Strikes (Minimum Service Levels) Bill

Debate between Andy McDonald and Kieran Mullan

Committee stage
Monday 30th January 2023 Commons Chamber

[Dr Mullan]

The Government are committed to extensive consultation to set the minimum service levels, and that sets the spirit in which they want to reach the agreements. Agreements, and positive engagement with industry about them, are in place in Europe. As we have seen with the current strikes, it is not as if the will is not there to agree and recognise that there needs to be a degree of minimum service. As I have said, we have it in the police and it is part of legislation. I do not think it is right that we rely on voluntary agreements to secure others such as ambulance service workers. On principle, I do not think that it should purely be up to the negotiating process to decide that. We should aim for negotiation and for agreement, but not rely on voluntary agreements.

The Government expect to consult on this. It is not the huge attack that Opposition Members make it out to be, as we have seen with the police. We are taking a negotiated, compromised position, similar to many countries in Europe. On that, I conclude my remarks.

[Andy McDonald (Middlesbrough) (Lab)]

It is interesting to follow the hon. Member for Crewe and Nantwich (Dr Mullan). As a proud trade unionist, I refer the Committee to my entry in the Register of Members’ Financial Interests. For the avoidance of doubt, I declare that I do not have an £800,000 overdraft facilitated by the chair of the BBC, a multi-million-pound repayment with His Majesty’s Revenue and Customs or shares in a tax haven.

I wholeheartedly oppose this hurried, vicious and anti-devolutionary Bill in its entirety, and will vote against it tonight. I rise to speak specifically to the amendments in my name and those of right hon. and hon. Members. Our country is in crisis. Millions of workers are seeing their terms and conditions ground down and their wages eroded. Many are unable to meet their bills and are saying very loudly “Enough is enough.” Yet this Government’s response to strikes called successfully—despite the most severe, draconian balloting requirements and restrictions that they have imposed on trade unions—is to say no to legitimate pay demands and to negotiations, and to attack the very right to strike itself. Britain already has the toughest anti-union laws in Europe.

No worker wants to go on strike. It is a last resort taken at a financial cost. That desperation is evidenced by workers beating some of the strictest thresholds in the western world to do so. The reason that workers are pushed to strike is that in the face of a spiralling cost of living crisis, they have no other option. No amount of tightening the screws on trade unions will change that material fact. This Bill will do nothing to change the reality for millions of British workers who have seen their real-terms incomes drop dramatically since 2010.

Medical Cannabis (Access) Bill

Debate between Andy McDonald and Kieran Mullan

Friday 10th December 2021 Commons Chamber

[Dr Mullan]

With the greatest possible respect, I do feel that I understand the challenges that the hon. Lady is talking about. I will go on to answer her question about the fact that we have talked about it for a long time, so how do we move it forward? As I will explain, unfortunately, that applies to a very wide range of treatments and clinical practices in the NHS and across the world. This is about the appropriateness of picking out one specific area of clinical practice and using primary legislation as a way to overcome one particular problem. That is my concern.

[Andy McDonald]

The hon. Gentleman is failing to grasp that we have done it. The change has been made. What I am hearing time and again from Government Members is them rewinding and revisiting the process. The medications we are talking about are authorised and have been prescribed. We do not need to go through this exercise again—we have done that, and we want to move on.

[Dr Mullan]

I have explained that there are two challenges here. There are licensed, accepted treatments that are not being used, and there are very many examples across the NHS and healthcare globally of accepted, best practice, effective treatments that are not necessarily used as widely as they should be. We should not be picking out a particular treatment and using primary legislation as a mechanism to overcome that in one example; we should be working across the system and doing the hard work that has to be done to change clinical practices, as I will go on to explain.

In terms of reopening the debate, as I have explained, there is still a debate to be had about unlicensed treatments where there is not an evidence base for their use. We are talking about two things today, and I wish hon. Members would be more careful in understanding the distinction between the two and not—[Interruption.] That is the argument I have made. I will carry on and make progress on the other issues I wish to discuss.

--- Later in debate ---

[Dr Mullan]

I respect the experience that the hon. Member brings to her role. At no point have I said that the only way in which we can proceed is through RCTs. Earlier in the debate, when Opposition Members started talking in broad terms about observational studies and, to my mind, they were unfortunately disparaging RCTs, my comments were about being cautious. RCTs are incredibly important—they are fundamental to the vast majority of clinical medicine. I agree that other types of studies will be needed in some circumstances, but people need to make those arguments to the National Institute of Health Research. It is not for us as parliamentarians to override well-established processes designed to ensure that things are done in an appropriate, fair, thought-through and well-funded way.

[Andy McDonald]

The hon. Member is eloquent, but he is making a case for the commission. As the explanatory note says, the commission would be

“required to consider the role of evidence other than from conventional controlled trials, including from observational studies and other countries in which cannabis-based medicines are more widely available.”

