Operational Productivity in NHS Providers

Andrew Gwynne Excerpts

Wednesday 1st July 2015 Westminster Hall

[Mike Weir]

The hon. Gentleman makes a good point. He is right about incentives. A happy workforce will be a much more productive workforce. There is a danger of putting increasing pressure on the workforce, especially in the NHS, where mistakes can be disastrous and can do a lot of damage in the long term, both to the system and patients. We have to be careful about some of these things. I was interested in what the hon. Member for Hendon said about the cost of agency workers. I think we would all agree on that point. It would be preferable to have full-time staff in the NHS, but agency workers are used for a reason: shortages.

The hon. Gentleman also talked about people from outside the EU working in the NHS, but again, this shows that there needs to be a more holistic Government policy. The Government recently announced an earnings threshold of £36,000, under immigration policy, for those who have been working in this country for six years. Many nurses working in the NHS throughout the United Kingdom are not earning that sort of money and have been in the NHS for many years. The Royal College of Nursing stated that if this policy was imposed, thousands of nurses could leave the NHS and could have to leave the UK. That is not in the best interests of the health service at the moment. When considering efficiency savings and how the NHS can better work for all our constituents throughout the UK, we have to think about such things .

[Andrew Gwynne (Denton and Reddish) (Lab)]

The hon. Gentleman is making an important point. Would it not be counterproductive if NHS nurses left to work abroad? That would leave a massive gap in the NHS workforce, probably requiring an increase in agency workers, which would cost the NHS more.

[Mike Weir]

The hon. Gentleman read my mind: that was my next point. Agency nurses are causing a drain on resources, because we have to employ so many already. That will not get any better if nurses cannot work in the NHS because of immigration policy. These people did not come to this country a few months ago; some have been here for many years. Many of these nurses are working in hospitals in all parts of the UK, whether Scotland, Northern Ireland or England. They are also working in the care system.

The Government are making a bad situation worse, perhaps because of other pressures on them to do with immigration, and are not dealing with the realities of the health service. Training new nurses to take the place of those who may leave will not happen overnight. It takes years to train a nurse properly. If these people have to leave suddenly, they will leave a huge hole in the NHS. That raises a question about the sustainability of the system. In summing up, the Minister might like to consider that; and perhaps he will take the matter up with Home Office colleagues and discuss the impact this policy may have on the NHS.

Efficiency savings are fine where they can be made. We are all looking for efficiency savings, and we understand that there can be some. For example, there are some interesting responses in the Carter review on medicines and prescriptions. Savings could be made there. A lot of medicines can be wasted if prescriptions are too large. Such system changes can save money, but it is wrong to look for the silver bullet that is going to change things and produce the £22 billion in efficiency and improvement savings.

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[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to see you in the Chair, Mr Pritchard. I congratulate the hon. Member for Hendon (Dr Offord) on securing this important debate. We have had a good debate, although fairly brief, and some important issues have been raised.

I formally welcome the Minister. We have had Health Questions and an Opposition day debate on health since he assumed his role, but this is my first opportunity to welcome him. I trust that his time at the Department of Health will be enjoyable and successful.

I am pleased to respond to the debate on behalf of the Opposition. The hon. Member for Hendon is right: the efficiency challenge for the coming years will dominate the debate about healthcare and shape our NHS in England for decades. As Members know—indeed, several referred to it specifically—the Government are committed to seeing £22 billion of efficiency savings in the NHS by 2020 to meet the £30 billion funding challenge. We have not yet heard any details of where the £8 billion in funding will come from; perhaps I can tease some of the detail out of the Minister. I do not wish to prejudge what may or may not be in the Budget, but it would be nice to have some indication, aside from the usual spin about a growing economy, of where he thinks the £8 billion will come from. Setting aside that question, we need to think carefully about how to meet the £22 billion gap that will remain once that £8 billion is found. To achieve savings on that scale would be a huge ask at any time, but when NHS trusts have huge deficits to tackle and providers say they are experiencing the biggest financial pressures they have ever seen, making these efficiencies will be a huge challenge.

It is probably appropriate at this stage for me to place on record my appreciation of and thanks to those who work in our national health service—at every level. It is not always popular to praise managers, but to meet the challenge the NHS will need a great deal of expert management. We therefore need to praise the work of not just the doctors, nurses, clinicians, porters and support staff, but the good managers, because they will face the real challenge of finding these efficiencies.

It is vital, not just for us but for all those who work in the NHS, that the Minister is as open and honest as he can be today about where the efficiencies will come from. One of the few people who has seen the detail of the planned efficiency savings is the former Care Minister, the right hon. Member for North Norfolk (Norman Lamb). Just last week, he said that the £22 billion efficiency savings in the five-year forward view are “virtually impossible” to achieve—words that will not fill people with confidence.

As the Minister knows, the Opposition have pressed the Government on a number of occasions to publish the assumptions underlying the £22 billion figure. I hope he will take that message back to the Secretary of State today, because we need to have a properly informed debate about the NHS’s long-term funding requirements. That is true not just of England, because the proposals will have knock-on consequences for the NHS in all the constituent parts of the United Kingdom, including Scotland and Northern Ireland, which have been represented in the debate.

We need to be honest about the fact that, whatever the scale of the efficiencies that need to be found, there will be no quick fix—a point eloquently made by my hon. Friend the Member for Bristol South (Karin Smyth). However, when budgets are tight, it is right that we debate how money can be better spent to meet the growing cost of delivering world-class healthcare.

With that in mind, let me cover a couple of pertinent areas. The first is procurement. Any doctor will tell us of sales representatives pushing every bit of kit and course of medicine under the sun—that is just the nature of salespeople, and that is what they do. In the NHS, there are around 500,000 product lines for everyday consumables, with cost variances of sometimes more than 35%, which is massive. The Carter review suggested that a catalogue of 6,000 to 9,000 product lines represents best practice. In part, the huge variety of products is a symptom of a more fragmented NHS. These days, we do not have the opportunity to use the NHS’s national purchasing muscle as much as we did, which is a shame and a wasted opportunity. However, having a reduced range of products—perhaps set out in a national catalogue, but definitely coming through the NHS supply chain—would be good for cost-effectiveness. I hope the Minister can take that point on board.

Part of the problem is the army of sales representatives, who are proliferating at all levels of the NHS. Their very existence represents a large dead-weight cost to providers. They can provide a useful service when it comes to selecting the best product for practitioners’ needs, but it is obviously not in their interests to provide products at the lowest practical cost; nor is it in their interests to promote other products or to give practitioners more information about the choices that may be available to them and their patients. It is, to some extent, an imperfect market, with smaller suppliers pushed out from the very beginning. There will always be a need for companies to provide high-end support and advice, but while representatives have a big influence on buying decisions, we must ensure that that influence is at least partly tracked.

Let me talk briefly about the cost of competition. The Minister is new to his post, but he will have paid close attention to the many debates we had on these issues before the election, so he will be aware of the Opposition’s concerns about the competition rules introduced in the Health and Social Care Act 2012. We know that the new competition framework is causing

“significant cost to the system”—

not my words, but those of the former chief executive of the NHS. Last year, we identified at least £100 million that in trusts and clinical commissioning groups alone was being spent on staff and lawyers to analyse tenders and to administer the tendering process. If the Minister is serious about making substantial savings, may I gently advise him that it would be a good start to look at the waste generated by the Act’s competition provisions?

One crucial area to analyse is the poor workflow in hospitals, and specifically the lack of adequate sub-acute services. At the moment, many discharged patients, particularly elderly ones, have nowhere to go. That is attributable mainly to the drastic cuts to adult social care we have seen in recent years. Sadly, I can only anticipate that those pressures will remain, and perhaps become more acute with coming spending reviews. We all know that if patients are not discharged, hospital beds are wasted and hospital workflow is disrupted, which costs the system an absolute fortune. That is to leave aside the fact that hospital is not the best or most appropriate place for such patients to be or for their care to be delivered.

[Karin Smyth]

The consequences of the 2012 Act included fragmentation of responsibility for the flow of patients through the system. Different commissioning organisations now commission primary care to support the patient outside hospital, there is separate provision of community services, and NHS England has an oversight role as well as a role in commissioning specialised services. In Bristol there are two major acute trusts that are largely commissioned by three different clinical commissioning groups, supported by NHS England and involving the Trust Development Authority and Monitor. A large room is needed for people to get around the table at meetings to consider things such as flow, and it is very complicated.

[Andrew Gwynne]

My hon. Friend hits the nail on the head, describing the complexities of the NHS in England. We have talked for several years in the House of Commons about the need for a properly integrated health and social care system. My hon. Friend has set out a prime example of the reason we need that.

