Oral Answers to Questions

Steve McCabe Excerpts

Tuesday 21st March 2017 Commons Chamber

[Nicola Blackwood]

My hon. Friend has raised this case with the Department and has been making a number of pleas on behalf of his constituent. It is a very difficult case and I would like to pass on my sympathies to his constituent. Obviously, the National Institute for Health and Care Excellence is independent and this drug is not recommended for TRAPS. I do not know the details of the case because it is confidential, but I will be very happy to meet my hon. Friend and his constituent to see if anything can be done.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I do not know if you spotted the rather topical news story about children’s dentistry this morning, Mr Speaker: there were 1,464 hospital admissions for children for teeth extractions across one clinical commissioning area of Birmingham last year, the highest figure since 2010-11. How does the Minister account for this, and what is he going to do about it?

[David Mowat]

The figures for child extractions are clearly disappointing and two key actions need to take place: less sugar, which we expect the soft drinks levy to help with; and getting more fluoride on to teeth, particularly through fluoride varnishing. That has increased across the NHS over the last year, and by 12% in Birmingham. We hope that that will make a difference.

Health and Social Care

Steve McCabe Excerpts

Monday 27th February 2017 Commons Chamber

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Often, the NHS estimates day debate is a rather perfunctory affair, but this year, five years into the reign of the present Secretary of State, we are entitled to ask what on earth is happening to our NHS and social care system. Can we any longer afford the extraordinary complacency of this Government? As an Opposition MP, I sometimes worry that, either by design or simple neglect, they will finally fulfil our worst fears that the Tory party is destined to destroy the NHS.

[Kevin Foster]

So much for cross-party dialogue.

[Steve McCabe]

I don’t think I need any lectures on cross-party dialogue from the party of the death tax and the £8 billion financial fib.

In Birmingham, we have seen £28 million cuts to the social care budget, bringing the service to its knees. Elderly people are being treated like cattle, lying around on trolleys, waiting in corridors and dispatched from hospital in the middle of the night. Everywhere we look, we see our hospitals, GPs and social care services collapsing under the strain.

This Secretary of State is quite happy to flex his muscles when it comes to bullying junior doctors, but it is always someone else’s fault when it comes to resources, management and administration of the NHS. There was a time when the deal was simple: in return for the red box and a ministerial salary, Ministers took responsibility —the buck stopped with them. But no more. I have lost track of how many parliamentary answers begin with the words, “The Department does not collect that data centrally,” or “It would not be cost-effective to provide information in that format”. Basically, Ministers do not know, do not want to know and do not want us to know what is really happening. They no longer preside over a genuinely national health service. Whether it is the postcode lottery that characterises the provision of IVF, with clinical commissioning groups ignoring NICE guidelines and making up their own criteria as they go along, or children’s dentistry, where there is a growing crisis and a heavy reliance on hospital emergency surgery because of the lack of provision and monitoring of proper dental services for children, all this Government want to do is hide behind and blame others for their shambolic decisions.

The latest disaster is the business rates revaluation, which in Birmingham is estimated to see a rise for University Hospitals Birmingham’s Queen Elizabeth hospital from £2.8 million to £6.9 million per year—talk about robbing Peter to pay Paul! And yet Ministers from the Department for Communities and Local Government and the Department of Health have not even met to discuss the problem—although I note that private hospitals get an 80% reduction because they are registered as charities.

In my constituency, we have been fighting a battle to save our Katie Road walk-in centre for several years: we have had stop-go consultations, money wasted, explanations and excuses that vary from month to month, consultations announced and then scrapped, and now we have a sustainability and transformation plan that sadly, as acknowledged, has turned into a secret strategy drawn up by non-elected bureaucrats from which the public and their elected representatives have been largely excluded. It seems that Katie Road is now caught up in this fiasco. With its contract scheduled to finish on the 31st of next month, we still do not know what is happening, although if rumours are true, even more money that ought to be spent on healthcare in Birmingham is about to be siphoned off to rescue bankrupt neighbours.

Only the other week, I discovered that the contract for South Maypole GP services was to be cancelled. It is apparently no longer cost-effective—not cost effective to provide GP services to the sick and elderly! Only under this Secretary of State could the NHS have come to this.

[Kevin Hollinrake]

In my remarks, I talked about a cross-party conversation. I could easily have pointed out that between 2011 and 2014 there was an 8.6% real-terms drop in health spending in Wales, under a Labour Administration, while there was a 4% increase in England, but would it not be better to have a constructive conversation about how we take the NHS and social care off the front pages of the tabloids and to sit down and work out a solution together?

[Steve McCabe]

It is always desirable to have that conversation when the Tories are in power. When Labour is in power, we talk about death tax campaigns and we hear about £8 billion funding fibs. It is funny how the argument always changes when they are responsible.

As I was saying, the contract for South Maypole GP services is about to be withdrawn. I found that out not when the CCG, which it turns out has been ruminating on this since November, told me, but when I was contacted by anxious constituents who had just found out they had eight weeks to find a new GP. Many of them are elderly people, and some have long-term conditions and rely on regular medication, but they are dismissed as if they do not matter. The loss of their GP service is treated like the closure of a local hairdresser or petrol station. They are told to shop around. Apparently the CCG thinks there are enough GPs in the area—enough at any rate to satisfy their little diagrams and tables on their secret little plans. Reducing demand for acute care is one of the Government’s plans to ease pressures in the NHS. Exactly how do we achieve that by closing walk-in centres and GP surgeries? Is that not the fastest route to our already overstretched A&E departments?

It is not just the estimates at issue here, but a proper long-term plan for the NHS and social care. This Secretary of State has failed us. His stewardship is a disaster. Rather than accepting more of it, the House should be calling for a motion of censure. The Government and the Secretary of State are presiding over the steady dismantling of the country’s greatest peacetime achievement. It is a total disgrace.

NHS Fertility Services

Steve McCabe Excerpts

Thursday 19th January 2017 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I beg to move,

That this House has considered decommissioning of in vitro fertilisation and other NHS fertility services.

It is a pleasure to serve under your chairmanship today, Mrs Gillan.

I am grateful to the Backbench Business Committee for granting this debate; to the right hon. Members for Carshalton and Wallington (Tom Brake), and for Wantage (Mr Vaizey), for their support in securing it; and to the many other Members who are either here today or who have indicated their support for a debate on IVF. Change is urgently needed in this area, and we have broad, cross-party support for such change.

I know that it is not customary, Mrs Gillan, to refer to the Public Gallery during debates such as this one, but perhaps I can just say in passing that I am told that a number of people have travelled here today because of the importance they attach to this issue, and because of their strong feelings that what is going on is not fair and needs to change. It is through listening to their experiences that I have begun to understand the extent to which the present arrangements are not working.

[Andrew Selous (South West Bedfordshire) (Con)]

Does the hon. Gentleman agree that, rather than imposing a postcode lottery on our constituents by withdrawing these services, the areas under financial pressure need to become more efficient and to look at how other areas manage their health systems better to make efficiencies, so that in vitro fertilisation can be provided everywhere?

