Health Care (Sutton)

Anna Soubry Excerpts

Thursday 28th February 2013 Commons Chamber

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

I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for his long service and the great work he did as a Department of Health Minister and for securing this debate. He has made a number of very good and important points—although I do not agree with everything he said—and I assure him that my officials will read his speech, and if I fail to respond to any of his points now, we will write to him. He has asked a number of questions, and I may not be able to answer all of them—and strongly suspect I will not be able to give the sort of answers he would like.

My right hon. Friend is standing up for his constituents’ health services, which is absolutely right. It is right that Members come to the House and speak up on behalf of their constituents. On hospitals and health care services, at the end of the day we all want the same thing: the very best services for our constituents. Everyone is entitled to the very best health services.

As my right hon. Friend will know, it is not my role to defend or to rubbish the “Better Services, Better Value” process. He has made some very good points, but I have no doubt that it was set up for the very best of reasons. There are no proposals at this stage, but there is a huge consultation stage. I am told the underlying reason for setting up the BSBV was to ensure that everyone in south-west London and Surrey Downs has the very best health services seven days a week, 24 hours a day.

A number of hon. Members who represent the area covered by the review have rightly made representations. Some, like my right hon. Friend, have spoken in this House. He has also been to see me, as have others, including my right hon. Friend the Deputy Leader of the House, and the Under-Secretary of State for Transport, my hon. Friend the Member for Wimbledon (Stephen Hammond), is coming to see me next week. My hon. Friend the Member for Croydon Central (Gavin Barwell) and the hon. Member for Mitcham and Morden (Siobhain McDonagh) spoke in the most recent debate on the future of A and E services, which was held only a few weeks ago. I shall refer to some of those speeches.

The area affected by the reconfiguration covers south-west London and the Surrey Downs. South-west London has a population of 1.4 million, the Surrey Downs have a population of 280,000 and between them they enjoy a health service that is funded to the tune of £2.8 billion a year. As my right hon. Friend the Member for Sutton and Cheam has made clear, although much of this is about saving money and meeting the Nicholson challenge —a scheme introduced under the previous Government and supported at the time by both Opposition parties, and one that continues because we recognise that those savings must be carried through—this is not about cuts. If anybody makes that case, as I have said before, they do no service to anybody or to the debate. This is not about brutal cuts but about trying to deliver the best service for people throughout the whole area seven days a week, 24 hours a day.

My right hon. Friend the Prime Minister, when he presented the Francis report to this place and answered various questions on it, gave an answer that we should all remember. I have used it before, but let me repeat it now. He said:

“Let me refer again…to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront”—

which is something on which we all agree—

“we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included”—

and it includes me, too—

“reach for the button that says ‘Oppose the local change”’.—[Official Report, 6 February 2013; Vol. 558, c. 288.]

I agree with those words. We are all beholden, whatever part we play in reconfiguring and reorganising health services, to ensure that we do not have an immediate knee-jerk reaction to oppose change. I am not saying that my right hon. Friend the Member for Sutton and Cheam has done that, but others have. Change is the right vehicle and the right driver to ensure that the people of this country get the best services.

To explain how difficult it is to make a reconfiguration, let me refer to the speech made by the hon. Member for Mitcham and Morden in the recent debate on A and E services. She said:

“My local NHS says it needs to reconfigure services because it has to deliver £370 million of savings each year—a reduction of around 24%, or how much it costs each year to keep St Helier hospital going. A programme has been set up, laughingly called “Better Services, Better Value”, to decide which of four local hospitals—St Helier, St George’s, Kingston or Croydon—should lose its A and E department. That is despite the fact that, across south-west London, the number of people going to A and E is going up by 20%, and that the birth rate in our part of London continues to rise.”—[Official Report, 7 February 2013; Vol. 558, c. 515.]

That is another hon. Member who would join my right hon. Friend in opposing any changes, cuts, closures and so on at St Helier.

[Paul Burstow]

The Minister is responding fully to the points I have made so far, but let me demonstrate the distinction between my point and that made by the hon. Member for Mitcham and Morden (Siobhain McDonagh). She has conflated the BSBV programme, which is a reconfiguration, with the Nicholson challenge. The Nicholson challenge is being taken forward separately in south London and BSBV does not deliver on it.

[Anna Soubry]

I am grateful to my right hon. Friend because I was going to agree with him that the hon. Lady’s analysis was not correct. The point that I am trying to make is that she seeks to defend her hospital, as my right hon. Friend does. She does not want changes that in any way undermine her hospital, and she makes that case with some passion. It is interesting that my hon. Friend the Member for Croydon Central, who also took part in that debate, made a speech that completely contradicted what the hon. Lady had said.

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Motion made, and Question proposed, That this House do now adjourn.—(Anne Milton.)

[Anna Soubry]

That is a peculiar, old-fashioned procedure, but none the less valuable and enjoyable, Mr Deputy Speaker.

My hon. Friend the Member for Croydon Central argued in the same debate in favour of the BSBV review on the basis that, according to one of the many reports that form part of the review, Croydon Health Services NHS Trust—in other words, his hospital—should have 16 whole-time equivalent consultants, but it has 4.9; St Helier should have 12 but has 4.5; Kingston hospital NHS trust should have 16 but has 10; and St George’s should have at least 16 but has 21. That suggests that departments across south-west London, with the exception of the one at St George’s, do not have anything like the recommended level of consultant cover. He went on, as we might imagine because he, too, wants the very best for his hospital and his constituents, to make the case that BSBV would deliver exactly what he wants for his constituency.

[Paul Burstow]

The hon. Member for Croydon Central (Gavin Barwell) made some important points in that debate, but he did not go on to make the key point that when we look at the figures for BSBV, we see that the cost of delivering the improvement that he and I both want is between £4 million and £7 million, yet under BSBV £350 million would be spent to do that.

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[Anna Soubry]

All I can say is, a good point well made, and move on towards my concluding remarks.

My right hon. Friend has asked me a number of questions. If I do not reply in full, I assure him that I will in a letter. I am told that a “do minimum” option should exist. I know that he knows this, because he was a Minister in the Department of Health, but I want to remind everyone that, for this scheme or any reconfiguration scheme to go forward to full public consultation, it has to pass four tests that were clearly laid down by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) when he was Secretary of State for Health. The four tests are support from GP commissioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice.

In conclusion, I shall deal with my right hon. Friend’s three final questions. I am told that a “do minimum” option should exist. In relation to whether CCGs are free to withdraw from the process, I think it is important that I read out what I am told; I do not want ever to be accused of not saying things I have been advised on. I am told that local CCGs are already a key to BSBV. However, and perhaps more important, after 1 April CCGs will be in the driving seat and by definition BSBV would be unable to continue without their support. That would seem extremely obvious.

[Paul Burstow]

That is very helpful. Given that CCGs will be in the driving seat from 1 April, does that mean they can hit the ejector button and get BSBV out?

[Anna Soubry]

I do not know the answer to that, and of course I would not put it in those terms, but I shall make further inquiries and certainly write to my right hon. Friend so that he has a proper and full answer to that very important question, which I have no doubt many other right hon. and hon. Members would like to ask in relation to other reconfigurations, notably in the south of England.

My right hon. Friend’s other question, in effect, was: would someone at the Department of Health look at BSBV? As he knows, from 1 April the NHS Commissioning Board will have responsibility for determining whether the four tests have been met, prior to a public consultation on BSBV. The Secretary of State only becomes involved quite some way down the line. I will not—I nearly said I was going to bore you, Mr Deputy Speaker; I would not dream of doing such a thing. However, the intervention of the Secretary of State can only occur much later down the line, when the matter has been referred to him by the overview and scrutiny committee of any local authority, by way of an independent reconfiguration panel, and so on.