I anticipate that the Minister will argue that some of the inefficiencies we have discussed will be addressed through integration. My problem is that many of the competition rules and requirements in the 2012 Act work against such an integrated health and social care system, even though both sides of the House want it. The Government will have to look carefully at the role of some of the rules and regulations they introduced, when local health economies reach the point of developing integrated care models. It is clear that representatives of a hospital trust, local authority adult social care and children’s care services, and the clinical commissioning group cannot sit around a table to plan an integrated health and social care system while many of the requirements placed on the NHS by the 2012 Act continue to apply.

To return to the issue of transfer and delays in hospitals, we all know that the NHS operates something of a just-in-time system. Such systems are used in industry, particularly for international stock control, and they make sure that nothing is wasted. There is little room for slack: if a patient is admitted for longer than necessary because of avoidable shortfalls elsewhere in the system, that can lead to the atrocious scenes that happen when desperately sick and injured people are left lying in corridors. I think that on one occasion, somewhere near the constituency of my hon. Friend the Member for Bristol South, someone was treated in a tent in a hospital car park. We hoped such images had long gone from the NHS.

I want to say politely but firmly to the Minister that the NHS is affected by what goes on in the social care system. Social care cuts are to all intents and purposes NHS cuts. I hope that he will get that message loudly and clearly and that the Prime Minister will stop insisting otherwise. All that demonstrates, as my hon. Friend the Member for Bristol South eloquently stated in her intervention, the need for a properly joined-up service. Labour Front Benchers have argued for that for some time and the previous Government were moving towards it. I am happy to provide guidance to the Minister on what we think should happen to that end, and to provide stern criticism if Ministers do not deliver.

I also want to talk briefly about the cost of agency workers, which the hon. Member for Angus (Mike Weir) touched on. The Health Secretary has belatedly sought to address that issue, but it has been years in the making. Ministers will know that hospitals have consistently cited recruitment difficulties, particularly for qualified nursing and medical staff and in accident and emergency departments. It is welcome that the number of training places has been increased in recent years, but it was a short-sighted mistake to cut the number of those places early in the previous Parliament. That has led in part to the present recruitment issues.

The Minister will know that the rising number of staff suffering from work-related stress has resulted in even more workforce pressures in the NHS. He will also know that the decision to cut nurse training posts has meant that many hospitals must either recruit from overseas or hire expensive agency workers. Health Ministers must make strong representations to Home Office Ministers, because if there was ever a sign of disjointed Government decisions, it was the recent announcement of changes to immigration policy. As we have already discussed, those changes may cause massive problems to some NHS trusts across the United Kingdom that already face challenges and have recruited from overseas.

The savings that the NHS will need to make in coming years are far more difficult than the low-hanging fruit or quick wins that some may think are available. All of us across the parties and across the constituent parts of the United Kingdom need to acknowledge that there will be no quick fixes to the challenge. There should be no mistaking how difficult things have been for many trusts in the past few years. The coming years will be just as difficult for them, if not more so. I hope that the Minister will agree in that context that we need a proper open debate, with all the facts, figures and information before us about where we can make the savings, and how we can ensure that more of the NHS’s funding is spent on what it does best—delivering high-quality patient care across the United Kingdom.

[Mark Pritchard (in the Chair)]

Order. Before I call the Minister I remind hon. Members of the new standing orders that allow the mover of the motion to wind up if there is time available. I am sure that the Minister will be mindful of that, with 30-plus minutes on the clock.

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[Ben Gummer]

I was going to come on to that, so I shall do so now that the hon. Gentleman has prompted me. There have been long and deep discussions about this. Our estimate is that no more than 700 nurses will be affected by the time the new rules are in place, which is a different number from that given by the Royal College of Nursing, whose number we do not recognise. It is small challenge given the scale of the workforce and one that we will surmount at the time, but we must see it within the broader policy of reducing immigration to this country from the hundreds of thousands to the tens of thousands—a policy that has broad support across the House and certainly in the country at large. It would be wrong for the largest employer in the country—one of the largest employers in the world—to exempt itself from that overall ambition.

In the end, we will achieve a sustainable workforce in this country only if we do all we can to ensure that those who are British and have grown up here and want to work in the NHS have the opportunity to do so. That is why it is important that we widen and open the avenues into working in the NHS, as the hon. Member for Bristol South suggested, over the next few years, in order to meet the challenge to which the hon. Member for Strangford alluded.

I want to quickly run through the other issues raised by my hon. Friend the Member for Hendon. On master vendors, he has a specific issue regarding some constituents with whom he has been dealing, but I understand that master vendors are managed under a series of arrangements with the Crown Commercial Service. Officials will meet with that organisation soon to discuss the overall issues around master vendors. It is for individual trusts to make such purchasing decisions, but I understand the issue he has raised and the terms in which he put it, and I will ensure that it is investigated properly.

My hon. Friend identified two areas involving agencies and fraud. Fraud is of course unacceptable, and the NHS has quite good systems for identifying it. Given the scale of the NHS, I find it surprising—it is entirely to the credit of those who work in the NHS—that fraud makes up such a tiny proportion of the excessive costs in the NHS.

On the revalidation of locum doctors, for which the General Medical Council is responsible, some doctors find it difficult to gather all the required supporting information needed for revalidation due to the peripatetic nature of the work. To help with that, specific guidance is available for both the doctors and their employers via NHS England and NHS Employers. Locum doctors are part of a larger issue about agency spend and foreign workers working in the NHS. I imagine that the three organisations will come together in the next few years to produce a more stable situation.

[Mr James Gray in the Chair]

Let me turn to the remaining points of the hon. Member for Bristol South. On the stability of the system, I hope and anticipate that one product of the general election is that the system will be broadly stable over the next five years. We intend to continue with the current structure of the NHS. There will be some small changes, such as that identified by my right hon. Friend the Secretary of State last week concerning the NHS Trust Development Authority and Monitor, but we are broadly content with how the system is set up. We must now proceed to ensure that it works.

The shadow Minister made a point about structures and fragmentation. There will always be a genuine dilemma here, because one can approach any system and say that change can be achieved by altering structures, but changing structures can lead to the same outcome. That has been the story of the NHS since its inception. It would be a mistake to think—the hon. Member for Bristol South and the shadow Minister were not suggesting this—that a structural change would somehow produce the outcomes that we all want. The priority is to ensure that the system’s wiring works correctly—that everyone’s interests are aligned and that the incentives are correct—so that people want to sit around the table and come to a considered decision, which can too often not be the case when there is an adversarial relationship between providers, producers and purchasers. That is why I hope that the system’s stability over the next five years will allow us to focus on the significant challenges mentioned by the shadow Minister.

[Andrew Gwynne]

When discussing competition rules, we often talk of public versus private, but two public parts of the NHS can also compete. Another NHS trust might have the tender for providing a service in another area and an integrated care organisation might want to bring that back in-house.

[Ben Gummer]

Absolutely. There are examples of that all over the country, but there are also examples of people working together in what might be considered competitive situations, so it is about ensuring that we copy the best and delete the worst.

Before I turn to the shadow Minister’s comments, I want to reflect on the contribution of the hon. Member for Angus (Mike Weir). The SNP spokesperson on health, the hon. Member for Central Ayrshire (Dr Whitford), has used a constructive tone in the Chamber so far, bringing some of her expert experiences as a clinician and also the experiences from Scotland. It is nice to be able to sit here and hear the experiences of people in Northern Ireland and in Scotland, and it would have been nice to have heard from Wales in this debate. Indeed, we do not yet properly learn from the best in Scotland, which would be all to our good, let alone the best in America or India.

The £22 billion in savings is an estimate not from the King’s Fund but from NHS England. It formed part of its plan, devised at the end of last year and some years in the making, which identified £30 billion of additional money that needs to be put into the service over the next five years. It stated that £22 billion could be generated internally—that was Simon Stevens’ estimate—which leaves an £8 billion shortfall. That is what we are pledged to provide. None the less, he, like everyone in the Chamber, has correctly seen that £22 billion is a large number and one that will take a great deal of intellectual and moral work to deliver. I welcome the tone with which everyone has approached this challenge in the debate.

A&E Services

Andrew Gwynne Excerpts

Wednesday 24th June 2015 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a good debate. I pay tribute to hon. Members who made their maiden speeches. I particularly congratulate my hon. Friends the Members for Dewsbury (Paula Sherriff) and for Salford and Eccles (Rebecca Long Bailey). Having been a student at the University of Salford, I had not realised until now that I followed in the footsteps of Marx and Engels by supping in The Crescent; you learn something new every day. The hon. Member for Dumfries and Galloway (Richard Arkless) also made his maiden speech. I congratulate them on their contributions. It is clear that all three will make their presence felt in the House of Commons in the coming years.

