Oral Answers to Questions

Anna Soubry Excerpts

Tuesday 16th July 2013 Commons Chamber

[Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op)]

1. If he will bring forward legislative proposals on standardised packaging of tobacco products.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

The Government’s policy remains unchanged. We are waiting to see how the legislation recently introduced in Australia pans out before deciding whether to follow.

[Cathy Jamieson]

Given some of the public health Minister’s previous pronouncements, some of us could be forgiven for thinking that the Government’s policy has changed. Will she advise the House, therefore, on who overruled her support for this policy? Was it the Prime Minister, the Health Secretary or Lynton Crosby?

[Anna Soubry]

Unfortunately, the hon. Lady has not listened to my last answer or, indeed, to my statement on Friday. The Government’s policy remains unchanged. We are waiting to see the evidence before making a decision. I take the very firm view that the best legislation is based on good evidence.

[Mr David Nuttall (Bury North) (Con)]

Of course, there are those of us who believe it is up to the individual to take personal responsibility for their own health and who entirely support the Government’s decision not to have any extension of the nanny state. Does the Minister agree that, before we introduce any new laws on tobacco, we ought to enforce more strictly the existing laws on not selling cigarettes to children?

[Anna Soubry]

My hon. Friend makes a number of excellent points with which I agree, save for one: with great respect, standardised packaging would not be an extension of the nanny state, because it would not impinge on anybody’s freedom or right not only to buy cigarettes, but to smoke them. It is all about ensuring that the package is not attractive, especially to young people, who are at risk of taking up smoking.

[Ian Austin (Dudley North) (Lab)]

18. Earlier this year, I met young people from Dudley who set up the Kick Ash project campaigning for plain packaging. They showed me evidence from research that plain packaging would stop young people smoking in the first place, which is something every MP ought to be committed to trying to do. If the Government reject plain packaging, will those young people be right to conclude that the Government take the advice of big tobacco companies and their wealthy lobbyists more seriously than the views of young people in Dudley?

[Anna Soubry]

First, I pay tribute to Kick Ash. I am more than happy to meet those youngsters; they seem to be doing a very good job. Secondly, we are not in anybody’s pocket. I am sure the hon. Gentleman can say he is not in the pocket of any trade unions either. This is an important decision, but we have not made it yet; we are waiting to see how things develop in Australia, and as I say, good laws are based on good, sound evidence. That is the way forward.

[John Pugh (Southport) (LD)]

Is the high evidential threshold being set for the plain packaging proposals to be applied across Government legislation or only where lobbyists are involved?

[Anna Soubry]

I am rather disappointed at that question from my hon. Friend. I can assure him that the Government take all these issues very seriously. I am proud of our emerging record on public health, but as I say, we have yet to make a decision, because, quite properly, we want to see what happens in Australia, and of course we are also waiting to see what happens elsewhere, notably in Ireland, where the Irish Government intend to introduce this policy. It might or might not be successful.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Minister says, quite correctly, that the best legislation is based on evidence, but should it not also be untainted by the activities of lobbyists? She will be aware that Department of Health officials met Philip Morris Ltd at the end of January this year, but although minutes of meetings with other tobacco companies that occurred at the same time have been released, the Department insists that the minutes of the meeting with Philip Morris have yet to be finalised. Is it not the truth that the Government are trying to cover their tracks over their relationship with Lynton Crosby and his clients and that when it comes to the decision effectively to drop plain packaging for this Parliament, all roads lead back to No. 10 and Lynton Crosby?

[Anna Soubry]

I have just seen a piece of straw flying over, which the hon. Lady attempts to clutch at. [Interruption.] “Clutching at straws”—it is a bit lost on the Opposition, but that is more a sign of their difficulties than ours. The minutes of the meeting with that tobacco company have been published this morning. The reason for the delay—I very much hope the hon. Lady is not suggesting for one moment that my officials have been in any way dishonest—is because unfortunately the tobacco company did not agree the minutes, and there was some to-ing and fro-ing. I really wish she would not subscribe to conspiracy theories where they do not exist.

[Stephen Timms (East Ham) (Lab)]

2. What recent assessment he has made of the effects on NHS services of changes in local authority spending on adult social care.

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[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I pay tribute to the work done on this issue by my hon. Friend, as well as by my hon. Friends the Members for Broxbourne (Mr Walker), for Croydon Central (Gavin Barwell), for Loughborough (Nicky Morgan) and many others. They have done a huge amount to remove the taboo associated with mental health. We are funding the “Time to Change” campaign, with up to £16 million being put in from 2011 to 2015. The programme works to support and empower people to talk about their mental health problems and to tackle the discrimination that so many of them face. It includes for the first time a tailored programme of work for children and young people.

[Bob Stewart]

How confident is my hon. Friend that general practitioners are able to make rapid assessments of potential mental health problems, particularly clinical depression, when patients present themselves perhaps for other non-related matters?

[Anna Soubry]

We know that a third of GP appointments are mental health-related, so GPs have a lot of experience in tackling mental illness. We also know, however, that it is not covered extensively in GP training, which is why the Royal College of General Practitioners has identified improved care for people with mental health problems as a training priority—this is to be welcomed—through its enhanced GP training programme.

[Mr Andrew Love (Edmonton) (Lab/Co-op)]

Yet mental health spending has been cut over the last two years and we find ourselves in a position where four in 10 mental health trusts do not have safe levels of staffing. What is the Minister going to do about the funding and the staffing levels in our mental health services?

[Anna Soubry]

Of course, the overall health budget will be rising by some £12 billion by 2015, and in relation to mental health, I have to say that I am exceptionally proud of this Government for making mental health such a priority, notably through the mandate. I think we are to be congratulated on at last recognising how important mental health is. In our view, it underpins almost all public health matters and so many of the troubles and conditions that people present to GP surgeries. Therefore, I think we are doing an extremely good job on this subject.

[Valerie Vaz (Walsall South) (Lab)]

4. What plans he has to implement the recommendation of the Francis report on safe staffing levels.

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[Jason McCartney (Colne Valley) (Con)]

5. Whether the new review of children’s heart surgery units will cover adult as well as paediatric cardiac surgery.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I am informed by NHS England that it will include adult surgery in its review of care for people with congenital heart disease.

[Jason McCartney]

Can NHS England assure us that a clear link will be shown between the feedback from patients, the public and stakeholders and the final configuration of services in the review of the Leeds children’s heart surgery unit?

[Anna Soubry]

Let me first pay tribute to the work my hon. Friend continues to do in support of his hospital and his children’s heart unit. NHS England has told me that individuals and patient organisations have all been encouraged to engage with and contribute to the local review process. The feedback received will be used to help to inform the outcome of the review of children’s heart surgery at Leeds.

[Mr Henry Bellingham (North West Norfolk) (Con)]

6. What plans he has to meet the acting chief executive of the East of England ambulance trust to discuss that trust’s recovery plan.

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[Caroline Lucas (Brighton, Pavilion) (Green)]

10. If he will take steps to ensure that people affected by muscle- wasting conditions in the South East Coast NHS area are adequately supported after September 2013; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

NHS England commissions some elements of neurological services through specialist services commissioning arrangements, while clinical commissioning groups commission general neurological services. I am informed that the Muscular Dystrophy Campaign and the Surrey and Sussex area team are considering funding the care pathway adviser post for a further six months.

[Caroline Lucas]

I thank the Minister for her answer, but an exploration just for the potential of a mere six months’ reprieve is not good enough. As things stand, for people with muscular dystrophy and their families in the South East Coast region, from September, that is set to be the only part of the country without access to a local care and support advocate. Therefore, will the Minister agree to meet me as a matter of urgency to discuss what can be done to ensure long-term funding for that vital post, which sufferers and their families want to see continue?

[Anna Soubry]

The simple answer is absolutely yes. My hon. Friend the Member for North Thanet (Sir Roger Gale) has also raised this matter through parliamentary questions and the like. I am more than happy to have that meeting.

[Margot James (Stourbridge) (Con)]

11. What steps he is taking to improve the care of vulnerable older people.

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[Heidi Alexander (Lewisham East) (Lab)]

12. What recent progress his Department has made on negotiations with acute providers on the capital and revenue costs of implementing the recommendations of the special administrator of the South London Healthcare NHS Trust.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Decisions on funding for each individual hospital are being worked through as part of the implementation planning process, in collaboration with the Department, to ensure value for money for the taxpayer. Decisions need to ensure that capacity is available in the right place and that quality and safety are maintained.

[Heidi Alexander]

Is it true that King’s College hospital wants £109 million in capital funding alone to cover changes at the Denmark Hill site and at the Princess Royal hospital, given that in January the Secretary of State announced £73 million of additional investment for all the other hospitals in south-east London to deal with displaced patients from Lewisham? Will the Minister explain where the money is coming from? Will she also tell us whether all this will be centrally funded, or whether local commissioners will be asked to pick up the tab?

[Anna Soubry]

What I can say is that it will be centrally funded, but as to the other detail in the hon. Lady’s question, I will have to write to her with those answers. As ever, my door is open and I am more than happy to meet her to discuss it further.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

13. What plans he has to increase the management capability of doctors elected to clinical commissioning groups.

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[Keith Vaz (Leicester East) (Lab)]

T4. Will the Secretary of State join me in congratulating Abbey primary school on becoming the first “silver star” school in Leicester for banning sugary drinks and for promoting healthy eating and exercise? Does he agree that this is the best way of preventing diabetes and obesity in later life?

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Absolutely. I would be delighted to come along and visit the school. May I give full credit to the right hon. Gentleman for his campaign and to the Silver Star charity, which does great work? That is why it is so right that we put public health back in local authorities, where it should always have been and where it was, historically. This sort of local action is very much the way forward, so I congratulate the school and the right hon. Gentleman again.

[Andrew George (St Ives) (LD)]

Further to the question raised by the hon. Member for Walsall South (Valerie Vaz), I have met the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) regarding safe staffing levels and I provided a substantial file of evidence on behalf of the Florence Nightingale Foundation in support of its 1:8 registered nurse to patient ratio. What part of that evidence are Ministers unconvinced by?

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[Tessa Munt (Wells) (LD)]

The Secretary of State will be aware of the case of Nadejah, the face of the Teenage Cancer Trust, who at the age of 23 has been refused the CyberKnife cancer treatment that could save her life. Her mother Michelle is here today. Will he intervene so that this young woman gets the treatment that her consultant, Professor Hochhauser, recommends, and will he meet Nadejah’s mother and me so that we can work together to unblock the funding so that she can get the treatment she so desperately needs?