As I said, my right hon. Friend has raised some important points. If they have not been addressed by me, they will be by way of a letter. I congratulate him again on having secured the debate.

Question put and agreed to.

Oral Answers to Questions

Anna Soubry Excerpts

Tuesday 26th February 2013 Commons Chamber

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

The Department has continued to work with all its partners to ensure that there is a swift and effective transition of public health responsibilities to where they should be—back with local authorities. We have made available £15 million to ensure that the transition is successful and complies with all the requirements that we have laid down.

[Rehman Chishti]

I thank the Minister for that answer. I invited the Silver Star charity to my constituency on Friday, where it offered free diabetes tests to all residents. Will local authorities be encouraged to work with such charities to improve public health?

[Anna Soubry]

The Silver Star bus is making many journeys because as well as going to my hon. Friend’s constituency, it is coming to mine on Saturday. It is an outstanding charity that provides diagnosis at a local level. I pay tribute in particular to the right hon. Member for Leicester East (Keith Vaz) because the charity goes to communities that are often hard to reach, such as the Asian community, where we need to do good work to reduce the level of diabetes, both type 1 and type 2. I look forward to local authorities working with outstanding charities such as Silver Star.

[John Healey (Wentworth and Dearne) (Lab)]

Why is the public health grant for next year £58 per person in Barnsley and £53 per person in Rotherham, but £130 per person in Westminster and in Kensington and Chelsea, especially given that deprivation is less and life expectancy at least seven years longer in those wealthy, Tory London boroughs?

[Anna Soubry]

I do not accept that for one moment. I am exceptionally proud of this Government’s commitment to public health which, in the difficult times that we have inherited, has ensured that local authorities are in some cases receiving an increase of some 10% in spending on public health. That is a record that I am proud of and that the Labour Government could not have matched.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

My hon. Friend will be aware that the local authorities and the Food Standards Agency have a public health responsibility to ensure that food entering schools and hospitals is appropriately labelled and is safe and healthy to eat. Does she have absolute confidence in the procedures that have been followed in that regard or might she be prepared to review them?

[Anna Soubry]

I am grateful for that question. I pay tribute to all my hon. Friend’s work on this matter, especially as Chair of the Environment, Food and Rural Affairs Committee. This has been a difficult time for all concerned. We need to ensure that all food is what it says on the label. Important work needs to be done to ensure that that is the case and to restore confidence to all consumers. We are very mindful of that in the Department.

[Keith Vaz (Leicester East) (Lab)]

I thank the Minister for her very kind comments. I know that the charity Silver Star is looking forward to visiting her constituency on Saturday and testing her for diabetes. I am sure that we will find her in perfect health. I remind her that, according to the national health service, it will take five years before all diabetics have access to the full nine checks. Will she consider issuing guidelines to local health and wellbeing boards to ensure that they raise awareness of diabetes?

[Anna Soubry]

I am concerned, as we all are, about diabetes and about the recent report. We have accepted all but one of its recommendations and a lot more work needs to be done. I pay tribute to Silver Star and to the work of Diabetes UK, for example in Boots. I was happy to go to the launch of a new system whereby people can go to clinics at Boots and get the sort of checks that Silver Star is doing. We recognise that there is a lot more work to be done and are making every effort to ensure that there is a huge improvement in the diagnosis and outcomes of everybody who is affected by diabetes.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

3. What recent assessment he has made of the future demand for accident and emergency and maternity services at (a) Guy’s and St Thomas’ NHS Foundation Trust and (b) King’s College Hospital NHS Foundation Trust.

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

11. What the reason is for the time taken to produce the Government’s sexual health policy document.

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

This is an important document, which we want to get right. I anticipate that it will be published next month.

[Mr Brown]

Will the sexual health policy document contain a strategic plan, effectively resourced by Government, to address and reduce HIV stigma, especially among health care professionals, the police, media, teachers and social services? Perhaps a good starting point could be to draw on the lessons and the success of the Government’s anti-stigma work on mental health.

[Anna Soubry]

I certainly support the sentiment behind the hon. Gentleman’s question, and make it clear that I wanted to ensure that the document included the need for everybody to eradicate prejudice in all sexual health work. I was very keen to put that in the document, and I am sure he will join me in welcoming its publication, which will, we hope, be next month.

[Kate Green]

The under-18 pregnancy rate has fallen by 25% in the past 10 years. Will the Minister confirm that the strategy document will make it clear that it is important to protect specialist, dedicated sexual health services for young people, such as the Brook service at the Talkshop in Trafford in my constituency?

[Anna Soubry]

The answer is an unequivocal yes.

[Mr Mark Spencer (Sherwood) (Con)]

Does my hon. Friend recognise the excellent progress that has been made in vaccination against the human papillomavirus to prevent cervical cancer in young girls? Will she find the time to meet me to discuss the benefits of vaccinating boys against that virus?

[Anna Soubry]

Yes, it is always a great pleasure to meet my hon. Friend, and he raises an important issue. I have met a number of other colleagues to talk about their concerns about screening—or rather the lack of screening—for young women under the age of 25 in relation to cervical cancer. That is a concern and we look forward to working on that. I am very happy to meet my hon. Friend.

[Liz Kendall (Leicester West) (Lab)]

The Government have been woefully complacent about producing their sexual health strategy. The Minister constantly says that responsibility for decisions lies locally, but will she admit that the Government’s reorganisation has created huge confusion, splitting the commissioning of sexual health services between GPs, councils and the national board, and that the Government’s lack of interest has delayed the sexual health strategy by 21 months? Will she explain the reasons for the delay, and when the strategy finally comes out, will she commit to it addressing seriously the rationing of access to contraceptive services for women aged over 25?

[Anna Soubry]

Is it not remarkable to have criticism of a reorganisation from someone who supported a Government who had nine reorganisations in nine years? The sexual health strategy document is very important, which is why we are working hard to ensure that it is absolutely right. I re-wrote a large section to ensure that it will deliver—[Interruption.] I do not know why the hon. Member for Hackney North and Stoke Newington (Ms Abbott), from a sedentary position, says “Ah.” It is an important document and we want to get it right, and I am sure she will welcome it when it is published. However, let me make it clear: any delay in the document is not preventing rightful commissioning at a local level. I saw that yesterday when I went to Bedford and met the Brook organisation and the Terrence Higgins Trust, which have long been engaged, certainly in that county, in a tendering process from the local authority to continue to deliver excellent services.

[Jeremy Corbyn (Islington North) (Lab)]

5. What recent discussions he has had with the Whittington hospital on the proposed disposal of its assets and reductions in medical and non-medical staff.

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[Kelvin Hopkins (Luton North) (Lab)]

6. What assessment his Department has made of harm caused to babies by alcohol consumed during pregnancy; and if he will make a statement.

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

Foetal alcohol syndrome is a severe, lifelong condition caused by heavy alcohol consumption during pregnancy, and foetal alcohol spectrum disorder is usually less severe. There is a consensus, however, that FASD is more widespread.

[Kelvin Hopkins]

I thank the hon. Lady for her answer and for her recent letter to me on this subject. She will be aware of the Medical Research Council’s research suggesting that 7,000 babies are born every year suffering from serious genetic and permanent damage. Just as worrying, however, is that even moderate consumption can have an impact on IQ. In America, all drinks containers must have the following written on them:

“According to the surgeon general, women should not drink alcohol beverages during pregnancy because of the risk of birth defects.”

When will the Government insist that all drinks containers in Britain carry the same slogan?