[Steve McCabe]

I certainly agree with the hon. Gentleman about a postcode lottery; there is a massive variation in service, so we must strive to achieve a cost-efficient system that is genuinely national in the way it is delivered. I agree with that absolutely.

This debate is about IVF and related services. At a time of so much concern about the NHS generally, the debate could easily drift towards becoming a series of questions about other aspects of the NHS, but I am clear that we asked for this debate to raise concerns associated with those who need treatment for infertility issues.

Infertility is a problem that does not get a lot of Government or parliamentary attention; in fact, it was not debated at all in the previous Parliament. Yet we know that it is an issue that affects one in six couples in the UK and is the second most common reason for a woman to visit her GP. The problems of infertility are recognised by the World Health Organisation as a condition for which medical treatment should be provided, but that is not how we approach the matter today in England.

I am immensely grateful to my constituent Louise Jackson for bringing this issue to my attention and for giving me permission to share some of her experience with people today. Louise and her partner have been together for more than 13 years and have been trying for a baby for nearly six years. After tests confirmed that they would need IVF treatment, they were refused it because Louise’s partner already had a child, as a result of a previous relationship in 1975. That child is actually older than Louise herself, who has said:

“Anyone who is experiencing fertility problems will understand the agonising pain and upset it brings on a daily basis. The fact that we have been refused treatment on the NHS just adds to the anguish. We cannot express enough how hard it is to not be able to have children naturally, never mind being faced with the fact we’ve been saving for years for the thousands needed for this treatment. I hope one day these laws will be changed for couples like us and others in the near future.”

My information is that four clinical commissioning groups in England—Mid Essex, North East Essex, Basildon and Brentwood, and South Norfolk—have already decommissioned their assisted conception services, essentially as a cost-saving measure. Also, more than one in 10 CCGs in England are currently consulting on reducing or entirely decommissioning NHS fertility treatment. That means that more than 60 Members of Parliament represent seats where the provision of IVF services is at risk.

The guidelines produced by the National Institute for Health and Care Excellence are fairly clear on the provision of IVF services. NICE recommends that all those women who are eligible for IVF should have access to three full cycles of IVF if the woman is aged under 40, and in 2013 it updated its guidance to recommend further that women aged between 40 and 42, and who meet some additional criteria, should have access to one full cycle.

Fertility Fairness is an umbrella body that has the support of several organisations, including the Royal College of Nursing, the Association of Clinical Embryologists, the British Fertility Society, the National Gamete Donation Trust and the Miscarriage Association. In 2016, it undertook an audit of every CCG in England and found that only 16% of CCGs offer three cycles of IVF, which is the NICE recommendation. That was down from 24% in 2013, while the number of CCGs offering just one cycle of NHS-funded IVF treatment has leapt to 60%. The Minister is on record as saying that she finds the decommissioning of such services “unacceptable”, so she will not be surprised if I ask her what she plans to do in response to these figures.

According to NICE, a full cycle of IVF treatment should include one round of ovarian stimulation and the transfer of all resultant fresh and frozen embryos, but only four out of 209 CCGs comply with the NICE definition of a “full cycle”. As a result, in many parts of England, these efforts to provide IVF on the cheap are—perversely—wasting resources, because this incomplete offer is rarely successful and compromises the cost-effectiveness of IVF as a treatment. It is a bit like giving less than the recommended dosage of any other drug or treatment.

As I have said, NICE offers guidance on age appropriateness for IVF. However, without being required to offer any kind of explanation, some CCGs have lowered the maximum age for IVF to 35; others have introduced non-medical criteria, such as refusing couples treatment if one of them has a child from a previous relationship, as happened in the case of my constituent, Louise Jackson; and apparently even more criteria are applied for same-sex couples, including a requirement to demonstrate that they have already paid privately for six cycles of treatment before they can be considered by the NHS. Those requirements do not look like medical criteria to me; they look like crude, discriminatory rationing, based on pseudo-moralistic prejudices.

In Birmingham, CCGs justify their approach by testing their proposals via public consultation, and in 2014 a consultation covering the criteria for eight CCGs across the west midlands was undertaken. Of the 351 people who responded, 40% were against providing IVF to a couple where one party has a child from a previous relationship; 40% disagreed with that view; and 20% did not know. Nevertheless, those proposals are now the criteria that must be met. I cannot imagine such a crude approach being adopted for determining treatment eligibility for any other medical condition, but that of course is part of the problem.

Too many people think, in defiance of the World Health Organisation, that it is a lifestyle issue and not a medical condition. That is not helped by the fact that the Department of Health merely asks that CCGs “have regard to” the NICE guidelines. This recognised medical condition can have a number of related impacts. If left untreated, it can result in stress, anxiety, depression and the breakdown of relationships. A recent survey of almost 1,000 people with infertility problems conducted by Middlesex University found that 90% of respondents reported feeling depressed and 42% reported feeling suicidal, which was up from 20% when a similar study was conducted in 1997. Some 70% reported a detrimental impact on their relationship, and 15% said that it had led to the break-up of their relationship.

The debate is not about statistics, though; it is about real people and the devastating impact that being denied treatment for infertility problems can have on their lives. On Monday afternoon, I took part in a digital debate with many members of the public, and they helped contribute to our debate today. Hundreds of people shared their experiences. I cannot name them all, but I would like to take this opportunity to thank them for their contributions. I want to briefly share just a few examples that illustrate the kind of problems that mean we need to see some significant change in the delivery of this service.

Kelly Da Silva from south Derbyshire said:

“This is such an important issue for me, the anxiety and depression caused as a direct result of infertility and involuntary childlessness has affected every aspect of my life and caused me to leave a successful 12-year teaching career. The emotional and social impacts are absolutely devastating.”

Becky Thomas is from Hertfordshire, and comes under the direction of a Cambridgeshire CCG. She said:

“My local CCG cut the amount of cycles they offer from three down to one and are considering getting rid altogether. I live in one area that actually offers three full cycles however I come under a completely different CCG. It shouldn’t be a postcode lottery. It’s not a lifestyle choice. It’s a medical condition.”

Erin Nina Desirae from Sheffield said:

“I am in a same-sex marriage. My wife and I have been together for six years and have always talked about having children. We assumed that the law in this country would support us and enable us to try for a family with help from the NHS. Unfortunately, we were surprised and hurt to find that same-sex couples are not offered fertility treatment on the NHS until we have first self-funded at least six cycles ourselves. Whilst a heterosexual couple can receive NHS treatment after two years of trying to conceive. This feels like discrimination. Why should we be treated differently?”

What of the costs? Evidence suggests that many of the decommissioning and service reduction decisions are driven largely by budget considerations. Reports show that the cost to CCGs of commissioning one cycle of IVF can range from £1,300 to £6,000. It varies dramatically across the country. For example, it is much cheaper in Newcastle than it is in Birmingham, without any obvious explanation. What kind of way is that to run a health service and provide a vital treatment? Is it not a classic example of the fragmentation of the NHS that many predicted would follow the Lansley reorganisation?