[Anna Soubry]

I am more than happy to meet the hon. Lady and the family but, as she knows, this is a treatment that we have talked about endlessly, and we have had many meetings, which I am more than happy to continue to have with her.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Since 2010, thousands of NHS staff have left the NHS with big, fat redundancy cheques, only to go through the revolving door and get new jobs in the NHS, often months later. Will the Secretary of State tell us how much has been spent on redundancy payments and whether he regrets that waste of NHS money?

Informal Health Council

Anna Soubry Excerpts

Friday 12th July 2013 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

EU Health Ministers met in Vilnius, in Lithuania, on 8 and 9 July. I represented the UK. The agenda included discussions on sustainability of health systems, mental health and well-being of older people, and of smoking prevention in youth.

The meeting began with a discussion on sustainable health systems, with emphasis placed by the presidency on the need to reduce health inequalities. There was broad agreement that innovation in technology is an important tool in making healthcare more efficient and affordable.

For the UK, I stressed that while the EU can add value to member states work on the three major life choices of smoking, obesity, and alcohol, it is important that the principle of subsidiarity is respected. I noted the important recent progress on the tobacco products directive, which crucially allows member states to go beyond the requirements of the directive where this is essential for public health.

Many member states highlighted the importance of member states collaborating to learn from each other.

There was also a discussion on the mental health and well-being of older populations, during which I stressed the equal importance of mental and physical health, and the UK work on dementia.

The second day included discussions on smoking prevention in youth, focusing on nicotine containing products and on the marketing of tobacco.

The meeting concluded with an AOB item on differential pricing of medicines in member states. A variety of different views were expressed but the UK and a number of other member states opposed the launching of any new EU initiative on the pricing of medicines as this is a matter of member state competence, while recognising the common issues faced by member states, particularly in relation to rare diseases.

Tobacco Packaging

Anna Soubry Excerpts

Friday 12th July 2013 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the Government’s response to the consultation on standardised packaging of tobacco products.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

The Government’s policy remains unchanged. The Government have today published a summary report on the consultation on the standardised packaging of tobacco products. The consultation was undertaken last year between April and August with the agreement of the devolved Administrations on a UK-wide basis. The summary report is available in the Library.

The standardised packaging of tobacco refers to measures that may be taken to restrict or end the use of logos, colours, brand images or promotional information on packaging. Any brand or product names would be displayed in a standard colour and typeface. The consultation was intended to explore views on whether standardised tobacco packaging would reduce the appeal of tobacco products to consumers, increase the effectiveness of health warnings on the packaging of tobacco products, reduce the ability of tobacco packaging to mislead consumers about the harmful effects of smoking and have a positive effect on smoking-related attitude, beliefs, intentions and behaviours, particularly among children and young people. To inform responses to the consultation and subsequent policy making, the Department commissioned a systematic review of evidence on standardised packaging. I am grateful to the academics who undertook the review at the university of Stirling, university of Nottingham and the Institute of Education. It is being published alongside the consultation document.

More than 668,000 responses to the consultation were received and the views expressed were highly polarised. Strong views were put forward on both sides of the debate and a range of organisations generated campaigns and petitions. Of those who provided detailed feedback, some 53% were in favour of standardised packaging while 43% thought the Government should do nothing about tobacco packaging. Having carefully considered those differing views, the Government have decided to wait until the emerging impact of the decision in Australia can be measured before we make a final decision.

Only one country, Australia, has adopted the policy, which it introduced on 1 December last year. New Zealand and the Republic of Ireland have announced that they intend to follow suit. We intend to wait, so we can benefit from the experience of countries such as Australia that have introduced standardised packaging. In the meantime, I want to promote wider public debate about whether we should introduce standardised packaging in this country, including in this House as well as in the media.

[Ms Abbott]

Mr Speaker, you would have to have a heart of stone not to feel sorry for the hon. Lady, who has been forced to be the face of this humiliating policy U-turn. Once again, the Government have tried to slip out an important policy statement by means of a written statement on a Friday, hoping to avoid parliamentary scrutiny. Once again, the Government have completely lost their way on public health and caved into big business. Today, the health of the nation is being sacrificed to the interests of big tobacco.

The Minister has conceded that the Government’s systematic review found that standard packaging would make smoking less attractive to young people. The Minister will have read the letter signed by 160 specialist consultants and professors calling on the Government not to enact this U-turn. The Minister might have heard the former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley), say:

“The evidence is clear that packaging helps to recruit smokers, so it makes sense…having less attractive packaging. It’s wrong that children are being attracted to smoke by glitzy designs on packets…children should be protected from the start.”

The Minister might even remember what she had to say—that she had been “personally persuaded” of the case for standardised plain packaging. The Opposition have to ask what happened. We suspect that Lynton Crosby happened.

Every single medical stakeholder, every campaigner on tobacco harm and every member of the public who is concerned about the fact that half of all lifetime smokers will die prematurely from their habit and that hundreds of children start smoking every day will be appalled at this decision. It bears no relationship to the evidence and people will die. Will the Minister tell the House whose decision it was to slip out the announcement on a sitting day by means of a written statement? Who was involved in making the decision and can she confirm that Lynton Crosby had no involvement whatsoever in today’s decision?

There can be no greater responsibility on Government than the heath of the nation. Every single Health Minister has declared their personal support for standard plain packaging and the Minister should be ashamed to have been dragged to the House today to set out this disgraceful U-turn.

[Anna Soubry]

May I apologise, Mr Speaker, for the fact that apparently I have been speaking far too quietly for perhaps the first time in my life? The hon. Lady clearly did not hear what I said, and I will repeat it. We have not made a decision. We have decided to wait, quite properly, to see the evidence as it emerges from Australia. I make it very clear that there is no change in the policy of this Government. Forgive me, Mr Speaker, but the Order Paper is quite clear—I see it before me—and states that there will be the publication in the Library today of a written statement on the matter of standardised packaging. I just heard a whole load of nonsense going up in smoke.

[Sir Peter Bottomley (Worthing West) (Con)]

When I was responsible for reducing drink-driving, I was told that we had to increase the penalties, lower the limit and increase the policing. Drink-driving deaths have come down by three quarters in the past 30 years. The reduction of smoking among men from 82% to about 20% mainly happened before we started throwing the law at everything. People smoke because they take it up as teenagers, and we say they are too young to smoke. We ought to say that only children take it up and to make it as unlikely as people picking their nose in public.

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[Anna Soubry]

I am very grateful for those comments. My hon. Friend is quite right that prevalence is now at about 20%, which is better than in many other countries. There is a very good debate to be had about whether we should take legislative action or change social attitudes. That is why I am so proud of our “Stoptober” campaign and the fact that we have had up to half a million hits on our website. Half a million quitting packs have been given out. It is a subtle combination of many factors. If only there were one silver bullet—but unfortunately there is not.

[Kate Green (Stretford and Urmston) (Lab)]

When the Minister publishes the analysis of the Australian experience, will she also publish an evidenced analysis of the number of avoidable deaths and illnesses that have resulted from the delay?

[Anna Soubry]

Well, I could say that the hon. Lady’s party, when it was in government, had 13 years to introduce such legislation. Indeed, I am more than happy to say that. If it was so simple to introduce standardised packaging, why did Labour not do it? It is not as simple as they now try to make out. Most importantly, I believe, Mr Speaker—and I do speak as a lawyer—you always want good legislation that is evidence-based. That is why I am more than content to support a delay, while we wait to see the evidence as it emerges from Australia.

[Philip Davies (Shipley) (Con)]

I congratulate the Government on this decision. The Minister will recall that the last time I raised this subject in the House, she told me that I would see the light, and I am delighted that she and the Government are the ones who have seen the light on this issue. She cherry-picked some numbers of people in favour of and against standardised packaging from the consultation. Could she tell us the figures from the full 688,000 responses? How many of those were in favour and how many against?

[Anna Soubry]

Forgive me; I do not have that information at my fingertips. I am more than happy to supply it to my hon. Friend by way of a letter, or any other mechanism.

The position I have set out is what we now need, and if there is a criticism that I would make, it is that we went to consultation first. All good legislation needs a good, healthy debate, followed by, perhaps, wider consultation. We now need to have that debate, and I am very happy to lead it.

[Chris Williamson (Derby North) (Lab)]

Does this not represent a shameful capitulation to the merchants of death who want to recruit more children to smoke, who will go to an early grave as a consequence? Can the Minister therefore confirm to the House whether or not Lynton Crosby has had any conversations at all with any Health Minister on this issue?

[Anna Soubry]

I can assure the hon. Gentleman that Mr Crosby has not had any conversation with any Health Minister on this issue. This really is a complete red herring. I can also inform him that I am very proud of the fact that we have banned cigarette vending machines, which will mean that people under the age of 18 in particular no longer have access to cigarettes by virtue of that site of sale, and I am also pleased that by 2015, we shall be ensuring that the ban on displays of cigarettes, which are currently banned in supermarkets without the provision of shutters, will be extended to smaller shops.

[Mr Mark Williams (Ceredigion) (LD)]

One hundred and fifty thousand youngsters are estimated to have taken up smoking since the end of the Government’s consultation, so the time scale is important. Can the Minister reiterate her assurance that this is not being kicked into the long grass, albeit in the outback, as we fear it may well be?

[Anna Soubry]

As I have explained, there has been no change of policy at all. What we have decided to do, based on the consultation, but most importantly based on what the Australian Government have done, is to look at that evidence as it emerges. I have spoken to the Australian high commissioner—[Hon. Members: “Oh!”] Hon. Members on the one hand claim that this is serious—

[Mr Speaker]

Order. Let us try to lower the decibel level. Questions should be heard with courtesy, which, to be fair, I think they have been, and the answers must be heard with courtesy.

[Anna Soubry]

I think this is important. I also spoke with one of the leading experts who have been involved in the legislation in Australia, and I was quite surprised that even after about three or four months, they could not give me a picture of any emerging evidence. That is why we need this time. I believe all good legislation should be based on firm, good strong evidence.

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

I am all for evidence-based policy making, not least from Australia—I declare an interest in being half Australian myself—but the Minister will be aware that my step-sister died of lung cancer at the age of 49, leaving four children. The Minister was kind enough to meet her late husband, whose children have set up the Deborah Hutton campaign to do work, particularly with young people, to prevent them from taking up smoking through innovative use of film and suchlike. What are the Government doing to prevent young people—particularly girls, whose lungs are more severely damaged by smoking—from taking up smoking?

[Anna Soubry]

I am grateful to my hon. Friend, and it was a great honour to meet members of his family. My own father died, after a lifetime as a heavy smoker, from lung cancer, so we are all well aware of the health risks. My hon. Friend makes the good point about what we are doing specifically to stop children from taking up the habit. I have explained about vending machines. Of course, there is also an EU directive; although it may not find a great deal of favour with some Members on my side of the House, it is a very good directive. Work began on it only a few weeks ago, which will mean, for example, that we will not—[Interruption.] The hon. Member for Streatham (Mr Umunna) is chuntering, Mr Speaker, and it is not always very helpful, as I know.