[Anna Soubry]

The hon. Gentleman makes a very good point. Our advice is clear and the chief medical officer continues to give this advice: women who are pregnant or trying to become pregnant should not drink alcohol. If they feel that they must drink it, they should drink one or two units once or twice a week, at the very most. Our advice is clear, but he makes a good point, and I am happy to discuss it with him further.

[Jim Shannon (Strangford) (DUP)]

Recent NHS figures show that £2.7 billion was spent on alcohol-related illnesses. Will the Minister consider a campaign across the whole of the United Kingdom, including the Northern Ireland Assembly and Northern Ireland as a region, to combat the issue of drinking during pregnancy?

[Anna Soubry]

That is a very good point. The overconsumption of alcohol, whether by a pregnant woman or not, greatly concerns the Government, and that is one reason we want to introduce a minimum unit price of 45p. It was a good point well made, and I am always happy to meet the hon. Gentleman to discuss the matter further.

[Mrs Madeleine Moon (Bridgend) (Lab)]

7. What funding his Department has allocated to research into pre-senile dementia.

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[Nick Herbert (Arundel and South Downs) (Con)]

T2. We used to believe that tuberculosis was beaten in this country, but the number of instances of it is increasing, and there were more than 9,000 new cases last year. Does that not suggest, particularly when the incidence of drug-resistant TB is a concern, that a comprehensive public health strategy is needed to tackle the disease? What steps is the Department taking to lead that strategy?

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

I am grateful for that question, because my right hon. Friend has identified the fact that TB is a growing problem. We are exploring the effectiveness of an approach across health sectors for a national strategy on TB, while ensuring that we recognise the local variances. We need to improve in that area.

[Andy Burnham (Leigh) (Lab)]

I am sure that, like me, the Secretary of State has spent recent weeks absorbing the Francis report and its recommendations; there are lessons for everyone at every level, particularly on staffing. New analysis to be published later today will show that the NHS is set to lose 12,000 nurses over the course of this Parliament, raising doubts about its ability to respond to Robert Francis’s recommendations on staffing. Will the Government say today whether they accept those recommendations and the principle of a minimum staff-to-patient ratio?

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[Tessa Munt (Wells) (LD)]

T4. Two years ago, the Prime Minister welcomed the installation of CyberKnife, the latest in cancer radio surgery equipment at the world-leading Royal Marsden cancer centre, as an example of how the NHS has progressed. Since then, the Royal Marsden has invited successive Health Ministers to visit the cancer centre but no one has accepted the invitation, and I am aware that Ministers have been to see other cancer treatment systems. Will the Secretary of State follow the Prime Minister’s lead and visit the Royal Marsden to see for himself the great progress that has been made there?

[Anna Soubry]

I understand that the Secretary of State has been to the Royal Marsden, but I am more than happy to accept the invitation and look forward to going along and seeing it for myself.

[Graeme Morrice (Livingston) (Lab)]

T10. What steps is the Secretary of State taking to prevent the fragmenting of the national health service through a massive reorganisation that is costing £3 billion, diverting much-needed resources from the front line?

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[Alun Cairns (Vale of Glamorgan) (Con)]

T7. Kevin Davies, a constituent from Cowbridge, visited my surgery yesterday. He is a prostate cancer patient and robotic surgery was deemed to be the most appropriate form of care. Unfortunately, robotic surgery for prostate cancer is not available in Wales and he was forced to travel to Bristol and pay £15,000 for the treatment. Will my hon. Friend agree to work with the Welsh NHS either to come up with a formal agreement whereby facilities are available to Welsh NHS patients or to press it to invest in its own facilities?

[Anna Soubry]

My hon. Friend makes a good point: in England, the NHS is benefiting from not suffering a cut in funding such as that imposed by the Labour Administration in Wales.

[Helen Jones (Warrington North) (Lab)]

The Prime Minister promised a fight to save district general hospitals, yet the Secretary of State’s recent decision on Lewisham suggests something completely different. Will the Secretary of State therefore give the House an assurance that the north Cheshire hospitals trust will not be forced into a merger or to downgrade its services because of financial problems elsewhere?

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

T8. Patients in Suffolk are very worried about the performance of the ambulance service. In the past two months, less than 60% of ambulances have hit the target for reaching emergency cases. The strategic health authority and others, including all the MPs in the region, are not happy about that. Will the Government intervene, too?

[Anna Soubry]

With two Ministers in the Department from the east of England, I can assure my hon. Friend that all of us are aware of the concerns that she and other Members have about their ambulance trust and, if I may say so as an east midlands MP, about the East Midlands ambulance trust. I know that Earl Howe, who has responsibility overall, has offered a meeting with Members from the east of England, and I am sure that that meeting will produce the sort of benefits that everyone hopes for.

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[Kerry McCarthy (Bristol East) (Lab)]

Recent comprehensive research by the international study of asthma and allergies in childhood found strong evidence of a link between fast food and asthma, but when I asked the Minister which public health responsibility deal partners he had discussed that with, he said that evaluating science was not within their remit. Does he agree that if the fast food companies have the kudos of being classed as public health responsibility deal partners, they ought to look into such research and actually take some responsibility?

[Anna Soubry]

Those are good points well made, if I may say so. I am more than happy to discuss that further with the hon. Lady, because I take the firm view that everyone involved in making, manufacturing, supplying and selling food has a responsibility to make sure that all of us have longer, healthier, happier lives. I am all for ratcheting up the responsibility deal.

[David Tredinnick (Bosworth) (Con)]

May I alert my right hon. and hon. Friends to the recently published road map for complementary and alternative medicine in Europe, which cost the European Commission £1.5 million? Will they look at it carefully to see where services can be extended in our own national health service?

Cancer Care (England and Wales)

Anna Soubry Excerpts

Tuesday 12th February 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 Riordan.

I congratulate my hon. Friend the Member for Vale of Glamorgan (Alun Cairns) on securing this debate. He makes the important point that it is not acceptable for cancer, of all the conditions that touch the lives of so many families, to be a party political issue. He is right, however, to bring to this place his concerns about the treatment of people in Wales who are suffering from cancer so that a comparison may be made with England and lessons might be learned by both countries. As he said, I am unable to respond to the detail of his concerns because Health Ministers in England are not accountable for health services in Wales, which are matters for the Welsh Assembly. I am sure the Assembly will read the account of this debate in Hansard and make particular note of some of my remarks on what seems to have been put about in the Principality.

[Guto Bebb (Aberconwy) (Con)]

In my constituency of Aberconwy in north Wales, and also in other parts of Wales, we are dependent on the health service in England to provide specialist services unavailable in Wales. We have been told time and again that patients from Wales often have to wait longer for treatment in hospitals in England. As a Health Minister in England, will my hon. Friend provide any guidance to Welsh Members on whether that is true?

[Anna Soubry]

As ever, my hon. Friend asks a particularly pertinent question, and, to be frank, I cannot immediately give him the answer. I can and will ensure that he receives a full response in a letter. He may also talk to any of my officials at the conclusion of this debate.

In England, the Government have committed to improve survival rates, reduce mortality rates and put patients at the heart of the service. In January 2011, we published a four-year cancer outcomes strategy that set out a range of actions for improving early diagnosis, screening, access to treatment and drugs and providing support to people living with and beyond cancer. That strategy is backed by more than £750 million for implementation, including more than £450 million for early diagnosis.

To improve early diagnosis, we must encourage people to recognise the symptoms and signs of cancer and to seek advice from their GP as soon as possible. Of course, we also need GPs to recognise cancer symptoms and, if appropriate, refer people urgently for specialist care.

Since 2010-11, the Department has been funding and delivering local, regional and national “Be Clear on Cancer” campaigns to raise awareness of cancer symptoms. We are currently running a regional pilot campaign for kidney and bladder cancers that is rather charmingly know as “blood in pee”; a regional breast cancer campaign aimed at women over 70; and a local pilot campaign for ovarian cancer.