In England, more than 200 CCGs are responsible for setting their own criteria and commissioning their own IVF services. To make matters worse, research suggests that the high cost of IVF in the private sector is forcing people to travel to such countries as the Czech Republic, where IVF treatment is far cheaper. The problem is that IVF is not anywhere near as well regulated in those countries as it is in the UK. As a direct result of reducing services in the UK, the NHS is being saddled with the high cost of complicated multiple pregnancies and births and other postnatal issues. There is also the additional cost to mental health services, which I touched on earlier. [Interruption.] As you can see, Mrs Gillan, I have successfully transposed a page of my notes. I hope you will bear with me for one second.

[Mrs Cheryl Gillan (in the Chair)]

Mr McCabe, this sort of thing happens to people all the time. We will bear with you.

[Steve McCabe]

I cannot believe I have done it, but I am extremely grateful for your patience.

As I was saying, the costs of people having to go abroad fall on the NHS, and that leads to further complications that may impact on our mental health services.

In the course of my speech, I have concentrated on the impact on women, but the issue does not solely affect women. It affects couples, same-sex couples and men. I understand that CCGs that are cutting back on IVF generally are also cutting back on ICSI—I am told that it stands for intracytoplasmic sperm injection and is the most common treatment for men with infertility problems—and I worry that men’s experiences of infertility are not fully appreciated. They may also suffer hidden trauma and stress as a result of their problems. I am grateful to Richard Clothier from Dunstable who said:

“The emotional strain served to us when our infertility was confirmed was absolutely horrific and debilitating. However, this does not touch the sides when compared with the mental health deterioration we endured from the precise point at which we learned our entitlement has been slashed by two thirds. Luton, in the same county, has three cycles, the rest of us in Bedfordshire get just one cycle.”

What do I hope to get from this debate? I hope that the Minister, by the time she has had a chance to reflect on all the contributions and the terrible experiences of so many people, will have heard enough to be convinced that she should set up an investigation into the provision of IVF services in England. I hope she will be persuaded to offer much stronger guidance to clinical commissioning groups that in all normal circumstances they should be expected to comply with NICE guidelines and at the very least offer a clear and unambiguous explanation for their reasons when they choose not to follow NICE guidelines. I hope she will be persuaded to look again at the case for setting a national tariff for the provision of IVF. It is simply ludicrous that when NHS resources are so stretched, as the hon. Member for South West Bedfordshire (Andrew Selous) said earlier, the same treatment can vary in price between £1,300 and £6,000. Those who have suffered with this condition feel they have been ignored and mistreated for far too long. They are entitled to expect that we will now act to address the problem.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe), my right hon. Friend the Member for Wantage (Mr Vaizey) and the right hon. Member for Carshalton and Wallington (Tom Brake), who is not in his place, on securing this important debate. I am grateful for the opportunity to discuss NHS fertility services. This has been a moving debate and, on behalf of the Government, I recognise at the outset that infertility is a serious condition, affecting a growing number of people: women and men and same-sex couples. I personally thank all of those who have allowed their stories to be shared today. They remind us powerfully of the distress that infertility causes. The value of their being shared in the debate cannot be overstated.

It is important to remember that those stories are not isolated cases. As hon. Members are well aware, fertility problems are estimated to affect one in seven heterosexual couples and, for couples who have been trying to conceive for more than three years without success, the likelihood of pregnancy occurring in the following year is 25% or less. We should keep those figures in our minds.

As my right hon. Friend said, infertility can and does have a powerful and lasting impact on the quality of life of those affected. Research has shown that there can often be psychological effects, as powerfully described in the debate, for both men and women suffering from fertility problems. It can cause stress and it puts pressure on relationships, primarily between the couple themselves but also on relationships with family and friends. It is therefore important that the NHS provides access to fertility services for those who need clinical help to start a family.

The availability of NHS fertility treatment is and always has been a matter for local determination. As my right hon. Friend said, these are not easy decisions to make, but we expect them to be made fairly. Decisions on the level of service provision are underpinned by clinical insight and knowledge of local healthcare need. That has been the case since the introduction of the purchaser-provider split in the 1990s, and today that determination is, as we all know, made by CCGs, which are clinician-led and have a statutory responsibility to commission healthcare services that meet the needs of their whole population, reducing inequalities and improving care quality.

While provision of services will, by necessity, vary—for example, the health needs and priorities of the population of Birmingham will not be the same as that of Bournemouth—it is right that those difficult prioritisation decisions are led by clinicians who know their patients and local areas best rather than being made centrally. The Government have made it clear that blanket restrictions on any healthcare treatment—including fertility services—are unacceptable. Where a service is not routinely commissioned, clinicians can still make individual funding requests for their patients when a clinical case can be made and if treatment is likely to provide significant benefit. It is the role of NHS England to ensure that CCGs are not breaching their statutory responsibility to provide services that meet the needs of their local population and to take action if such breaches do take place.

[Steve McCabe]

I recognise what the Minister says about this being an issue for local determination. However, does she agree that it does not make sense to use moralistic criteria to ration the provision of services, which—as in the example I cited in Birmingham—is then put to a public poll that produces an inconclusive result on a very low turnout? Surely that is not the kind of local determination we want. Is that not something that NHS England should act on?

[Nicola Blackwood]

The hon. Gentleman gave a very good opening speech in which he raised some points that I will comment on. The quality of commissioning of fertility services is one of those points, and having regard for guidance already in place to guide local commissioners in commissioning fertility services is a point on which I am about to comment. He has anticipated my speech as only a seasoned politician can.

NICE first introduced its fertility guidelines in 2004. As with all clinical service guidelines, they have never been mandatory. Successive Administrations have supported the principle of locally determined implementation of key recommendations of the guidelines, because decisions about local services should be made as close to patients as possible by those best placed to work with patients and the public in their area to understand their needs. However, it is sadly the case that implementation has been variable over the years, particularly with the provision of three IVF cycles for qualifying couples, as we have heard. As the hon. Member for Birmingham, Selly Oak and the shadow Minister rightly said, the 2016 Fertility Fairness survey showed that just 16% of CCGs provided the recommended three cycles of IVF, with 22% providing two, 60% providing one and 2% providing no IVF funding at all.

I understand that commissioners in some areas are undertaking their own evidence reviews, as the hon. Member for Birmingham, Selly Oak said, to determine whether their CCG should offer IVF. I take this opportunity to say that that is unnecessary. NICE was established for the specific purpose of reviewing the available clinical and scientific evidence of a treatment’s effectiveness and, working with a wide range of stakeholders, to make recommendations based on that evidence about services that should be available to all within the NHS. NICE guidelines for fertility services are robust and fit for purpose, and there is no need for them to be second-guessed by commissioners.

The hon. Gentleman also raised NICE guidelines for same-sex couples. NICE guidelines seek to offer heterosexual and same-sex couples the same access to investigation and treatment for fertility problems, the criterion for which is a failure to conceive over a set period of time. NICE sets that criterion to ensure that NHS funding is available for donor sperm for female same-sex couples, or surrogacy arrangements for male same-sex couples, on the basis that they are medically sub-fertile, not that their childlessness is owing to the absence of gametes from the opposite sex—sperm or eggs.

