Tobacco Control Strategy

Andrew Gwynne Excerpts

Thursday 17th December 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Betts. I begin by thanking the Backbench Business Committee for granting the debate, and I take the opportunity to wish all hon. and right hon. Members, the Clerks and everyone else sitting in this room a very merry Christmas.

Clearly, it is always a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford), because she speaks about these issues with such passion and a great deal of knowledge. She adds greatly to our debates. The need for a strategy and for funding to make it happen is pressing, and I am glad we have had the chance to discuss it today. I thank my right hon. Friend the Member for Rother Valley (Kevin Barron). His interest in the issue is, as we are all fully aware, not just passing; he has been championing the issue for a great number of years, and I commend him and the hon. Member for Harrow East (Bob Blackman) on the work that they have done on it through the all-party group.

I start with the problems with the autumn statement—an issue raised by all Members who have contributed so far. It is clear that the autumn statement brought yet more cuts to the public health grant. As a result of year after year of cuts to public health budgets, there has been a consistent fall in the number of people using local smoking cessation services. It is not the kind of thing that can be done half-heartedly. We can throw a little cash at the problem and suggest we are tackling it, but if we spend too little, the returns will be minimal. We may as well spend a sufficient amount and enjoy much greater returns on the investment in public money. We all know that a smoker may throw themselves into an attempt to stop—usually in the new year period, following a new year’s resolution—but if the support is not there, many of them might fail in their attempts. Even worse, after a failed attempt with insufficient support, they are unlikely to try again; that is just human nature. It is worth getting it right the first time round, and giving people the support that they need. That is why some of the cuts to the public health budget have been short-sighted and are the falsest of false economies.

I fear that most smoking cessation services will not survive a 24% cut to the non-NHS part of the Department of Health’s budget. I want public health bodies to be able to push to make children born today the very first smoke-free generation, but I am worried that their ability to do so will be damaged by the reduction in funds.

Let us consider just one aspect of the cost of smoking that may be overlooked. The general health implications of smoking are well known and documented, but mouth cancer often gets overlooked. Oral cancer kills more people in the United Kingdom than cervical and testicular cancers combined, yet there is still an alarming lack of public awareness about oral cancer. Nine out of 10 oral cancer cases are preventable, and two thirds of cases are a direct result of smoking, so improved awareness of all the possible health problems caused by smoking is one role of local public health services. Awareness as a concept can often be dismissed, but when it comes to deterring people from using tobacco products, it is invaluable, yet such services will be slashed in the upcoming public health bonfire. I call on the Government and the Minister, for whom I have a great deal of respect, to think again and try to reverse some of the cuts to public health services.

I welcome the introduction of standardised packaging for cigarette packets by May next year. There are powerful arguments in favour of it, and I am pleased that the Minister pushed ahead with the policy, with cross-party support, albeit that there were a few recalcitrant members of Government, and even louder voices against on the Back Benches. Nevertheless, we got that through, and I commend her on the work she did in pushing for that.

This month marks the third birthday of plain packaging. Australia’s Tobacco Plain Packaging Act 2011 came into force on 1 December 2012, which made it the first country to halt the use of figurative trademarks on tobacco products. In the past few months, both France and Canada have taken significant steps forward in introducing a similar ban. France should be introducing a ban in May, at the same time as our standardised packaging laws come into force.

The importance of removing legitimacy from such activities cannot be overstated. Take the example of the ban on smoking in cars, championed by my predecessor as shadow Public Health Minister, my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger). The purpose is obviously not to punish every single driver smoking in a car with children; that would be impossible to enforce. The real purpose is to send a very strong message that it is not acceptable to smoke in cars with children, and that it is punishable by law. A similar example is the ban on driving without a seatbelt. There are not many convictions, but the number of people using seatbelts soared after the ban was introduced. Our approach must include encouragement as well as enforcement.

I come on to my main point. The previous tobacco strategy was, on the whole, a success. It has encouraged the introduction of measures such as standardised packaging, which are to be welcomed, but I am concerned that a new strategy has not been developed yet. I welcome the Government’s commitment to establishing a new strategy in the new year, but I have concerns about their ability to implement it fully and comprehensively.

In October last year, the five-year forward view noted that

“The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

As the hon. Member for Central Ayrshire said, Simon Stevens has gone on record to say that as part of the efficiencies that the NHS is looking to implement, £5 billion will come from prevention, but how can we achieve £5 billion in prevention when preventive services are being cut back—or, in some cases, removed altogether? I hope the Minister can give Members of all parties, who want the same outcomes, assurances that cessation and other public health services at a local level will not see the axe fall on them in the way it is suggested they might, and that the £5 billion of efficiencies that Simon Stevens has identified as coming from prevention are achievable through the role and remit of the Minister with responsibility for public health.

I will return to the point that I opened with. A person is four times as likely to quit smoking successfully with the help of specialist support, but those services are under attack. In the autumn statement, the Chancellor announced further cuts in the public health grant, amounting to an average real-terms cut of 3.9% each year to 2020-21. That translates to a further cash reduction of 9.6%, in addition to the £200 million-worth of cuts announced in the summer Budget.

Meanwhile, tobacco, as we have heard from other Members, is still the single biggest cause of premature and preventable death, responsible for 100,000 deaths every year in the UK. Some 10 million adults still smoke. More than 200,000 children aged 11 to 15 begin smoking every year. This is an income inequality issue, too. In 2014, 12% of adults in managerial and professional occupations smoked, compared with 28% in routine and manual occupations. People with mental health conditions, prisoners and the homeless are far more likely to smoke than the general population. In my constituency, smoking rates are still far too high and well above the national average. In Tameside, where smoking is prevalent—a quarter of the population smokes—450 deaths a year and 2,500 hospital admissions are attributable to smoking. I know how much this contributes to poor health, which places a huge pressure on health and care services locally, and causes untold misery for the communities and the families of those affected.

I want to touch briefly on the point made by my right hon. Friend the Member for Rother Valley about e-cigarettes, because I have seen them work for people who have smoked for a very long time. The e-cigarette not only helped to wean them off tobacco, but, by reducing nicotine levels over a long time, removed the need for nicotine and got them off cigarettes altogether. I implore the Minister to ensure that any regulations she introduces are proportionate, as my right hon. Friend said.

I ask the Minister to keep a watching brief, though, because I am a little concerned. I am starting to see in my constituency the glamorising and normalising of smoking among young people through the use of e-cigarettes. I fully support them as a product to help people come off smoking, but as a gateway product to smoking, they worry me considerably. I accept that there is probably nothing more than anecdotal evidence at this stage, which is why I urge the Minister to keep a watching brief, but having seen the marketing of some e-cigarette products, I am concerned that it uses precisely the same marketing tactics as we saw used by tobacco companies, which brought about the introduction of the regulations on standardised packaging. Let us make sure that e-cigarettes are used for their correct purpose: to bring people off smoking. If there is evidence that they are starting to become a gateway product to smoking, I hope very much that the Minister will look again at whether action is required.

Health inequality is one of my biggest bugbears, and smoking is one of its most virulent causes. A comprehensive strategy to reduce smoking rates is imperative if we are to tackle the issue. The Opposition will support the Minister with responsibility for public health and the Government in developing such a strategy, building on the achievement of both her Government and the previous Labour Government over a number of years. I hope that she can give some assurances on the issues that Members have raised, and some Christmas cheer to Members looking for a renewed strategy on this very important issue.