I thank the other Members who have contributed, particularly my hon. Friends the Members for Birmingham, Edgbaston (Ms Stuart), for Hartlepool (Mr Wright), for Hammersmith (Andy Slaughter) and for Ealing Central and Acton (Dr Huq), and the hon. Member for Central Ayrshire (Dr Whitford), who leads on health issues for the SNP. On the Government Benches, we heard from the hon. Members for Totnes (Dr Wollaston), for Sittingbourne and Sheppey (Gordon Henderson), for Lewes (Maria Caulfield), for Crawley (Henry Smith), for Braintree (James Cleverly), for Bath (Ben Howlett), and for Morley and Outwood (Andrea Jenkyns). Many Conservative Members stuck very closely to their party’s policy research unit paper, a copy of which I was conveniently sent earlier today. I congratulate them on being so loyal to their Whips Office.

It would be very remiss of me not to place on record my own tribute to the doctors, nurses, healthcare assistants and other dedicated NHS staff who provide such extraordinary and professional care. Many Members of this House who have been here for a number of years will know that I had a run of bad health about five years ago. As a result, I became far more familiar with my own local hospitals, Tameside general and Stepping Hill, than I had hoped to, even given my position as a constituency Member of Parliament and a shadow Health Minister. I have experienced the very best of NHS care. If I am honest, I also experienced some care that did not meet the standards that we perhaps expect of our NHS. I know, however, that we have a workforce who are completely dedicated and caring.

The House should be in absolutely no doubt, though, that those staff are under a great deal of pressure—sustained pressure that has been building over the past five years. The facts need to be laid out in the open, and Ministers need to be challenged on their fictions. They made all sorts of desperate promises to get them through an election campaign, and now they need to show where the money is going to come from to pay for those promises and to set out exactly how they are going to deliver them. Yet what have Ministers been doing since the general election? I do not disagree with Professor Sir Bruce Keogh’s decision to improve the publication of data for mental health and for cancer—that is welcome—but I do disagree with what this Government intend to do in relation to A&E data. Instead of dealing with the pressure facing the NHS in England, they have decided to stop publishing weekly data about those pressures.

[Helen Whately]

Will the hon. Gentleman acknowledge that the NHS leads the world in transparency, and that an excessive focus on one data point—the four-hour target for A&E—is detrimental overall to patients?

[Andrew Gwynne]

We should remember, of course, that the last Labour Government started that transparency with heart and stroke data.

I think we all know what is going on here. There can be no clearer sign of the Tories’ failure on the NHS than the fact that hospital accident and emergency departments have now missed their own four-hour target for 100 weeks in a row. This is a landmark failure, to which the Prime Minister promised he would not return. The reality is that this Government caused the crisis by making it harder to see a GP and by stripping back social care services.

Let us be under no illusions—[Interruption.] The Secretary of State can chunter, but social care cuts are NHS cuts. The Government made damaging mistakes that have seen the number of people going into hospital soar. The best thing that they could do is to admit it and explain what they are going to do to fix the problem. It is stunning that their only solution is to spin their mistakes and to make the NHS less transparent.

Let me briefly come on to nurse staffing problems. Only this week, we have seen yet another example of poor policy coming out of the Department of Health. If it insists, along with the Home Office, that migrants not earning £35,000 after six years must go home, that will cut a hole right through the middle of our NHS. The Royal College of Nursing estimates that 6,620 nurses will have to leave the country by 2020. Because of the Government’s failure to train adequate numbers of nurses in the UK, those nurses will have cost almost £40 million to recruit from overseas. People coming from other countries to work in the NHS make a huge contribution and our health service would not be able to cope without them, but this is now a mess entirely of Ministers’ own making.

The short-sighted cuts to nurse training in the early years of the last Parliament left NHS hospitals with no option but to recruit from overseas or hire expensive agency nurses. That is also one of the main reasons why many hospital trusts are now in deficit. It was an absolutely profound error and I hope that the Minister will acknowledge that. As ever with this Government, patients and taxpayers will pay the price for the Prime Minister’s mismanagement of the health services.

There have been further mistakes. On GP access, it stands to reason that if it is made harder to see a GP, people will be more likely to end up in hospital. As we have heard, the reasons for the crisis are many, but the lack of access to GP services appears to account for much of the problem. No amount of obfuscation and massaging of figures can hide the fact that this Government have made it harder to get a GP appointment. All Members will know of constituents who have had to phone their doctors only to be told that no appointments are available and that they should ring back the next day—which they do, only to experience the same problem again. That they end up in frustration in A&E should not come as any shock.

The Prime Minister has now repeated his 2010 promise to provide access to GPs seven days a week, but he cannot even provide access to them five days a week. When patients want up-to-date information on how their local hospital is performing, this Government plan to publish the data less frequently. I hope that the Government will now see sense, and I commend our motion to the House.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

I welcome my hon. Friend warmly to his place; he hits the nail on the head. We had a big problem with diagnosis—less than half of the people who had dementia were getting a diagnosis—and we have made progress on that. It is still the case that in some parts of the country, although I hope not in Mid Dorset, when someone gets a diagnosis not a great deal happens. We need to change that, because getting that support is how we will avoid tragedies such as that in Weaver Vale, which we heard about earlier.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Secretary of State knows that the availability of social care for vulnerable older people has a big impact on the NHS, especially for people with dementia, yet 300,000 fewer older people are getting help compared with 2010. Given that the Secretary of State has said that he wants to make improving out-of-hospital care his personal priority, can he confirm that there will be no further cuts to adult social care during this Parliament, which would only put the NHS under even more pressure?

[Mr Hunt]

I can confirm that we agree with the hon. Gentleman and the Opposition that we must consider adult social care provision alongside NHS provision. The two are very closely linked and have a big impact on each other. I obviously cannot give him the details of the spending settlement now, but we will take full account of that interrelationship and recognise the importance of the integration of health and social care that needs to happen at pace in this Parliament.

Health and Social Care

Andrew Gwynne Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Jane Ellison]

No, I cannot give way at this moment.

The coalition Government had an excellent record on cancer. Yes, there is further to go, and that is why we have made it central to our plans. We want to see the NHS go further and faster on diagnostics. That is why NHS England has an independent taskforce looking at this issue. We got its interim report in March. We will get its final report in the summer and we will act on it.

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is bluster.

[Jane Ellison]

The hon. Gentleman says it is bluster. Is it bluster to talk about the £1 billion invested in the cancer drugs fund?

Nurses and Midwives: Fees

Andrew Gwynne Excerpts

Monday 23rd March 2015 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Havard. It is also a pleasure to follow my hon. Friend the Member for Foyle (Mark Durkan). We recently had the pleasure of serving for 13 hours that we will never get back on the Committee for the National Health Service (Amended Duties and Powers) Bill, which my hon. Friend the Member for Eltham (Clive Efford) promoted. It is quite a novelty to speak in a health debate in which hon. Members have actually spoken about health. It feels quite unique after the debates in that Committee.

As is customary, I place on the record my appreciation of and congratulations to the petitioners, who managed to achieve the number of signatures necessary for the debate, and my hon. Friend the Member for Blaydon (Mr Anderson) and the Backbench Business Committee on getting it on the Floor of Westminster Hall today. I also pay tribute to all who work in our national health service, not only the nurses and midwives in particular, but everyone who helps make the NHS the service that it is. We are now only five and a half weeks from the next general election and we are in the last full week of the 2010 to 2015 Parliament. Issues such as the one that we are debating show the direction in which our health service has been heading.

It is totally wrong to impose further charges on nurses and midwives, especially when many are facing a cost of living crisis caused by the Government. Wages are falling and prices rising; this is now set to be the first time in living memory when people will be worse off at the end of a Parliament than they were at the beginning. Yet the Nursing and Midwifery Council wants to increase the burden on the shoulders of registrants. What message does that send to the nurses, midwives and patients whose interests it is there to protect? I think a pretty poor one.

We have all had similar cases, but the hon. Member for Congleton (Fiona Bruce) put her constituent’s very eloquently. I am sure that other Members have such cases to pursue with Ministers, which highlight the issues surrounding the debate. We are talking about not only numbers, but real people, and it is right for such matters to be raised. Taken together with the 1% pay rise—for which, to put it bluntly, nurses had to fight tooth and nail after the Government initially indicated that they would not honour their pledge—the move we are discussing today shows what the Government think of public sector workers. When Labour gets into power, clearly we will have to look carefully at the books, but we absolutely will not do what this Government have done: break every single promise made to NHS staff.

As we have heard throughout the debate, in particular from my hon. Friends the Members for Blaydon, for Easington (Grahame M. Morris) and for Foyle, the Government should have introduced the Law Commission’s draft Bill on the regulation of health and social care professionals, which included some good measures. Had the Government introduced it, it would have enabled the NMC to increase efficiencies and decrease costs. Instead, the Government have been introducing a swathe of delegated legislation to form something of a patchwork quilt of reform. Indeed, I seem to remember, Mr Havard, that you chaired two statutory instrument Committees only last week—

[Mr Dai Havard (in the Chair)]

At the same time.