Access to NHS-funded investigations is commissioned in female same-sex couples who fail to conceive after six cycles of artificial insemination within a 12-month period. NICE recognises that same-sex couples could be disadvantaged, because they may have to pay for artificial insemination before they can be considered for NICE assessment and possible treatment. NICE considers six cycles to be equivalent to the 12-month period of unprotected intercourse required of heterosexual couples before they are offered investigation for fertility problems. Same-sex couples are offered access to professional consultation and advice in reproductive medicine before they embark on attempts to conceive, to ensure that they are informed about appropriate and safe self-funding attempts. I can tell the hon. Member for Birmingham, Selly Oak that NICE is due to review its fertility guidelines this year, and he may wish to write to NICE’s guidelines review team to offer his views on the issue. The Department of Health will certainly be doing so.

On the implementation of NICE guidelines, I commend CCGs, such as Camden, Oldham and others that have been mentioned, that have implemented the NICE fertility guidelines in full and continue to offer three IVF cycles to qualifying couples. That shows it is entirely possible for CCGs to implement NICE’s IVF provision recommendations. It was disheartening to learn from the Fertility Fairness survey that access to IVF treatment on the NHS has been reduced in so many places, and it is deeply disappointing that some CCGs have stopped routinely commissioning it. I strongly encourage all CCGs to implement the NICE fertility guidelines in full, as some CCGs are successfully doing.

--- Later in debate ---

[Steve McCabe]

I thank the various Members who have taken part in this debate: the right hon. Member for Wantage (Mr Vaizey), my hon. Friends the Members for Coventry North East (Colleen Fletcher) and for Ellesmere Port and Neston (Justin Madders) and the hon. Member for South West Bedfordshire (Andrew Selous), who has now left. It is never easy on a Thursday afternoon, but I really felt we had to have some focus on this issue in this place today.

I am extremely grateful to the Minister for the tone she adopted in her response. One reason why I asked her to instigate an investigation into what is happening is that I understand, from a parliamentary question I submitted, that the Government do not, as a matter of routine, centrally collect information on the provision of infertility services. While I acknowledge her point about provision being locally determined, the extent of the disparity has been a revelation to me. It is difficult to believe we are talking about a national health service when we see that level of disparity. I gently say to her that there would still be some merit in a further investigation into the extent of the variation in England at present.

I am extremely pleased to hear that the Minister plans to write to NHS England. I interpret that as meaning she will put pressure on NHS England to put pressure on the CCGs that are not complying with the NICE guidelines. I will certainly take the opportunity to write to NICE about the experience of same-sex couples, as she suggested, although the key here is obviously that the NICE guidelines have to be followed. That is the central problem.

I was extremely pleased to hear that the Minister is taking steps on benchmark pricing, which may well lead to the construction of a national tariff. All I will say on that is: the sooner, the better. If she were able at some stage to offer us a realistic timescale for that, it would be some comfort to the very many people who have contacted all of us to explain the pain and anguish they have suffered as a result of this condition. I am grateful to Members for their contributions and to the Minister for a thoughtful response.

[Mrs Cheryl Gillan (in the Chair)]

This has been a very valuable and important debate.

Question put and agreed to.

Resolved,

That this House has considered decommissioning of in vitro fertilisation and other NHS fertility services.

Child Cancer

Steve McCabe Excerpts

Monday 28th November 2016 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I begin by congratulating the hon. Member for Bath (Ben Howlett) on introducing the debate and on the thoughtful way in which he presented the arguments. I am pleased to make a short contribution. I have come at the urging of my constituent Debbie Moran, whose young daughter Abigail is just five and was diagnosed with a childhood cancer at the age of three. I understand Abigail is in remission, and we wish her and the rest of the family all the best for the future.

The figures I have seen suggest that each year more than 6,000 young people across Europe die of cancer, but by 2020 there will be nearly half a million childhood cancer survivors. I hope we will bear that progress in mind today. I welcome the work of the European Network for Cancer Research in Children and Adolescents, SIOPE—the European Society for Paediatric Oncology—and the European paediatric haematology and oncology community. I particularly welcome SIOPE’s seven-point plan to increase over the next 10 years the cure rate and the quality of survivorship for children and young people with cancer.

Like the hon. Gentleman, I hope that whatever decisions this country makes over Brexit, we will remain an active part of the important European cancer research and treatment community. As the hon. Member for South Ribble (Seema Kennedy) said, we need more innovative treatments introduced into child cancer care. We need the development of precision cancer medicine to help guide decisions on which therapies to use. We need to increase our knowledge of tumour biology and speed up the translation from basic research to clinical care. As my hon. Friend the Member for Alyn and Deeside (Mark Tami) said, we also need to improve the quality of survivorship and address the consequences of cancer treatment, such as the long-term side effects in all their various forms. Basically, we need to understand more about the causes of childhood cancers.

Although there has been significant progress over the past 50 years—the hon. Member for Bath described some of that—it has largely been achieved by using intensive chemotherapy regimens combined with surgery and/or radiotherapy. There is some evidence to suggest that patient survival has plateaued over the past five years, which hastens the demand for more innovative treatments.

The petition focuses on the problems we need to address, such as the lack of sustained and sufficient funding. As has been suggested, there is also poor access right across Europe to new paediatric drugs. Too many countries do not recognise paediatric haematology and oncology as a sub-speciality. For the sake of Abigail and thousands of children like her, and in memory of Poppy-Mai, whose parents are the originators of the petition, we need to dedicate ourselves to saying that we recognise the seriousness of the issue and that we are going to do more.

Health Service Medical Supplies (Costs) Bill

Steve McCabe Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Mr Hunt]

I am grateful to my hon. Friend for raising that issue. Although the measures he mentions are not directly covered in this Bill, he reminds the House that the business of getting value for money from our drugs business is everyone’s business throughout the NHS. There is a huge amount of prescribing of medicines that is not strictly necessary. Indeed, we had further evidence of that from the Academy of Medical Royal Colleges this morning. My hon. Friend makes an extremely important point: this Bill is part of the effort to get better value for money from our medicines budget, but initiatives such as the one he talks about are equally important.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Further to that question, I can see how the Bill will deal with the issue of debranding, and that is very welcome, but I understand there are three other areas of concern. There is the question of price delay, which the Competition and Markets Authority has been looking at, and there are the problems of tying and bundling and so-called loyalty schemes, all of which act to inflate the cost of medicines to the NHS artificially. Will the Bill also deal with those areas?

[Mr Hunt]

It will deal with some of those concerns, and we will listen to all the concerns raised by hon. Members during the progress of the Bill. On the particular issue the hon. Gentleman raises, the CMA is already investigating the behaviour of pharmaceutical companies in certain situations, but it has become clear to us that there is a particularly unethical and unacceptable practice of drugs companies getting control of generic drugs for which they command a monopoly position and then hiking the prices. There was one product whose price increased by 12,000% between 2008 and 2016, and if the price had stayed the same as before the increase, the NHS would have spent £58 million less. The Government’s conclusion is that the simplest and quickest way to sort this out is through new legislation, but I will happily take the hon. Gentleman’s other concerns offline and look into them further.