I had the great pleasure of attending the all-party group on ovarian cancer, chaired with great ability, compassion and campaigning skill on behalf of ovarian cancer sufferers and their families by the hon. Member for Washington and Sunderland West (Mrs Hodgson). That is an example of a cross-party initiative on cancer, which is as it should be.

As part of the pilots and schemes to raise awareness, there is a more general campaign on cancer symptoms called “Know 4 Sure”, which lists four key symptoms: unexplained blood not from an obvious injury; an unexplained lump; unexplained weight loss; and unexplained pain that does not go away. If someone has one or more of those symptoms, the message is clear: “Go and see your GP.” There is information on GP attendance, and urgent referrals for suspected cancer and diagnostic tests will be analysed to assess the impact of the campaigns. We will study the campaigns to see how effective they have been. If we need to roll them out across England, we will do so. I hope the Welsh Assembly will look at the success or otherwise of those campaigns and learn accordingly.

Support for GPs is important, and a range of support is available to help them assess when it is appropriate to refer patients for suspected cancer, but we know we can do more. As part of the preparation for all the campaigns, we commissioned Cancer Research UK to produce briefing materials for GPs within the relevant networks. We are promoting GP direct access to four key diagnostic tests to support early diagnosis of bowel, brain, lung and ovarian cancers. We have provided GPs with best practice guidance on using those tests, and we are publishing data on their usage. We are also working on providing electronic and desk-based cancer decision support tools to help GPs assess and identify patients with possible cancer more effectively.

We know how valuable screening is, and we are working to deliver age extensions for bowel and breast screening programmes. We will continue to support the roll-out of evidence-based screening programmes. For example, we are introducing bowel scope screening to the existing national bowel screening programme. We are aiming for 60% roll-out by March 2015. Experts estimate that the bowel scope programme will prevent some 3,000 cancers every year and save thousands of lives.

The hon. Member for Nottingham South (Lilian Greenwood), who is no longer in her place, rightly mentioned some of the difficulties we face with some men, notably in the black community, who are more at risk of prostate cancer. I will provide her with details on the Department’s various initiatives to ensure that we pay particular attention to those parts of our community that need such information to ensure they go along to have the screening and to see their GP if they have any concern about that aspect of their health.

As my hon. Friend the Member for Vale of Glamorgan explained, once cancer is diagnosed it is important for patients to have access to appropriate treatment delivered to a high standard.

The latest cancer waiting times show that 95.4% of patients in England—or 291,974 patients out of 306,011—were seen by a specialist within two weeks of an urgent GP referral for suspected cancer. We set high levels of expected performance, which in that case is 93%, so I am pleased that we have exceeded our own high standards. Some 87.3% of people treated began their first definitive treatment within 62 days of being urgently referred for suspected cancer by their GP, and 98.4% of people treated began first definitive treatment within one month of receiving their cancer diagnosis. We should celebrate those figures, but, of course, we can always do better.

We are expanding radiotherapy capacity by investing more than £173 million over four years and ensuring that all high-priority patients with a need for proton beam therapy get access to it abroad. That includes £23 million for the radiotherapy innovation fund, which is designed to ensure that, from April 2013, radiotherapy centres are ready to deliver advanced radiotherapy techniques to all patients who need it. From April, cancer treatments will be planned and paid for nationally by the NHS Commissioning Board, which means that, for the first time, cancer patients will be considered for the most appropriate radiotherapy treatment regardless of where they live.

My hon. Friend mentioned the cancer drugs fund. Between 1 October 2010 and December 2012, the fund stood at £650 million and helped more than 26,500 cancer patients in England to access the additional cancer drugs their clinicians recommended.

When I was first elected to this place, I received letters from constituents who were rightly upset and concerned that they spent so much of their own money to access certain drugs, and I do not think I have had one such letter or e-mail for at least 18 months. That is a mark of achievement.

To be absolutely clear about the funding of the cancer drugs fund, it is not true that any reduction has been made in any service. It is not true to suggest that money has been taken from the NHS budget. If anybody says such a thing, I am afraid they are either deliberately not telling the truth or just plain ignorant. I am happy to explain how the coalition Government have funded the cancer drugs fund in England. Raising the threshold for national insurance effectively saved the NHS £200 million. That £200 million was not secreted away or given to the Treasury or anybody else; it was the start and has been the continuation of the cancer drugs fund. I hope that that is clear. I know that it will be recorded in Hansard, and no doubt my hon. Friend and others will be able to publicise it widely in Wales and set the record absolutely straight.

In the last minutes available to me, I will explain cancer networks. The NHS Commissioning Board has set out its plans to establish a small number of national networks from 1 April to improve health services for specific patient groups or conditions such as cancer and cardiovascular disease. The cancer networks have existed for some time, and they have worked extremely effectively. It seems a bit odd, but those involved in the delivery of care and treatment for people suffering from cancer, for example, were not always the best at communicating among themselves, so the networks were set up, with great success. We are building on that success.

We have increased the amount of money going into the new strategic clinical networks, and we are confident that they will continue to work closely with providers and commissioners in the new health system and to play an important role in improving cancer care. I understand that transition arrangements, which concerned a number of people, are now well developed, and good progress is being made, with appointments in key positions in the clinical networks.

We are committed, however, to improving the experience of cancer patients. It is not all about early diagnosis, screening and treatment; it is also about cancer patients’ experience. The 2011-12 national cancer patient experience survey found that 88% of cancer patients in England rated their care as excellent or very good; of course, we aim to increase that figure. The results are helping trusts to identify areas in cancer care that need improvement locally and to raise standards across the service.

A 2012-13 survey will commence later this month. I am not sure how a 2012 survey can begin later this month; it looks like a bit of a typing error. That will get me into trouble with my officials. Such a survey is about to commence. It is an important piece of work, because it will enable us to identify and build on progress already made. From April, responsibility for such surveys will move to the NHS Commissioning Board, but hon. Members can be assured that this Minister will keep a close eye on it. The clinical commissioning group outcomes indicator set is the responsibility of the NHS Commissioning Board, but again, it drives improvements across the piste, as we say.

I add my profound support for Maggie’s cancer caring centres, whose praises the right hon. Member for Oxford East (Mr Smith) rightly sang. I visited the one in Nottingham the other week and saw there the excellent support that it gives, not just to cancer patients but to their families. Even if there has been a bereavement, the care and loving support continues. It is a remarkable organisation, and I hope that it will grow and become available to even more people.

In partnership with Macmillan Cancer Support, we are working on the national cancer survivorship initiative to implement improved care and support for cancer survivors. We want health services that are responsive to individual needs and that ensure access to specialist care when needed. We will shortly publish a document setting out the evidence base for future services to support people living with and beyond cancer in England. I hope that the Welsh Assembly Government will look to the experience in England and learn from it; I am sure that there are elements that we can learn from them as well. It is to be hoped that the outcomes in Wales will meet the success of the outcomes in England.

Question put and agreed to.

Accident and Emergency Departments

Anna Soubry Excerpts

Thursday 7th February 2013 Commons Chamber

[Jim Dowd]

No, that is not the case.

It is a question of whether being reasonable gets one anywhere. People in Lewisham have tried being reasonable with the trust special administrator and with the Department of Health, but so far it has got them nowhere, so they are having to consider other methods.