Victims of Contaminated Blood: Support

Andrew Gwynne Excerpts

Wednesday 16th December 2015 Commons Chamber

[Jane Ellison]

My hon. Friend, who has campaigned long and hard on this issue, is right to reiterate the importance of the views given in that report. I confirm that they have already informed our thinking about how we go forward, as indeed have the views of many colleagues on all sides of the House expressed over many months and years. I can assure him that the report will be considered. I have previously committed, and I reiterate the commitment today, to conducting a root and branch reform of the current schemes.

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

Thank you, Mr Speaker, for granting this urgent question. I pay tribute to all the Members of this House who have been a strong voice for the victims of contaminated blood, but in particular to my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) who has been tireless in her pursuit of answers.

This scandal saw thousands of people die and thousands of families destroyed through the negligence of public bodies. Over the years, the response of Governments of all colours just has not been good enough. It is a real shame that we are here yet again wondering why action has not been taken. I do not think anyone doubts the sincerity of the commitment that the Prime Minister made back in April, but does the Minister understand the disappointment that people have felt in recent months as promises to publish arrangements and to make statements have been broken repeatedly? Does she accept that that has only raised false hope among a community that already feels very betrayed?

Given the further delay that the Minister has announced today, what guarantees do we have that the January consultation date will be met? What redress—other than an urgent question through you, Mr Speaker—will there be if it is not? A consultation is fine, but will she say when any new scheme will be implemented? It is important that any new arrangements are properly scrutinised, so will she commit to a debate in Government time to allow that to happen? Finally, does the public health Minister appreciate that the longer this goes on, the longer we leave in place a system that is not working and leaves victims without adequate support?

No amount of money can ever fully make up for what happened, but we owe those still living with the consequences the dignity of a full, final, fair and lasting settlement. This injustice has gone on for far too long. The time for action is now.

[Jane Ellison]

As I have already said, I of course regret the delay. This is a very complex area. I appreciate the tone with which the shadow public health Minister responded, because, as he said, Governments of all colours have not turned to this issue. We have turned to the issue and we are addressing it in a great deal of detail. It is a complex area. There is a very diverse range of affected groups impacted by this tragedy and we must get the consultation on reform right for all of them. I have been clear, in my response to the urgent question, that we have been considering the funding issue. We are, of course, aware of potential litigation in relation to the scheme as it stands. I cannot comment further on that, but the House will appreciate that that adds a level of complexity to dealing with this matter.

I am always extremely happy to come to the House to explain. The scheduling of debates in Government time is not a matter for me, but it goes without saying not only that I would be delighted to debate the matter but that I am happy to talk to colleagues, including shadow Front-Bench colleagues, privately or otherwise, about this matter. That commitment remains.

Cystic Fibrosis

Andrew Gwynne Excerpts

Tuesday 8th December 2015 Westminster Hall

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

It is a pleasure to be back, having spent four and a half weeks in cold, wet Oldham, running the Labour party by-election campaign. I pay tribute to my fellow shadow Ministers for standing in for me in numerous Westminster Hall debates. It is good to be back, and it is good to see you in the Chair, Sir Edward.

I pay tribute to my hon. Friend the Member for Dudley North (Ian Austin) for making sure that this important debate could take place. He is right that we need to make sure that access to pharmaceuticals is one of the most important policy areas. With the results of the accelerated access review coming out in the new year, the effectiveness of NICE is very much on the agenda.

I also pay tribute to the right hon. Member for Chesham and Amersham (Mrs Gillan), who spoke powerfully about not only Archie, but Duchenne muscular dystrophy, which is a terrible disease, and she is right that we need to do much more to make sure drugs are available to treat it. I hope the case she made for Translarna will not fall on deaf ears with Ministers, because such drugs can make a big difference to the quality of life of children such as Archie. The right hon. Lady has put that case very powerfully in her question to the Prime Minister, and in her contribution today.

In June 2009, the previous Labour Government adopted the European Council recommendation on action in the field of rare diseases, which recommended that member states should establish and implement plans and strategies for rare diseases. Following on from work set out before the 2010 election, the coalition Government published the UK strategy in November 2013. NHS England published its statement of intent with regard to the UK strategy in February last year.

Since then, we have had the five-year forward view, which reaffirms NHS England’s commitment to achieving better outcomes for people with rare diseases, and when the Minister concludes the debate, I am sure he will give us more detail about how he sees the points made by my hon. Friends the Members for Dudley North and for York Central (Rachael Maskell), the hon. Member for Strangford (Jim Shannon) and the hon. Member for Linlithgow and East Falkirk (Martyn Day), who leads for the SNP on these matters, and the right hon. Member for Chesham and Amersham. Rare diseases are a crucial part of the five-year forward view, and given that the UK leads in life sciences, there is no reason why we cannot start to push the boundaries on what is achievable in respect of the drugs available for rare diseases.

The problem is that, although each of the publications I mentioned set out some laudable intentions, the actions arising from those publications have been baby steps in comparison with what we actually need. Changes resulting from the Health and Social Care Act 2012 have left patients and professionals to navigate a labyrinth when accessing medicines that, in many cases, have already been approved or have received licences. That really should not be happening.

Before the last election, the Opposition said unambiguously that we would reform NICE from top to bottom to remove the requirement to enforce competition rules and to ensure that access to medicine was decided on the basis of a medical justification, balanced with consideration of how much money we had available. I think we all now agree that NICE needs some reform. The current appraisal system makes decisions based on 24 weeks of clinical trials data, but that understates the efficacy of drugs that provide long-term stabilisation of a condition.

Other Members have spoken of the frustration cystic fibrosis patients have felt at not being able to access new treatments because those will not be approved given the way NICE appraises them. As my hon. Friend the Member for York Central said, the NICE system is not set up to assess precision medicines, and the issue extends well beyond cystic fibrosis to other rare diseases. Members have spoken powerfully about cystic fibrosis, and what we have heard about could be an excellent platform for testing new ways of doing things, and that could, indeed, also be the case with muscular dystrophy. The appraisal system for innovative medicines needs to be overhauled and to be adapted to include personalised medicines. Until the system is prepared to look at the value of new medicines over time, instead of looking for more rapid effects, it will not be suitable for its purpose.

I have some specific questions for the Minister. I am concerned that the highly specialised technologies evaluation programme could limit access to medicines for people with rare diseases. There are widely held concerns that the process, which was introduced after the 2012 Act to appraise medicines for rare diseases, is opaque and that the topic selection process is out of date. Does the Minister have plans to work with NICE to update the selection criteria for the pathway? Am I right that the process does not take into account conditions defined by genetics, biomarkers or differences in clinical presentation? Will he look again at that? Will he, as other hon. Members have asked, meet representatives of Muscular Dystrophy UK and the Cystic Fibrosis Trust to discuss those matters?

I accept that there has been huge investment in life sciences in the UK, but the current system, which encourages investment in technology and does not facilitate patient access to it, is unsustainable and wrong. Without such reform as we have discussed, funding for research on the relevant medicines could dry up and we could lose crucial shots at tackling a lot of rare diseases once and for all. The accelerated access review is a timely opportunity to take a careful look at how people get access to the kinds of medicines that might change their lives. It would be a tragedy if we threw that opportunity away.

I do not doubt for a moment that the Minister is fully behind every Member taking part in the debate in wanting to expedite the availability of the drugs in question, and I am keen to hear more about how the Government plan to do that. I commend Members for speaking so powerfully in a consensual cross-party manner in today’s debate and at other times when we work in Parliament to promote such causes. I hope that the Minister will answer all the questions that have been asked, and offer a glimmer of hope for those people who seek access to such drugs.

