of Medical Sciences, the Medical Research Council, the Wellcome Trust, Action Against Medical Accidents, the Association of Medical Research Charities, the Association of Personal Injury Lawyers, the British Medical Association, the British Pharmacological Society, Cancer Research UK, the Good Thinking Society, Healthwatch, the Medical Protection Society, the Medical Defence Union, the Motor Neurone Disease Association, the National Institute for Health and Care Excellence, the NHS Health Research Authority and the NHS Litigation Authority.

Richard Francis QC, one of our most respected national authorities on patient safety, opposes the legislation. I think that we ought to reflect carefully on his words:

“If there is misunderstanding then it should be corrected by guidance, not by legislation which exposes vulnerable patients to unjustified risk and deprives them of remedies when mistreated by those who have no acceptable justification for what they have done.”

Those are very serious words indeed. The legislation is also opposed by the Royal College of General Practitioners, the Royal College of Physicians, the Royal College of Psychiatrists and the Royal College of Radiologists. That is an important list.

There is a powerful lobby in favour of this legislation that purports that those who oppose it are somehow dinosaurs.

I urge the Minister to read the letter from 100 leading oncologists that was published in The Times on 13 November, which states:

“We devote our professional lives to treating patients with cancer and advancing research that contributes to finding more effective treatments for cancer. We neither want nor need Lord Saatchi’s bill. We do not believe that it will help our patients or future patients. We are dismayed that the bill is being promoted as offering hope to patients and their families when it will not make any meaningful difference to progress in treating cancer.

The law of medical negligence does not hinder our work or prevent innovation. There have been significant advances across all the modalities of cancer treatment over recent decades. There was no call for this change in the law from the medical profession. The current law already allows us to use off label drugs and to try new treatments when they are in patients’ best interests.

We are concerned that rather than promoting responsible scientific innovation in the treatment of cancer, the Medical Innovation Bill will actually encourage irresponsible experimentation producing nothing more than anecdotal ‘evidence’, at the potential expense of causing serious harm and suffering to patients, their families and carers. Innovation is best carried out within the discipline of controlled clinical trials, not by individual doctors acting on a whim.”

I think that sums it up well.

Were we to title the Bill correctly, it would be called the medical anecdote Bill. We should be saying that it makes provision in relation to anecdotal treatments in medical treatment. If we titled it correctly, there would be no question whatsoever of its having Government support. I urge the Minister in the strongest terms please not to give the Bill Government backing. To do so, I think, would be to our great shame. We would undoubtedly have to return to amend it. It would put patients at risk, and it would put recruitment to clinical trials and genuine innovation at risk.

I look forward to hearing the Minister’s response and about the many good things the Government have done to promote genuine innovation. I will not detain the House by offering that list now, because I know the Minister has done more than anyone I can think of in the House to promote true medical innovation. I therefore hope he will recognise that the Bill would do quite the opposite, and ensure that it does not progress.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

I thank my hon. Friend the Member for Totnes (Dr Wollaston) for securing this Adjournment debate and giving the House, albeit only a few of us, the chance to debate what is, I agree, a very important issue that is the subject of live discussion in another place. I also thank my hon. Friend the Member for Cambridge (Dr Huppert) for his comments.

My hon. Friend the Member for Totnes is a tireless campaigner for good health care and good medicine, as Member of Parliament for Totnes, as a member of the medical profession, and as Chair of the Health Committee. I very much welcome her contribution. I will first deal with the points that she made, then set the scene and provide a little context about the Government’s view of this Bill, and then close with what I hope may be some reassurance about our commitment to patient safety.

My hon. Friend made a number of important points, which I repeat merely to signal that I have heard them loud and clear. She said that the Bill might risk creating a carte blanche, or open door, situation as an inadvertent side effect of unjustified and unsubstantiated claims. My hon. Friend the Member for Cambridge mentioned homeopathy and other non-evidence-based forms of medicine. My hon. Friend the Member for Totnes highlighted the danger of relying too heavily on the protection of a clinician merely seeking the endorsement of a fellow clinician. Implicit in her concern is the fact that most of us could probably find one person in life to support our own prejudices, however well intentioned.

My hon. Friend highlighted the risk of unethical approaches and the danger of back-door promotions, which none of us wants to see. On the danger of undermining public and patient trust in clinical trials, she knows that I am passionate about achieving precisely the opposite. We are very proud in this country that more and more of our patients are enrolling in clinical trials. The NHS is running a fabulously successful programme of promoting research medicine, and this year the numbers are up by 24% or 25%. That is good for patients, good for NHS research, and good for our life sciences sector.

My hon. Friend has highlighted the danger of accidental errors across the system today. We live with that risk, but I hear her point that it would be a disaster if the Bill inadvertently made errors more likely, rather than less. She also raised concerns about the Bill not promoting evidence-based medicine or requiring claims to be based on clear patient benefit. She made a specific point about the Cancer Act 1939, which I will follow up and deal with by letter, if I may.

