O’Neill Review

Debate between Alex Chalk and Kevin Hollinrake

Tuesday 7th March 2017 Westminster Hall

[Kevin Hollinrake]

Yes, what we need is a mixture of solutions. The UK by its own admission is mid-range across Europe in its use of antibiotics in agriculture. That is one thing, but we have been world leaders on this issue and for me mid-range is not where we need to be; we need to be at the forefront and world leaders in terms of best practice, whatever aspect of this issue we are dealing with.

There are four key recommendations in the O’Neill review’s 10 main recommendations. The last one is on market entry rewards to solve the problem of pharmas not investing in research and development, as well as a possible levy on drug companies that do not invest in research.

[Alex Chalk (Cheltenham) (Con)]

The World Health Organisation has made it clear, chillingly, that resistance to last resort antibiotics is present globally, so we have to act. Does my hon. Friend agree that we will not create vital new drugs until we align better the public health needs with the commercial incentives, and that Governments need to correct what is the most dangerous market failure in history?

[Kevin Hollinrake]

That is correct, and the review sets that out clearly. At the moment, if there is not a commercial return, it is difficult for pharmaceutical companies to invest in this field, although some are. For example, AstraZeneca recently sold its late-stage small molecule antibiotic business to Pfizer and so stepped out of research and development, but others, such as MSD, are still investing. It cannot be right that some companies are willing to invest—perhaps for altruistic purposes—when others are not. The O’Neill review discusses whether there should be a reimbursement or an insurance model, so that pharmaceutical companies can be sure that they will get a certain amount every year for drugs if they do develop them. It cannot be right that some contribute and some do not, so a levy for those that do not seems sensible to me. I do not think it should be left simply to big pharma to solve the problem.

The O’Neill review talks about a global AMR innovation fund—GAMRIF—to make funding available for smaller third sector organisations. Having Antibiotic Research UK, the world’s first charity in this field, in my constituency is how the issue was brought to my attention. It is doing fantastic research. From donations made by individuals, it has got hundreds of thousands of pounds that it is investing in “resistance breakers”, which is blending drugs together to repurpose existing antibiotics. That again is one of the recommendations in the report. Yes, big pharma, but we have also got to make some funding available to the smaller organisations, too.

Health and Social Care

Debate between Alex Chalk and Kevin Hollinrake

Monday 27th February 2017 Commons Chamber

[Kevin Hollinrake (Thirsk and Malton) (Con)]

It is a pleasure to follow the hon. Member for West Lancashire (Rosie Cooper), who made some interesting points, particularly about fundamental reform of services, which I will address later in my remarks.

Members on both sides of the House have alluded to the fact that this debate is set against the background of hugely increasing demand and, in many ways, decreasing supply, particularly in adult social care, to which I will restrict my comments. I was interested to take part in the Communities and Local Government Committee inquiry, to which the Chair, the hon. Member for Sheffield South East (Mr Betts), referred. On increasing demand, there was a 33% increase in the past 10 years in the population who are aged 80 and over. There is a projected 100% increase in that population over the next 20 years, and a 50% increase in 65s and over in the same period. Interestingly enough, there will be only a 4% increase in the population who are below the age of 65 over the next 20 years. That is an interesting dynamic when we think about who will provide the care that will be needed for all the people who are getting older.

An area of adult social care we can sometimes forget—it has not been mentioned—is care for those with learning disabilities. That population is increasing rapidly and will increase again over the next 20 years, which means more profound challenges for our health and adult social care services.

On the backdrop of the decreasing supply of provision, everybody has to take part in ensuring that the books balance. We are reducing the deficit from £156 billion a year in 2010 to around £68 billion this year, which is no mean feat. We must understand that there is no bottomless pit, and that we have to make difficult decisions on allocating our spending.

Local authorities have borne the brunt of the 37% reduction in overall spending—it is a 25% reduction after council tax increases. Adult social care accounts for around 33% of local authority discretionary spend. It is therefore inevitable that that will be a focus when local authority managers try to balance the books. There are other competing pressures, such as the national living wage, which soaks up a lot of the extra money allocated to adult social care. It is not just about local authorities: providers are also under huge pressure. Some 59% of care homes are below the profitability threshold. Homes are closing and some providers are returning their contracts to local authorities.

There are other elements relating to the provision of what we would call a well-functioning health and social care service. Other reductions include a 28% reduction in the number of community nurses, who provide the key services that stop people going into the health and social care system. In my constituency, simple things like sitting services, local dementia clubs or something called Kurt’s Club in my hometown of Easingwold have either closed or had services reduced in recent weeks and months. Again, that puts more pressure on the system.

Delayed discharges also have an impact on the NHS. Hon. Members who spoke earlier know far more about this than I do, but when Simon Stevens gave evidence to our Committee he estimated that the NHS spends up to an extra £1 billion due to delayed discharges. There is an impact on the whole system.

The Government have responded with £2 billion more since 2010, with the adult social care precept, the better care fund and the adult social care grant adding between £3.5 billion and £4 billion by 2020. There is no doubt, however, that all the evidence we have heard from a number of different sources—the King’s Fund and the like—points to an investment shortfall of between £1 billion and £2 billion.

[Alex Chalk (Cheltenham) (Con)]

On the shortfall, does my hon. Friend agree that the time has come to bite the bullet and increase social care funding? Does he agree that doing so in the short term would provide the financial headroom to enable trusts like mine in Gloucestershire to achieve the meaningful reconfiguration of services through the STPs that will reflect the changing health priorities and demographics? It is a sprat to catch a mackerel.

[Kevin Hollinrake]

My hon. Friend makes a very strong point. I do feel that we need more money now. I am sure the question of whether more money might be available is taking up some of the Chancellor’s time as he works on his Budget calculations for 8 March. In the short term, we need more money to plug the gap. In the longer term, we need a cross-party conversation on how we solve this problem.

The Select Committee has been an excellent forum through which to explore this issue and many others. As the hon. Member for Sheffield South East (Mr Betts), the Committee Chair, mentioned in his remarks, we went to Germany to examine its system. It was very enlightening. In 1995, Germany moved from one system to another: from a local government-funded system that just did not work—they clearly saw this coming before we did—to a social insurance system. They are more used to that system in Germany, which has similar systems in place for health, pensions, unemployment and accident insurance. It works very well. It is cross-party, seems to be apolitical and takes a salary contribution of about 1.175%. It is a bit like auto-enrolment, but it is compulsory—it is a mandatory scheme. It means that when people need care they have a pot to call on. Needs are independently assessed, so they receive the level of provision that suits them. It can also be used to provide domiciliary care. Money coming back out of the system at the right time can go to help family members look after the person who is ill, so it has a social benefit as well as being a sustainable system that works in the longer term. We should look at that model. It is not the only one, but I reiterate—I know Members on both sides of the House feel the same way—that we should look at this issue in a cross-party way to ensure long-term sustainability.