Just how many hospitals up and down the country are under threat is evident from the Members who are present this afternoon. In many cases, the accident and emergency unit is the heart of a buoyant and thriving hospital. So much else stems from the work of A and E units. My hon. Friend the Member for Barrow and Furness (John Woodcock) outlined the point that in many parts of the country outside London, it is as much a question of geography as the number of people because of the threat that people will have to travel great distances to get the treatment they need. A and E units have such a critical function that Professor Sir Bruce Keogh, the medical director of the NHS who has already been mentioned, has highlighted the scale of the problems across the country and, I am led to believe, is undertaking a review of A and E units.

I am somewhat less reassured by Sir Bruce’s view of democracy and the role of local representatives. He is not alone in holding that view. Many medical professionals and particularly administrators—Sir Bruce straddles both roles as he is an administrator and a clinician—believe that they should decide what is best for people and that people must put up with it. They believe that local representatives, whether they be Members of Parliament, local councillors or the local council, have no right to interfere. I have to say to Sir Bruce and the other professionals at the Department of Health who operate under that illusion, that that is not how a democracy works. In a democracy, people need to be persuaded that what is being done is in their best interests. If there is to be change, the result must be a system that is safer and more reliable than the one that it replaces. Simply turning to people in a patronising and condescending fashion and saying, “You don’t understand what we understand,” is not the way to treat the citizens of this country.

The threat posed by the unsustainable providers regime in the South London Healthcare NHS Trust is a threat to every single trust in the country. If the Government get away with the way in which they have conducted the regime in Lewisham, they will be able to do it anywhere. The whole scheme has been designed, promoted and decided on by the Department of Health without any objective external appraisal.

The objective of the exercise in the case of the South London Healthcare NHS Trust was to revive a dormant and defunct NHS London scheme to reduce the number of A and E units and functioning hospitals in south-east London from five to four. That plan was put before the previous clinically led review, “A picture of health”, and rejected. It was also rejected by the subsequent review of that review by Professor Sir George Alberti, who is now the chair of the trust board at King’s College hospital. The plan did not survive because it does not make sense on clinical grounds. What is happening now in south London is being done entirely on financial grounds.

Although Lewisham hospital is being devastated via this back-door reorganisation, the Secretary of State and his predecessor originally denied that it was a reconfiguration. Unfortunately, in his statement last Thursday, the Secretary of State confirmed that it was a reconfiguration. Had they been honest and straightforward and told the truth at the outset, there would have been an entirely different procedure, which would have been amenable to external review and would have had an appeals process. They would have had to stand up the case for the action that they are now contemplating. This situation has been engineered entirely by the officials and their acolytes within the fortress of Richmond house. All the clinical evidence that they have taken any notice of has been paid for. It has come from people who work at the Department of Health or people who have been brought in to the so-called clinical advisory group by the trust commissioner.

It is an irony bordering on contempt, not only for the people of south-east London, but for people from much further afield, that the trust special administrator who was brought in to save the overspending South London Healthcare NHS Trust overspent his own budget by more than 40%. The final bill is not yet in, but he has spent £5.5 million. All he did was take off the shelf a scheme that NHS London, while in its death throes—it has only a month or so before it is replaced—wanted to use. We need only look at the chronology to see that this is what was intended all along. The trust special administrator did not reach a conclusion; he started with the premise to shut down Lewisham hospital.

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

Will the hon. Gentleman give way?

[Jim Dowd]

I certainly will; I need the extra minute.

[Anna Soubry]

Is the hon. Gentleman saying that the trust special administrator was given a brief and did not act independently? Does he recognise that he had two hospitals in PFI agreements that were losing £1 million of taxpayers’ money in those agreements—money that should have been spent on health services?

[Jim Dowd]

That is not true; we do not have that. That is in South London Healthcare NHS Trust. Lewisham Healthcare NHS Trust is in balance—[Interruption.] I am saying that a trust special administrator was given a remit to close Lewisham hospital. Why on earth were Lewisham Members invited to the meeting to discuss South London Healthcare back in July? This scheme has been hatched in the Department of Health, and the Minister does herself no credit by attempting to defend the indefensible.

--- Later in debate ---

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

I congratulate the hon. Member for Ealing, Southall (Mr Sharma), my right hon. Friend the Member for Newark (Patrick Mercer)—if he is not right hon., I am sure he will not complain at my saying that he is—and my hon. Friend the Member for Eastbourne (Stephen Lloyd) on securing the debate. It has been a good debate, if rather heated at times. There has been a great deal of passion, and rightly so. Fighting to defend our NHS and our hospitals in whatever way we need to is something that all Members should do. It is one of the reasons that we come here—to be champions of our local causes and to advance the cause of our constituents.

I apologise to the hon. Member for Lewisham West and Penge (Jim Dowd) if my intervention exacerbated his rising blood pressure. As the Minister for public health, I get concerned about his blood pressure, but he made it clear that he spoke with passion.

[Jim Dowd]

Will the Minister give way?

[Anna Soubry]

I have only about nine minutes, and I hope he will forgive me if I do not take any interventions. I will answer any points that he wants to raise in a letter or in any other way.

Yesterday, many of us took the view that we had seen one of the best moments in Parliament, when the Prime Minister rose to talk about the Francis report. It has been noted not only by Members but in the press and elsewhere that his statement and the responses of Members on both sides of the House were made without any finger-pointing, any blame or any party political point scoring. Many people think that it was a refreshing moment. I want to remind the House of what the Prime Minister said in response to an hon. Member’s question to him. He said:

“Let me refer again, however, to one of the things that may need to change in our political debate. If we are really going to put quality and patient care upfront, we must sometimes look at the facts concerning the level of service in some hospitals and some care homes, and not always—as we have all done, me included—reach for the button that says ‘Oppose the local change’.”—[Official Report, 6 February 2013; Vol. 558, c. 288.]

In quoting the Prime Minister, I pay tribute to the comments of my right hon. Friend the Member for Newark, my hon. Friends the Members for Banbury (Sir Tony Baldry) and for Croydon Central (Gavin Barwell) and the right hon. Member for Tottenham (Mr Lammy). These matters are not easy. My hon. Friend the Member for Croydon Central explained how he sat on one side of the fence, regarding the reconfigurations in his area, and in direct contrast to the hon. Member for Mitcham and Morden (Siobhain McDonagh). She is doing the right thing in talking about the needs of her constituents and fighting for them as she does, but that is an example of a reconfiguration in which two Members want to do their best but are effectively at odds. That is inherent in these sorts of changes, and in these concerns about the future of our accident and emergency services. Indeed, I have had meetings with my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), because they too have views on the reconfigurations in their area, as we might imagine.

I want to set the record straight and make it clear that the reconfiguration of clinical services is essentially a matter for the local NHS, which must, in its considerations, put patients at the heart of any changes. As my hon. Friend the Member for Banbury said, the NHS has always had to respond to the changing needs of patients and to advances in medical technology. As lifestyles, society and medicine continue to change, the NHS needs to change too. The coalition Government’s overall policy on reconfiguration—if I have to repeat it, I will, to make it absolutely clear—is that any changes to health care services should be locally led and clinically driven. That is our policy, and those who seek to say otherwise do so in order to score cheap political points, which do them no favours whatever.

Let me turn, if I may, to the comments made in the excellent speech by my hon. Friend the Member for Newark, which was also touched on by the hon. Member for Hartlepool (Mr Wright). It is absolutely right and it is the case that there is confusion about the terminology. What does “urgent care” mean; what does “A and E” mean; how does it all fit in; where do we go? The hon. Member for Hartlepool made a very good point when he talked about the need for good public transport services to be part of any reconfiguration. I accept that.