Most concerning of all, my hon. Friend ran through a very long list of medical and health organisations that she described as being opposed to the Bill. I will look into that following the debate because—I will say more about this in a moment—we do not want the measure to be divisive or to alienate or undermine the consensus about the importance of good medical research in the UK and the NHS. I take that point seriously. My hon. Friend flagged up the letter from 100 oncologists that appeared in newspapers recently. Since that was published, there have been a number of discussions about—and, indeed, amendments tabled to—the Bill in the Lords. I want to have a look and make sure which, if any, of those concerns are extant as the Bill completes its passage through the Lords. I will say more about that in a moment.

My hon. Friend the Member for Cambridge endorsed those comments. I note in particular his comments about the importance of evidence-based medicine. As with so many issues that we deal with in this House, a good test is to ask: would I apply this to myself? Certainly, for myself and my family, I am a strong believer in evidence-based medicine. I am a believer in innovation as well, but my hon. Friend made an important point. I particularly enjoyed his mention of the politician’s syllogism: “We must do something; this is something; ergo, we should do it.” I assure him that that is not in any way the reason for the Government’s benign support for the Bill’s principles and the case it seeks to make to promote innovation. I align myself hugely with his comments about not wanting to open the door to quackery.

[Dr Wollaston]

Lord Saatchi has said that 20,000 people support his Bill, but if people are asked whether they are in favour of medical innovation, they are likely to answer yes, and if the same people are asked whether they are likely to support medical anecdotes, I think they are likely to say no. Sometimes the answer depends on the question being asked.

[George Freeman]

I am sure my hon. Friend is right. She makes an excellent point about the nature of the question having an impact on the answer one gets. I have repeated the concerns because they bear repetition and are important, and I want to signal that I am taking them seriously.

I want to set the scene in terms of the Government’s commitment to patient safety, the context in which innovative medicines are being developed, and the changes in the sector that are challenging some of the traditional methods of drug development. I will then address some of the specific points that my hon. Friends the Members for Totnes and for Cambridge have made and say something about the Government’s position on the Bill.

The Government’s response to the Mid Staffordshire NHS Foundation Trust public inquiry, led by Sir Robert Francis, “Hard Truths: The Journey to Putting Patients First”, demonstrated beyond any doubt, I hope, the Government’s absolute commitment to creating a new culture of openness, compassion and accountability and a renewed focus on patient safety right at the heart of the NHS.

The truth is that the NHS is one of the safest health care systems in the world. I am delighted to report that, in the recent Commonwealth Fund report comparing the US health care system with those of 11 other nations, the UK came top. However, there is always scope to improve health care standards universally and to reduce avoidable harm further. That is why the Secretary of State set the ambition this June, at the launch of the Sign up to Safety campaign, to reduce avoidable harm by half and save 6,000 lives over the next three years.

We have put patient safety right at the heart of the Government’s agenda for health. For that reason, I am delighted that the Government are actively supporting the Bill on patient safety sponsored by my hon. Friend the Member for Stafford (Jeremy Lefroy). The Bill has several important provisions on the use of data to drive safety across the system and to ensure transparency and accountability in health outcomes.

Why do we need to look at mechanisms for promoting innovation? My hon. Friend the Member for Totnes was kind enough to signal her awareness that the Government—particularly me, as the first Minister for life sciences—have taken an active role in trying to promote it. The reason is that we face a challenge in the field of drug discovery and development, as well as in medical technology generally. There is a challenge and an opportunity.

The challenge is that the more we know about disease, genetics and data—the datasets at our disposal in the NHS, and the history of drug reactions and the way in which patients respond to diseases differently—the more we realise that patients respond to the same disease or the same drug in different ways, and that those ways can often be predicted. These insights are beginning to change the way in which drugs are developed.

Increasingly, we do not need the one-size-fits-all, blockbuster drugs that we have traditionally expected the industry to bring us after long, slow, protracted and increasingly expensive clinical trials and randomised, double-blind trials. Of course, those trials have a strong part to play in our system, but the more we know about the nature of disease and the extraordinary breakthroughs that our biomedical and life sciences sector is making, the more the agenda shifts to designing around patients, as well as around tissues, data and genomics. That is why the Government are so committed to shifting our policy landscape to support the extraordinary role that our NHS can play globally. It is a uniquely well positioned, integrated national health care system, with extraordinary leadership in genomics and informatics, which the Government are actively supporting.

My hon. Friend made the point that the randomised, double-blind trial has given medicine great service in the 20th century, and I agree. As we move further into the 21st century and see the transformational power of new technologies, it is equally true that the system of expecting the industry to go away and spend 10 to 15 years, and an average of £1.5 billion, to develop a new drug—many of them fail in late-stage clinical trials, because of some toxic side effect in one patient or a few small number of patients—is leading to a crisis in the industry and in the pipeline for new drugs and new treatments, and to patients increasingly suffering because we cannot give them innovative medicines.