Cities and Local Government Devolution Bill [Lords]

Andrew Gwynne Excerpts

Monday 7th December 2015 Commons Chamber

[James Wharton]

First, I should put on the record my gratitude and that of my colleagues for the representations made by hon. Members who were keen to see the new clause included in the Bill, and to support and empower their local national parks authorities to do the best job they can and to continue to contribute to the communities they represent. In particular, I am grateful to my right hon. Friends the Members for New Forest East (Dr Lewis) and for New Forest West (Mr Swayne) and my hon. Friends the Members for Thirsk and Malton (Kevin Hollinrake), for Penrith and The Border (Rory Stewart), for Berwick-upon-Tweed (Mrs Trevelyan) and for Richmond (Yorks) (Rishi Sunak). I would like to add Councillor Gareth Dadd of North Yorkshire County Council, who made strenuous efforts to convince us of the merits of these changes and kindly arranged for me to meet representatives of the North Yorkshire national park authority and National Parks England.

In the light of this weekend’s flooding, I think it important to reiterate the comments of my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs in the statement that we have just heard, and I offer my sympathy to the people of Cumbria and other affected areas in recognition of the significant impact of what has happened there as a result of the unprecedented weather events.

Before speaking expressly to the content of the new clause and amendment, I would like to say a few words about the role of the national park authorities in water management in the context of what has happened this weekend, and about how the changes might assist them in further performing that role. Although national park authorities do not have responsibility for emergency planning, the planning decisions they make and the development control conditions they enforce can make a big difference to the demands placed on those who do have to respond during an emergency.

National parks have an important role to play in managing the water environment and helping with restoration work. For example, the floods of November 2009 caused severe damage to the rights-of-way network in Cumbria and the Lake District national park. Over 250 bridges were damaged or destroyed and 85 paths needed repair. The function-specific general power of competence that we are discussing with these amendments could be used to enhance the national park authorities’ ability to respond to flood emergencies by enabling them to enter into partnerships, to develop skills and capacity within small rural communities and businesses to assist with the responses needed, to develop specific skills to combat future flood management, and to adapt the network to improve flood resilience.

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

Given that national parks might cover one or more metro mayor areas—for example, the Peak District national park is partly in Greater Manchester and partly in South Yorkshire, two areas that might well have metro mayors quite soon—is there not a case for having some co-ordination for emergency planning to make sure that there is the same resilience and the same emergency planning in the different parts of the national park?

[James Wharton]

The hon. Gentleman makes an important point. We want to see co-ordination, and there are already structures in place to deliver it and to ensure that different bodies work together to respond as efficiently and effectively as possible. From what I have seen happening in Cumbria and other areas over the weekend, a number of those bodies are working very hard to deliver for local communities. The hon. Gentleman puts an important point on the record. We absolutely want to see as much co-operation as possible, and we want to empower these public bodies to carry it out wherever possible. That underlies in many ways the purpose of devolution, so it is an apt time for the hon. Gentleman to put his comments on the record.

Junior Doctors’ Contracts

Andrew Gwynne Excerpts

Wednesday 28th October 2015 Commons Chamber

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

We have had a comprehensive and powerful debate, with 23 speakers and many more Members who would have liked to contribute if we had had more time. I would particularly like to thank my right hon. Friend the Member for Oxford East (Mr Smith), my hon. Friend the Member for West Ham (Lyn Brown), my right hon. Friend the Member for Enfield North (Joan Ryan), my hon. Friends the Members for Wakefield (Mary Creagh), for St Helens South and Whiston (Marie Rimmer), for Workington (Sue Hayman), for Bolton South East (Yasmin Qureshi), for Easington (Grahame M. Morris) and for Ealing Central and Acton (Dr Huq); the hon. Member for Central Ayrshire (Dr Whitford), the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Strangford (Jim Shannon); and the hon. Members for Totnes (Dr Wollaston), for Bristol North West (Charlotte Leslie), for Finchley and Golders Green (Mike Freer), for South West Wiltshire (Dr Murrison), for Blackpool North and Cleveleys (Paul Maynard), for Morecambe and Lunesdale (David Morris), for Vale of Clwyd (Dr Davies), for Sherwood (Mark Spencer), for Erewash (Maggie Throup), for Boston and Skegness (Matt Warman) and for Morley and Outwood (Andrea Jenkyns).

Members of all parties have spoken with great passion and praise for our junior doctors, who work tirelessly to deliver good quality services—despite the challenges they face in an NHS that is increasingly under pressure and under strain.

[Andy Slaughter]

rose—

[Andrew Gwynne]

I do not have time to give way, I am afraid.

I echo those sentiments of sincere thanks, but we have heard of junior doctors who already work weekends, already work nights, already work holidays and give their all for their patients. Despite all this, the junior doctors now face a situation that has left them feeling deflated, demoralised and devalued.

Patient safety has been a key theme of today’s debate. Some Members have valiantly leapt to the Health Secretary’s defence, but those voices have been far outnumbered by Members who are deeply concerned that this contract is unsafe for doctors and unsafe for patients.

Members have argued that the removal of the financial penalties that apply to hospitals that force junior doctors to work unsafe hours risks taking us back to the bad old days of overworked doctors, too exhausted to deliver safe care. The BMA says this safeguard, which is built into the current contract, has played an important role in bringing dangerous working hours down. Removing this financial disincentive to overworked junior doctors is extremely alarming, especially at a time when junior doctors are already coming under an enormous amount of pressure and strain. If the Health Secretary would just listen, he would hear junior doctors shouting loudly and clearly that they cannot give any more.

Many Members highlighted the protests and marches that have taken place throughout the country in recent weeks. We had only to catch a glimpse of the placards that were waved as thousands of junior doctors marched against the contract to understand that those doctors now fear for their own health and well-being. I was struck by one banner which read, “I could be your doctor tomorrow, or I could be the patient”, and those doctors’ concerns have been echoed by many Members today. How can the Secretary of State possibly say that he is acting in the interests of patient safety if the very people who work in the NHS say he is putting safety at risk?

Another argument that has been advanced today is that the contract is necessary to ensure that our NHS works seven days a week. Not only does that argument do a huge disservice to our NHS staff who already provide care seven days a week and 24 hours a day, and reveal just how out of touch some Conservative Members are with the realities of working on the frontline in our NHS, but it is wholly inaccurate. If this junior doctor contract were imposed in its current form, it would have the opposite effect, as many independent clinical voices have warned.

It is a bitter irony that the problems that the new junior doctor contract was supposed to be trying to address when it was originally proposed back in 2012—the need to introduce better pay and work-life balance—are the very problems that will be made worse should the contract go ahead in its current form. In letters to the Secretary of State, the presidents of a number of royal colleges and faculties have made it very clear that they share those concerns, but he presumably thinks that they too have been misled.

The Secretary of State said that he did not intend to cut the pay of any junior doctor, but his sums simply do not add up, and everyone can see through the spin. No one with a GCSE in maths can believe that no doctor will be worse off as a result of the new contract. Let the right hon. Gentleman come to the Dispatch Box in the minute that I have left, and answer this question. To what percentage of junior doctors currently working within the legal limits will what the Secretary of State has said today apply? Is it 50%? Less than a quarter? What is it?

[Mr Jeremy Hunt]

All of them.

[Andrew Gwynne]

In that case, I ask the Secretary of State to explain this. If the pay envelope is not increasing, and if the pay is not being reduced, how can these sums add up? They just do not add up, and I suggest that he go back to night school and learn some basic arithmetic.