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[Andrew Gwynne]

At the same time!

I do not understand why the Government could not have found time to introduce the measures in the draft Bill. Even the head of the NMC, Jackie Smith, thinks that the Government have not gone far enough. She has complained that she is fully aware her organisation is not resolving cases quickly enough, but that the legislation as it stands does not allow the NMC to do things any quicker. Likewise, the Royal College of Nursing, the Royal College of Midwives, the Patients Association, the Parliamentary and Health Service Ombudsman, the Care Quality Commission, Unison, Unite and others have voiced their strong support for the draft Law Commission Bill.

In response to the Francis report, the Prime Minister hailed the draft Bill, but then promptly forgot about it. It is simply not a priority for the Government. In response to the draft Bill, they said that they would be

“committed to legislating on this important matter when parliamentary time allows”,

but we have already heard how, towards the end of this Parliament, it has been dubbed the “zombie Parliament”: we have one-line Whip after one-line Whip and we have finished business earlier than the normal moment of interruption on many days. There has been plenty of time to introduce the measures had the Government seen fit to do so. Certainly given the supposed cross-party consensus on the measures, they could have reached the statute book by Dissolution. Judging by the lack of any sort of activity in the House in recent months, the Government have had their chance many times over. Sadly, only a few days of the Parliament now remain.

It looks to me as if the only people opposed to the draft Bill were Ministers. To be fair to the Minister present, whom I like, I do not think that that is through any malice, but that it is rather a result of inertia, or perhaps a lack of attention—I do not know. Let me place clearly on the record, however, that Labour supports reform and simplification of the legal framework for regulation. The draft Bill would enable the regulators to work better together and to share functions and, crucially, to make savings and to keep their costs down. The Government’s failure means that they are now leaving the NMC to force nurses and midwives literally to pay the price.

We went through the same procedure three years ago: the NMC announced that it had to put its fees up; it held the consultation that it is obliged to do; and it promptly increased the fees by one third. In that instance, the consultation showed an overwhelming majority of respondents opposed to the plans. This time it has put the fees up by another fifth, which means, as we have heard from other Members, that the fees will have gone up by £44 in three years, an increase of more than 50% on 2011.

The e-petition has shown the strength of feeling. As my hon. Friend the Member for Blaydon stated, 114,000 signatures is some doing—not many e-petitions make the 100,000 threshold necessary to be considered for a debate in Westminster Hall or in the main Chamber. This e-petition is one of the most modest and reasonable of the ones to meet the criteria, so I genuinely hope that the Minister will consider it in the few days left to him to be accountable to Members of this House of Commons—after Dissolution there will, of course, be no Members of the House of Commons, although the Minister will remain in his post until the formation of a new Government. I want his commitment to give the e-petition the full consideration that it deserves.

I will say a little about the other duties of nurses. Later this year, the NMC will introduce a new process of revalidation for registrants that will place additional requirements on those wishing to stay on the register. It will require significant efforts from registrants. Together with pay restraint lagging well behind increases in the cost of living and an environment of demand, unrest and difficult decisions, it is difficult to see how further increases in the registration fee would not simply demonstrate to nurses that they are not valued. Encouraging staff to leave the NHS is the last thing that we should be doing given the UK’s shortfall in nurses and midwives.

Furthermore, why would new students decide to go into nursing and midwifery when the Government are making life even more difficult for graduates? Nurses have been subjected to an effective cut in their pay of between 8% and 10% since 2010, and the latest move is unacceptable. The Labour party seeks to reverse some of the trends: we are fully committed to a time to care fund, which will pay for 20,000 additional nurses and 3,000 extra midwives, along with 8,000 new doctors and 5,000 extra home care workers over the period of the next Parliament.

I am sympathetic towards the NMC’s complaint that it has no room for manoeuvre when it comes to cutting costs. The real shame here is the lack of reform, but the NMC has £10 million in its reserves. Now that reform is clearly not that far away, perhaps it will consider holding off the fee rise. I understand why it has proposed and gone ahead with that rise, as under current law the fee is almost its sole source of income, and it has a statutory duty of public protection. However, the increase is not reasonable under the circumstances, especially when looked at in the light of the fee bump in 2012.

As far as I am concerned, the blame for this situation lies at the door of the Ministers who could have made changes. The Minister had his chance to introduce the draft Bill in this Parliament, but it will be left to the next Labour Government to make the changes that are so desperately needed.

--- Later in debate ---

[George Freeman]

The Government take recommendations from the Health Committee very seriously—we have done so on a number of issues. It is interesting to quote what the Committee has said on this matter:

“We would urge the NMC to avoid further fee rises and to consider fee reductions for new entrants to the register.”

My point is that it is the NMC’s responsibility to deal with the issue. It is accountable to Parliament, and the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, observes its recommendations closely. However, its internal organisation is a matter for itself.

[Mr Philip Hollobone in the Chair]

[Andrew Gwynne]

The Minister is correct that the NMC is accountable to Parliament, but it has asked for legislative changes, and the legislative programme is largely under the control of Ministers, so why have the Government not acted?

[George Freeman]

It is a fair question, which I will come to, but it has nothing to do with the importance of getting this right; it is merely a matter of the regrettable constraints of parliamentary time. One reason why I very much hope my colleagues and I will be returned in May, Mr Hollobone—I was about to call you Mr Havard; I welcome you to the Chair—is that we will be able to get on with that important reform.

For the benefit of the House, let me finish summarising some of the important information about the NMC. The NMC’s total income for 2013-14 was £65 million. Its fee income was £62 million, which is quite a substantial sum. It received a grant of £1.4 million from the Department of Health and investment income of £1 million. Its expenditure totals £70 million, with £24.18 million, or 34%, going on staff. Its permanent headcount has been going up year on year. The average for the year 2014-15 was 496. The NMC had 521 permanent staff on the payroll in March 2014 and 577 in March 2015. The permanent headcount for March 2016 is projected to be 606. I merely point that out to highlight that the NMC faces some important considerations in driving productivity and efficiency internally to deliver the service it is statutorily required to deliver to its members, who fund it through subscription.

Let me turn now to the relationship between the PSA and the regulations we have introduced. The proposed change will be introduced in the Professional Standards Authority for Health and Social Care (Fees) Regulations 2015—or S.I., 2015, No. 400, with which you will be intimately familiar, Mr Hollobone, as an assiduous observer of these things—which have already been laid in Parliament. The NMC’s council meets this week to decide its policy towards them, so this debate is, again, extremely timely.

The NMC has decided to increase its fees for nurses and midwives from £100 to £120. The rise was effected through the Nursing and Midwifery Council (Fees) (Amendment) Rules Order of Council 2014, which came into force on 1 February. Although the NMC is an independent statutory agency, the Government have made it clear that they expect the NMC council to have clear justification for, and to consider nurses’ and midwives’ financial constraints when making, decisions on fees. I will say a little more in a moment about that and about the importance of the Bill to modernise the NMC’s constitution.

The NMC has consulted its registrants on the proposed fee rise, but I am aware of the strong body of opinion among those who opposed it, and that has been expressed in the debate and in the number of people who have signed the petition. The NMC says that it has not taken its decision lightly and that it has considered the responses to the consultation in detail and carefully listened to the issues raised, and I have no reason to doubt that. However, I remind hon. Members that the NMC’s first duty must be to deliver its core regulatory functions and to fulfil its statutory duties to ensure public protection, and the fee rise must be justified against its core duty.

Let me touch now on the Government grant, which is important. I appreciate that, since the NMC was established in April 2002, there have been a number of increases in its annual registration fee, and I appreciate the impact that that has had on dedicated nurses and midwives working long hours in difficult roles to provide excellent care. That is why, in February 2013—more than 10 years after the increases started in 2002—the Government awarded the NMC a substantial, £20 million grant to ease the pressure.

One purpose of that grant was to allow the NMC to protect nurses and midwives—particularly lower-paid nurses and midwives—from the full impact of a proposed annual registration fee rise. The grant meant that, in 2013, the NMC was able to raise its fee from £76 to £100 and not to £120, as originally intended. With a week before Parliament dissolves, the Government have no plans to give the NMC a further grant to subsidise the 2015 registration fee increase. Given that we continue to have to make tough decisions to put the economy back on track, and that we have given the NMC £20 million, it now needs to work out internally how best to allocate the fee increase, which I should remind hon. Members is equivalent to £3 per member if it is spread equally among them.

I am pleased to say that, as part of the broader package of measures the Government are putting in place to support the lowest-paid workers in the NHS, all the major NHS trade unions accepted the Government’s pay offer on 9 March. It will be implemented from 1 April, giving more than 1 million NHS staff, including most nurses and midwives, a 1% pay rise, without risking front-line jobs or costing the taxpayer more money. That means our lowest paid staff will receive the biggest rise.