Part of the agenda for this Government and all western Governments is to look at how to accelerate the way in which our health systems support research and to bring innovative medicines, as well as devices, diagnostics and other innovations, to benefit patients more quickly.

[George Freeman]

The hon. Gentleman makes an important point. I want to take this opportunity to pay tribute to the work being done in that cluster at Queen’s. I am delighted to say that I will be coming in the new year to support it and to show, as the UK Minister, that there are great clusters in Scotland, Northern Ireland and Wales. I very much look forward to that visit.

The truth is that the landscape is changing. Part of the challenge that we all face is to find ways to accelerate earlier access to innovative treatments for patients, and earlier access for those developing innovative drugs, devices and diagnostics to our health system, so that we can more quickly design innovations that are more targeted and personalised. We are seeing the first genuinely personalised cancer therapies and drugs that, in the unfortunate event that one is diagnosed with cancer, can be designed around one’s genetic profile. I was at a seminar on that development this morning. It is changing the landscape of drug development. We are keen to ensure that we benefit from it in the UK and that we use every mechanism in the NHS to support it.

[Dr Wollaston]

Does the Minister accept that a doctor who uses such innovative treatments within the NHS is protected under existing law and that we do not need new legislation to make them available to patients?

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[George Freeman]

I am merely trying to set out a balanced review of the arguments. In closing my speech, I will give an assurance that I hope will satisfy my hon. Friend on that point.

On protection, under existing common law and in the Bill doctors must show that they have acted responsibly. They cannot simply go through the motions and seek advice from an inappropriate source as that would not be “responsible”, which is the key test in the Bill and common law. Even if doctors follow the steps in the Bill when deciding to adopt an innovative treatment, they might still carry it out negligently and be subject to a negligence claim in the same way. When something goes wrong it is right that patients are free to seek compensation, and that will continue to be the case. The Government do not want any undermining of protection for patients against clinical negligence.

My hon. Friend the Member for Totnes made a point about the Bill not requiring doctors to seek the prior agreement of an appropriately qualified doctor, and instead being required only to take account of their views. I would not want the Bill to give a carte blanche to quackery or non-evidence based medicine. The Bill requires a doctor to take full account of the views of at least one appropriately qualified doctor, just as any responsible doctor would be expected to do, and they would not be able to ignore certain views or give them minimal weight by just “noting” them unless there were reasonable grounds for doing so. All doctors will be bound by the core and primary duty of responsibility and care to their patients. If the Bill were to require the explicit agreement of another doctor to innovate—that is one suggestion made in the other place—we are worried that that would open the possibility of a new negligence action against the countersigning doctor and lead to more confusion. We would not be able to give the countersigning doctor any certainty about their legal position, and they would not be able to rely on provisions in the Bill.

My hon. Friend made a point about undermining confidence in clinical trials. Although the Bill has raised awareness of innovation in medical treatment, it does not confer additional rights on patients to demand innovative treatment. It will still be for the doctor to decide the most appropriate course of treatment in discussion with their patient and using their best professional clinical judgment. Nothing in the Bill allows doctors to bypass any processes or requirements set by their trust when undertaking innovative treatments in the NHS, which includes ensuring that the commissioner would fund the treatment if it is to be provided within the service.

Individual innovation is important but no substitute for medical research and testing the efficacy of new treatments in a systematic way. A large part of my work is about ensuring that we use all of our £1 billion a year for the National Institute for Health Research infrastructure in the NHS, to ensure—as the Prime Minister set out in his speech when launching our life science strategy—that every willing patient is a research patient and every hospital a research hospital, and that we learn from evidence that we develop daily in our interaction with patients. Lord Saatchi and Ministers are determined that doctors should learn from innovative medicine as we go along, and a large part of the NIHR and our data programme is about ensuring that we pick up and track innovations and outcomes more accurately across the system.

[Dr Wollaston]

Does the Minister accept that that cannot happen under the Bill, and that those things will remain a series of unlinking anecdotes? In medical science and for the safety of patients no one will be able to track whether there were unintended consequences or benefits, and it will not advance the cause of medical innovation whatsoever.

[George Freeman]

I would be interested to see the Bill once it has completed its passage through another place and ensure that it contains adequate provision for evidence-based medicine, and that, by encouraging innovation, we are not in any way encouraging medicine that is not supported by the best evidence available.

My hon. Friend spoke about consultation. The Department of Health carried out a full consultation on the issues raised in the Bill, which ran from February to April this year. It was delighted to receive 170 responses to that consultation, making clear a range of opinions. Responses came from a range of audiences, professional bodies, patients and clinicians. Four regional public consultation events were also held. Lord Saatchi attended those events and it was in no small part thanks to his involvement that a number of changes were made to strengthen the oversight mechanisms in the Bill. At every stage, the Department of Health has engaged with Lord Saatchi to develop amendments to align the policy of the Bill with the legal and expert clinical advice we have taken, including from Sir Bruce Keogh.