--- Later in debate ---

[Justin Madders]

My hon. Friend tempts me a little way outside my brief. I note, though, that our health service is entering into partnerships with Google, so I hope that questions are being asked by Ministers about the taxation arrangements.

We know that the vast majority of the generics sector is well controlled by competition and delivers value for money to the taxpayer, and we welcome the extension of pricing controls where competition has failed. Is the Minister confident, however, that the steps taken in the Bill are adequate? We have seen, as my hon. Friend the Member for Wolverhampton South West mentioned, how adept international companies can be at moving figures around to avoid taxation, and we clearly want to ensure that the system that we develop is not vulnerable to the gaming that we have seen elsewhere. I do not think for a minute that given the vast sums of money at stake, the companies will just shrug their shoulders and take the hit if they can avoid it.

I was more than a little concerned when I read a section about this Bill in a Concordia investor presentation, which said that in the past the Department of Health

“would seek informal negotiations with manufacturers where it believed there were pricing issues. We believe this step will remain.”

The notion of informal talks with officials brings up uncomfortable memories of the sweetheart deals between multinationals and Her Majesty’s Revenue and Customs. Although I am happy for chains of communication to be open with such companies, can the Minister reassure us that in all cases prices will be regulated through a transparent, formal process and not through behind-the-scenes talks?

[Steve McCabe]

Where the advertising budgets of pharmaceutical companies dwarf their R&D budgets, is there not an argument for the Government to look again at the tax position of those companies, as well as at the price of their products?

[Justin Madders]

We will not get very far with this Government on corporation tax. They have been going in a direction that we would not have chosen. They have decided on the measures in the Bill as the best way to control prices and we will see how they get on. Will the Minister confirm that if it becomes clear in a few years that we have opened up another set of loopholes, we can expect the Department to take the lead and to be proactive in its investigations, rather than relying on a team of journalists to expose the problem?

We know that in Scotland the rebate that has been generated has been used to create a dedicated fund to give patients access to new medicines. Will the Minister consider investigating similar models and ensuring that the benefits of the scheme are used for the purpose of improving our frankly poor record in allowing patients to benefit from new medicines? We accept that there will always be challenges in matching funding to new drugs, but there is at least a degree of logic in allowing savings made in the drugs bill to be reinvested to enable new products to reach patients more quickly.

We welcome today’s report by the Accelerated Access Review, which sets out an ambitious plan that could see patients accessing new lifesaving treatments up to four years sooner. We hope the Minister will take this opportunity to give financial backing to the aims of the review by committing to using future rebates from the pharmaceutical sector to improve access to treatments. I ask the Government to seriously consider this, as there are growing concerns about access to new drugs and treatments in this country, and particularly about the widening gulf between the UK’s record on developing new drugs and the ability of the NHS to ensure that all patients benefit sufficiently.

The “International Comparisons of Health Technology Assessment” report published in August by Breast Cancer Now and Prostate Cancer UK shows that NHS cancer patients in the UK are missing out on innovative treatments that are being made available in some comparable countries of similar wealth. This is at the same time as a number of medicines have been delisted by the Cancer Drugs Fund after it overspent its budget, and the failure to extend this scheme to innovative treatments as well as medication. There was a report in The BMJ in July entitled “A pill too hard to swallow: how the NHS is limiting access to high priced drugs”. It came to similar conclusions when looking at new antiviral drugs that held out a real prospect of eliminating hepatitis C but which were very expensive.

NHS Sustainability and Transformation Plans

Steve McCabe Excerpts

Wednesday 14th September 2016 Commons Chamber

[Ms Abbott]

I need to make progress.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Will my hon. Friend give way?

[Ms Abbott]

Yes.

--- Later in debate ---

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I think we can spot that the hon. Lady has just given way to a Government Member and now she is giving way to an Opposition Member. We do not need the cheering to go with it.

[Steve McCabe]

I want to check this with my hon. Friend. The last time I checked, Simon Stevens had said that STPs were designed to make up the £22 billion shortfall that the Government are not prepared to put in. Is that not the case?

[Ms Abbott]

It is indeed the case; rather than being an anodyne managerial exercise, the sustainability and transformation plans are designed to make up the missing £22 billion.

One of the most alarming aspects of the STPs is their secrecy. England has been divided into 44 regional footprints, and it is worth noting that they are called footprints to distract from the fact that they are ad hoc regional structures—they are the exact same regional structures that the Tory health Bill was supposed to sweep away. Because they are ad hoc and non-statutory, they are wholly unaccountable. In the world of the STPs, the public have no right to know.

Contaminated Blood

Steve McCabe Excerpts

Tuesday 12th April 2016 Commons Chamber

[Nadhim Zahawi]

I have had similar representations from my constituents, and I hope that those on the Treasury Bench take on board the comments of Andy Gunn and of others in my constituency.

The vastness of the loss we are addressing today is such that even the ideal solution cannot do much to address it, but what has been proposed does so much less. The proposals contained in the consultation are far from what the victims of this injustice expected or were led to believe they would receive. I know that many of my colleagues have similar stories to tell. I have had constituents visit my surgeries who have always been so incredibly strong about what has happened to them and hopeful for the potential of a good settlement from the Government, but have now been left in tears. They feel let down and fear that these proposals will make life even harder for them.

Those are people whose lives have turned out to be radically different from what they had planned, through absolutely no fault of their own. They struggle to get insurance or pensions—things we take for granted in this place—and have had their careers curtailed. Even worse, they have been unable to have children, or have seen loved ones die tragically soon. These people should be helped and need to be provided with a full and final settlement that allows them to move on, without being worse off.

There remains much misunderstanding about the medical conditions of the victims and the treatments available. The improvements in care for those with HIV/AIDS have been a blessing for many. However, the disease remains incurable, and haemophiliacs and those with other conditions such as hepatitis C cannot take the medication that could help them. We must also properly consider those infected by more than one disease. Those with both HIV and HCV have a threefold greater risk of progression to cirrhosis or decompensated liver disease than those infected only with HCV. We should not misunderstand, underestimate or underplay the dangers of these diseases.

My constituents, and the constituents of so many of us here today, have suffered a grave injustice. It is an injustice that they never expected to suffer, would never have been able to prepare for, and for which the blame rests entirely elsewhere. They or their loved ones have experienced terrible illness and their lives have been changed or ended. “Unfairness” does not seem strong enough to describe it, but that word is the best we can do.

The Prime Minister was right to apologise, but this consultation does not go far enough. When my constituents only have to look north of the border to see a better deal on the table, with talk about public monuments to those sadly lost, and are then faced with an option here that could leave them in an even worse position, anger and resentment are more than understandable.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Does the hon. Gentleman agree that there is a danger that the consultation will undo the good of the apology? The impact assessment states that the intention of the policy is to safeguard the interests of those who are chronically infected and receive an annual payment, but that annual payment is no longer index-linked, and people have made their assumptions on that basis. My constituent, Norah Tracey, has had to take early retirement because she has hepatitis C, and she based her projections on those financial assumptions. If it is no longer index linked, we are making a mockery of what the impact assessment says and we are undoing the sincerity of the apology.