I want to update hon. Members on the changes, because they are an important wider consideration against which to view the impact of the fees. For the lowest- paid, the 1% rise will mean an increase of up to 5.6%, or an extra £800 in their pay packets. I have looked at the salary figures, and the average, ending March 2014, for nurses, midwives and health visitors—the people we are talking about—is £31,000. They will get the 1% rise, which is an extra £800.[Official Report, 25 March 2015, Vol. 594, c. 3MC.] Importantly, staff earning between £15,000 and £17,000 will get an extra £200, which is equivalent to 2.3%. Nursing staff earning up to £40,558 who are not at the top of their pay band are still eligible to receive an incremental increase.

Let me take issue with the point that the Government are not looking after the lowest-paid. The pay offer specifically makes sure that the increases the system can afford are targeted at the lowest-paid. Those earning more than £56,000 are more able to cope with the challenges of pay restraint. We are supporting the poorest in the system most, and we are making the highest-paid bear more of the burden. Finally, the bottom pay point will be abolished, seeing the lowest pay rise from £14,300 to £15,000, with about 45,000 on the lowest two pay points benefiting.

--- Later in debate ---

[George Freeman]

I am glad, again, that the hon. Gentleman raises that, because fortunately the Chancellor was able to confirm that the Office for Budget Responsibility has confirmed that finally people in this country are better off, after a very difficult period. I am not going to pretend that it has not been difficult. The reason was that we inherited a chronic legacy of debt, deficit and structural deficit, which was tackled by the previous Government nowhere less than in health care. That created a situation in which, despite a growing economy, we face a huge structural challenge, exacerbated by demographics.

This year there are 1 million more pensioners in the system—1 million more people needing and generating high health demand. I do not hold the Opposition responsible for that. However, the lack of reform and the structural issues at the heart of the health service, which mean that the health structural deficit is growing faster than the general economy, have left us with a challenge. We need to tackle that.

As the hon. Member for Blaydon pointed out, the NMC has stated that there has been a significant rise in its costs, because of fitness-to-practise referrals, which are up more than 100% since 2008-09. Since 2008-09 it has raised its fee by only 63%, making up the bulk of the difference in cost through a programme of efficiencies. Without those it would have had to scale back its fitness-to-practise activity, or generate additional costs earlier. The NMC has provided assurances that it is committed to continuous improvement in carrying out its regulatory functions and will continue to deliver more efficient ways of working to maximise the value of registration fees and to keep them at the lowest level possible while enabling it to fulfil its statutory duty. The NMC is a £70 million-a-year organisation with substantial opportunities to put efficiencies in place, to reduce the cost of the £3 extra cost on its members.

As to the need to update the NMC constitution, the Government have worked with it to make changes to its legislation. We have made good progress with legislative change to reform the way it operates. On 11 December 2014 an order made under section 60 of the Health Act 1999, amending the Nursing and Midwifery Order 2001, came into force. Those changes to the NMC’s governing legislation will enable it to introduce more effective fitness-to-practise processes, while not lessening the public protection it provides.

A key amendment to the NMC’s governing legislation enables it, through its rules, to delegate the decision-making functions currently exercised by its investigating committee to its officers known as case examiners. The intended effect is to speed up and therefore reduce the cost of early-stage fitness-to-practise proceedings, as it will not be necessary to convene the full investigating committee to consider every allegation of impairment of fitness to practise. That should result in financial savings to the NMC as well as greater consistency in decision making. I think we would all welcome that. The rules that bring those changes into effect come into force on 9 March.

The section 60 order has helped the NMC by providing a degree of modernisation of its legislation. However, there is still much to do and that is why we asked the Law Commission in 2011 to review the whole framework of legislation underpinning professional regulation. The report was published last year and we published the Government response in January. I am aware that the decision not to progress a professional regulation Bill to take forward the thinking in the report in the current parliamentary Session was a disappointment to the NMC, as it was to us. We want to move on, but parliamentary time, as you know, Mr Hollobone, is an eternal constraint on Government’s ability to implement. However, that decision provided an opportunity to invest time in getting that important legislative change right, for the benefit of those who will be affected by it. Of course, it will not restrict the NMC’s ability to implement its own internal modernisation and efficiency programme, or to decide how to deal with the internal allocation of its fee obligations to the PSA. It is free to do that.

[Andrew Gwynne]

The Minister will know that a number of the changes and efficiencies that the NMC would like to implement require further legislative change. With those changes, it could free up some of its £10 million reserves, to offset some fee charges. Could we give the NMC some certainty, on a cross-party basis, that, whoever forms the next Government, we will bring in those changes? That would give it the certainty that it could use the reserves to offset the fee increases.

[George Freeman]

I am delighted to confirm that the Government remain committed to introducing primary legislation to address those wider reforms to the system of professional regulation; and it sounds as though, if the hon. Gentleman and I are in our posts then, that may well have cross-party support. That would be an important measure, and our inability to pass it before the end of this Parliament is not a sign of its importance; it is merely a function of the challenge of the availability of parliamentary time.

It is worth pointing out that the performance of the NMC has been challenged and highlighted by a number of bodies, including the Select Committee, but also by some of its members—nurses and midwives. It has had a troubled past with its performance, which is why Ministers commissioned the predecessor body of the Professional Standards Authority, the Council for Healthcare Regulatory Excellence, to undertake a full strategic review in 2012. That review put forward 15 high- level recommendations for improvement in the delivery of the NMC’s regulatory functions, and set an expectation that demonstrable improvements should happen within two years.

In 2014, the NMC commissioned KPMG to undertake an independent review to assess its progress, and KPMG concluded that the NMC had made a substantial number of improvements, which cumulatively placed it in a much stronger position than in 2012. That improvement was recently recognised by the Secretary of State for Health in his oral statement to the House about the Morecambe bay investigation. However, the NMC itself recognises that there is still much more to be done, and so the processes of improvement continue. Ministers have made it clear that we expect the NMC to work towards and ensure compliance with the standards of good regulation, and to continue looking for more efficient ways to work.

Hon. Members on both sides have raised points that I want to deal with. Several mentioned how the fees of part-time nurses are dealt with by the NMC, which is an interesting point. It is not for me to tell the NMC how to deal with it. That is for the NMC to decide, as an independent body, but I should have thought that, on the basis of pure justice and equity, members who do not work full time and therefore do not earn the same as those who do, and who do not generate, even on a pari passu basis, the same level of exposure to the costs or their organisation, would not have to pay the same costs. However, that is of course a matter for the NMC.

The hon. Member for Blaydon raised several questions, including whether the NMC will review its guidelines on fitness to practise, and provide guidance on fitness to practise cases. Those are all matters for the NMC as an independent body, but new legislation means that nurses can pay fees in instalments, and that fees can reflect part-time work.[Official Report, 25 March 2015, Vol. 594, c. 4MC.] The hon. Gentleman made an important point in his speech about part-time nurses.

The hon. Gentleman also spoke about revalidation. The truth is that the majority of the cost of nurse revalidation will fall on the employers that will be responsible for supporting their staff through revalidation. The revalidation drive is an important means of raising professional standards, and it will ensure that the public have faith and confidence that we are raising standards for nurses and midwives.

Epilepsy

Andrew Gwynne Excerpts

Thursday 26th February 2015 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

I, too, congratulate the hon. Member for South Thanet (Laura Sandys) on securing this debate. I pay tribute to her outstanding work to advance the cause of those who suffer from epilepsy. She will certainly be missed from this place.

There have been 11 Back-Bench contributions to this debate. I thank my hon. Friends the Members for Vauxhall (Kate Hoey), for Erith and Thamesmead (Teresa Pearce) and for Walsall South (Valerie Vaz), my right hon. Friend the Member for Knowsley (Mr Howarth), my hon. Friend the Member for Easington (Grahame M. Morris), the right hon. Member for Chesham and Amersham (Mrs Gillan) and the hon. Members for Wycombe (Steve Baker), for Leeds North West (Greg Mulholland), for Southend West (Sir David Amess) and for Cheltenham (Martin Horwood) for their considered contributions.

Advocates such as the hon. Member for South Thanet and the others who have spoken today are crucial because of the stigma around epilepsy, which is almost unique. Epilepsy is portrayed on television as somebody falling to the ground and foaming at the mouth, as we have heard in this debate, with the treatment invariably involving an ambulance with flashing blue lights. Somebody with epilepsy may suffer a seizure only once or twice a year, if that, but will live with the stigma of epilepsy all year round. Sufferers would probably prefer to focus on talking and on tackling the stigma.

I find appalling and completely discriminatory the case that was raised by my hon. Friends the Members for Vauxhall and for Easington of the Transport for London employee who was sacked. I hope that action can be taken to rectify that situation.