[Mr Speaker]

Order. So the hon. Lady knows. Was she perchance speaking as a practitioner?

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[Anna Soubry]

If I were in court, I think I would have to plead guilty to that one, Mr Speaker. In all seriousness—it is a very serious point—one of the things in the EU directive that we specifically looked at was the percentage of the package that should contain health warnings. It is now going up to 65%. There will be no flavourings. Again, this is very important in tobacco products. All this is designed for the next generation.

It is really important to add this: standardised packaging was about making cigarette smoking unattractive to young people. It is the next generation; that is the fundamental aim. That is why it is really important, even for those who use that aim to argue in favour of standardised packaging, that we find out what the evidence is in Australia, which is doing it. That is why my hon. Friend is right to say that good, evidence-based legislation is always the best.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I am proud that the Labour Government in 2006 gave a free vote on the legislation for smoke-free workplaces. That was an important step forward. Perhaps the Minister should be thinking in those terms now, because today’s decision to take no action will really disappoint the 190 health organisations, including the royal medical colleges and the World Health Organisation, that have supported the move to standardise packaging on tobacco products. Will they not now be drawing the conclusion that the Government, as my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) has said, have given in to vested interests and entirely lost their way on public health?

[Anna Soubry]

I do not give in to pressure from anybody, and neither does anybody else in my Department or indeed in my Government. We have taken a decision to wait for the emerging evidence from Australia, and that is the right thing to do.

[Jacob Rees-Mogg (North East Somerset) (Con)]

May I welcome the wise statement made by my hon. Friend today, and remind her that it is often the case that parties in opposition are all in favour of freedom, and when they get into government they are suddenly in favour of the nanny state?

[Jacob Rees-Mogg]

I did indeed; I was very fortunate. [Laughter.] It is a pity some Opposition Members did not, but never mind.

When liberties are removed, it should always be done, as my hon. Friend says, on the basis of evidence, because freedom is very precious, and the state does not have the right to interfere willy-nilly.

[Anna Soubry]

I agree that the state does not have a right to interfere willy-nilly, but of course standardised packaging does not prevent anybody from buying cigarettes or inhibit their right to smoke cigarettes if that is their choice, so with respect to my hon. Friend, this is not a nanny state argument at all. The packaging would be affected, but people would remain free, as ever, to buy cigarettes and to smoke them.

[Ian Paisley (North Antrim) (DUP)]

I, too, congratulate the Government on their courageous and brave decision to do the right thing, and I would encourage the Minister to keep on changing in this matter. She has protected 1,000 jobs directly in my constituency today as a result of this, and for that I am truly grateful. But may I also say that with clarion certainty today, we now have a statement from the Government that policy in this area will be based on evidence, not emotion. That is incredibly important, in order that we can get to sensible decisions. On that basis, turning to the tobacco directive, will the Minister now agree for her officials to meet me and industry representatives who employ people in my constituency, given that the Minister’s Department has already met with Ms Linda McAvan, the MEP and reporter, on the tobacco directive, because it is only fair that we have proper, full, evidence-based debate on this matter?

[Anna Soubry]

The hon. Gentleman knows that he and I do not agree on this matter. Of course, we have not made a decision; that is the whole point. We are waiting to see the evidence as it emerges from Australia before we make a decision. I am more than happy to meet him again, as I have done in the past, but I can tell him: I am not going to meet those whose business is to trade and to manufacture tobacco. It is bad; it is horrible stuff. It kills people. It does great damage to people’s health.

[Mr Christopher Chope (Christchurch) (Con)]

I draw attention to my entry in the Register of Members’ Financial Interests.

I congratulate my hon. Friend on her indecision. I also draw to her attention the fact that there does not seem to be any evidence that the sale and availability of illegal drugs in plain packages has reduced their attractiveness to young people.

[Anna Soubry]

I could speak for a very long time about illegal drugs and how we make them less attractive to young people. We know, for sure, that we need a subtle mixture of different measures that persuade young people not to take substances that are harmful to them. I am more than happy to have that conversation with my hon. Friend.

[Valerie Vaz (Walsall South) (Lab)]

Apart from vending machines, what public health initiatives is the Minister going to undertake immediately to stop 570 children a day taking up smoking?

[Anna Soubry]

We have a number of measures. For example, we have some of the toughest tax and duty measures in relation to tobacco. The “Stoptober” campaign was phenomenally successful last year. We have a TV campaign that is encouraging people not to smoke in cars, for example, as well as our other continuing work. With public health being devolved back to where it always should have been—to local authorities—a number of authorities, notably up in north-east England, have taken grave measures to tackle smoking by educating young people, in particular. This is all good work that will continue through Public Health England.

[Penny Mordaunt (Portsmouth North) (Con)]

I can see the merits of standardised packaging. Companies have invested heavily in equipment to produce complex packet designs in order to make counterfeiting harder. Does the Minister agree that if standardised packaging is adopted, whatever the future designs are, the packaging should still be sufficiently complex and difficult to forge? These are just the sort of issues that she and her Department must now look at in depth.

[Anna Soubry]

Absolutely. One of the problems in this debate is that unfortunately it has been called plain packaging. It is far from plain. As, in effect, the Government would be in control of what goes on to the cigarette packet, there is provision to make it as complicated as possible, with a variety of colours, watermarks, holograms and so on. Far from being a counterfeiter’s dream, it would be a counterfeiter’s nightmare.

[Ann McKechin (Glasgow North) (Lab)]

The Minister said that this is a joint consultation with the devolved authorities. Can she confirm whether Scottish Government Ministers were happy to hit the pause button for an undefined time period?

[Anna Soubry]

I have been very pleased to have a number of discussions with colleagues north of the border and in Wales. It is a pleasure, as always, to continue to work with them.

[Mr Peter Bone (Wellingborough) (Con)]

I draw the House’s attention to an interest in the register.

I congratulate the courageous Minister on making this decision. She has led from the front and done completely the right thing in having an evidence-based decision. The shadow Minister’s attack on her was completely unfounded. This Minister would never do something against her principles; if she thought it was wrong, she would resign. Is not this exactly the way Government should be: evidence-based rather than rushing through things?

[Anna Soubry]

I agree.

[Mr Kevan Jones (North Durham) (Lab)]

It is a first for this Government to determine policy by waiting to see what the Australians do. What time period will there be for the consultation? Has the Minister’s position on this issue, and that of her colleague the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), changed?

[Anna Soubry]

I have absolutely no problem whatsoever with waiting to see what happens with the introduction of the legislation in Australia. The hon. Gentleman knows that the aim of standardised packaging is to dissuade young people from taking it up.

[Mr Jones]

How long?

[Anna Soubry]

I am answering the hon. Gentleman’s first question first, after which I will move on to the next one. That is the aim of the introduction of standardised packaging. If a good experiment is up and running that will produce evidence, what could be a more sensible thing for Government to do? As to the length of time, I cannot answer that question, because we have to wait and see the evidence as it emerges. I thought that we might see some sort of change quite quickly in Australia, but we have not seen it yet; I am surprised about that. I am afraid it is a case of “How long is a piece of string?” We have to wait and see how the evidence emerges.

[Richard Burden (Birmingham, Northfield) (Lab)]

The Government’s own review found a solid case for standardised packaging, and the Minister says that she is personally persuaded of that case. The Government’s consultation finished not far short of a year ago, and now she says that their position has not changed. Does that mean that their position was always just to wait and see whether anybody else did it before making a decision? If not, what on earth was the point of the consultation and the statements she has made up until today?

[Anna Soubry]

I appreciate that the hon. Gentleman may have a problem with this, but we have had, and continue to have, an open mind. I have no difficulty with that. We had a consultation that closed in August last year. The Australians passed their legislation and it came into effect in December last year. It is absolutely right and reasonable to see the evidence as it emerges from Australia before making a final decision. That strikes me as responsible, grown-up government.

[Karl Turner (Kingston upon Hull East) (Lab)]

When did the Minister last speak to Lynton Crosby?

[Anna Soubry]

I think it would have been in 2004.

[Mark Durkan (Foyle) (SDLP)]

Like other Members, I regret that the Government have flinched on this. However, I welcome the fact that the Minister still clearly refutes the fallacy that standardised graphic packaging with markers would in any way aid smuggling or counterfeiters. Will the pause mode that the Government have now moved into still allow them to work with their Irish counterparts, perhaps moving on a synchronised basis in relation to these measures to make sure that this move happens throughout these islands?

[Anna Soubry]

I am very grateful for those comments. I know that the Republic’s Minister for Health is a firm advocate of standardised packaging. In fact, I think that if he could he would go even further and make tobacco illegal. I hope that he will not mind me saying that in public, but I believe it is his view. It is an absolute pleasure to work with him. We learn from each other. At the various European Union Health Ministers’ meetings we exchange ideas and experiences. That is why—I keep saying it, but it is absolutely right—we must wait and see the evidence as it emerges from Australia.

[Ian Paisley (North Antrim) (DUP)]

On a point of order, Mr Speaker. How can I correct what I consider to be misleading information? How can it be the case that the Government have not met representatives of the tobacco industry when I have accompanied them to meet the Government every year since I have been a Member of Parliament and the previous Member of Parliament for North Antrim has accompanied them to meet the Government for the past 30 years? Can that be corrected in some way, because I believe that it was misleading the House to assert that there would be no such meeting?

--- Later in debate ---

[Mr Speaker]

I am grateful to the hon. Gentleman for his point of order. My understanding was that the Minister was asked whether she would meet representatives of the tobacco industry and she indicated that she did not intend to do so. I do not think that she was making any wider claim about what had happened with other Ministers or on previous occasions; she was simply signalling that it was not her intention to meet them. If the Minister wants to speak, she is welcome to do so.

[Anna Soubry]

I will write to the hon. Gentleman.

[Mr Speaker]

I think the position is now clear; the Minister has kindly committed to write to the hon. Gentleman.

Prescription Charges (Long-term Conditions)

Anna Soubry Excerpts

Wednesday 10th July 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate my—I have to say—hon. Friend the Member for Colchester (Sir Bob Russell) on securing the debate, although I do not think that he made much of a friendly speech, and I have no doubt that he will not be much impressed by my response. He rightly brings the subject before the House, as is his right, and so he should. However, I think that we have to be completely realistic and honest about the situation in which we find ourselves. The simple truth is that if we extended the exemptions to all long-term conditions it would cost a considerable amount of money, and, in the words of a member of the previous Government, there is no money. I am very proud of the fact that the coalition has been able to secure the NHS budget at a time when we have had to take tough decisions and cut other budgets. We have not only maintained the NHS budget; by 2015 we will have seen a rise in the amount of money going into the NHS under the tenure of this Government. I am very proud of that.