We know that the BMA has been conciliatory today: it has offered to speak to the Secretary of State again. I ask him, please, let us take this down a notch. Let us get him talking to junior doctors again. The simple fact is that these are the junior doctors who work in our A & E; these are the junior doctors who work in every department of every hospital on the frontline. They come in early and leave late, they already provide care for seven days a week, 24 hours a day, and they deserve a lot better than this Government.

Cities and Local Government Devolution [Lords] Bill

Andrew Gwynne Excerpts

Wednesday 21st October 2015 Commons Chamber

Amendments 43 and 44 are tabled in the name of my hon. Friends the Members for Altrincham and Sale West, for Hazel Grove and for Bury North. Amendment 43 seeks to enable an individual local authority to leave a mayoral combined authority without the need to dissolve and reform the combined authority and provides that where that occurs, the resource is split according to a fair and proportionate division. Amendment 44 would require the Secretary of State to abolish and reform the combined authority when a constituent council wishes to leave. One of the benefits of establishing a combined authority is the long-term stability it offers for the area it covers and the duties it has. These are statutory bodies and that long-term stability is important, but I understand Members’ concerns about how changing circumstances could lead to changes in how the local area would want to work, the geography over which a combined authority should be formed and the functions it should have. I will listen carefully to the comments they make later in the debate.

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

On the question of dissolving a combined authority, will not the difficulty always be that pooling and sharing arrangements will have been put in place and borrowing arrangements will have been made that a constituent authority might not easily be able to exit? That would make the long-term stability of the combined authority very uncertain were the amendment to be passed.

[James Wharton]

The hon. Gentleman makes a salient and important point. The Government will not support the amendment for that very reason, but I will listen carefully to the speeches that are made because it is important that we address concerns to the fullest extent to which we are able without attracting from the intention of the Bill and the intention of the Government to deliver on our agenda.

Clause 3 provides flexibility to enable a single local authority to leave, in line with the comments that the hon. Gentleman has just made, if it does not wish to continue to be part of a combined authority. A council can also leave a combined authority once a mayor has been elected for the area of a combined authority without the need for the combined authority to be dissolved and reformed, using exactly the same process as is used to establish such an authority of undertaking a governance review demonstrating that the change would improve the exercise of functions. In addition, a council that wishes to leave a combined authority can do so if it obtains consent from the other constituent councils of the combined authority, and if there is one, the mayor. Again, I will listen carefully to the comments of hon. Members with a view to finding a position that can get broad agreement across the House as the Bill makes progress.

Amendment 39 is tabled by my hon. Friend the Member for Amber Valley (Nigel Mills). It applies to circumstances in which a combined authority is proposed and seeks to require that no order can be made for a combined authority unless local government electors have been consulted on replacing the existing county councils and district councils with unitary authorities. That moves away from the flexibility we want to be to deliver and puts conditions on deals that we might want to make but that we do not necessarily want to impose. Again, I will listen very carefully to my hon. Friend’s comments later on in today’s discussions.

--- Later in debate ---

[Mr Betts]

I would not want to second guess the motives of the Secretary of State, so I will use my own arguments to resist what the Government are trying to do.

Apart from the inconsistency of approach, the proposals are confusing. That takes me back to the point I made in my intervention on the Minister. In the Sheffield city region the economic powers, which are important and cover skills, economic development and the infrastructure associated with it, are to be devolved to the combined authority, which will cover nine districts—four metropolitan and five non-metropolitan districts. But as I understand it from the deal, the mayor will have responsibility for just transport. So the mayor is to run transport, and the combined authority is to run economic development. The public want some consistency of approach on these matters. I do not believe that the combined authority, the district, would naturally have come forward with a proposal that broke up the responsibilities in this way.

[Andrew Gwynne]

My hon. Friend is making a powerful case. The difference between his deal and the Greater Manchester deal is that the Greater Manchester deal is within a single metropolitan county, so functions such as police and eventually fire and rescue can also be devolved to the Mayor’s office.

[Mr Betts]

There is a big difference in the Manchester case. I am not arguing that Manchester should have a mayor imposed on it. If Manchester wants that, that is a matter for it, but it is different. In Sheffield we have hybrid devolution, with transport going to the mayor, but the mayor is not going to cover the nine districts. The mayor will cover only four districts—the old south Yorkshire districts—so how are people to understand the devolution deal, which has one set of governance arrangements for economic powers and skills, and another set of governance arrangements for transport, where one set of governance arrangements covers four authorities, whereas the other set covers nine?

The whole purpose of combined authorities is to bring local authorities together on a voluntary basis to cover a travel to work area—the natural economic entity—yet transport, the mayor and the associated powers will not cover the whole travel to work area of Sheffield. This is a real dog’s dinner. It is not going to work, and it is certainly not going to be understood by the public.

That leads me on to my second point. There is a problem with mayoral imposition, which in Sheffield’s case will not cover all five areas. Other districts can choose to join the arrangements for mayors if they wish. My understanding—I may be wrong—is that the districts of north Derbyshire and north Nottinghamshire, which are part of the Sheffield city region, are going to join the combined authority, which they are part of, for the economic powers. However, for transport powers to be devolved to those areas through a mayor, those districts will not merely have to agree, but they will have to get the county, which is the transport authority, or two counties, to agree as well. Does the county have a veto over what happens to devolution in the Sheffield city region?

This is not workable. At the same time as the Sheffield city region has a mayoral possibility, Derbyshire and Nottinghamshire are looking at having a joint combined authority, which would have a mayor as well. As I understand it, the mayor can exist for the districts of north Derbyshire and north Nottinghamshire only if those districts agree to the county mayor for Derbyshire and Nottinghamshire being created. So they have a veto over that. At some stage, surely, Ministers have to take some responsibility for coming forward with proposals to sort out this mess, or it will stop devolution working effectively in these areas.

--- Later in debate ---

[Ann Coffey]

The hon. Gentleman will appreciate that when I read an explanatory statement that says:

“The intention of this amendment is that elected mayors will be introduced only if that proposal has been endorsed, in a referendum, by 50% of the population”,

I am likely to believe the Clerks.

[Andrew Gwynne]

My hon. Friend will know that the Greater Manchester devolution settlement came from the bottom up, from the 10 councils of Greater Manchester, and the 10 leaders always intended to appoint an 11th member of the combined authority to act as full-time chair. The mayor merely becomes that 11th member.

[Ann Coffey]

I thank my hon. Friend for that intervention—his knowledge in this area is comprehensive.

As I was saying, 50% is a very high bar that is unlikely to be reached, so amendment 51 is, in effect, a wrecking amendment intended to stop the devolution of decision making from Whitehall to Greater Manchester. It is a kick in the teeth for the people of Greater Manchester.

The population of Greater Manchester is 2.7 million, and we have a shared sense of identity, even if, at the very minimum, it is, “We’re different from London.” Surely it is right that services to meet the needs of local people should be designed locally. Local people care about that much more than they do about esoteric arguments about organisational arrangements. Greater Manchester comprises 10 local authorities, 11 police divisions and 12 clinical commissioning groups. We have an opportunity to bring those resources together. Too often there are barriers to working together and sharing information and the delivery of services because of boundaries between councils and, for example, health agencies. The combined authority would bring together the strength, competence and experience of the existing local authorities and other agencies in Greater Manchester under the leadership of an elected mayor, which is supported by the 10 local authorities, so that the public can see the public face of that new devolved authority.

[Andrew Gwynne]

Of course, the point is that the Greater Manchester combined authority already exists in statute; it is a body corporate. The Bill will allow the 11th member, who chairs the combined authority, to be directly accountable to the 2.7 million people who live in Greater Manchester. Surely that is a good thing.