[Nadhim Zahawi]

I thank the hon. Gentleman for that intervention. I have heard similar representations from my constituents. Indeed, the all-party group found that the representations were very similar across the board. I sincerely hope that those on the Government Front Bench are listening to these interventions today.

The Prime Minister said last year:

“As a wealthy and successful country we should be helping these people more. We will help them more”—[Official Report, 11 March 2015; Vol. 594, C. 289.]

I agree with him and support those words entirely. I hope that the Minister and the Department of Health will ensure that the settlement for the victims will meet the intentions of what the Prime Minister said last year.

Katie Road NHS Walk-in Centre

Steve McCabe Excerpts

Wednesday 24th February 2016 Commons Chamber

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Tonight I am seeking an opportunity to shed some light on the continuing saga of the Katie Road NHS walk-in centre in my constituency. Its future status has been in doubt ever since its fate was placed in the hands of one of the new clinical commissioning groups. My constituents have had to live with rumours, on-off consultations and continuing threats to the long-term future of an immensely popular and highly valued service that sees about 70,000 patients a year. The origins of the service lie in concerns that the large number of students in the area, as well as vulnerable individuals—often with mental health conditions and in unstable accommodation—were placing a demand on GP services that could not be met by existing provision, which was in turn placing intolerable strains on the local accident and emergency services.

My own fairly extensive consultations with constituents have established that the centre is regularly used by those who cannot easily secure quick appointments with their own GP. That is often a problem for those in work—especially those who work unsocial hours—and for families with elderly relatives or young children who cannot easily gain access to GPs at weekends or in the evenings. The Katie Road centre sees about 300 to 400 patients during an average weekend.

There is now fairly widespread recognition of the value of walk-in centres. The 2014 Monitor review reported rising demand for the service year on year. About 70% of the centres that were surveyed reported that they were seeing an average of 20,000 to 45,000 patients a year, as opposed to anticipated attendances of between 12,000 and 24,000. Yet despite the demand and support for walk-in centres, local commissioners have closed more than 50 since the start of 2010, reduced services at 23 others and reduced overall capacity by about 20%. I am not aware that, other than the Monitor report, there has been any substantial review into the impact of that loss of provision. I wonder whether the Minister is in a position to enlighten me, and whether he might take this opportunity to say what the Government’s position is on urgent care generally and walk-in centres in particular. I noticed that the Department of Health consultation “Refreshing the Mandate” says that

“we want to improve people’s access to primary care through new forms of provision including rapid walk-in access.”

In early 2013, Birmingham CrossCity clinical commissioning group announced plans to consult on the future of the Katie Road walk-in centre. That was apparently based on a report commissioned by the former South Birmingham primary care trust, a report that remains secret to this day. I first asked to see a copy of it in March 2013. In June 2013, the CCG called off its plans for walk-in centres and it was announced that they had been saved, only for the chair of the clinical commissioning group to reveal later that it planned to renew the contract temporarily and that Katie Road had been saved for 12 to 18 months. Later, the CCG announced that it planned a two-stage consultation, with a pre-consultation phase and then a main consultation with the public.

Naturally, I wanted to ensure that my constituents had their say on the matter. When I consulted them, I discovered that more than 72% had experience of using the centre and were firmly opposed to any plans to close it.

[Craig Whittaker (Calder Valley) (Con)]

I agree that walk-in centres have the ability to take pressure off overworked A&Es, but does the hon. Gentleman agree that the best way to take pressure not just off A&Es but walk-in centres is to have GP surgeries open seven days a week, so that people can access services overall?

[Steve McCabe]

I might agree with that, but one of the problems in my area is that GP surgeries have been cut as well, so that is not the answer.

As I said, more than 72% of the people I consulted had experience of using the centre and were firmly opposed to any plans to close it. I also found that 56% of people had used the centre for out-of-hours emergency treatment, and 55% expressed serious concern about any plans to move the service to or near the A&E unit. My findings are consistent with that of the survey conducted on behalf of the NHS central midlands commissioning support unit in 2012, which found that more than two thirds of patients surveyed at eight walk-in centres and urgent care centres across Birmingham and Solihull indicated that they had attended because of an access-related issue—for example, they could not get an appointment with their GP or had to wait a considerable time to be seen.

There were major objections from my constituents to relocating their walk-in centre to the main hospital. They referred, for example, to the distance, waiting times, parking and accessibility. During a visit to Katie Road, I witnessed an ambulance crew bring into the walk-in centre an elderly lady in need of stitches to a leg injury. They did that rather than take her to the A&E unit because of their concerns over the likely delays. The CCG’s own figures suggest that an average visit to the walk-in centre costs around £45, as opposed to £75 to £100 for an A&E visit.

I am aware that there are many examples of walk-in centres being co-located with other health or social care services, and that some have a pharmacy on site or are co-located with diagnostic services such as X-ray services, dental facilities or family planning, but I should like to ask the Minister whether there is any evidence that shows an obvious advantage in co-locating an urgent care or walk-in centre alongside an A&E unit, especially evidence that would outweigh such negatives as distance, waiting times, parking and accessibility. In fact, is it not the case that most walk-in centres have a limited ability to refer patients on to secondary care services, as patients needing a referral to secondary care are normally referred by GPs, who are the traditional gatekeepers—a role that has, if anything, been strengthened as a result of the reorganisation of the NHS?

In autumn 2013 the CCG commenced its pre-consultation. The chair of the CCG met with a number of my constituents in February 2014, when he heard clearly their desire to retain Katie Road and their objections to a plan being pushed by the CCG to relocate the walk-in centre to a site at the University Hospitals Birmingham NHS Trust site, adjacent to the hospital’s A&E unit. In July 2014 I invited the chair of the CCG and a number of his staff to take part in a second meeting attended by more than 80 constituents—we were limited by the size of the room, or it would have been many more. At that meeting they heard clearly once again that there was total opposition to the closure of the walk-in centre and the plans to relocate to the hospital. That review or consultation eventually fizzled out, with the promise of a bigger and better consultation later in 2014.

[Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)]

The issue of such walk-in centres closing down is difficult for all of us in our constituencies. It is no good Conservative Members saying that we will have a seven-day a week GP service, because what they have done already with regard to the junior doctors dispute shows that they are not capable of doing that. That means that our constituents will continue to suffer. In particular, those at work cannot access services and are therefore put at greater risk through further misdiagnosis or non-diagnosis.

[Steve McCabe]

My hon. Friend will know very well that there is a problem with GP provision in his part of Birmingham as well as my own, so it is difficult to see how it could be stretched further.

As I said, we were promised a bigger and better consultation for later in 2014, but that was abandoned in light of the impending general election, the date of which had, obviously, been known since the Fixed-term Parliaments Act 2011.

No satisfactory explanation for the proposed change has ever been provided, but now, once again, the CCG wants to consult on the future of the walk-in service. This time it apparently wants to consult on a new model of service, the details of which are known only to itself but which has apparently not been clinically tested. It appears that, once again, it involves plans to relocate the walk-in centre to a site adjacent to the A&E unit.