NHS (Five Year Forward View)

Sarah Wollaston Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Speaker]

The Secretary of State confirms that he is not making any allegation of personal dishonesty against any individual. Enough: we are grateful. We will leave it there for now.

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the statement. The extra funds for the NHS constitute a clear endorsement of Simon Stevens’s excellent “Five Year Forward View”. I particularly welcome the announcement of multi-year budgets and investment in patients’ ability to control their own records. Will the Secretary of State confirm that the process of creating paperless NHS hospitals will move seamlessly from primary to secondary care, and will be controlled by patients themselves?

[Mr Hunt]

The commitment to a paperless NHS is not a commitment to the creation of paperless hospitals by 2018; it is a commitment to the creation of a paperless NHS so that, with patients’ consent, information can flow seamlessly between different parts of the system. The interface between primary care and secondary care, and social care, is a very important part of that process.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 25th November 2014 Commons Chamber

[Norman Lamb]

I completely agree with the hon. Gentleman about the importance of children and young people being able to access treatment and support. If the truth be known, it has always been like this. It has always been the Cinderella of the Cinderella service, which is why we established a taskforce this summer, bringing in a whole load of experts and, importantly, consulting children and young people so that we can develop a modern health service for the mental health problems of children and young people. We hope to report early next year.

[Dr Sarah Wollaston (Totnes) (Con)]

19. As the Cabinet taskforce sets out on this important work, will the Minister reassure me that it will bear in mind the important finding of the Health Committee’s inquiry into CAMHS—Child and Adolescent Mental Health Services—that it is the tier 1 and tier 2 services that really make the difference in preventing the need to access the service when children are much more unwell?

[Norman Lamb]

I very much appreciated and supported the findings of the Health Select Committee report into children and young people’s mental health services. The hon. Lady is absolutely right that we need to focus far more on preventing ill health and preventing a deterioration of it. If we can get into schools and work much better at maintaining people’s mental well-being, we can achieve much better results.

Ebola

Sarah Wollaston Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

I thank the shadow Health Secretary for the constructive tone of his comments. That is totally appropriate and I am grateful. I will start with the point on which he finished, because the most crucial thing we can do to protect the UK population is deal with the disease at source and contain it in west Africa. That is why I am working extremely closely with the International Development Secretary, and she is working closely with me because the role of NHS volunteers is important. The right hon. Gentleman is absolutely right: the initial international response has focused on taking the three worst affected countries and giving them a partner country in the developed world to help them—we are helping Sierra Leone, America is helping Liberia, and France is helping Guinea.

That has worked up to a point, but we need more help from the rest of the international community. I had a conversation earlier today with US Health Secretary Burwell. We talked about a co-ordinated international response for the whole of west Africa, because we will not defeat this disease if we operate in silos. We need to recognise that this disease does not recognise international boundaries; the right hon. Gentleman was absolutely right to make that point.

Let me try to give the right hon. Gentleman some of the information he requested. First, he is absolutely right to raise the issue of the protection of health workers. That has to be our No. 1 priority both here in the UK and abroad. That is why we are building a dedicated 12-bed facility in Sierra Leone that will give the highest standards of care, equivalent to NHS standards of care, for health care workers taking part in the international effort to contain the disease there. That is also very relevant to health care workers here: events in both Spain and the US will have caused great concern.

I am satisfied that the official advice to health care workers is correct. The Centers for Disease Control and Prevention in the US, the US equivalent of Public Health England, believes that breaches in protocol led to the infection of the US nurse—the case we have seen in the media recently—but it is investigating that. The advice is always kept under review and if that advice changes we would, of course, respect that. It is important that we follow the scientific advice we have, but that the scientists themselves keep an open mind on the basis of new evidence as it emerges. I know that they are doing that.

The right hon. Gentleman talked about the full range of figures. He is absolutely right to say that we will maintain public confidence in the handling of this by being totally open about what we know. The reason we have stuck carefully to the formula of “a handful of cases” is because it is genuinely very difficult to predict an accurate exact number. Let me say this: we would not have used the formula of “a handful of cases” if we thought that the number of cases over the next three months would reach double figures. However, it is also important to say that that was a current assessment. That assessment may change on the basis of the evidence. I will, of course, keep the House informed if it does change.

The right hon. Gentleman talked about screening. It is important to deal with a misunderstanding. Why did the policy change on Thursday? The answer is that it changed because the clinical advice from the chief medical officer changed on Thursday. Her advice changed not on the basis that the risk level in the UK had changed—she still considers it to be low—but because she said that we should prepare for the risk level going up. That is why we started to put in place measures, but they are not measures primarily intended to pick up people arriving in the UK who are displaying symptoms of Ebola. We think that most of those people should be prevented from flying in the first place. The measures are designed to identify people who may be at risk within the incubation period of developing the disease, so that we can track them and make sure they get access to the right medical care quickly.