I am pleased to say that on 18 January 2013, the NHS Commissioning Board announced that it is to review the model of urgent and emergency services in England. The review, which will be led by the medical director Sir Bruce Keogh, will set out proposals for the best way of organising care to meet the needs of patients. The review will help the NHS to find the right balance between providing excellent clinical care in serious complex emergencies, and maintaining or improving local access to services for less serious problems. It will set out the different levels and definitions of emergency care. This will include top-level trauma centres at major hospitals such as my own, the Queen’s medical centre in Nottingham —and here I hope that my hon. Friend the Member for Newark would accept that the journey to that centre down the A46 has added to provision for the great town of Newark. The definitions will be looked at and the review will take into account, as I say, the trauma centres at major hospitals, but also local accident and emergency departments and facilities providing access to expert nurses and GPs for the treatment of more routine but urgent health problems.

[Mr Virendra Sharma]

rose—

[Anna Soubry]

I am not giving way. I really, truly do not have the time, and I am trying to respond to all the points raised. I want to make reference, and indeed give credit, to all Members who have taken part in the debate.

As part of the review’s work, it needs to consider public understanding of the best place to go for care.

Let me refer to the important and valid speech from my hon. Friend the Member for Ealing Central and Acton (Angie Bray). She spoke about the fact that many of her constituents and others—full credit to a cross-party campaign—feel that this has been a fait accompli or a done deal. She spoke about the need to work with people—other hon. Members have talked about that, too—and the need for those conducting these configurations to work with the people and to explain things to the people. She put it very ably, if I may say so, when she emphasised the importance of “taking people with you”. I think everybody should remember that important point.

I pay tribute to the remarks made by my hon. Friend the Member for Enfield North (Nick de Bois). He made a number of points, all of which, he will be pleased to know, I have written down. I know he is meeting the Secretary of State in just a couple of weeks’ time or it may be next week. Again, this is a cross-party meeting. I will not go through all my hon. Friend’s points, but I think they are important ones, which I know he will put with great force to the Secretary of State.

My hon. Friend the Member for Eastbourne talked about the four principles and four tests of any reconfiguration, and the importance of support from GP commissioners.

I see in their places the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham East (Heidi Alexander) who raised points about the very difficult decision taken on Lewisham and other hospitals—a decision that I think was absolutely right. I know it has caused great concern, but Lewisham will not lose its A and E. It will see a reduction, but it will not lose it. Those Members and others have stressed the need for GPs to be part and parcel of what happens. My hon. Friend the hon. Member for Enfield North expressed concern about the possibility that the fact the clinical commissioning groups had yet to come into operation had not been taken into account.

I see that the clock is against me. I had many more things to say, but I cannot now say them. What I will say is that I thank all who have contributed to what has been a good debate, and that, if I have not replied to any points that have been made, I will write to the Members concerned.

Nutrition Labelling

Anna Soubry Excerpts

Thursday 31st January 2013 Written Statements

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

Today we have published the response to the front of pack nutrition labelling consultation held from May until August 2012. This is a joint response on behalf of the Department of Health, other Health Ministers across the UK and the Food Standards Agency.

This consultation provided us with helpful information on the views of the public, food industry, non-governmental organisations and others on the voluntary provision of repeat nutrition information on the front of food packages, which informed our thinking on this subject. Great progress has been made since the consultation finished towards an emerging consensus for a consistent front of pack scheme. In particular, all 10 of the major UK food retailers are now publicly committed to working with us, and each other, to help achieve our goals.

UK Health Ministers announced on 24 October 2012 our preference for a consistent front of pack system across the UK based on a “hybrid” scheme combining colours and percentage guideline daily amounts. Officials across the UK are now working with the food industry and others to agree the detail of this hybrid approach.

“Front of pack nutrition labelling: joint response to consultation” has been placed in the Library. Copies of the response are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper office. It is also available at: www.dh.gov.uk/health/ category/publications/consultations/consultation-responses/.

Human Fertilisation and Embryology Authority and Human Tissue Authority

Anna Soubry Excerpts

Friday 25th January 2013 Written Statements

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

The Department of Health is today publishing its response to its “Consultation on proposals to transfer functions from the Human Fertilisation and Embryology Authority and the Human Tissue Authority”.

In “Liberating the NHS: Report of the arm’s-length bodies review” (2010) the Department set out its proposals for reducing bureaucracy and increasing efficiencies. This included proposals to transfer all functions from the Human Fertilisation and Embryology Authority (HFEA) and the Human Tissue Authority (HTA) with a view to abolishing the two organisations by 2015. The public consultation set out options for taking this work forward and ran between June and September 2012.

The Department has welcomed the responses it has received to this important consultation. The responses have come from a range of representative bodies, leading organisations and individuals and we are grateful for the time and effort respondents have put into this. The Department recognises that the majority of respondents do not favour a transfer of functions to the Care Quality Commission and the Health Research Authority and has listened to the strong message about the risk of losing specialist expertise if functions were to be transferred. We have therefore concluded not to transfer the functions at this time.

The Department has also given very careful consideration to the clear message from the consultation of the need for a review of the way in which the HFEA and HTA undertake their functions. I have therefore commissioned an independent review to start immediately. This review will look at:

the scope to streamline the way in which the two bodies undertake their regulatory and statutory functions, including through joint working, sharing resources and information and working more closely with other health sector regulators;

the scope to reduce and rationalise the burden of inspection, information collection and process of research approvals that falls on the regulated sector, without compromising the safeguards in the respective Acts; and

the scope for shared authority membership and leadership, and of a merger of the two bodies.

It will report to me and the Minister for the Cabinet Office by April 2013.

As a result of our decision, we do not intend to proceed with the policy facilitated by clause 75 of the “Draft Care and Support Bill”, (Cm 8386), which would amend the Public Bodies Act to allow for abolition of the HFEA and HTA.

A copy of the “Government response to the consultation on proposals to transfer functions from the Human Fertilisation and Embryology Authority and the Human Tissue Authority” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Terminal Illness (Access to Medicines)

Anna Soubry Excerpts

Wednesday 23rd January 2013 Westminster Hall

[Jim Shannon]

There are parts of the world where drugs can be made more cheaply, and they include India. The drugs in India are equal to those made in the USA, for example, but can be made more cheaply. Why do not we obtain those similar drugs, at a cheaper price, so that we can provide the relevant care, as my hon. Friend has suggested? We should take that on board.

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

I hope that the hon. Gentleman will be interested to know that last week I went to India where I had that precise conversation with several organisations. We hope that a memorandum of understanding will emerge, involving the regulatory bodies with which I had meetings. The hon. Gentleman is right to point out that we can take advantage of the great work being done in India to produce medicines that are just as good as those made anywhere else, and often at a fraction of the price.

[Jim Shannon]

Those are the sort of responses we hope to hear, because they show that the Government are working. The Minister, as we knew she would, has come up with a practical, physical response, and is doing the things that we have been hoping will come out of the debate. I thank her for initiating the process she outlined, and for moving things forward.

I am pleased to support the hon. Member for The Cotswolds in his cause of drawing attention to motor neurone disease, cancer and other illnesses, so that a treatment path will not be simply a step along the road to the end of life, but may enhance the quality of life. Perhaps a successful treatment path can be developed. According to Empower: Access to Medicine,

“Speeding up the development and availability of drugs that treat life-threatening diseases would benefit everyone in society.”

I believe that too. Everyone present will know people whom new drugs could help. The current testing and development process is long, cumbersome and expensive. In fact, a recent report by the Office of Health Economics found that it takes five years, on average, after the launch of a new drug, to win NICE approval. That time scale can be more than doubled when the time taken for a new drug to go from the development stage through to phase 3 and beyond is added. As an example, no new drug has been approved for motor neurone disease since riluzole was approved 20 years ago. Are we happy to sit back and rely on that one drug, or should there be more research? We need more research; we need to fund it, and we need it to be made possible.