As the Minister will know, sections 75 to 77 of the Health and Social Care Act 2012 specifically state that commissioners are required to act in a transparent way when procuring services:

“Transparency is important in ensuring that commissioners are accountable for their decisions. As noted, commissioners also have a duty to involve the public in commissioning decisions.”

It is not clear to me where in that part of the Act there is support for a series of bungled and inadequate on-off reviews and a constant determination to impose one outcome irrespective of the arguments to the contrary. I would welcome the Minister’s view on that. I am deeply concerned at the continuing threats to the service, which plays such a vital part in the delivery of healthcare for my constituents. I cannot see how the loss of a provision such as Katie Road is consistent with the Government’s ambitions for a seven-day NHS—perhaps the Minister can advise me on that.

Ironically, I have recently discovered that the opening hours of the Katie Road centre are to be extended to help cope with winter pressures. Dr Lumley, who works with the neighbouring CCG, which also serves south Birmingham, is quoted in the press as saying, in response to that announcement, that

‘this is great news for patients in Birmingham and means they can access the Walk in Centre until late, seven days a week.”

Such a pity her views are not shared by her colleagues in CrossCity CCG, who assumed responsibility for Katie Road in the carve-up following the introduction of the Lansley reforms.

It seems to me that the CCG is clearly out of its depth in handling a public consultation, or certainly one that can command any public confidence. What advice and support, if any, do the Government offer to CCGs on conducting consultations with the public? I am curious to know how much public money—money that could obviously have been spent on patient care—the CCG has spent on its on-off reviews and consultations so far. Is there any limit to how much public money a CCG is entitled to spend on a review or consultation on a single issue? If so, how much is it? Who is ultimately responsible for making a decision on the future of urgent care provision in south Birmingham? Do the Government accept any responsibility for this unsatisfactory state of affairs, and is there anything the Minister can do to help me and my constituents secure the future of this popular and well used health resource in south Birmingham, which is clearly needed and highly valued?

At the very least, I urge the Minister to write to the chair of the CCG following this Adjournment debate, urging him to communicate properly with my constituents and their elected representatives, to stop repeatedly trying to impose plans that have already been rejected and to bring this whole sorry state of affairs to a satisfactory conclusion.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank the hon. Member for Birmingham, Selly Oak (Steve McCabe) for his clear outlining of the case for his constituents and for Katie Road walk-in centre, and I congratulate him on securing this debate. He touches on an interesting issue for the NHS as a whole, one with which clinicians have been grappling in the past few years: what is the nature of urgent and emergency care in a world where demography is changing rapidly, where demands on the service are changing and where there are incredibly different and disparate populations? He rightly points out that he represents a constituency that has a high student population, that has areas with high levels of deprivation and that has a wide mix of ethnic diversity. Other parts of the country have a significantly ageing profile and do not have the ethnic mix that he is able to enjoy in his part of Birmingham; they have a different socio-economic profile.

What is clear for commissioners and for clinicians is that the answer for urgent and emergency care in one area is different from that in another. I know that might be stating the bleedingly obvious, but it was something that was not observed by the NHS before Professor Sir Bruce Keogh initiated his review of urgent and emergency care in 2013. The result of that was a holistic, sensible and coherent plan for how urgent and emergency care should be delivered across the country. The variation in care, from Northumbria down to Cornwall, is extensive at the moment; there are considerable differences. The hon. Gentleman has highlighted the fact that there are differences even within the city of Birmingham. At the very least, we have made progress in the past few years in having a vision of what urgent and emergency care should look like. The challenge is to try to implement that across the service, which is why, over the past two years, considerable work has been done by clinicians and commissioners to try to understand how the principles of the Keogh review can inform the reshaping of emergency and urgent care in their patches.

As the hon. Gentleman has identified with the issue of one walk-in centre—he can imagine how such local controversies become all the greater when they involve accident and emergency centres and trauma centres—these are matters that are very close to the hearts of constituents, who rely on those services. Those services are there in their moment of need, and they are, in a very real sense, the single greatest embodiment of the NHS and its values. We must treat urgent and emergency care with the utmost care.

The plans that are being worked up across the country are being done carefully with commissioners in co-ordination with NHS England and, ultimately, with Professor Sir Bruce Keogh. Let me give the hon. Gentleman an idea of why that has been so carefully done and the extent of care that has been taken: it was only in the autumn that the route map for the whole country was published. I hope he will therefore understand why his local CCGs have had to revise the timetables by which they have been looking at urgent and emergency care. As he pointed out, they began their own study of this in Birmingham before Professor Sir Bruce Keogh undertook his review. They have had to revise their thinking in the light of that, and I know that they are taking forward their current consultation on the basis of the route maps that have been designed by NHS England with commissioners around the country.

The hon. Gentleman makes a fair point about process. I know why he is frustrated, and I completely understand his frustration. I also understand his irritation at the bureaucratese that can fly in his face as a representative of local people. I cannot specifically talk about the consultation of which he speaks because I do not have a detailed knowledge of it. All I can say is that in the NHS there are good and bad consultations. What we have tried to do over the past five years—and I am trying to do this in my current position—is to ensure that we bring the worst consultations up to the best, that we learn from where they have gone wrong and that they go better. I can of course commit to write to the chairman of his CCG, perhaps highlighting the work that has been done around producing very good consultations, reiterating the points that he has made in his speech, and asking for a clarification around each and every point that he has raised, so that he feels satisfied that he has raised his issues in the Chamber and that he can provide answers to his constituents. Clearly, he feels that, at the moment, there is much confusion and not too much clarity.

I spoke to senior commissioners in the CCG today in advance of this debate to ensure that I was availed of the facts of the situation. They assured me that there is a full intention to continue services at Katie Road. The centre’s value is understood and well known, which is precisely why there was a temporary extension of the hours till 10 pm to deal with the winter pressures that are felt across the service. The commissioners also made it clear that there has not been a predetermination about the location of a further urgent care centre. It will be in Selly Oak, and it will be considerably larger than Katie Road so it will be able to accommodate more services and will be of greater use to the hon. Gentleman’s constituents. The commissioners have not come to a decision yet about where it should be located. I know that they will want to engage fully with him and with the community in order to ensure that it goes to the right place.

[Steve McCabe]

When the Minister was given an assurance that Katie Road would continue, he was presumably told that the contract was due to come to an end. Was there any indication that there was an intention to have yet another roll-over contract, or whether there is a timescale attached to the consultation—yet another one?

[Ben Gummer]

No, I was not assured in that level of detail—I can ask for that information in my letter to the chairman of the CCG—but I think that the intentions were clear, and they seemed entirely honourable. They understood the purpose of the centre, and they clearly saw the disadvantage of those services discontinuing before a new urgent care centre opens. I think that they understand the hon. Gentleman’s perfectly reasonable point that there needs to be some sort of continuity of service so that local people know where to go and can feel confident about local service provision.

On the important point about location and co-location, it will be different for different areas. The hon. Gentleman might have local pressures at University Hospitals Birmingham that do not pertain elsewhere in the country. It might be right—we are having exactly the same discussion in my constituency at the moment—to make use of an A&E brand and say, “Right, you have one simple place to go,” or it might be right to locate services on a different site. That will be different for different places. That is why it was decided in 2009, under the previous Labour Government, to give commissioners a greater role in local decisions on urgent and emergency care, because they are the ones who know their patches best, and what I write in Whitehall might not be right for local conditions in Selly Oak, or anywhere else for that matter.