[Ann Coffey]

My hon. Friend is absolutely right; it is a good thing. When people talk to me—and, I am sure, when they talk to him—and ask who they can go to, to them having a mayor makes perfect sense.

Of course, there are outstanding issues with regard to health, but there is nothing in the Bill that will take away from the people of Manchester the right to national health services enjoyed by people elsewhere. The problem in Greater Manchester is the fragmentation of health, so it is good that these proposals will help reduce the number of commissioning organisations and allow providers to work together in a more collaborative way for the benefit of local people. However, we need a funding settlement that gives greater flexibility in developing high-quality health and social care services in the community across Greater Manchester as an alternative to hospital admissions, and at the moment it is difficult for each clinical commissioning group to free up resources in order to do that. Without that investment, the demand for expensive hospital care will continue. The authority cannot simply be a bank that hands out money under the current funding arrangements.

There has been a lot of talk about accountability, but in my experience accountability is at its best when well-informed elected representatives, such as my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), demand answers and are willing to make their case loudly and publicly. No complexity in the arrangements for governance can take the place of that, and that is the accountability that the public expect us to ask for.

Last year I did some work looking into child sexual exploitation across Greater Manchester, at the request of the police and crime commissioner, Tony Lloyd, and following that I published my report “Real Voices” last October. Talking to children at risk of child sexual exploitation, it is absolutely clear that they do not observe local government boundaries, health boundaries or police boundaries, and neither do their predators. The digital age has redefined boundaries. A lot of progress on that has already been made across Greater Manchester. In particular, I want to congratulate Project Phoenix, a cross-boundary, multi-agency response to child sexual exploitation across the whole of Greater Manchester, which is working to ensure that child victims receive the same standard of response regardless of where they live. It has also initiated a very successful “It’s not okay” campaign to build public awareness of child sexual exploitation and help young people recognise when they are being groomed. It is clear that work on this crucial agenda will be enhanced by more devolution powers for Greater Manchester. We must overcome the silos and boundaries that prevent people working together to protect children from abuse.

Amendment 51, if passed, would be a kick in the teeth for the people of Greater Manchester and their children, who have felt for years that their voices have been ignored by Whitehall and Westminster. Devolution and the creation of a mayor offer the opportunity to the people of Greater Manchester to develop services that reflect their priorities and needs. We should take that opportunity and be positive about the opportunities we are being offered.

--- Later in debate ---

[Mr Betts]

I agree with what my hon. Friend the Member for Nottingham North (Mr Allen) said about the need for a wider constitutional settlement. That was apposite, and at some point we will have to address those issues. I agree with his points about subsidiarity and taking that below the level of an individual local authority, and about encouraging the process down.

Fiscal devolution is a challenge, and Members have reflected different perspectives from different parts of the country. It is a challenge, but not one that we should duck. I am Chair of the Communities and Local Government Committee, on which the hon. Member for Carlisle (John Stevenson) sat in the previous Parliament. He made important and valuable contributions to our report. We found a way to take on board proposals from the London Finance Commission about the wider devolution of property taxes, while recognising the need to protect areas that will perhaps struggle to raise business rates and other property taxes easily, or to get back money from areas that simply watch property prices rise and receive enormous windfalls. We must have balance in the system.

The Committee has begun an inquiry into the workings of devolution and the Bill, but since then the Chancellor has made his announcement about the full localisation of business rates. The Committee will want to come back and look at how that will be done. I think most Members would support the principle behind such a move, but how will we implement it to ensure protection for poorer areas? How will we devolve more powers to local government to take account of the extra money made available as part of that process?

[Andrew Gwynne]

My hon. Friend is right to say that the Select Committee must consider business rates retention in detail. One possible solution for devolved city regions might be the pooling and sharing of business rates. For example, parts of Greater Manchester are key drivers of economic growth, and that wealth should be spread across the whole conurbation for the benefit of all.

[Mr Betts]

My hon. Friend is right, and the Committee made that recommendation in the previous Parliament. It is a way that we can devolve the redistribution process to more local areas. That does not work everywhere, but it would probably work well in areas such as Manchester that have a spread of different local authorities

--- Later in debate ---

[Andrew Gwynne]

I apologise for the fact that I have only just come into the Chamber for this part of the debate. I have been on Front Bench duty in Westminster Hall.

I am interested in what the Minister is saying about the Secretary of State’s oversight of devolved health in Greater Manchester, which is clarifying one of the issues about which I know a number of Greater Manchester MPs are concerned. May I ask, however, whether any thought has been given to coterminosity? In the case of most of the functions that have been devolved to Greater Manchester, there are coterminous boundaries with the 10 metropolitan boroughs. The NHS is slightly different, in that one of the CCGs—one of my own CCGs, Tameside and Glossop—extends to Derbyshire as well, because Glossop is not part of Greater Manchester.

[Alistair Burt]

I know the area well, and I know exactly what the hon. Gentleman is referring to. Yes, that is part of the consideration, but it is essentially part of the consideration of the combined authority. Not only will it have to devise the working of its services within the confines of what is commonly known as Greater Manchester, but it will have to recognise that some of the provision of those services is carried out by those with cross-border responsibilities, and work something out with the adjoining areas. Nothing in the Bill speaks to that, because it does not relate to what I am discussing—the control of standards and the like—but the hon. Gentleman is absolutely right. That is part of the process that people will be going through.

--- Later in debate ---

[Alistair Burt]

I have read the report of the debates in the House of Lords on exactly this topic, because there was a lot of confusion. My understanding is that it depends on precisely what the breakdown is. Let us suppose that the breakdown, or failure, is in the way in which services have been put together by the combined authority. This is purely off the top of my head, and does not refer to anything of which I have any current knowledge. Let us suppose that there was a dispute between two constituent areas of Greater Manchester, one of which claimed that there was some inequity between the service that it was receiving and the service being received by the other. It might be claimed, for instance, that the combined authority’s decision was somehow disadvantaging Ramsbottom in favour of Bramhall. In the event of such a dispute, the buck would stop with those who were making the decisions locally, and that is the combined authority. The matter would not go anywhere near the Secretary of State. What the Secretary of State retains responsibility for is the standards and whether or not there has been a breach of NHS duties in relation to anything that falls within his own overall responsibility. So the buck still stops with the constituent authority that is delivering the service. In relation to a CCG that is not performing properly, the buck will stop with the CCG, not the combined authority. If there is a lapse of standards in anything connected with the NHS, ultimately the regulators govern that and the Secretary of State would be responsible. But if it is a decision being taken by those who are responsible for the new combined authority to do with where services go and it is within their remit, it will be a matter for them—the buck will stop with them. The short answer, therefore, is that where ultimately responsibility lies depends on where the breakdown is, but it is clear in relation to each of the services and it does not mean anyone can evade their responsibilities.

[Andrew Gwynne]

I think my right hon. Friend the Member for Leigh (Andy Burnham) had a better definition of what the Minister is trying to say. He said it is the Secretary of State’s responsibility to set out the “what”, and the “how it is delivered locally” is for local commissioners or the combined authority in the case of Greater Manchester. The “what” remains with the Secretary of State; the “how” is devolved to the local area.

[Alistair Burt]

I think between the hon. Gentleman’s right hon. Friend, me and the Secretary of State we have probably got where we need to get to in relation to this. I wanted to make clear that there will not be a confusion of who is responsible for what; someone is ultimately responsible for each bit, but who is responsible in each particular case depends on where the breach is.