My hon. Friend asked whether it is right and fair that all these long-term conditions do not receive free prescriptions. He then drew a contrast with people who, in his words, have “self-inflicted lifestyle choices”, referring to those who have drug addition, alcohol addiction, obesity problems and so on. I would challenge him on that. I do not take the view that it would be right in any way, shape or form to make such suggestions about people who are having their prescriptions paid for because of their income status but have those afflictions. I can assure him that addiction is not some lifestyle choice. Many people who are addicts are born addicts; it is a disease that needs treatment, and those who are unfortunate enough to suffer from it need our support. I am sure that he is not suggesting that we should take money away from those unfortunate people in order to give it to those who are, I accept, equally in need.

[Sir Bob Russell]

I regret that the Minister is drawing an inference that I did not intend in any way. I was merely making a comparison in saying that some people have been dealt unfairly with by mother nature in having to pay to stay alive, whereas others who we are told can be treated are, for whatever reason, getting free treatment.

[Anna Soubry]

I am pleased that my hon. Friend has made that point, because some people, I can assure him, would have made such an interpretation. I am pleased that we have set the record straight.

In fact, the current system does provide support for people who need it the most. In 2011, for example, about 94% of all prescription items were dispensed free of charge at the point of dispensing. It is estimated that about 60% of people in England are exempt from charges. A wide range of exemptions exist to help the most vulnerable, those requiring prescriptions the most and those most in need of support. People aged 60 and over, women who are pregnant or are in the 12-month period following childbirth, those on income support, those with pension credit, those on income-based jobseeker’s allowance, those on income-related employment and support allowance, and those in receipt of a variety of tax credits all rightly receive free prescriptions.

As we have heard, people who use prescriptions frequently can buy a prescription prepayment certificate that allows anyone to obtain all the prescriptions they need for the equivalent of £2 per week. The cost of the annual prescription prepayment certificate has been frozen at £104 for the past four years, and the cost of the three-monthly certificate has been frozen at £29.10 for two years. There are options whereby people can pay by direct debit. I concede that the system is not perfect, but it is very good.

My hon. Friend asked, properly, why we have this system in England whereas in Wales, Scotland and Northern Ireland prescriptions are free. I am sure that he knows the answer: health is a devolved matter. It is for those in the Scottish Parliament, the Welsh Assembly and the Northern Ireland Assembly to decide how they will spend their budget. The simple truth is that making prescriptions free for all in those countries has taken money away from other areas of their health budget. We have decided to spend our allocation of money in a different way, and rightly so, especially when we consider that the prepayment certificate of £104 a year is eminently fair for people who are unfortunate enough to have the long-term conditions that my hon. Friend identified and described. It is important to put forward that argument as well.

As it happens, I suffer from a long-term condition—asthma—and have the benefit of an excellent GP. I am sure that that will not win me any extra favours with my hon. Friend—although I am sure he will be grateful for my comments—but I, like most of us, have an outstanding GP who has made sure that my medication is at such a level that I do not now need a prepayment certificate, because we are managing my condition.

I am not suggesting that one should always be alert to the financial cost of issuing prescriptions, but I think it is right and fair to say that many general practitioners are aware of it. Increasingly, prescribing GPs—in other words, all GPs—are taking on the huge responsibility of bearing in mind the cost to the national health service of the prescriptions they issue their patients.

I pay tribute to the Prescription Charges Coalition, which has worked with officials in my Department to help raise awareness of the help available to patients with the cost of their prescriptions, particularly the prescription prepayment certificate. The awareness-raising work with the PCC has already had encouraging results. Purchases of certificates in the first quarter of this year were 13% higher—about 50,000 extra—than in the same period in 2012, when this work began. We continue to work with the PCC to consider how we might build further on that awareness-raising activity.

My hon. Friend asked a number of questions and I hope I will be able to answer them all. If not, the usual rules will apply and my officials will, of course, write to him. Since 1968 the only condition that has been added to the list is cancer in September 2008, as announced by the then Prime Minister. I pay tribute to the work of Sir Ian Gilmore. The Health Committee has produced a report and answers have been provided, but I think it is fair to say that this is all about cost. I accept that things have changed a lot since the late 1960s, but the simple reality is that if we extended free prescriptions to all long-term conditions it would cost an incredible amount of money, and I am afraid to say that that is money that we simply do not have.

It would be very difficult to consider particular conditions in isolation and to somehow choose one. My hon. Friend has advanced the case of cystic fibrosis and one can understand why: nobody chooses to have cystic fibrosis; it is a thoroughly unpleasant condition.

[Sir Bob Russell]

I did say that I was using cystic fibrosis as an example of various long-term conditions. All I ask is that the Minister and her officials look at the recommendations of Professor Sir Ian Gilmore, because at least that would give some encouragement to people with long-term conditions that the Government were looking at their situation seriously.

[Anna Soubry]

That is a valid point, well made, but the Government’s attitude is that it would not be right in the current situation to look at just one particular condition in isolation, because others would argue, with vigour—and rightly so—that their condition was as valid of an exemption as any other.

My hon. Friend asked why the Government have not introduced more flexible prescribing patterns and moved away from the 28-day prescribing policy. The responsibility for prescribing, including repeat prescriptions and the duration of prescriptions, rests with GPs and other doctors who have the expertise and who rightly take clinical responsibility for that particular aspect of a patient’s care. Doctors can prescribe flexibly and take decisions about prescribing patterns on the basis of a patient’s need. Ultimately the decision must be left to the doctor, but guidance has been issued by the National Prescribing Centre about prescription terms, encouraging prescribers to be receptive to the needs of patients and to use appropriate prescribing patterns.

My hon. Friend asked about the lack of relevant data on the costs and consequences of the current prescription charging system. At the moment, some £450 million is raised each year by charging people for their prescriptions, which is equivalent to about 13,500 qualified nurses or 3,500 hospital consultants per year. One can see the power of that money from prescription charging, but given the lack of relevant data, more research is needed to inform policy. It is important that we make best use of the available evidence and identify gaps in knowledge. We would, of course, welcome input from groups such as the Prescription Charges Coalition about any evidence it is aware of or studies that may have been undertaken in that area. That would help inform any research proposals that the Department of Health might consider in its assessment of research priorities. I hope that may be of interest and comfort to my hon. Friend.

As I have said, the Government report that 90% of prescription items are dispensed without charge, but up to three quarters of those of working age with long-term conditions are believed to pay for their prescriptions. Current exemptions provide valuable help for those on the lowest incomes. They must always be our priority because they simply do not have the means to pay for a large number of prescriptions.

Older people generally have the greatest need for medicine, and I am sure that my hon. Friend will have visited a pharmacy and seen, as I did in my constituency, the amount of medication that is often required for older people, which can be quite astronomical in size and complexity. Many older people have good, long, happy and healthy lives because of the abundance of medicines they receive, and that is one reason why we have an exemption for older people.

Although people with long-term conditions will continue to pay for their prescriptions, the prescription prepayment certificate ensures that they can pay at considerably reduced cost. By repeatedly freezing the price of a prescription prepayment certificate and introducing a direct debit payment option to spread the cost of a 12-month certificate, we ensure that those certificates are accessible to those who need multiple prescriptions.

I am happy to take an intervention, but I hope I have explained the Government’s current policy. It is right and proper for this issue to be raised, but at the moment the simple truth is—it gives no one any pleasure to say this—we simply do not have the money to do all that my hon. Friend urges on me.

Question put and agreed to.

HPV Vaccine

Anna Soubry Excerpts

Tuesday 2nd July 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate my hon. Friend the Member for Finchley and Golders Green (Mike Freer) on securing the debate and bringing this important subject before the House. He speaks, as ever, with considerable knowledge and makes a powerful argument. I would not expect anything other than that from my hon. Friend.

I shall not rehearse the statistics on vaccination— they were well explained by my hon. Friend—and the success that it has had in its take-up among young women. It has been a success. Seven million doses have been given so far in the United Kingdom, and we have achieved one of the highest rates of HPV vaccine coverage in the world, with 87% of the routine cohort of girls completing the three-dose course in the 2011-12 academic year. That contrasts with 35% take-up in America. The very low take-up in America explains why America has extended the vaccination to boys as well as girls; it is only 35% in girls.

As my hon. Friend explained most ably, because of the high uptake of HPV vaccine among girls, it is argued correctly that many boys are indirectly protected against HPV-associated cancers, such as anal cancer and head and neck cancers, as transmission of the virus between girls and boys should be substantially lowered. But of course, my hon. Friend is making the point that it does not protect men who have sex with men, and men who have sex with women who have not had the vaccine.

[Jim Shannon]

In my intervention on the hon. Member for Finchley and Golders Green (Mike Freer), I made the point about conducting campaigns regionally and UK-wide. Has the Minister had any discussions with the Health Minister in Northern Ireland, for instance, or the Health Minister in Scotland to ensure that we have a UK-wide strategy to address this issue?

[Anna Soubry]

I am going to repeat everything that has been said, and I agree; that is a very important point. As my hon. Friend the Member for Finchley and Golders Green argues, the vaccine does not protect men who have sex with women who have not been vaccinated, because they may have been in a country where the vaccine was not available to them. So I completely take the point, which is well made, and ask my officials to take it back to the Department.

As hon. Members know, the Department of Health is advised on all immunisation matters by the Joint Committee on Vaccination and Immunisation—an independent expert advisory committee—and our HPV vaccination policies are accordingly based on the advice of the JCVI. When the committee considered the introduction of the HPV vaccine in relation to cervical cancer, it did not recommend the vaccination of boys because with high vaccine uptake among girls, as is the case in the UK, it is judged that there would be little benefit in vaccinating boys. With the high uptake of HPV vaccine among girls, we would expect many boys to be indirectly protected against vaccine-type HPV infections and associated diseases, including anal cancer, head and neck cancers and penile cancers. However, the JCVI recognises that under the current programme, the same protection may not be provided to men who have sex with men, and of course men who have sex with women who have not had the vaccination.

[Mr Spencer]

I hope the Minister would recognise that, obviously, ideally we should be vaccinating boys who are pre-puberty, and at that stage we have no idea of their sexual orientation or whether they may fulfil their career abroad or in the UK, so we have no way to identify whether they are at risk.

[Anna Soubry]

I am going to struggle, because that is another good point. I always try to be honest when I come to the Dispatch Box and when hon. Members make good points—points that were made not only by my hon. Friend, but by the hon. Member for Airdrie and Shotts (Pamela Nash).

The point raised by the right hon. Member for Wolverhampton South East (Mr McFadden) is related to the actual vaccine, and I am more than happy to discuss that case, or any other adverse reactions of young women to the vaccine, with him. I am very sorry for his constituent, and I am more than happy to have that discussion with him and help in any way I can. He raises an important point.