I cannot therefore give the hon. Gentleman an answer on co-location because it will be different in different parts of the country, but what I can tell him is that my letter to the chairman of the CCG will include a particular reference to the fact that he and his constituents wish to be consulted and that there needs to be a clear rationale behind the location so that people feel that it is done not for the ease of NHS-land, but for the betterment of patient service.

The hon. Gentleman asked about consistency with seven-day services. I would like to reassure him that we are building seven-day services on the basis of the urgent and emergency care networks that were outlined by Professor Sir Bruce Keogh in his 2013 review and the consequent work. Contrary to the suggestion of his hon. Friend the Member for Birmingham, Perry Barr (Mr Mahmood), the seven-day services programme is entirely clinically led. It draws on the work that the Academy of Medical Royal Colleges undertook in 2013 to develop 10 clinical standards. That is the basis of the work we are taking forward. The contract reform that we have undertaken, both for junior doctors and for consultants, is based in part on the recommendations of those 10 clinical standards, so it is routed entirely in the need to respond to the top clinicians’ advice on how we achieve consistency of service across seven days of the week.

I would therefore expect the results of any consultation into urgent and emergency care in Birmingham to match precisely the overall work that we are doing to ensure consistency of standards across seven days of the week, good access for patients and a clear and transparent approach to urgent and emergency care, which in parts of the country, as the hon. Gentleman has identified, can at times be both patchy and confusing.

Finally, the hon. Gentleman asked whether there is a threat to walk-in centres. Under this Government he will see continued investment in urgent and emergency care. We will seek to find greater clarity around urgent and emergency care so that there is a clearer brand and more easily recognisable services for local people, so that we eliminate inconsistencies across the service and so that we fulfil the best clinical advice on how to achieve better services in urgent and emergency care by following the recommendations of Professor Sir Bruce Keogh and the work that has been done by local clinicians since. I do not believe therefore that there is a threat to urgent and emergency care services, and I believe they will improve over the next four years.

That is why I am happy to promise the hon. Gentleman that I will continue to answer questions on Katie Road. Should he have any further concerns, I would be delighted if he came to me so that we could talk about them. I will do what I can to allay those concerns and to make representations on his behalf to his clinical commissioning group so that he can get the answers he seeks.

Question put and agreed to.

Sugary Drinks Tax

Steve McCabe Excerpts

Monday 30th November 2015 Westminster Hall

[Dr Huq]

No, but alcopops and such things have always been popular with young people, because they look harmless, but some of them have a high alcohol content. We have a golden opportunity, because the Government are working on a childhood obesity strategy, and we must not waste that opportunity We must think long-term and heed the BDA chief’s words:

“Public health policy must be guided by evidence, not by personal prejudice or commercial interests.”

So happy Sugar Awareness Week, one and all. I will be interested to hear the summing-up speeches.

[Steve McCabe (in the Chair)]

We have just over an hour, but I remind Members that we do not have to fill the entire time. I would, however, like enough time to be left for Helen Jones to reply to the debate. I call Philippa Whiteford.

--- Later in debate ---

[Geraint Davies]

On a point of order, Mr McCabe. Like you, I sit on the Panel of Chairs. I was here for the first one and a half hours of the debate, and I had to leave the room for 20 minutes. I have introduced a Bill on sugar, and I was wondering whether I could crave your indulgence and make a small contribution, given that the debate is meant to go on until 7.30 pm.

[Steve McCabe (in the Chair)]

You are welcome to intervene in the debate, Mr Davies, but we have moved on to the winding-up speeches.

[Geraint Davies]

I appreciate that, but I was wondering whether you might exercise some discretion.

[Steve McCabe (in the Chair)]

No, we are going to continue with the winding-up speeches.

[Barbara Keeley]

I was saying that I have concerns about how children and their families manage in the school holidays. For anyone who has not heard about it, I want to commend the Feeding Birkenhead project, and the work done on it by my right hon. Friend the Member for Birkenhead (Frank Field). The project makes sure that children have healthy food in the school holidays. It is sad that we need to think about that issue, but we do.

Between April and September 2015, Trussell Trust food banks in Greater Manchester gave more than 22,000 lots of three-day emergency food supplies to people in crisis. Of those, nearly 9,000 were directed to children. We have talked about choice, but if we think this through, we realise that, if families rely on food banks to feed their children, that will limit the number of healthy meals they can make with fresh food. Clearly, for people in the upsetting circumstances of not managing financially, feeding their child with something is better than seeing them go hungry.

At the start of the debate, we heard about people who do not have local shops that sell healthy food, and we have to take that into account, too. Some people are also fuel-poor, while others work a number of jobs, which leaves them with little time to cook. We must not, therefore, jump to conclusions about why people are in this situation.

We should look at the wider issues around poverty, which must be addressed to ensure that people can access a good-quality diet. There is an awful lot more to achieving a good-quality diet than just wanting to do that. How, therefore, does the Minister plan to help families that have to rely on food banks? Next weekend, I will be helping the Trussell Trust food bank to collect food in my local supermarkets. On a previous occasion, one donor gave me lots of vegetables—onions and things like that. I thought they were part of her shopping, so I ran after her to give them back. However, she said, “That is just to liven the donations up. All the packet food seems a bit dull.” However, that is not the way Trussell Trust food banks operate—they have to have packet and tinned food. We have to think through what is happening in families where there is a reliance on donated food, which will not always contribute to a good enough diet.

Education must play a significant role. We want to provide children and adults with information about how they can achieve a healthy diet. One of the most interesting things Jamie Oliver has done—it was not his recent interventions here in the House—was his programme showing people how to cook. There were families that existed entirely on one or two sorts of takeaway.

Junior Doctors’ Contracts

Steve McCabe Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

I am not saying that the existing contract is perfect—I do not think that the British Medical Association would say that either. A few months ago, an alternative contract was being discussed, the work on which was led by the former Health Minister, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter). The answer is not the contract that is on the table at the moment.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The Secretary of State may say that the overall pay envelope remains the same, but, as far as I am aware, it has been really hard to fathom how the difference between the local education training board contribution and the individual trusts will work. It may not be the same, but even if it is, is this not an example of further administrative and organisational costs being imposed on the health service by a Tory Secretary of State?

[Heidi Alexander]

My hon. Friend is completely right. The lack of clarity in all these negotiations is something that I will come on to later.

The truth is that if the Secretary of State wanted to persuade junior doctors that industrial action is not the answer, he has the power to do so; it is his political choice.

Junior doctors are the lifeblood of the NHS. Two weeks ago, I spent a morning shadowing a junior doctor at Lewisham hospital. It was the single most powerful thing I have done since taking on this role. I was blown away by the skills, knowledge, humanity and professionalism I saw. The junior doctor I shadowed was working a gruelling 11-hour night shift and regularly works 60-hour weeks. I left the hospital asking myself how it could possibly be right to say to that individual, “You might be paid less for the work that you do.”