As I mentioned, we think we will reach 89% of people arriving in the UK from the affected countries. We will continue to review that. If the numbers increase and the risk level justifies it, we have contingency plans to expand the screening, for example to Birmingham and Manchester. The reason we have included Eurostar at this early stage is because there are direct flights from those three countries to Paris and Brussels, from where it is easy to connect to Eurostar. We will use the tracking system for people who are ticketed directly through to the UK in order to identify, where we can, people who then independently get a Eurostar ticket. It is important to say that because they are changing the mode of transport in Paris and Brussels, tracking is not as robust as it would be for people taking a direct flight to the UK. We will not be able to identify everyone, which is why we need to win the support of people arriving in the UK from those countries, so that they self-present, in their own interest, to give us the best possible chance of helping them if they start contracting symptoms.

I am satisfied that the Trexler beds and the negative isolation rooms are safe both for health care workers and in preventing onward transmission. They use different systems—one of them is a tented system and the other is based on people wearing personal protective equipment —but I am satisfied that both of them are safe. I will continue to take advice on that. It is very important that ambulance staff know that someone is a potential Ebola case, so that they wear the PP equipment.

As we will not be able to identify everyone who comes from the affected countries, it is important that the 111 service knows to ask people exhibiting the symptoms of Ebola whether they have travelled to those affected areas. The right hon. Gentleman asked what those symptoms are. They are essentially flu-like symptoms, but they are not dissimilar to the symptoms someone might exhibit if they had, for example, malaria. That is why it is important to ask for people’s travel history and whether they have had or may have had contact with people who have had Ebola, in order to identify the risk level.

We would like to continue using ZMapp for people in the UK who contract the disease, but that is subject to international availability. It might not be possible to get it for everyone, because there is such high international demand, but we will certainly try.

In terms of the development of a vaccine, we are doing everything we can to work with GSK to bring forward the date when a vaccine is available. Indeed, we are considering potentially giving indemnities if the full clinical trials have not been conducted.

[Dr Sarah Wollaston (Totnes) (Con)]

May I welcome the Secretary of State’s statement and pay tribute to all the staff who are giving him professional detailed scientific advice? I join him in paying tribute to all the NHS personnel, our forces personnel and diplomatic staff putting their own lives at risk in west Africa.

I am particularly pleased to hear that those individuals returning to the UK or coming to the UK from west Africa will be able to access support in a timely manner and in a manner that does not put other individuals at risk in crowded health care settings. Will the Secretary of State say more about the testing arrangements, which I hear are going to be at Porton Down? Does he have any plans to make further testing centres available so that testing can happen more rapidly?

[Mr Hunt]

I thank my hon. Friend for her comments and her support for the statement. I want to pay particular tribute to the chief medical officer and Dr Paul Cosford at Public Health England, who have done an enormous amount to make sure we develop the right policies, which are both proportionate and enable us to prepare for the future. The Government are hugely grateful for their contribution.

We are satisfied that the testing arrangements at the PHE facility at Porton Down are adequate to the level of risk, but one of the reasons why I wanted to announce to the House the current estimate of the number of Ebola cases we are dealing with in the UK was to make the point that we will continually keep those arrangements under review should the situation change. We need to recognise in a fast-moving situation such as this that it might well change, and I will keep the House updated, but in such situations the resilience of all those very important parts of the process will be checked.

Regulatory Reform

Sarah Wollaston Excerpts

Tuesday 9th September 2014 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I apologise for missing the opening speeches, but I was chairing the Health Committee. I am delighted to have been here to hear my hon. Friend the Member for Bedford (Richard Fuller). I absolutely agree with him, and am grateful to him for raising this issue of the tension that exists between localism and the decisions that are being made in good faith by clinical commissioners. There is a need for us to engage local people in decision making to ensure that we get the best possible outcome for them.

I am sure that other Members have raised concerns about Healthwatch and the possibility of the local voice being squeezed out. Will the Minister address the issue of the time scale that is often given to local people to consider quite detailed proposals? Indeed, detailed proposals will be given to local health and wellbeing boards at Devon county council with only a day’s notice, and there is no obligation to include local healthwatch. We need guidance in that area, especially if we are to have committees in common, which I support.

I will support the regulatory reform order, as it is a good thing. Like my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), I think that we could go further and involve other groups in these permissive arrangements. As he will know, for people living on the boundaries of clinical commissioning groups, such arrangements do not always appear to be logical. This will allow commissioning to take place over a wider area with better outcomes for patients and often with great saving. I absolutely support the measure, but the concerns expressed by Healthwatch, which have also been expressed to me, need to be addressed.