As we have heard, in June 2012 the JCVI was presented with data on HPV infections and it noted that there is early evidence to suggest that the HPV immunisation programme in England is lowering the number of HPV 16 and 18 infections—the strains of HPV that are linked to these unpleasant cancers—in females in birth cohorts that have been eligible for vaccination.

I accept that the data are very limited on the prevalence of HPV infections among men who have sex with men, but we hope that research under way at University College London will provide more data and an age profile of HPV prevalence. HPVs, particularly types 16 and 18, are associated with the majority of anal cancers as well as cervical cancers, and to a lesser degree with penile, vaginal, vulval and head and neck cancers, but HPV types 16 and 18 predominate in cancers at those sites that are HPV-related. Data on the impact of HPV vaccination on infection at some of these non-cervical sites are limited.

The JCVI noted that the potential impact of HPV vaccination on non-cervical cancers would make the current HPV immunisation programme even more cost-effective, but it would remain the case that, given the expected effects of immunisation on HPV transmission and the indirect protection of boys that accrues from high coverage of HPV vaccination in girls, vaccination of boys in addition to girls was unlikely to be cost-effective. That argument, which we know is advanced, is combated by all that has been said by my hon. Friends the Members for Sherwood (Mr Spencer) and for Finchley and Golders Green, who urge us to consider the cost of treating someone who has one of these cancers.

Evidence for indirect protection would continue to be evaluated by the ongoing HPV surveillance programme at the former Health Protection Agency, now part of Public Health England, but the JCVI agreed that there may be little indirect protection of men who have sex with men from the current immunisation programme. Therefore, the impact and cost-effectiveness of vaccination strategies for men who have sex with men, with the offer of vaccination through general practice and/or at genito-urinary medicine clinics, needed to be assessed. In addition, data on the prevalence by age of HPV infections in men who have sex with men and in the settings where vaccination could be offered to them were needed to determine the potential effectiveness and cost-effectiveness of HPV vaccination of men who have sex with men. It would also be important to understand better the rates of HPV-related disease in men who have sex with men and the influence of HPV on HIV infection.

As we have heard, in August 2012, the JCVI issued a call for evidence from interested parties, including for information to inform a study on the impact and cost-effectiveness of HPV vaccination of men who have sex with men. Any new proposals for the vaccination of additional groups will require supporting evidence to show that this would be a cost-effective use of resources. The JCVI also asked the HPA, now part of PHE, to undertake that study. The study is under way and, once completed, will be considered by the JCVI, at the earliest in 2014. The Department will consider carefully the advice from JCVI, once the committee has completed its assessment.

[Pamela Nash]

May I reiterate the point the hon. Member for Strangford (Jim Shannon) made about the need to have conversations with ministerial colleagues in Scotland, Wales and Northern Ireland? As the hon. Member for Finchley and Golders Green (Mike Freer) argued powerfully, this is about homosexual men and men who have sex with men, but also about men who have sex with women who have not been vaccinated. It is important to have those conversations with the other nations.

[Anna Soubry]

I am grateful for that intervention. I was about to conclude by saying that it is only fair and right to acknowledge the powerful arguments that have been advanced by a number of hon. Members this evening. They have certainly caused me to take the view that I will not hesitate to contact the JCVI, as a matter of urgency, to raise all these important points with them. The committee is an independent expert body, and when it gives its advice to the Government, the Government are—quite rightly—bound to accept that advice.

[Mike Freer]

I am grateful to my hon. Friend for the commitment and the confirmation that the JCVI is now looking at this, but while we are waiting for 2014 and the results, can my hon. Friend confirm, if not tonight then in writing, that the Department of Health will give some guidance that sexual health clinics and GUM clinics can offer the vaccinations as an option before that becomes mandatory, should the JCVI recommend that?

--- Later in debate ---

[Anna Soubry]

I had thought that that was already the situation; but if I am wrong, I will not hesitate to agree to a quite proper, reasonable request. I think that I am wrong.

[Mike Freer]

My hon. Friend is being very generous. May I confirm that the vaccination is available only to men on private health schemes and that they have to pay for it?

[Anna Soubry]

Forgive me—it is available, but people have to pay for it. The point being made is that they should not have to pay for it. It should be available, like any other vaccination. That is a good point, and one that I am more than happy to take up.

These are all important and powerful arguments, especially when they are advanced on the basis of inequality, which should concern us all, wherever it may lie, and a good argument has been made that it is simply not fair on men who have sex with men that they should not have the same sort of protection as heterosexual men. If for no other reason, that demands that I make further inquiry.

I repeat—I am sorry to have to repeat it—the committee is an independent body, but it has such force and power that when it makes a recommendation, there is no debate or argument about it: the Government follow its recommendation. I am more than happy to take the matter forward and to make sure also, which is very important, that the committee’s recommendations and findings are made as soon as possible. At present, I am told that that will be in 2014 at the earliest, but it seems to be the sort of matter that requires everybody’s most urgent attention. I hope that is a positive note on which to finish.

Question put and agreed to.

Health Council

Anna Soubry Excerpts

Thursday 27th June 2013 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

The health part of the Employment, Social Policy, Health and Consumer Affairs (EPSCO) Council met on 21 June 2013 in Luxembourg. I represented the UK.

After considerable discussion and changes to the proposed text to address concerns of member states, including the United Kingdom, the Council agreed a general approach to the tobacco products directive. The UK secured a number of key changes to address UK policy priorities including: the ability to maintain picture warnings on all types of smoked tobacco; a more flexible approach to cross-border distance sales; adequate freedom for member states to take forward domestic public health policies in certain key areas, aiming for a higher level of health protection where this is justified. The UK supported the general approach. Four member states were not able to support the general approach.

The presidency provided progress reports on negotiations on the clinical trials regulation and the medical devices regulations.

Under any other business, the presidency provided information about the proposal for a decision on serious cross-border threats to health, the drugs action plan, the importation of active pharmaceutical products, the cross-border healthcare directive, the transparency directive and middle east respiratory syndrome coronavirus.

In the margins of the meeting I discussed the UK’s front-of-pack labelling scheme for food with Commissioner Borg and the Italian Minister, emphasising the voluntary nature of the recommendation.

Kettering General Hospital A and E

Anna Soubry Excerpts

Wednesday 26th June 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

As ever, it is a pleasure to serve under your chairmanship, Mrs Brooke. I congratulate the hon. Member for Corby (Andy Sawford) on securing the debate. He quite properly brings forward his constituents’ concerns about their hospital. I am delighted that he is working with two other Members of Parliament whose constituencies are served by the hospital.

I am especially grateful to the hon. Gentleman, if I may say so, for having contacted my office and spoken to my officials before the debate. If only all hon. Members took such a positive step, because it assists hugely. He is quite right to make the point that this is not the stuff of party politics. I fear that I may not be able to answer some questions that he quite properly asked. If that is the case, I or my officials will write to him to ensure that all the matters he raised and all the questions he asked are given proper and full answers.

I am very pleased that the hon. Gentleman will meet the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), on 16 July, with my hon. Friends the Members for Kettering (Mr Hollobone) and for Wellingborough (Mr Bone). I am sure that there is no connection, but having said that, a frog has entered my throat. I am going to stop for a minute.

[Annette Brooke (in the Chair)]

That would be wise.

[Anna Soubry]

I am sorry.

The hon. Member for Corby has raised important issues about accident and emergency services, although I will not be dealing with the national situation. As we know, there have been some issues and problems in emergency departments throughout the country, many of which have been well rehearsed in this place.

Underlying themes and problems are often common to all our accident and emergency departments. Undoubtedly, many of the problems at Kettering’s accident and emergency are exactly the same as those that have caused so much difficulty in other A and E departments in this country. I am pleased that huge progress has been made and that overall performance is improving across the country as might be expected, especially given my Department’s efforts.

The hon. Gentleman has pointed out how health services are under pressure in his constituency and having a knock-on effect at Kettering, and those pressures are being experienced across the whole system. He quite properly identified that the reasons for that are complex. Dealing with those pressures means looking at the underlying causes, which the Department has been doing by working with NHS England.

The hon. Gentleman pointed out that Kettering General Hospital NHS Foundation Trust is experiencing many of the issues that I have highlighted. I am aware that, as he told us, the trust has not met the A and E standard. It has struggled with that difficulty for some time. He will know that Monitor, as the regulator of foundation trusts, has unfortunately found that the trust is in breach of its licence in relation to its A and E performance, as well as wider financial and governance issues. That will cause concern not only to the people who use the hospital, but to its outstanding staff.

Monitor has required the trust to implement an urgent care action plan to ensure that it can return to compliance against the A and E standard. The deadline for that is 1 July, so it will not be long before the trust has to implement it. Monitor is working with local commissioners and NHS England to support the trust to meet that requirement.

I appreciate that the hon. Gentleman feels that further investment is needed to expand facilities at the trust to improve its position. It is right that, as I understand it, he has had meetings with the chair of the trust and other Members of Parliament, and that letters have been written, to request assistance in securing extra capital funding. Some £5 million to £10 million has been requested, so that the trust can redevelop and expand its A and E department.

Of course it is for NHS foundation trusts to develop and take forward their own capital investment proposals, and trusts such as Kettering can apply to the Department for a capital investment loan. We understand that the trust has allocated some of its capital budget this year to make improvements within A and E, and it has worked with commissioners to redesign what we call pathways to improve flow. Hot clinics and ambulatory pathways have been developed, which divert patients away from A and E and avoid GP admissions, which, as we know, often stack up in the Department.

On the matter of whether Kettering has ever closed its doors, I am told that its accident and emergency department has never done so, and it is important to put that on the record. I am told that there was a period in February when the hospital trust effectively advised members of the public—I think that this sounds like a sensible piece of advice—to ensure that they only went to A and E if they had had an accident or an emergency. In other words, to use the jargon, they were told to use the department appropriately, because the trust had become aware of a sudden and acute rise in people using A and E. Actually, that is a good message for all of us to take back to our constituents. The department is not called “accident and emergency” for no good reason; it is for accidents and emergencies.

When we had a debate on A and E in the main Chamber, Members from both sides told stories about people presenting at A and E when they could have gone to the pharmacy or just taken a paracetamol. The point I am making is that, often for understandable reasons, people attend A and E when they cannot get the appointment they want at the GP surgery. There is this wider issue that perhaps we do not do what we used to do in the past, which was to self-administer, take advice from our brilliant pharmacies or ring the GP surgery for advice before simply turning up at A and E.