I, too, looked online at Epilepsy Action’s very useful tool. I found that my local clinical commissioning groups, Tameside and Glossop CCG and Stockport CCG, had not produced a written needs assessment for people with epilepsy, or appointed a clinical lead for epilepsy to take charge. That point was made eloquently by my hon. Friend the Member for Walsall South, the hon. Member for Southend West and others. I ask the Minister to consider how we can ensure that CCGs undertake adequate needs assessments of people with epilepsy. It is increasingly important that local plans are drawn up for local provision.

It is important to recognise that epilepsy care has moved from predominantly secondary care to being based more and more in primary care. That has positives and negatives. Clearly primary care is more accessible, and therefore easier to access on a regular basis, but on the other hand it is less specialist. Some professionals operating in primary care might not have the expertise needed to recognise things that would be significant to a specialist. Some things can be done only in secondary care, as we heard from the hon. Member for Wycombe.

I particularly want to press the Minister on the issue of brain surgery. It is estimated that about 5,000 adults could and should benefit from brain surgery, which is the only cure for epilepsy. To put that in context, only about 3,000 adults have that life-changing surgery each year, so there is clearly more that can be done. Are there any plans to direct NHS England to increase the number of operations undertaken, to produce an adult epilepsy service similar to the one that, to be fair, has been created for children’s epilepsy?

According to Epilepsy Action, there are about 30,000 accident and emergency attendances due to epilepsy each year. According to the national audit of seizure management in hospitals in 2014, 18,000 of those could be prevented by the implementation of a better care pathway for people with epilepsy. What is being done to ensure that all A and E departments have a clear referral pathway for patients presenting with a suspected seizure?

There is clearly a welcome focus on research and development in policy terms. The 100,000 Genomes Project is a good example of the potential for genetics research to change lives. It would be nice to see the project encompass more specialist research into epilepsy, because genetics research could have an untold impact on epilepsy treatment.

A number of Members, most recently the hon. Member for Cheltenham, mentioned SUDEP. This week I, too, heard from the family of Emily Sumaria, who are in Westminster today. As we have heard, Emily died in her sleep while at university. She was bright and funny, with a lifetime ahead of her. Her epilepsy was to all intents and purposes under control, and she lived a relatively normal life. Emily was never told of the risk of sudden unexpected death in epilepsy, which primarily affects young people. The worst that she feared would happen if she had a seizure was that she would have her driving licence removed. Her mother is certain that if she had been told of the risk, she could have taken the necessary precautions and made the necessary adjustments to her lifestyle.

Emily was simply given a regular prescription, and basic mistakes in the moving of her medical records from her home GP practice to her new one at university resulted in her new doctor halving her dose without her knowledge. In preparing for the debate, I found that some medical schools do not include SUDEP in their curriculum in any great detail. It is asking a bit much for young people to research the risks of SUDEP and precautions against it, given that their doctors will themselves often not be fully aware of the details. I suspect that the inclusion of SUDEP, epilepsy deaths and epilepsy risks in the programme at medical schools would help to change that. Perhaps the Minister will give his thoughts on whether that could be brought to the attention of medical schools.

The Opposition have said that we will give every patient full ownership of their medical data; they would be able to share the data with whichever organisations they saw fit. We hope that with more people taking control of their data, we will be able to establish more data-driven research projects. I doubt that a patient suffering from epilepsy would object to their data being used to develop a cure, but the point is that they would have to give consent for the data to be used in that manner. Data would be more free and research would be immeasurably improved, but the final say would go to the patient.

Let me finish on a positive note, because I am optimistic about the future. Epilepsy research is going from strength to strength, and we are making improvements in treatment, with pharmaceuticals and surgery providing hopeful prospects of a cure. I looked at the NHS Choices website before this debate, and 17 clinical trials are recruiting now in the UK with the aim of advancing our knowledge about the condition. I thank hon. Members who have contributed to the debate, especially the hon. Member for South Thanet whom I wish well for the future.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 24th February 2015 Commons Chamber

[Dr Poulter]

There is a lot of work going on in this area. First, we are encouraging and supporting GPs who have had career breaks, perhaps because they have started a family, to get back into the profession more easily than they have been able to do in the past. Secondly, we also have the commitment that 50% of medical students and doctors leaving foundation training will become GPs in future. That will make sure that we have 5,000 more GPs by 2020.

[Andrew Gwynne (Denton and Reddish) (Lab)]

But the Government’s reorganisation took billions of pounds away from the NHS front line. Figures released last week show that fewer than a quarter of medical students now enter general practice, because they can see the pressure that Ministers have put on it, while GP morale has collapsed. Should the Minister not now admit that the reorganisation was a mistake and instead match Labour’s pledge to invest an extra £2.5 billion a year to recruit 8,000 more GPs and guarantee appointments within 48 hours?

[Dr Poulter]

I know that the Labour party is full of professional politicians, but medical students do not just leave medical school and straight away become GPs; they become foundation doctors. As I have outlined, 50% of the people leaving their foundation training will become GPs in future, which will increase the number of GPs by 5,000. Under this Government the number of GPs in education, training and working in the NHS has increased by 1,000, which is a move in the right direction.

Improving Cancer Outcomes

Andrew Gwynne Excerpts

Thursday 5th February 2015 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

I congratulate the hon. Member for Basildon and Billericay (Mr Baron) on securing this incredibly important debate and on the considered way in which he set out the issues in his opening speech.

I thank my hon. Friends the Members for Washington and Sunderland West (Mrs Hodgson) and for Easington (Grahame M. Morris), the hon. Member for Castle Point (Rebecca Harris), the right hon. Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Salisbury (John Glen). I have not left out the hon. Member for Filton and Bradley Stoke (Jack Lopresti), but have left him to the end. I pay special tribute to him for the moving way in which he shared his personal experience. His message will have offered hope and inspiration to people who are listening to this debate. I thank him especially for that.

I extend my thanks to the Backbench Business Committee for ensuring that this debate could go ahead. It is crucial that when we mark important events such as world cancer day, the message goes out from this House of Commons that, whatever our political differences on whole areas of public policy, including the national health service, when it comes to matters such as our commitment to tackling cancer, we speak with one voice.

It is a particular privilege to take part in this debate on behalf of Her Majesty’s Opposition. From the outset, I want to echo the proposer of the motion in paying my own tribute to the various cancer all-party parliamentary groups, which do such good work to highlight these issues in Parliament. Cancer care and prevention is one of the most important policy areas for politicians to consider.

When I was a teenager, my mother was diagnosed with ovarian cancer. I would like to say a personal thank you to my hon. Friend the Member for Washington and Sunderland West for the work that she does on ovarian cancer. Despite my mother paying numerous visits to her GP in the months before she was diagnosed, the cancer was not picked up until a later stage. As my hon. Friend described, although the symptoms were there, they were put down to other factors such as heavy lifting at work. By the time the cancer was diagnosed, it was too late for treatment to be effective and my mother passed away in hospital when I was 19. Not a day goes by that I do not miss her. Not only was I robbed of my mother; my three children missed out on a pretty fantastic grandmother. I therefore understand the very personal hurt that a loss from cancer can cause.

I do not blame the GP for not spotting my mother’s cancer. As my hon. Friend the Member for Washington and Sunderland West set out, patients with ovarian cancer often present with symptoms that are not easily recognisable. However, it did make me question what more could have been done. That was in 1994. In the 20 years since, we have made huge progress in improving cancer services. In the last decade, five-year survival rates improved for nearly all types of cancer. However, as we heard in the opening contribution of the hon. Member for Basildon and Billericay and in the speeches of other hon. Members, we still lag behind other countries.

There is worrying evidence from the past five years that the progress that we have made on cancer care has stalled to some extent. People are waiting longer for vital tests and the national cancer target has been missed in the past three quarters. Over the past four years, cancer spending has been reduced by £800 million in real terms. It is worth saying that in government, Labour created 28 cancer networks to drive change and improvement in cancer services. Those networks brought together the providers and commissioners of cancer care to plan and deliver high-quality cancer services in their areas. They helped to oversee and drive up the quality of services that were delivered to cancer patients. By significantly changing their structure and reducing their budgets by millions, as well as by scrapping the highly regarded national cancer action team, I would argue that the Government have disrupted those networks.

Cancer Research UK published an analysis late last year that suggests that cancer services have been weakened by the shake-up of the NHS. It also suggested they lack the money to cope with the fast growing number of people getting the disease. The charity found that real-terms spending on cancer reached a record high of £5.9 billion in 2009-10, but since then it has declined to £5.7 billion in 2012-13. So not only has the money been reduced, but the delivery mechanisms, which helped share expertise and best practice, have been dismantled.