So the net is wide. We are not pre-determining the evidence that would be considered. Opposition Members are saying that randomised control trials are not appropriate—we agreed on that; he has said that that is problematic—and there are other ways to look at this. We are not pre-determining it. We are saying that a commission of experts should do exactly that. Can he not see that he is speaking in favour of the Bill?

--- Later in debate ---

[Dr Mullan]

As my hon. Friend says, this is creating complexities and competing relationships that need to be given considerably more thought, rather than our aiming to promote a particular treatment.

We have talked about the risks. I now want to describe some of the many ways in which healthcare practitioners are held to account for their decisions. This is particularly important in relation to the unlicensed use of a medicine. First there is the sense of personal, moral or social responsibility that we would hope anyone involved in healthcare feels. Even if we do not necessarily take the Hippocratic oath any more, we are signed up on the basis of the fundamental principle, “First, do no harm”. Understanding that can be complicated, as I have tried to explain in relation to side-effects, for example.

Secondly, we are accountable to our employer. For example, a person working in a hospital is not free to practise as they wish. Their employer will have reasonable expectations that they ensure that their practice is safe, evidence based and works in the best interests of their patients. Increasingly, employers will place a big emphasis on following best practice guidelines from royal colleges, the National Institute for Health and Care Excellence and others that restrict their practice in some regard.

[Andy McDonald]

There is nothing in this Bill that will substitute our view and our professional assessment for that home medical practitioner. I want to congratulate the Members on the Conservative Benches: the clock is running down to 2.30 and they have successfully talked out this Bill. May I just ask anybody on those Benches to volunteer some explanation that I can take back to my constituents who wanted to see us make progress today, and we have not. By the way, can they also think of something that I may be able to say to my wife?

[Dr Mullan]

I think the hon. Member will understand that legislative progress is not an exercise purely in discussion. We should not be putting forward legislation if Members on one side of the House do not feel that that legislation should be passing into law. I am very happy to say that, for the reasons that I have outlined and will continue to outline, I do not feel that this legislation is appropriate, and I do that and will still sleep soundly tonight. It does not mean that I do not understand the deep concern, the hurt, and the anguish that individual parents are feeling. As I have said, I have worked in this field for a long time. There are very many people who suffer hurt and anguish in relation to treatments. I can talk about my own personal experience. My mother was diagnosed and treated for cancer. There was a period of a couple of years where I had seen a treatment that I wanted her to be on because I felt that it would be effective. There was some evidence to suggest that it was effective. We had to wait a couple of years for the further studies to come out, recommending that particular treatment. I have a young boy in my constituency, or a neighbouring constituency, whose family has raised an enormous amount of money to go to another part of the world to try a treatment that we do not consider to be sufficiently evidence-based—

[Andy McDonald]

That is not this—

[Dr Mullan]

The Member shouts from a sedentary position, but I am afraid that we are talking about a relevant issue. Labour Members want unlicensed treatments to be brought forward. There is a mixture of unlicensed treatments and licensed treatments.

--- Later in debate ---

[Dr Mullan]

I am not familiar with the discussions the hon. Member may or may not have had—I am sure the hon. Member did have them—with the Government in relation to pots of money. Again, I will gently say that there are enormous pressures on NHS budgets. That is why we have NICE, for example, to take out some of the emotion and personal feelings people have in relation to clinical care, and to try to look objectively at what secures value for money. I am not aware of what work the Department may have done on whether this represented an equitable use of resources for this particular area of clinical care. I will be happy to write to the Minister and make inquiries, as I am sure Opposition Members and the all-party group have done.

[Andy McDonald]

On cost-efficiency, does the hon. Member not agree that, considering the cost of emergency admissions to hospital and the use of intensive care and expensive medicines that do not work as effectively, this system would be a much better use of national health resources and would actually be a financial economic benefit to our nation, not a detriment?

[Dr Mullan]

I agree. I am sure that that is part of the reason why some treatments secured a licence and NICE approval. Again, we must not give the impression to people listening to the debate that the NHS’s systems are not engaging with this issue. I am sure that some treatments were approved. I am sure—or would hope, if the evidence is there—that future treatments might also secure approval as we go forward, particularly if the evidence is there to demonstrate that they are of use. I just reiterate that the things that Members on the Opposition Benches have been asking for have been happening. It may be at a rate that frustrates them, but I share that frustration, as do many others, and it goes across lots of different clinical treatments. I have direct experience of it, and it is not just an issue for the NHS; it is a global issue for modern healthcare systems when a vast amount of money is going into medical research with new treatments all the time. Governments need systems to decide which treatments they approve and so that they can look at the evidence properly. That is why we have the MHRA, NICE, the royal college guidelines and NHS best practice guidelines. All those things are in place.