As I have said, meetings have taken place, and, as I understand it, the trust has been working with local commissioners in the way that I have described. The hon. Gentleman mentioned the new Corby urgent care centre. I think I saw it before I was in this position—I was there for other reasons which I am sure the hon. Gentleman will understand—when it was in the process of being constructed. I am delighted that it is now open. It is called an urgent care centre. To be frank, we do not always use the best language when it comes to naming places where patients can go. In fact, the review, which is being conducted in the Department of Health, is looking at the sort of language that should be used, so that people understand where they have to go when they have a particular problem. I am delighted that the centre has opened in Corby and is providing additional urgent care services to the hon. Gentleman’s constituents, which should help to ease the unnecessary attendances at the A and E department of Kettering General.

I also want to mention the East Midlands Ambulance Service NHS Trust, because it is of concern to all of us who represent seats in the east midlands. I know that the hon. Gentleman has rightly talked about how problems with EMAS have affected services in his constituency.

[Andy Sawford]

I wanted to cover more issues in my opening remarks. The Minister is absolutely right to say that EMAS is a huge concern for all MPs across the region. I am sure that she is aware that the proposal is for the hub that would serve my constituents now to be at Kettering and for the level of service to be reduced at Corby, which is a concern for us.

[Anna Soubry]

Indeed, and it is right that the hon. Gentleman should raise that concern. I think I am right in saying that Earl Howe, who is the Minister with responsibility for the ambulance service, has agreed to meet the hon. Gentleman. If he has not agreed that, then he just has. In any event, Earl Howe will be more than happy to meet the hon. Gentleman to talk about the various issues.

The hon. Gentleman will also be aware that the NHS Trust Development Authority has intervened at the East Midlands Ambulance Service NHS Trust and is working with local commissioners to ensure that it has robust turnaround plans in place to improve its performance. The fact that the ambulance service has not been meeting the high standards that we all expect of it has been a long-standing problem in the east midlands. It is now implementing proposals to improve the way it delivers services across the east midlands through its “being the best” programme. That includes the replacement of some ambulance stations, including the one in Corby. It is creating 108 community ambulance posts, 19 ambulance stations and nine purpose-built hubs or superstations to enable ambulances to be dispatched from strategic points across the region to meet demand. I know that the “being the best” proposals have been referred to the Secretary of State by Lincolnshire county council. I do not know whether Northamptonshire will now take the same course, but it may not need to as Lincolnshire has already made the referral. As a result, the Independent Reconfiguration Panel is due to advise in the next few days, so it would not be right for me to make any further comments on that matter.

I will conclude now unless of course the hon. Gentleman wants to intervene again, which I am more than happy about because we still have four minutes.

[Andy Sawford]

I thank the Minister for giving way again and I am delighted to take up the opportunity to use up a little more of the time we have available. It is of course very welcome news that those proposals have been referred to the Independent Reconfiguration Panel. However, I must say to her that, irrespective of how those proposals proceed, I have no confidence in the trust board of the East Midlands Ambulance Service NHS Trust or in its leadership and management.

I will be interested to hear the Minister’s comments about what role, if any, the Department of Health can play in intervening when there are concerns about the management of an ambulance trust. I know that hon. Members from across the eastern region ambulance service, which also serves some of my constituency, have—frankly—successfully changed the leadership of that service. I feel that we may need to make some progress in that regard ourselves.

[Anna Soubry]

The diplomatic answer to that is to say that, yes indeed, east of England MPs have quite rightly taken their concerns to the highest level and there has been some serious intervention. There has been a report; we had a 90-minute debate here in Westminster Hall only yesterday on it. I have to say that apparently most members of the board of that ambulance service still remain in place, but the board has a new chair. There has been a full report into the service and there is hope that many of the report’s recommendations will now be put forward.

I must say that the Care Quality Commission, notwithstanding some of the comments that were made last week, can play a hugely important role in looking at the performance of ambulance trusts. I speak now as a constituency MP when I say that I myself have been in contact with the CQC and I urge the hon. Gentleman perhaps to take the same course, because the CQC can really play an important role in ensuring that ambulance services and indeed many other providers of health care are absolutely up to standard and providing the services that they should be providing. That may be of some assistance, but I must say that I think things have improved.

[Andy Sawford]

The Minister says that there are issues at Kettering General hospital’s A and E department that are in common with those in other hospitals. Finally, I draw her attention to the exceptional case for investment in Kettering General hospital, because of the growth in population locally. Corby has the highest birth rate in the country; it is the fastest growing town in the country; and the Northamptonshire area is one of the fastest growing areas in the country, so this is an exceptional case.

--- Later in debate ---

[Anna Soubry]

That is a good point well made, and no doubt this will all be discussed at the meeting to be held on 16 July and the hon. Gentleman will make that point again with all the right force that he should.

I was going to say “in all seriousness”, as if I was being flippant, which I was not being. However, I hope that Kettering General hospital continues to work with Monitor, NHS England and its local commissioners to put in place robust plans for improving its position. That should also include working with all the elected Members in the area, so that we can be sure that the hospital delivers absolutely the best services to the people it seeks to serve and should be serving.

Question put and agreed to.

Mitochondrial Disease

Anna Soubry Excerpts

Tuesday 25th June 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) not only on securing the debate but on highlighting the impact of mitochondrial disease on families, and the potential of the new techniques to prevent suffering and premature death and bring hope to the many families who seek to prevent their children from inheriting these sorts of diseases in the future. The hon. Lady does everyone a service in raising the issue. It is a controversial issue, and she has asked me some direct questions.

The Government fully recognise the sensitivity of the issues, and since researchers first approached my Department in 2010 requesting that we make regulations, we have been collecting expert opinion and public views. I will be up front, and say straight away that the chief medical officer has given the issue her careful consideration in the light of the advice and the findings of the Human Fertilisation and Embryology Authority, following the consultation period. I anticipate that she will set out the Government response before the summer recess and, even with my poor mathematics, I can work out that that should certainly be within the next few weeks.

I emphasise that the Department of Health has given careful consideration to the advice and information passed to us by the Human Fertilisation and Embryology Authority on 28 March. We have also taken account of other published reviews, such as the one in 2012 by the Nuffield Council on Bioethics in its report on “Novel techniques for the prevention of mitochondrial DNA disorders: an ethical review”.

Our considerations are being led by the chief medical officer. It is right, if we are to move forward, that she should be the person to lead on the proposals—she may reject them—and, as the CMO, to make any announcement and to be at the forefront of any decision. I am told that her considerations are almost complete.

We recognise that allowing the treatment would give an opportunity for women who carry mitochondrial disease the choice—it is important to state that if regulations are introduced, they would have a choice—to have genetically related children without the risk of serious diseases; I am grateful to the hon. Lady for giving examples of those diseases, and it is the understandable desire of many parents, especially women, not to allow them to be inherited by a child.

This issue is about giving women a choice on whether or not their DNA is put into another woman’s egg. In effect, a woman would be hijacking the batteries, because mitochondria are the batteries that provide the energy, and when they do not work, they cause these diseases. This is not about any kind of genetic engineering, about which people would rightly be concerned.

When the science and the real benefits are explained to people, and the fact that the child who is born has the same genetic background as their mother, they will see that the press have perhaps been a bit misleading in saying that, if it all goes ahead, some children will have three parents. They really will not: they will have their biological mother and father. It is simply that the batteries have been taken from another woman’s egg so that they are sure that any child does not bear some of the very serious diseases that often lead to premature death.

We recognise the concerns that have been raised about whether such techniques are a form of germline or genetic modification in human beings and about whether it would be ethical to allow them in treatment, and those considerations are important. Technically, the resultant embryo would be formed from the eggs of two women, but the genetic material that relates to the child’s characteristics would have been removed from the donor egg, so the child will have genes from the patient and her partner—in other words, from the child’s mother and father—but they will also have healthy mitochondria.

[Chi Onwurah]

I thank the Minister very much for the constructive form of her response and for the new information. Her point about the child not having the genetic material is very important. Will she emphasise that the process is nothing like changing the eye colour or height of the unborn child? An important point to get across is that there is no genetic modification in that sense.

[Anna Soubry]

I absolutely agree. I am perhaps putting the subject in simple terms, but that is how it is. This is actually about the fact that if someone is effectively carrying this particular disease, the mitochondria—the batteries that charge things—are replaced to make sure that they do not have these diseases. Because the mitochondria cannot be taken out of the mother’s egg, a donor egg has to be found. The DNA is removed from that egg and the mother’s DNA is put in—taking those good healthy mitochondria or the batteries—so that she has a healthy egg that, in due course, can be fertilised by the father in the normal way. It is absolutely right that the genetic make-up of a resultant child will be the mother’s and father’s. That does not of course guarantee that the child will have the same colour eyes as their mother, as we all know, especially me as a blue-eyed mother with two brown-eyed daughters. As ever, Mr Davies, I digress, but this is a serious matter.

I pay great tribute to researchers at the International Centre for Life in Newcastle. The hon. Lady should not hesitate to do so, whether her father was there or not, because it is a fine institution. They have been developing their groundbreaking expertise for many years. In anticipation of significant advances in this field, the Human Fertilisation and Embryology Act 1990 was amended in 2008 to introduce a regulation-making power that, if implemented, would enable mitochondria replacement to take place in treatment.

The powers are therefore there, but it is important to say that they would not be implemented in some secondary way. I understand that the matter would have to come to this place and that, in any event, there would be a debate. That is my understanding, but if I am wrong I will correct that, as you would expect, Mr Davies.

In 2010, Newcastle researchers approached the Department of Health and, in the light of their progress, requested that we consider introducing regulations to allow mitochondria replacement in treatment. In response, the Department asked the Human Fertilisation and Embryology Authority to get independent advice about the safety and efficacy of the techniques.

An expert advisory group was established, and a report was passed to the Department in spring 2011. It found that the techniques were not unsafe, but it recommended that further research be undertaken. After careful consideration of that report, the Department of Health and the Department for Business, Innovation and Skills commissioned the HFEA in autumn 2011 to undertake a comprehensive set of public consultations to identify the public’s views about and understanding of this complex and sensitive issue. That consultation was held between July and December last year. It looked at the social and ethical issues raised by mitochondria replacement, as well as addressing a range of practical regulatory issues.

In collaboration with Sciencewise, which has a key role in helping the public to understand complex scientific issues, the HFEA took many different approaches to ensure that it gathered public views on the issue. It held workshops with members of the public, tracking their views over time and in response to new information. It ran what is called a representative survey, an online public consultation, two public meetings through which interested groups and individuals could express their views, and a focus group with families who are personally affected by mitochondrial disease, because their views are extremely important.

The HFEA report was published on 28 March and was passed to the Department. It provided us with three separate strands of advice: the outcome of its public dialogue and consultation; a scientific update on the safety and efficacy of the new techniques; and the issues to consider in introducing an appropriate regulatory framework. The public consultation indicated, overall, that there is general support for allowing the treatment techniques to be used, as long as they are safe and carefully regulated.