Secondary Breast Cancer

Andrew Gwynne Excerpts

Wednesday 21st October 2015 Westminster Hall

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

I congratulate the hon. Member for North Warwickshire (Craig Tracey) on securing this important debate and the laudable and worthwhile work he is doing as a member of the all-party group on breast cancer.

We have made huge progress on improving cancer services—in the past decade, five-year survival rates for nearly all types of cancer have improved—but we still lag behind other countries, and there is worrying evidence from the past five years that the progress we have been making on cancer care has stalled, or potentially even gone backwards. In government, Labour created 28 cancer networks to drive change and improvement in cancer services. The networks brought together the providers and commissioners of cancer care to work together to plan and deliver high-quality cancer services in their areas. They helped to oversee and drive up the quality of services delivered to cancer patients. By significantly changing their structure and cutting millions from their budgets, as well as by scrapping the highly regarded national cancer action team, the coalition Government disrupted those networks.

Our hard-working clinicians and staff are trying their best within the system; despite the challenges, they continue to deliver quality care, so we should all pay tribute to them. Early diagnosis is critical to improving cancer survival because treatment is more likely to be successful at an earlier stage. Naturally, far too many of those people diagnosed through the emergency route are in the advanced stages, meaning the prognosis is poor compared with that for cancer diagnosed through other routes.

The nature of cancer is changing. Just as with AIDS, rapid advances in technology have meant that for many cancer is no longer the death sentence it once was. Such welcome changes do, however, mean that cancer is increasingly being considered a long-term condition, which has its own requirements in terms of long-term care and support. The chance of recurrence, as in secondary breast cancer, underlines the importance of remaining vigilant. It is possible to reduce considerably the probability that people with cancer will experience long-term poor health following treatment by providing appropriate and co-ordinated support and intervention. That is what we must do.

No breast cancer patient should end up lost in our vast health system, unable to find the treatment to which they are entitled. 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 and wellbeing. The current formulaic approaches are not meeting the needs of cancer patients, and the current hospital-based follow-up service simply will not cope with the growing cancer population.

If implemented, the strategy developed by the Independent Cancer Taskforce in its report would be a huge leap forward. I am pleased that the Department of Health has already made some commitments, and we look forward to hearing more following the spending review, but we need to ensure that these things actually happen. Equally, the cancer strategy recommendation of a “living with and beyond cancer” programme to ensure that people are fully supported and their needs are met should be followed through. I commend those developing support networks in their local areas, but they deserve more backing from the Government. I welcome the Government’s commitment to ensuring that everybody has a recovery package by 2020. That is crucial, as one in three people experience moderate to severe unmet needs after their treatment.

We owe it to the families battling secondary breast cancer today to continue to have high ambitions. I thank all Members for their contributions. Despite political differences, we do all have the same ambition: to bring forward the day when this terrible disease is beaten.

Cancer Drugs

Andrew Gwynne Excerpts

Tuesday 20th October 2015 Westminster Hall

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

It is a pleasure to see you in the Chair, Mr Hollobone, and to follow the hon. Member for Motherwell and Wishaw (Marion Fellows).

I commend the hon. Member for Strangford (Jim Shannon) on securing the debate through the Backbench Business Committee and on the way in which he opened it. He has set the correct tone for how we seek the improvements we would like to see in access to cancer drugs for all our constituents. He was absolutely right to say that cancer touches every family. I lost my mother to ovarian cancer 21 years ago, and it is as painful to talk about today as it was then, when I was teenager. Only last week, my aunty passed away from cancer. It was a quick movement from the diagnosis to her passing, and I would like to place on the official record my thanks and tribute to all the staff at Willow Wood hospice in Ashton-under-Lyne, who looked after her so beautifully in her last days and hours. I also express my condolences to Evan, Shana, Sonya, Lal and Connor, who she has left behind.

The hon. Member for Strangford was absolutely right to say that we have made advances, but we still lag behind many comparable countries in cancer treatment. Access really does matter. I represent a cross-borough constituency, so I have to deal with two of everything, from police divisions right through to NHS trusts. Early on in my time as the Member of Parliament for Denton and Reddish, a constituent who had been diagnosed with breast cancer came to my advice surgery. She explained that her specialist had recommended Herceptin for its treatment, but that it was not available in her primary care trust area. If she had lived across the road, across the invisible administrative line—but still in the same constituency, with the same Member of Parliament—she would have had access to the drug. That was one of those moments when it was perfectly acceptable for the Member of Parliament to throw all the toys out of the pram. I did so, and thankfully I managed to get the primary care trust to change its mind.

Several years later the lady came to my surgery again, about something completely different, and it was one of those proud moments when one realises one has made a difference. She said, “Mr Gwynne, you don’t recognise me, do you?” and I replied, “I’m sorry, I don’t. I have met lots of people in my time as an MP. Should I recognise you?” She said, “I’m that lady you got Herceptin for, and I’m still here.” I do not know whether the Herceptin made a difference, but she believed that it did, and she would not have had access to it if I had not thrown all the toys out of the pram. That is why I start by commending the Government on the introduction of the Cancer Drugs Fund. The fund has been of significant benefit to patients, and that is to be welcomed—it would be churlish not to recognise the difference it has made. I am a little concerned, however, that the Government—as we have already heard—are now presiding over a series of reductions, which threaten the progress made.

We have already seen 18 treatments cut, and now NHS England has announced that a further 25 are due to be removed from next month. The Rarer Cancers Foundation has estimated that if all the cuts go ahead, more than 5,500 patients a year could be denied access in the future. My hon. Friend the Member for Scunthorpe (Nic Dakin) and others during the course of the debate have made that point powerfully.

Is the Minister content to stand by as the cuts are made? What will he do to help the patients who will miss out on these treatments if they are removed? At Prime Minister’s Question Time last week, the Prime Minister lauded NHS England’s negotiation process as a means of securing better value for the taxpayer, yet I fear the truth is rather different. I hear reports from charities and drug companies that suggest that NHS England has refused even to discuss discounts on some of the treatments threatened with cuts. Far from wanting to strike a deal that works for the taxpayer and helps patients, NHS England seems intent on leaving deals on the table. It is sad that efforts to save money on a range of drugs have been spurned. The chief executive of NHS England once said that he wanted his organisation to:

“Think like a patient, act like a taxpayer.”

The current position, however, seems to be against the interests of taxpayers and patients. Will the Minister intervene in NHS England to ensure that it considers every single offer that is put to it and that it redoubles efforts to maintain access to these drugs while securing the savings we all want to see?

The Minister cannot wash his hands of the issue when the process is evidently failing patients and delivering poor value for public money. Other countries seem to be able to make the drugs available without spending more money on their health services, which implies that they are better at striking deals, or at least are more flexible in doing so. Why are we not following the same process? Why should our constituents be denied these drugs when patients in other countries have access to them?

In brief response to my hon. Friend the Member for Torfaen (Nick Thomas-Symonds), I place on record that we on the Labour Front Bench support his private Member’s Bill on off-patent drugs, which has the support of the Association of Medical Research Charities and will help to improve access to off-patent drugs. We also need to look at ways of encouraging clinicians to use off-patent drugs.

I will touch briefly on points that my right hon. Friend the Member for Oxford East (Mr Smith) and the hon. Member for Foyle (Mark Durkan) made on radiotherapy and surgery and the benefits that extending access to those treatments can provide. Going into the general election, the Labour party’s position was that we would extend the Cancer Drugs Fund to become a cancer treatment fund that would include radiotherapy and surgery. What consideration have the Government given to ensuring that all the innovations will be available as part of the fund?