Community Hospitals

Sarah Wollaston Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to serve under your chairmanship, Mr Owen.

I, too, congratulate my hon. Friend the Member for Dover (Charlie Elphicke). I cannot remember a more encouraging debate in this House about community hospitals. The success stories we have heard—not just from Dover, but the extraordinary success in Andover outlined by my right hon. Friend the Member for North West Hampshire (Sir George Young), and those in Vale, Congleton, Maldon and other places—show what community hospitals can achieve.

I was encouraged by what Simon Stevens had to say. He talked about how we should learn from other countries in providing care closer to home, but we do not need to go to other countries. The Health Committee has visited Scandinavia, and in Denmark and Sweden I was shown slides from Brixham community hospital. There we go: we actually have wonderful examples in this country. I pay tribute to the four community hospitals in my constituency: Brixham community hospital, Totnes community hospital, South Hams hospital in Kingsbridge, and finally Dartmouth hospital. They are wonderful services.

I do not want to reiterate the excellent points that have been made by my hon. Friend the Member for Dover, but community hospitals do not exist in isolation. The debate should consider not just community hospitals, but all the volunteers and services that surround them and enable them to fulfil their role. I talk not just about the wonderful leagues of friends, which work so hard for our communities and in community hospitals, but about the wider networks that help community hospitals to prevent hospital admissions, to facilitate early discharge and to prevent readmission. I will focus on why that is so important.

Simon Stevens has said that the greatest challenge facing the NHS is the rising elderly population and how we care for them. It is good news that we are living longer. That is sometimes presented as if it is gloomy news when it is great news. However, with that comes an increased number of people living with long-term conditions. From our recent Health Committee inquiry, we know that long-term conditions now account for 70% of our entire NHS and social care spending. The number of people aged over 85 will double in the next 20 years. Again, I stress that that is a good thing, but it needs some forward planning.

I ask the Minister how we will ensure that the resources from the better care fund support our community hospitals and the wider webs around them. Last month, Simon Stevens heard an important message when he visited Dartmouth hospital and met with representatives from staff, community volunteers and patients. The message was how frustrating the complications of tendering rounds can be for these volunteer groups. Sometimes those groups spend their time trapped in endless cycles competing for small pots of money. Those funds tend to go to new projects and often do not provide the ongoing funding that well-established, excellent community services provide. Will the Minister look at the mechanisms that sometimes lead to national organisations receiving funding because they can put forward flashier bids, at the expense of excellent local services? Those national bodies might have no local-facing presence.

We need to look at how we can ensure that the arrangements get money to the local services and the right people, and at how to make the processes simpler and less bureaucratic. There is nothing that drives out volunteers quicker than being trapped in endless contracting rounds, rather than doing what they really want to do: provide services to people. I hope the Minister will look at what is happening on the ground in local communities and try to sweep away some of that bureaucracy. That will help our community hospitals to deliver better services.

As my right hon. Friend the Member for North West Hampshire said, we need to demonstrate value for money, not just excellent care. I have worked in community hospitals and I know, from patients and colleagues, how important they are to local communities. We know that, but we also have to be able to demonstrate that they are financially viable. That viability often comes from adjusting the way financial drivers in the NHS work. If the Minister wants to help community hospitals, my message to him is to look at what is happening on the ground and make those adjustments happen.

I have concerns about the way consultations about changes to services take place. We need honesty about changes to community hubs. If that means losing beds in community hospitals, we need to be clear about that with communities. Where other arrangements are going to be put in place, such as using nursing home beds rather than community hospital beds, we need to be clear that there is an evidence base that that provides the services people want. We sometimes lose the heart of our community hospitals if we lose their beds. Community hospitals work better if we can retain those step-down, step-up intermediate care beds. That is crucial for communities. If there are to be changes, we need to have honesty during consultations.

Adequate notice also has to be given. This morning I was very concerned to see in an e-mail that Northern, Eastern and Western Devon clinical commissioning group proposes to close some community hospital beds. The detailed consultation will be given to the health and well-being scrutiny panel only the day before. That is not adequate time to scrutinise the plans. Will the Minister ensure that a clear message comes down that, if we want to have local democratic accountability, people must be given adequate time to scrutinise proposals? We must try to avoid terms such as “the direction of travel” in consultations with local communities. People do not know what that means. They want to be clear on what the proposals are and to be given an opportunity to feed back.

Finally, on community ownership, putting the “community” back into community hospitals is important. We need flexibility so that communities that want to take that on can take over from NHS PropCo. That issue, which I would like the Minister to comment on, was raised in a previous debate. I also have a word of caution on social enterprise. I fully support social enterprises but, in some rural communities, a change from NHS terms and conditions of service can place community hospitals under threat if NHS staff do not wish to work there. If people have the choice to work at a hospital where they will have NHS terms and conditions of service or at a hospital where they will not, I can tell the Minister where they will choose to work. That can pose a threat. No one can campaign to keep open a hospital with no nurses. Can the Minister touch on that? If we are going to shift to a social enterprise, we have to be mindful of the impact on future recruitment.