We appreciate and recognise, however, that a range of views, not all of which were in favour of a change in regulation, was strongly expressed through the consultation. A significant response came from the religious community, which was not in favour of allowing the techniques, whereas the scientific community, bioethics groups and patient and family groups were in favour.

The expert panel, which was reconvened by the HFEA, concluded that although there continues to be nothing to indicate that the techniques are unsafe, further research on some specific aspects should be undertaken. All the recommended research is currently being undertaken either in Newcastle or Oregon in the United States. The expert panel expressed the view that insufficient research is currently available to recommend one particular technique above another. It also recommended long-term follow-up monitoring of any children born as a result of the techniques.

I conclude where I began by saying that we anticipate that the CMO will announce the Government’s response very soon—before we break for the recess—which is at least some good news. As the hon. Lady said, the issue has been ongoing for several years, so it is important to find out whether it will reach the sort of conclusion that she wants, and we anticipate that that will be very soon.

Cross-border Health Care (England and Wales)

Anna Soubry Excerpts

Tuesday 25th June 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) on securing this debate. He has raised a number of important topics—notably, the difficulties of people resident in England who are registered with a local GP whose service is deemed to be in Wales, even though the surgery may be in England. I am fully aware of my hon. Friend’s keen interest in local health matters affecting his constituents and his tireless work to support Hereford hospital. The whole House will agree that we would all expect good quality patient care, regardless of which part of the country we live in.

As my hon. Friend knows, I am very sympathetic to the concerns he has raised about English residents who are unable to access English hospital care because they are technically registered with a Welsh GP practice—even when, as I said, for a small number of patients, that GP surgery is physically situated in England.

I am told by my officials that the NHS services that any patient can access, and their NHS rights, are determined by their GP’s country of registration. As we have heard, that is formulated through protocol between NHS England and the Welsh Assembly; it means that, legally, a person has to be registered with an English GP practice to access English NHS services.

I am very concerned that despite an English border patient’s right to register with a GP practice on either side of the border, that is not always possible in practice. I recognise that, in rural communities, patients often do not feel a choice is available, given that the most accessible practice is a Welsh one. I also recognise that many people are registered with a local GP in England but the main practice is over the border in Wales. Those people may not want to change their GP practice. Why indeed should they? We could understand why they might, because in Wales people unfortunately do not get some of the excellent access to services that we enjoy in England. I am very concerned about this. I am told by NHS England that it has asked its legal advisers to review their earlier advice on the protocol signed between it and the Welsh Government with reference to the specific concerns that Ministers—that is, me—and the Welsh Secretary have raised.

[Lady Hermon (North Down) (Ind)]

It is very kind of the Minister to take an intervention at this stage. Will she kindly confirm that when she invites her officials to look at this issue they will take up the suggestion made by the hon. Member for Strangford (Jim Shannon) and look at the valuable lessons that have been learned in Northern Ireland about the useful co-operation across a land frontier with the Republic of Ireland and a key, integral part of the United Kingdom—Northern Ireland?

[Anna Soubry]

I am grateful for that intervention and for the wise words of the hon. Member for Strangford (Jim Shannon), who, as ever, brings a great depth of experience to these matters. Yes, we will certainly take that on board.

All this came about because of a meeting between me and my officials, the Welsh Secretary and my hon. Friend the Member for Forest of Dean (Mr Harper). As a result of that meeting, I have asked NHS England to work locally with GP practices in the border counties to review their practice boundaries with the aim of providing additional choice of GPs to those who do not currently have it. I am keen that all English patients are able to access an English GP if they wish or that they can register with a Welsh GP if that is their choice and they are aware of the impact of that decision. I have also asked NHS England to review the protocol as it currently stands.

I have asked the Welsh Government to review their policy on out-of-area treatments to consider an exception for English residents—specifically, that GPs operating from branch surgeries in England should be exempt from the requirement to seek prior approval for English resident patients to be referred to hospitals in England. These are all matters of concern not only to constituents of my hon. Friend the Member for Hereford and South Herefordshire but to others. We have heard about that from my hon. Friend the Member for City of Chester (Stephen Mosley) and my hon. Friend the Member for North Herefordshire (Bill Wiggin), and of course I know of the concerns of my hon. Friend the Member for Forest of Dean.

I am informed that since the meeting with the Welsh Secretary and my hon. Friend the Member for Forest of Dean, NHS England has had several further meetings with colleagues in the Welsh Government and local health boards based in Wales to discuss these concerns so that they can be addressed. There have been constructive discussions with Aneurin Bevan local health board, which has confirmed that it will undertake a review of the application of its policy on out-of-area treatment. I understand from NHS England that work will continue on this review over the next few months, and I will of course keep everybody fully informed and up to date on any progress.

[Bill Wiggin]

Will my hon. Friend give way?

[Anna Soubry]

Of course, but quickly.

[Bill Wiggin]

I am most grateful to my hon. Friend. I am really heartened by the positive things she has said, and I congratulate her on the work she has done. Will she also look at the impact of cross-border patient numbers on hospitals, which also badly affects us in Herefordshire?

[Anna Soubry]

Indeed. I will come to the effect on Hereford hospital, but I am more than happy to write to my hon. Friend about his specific point. The usual rules apply: if there are questions that I have not answered I will of course write to any hon. Member.

We have asked the Welsh Government to request that other local health boards along the border in Wales should similarly review the application of their own policies for out-of-area treatment affecting patients in the same circumstances. In many of those areas patient numbers are much smaller, but that does not matter; these are important issues for these individuals.

In the light of the further legal advice that NHS England is seeking, I am advised that it will review the protocol with the Welsh Government in view of my concerns and those of other hon. Members, the updated legal advice, the outcome of the local health boards’ reviews of the application of their policies on out-of-area treatment, and feedback that we have received from local NHS bodies on the operation of the protocol. The review will be undertaken in the autumn following completion of the reviews by the local health boards.

My hon. Friend the Member for Hereford and South Herefordshire is concerned that the policy of the Welsh Government that those who are registered with a Welsh GP must use Welsh NHS services will have a direct impact on the viability of Hereford hospital. I share his concern, but I understand that a number of other factors affect the viability of the hospital and the Wye Valley NHS Trust.

I was a bit concerned when I read the next part of my brief, because it has been worded in an interesting way by my very able officials. It states that those factors include

“the drop in the numbers of young people locally leading to a lack of activity in maternity services”.

I am not sure what “lack of activity” young people have been guilty of. I think that what is meant is that there are not as many young people in the area, because there is undoubtedly a higher proportion of retired elderly people in the population. It is obvious that if there are fewer young people, people are less likely to be having babies and are therefore less likely to use maternity services. I am sure that activity remains at a high level.

As my hon. Friend is aware, Wye Valley NHS Trust published a strategic outline case in March this year, setting out the options for its future form to create a clinically sustainable model for local people. I have been advised by the NHS Trust Development Authority that it has been working with the trust to develop a full business case, which it expects to receive for consideration by the end of this month. Again, I make it very clear that I am more than happy to revisit this issue with my hon. Friend and others following the outcome of that process.

[Jesse Norman]

Wye Valley NHS Trust has informed me that the policy has cost it between £1 million and £2 million so far. Given that it is running a deficit of £8 million to £10 million, that is a significant sum. The work that is being done pre-supposes the current funding formula. In a way, it therefore pre-supposes the point at question, which is whether the formula is fair. As I have submitted, it clearly is not.

[Anna Soubry]

I do not doubt for one moment the veracity of what my hon. Friend has told me about what he, in turn, has been told. That is a substantial amount of money and it would go a long way to explaining part of the deficit. These are terribly important matters.

The funding formula has been raised yet again. The argument advanced by many Members on both sides of the House is that the formula does not take account of the relatively high cost of delivering services in rural areas or reflect the fact that many rural areas such as Herefordshire have relatively older populations. I have had a number of conversations with hon. Members who make exactly the same complaint as my hon. Friend.

I am reliably informed—this point is important—that allocations to individual clinical commissioning groups, which are made up of the GPs and other clinicians who now commission services locally, and the formula that is used to decide what those allocations should be, are the responsibility of NHS England. I am not seeking to pass the buck, but it does bear that responsibility. In making those allocations, NHS England relies on advice from the Advisory Committee on Resource Allocation. ACRA provides advice on the share of available resources provided to each CCG to support equal access for equal need, as specified in the mandate given by the Secretary of State to NHS England.

Therefore, NHS England does not set income for CCGs on an equal cost-per-head basis across the country. Instead, allocations follow an assessment of the expected need for health services in an area, and funds are distributed in line with that, meaning that areas with a high health need should receive more money per head. The calculation is based on the age of the populations, relative morbidity and unavoidable variation in cost. The objective is to ensure a consistent supply of health services across the country. The greater the health need, the more money is received because the more health services are needed.

I know that some hon. Members just do not accept that that is the reality with the allocations to their CCGs and, in effect, to their constituencies. NHS England plans to review the funding formula for 2014-15 and the following years better to reflect the needs of local communities and enable the best outcomes for local people. Perhaps there is hope in that. Obviously, I must say quickly that I cannot make any promises.

If anybody would like to intervene, we do have the time. Hon. Members often want to make a point, but do not feel that they can make a speech.

[Roger Williams (Brecon and Radnorshire) (LD)]

I thank the Minister for her kindness and I am sorry that I was not here at the start of the contribution from the hon. Member for Hereford and South Herefordshire (Jesse Norman). Hereford hospital is key in delivering medical services to people in my constituency in Wales. If it had not been for the co-operation of my predecessor, Richard Livsey, the rebuilding of Hereford hospital might not have taken place, because it needs patients from the east of Wales too.

[Anna Soubry]

I am grateful to my hon. Friend for that intervention. My officials will listen to the debate and read it in Hansard. All the points that have been made about Hereford hospital—equally important points could be raised by others about the effect on other hospitals—must be considered, because they are important. It would not be right or fair if hospitals felt that they were suffering as a result of a system that is basically not fair through no fault of their own.

[Jesse Norman]

We have a little time, so I am very grateful to the Minister for giving way again. Will she ask her officials to look more closely at the functioning of ACRA? The formula under which we are labouring was set up in 2002. There is a clear case to be made that, contrary to its desire, it is not delivering funding to the areas of greatest need, but to areas defined by a deprivation formula. The truth is that morbidity and age go together, not deprivation and morbidity.

[Anna Soubry]

I might not share my hon. Friend’s final remarks, but we know that NHS England, which is in charge of distributing funds to CCGs, is considering the formula. It will no doubt bear in mind the argument made by him and others who believe that ACRA’s formulation is not delivering in the fair way that we all agree was intended.