Currently, pharmaceutical companies do not have a financial incentive to invest in developing new drugs for rare or “orphan” diseases—I am being careful in my terminology—because of the small number of the population who are affected and the high and uncertain costs of the drug development process. The drug regulatory regime is therefore clearly having a significant impact on those with life-threatening and rare diseases.

Just yesterday, the shadow Secretary of State held a meeting on special commissioning. Five speakers introduced the issues. The gentleman who spoke on cystic fibrosis said that drugs are available only in certain parts of the United Kingdom. He is worried that we are setting an imbalance, which I have taken up with my colleague back home, Edwin Poots, the Minister of Health, Social Services and Public Safety, to ensure that cystic fibrosis drugs are available to sufferers when they need them not only in England, but in Northern Ireland, Scotland and Wales.

The panel hosted by the shadow Secretary of State outlined the need for drugs allocation. There was a guy representing HIV patients, and 100,000 people in the United Kingdom are receiving HIV drugs to prolong their life. The man who spoke yesterday has lived for 20 years with the drugs that are available, but are those drugs available across the whole United Kingdom?

--- Later in debate ---

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

It is a pleasure, Mr Caton, to serve under your chairmanship. I congratulate my hon. Friend the Member for The Cotswolds (Geoffrey Clifton-Brown) on securing this debate on a subject of which he clearly has considerable knowledge. I thank other hon. Members who have spoken, and pay tribute to the work done by Empower: Access to Medicine, particularly that of Mr Les Halpin, who has been spoken about in glowing terms. I add my good wishes to him to those of my hon. Friends the Members for The Cotswolds and for Southport (John Pugh)—the latter is giving me a thumbs-up, as I remembered the correct name of his constituency. A great failing of mine is not to remember it. I hope that Mr Halpin is able to watch this debate, and I know that he and many others will want to read it.

If I may say so, the debate is a good example of Parliament at its absolute best. Yet again, there is a story in one of the papers criticising Members of Parliament for expenses properly incurred. If only the press, instead of printing another knocking story, would come along and listen to debates such as this when important issues are put into the public domain with care and considerable knowledge. As is often the case in such debates in Westminster Hall, there has been an outbreak of political unity. Political parties play no part in this issue, and Members properly ask the Government tough questions. I pay tribute again to my hon. Friend the Member for The Cotswolds because he is a pleasant thorn in the Government’s side, and properly so. He has raised and is championing an issue that a constituent brought to his attention, and is holding the Government to account.

I fear—well, I know—that I cannot answer all the questions that my hon. Friend and the hon. Member for Copeland (Mr Reed) have asked and, as is the usual rule, if I cannot do so, my excellent officials will provide written responses. The matter is not in my portfolio—I am not making excuses—so I am not particularly familiar with it, and I am grateful for the excellent briefing that has been provided by my officials. Perhaps I will be forgiven for reading out a large part of my speech, which I do not normally do because I like to look as though I understand everything I am speaking about, but the subject is important and technical.

I would like to take credit for the approval of Kalydeco, a drug for cystic fibrosis users, but it was the National Institute for Health and Clinical Excellence that gave approval for it to be prescribed. The only reason I know anything about it is because one of my constituents wrote to me. A cystic fibrosis campaigning group has quite properly been contacting Members of Parliament, urging them to make all the representations that they can about the benefits of the drug. A very small number of people will benefit, because it relates to those who have cystic fibrosis because of a particular genetic disorder, but it will undoubtedly revolutionise their lives. I was certainly pleased to see that it will now be available for prescription.

The development of new medicines is a long and expensive process, as we all agree. The Association of the British Pharmaceutical Industry estimates that only one in 5,000 researched new compounds receive regulatory authority approval, taking 10 to 12 years on average. That is the scale of the research and the difficulties, in many respects.

The life sciences industry is undergoing rapid change. The time and cost involved in developing new medicines is rising, and the old “big pharma” model of having thousands of highly paid researchers working on a pipeline of blockbuster drugs is declining. A new model of collaboration, about the outsourcing of research and early clinical trials on patients, has emerged. Many patients with serious or life-threatening illnesses, who understandably expect that they should be able to access the latest and most effective treatments, feel that regulatory procedures can hamper access.

Turning to life sciences strategy, this country has a strong history of drug discovery and development, and improving access to medicines has long been a Government priority. The “Strategy for UK Life Sciences” was launched in December 2011. Recognising the issues facing the life sciences, the 10-year strategy includes measures to support innovation and early-stage development. My right hon. Friend the Prime Minister published a progress report and refresh of the strategy only last month.

My hon. Friend talked about adaptive licensing, as did other hon. Members. I would like to set out the arrangements that we are putting in place for an adaptive licensing pilot programme, with the objective of advancing and maximising the potential of existing flexibilities in the drug licensing processes to improve public health and stimulate innovative drug development.

The Medicines and Healthcare products Regulatory Agency—I shall refer to it as the MHRA, as opposed to its otherwise very long name—has convened an expert group on innovation in the regulation of health care and agreed to a tripartite programme to take that work forward. It includes work at EU level on how the existing flexibilities in EU regulation can be used to bring forward innovative products; work at national level exploring options to help companies maximise the potential of existing drug licensing processes; and work at arm’s length from the MHRA and Government. The co-ordination of some other activities required for the pilot will be undertaken by the Centre for the Advancement of Sustainable Medical Innovation, including the exploration of suitable candidate products. However, pharmaceutical companies must come forward and nominate candidates for adaptive licensing.

Last year, we consulted on an early access scheme to make certain new and promising medicines available to patients in the UK before they are formally licensed. The MHRA is currently assessing the consultation responses. If introduced, the early access scheme would be designed for promising new medicines that will treat, diagnose or prevent life-threatening, chronic or seriously debilitating conditions without licensed treatment options. It would provide a scientific opinion from the MHRA on the benefits and risks of a new medicine about a year before the licensing process was completed. That additional information would assist both clinicians and patients in making treatment decisions in areas of unmet need, such as those described earlier by my hon. Friend. Both programmes are in a very early stage of development, as I think we all appreciate, and we will have more to say on that in the near future.

Turning to stratified medicines and genomics—I cannot pronounce it, but I am sure that Hansard will correct me if I get the word wrong—ongoing work on stratified medicines will improve our understanding of why groups of people with particular diseases respond differently to treatments. That point was very well made by my hon. Friend the Member for Southport. Our initiative to sequence 100,000 whole genomes from NHS patients will provide valuable information for researchers to gather new insights into health and disease and to develop new diagnostic tools and treatments.

Rare diseases are classified as conditions affecting no more than five in 10,000 people in the EU. Patients with rare conditions deserve the same quality, safety and efficacy in medicines as those with more common conditions. Since the pharmaceutical industry has little interest, under normal market conditions, in developing medicines intended for small numbers of patients, the EU offers a range of incentives to encourage the development of what are called “orphan” medicines in order to address the unmet clinical need.

Applications for the designation of orphan medicines are reviewed by the European Medicines Agency’s Committee for Orphan Medicinal Products—in its short form, the COMP. Via the MHRA, the UK takes an active role in the decision-making processes at the COMP, ensuring that applications for orphan drug designation are appropriately recognised and encouraging companies to develop their products further. Taking that one step further, I join the hon. Member for Strangford (Jim Shannon) in paying tribute to the research being undertaken at Queen’s university Belfast, and I know that many other universities throughout the whole United Kingdom are doing research into that sort of medicinal pharmaceutical advancement. They do not have some of the constraints of pharmaceutical companies, or perhaps the desire that some of those companies have to make a profit, so it is often universities that are best placed to do some of that invaluable research and development.