I pay tribute to all the community hospitals in my constituency, their staff and volunteers. They are valued beyond belief by their local communities. I wish them well for the future.

Mitochondrial Replacement (Public Safety)

Sarah Wollaston Excerpts

Monday 1st September 2014 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I rise to urge the Minister not to delay bringing forward the regulations, and I urge the House not to lose sight of the children and their families who are devastated by mitochondrial diseases. Of course it is absolutely right that the House debates the ethics, as so many Members have pointed out, but at times the language used has clouded those arguments. We have heard terms such as “eugenics”, “three-parent babies”, “designer babies”. This is not about wanting to create a child who is more beautiful or more intelligent. This is about wanting to spare families and children from a lifetime of devastating medical problems. We have the potential to do that. I fully respect those who oppose this on ethical grounds—they are entirely consistent in their view—but I am concerned that there has been selective misquoting from the scientific evidence. The House is not really qualified to examine the evidence in detail, and that is why we have expert panels, and bodies such as the HFEA, to advise and regulate this, and they do so with a great deal of thoughtfulness and expertise.

We have to be clear that the third scientific review, the expert panel, which I regret has been selectively misquoted, has looked at that evidence and has concluded that it does not show that the technique is unsafe. We will not know whether the technique is effective until we allow trials in a human context—it may be that there are complications; we have to be honest about that, and we have to be honest that this is not the same as a blood transfusion—but we do know absolutely for certain that families and children are suffering now from these diseases. That is why, on the balance of the safety issues and the advice from the expert panels, we should not reject this on safety grounds.

The point made by the hon. Member for North Antrim (Ian Paisley) about the child sitting in front of him in his surgery whose parents would not change that child was particularly powerful. No one is asking to change a child. What we are asking is for future generations of children to be spared that part of them that creates the suffering, but to keep within them all the personality and everything else in their genetic make-up that makes them who they are.

I am also concerned to point out that if I were to donate my mitochondrial—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order.

--- Later in debate ---

[Fiona Bruce]

I thank all hon. Members who have contributed to this debate. The number who have contributed and the serious intent and concerns expressed highlight the grave concern that Members feel about this issue, which I believe reflects public concern. That is why it is so important that the final decision on this issue is brought back to the House. Full debate and consideration should be available to us after the critical research recommended by the Human Fertilisation and Embryology Authority has been conducted, published and peer reviewed.

My hon. Friend the Member for South Derbyshire (Heather Wheeler) said that we should listen to the science, and that is precisely my point. It is said that the Government intend to lay regulations this autumn, before the pre-clinical research recommended by the HFEA in its three reports has been concluded, written up and assessed in peer reviewed journals. I simply say that it cannot be right to ask the House to make such a decision before the tests have been concluded. As my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) said, there has always been an understanding that we must proceed only when the safety of these issues has been properly assessed.

As a mother, I know that no mother would want to conceive a child with mitochondrial disease, but neither would they want to conceive a child with potential genetic abnormalities because adequate safety tests on maternal spindle transfer and pro-nuclear transfer were not carried out.

Question put and agreed to.

Resolved,

That this House takes note of the Human Fertilisation and Embryology Authority’s most recent scientific review into the safety and efficacy of mitochondrial replacement techniques which highlights concerns for subsequent generations of children born through maternal spindle transfer and pronuclear transfer; welcomes the recent comments of scientists including Professor Lord Winston that, prior to the introduction of such techniques, more research ought to be undertaken and a full assessment conducted of the potential risk to children born as a result; and calls upon the Government, in light of these public safety concerns, to delay bringing forward regulations on mitochondrial replacement.

[Dr Sarah Wollaston (Totnes) (Con)]

On a point of order, Madam Deputy Speaker. Is it in order to ask whether Professor Lord Winston was consulted before his name was added to the motion on the Order Paper?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

It is in order to ask the question. I cannot give the hon. Lady an answer, but I have heard what she said, and I am sure that those who were involved in that have heard what she said. If the noble Gentleman was not consulted, I would consider that to be most discourteous.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 15th July 2014 Commons Chamber

[Norman Lamb]

The hon. Lady raises an important point, which she and I have discussed before: the fact that very many people who end up taking up their own lives have had no contact at all with statutory services. I would be happy to discuss further with her what additional steps we can take to ensure that those people get the support they need.

[Dr Sarah Wollaston (Totnes) (Con)]

I am delighted to see all the members of the Front-Bench team in their places this morning—or this afternoon, I should say. The principle of parity of esteem should also apply to consent to treatment. Does the Minister agree that the offer of talking therapies and other therapies must always be based on the principle of informed consent? Has he held any discussions with his colleagues in other Departments?