In conclusion, I am pleased that NHS England has responded to my concerns, and the concerns of my hon. Friend the Member for Hereford and South Herefordshire and others, most notably my hon. Friend the Member for Forest of Dean, with whom I had a long meeting. As a result, NHS England is doing what we had hoped it would. I am encouraged by the dialogue that has been taking place between NHS England, the Welsh Government and local health boards in Wales, and I hope to see further rapid progress. We must not let anybody drag their heels. I look forward to being able to update my hon. Friend the Member for Hereford and South Herefordshire, and others who represent border communities, in the autumn. I undertake to do that once NHS England has finished its review. I once again congratulate my hon. Friend on securing the debate on this important issue. While it might not affect a huge number of people, it is a very important issue for them and they feel that there is an injustice. It behoves all of us to ensure that we eradicate any injustice.

Question put and agreed to.

East of England Ambulance Service

Anna Soubry Excerpts

Tuesday 25th June 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I begin by paying tribute to my hon. Friend the Member for Witham (Priti Patel) for bringing this matter, quite properly, to Westminster Hall this morning, for giving an excellent speech, and for her outstanding campaign on behalf of her constituents. In simple terms, she seeks to hold the ambulance trust, which clearly has performance figures that are simply unacceptable—they are the lowest in the country—to account. There is a clear feeling of anger—that is no criticism at all; it is based on frustration. I know that my hon. Friend the Member for Suffolk Coastal (Dr Coffey) has joined her in this admirable work, and despite raising the issue and notwithstanding all their efforts, they are frustrated and angry because they feel that it has taken many months for the trust to even begin to make some sort of attempt to address the inherent problems that it clearly faces.

Another thing that clearly emerges from the many interventions and excellent speeches by hon. Members this morning is that there is wholesale support, and many tributes, for the staff—the front-line workers. Nobody is for one moment saying that there is any failing on their part. The failing is clear: it is failing at a leadership level and at board level. There is a failing of leadership, which must be addressed as a matter of some urgency.

I only have about 12 minutes to address the many points that have been made, so the usual rules apply: anybody who has asked a question that I am not able to answer in my short speech will, of course, get a written answer. I just want to deal quickly with the important point made by my hon. Friend the Member for North West Norfolk (Mr Bellingham), who asked whether the usual rules that apply to non-executives on public limited companies, or on companies that are listed on the stock exchange and so on, apply to non-executives who are appointed to NHS trusts. I must tell him that the rules are not the same; their responsibilities and duties are different. I will provide more detail in a letter to my hon. Friend, but it is not as simple as it is when people are non-executive directors on other bodies, where it could be said there is much more accountability and much more of a duty on them to resign when there have been the sorts of failings that we have heard about today—if that was applied to a business, for example.

[Robert Halfon]

Will the Minister give way?

[Anna Soubry]

May I just make one other point? Then I shall be more than happy to give way, although the clock is against me, as my hon. Friend will appreciate.

Here we have another issue that should concern, as I know it does, all hon. Members, on both sides of the House. It is the culture that is now becoming clear. I take the view that it is not a new culture. I suspect that it has been there for many years. It is just that it is now being exposed, often through the admirable work of Members of Parliament and because of the work of my right hon. Friend the Secretary of State for Health. That is a mates culture, where people’s priority is to protect their mates, systems and procedures, as opposed to what should be the absolute priority for somebody in the NHS, which is to protect the patient—not their friends and the structures, but the patient—and also, of course, the hard-earned money of the taxpayer.

[Robert Halfon]

My hon. Friend will have heard me set out the treatment of Harlow residents. Does she agree with me and with our hon. Friend the Member for South Norfolk (Mr Bacon) that the East of England ambulance trust is too big and should be broken up, and that we should restore the Essex ambulance service trust?

[Anna Soubry]

That is a good point, but it is not for me to say whether it has any merit that should be taken forward. But clearly it is an important point, which must now be considered.

May I quickly pay tribute to all the very helpful interventions from hon. Friends? My hon. Friend the Member for Broadland (Mr Simpson) talked about the buck passing in the NHS and the recycling. We also heard from my hon. Friends the Members for Maldon (Mr Whittingdale) and for Huntingdon (Mr Djanogly). My hon. Friend the Member for Waveney (Peter Aldous) made an excellent speech. My hon. Friend the Member for Suffolk Coastal also made an excellent and important speech. There were interventions from my hon. Friends the Members for Clacton (Mr Carswell) and for Cambridge (Dr Huppert) and from my right hon. Friend the Member for Saffron Walden (Sir Alan Haselhurst). There were speeches by my hon. Friends the Members for Harlow, for North West Norfolk and for South Norfolk (Mr Bacon). They all made important and good points.

We know that overall in England in 2012-13 the number of emergency calls to ambulance services was 9.08 million—a 6.9% increase. That is an important figure, I would suggest. We know that overall, in England, the performance figures are stable. That does not really assist in this debate, of course, because we also know that the East of England ambulance trust and, I have to say, my own, the East Midlands ambulance trust, have serious failings and the performance figures are simply not good enough.

The best that I can say of the performance of the East of England ambulance trust is that it has not been good. It is clearly recognised as the lowest-performing ambulance trust in England. As with the national picture, its overall poor performance figures hide huge discrepancies between the services and response times in the urban and rural areas that it covers. There are too many stories—we have heard many today—of patients in distress having to wait hours for ambulances, or solo paramedics being sent when an ambulance is needed. Solo paramedics cannot transport patients and might not, for instance, be able to lift or move a patient unaided. It is simply not good enough.

It is clear to me that some hon. Members and many patients might be forgiven for thinking that the trust seems to have forgotten that it is there to serve all patients and not only tick the performance boxes as far as it can. Concentrating resources in towns and effectively abandoning people in the countryside is simply unacceptable.

[Mr Bacon]

Will the Minister give way?

[Anna Soubry]

May I make some progress? Then I will take an intervention. The latest figures, as we have heard, show that the East of England ambulance trust failed to deliver two of the three response time standards. The exception was the performance against Category A Red 1—immediately life threatening—calls, where the 75% standard was achieved, with 75.8% of calls responded to within eight minutes.

[Mr Bacon]

The phenomenon of people forgetting what they are there for, which my hon. Friend alluded to, is of course what would happen in a mates culture. I have had the feeling for a long time that there has been the growth of what we might call a self-serving nomenclatura that looks after its own interests first. Then I heard my hon. Friend the Member for Bristol North West (Charlotte Leslie) on the radio the other day referring to a mafia within the top of the NHS, looking out for their own interests. What I want to know is, as this is a recognised phenomenon—I do not think we are going mad—what is the Department going to do about it?

[Anna Soubry]

In short, what I will say is that the Secretary of State has made it clear that it is a culture that he will not accept, and that no member of his ministerial team will accept. He is now becoming undoubtedly the champion of the patient. We are seeing that. We saw it last week with the CQC and then of course we saw the change: the names of people who had been put forward in the report were made public and people are now being held to account. We are beginning to see at least a tackling of this culture; we now need to see some results.

[Mr Keith Simpson]

My hon. Friend has alluded, as have other hon. Friends, to leadership. Is the NHS thinking of positively recruiting from senior retired people from the armed forces, who display leadership and the ability to get people to work together? A brigadier had to sort out BSE over 10 years ago, because nobody in the Department for Environment, Food and Rural Affairs could.

[Anna Soubry]

That is an excellent point, extremely well made. I shall certainly take it away and speak to the Secretary of State, because this really is important, but to be fair to the NHS, it does have its own leadership academy, where it seeks to bring on people. That is within the NHS. But I think that we should involve far more people from other fields, who could come into the NHS—people with huge skill sets, who have proved those in other walks of life. I am thinking of, for example, retired judges, who would have an invaluable role to play—people who have shown real leadership and not been afraid to make tough decisions in the right circumstances. All these people should now be being looked at actively to play a role.

[Priti Patel]

Will the Minister give way?

[Anna Soubry]

I will take one quick intervention with four minutes to go.

[Priti Patel]

I thank my hon. Friend for giving way; she has been very generous. There is a specific issue not just about leadership but about accountability with this trust. Is the Minister able to tell us what is preventing the current non-exec directors from resigning their posts immediately?

[Anna Soubry]

I know of no reason why they should not. Of course, it is a matter for their own consciences. I am not one who normally shies away from giving an opinion, as my hon. Friend, I hope, would agree, but I think that in this instance it is very important that Ministers do not give an opinion and do not get involved. I think that would be quite improper. It is for those people, or anybody who has come under criticism, to examine their own role and their own conscience and act accordingly.

We might well ask why some ambulance services with comparable funding to the East of England trust—this is not about funding, cuts or money; it is about leadership and poor management—and the same mix of urban and rural areas can provide a good level of service and others cannot. I believe that the ambulance staff will generally be the same in their dedication to caring for patients, so as I said, it is all about effective—or in this case, ineffective—management.

The trust has recently had the benefit of an excellent governance review prepared by Dr Anthony Marsh. I pay public tribute to him and thank him for that. I have referred to it already, as have other hon. Members. It is a clear and professional account, and I will arrange for a copy of it to be placed in the Library. Dr Marsh is, as we know, the chief executive of the West Midlands ambulance service and he chairs the Association of Ambulance Chief Executives, so he knows what he is talking about. His report, as we have heard, reveals how poorly the trust has been managed and how the valiant efforts of front-line staff have been undermined. My hon. Friend the Member for Harlow described them as “lions led by donkeys”.

Results from the 2012 staff survey for the trust underline that. Only one key finding improved; nine key findings became worse. The East of England ambulance service trust had by far the worst staff survey results of all ambulance trusts in England, with 13 of the lowest scores. Its sickness levels—I think this is a very important statistic; it says it all—are nearly twice the average of those in other trusts. However, I am pleased to say that Dr Marsh will be working closely with the trust over the coming months to ensure that the necessary action is taken, and taken quickly.

The NHS Trust Development Authority—it is called the TDA—provides the line of accountability from local NHS trusts to the Secretary of State for the performance of the organisation. Steps have already been taken to address poor performance. As we know, a new interim chair, Dr Geoff Harris, has been appointed; he took up his post at the end of May. His first task is to review the trust board and ensure that the right people are on it. He needs, if I may say so, to be quick and decisive. To make the necessary changes, the board needs to be fully capable of radically improving its performance. I am fully aware that many hon. Members hold strong views about the role that board members play, and I have made my comments accordingly. The duty of the trust board is to add value to the organisation, enabling it to deliver health care and health improvement within the law and without causing harm. It should do that by providing a framework of good governance.

Earl Howe, as we have heard, is the Minister responsible. He has taken a close interest in the matter and visited the trust at the end of May. He has met hon. Members. He is committed to convening a second meeting towards the end of this year, when we all expect to see real evidence of changes for the better. We will of course continue to monitor the situation closely.