On the pharmaceutical price regulation scheme, I fear that there is more bad news to come for cancer patients. In August, the Department of Health snuck out some changes to the PPRS on a Friday afternoon, and I fear that the implications of that news could be bad indeed. The change agreed with the Association of the British Pharmaceutical Industry effectively limits the level of PPRS rebates that drug companies have to make on expenditure through the Cancer Drugs Fund. That creates a financial black hole over the lifetime of the PPRS that the Rarer Cancers Foundation tells me could amount to £567 million. The Government need to find more than half a billion pounds to cover the gap between projected Cancer Drugs Fund spend and PPRS rebates. Will the Minister tell the House how this gap will be filled? Can he reassure patients that the budget for the CDF will not be cut and that patients will not miss out as a result of that secret deal between the Government and the drugs companies?

Finally, I want to cover the consultation on the future. The cuts announced to the Cancer Drugs Fund in September were an inevitable consequence of an abject failure to fix the system. The Government’s record on the reform of drugs pricing and assessment is a sorry tale of promises not kept. First we had value-based pricing, which was meant to be the solution, but went nowhere. Then we had value-based assessment, which was derided by all sides and shelved by NICE, the very organisation that proposed it. The hon. Member for Foyle made some powerful points and interesting suggestions not just on the combined purchasing power of the various NHS systems across the devolved Administrations, but on the wider purchasing power of all the Administrations of the islands on which we reside. I would like the Minister to consider that.

We have the promise of Cancer Drugs Fund reform, but the process is already riddled with confusion and delay. The NHS England working group on reform was shut down as quickly as it was set up. A consultation was promised for July and then September—now it is October and we still have no consultation. In drawing the debate to a conclusion, will the Minister provide an update on when the consultation will finally be published? If he cannot do so, will he intervene with NHS England to ensure that Members are updated so that they can reassure the many of thousands of cancer patients whose treatment depends on satisfactory reform?

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 13th October 2015 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

The north Lincolnshire scheme is designed to try to encourage doctors to make sure that there are no inappropriate referrals to secondary care; it is not designed to prevent appropriate ones. Over the past five years we have seen an increase of 600,000 in urgent referrals for cancer care, for example. We want to see that continue. It will not be helped if there are inappropriate referrals, and that is what the scheme is about.

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

Last week senior officials at Monitor reported being leaned on by the Department of Health to suppress the publication of financial figures ahead of the Conservative party conference. This week the Health Secretary has been accused of vetoing the release of impartial independent reports on measures that could reduce our consumption of sugar. Does he not understand that leadership on transparency must come from the very top? Will he now commit to practising what he preaches on NHS transparency and release this report immediately?

[Mr Jeremy Hunt]

I will take no lessons on transparency from the Opposition. Professor Sir Brian Jarman said that the Department of Health under Labour was a “denial machine” when it came to the problems of Mid Staffs. We have made the NHS more transparent than ever before, and we will continue to practise transparency.

NHS (Contracts and Conditions)

Andrew Gwynne Excerpts

Monday 14th September 2015 Westminster Hall

[Paul Scully (Sutton and Cheam) (Con)]

It is a pleasure to serve under your stewardship, Ms Vaz. It is also a pleasure to follow two fellow members of the Petitions Committee, including the Chair, the hon. Member for Warrington North (Helen Jones). The Petitions Committee is a new Committee, and we are feeling our way. As hon. Members have heard, we cannot debate no-confidence motions; petitioners cannot seek a vote of no confidence in a Secretary of State or anybody else. None the less, it is important that we reflect the views and concerns of people who raise substantive matters with us, and I am glad that we have the opportunity to do so today.

Confidence and good staff morale in the NHS are important. In my constituency, morale in our local hospital, St Helier, has been comparatively low for several decades, for a number of reasons. A reorganisation has been recommended in the past couple of years, which we have successfully fought off so far. The NHS clinicians wanted to move A&E, maternity services and children’s services to St George’s in Tooting. One of the reasons why they wanted to do so was the shortage of consultants in St Helier. They wanted to concentrate consultants’ time in St George’s, which is too far away for residents.

One of the big driving factors in that, to my mind, is the fact that over 20 or so years, our local hospital has been used as a political football. People have said, “St Helier hospital is due to close. We have got only a short time, and we have to save it. We have to fight for this, because it will close some time soon.” I do not know about you, Ms Vaz, but if I were a consultant looking to work in the NHS, would I want to go and work in a hospital that is always apparently under threat of closure? No, I probably would not. I would probably go to St George’s or one of the hospitals that are being talked up. I have seen at first hand how staff morale in the NHS can be fragile. The same thing has happened nationally as well. How many times have we heard that we have 24 hours to save the NHS? We keep seeing, hearing and reading that, time after time. It is important to build confidence.

We also have a manifesto commitment to deliver. We talked in our manifesto about having a seven-day NHS, and we have been elected as a Conservative Government, so it is important that we deliver our promises. We have to work with the profession to do that, however. Why do we want a 24-hour NHS? We have heard some of the arguments about safety and patient outcomes, and at the end of the day, patient outcomes are what it is all about. There is also an argument—although, as my hon. Friend the Member for Totnes (Dr Wollaston) described, it is a secondary priority, because we do not want to divert too many resources—for convenience and fitting in with people’s lifestyles, which I will come back to in a moment.

The 2003 consultant contract made the seven-day move a lot more expensive to deliver, so we need to change things. Consultants, as we have heard, can refuse to work weekends, but it is quite apparent that a great many do not choose to opt out. We are not saying in a broad-brush way that every consultant opts out of such working. None the less, we need to have a degree of consistency if we are going to move towards a seven-day NHS, because we want to make sure that the healthcare in hospitals around the country is as consistent as possible. Removing the opt-out will leave a new limit of working a maximum of 13 weeks in a year—one in four weekends—which still gives plenty of opportunity for family life and for flexibility in rotas, while delivering better patient outcomes.

The changes also recognise the need for proper reward in areas such as A&E and obstetrics, with higher-performing consultants able to earn a bonus of up to £30,000 a year, and with faster pay progression for new consultants. The hon. Member for Warrington North talked about support services, which are crucial for front-line consultants, doctors and nurses. I am pleased to hear that diagnostic services will be moving in the same direction so that patients can have quicker access to information and advice about their conditions.

I have talked about convenience, and GP services cannot be boiled down to some sort of retail operation such as late-night shopping or Sunday opening. None the less, we need flexibility. The 2004 GP contract led 90% of GPs to stop providing out-of-hours care at night and at the weekend. That contract, in many cases, helped to break the personal link between patients and those responsible for their care, which has been especially hard on elderly people. Caving in to the unions at that point effectively restricted GP services to a five-day service, which created extra pressure on A&E.

I have had the misfortunate of having to use my local hospital’s A&E service four times in the past 18 months with my elderly mum and my wife. My wife stood on a six-inch spike in a park, and when she was writhing around in agony with a spike though her wellington boot, there were a lot of people in A&E who had experienced neither an accident nor an emergency. Those people did not know where to go, they chose not to go to the GP, the appropriate care was not signposted clearly enough, or the GP simply was not open. We need to address those pressures, and a seven-day service will help.

The proposal is part of our wider NHS reforms, which since 2010 have moved to bring patient decisions closer to patients. We need to provide services that patients want, rather than a Henry Ford one-size-fits-all approach—we need greater flexibility. We have largely moved away from that, so we need to continue the move towards a seven-day service and towards greater flexibility. A seven-day service fits in with people’s working practices, childcare and busy lives. There is also greater take-up of digital initiatives such as the NHS national information board, and people are being brought in to help support the greater use of technology.