Our hard-working clinicians and staff are trying their best within the system, and despite the challenges, continue to deliver quality care, and we should all recognise and pay tribute to the work that they do across the NHS. Let me come on to what we would do were we in government. We have made a commitment that within the first six months of the election, the next Labour Government will publish a cancer strategy with the goal of being the best in Europe on cancer survival. That would include increasing the rate of cancers diagnosed early, which—as we have heard in this debate—drastically increases the chances of survival. At the moment, just over half of cancers are diagnosed at an early stage, but over the next 10 years, we want to see that increase to at least two in every three cancers. If the benchmark of today’s best performing areas—60% of all cancers being detected early—were met across the country, it would mean 33,000 more cancers diagnosed early each year by 2020.

We also plan to make leaps forward on screening and diagnostic tests. We have announced that we will put an extra £750 million of investment into testing over the next Parliament. That will enable us to guarantee a maximum one-week wait for tests and a one-week wait for results by 2020. That will be the first step towards achieving one-week access to key tests for all urgent diagnostics by 2025. That will be made possible by new investment, paid for through a levy on the tobacco industry, because it is only right that those who make soaring profits on the back of ill health should be forced to make a greater contribution in that area.

We will also ensure that the new bowel scope screening programme is rolled out by 2016, which I know will please the hon. Member for Basildon and Billericay. Research has found that patients who are able to see their GPs within 48 hours are less likely to have their initial cancer diagnosis via an emergency hospital admission.

[Mr Baron]

The whole cancer community has been behind the all-party group on cancer and the cancer-specific all-party groups in pushing for the one-year survival rates to be broken down by CCG and put on the delivery dashboard. The shadow Secretary of State welcomed that development when he spoke at the Britain against cancer conference in December. I do not intend to make predictions about who will win the general election during this debate, but may I press the hon. Gentleman—I am pressing my own side—to ensure that if Labour wins it will attach as much importance to the one-year figures and pursue those CCGs that are underperforming, in order to drive forward initiatives at a local level that encourage earlier diagnosis, as I know my party will do, once returned.

[Andrew Gwynne]

I absolutely agree with the hon. Gentleman. In fact, my right hon. Friend the Member for Leigh (Andy Burnham) has given that commitment as shadow Secretary of State. We need to make sure that if CCGs are not performing as well as they could be in this area, Ministers and NHS England take every action they can so that we bring standards up and everyone can expect the same level of treatment, irrespective of which part of England they live in.

The right hon. Member for Sutton and Cheam is not able to be here for the winding-up speeches but, as a courtesy, he let both Front Benchers and the proposer of the debate know that he would not be able to be here. He was right to raise the issue of long-term funding for the NHS. I do not think it is appropriate to talk in a knockabout fashion in this debate about who is going to raise what or when, but Labour has committed to the new time to care fund, which will enable us to have 8,000 more GPs by 2020. That, undoubtedly, will help to improve access and ensure that doctors get more time with their patients.

At the moment, fragmented primary care makes it more difficult for patients, particularly the elderly, to see one doctor who can develop a long-term view of long-term complex conditions. That is why, alongside our commitment to guaranteed GP appointments within 48 hours, we have made an equally important pledge to ensure that patients can book ahead with a GP of their choice.

Hon. Members may also have heard that Labour wants to work with the Teenage Cancer Trust to expand its cancer awareness programmes across all schools in England. Too many young people leave school without knowing the warning signs of cancer. Every young person should have the opportunity to learn more and know where to go if they are worried about their health. We in this place, on both sides of the House, owe it to our young people to teach them the signs of cancer and it is just as important to build their confidence so they can seek help. Early diagnosis, as we have heard, is critical to improving cancer survival, because treatment is more likely to be successful at an earlier stage. I commend the hon. Member for Castle Point for her powerful contribution today, and for the work she is doing in her constituency along these lines to make sure, working with those charities, that young people are more aware of the symptoms of cancer and where they should go if they exhibit signs of ill health.

When doctors catch bowel cancer at the earliest stage, more than nine in 10 people survive for at least five years. At the moment, however, fewer than one in 10 people with bowel cancer are diagnosed at the earliest stage. Many Members will be aware of the appalling statistic that a quarter of cancer cases in England are currently diagnosed through an emergency route. Naturally, far too many of these cases are in the advanced stages, meaning the prognosis is poor compared with cancer diagnosed through other routes.

Late diagnosis is not just worse for health outcomes; as we have heard, it can cost more too. The average cost of treating stage 1 colon cancer is about £3,400, compared to £12,500 at stage 4. Analysis by Incisive Health found that if all CCGs were able to achieve the level of early diagnosis of the best CCGs—our long-term target—then across all cancers we would be making annual savings in treatment costs of about £210 million. That touches on the points made by the hon. Member for Basildon and Billericay, as well as by the hon. Member for Salisbury and the right hon. Member for Sutton and Cheam.

The hon. Member for Salisbury also touched on the postcode lottery for diagnostics and treatments. He is absolutely right. With the leave of the House, I would like to talk about a case from my early time as a Member of Parliament, back in 2005. I have the privilege of representing a cross-borough constituency, so I have two of everything. I have two local authorities and two police divisions and so on. Back then, there were two primary care trusts. My constituent came to my surgery having been diagnosed with breast cancer. Her doctor had decided that the best treatment for her was Herceptin. If she had lived in the other part of my constituency, the primary care trust responsible would have provided Herceptin treatment for her, but because she lived on the other side of a road, with an invisible line down the middle, she was not able to access that treatment. It was one of those moments where it was appropriate for the MP to throw all his toys out the pram, and thankfully the PCT changed its decision. One of my nicest moments as an MP was about two years ago when the lady, whom I did not recognise, came back to my surgery with a completely different case. At the end, she said, “Mr Gwynne, you don’t recognise me, do you?” I looked blank, and panic-stricken, because we deal with so many constituents, and she said, “I’m that lady you got Herceptin for. I’m still here.” It was one of the proudest moments of my time so far as an MP.

That brings me to our plans for treatment. We have pledged that a Labour Government would continue to work with the cancer drugs fund, but we also recognise that the fund unreasonably excludes other advanced treatments. This takes up the point made by the hon. Member for Castle Point and the firmly and long-held views of my hon. Friend the Member for Easington. For that reason, we would expand the cancer drugs fund to include other treatment options, such as radiotherapy and surgery—the two treatments that together are responsible for nine in 10 cases where cancer is cured. That point has been powerfully made by my hon. Friend on so many occasions—it is still ringing in my ears.

The nature of cancer is changing. Just as with AIDS, rapid advances in technology mean that cancer is no longer the death sentence it once was, and this welcome change means that cancer is increasingly considered a long-term condition, which brings its own requirements, in terms of long-term care and support. A report from the King’s Fund suggested that as cancer survival rates improved, health care services needed to improve the quality of life of the growing number of people with cancer. The needs of cancer patients often span every tier of care in our system, yet it often proves incredibly difficult to navigate the various systems. We therefore plan to give everyone with the greatest need a single point of contact. This person will be their co-ordinator and advocate in the system, identifying their needs and ensuring they are met. No cancer patient should end up lost in our vast health system, unable to find the treatment they are entitled to.

Cancer survivors have to be properly supported once their treatment stops to help their recovery and minimise the impact of their illness on their overall health. The current formulaic approaches are not meeting the needs of cancer patients, and the current hospital-based follow-up service will not cope with the growing cancer population. We owe it to families battling cancer to continue to have high ambitions. In that spirit, Labour has set out its plans for improving early diagnosis and expanding access to new innovative cancer treatments. I thank all Members for their contributions. Despite our many political differences, we have the same ambition for cancer—to bring forward the day when this terrible disease is beaten.

Respiratory Health

Andrew Gwynne Excerpts

Tuesday 3rd February 2015 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Dorries. I congratulate the hon. Member for Stevenage (Stephen McPartland) on securing the debate. I commend the work that he and the all-party group on respiratory health do to raise awareness of these important issues in Parliament.

It cannot be denied that care for respiratory health conditions demands far more attention than it currently receives. Asthma, after all, is one of the most widespread and pernicious conditions around, and takes up a huge amount of resources in our health service. I share the hon. Gentleman’s concerns. We need to ensure the proper use of inhalers. My eldest son is asthmatic. He certainly has regular asthma reviews, and my wife and I, like the hon. Gentleman, try to ensure that such reviews are never missed, because they are so important.

The amount of research time that asthma gets is not proportionate to the scale of the problem, and routine asthma care simply is not up to scratch. The hon. Gentleman made that point well; the fact that he has been receiving pretty much the same treatment for the past 15 years speaks volumes. Respiratory disease is the third biggest killer in the UK, but the risk of conditions such as chronic obstructive pulmonary disease and asthma is perennially underestimated. The rate of deaths from respiratory disease in the UK is around three times that in Estonia and Finland.