[Norman Lamb]

I completely agree with my hon. Friend. It seems to me to be inherent in the nature of therapy that people go into it willingly. The idea that we could frogmarch them into therapy against their will simply would not work. We could end up with a dangerous and costly tick-box exercise that achieved nothing, so there is no plan to introduce compulsion to access therapy.

NHS Investigations (Jimmy Savile)

Sarah Wollaston Excerpts

Thursday 26th June 2014 Commons Chamber

[Mr Hunt]

I thank the shadow Health Secretary for the constructive tone of his comments. Many of the suggestions he has made are very sensible. We will take them away and look at them, but I will go through a number of them now. First, we will indeed make sure that all Savile’s victims get the counselling they need. I think that it has been made available to them, but it is absolutely right to double-check that they are getting every bit of help they need and that we are taking all reasonable steps.

I hope that what has happened today will be, in its own way, another landmark for all victims of sexual abuse in giving them the confidence that we are changing, not just as an NHS but as a society, into being much better at listening when people come forward with these very serious allegations. It hits you time and again when reading these reports how many people did not speak up at the time because they thought that no one would believe them. We are not going to change that culture overnight, but we have to be a society that listens to the small person—the person who might get forgotten and does not feel they are important in the system.

On the claims for compensation, the right hon. Gentleman is absolutely right to say that the first draw for those claims will come from the Savile estate. I hope I can reassure him, however, that, as we have said, the Government will underwrite this so that if there are any claims that are not able to be met by the estate we finance them from the public purse. We think it is important that we should do that, although Savile’s estate is the first place to start, for obvious reasons.

The right hon. Gentleman is right to say that if there is evidence that people have criminally neglected claims that were made at the time or behaved inappropriately—even if it is not a matter for the law and they behaved in a way that could make them subject to disciplinary procedures in NHS organisations—that should be addressed. We will urge all NHS organisations to look carefully at anyone who is mentioned in the reports. Of course, the police will, naturally, look at the evidence against any individuals, who of course have the right to due process, which everyone in the House would accept.

On the specific point about the behaviour of one Minister and what it suggested about the motivation for Savile’s approval for his job at Broadmoor, my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke), who was Secretary of State at the time, has said that that behaviour would be indefensible now and that it would have been indefensible at the time. I agree with him. Everyone must be held accountable for the actions they took.

We are doing a great deal to make sure that all NHS staff are trained to feel more confident about speaking out. The Mid Staffs whistleblower Helene Donnelly is now working with Health Education England to see what needs to change in the training of NHS staff in order to change that culture.

On the new disclosure and barring scheme, we are already doing work to examine the reason for the drop in the number of people who are being barred from working with children. The Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) is looking into that. I have given this a lot of thought and it is important to say that in the current environment, were we to have another Savile, it is likely that the disclosure and barring scheme would bar him from working with children and in trusts, but that is not certain because he was never convicted of a crime. The Criminal Records Bureau checks would not have stopped that, but it is possible for the disclosure and barring scheme to prevent people from working with children and vulnerable adults even if they have not committed a crime. For example, their employment track record may show that they were dismissed for doing things that raised suspicions. It is also important to make the point—I think everyone in the House will understand this—that it is not possible to legislate to stop all criminal vile activity. What we depend on for the disclosure and barring scheme to work is a culture in which the public and patients feel able to speak out and staff listen when they do so, in order that these things surface much more quickly.

Finally, the question of whether any further inquiries are necessary will, of course, be considered. The first step is to let Kate Lampard do her full report. At this stage, she has not drawn together all the different inquiries and tried to draw lessons from the system as a whole. I asked her to do two things. The first was to verify independently that the reports of NHS organisations were of the necessary quality, and I think she has done that superbly. The second stage of her work is to see what lessons can be drawn from the system as a whole. We need to hear what she has to say about that and, indeed, what the Department for Education and the BBC learn from their reports, and then we will come to a conclusion about whether any further investigations are needed.

[Dr Sarah Wollaston (Totnes) (Con)]

May I join the Secretary of State in paying tribute to the victims? They were not silent. What today’s reports show is that very many people witnessed—even directly condoned—some deeply inappropriate behaviour. How could it ever be acceptable for a celebrity to be able to watch female patients showering? Will the Secretary of State join me in sending a message to NHS staff that they should always raise concerns if they witness such behaviour and that they will be protected if they do so?

[Mr Hunt]

I am absolutely happy to do that. I wholeheartedly agree with my hon. Friend’s comments. The NHS needs to move to a system where it is the norm rather than the exception to report, and where NHS staff feel comfortable that reporting any concerns is an absolutely normal part of their job. She is right to say that one of the most disturbing things in the reports is the clear evidence that some people helped Savile in what he did—for example, that people were escorted to his private room in Broadmoor—which is very shocking. That is why it is very important that everyone is vigilant. I totally agree with what she said.