Members have talked about the statistics on satisfaction with the NHS over the past few years. The Commonwealth Fund’s report in 2014—four years after the Conservative-led Government took over—showed that, according to the fund’s records, the NHS is the best-performing health service in 11 countries.

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

The hon. Gentleman has surely read the detail of that Commonwealth Fund report. Much of the data that were used data from the previous Labour Government.

[Paul Scully]

The hon. Gentleman will also find that the NHS improved over those years. We were second when the Labour Government were in power, so we have improved, and more data are still coming through. That is backed by public confidence, which has gone up by 5 percentage points to its second-highest level in the period covered by the report. The number of people in England who think that they are treated with dignity and respect increased from 63% in 2010 to 76% last year, according to Ipsos MORI. Record numbers say that their care is safe, and the number who think that the NHS is one of the best systems in the world has increased by 24 percentage points in the seven years since Mid Staffs. That is a great base from which to start, but we need to continue working with healthcare professionals to secure the seven-day NHS that we need and people want to see. Shouting and using the NHS as a political football will not get us very far.

--- Later in debate ---

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

It is a pleasure to see you in the Chair, Mrs Gillan. We have had a good debate, and it is a pleasure to speak in it, for a number of reasons. This opportunity comes with a number of pressures. I note that this is the first debate relating to an e-petition under the new system. As the shadow teams are still being put together, I am not sure whether this will be my last outing as a shadow Health Minister or as a shadow Minister altogether, but patience is a virtue and time will tell.

It is a particular pleasure to respond to my good friend the Member for Warrington North (Helen Jones), who opened the debate. From my slightly partisan perspective as the shadow Health Minister, I thought she made a devastating critique of the Government’s record on the NHS. She will be an outstanding Chair of the Petitions Committee, which is, again, a parliamentary first. I declare an interest: in my first Parliament, from 2005 to 2010, I was a member of the Procedure Committee, and we looked at the practicalities of having a proper petitions facility and a petitions Committee to back that up in the House of Commons. The wheels of democracy take a long time to turn, but here we are 10 years later with the Petitions Committee, debating the first of the probably great number of petitions already lodged with the House of Commons. I welcome my hon. Friend to her post.

While I am making welcoming remarks, I welcome the promotion of my hon. Friend the Member for Lewisham East (Heidi Alexander) to the role of shadow Health Secretary today. She will be a doughty campaigner for the NHS in that role, as she has been for her constituency, not least because she cut her teeth on the Lewisham hospital issue.

I also pay tribute to my right hon. Friend the Member for Leigh (Andy Burnham), who has served diligently and excellently as the shadow Health Secretary for the past four years. I have been privileged to work under him. He has been committed to the national health service in his time as a Health Minister and as the Health Secretary, and in his time in opposition.

There was a need to adjust the terms of the debate to ensure that we addressed the issues and not the personalities, but we have all alluded to why we are here, what triggered the petition and the reasoning behind it. Government Members might want no challenge to their record and policies, but the fact is that while we agree on a large area of health policy—where we do, it is right that there is consensus—we will not avoid political debate just because it is uncomfortable for some Members. It is right that where the Opposition—whichever parties they may be—have differences of opinion with the Government of the day, we are able to raise them.

When it comes to the seven-day NHS, the Health Secretary has a habit of spinning the data to suit his purpose and to divert attention away from some of the Government’s failures on the NHS. Of all his public pronouncements since the election, the most controversial —indeed, it inspired many people to sign the petition—was his suggestion that NHS staff are avoiding working at the weekend. As we heard from the hon. Member for Central Ayrshire (Dr Whitford), that is just not the case, and she speaks with a vast amount of experience. Let me reiterate: it is not true, and we know it is not true.

I want to place on record my appreciation and thanks to all who work in our NHS: the consultants, the doctors, the nurses, the support staff and the ancillary staff. They do a tremendous, often thankless job under difficult circumstances. The deluge of social media users sharing photos of themselves working at the weekend on wards and in surgeries demonstrated just how absurd the Health Secretary’s claim was. Indeed, according to a series of freedom of information requests, only 1% of consultants in our health service actually opt out of weekend working.

The Health Secretary told consultants they needed to “get real”, but it is the Health Secretary who needs to get real. Rather than picking fights with hard-working NHS staff, he should be consulting them on the best way to deliver seven-day services. If the Government are serious about delivering further weekend care, they have to stop coming out with speculation and conjecture, and must urgently define what they want to deliver and how they plan to pay for it. Demonising doctors who are already working evenings and weekends will get us nowhere.

A seven-day NHS is the aim of all those who want the best health service in the world—I include myself among them—but to achieve one, we have to listen to those on the frontline and address their concerns. Staff are rightly worried about losing their antisocial hours pay, the effect of which could be devastating for huge numbers of assistants and nurses. Working at night is as expensive as shifts get, with transport and childcare being more expensive or totally unavailable, and all the evidence shows that night shifts have a detrimental effect on people’s health. It is only right that such shifts are appropriately compensated. I sincerely hope that the Minister, for whom I have a great deal of respect, will address that point in his reply.

We must not forget that the seven-day NHS pledge has been made many times before. It was in the 2010 Conservative manifesto. The Prime Minister repeated it in October 2013, and in September 2014, and of course it was also in the Conservatives’ 2015 election manifesto. The question I am pondering is: if they promised it before and failed to deliver it, why on earth should anyone believe them this time? We would all welcome a seven-day service, but that must be matched by the funding necessary to recruit, support and, importantly, retain hard-working NHS staff. We have already heard that there is a shortage of nurses; there are fewer nurses per head of the population than in 2009-10. The head of Health Education England, Ian Cumming, said earlier this year that

“GP recruitment is what keeps me awake at night.”

The scale of the recruitment crisis is startling even to those of us who have been following the fortunes of the two Health Secretaries since 2010. The coalition Government were wrong to cut training places as one of their first acts, and immigration policy is not joined up with the need for recruitment from abroad. If adequate numbers of staff are not being trained at home, the two polices do not make any sense together. As we have heard, retention is a big challenge; it is about not only the new staff coming through the system but the staff leaving at the other end.

My message to the Minister and the Health Secretary is this: if they want to deliver a seven-day NHS, we will work with them, but they will not achieve it by picking a fight with staff and, importantly, they will not achieve it unless it is properly funded. The Conservatives made many promises on the NHS before the election, many of which the Government have already dropped, and many more of which have not been funded. If the seven-day NHS promise is to be realised, I implore the Minister to work closely with the health service unions and actually go out and speak to the health professionals that keep our system going.

More broadly, we need a serious debate about how services are organised across the whole week, so that people can stay healthy in their own homes. The Minister and I have debated the concept of whole-person care on numerous occasions—in fact, we debated it at length both before and during the general election. There was a degree of consensus around the plans of my right hon. Friend the Member for Leigh. We desperately need to make sure that all parts of our health and care service work together to ensure that care focuses on the individual.

It is no good Government Back Benchers lauding the ring fence for the NHS budget when, as we heard from my hon. Friend the Member for Warrington North, social care budgets have been ransacked. I should not need to remind Government Members, but the fact is that social care cuts are NHS cuts because of the pressure that they cause throughout the health system. Let us look carefully at the workforce issues that triggered the petition and this debate. Let us work with staff, because without them the NHS will not be transformed into that single health and social care service. For all of us who care about the NHS, ultimately that must be our goal.