Like the hon. and learned Member for North East Hertfordshire (Sir Oliver Heald), I get wheezy at sport. That has nothing to do with being asthmatic; it is more to do with my fitness levels. However, he made an important point that awareness of asthma, in the medical community in particular, is crucial. In 2010, I was very ill. My GP diagnosed asthma and prescribed me inhalers, which made me much worse because I was not asthmatic; I had pneumonia. That highlights the real need for the GP community to understand the specific needs of patients and whether asthma is prevalent, because some medication, as I found out to my detriment, can make people much sicker.

We have not touched on smoking to any degree, but we need to reduce its impact on respiratory health. That is a key factor. Patients need to be supported by clearer links being made between smoking and the start of respiratory disease, and there needs to be easier access to effective smoking cessation services and implementation of appropriate tobacco control measures.

There is, of course, a general awareness of the dangers of smoking. Needless to say, many have accepted the associated risks, but many have not. Two thirds of adult smokers took up smoking as children, so alongside measures to help people to quit smoking, we need to support those who have quit so that they do not relapse. We need to reduce exposure to second-hand smoke, and we should focus on protecting children and helping them not to take up smoking in the first place.

Around 10 million adults in Britain—about 20% of the population—smoke. Every year, smoking causes around 100,000 deaths. It is a major driver of health inequalities. Smoking rates are markedly higher among low income groups. I was pleased to see that the APPG report recommended the urgent implementation of standardised packaging for cigarettes, which Labour wholeheartedly agrees with. An independent report by King’s college London found that it was

“highly likely that standardised packaging would serve to reduce the rate of children taking up smoking”.

I commend the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), on her commitment to introducing plain packaging; I hope that the Minister present today will join her in the Lobby and encourage his colleagues in the Cabinet and on the Back Benches to support the measure. Christopher Hope of The Daily Telegraph only last week suggested that as many as 100 Conservative MPs planned to vote against the measure. Will the Minister support the measure and, if so, will he encourage his colleagues to do the same?

There are other measures that the Government could implement to reduce rates of smoking. Tackling the problem of toxic second-hand smoke, for instance, is crucial. It can pose terrible challenges to children’s health because of their smaller lungs and faster breathing, and the risks are increased in the confines of a car, for example. It is staggering that every year, second-hand smoke results in about 300,000 GP visits and nearly 10,000 hospital admissions among children.

That is why I was proud of the sterling efforts of my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) in getting a ban on smoking in cars through Parliament. More than 430,000 children every week are exposed to second-hand smoke in the family car, so when the House of Commons voted overwhelmingly for a ban, it was a great moment. However, the onus is now on the Government to act according to the wishes of the House, and to make the measure law at the earliest opportunity. I call on the Minister to commit to taking that step.

I was pleased by the proposals in the all-party group’s report for more joined-up asthma care. As part of Labour’s 10-year plan for the national health service, we have proposed a joined-up approach to long-term care, with patients being given more say in their care plans and more control over their data, so that that they can make more informed choices. That would be particularly pertinent to conditions such as chronic obstructive pulmonary disease, where a bad flare-up can prove life-threatening. Patients with such conditions should have more say in their care pathways. COPD exacerbations are the second most common cause of emergency hospital admissions, so it is clear how important it is to ensure that people can prevent complications where possible.

Clearly, there is some way to go on cutting rates of smoking and giving people support to stop smoking. However, it is also our responsibility to give people the option to influence their own health care. Hospitals provide advanced care, which often cannot be provided anywhere else, but swift developments have meant that lots of care that could previously be provided only in hospital can now be provided in the community. That is a huge leap forward. On the whole, the most deprived are admitted to hospital more often, not because of a higher propensity to fall ill, but because of the inadequacy of community services.

For example, with forms of COPD, most medical professionals firmly believe that good self-care can provide an incalculable benefit to patients. Those who know exactly how to administer their own long-term care tend to live longer and experience less pain, anxiety and depression. They also enjoy a better quality of life because they are more active and independent.

[Sir Oliver Heald]

That bears on a point made by my hon. Friend the Member for Stevenage (Stephen McPartland). Does the hon. Gentleman agree that, in many ways, carers have an important role as well? When someone encourages a person to take their medicine on time, or to go to their annual review, that is important. Carers are often unsung.

[Andrew Gwynne]

I absolutely agree. Carers have an important role in how we integrate health and social care, and we should never underestimate the role they play in providing care for close relatives and friends. The hon. and learned Gentleman is right.

It is only with integrated care that complications can be spotted earlier and hospital admissions potentially avoided. Regular reviews with a patient’s health care team, including information-sharing with other parts of the NHS, can make all the difference. However, there is also a lot to be said for the provision of far more advice and help to those caring for people with COPD.

Labour has said that it will guarantee a single point of contact for people with complex physical and mental health conditions—somebody with the authority to get things done. We will also establish the right to a personalised care plan, developed with the individual and their family, tailored to personal circumstances and not restricted by service boundaries. Patients with conditions such as COPD will also have the right to access peer support and advice from others learning to manage the same condition, which could prove helpful.

I commend the hon. Member for Stevenage on his hard work in advancing the cause of those with respiratory health conditions. Irrespective of the general election outcome, which is largely out of the control of all of us, this issue must be an absolute priority for whomever forms the Government in the next Parliament, and I give the hon. Gentleman a commitment from the Labour party that, if we find ourselves on the Government Benches, it will be.

NHS (Government Spending)

Andrew Gwynne Excerpts

Wednesday 28th January 2015 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

I have the real-life experience of having worked for the NHS for 33 years, and I am not a doctor.

I have seen the NHS go through many changes, but I have never seen such industrial unrest and poor staff morale as have developed under this Government. This Government claim to have employed more doctors and more nurses, yet they are not talking about the cuts to other services and other staff, and the redundancies and the outsourcing of work to the private sector.

This Government like to claim that all is wonderful in today’s NHS, but those of us who work, or have worked, within it know that that is not the case. The NHS still operates to a large extent on the good will of the staff. This Government have been withholding a pay review body-recommended rise of just 1% to all NHS staff. Only now that an election is looming has the Secretary of State finally agreed to meet the trade unions, and now that meaningful negotiation appears to have finally commenced and the strike that was planned for tomorrow has been suspended the Government are claiming that as some kind of victory. There is no victory, and this Government need to remember that they have presided over a series of strikes and industrial unrest on their watch and only now that there is an election on the horizon do they see fit to address these issues.

I welcome this motion which proposes to invest £2.5 billion into our NHS. Staff have seen £3 billion being wasted on a costly reorganisation which nobody wanted, which was not necessary and which was in neither the Tory nor the Lib Dem manifestos. NHS departments such as the one I used to work in, pathology, have been making so-called efficiency savings for the last four and a half years, to the extent that if someone resigns from a post a business case has to be made for them to be replaced. In today’s NHS, decisions are being made not on clinical grounds, but on financial ones.

It is an absolute disgrace that this Government’s spending plans will return our public spending as a share of national income to levels last seen in the 1930s, before we had an NHS. The Tories assert that they will protect the NHS yet propose to cut spending on services to levels seen in countries where almost half the health service is privately funded.

The Government even deny that the NHS is being privatised on their watch, yet the evidence is of piecemeal privatisation of services. In my own area of the north-west, ambulance services have been privatised and are now run by Arriva transport, a bus company. This service is a source of constant complaints from my constituents, with patients being left to wait and being unable to get hospital for important medical tests. Medical staff tell me they struggle to get through Arriva’s complicated system of questions and answers—to which my hon. Friend the Member for Bishop Auckland (Helen Goodman), who is no longer present, has already referred—in order to secure patient transport.

[Andrew Gwynne (Denton and Reddish) (Lab)]

My hon. Friend is making a great case and is absolutely right about Arriva and its patient transport service in Manchester. Is she aware that many of the hospital trusts in Greater Manchester are now having to put in their own arrangements, which is costing the public purse even more, because of Arriva’s failure?

[Liz McInnes]

I thank my hon. Friend for his intervention, and yes I am aware of that shocking fact. This contract needs to be looked at as a matter of urgency. The private sector is not providing the service that was commissioned.

Medical staff have trouble getting the Arriva ambulance service to come out. If medical staff have difficulty getting through the question and answer system, imagine how patients must feel, and how they manage when they try to get patient transport from home to take them to hospital for urgent tests that need to be done in order to secure the treatment they need.

My constituents also complain to me about GP appointments. A lot of them are unable to get GP appointments within a week, and this is supported by the results of the GP patient survey. If this Government are allowed to carry on as they have been, more and more people will end up waiting a week or more to see a GP or even be unable to get to see one at all. Labour will guarantee a GP appointment within 48 hours, and on the same day for those who need it, funded by our time to care fund, as opposed to suggestions made from the Opposition Benches such as “People with chronic illnesses like diabetes and thyroid disorders should be charged for their drugs”, or “Patients should be issued with receipts for the costs of GP and A and E appointments.”

The NHS is not safe under this Government, and most NHS staff are aware of that. Only Labour can reverse the damage currently being done to our NHS.