[Jim Shannon]

The work that is done at Queen’s university could not happen without partnership with the pharmaceutical groups, and clearly, they can use the partnerships to their advantage in creating new medicines. Partnerships are what life is very much about. A partnership is how we can work together to make it better, and that is a partnership that can work.

[Anna Soubry]

I am grateful for that intervention and I completely agree. It is great when we see business working with our universities on research. It can be highly productive and undoubtedly mutually beneficial, including to the rest of society, and that collaborative approach is much to be welcomed. It is fair to say that many universities, at first, had a bit of resistance to working with business, seeing it somehow as sullying themselves. However, over time they have recognised the absolute mutual benefit to both and, of course, that includes, should it be successful, a benefit to society.

[Mr Jamie Reed]

I am grateful to the Minister for her contribution. It is clear that there is an emerging cross-party consensus—dare I say it, a coalition—which is a tremendous sight to behold for everyone who cares about this issue. She talks about the difficulties posed by the research and development sector when it comes to manufacturing medicines for orphan diseases, and the costs inherent in producing them because of the market basis on which they are produced—no argument there. However, could she explain how that might affect the commissioning choices of clinical commissioning groups when it comes to purchasing those very same medicines, given the inherently inflated costs?

[Anna Soubry]

I cannot give a short answer in this debate, but that is important and it has been raised by a number of hon. Members. On that basis, I will ensure that a proper and full written response is given, both to the hon. Gentleman and all other hon. Members—I suspect that my hon. Friend the Member for Southport and the hon. Member for Strangford will also be interested in the answer. All present will certainly get a written answer to that, because it is an important point; clarity is clearly being sought, and it will be given.

Returning to NICE, once effective new drugs are brought to market, it is important, as we all know, that they are made available to the patients who will benefit most from them on terms that represent value to the NHS—that means, of course, value to the taxpayer. NICE has played an important role in that by providing robust, evidence-based guidance to the NHS on drugs and treatments. In the great majority of cases, NICE now publishes draft or final guidance on significant new drugs within a few months of their launch. In 2011, for drugs appraised using its single technology appraisal methodology—the methodology used for the great majority of new drugs—NICE issued draft or final guidance an average of four months after the date of market authorisation. The end-of-life flexibilities introduced into NICE’s appraisal process from 2009 have allowed a number of important drugs for terminal illnesses affecting a small number of patients to be made available on the NHS.

The NHS constitution sets out patients’ rights to medicines positively appraised by NICE, underpinned by a statutory funding direction. In December 2011, the NHS chief executive’s report, entitled “Innovation, Health and Wealth”, introduced a NICE compliance regime to help to ensure that medicines approved by NICE are made available on the NHS quickly and consistently. Furthermore, since the cancer drugs fund started operating in October 2010, more than 25,000 patients have received cancer drugs that they would previously have been denied. Our priority is to give NHS patients better access to effective and innovative medicines. That is why we will move to a system of value-based pricing for new branded medicines from January 2014, following the end of the current pharmaceutical price regulation scheme.

[Geoffrey Clifton-Brown]

I am grateful to the Minister for giving way, because I sense that she is coming to the end of her speech. Could she comment on two aspects that I raised? The first is the early access to medicines scheme. Quite rightly, the current licensing scheme is intended to eliminate all risk, but could there not be a system whereby, for people with a terminal illness, a drug might be given a provisional licence on a fully informed patient basis so that it could be trialled by those people, perhaps for the benefit of others coming along afterwards? Secondly, could she comment on the issue of strict liability—the legal liability for drugs of this sort being given, which makes it very difficult for people to use such techniques?

--- Later in debate ---

[Anna Soubry]

I am very grateful to my hon. Friend for raising those points. As he will understand, I cannot give a commitment either way on them, but they are very important points—points that I took not only out of his speech, but out of the speech of my hon. Friend the Member for Southport, who referred to me as a lawyer. I am a criminal lawyer, but I am not trying to take any responsibility for this, because it is a long time since I studied negligence and strict liability. However, I absolutely accept that there is a very strong argument to be made that the current state of the law does not help. Equally, there is a strong argument, as has been advanced, about people with a terminal illness being able to be prescribed medicines on a provisional basis, in precisely the sorts of conditions that my hon. Friend the Member for The Cotswolds described.

The hon. Member for Strangford, in particular, raised end-of-life care. That is a very difficult issue. It is the subject of almost endless debate in this place, or at least it should be. For what it is worth, my personal view is that often these matters should be the subject of discussion between a patient and their GP. Although it was many years ago that my father faced a terminal illness, he spoke at length, before the final stages of his illness, with our then general practitioner, who was utterly brilliant, about his death and how that death could be in some way planned for, if it is ever possible to do such a thing. Sometimes that can be done. There is sometimes a certain amount of flexibility to be able to plan a death and to say what one does and does not want. These are intensely personal matters. I sometimes think that there is a danger of over-regulation and almost too much transparency, if there can ever be too much transparency. Sometimes it prevents what should be very private discussions.

The other thing to say is that families, too, often feel excluded from many of these decisions. It is important that families are involved as much as possible, especially when the person is quite elderly. We all know the sorts of case that exist. Perhaps this is an old-fashioned view, but I think that the unique and very special relationship between a patient and their GP—perhaps their nurse as well—is incredibly important, and there should almost be an acceptance that it is between the two of them in the final stages.

Like many Members, I suspect, as a constituency MP I have received letters from constituents who have spoken with real distress about their hopes for the final stages of a loved one’s life just not being recognised. I think that it was the hon. Member for Strangford, or perhaps it was my hon. Friend the Member for The Cotswolds, who talked about the number of people who wanted to die at home but were not able to do so. [Interruption.] It was my hon. Friend, but I am sure that the hon. Gentleman would take up the point as well. As I said, a number of my constituents have spoken very movingly about this. I am thinking of one particular case in which a woman described how she had sat and talked with her late husband about the desire for him to die at home. They were sensible people who had thought these things through, but as it happened, because of a failing in palliative care—we have not got it all right, by any means—that did not happen. That is terribly sad and, frankly, in many cases there are no excuses for it. I am digressing, Mr Caton—forgive me—but I think that we should be able to have a more open and honest debate, which would then bring up the very issues that my hon. Friend has raised.

I have almost concluded my remarks, but I want to touch on a very important point raised by my hon. Friend the Member for Southport about India. I think that I am right in saying that he said that, in his opinion, India did not have a particular history of innovation in creating new drugs. But my view is that it does have a remarkable capacity to look at existing drugs and produce them considerably more cheaply than other countries, including ourselves.

When I went to India last week, one of the things that I came away with was that what drives the Indians is affordability. As might be imagined with a population of 1.2 billion, there are excruciatingly high levels of poverty and deprivation, but there is also an emerging health care system. I know that there is a great deal of research, which is being led by the desire of doctors to improve clinical outcomes. The doctors often go to great research institutions and say, “How can you help us to develop this?” or “How can we solve this problem?” There is therefore innovation in India but my hon. Friend’s point was a good one.

I understand that the development of new drugs for rare and life-threatening diseases is vital, and it is important to the coalition Government. I hope that I have been able to illustrate the breadth of the work that the Government are undertaking to improve access to new and existing medicines for NHS patients and to encourage the development of important new drugs to treat life-threatening diseases. I can assure my hon. Friend the Member for The Cotswolds and others that the Government’s priority is to ensure that NHS patients are able to access the most appropriate treatments to treat and manage their conditions.

Hospital Services (South London)

Anna Soubry Excerpts

Tuesday 22nd January 2013 Westminster Hall

[Heidi Alexander]

My right hon. Friend is right to highlight those issues. I would add that the close working between Lewisham hospital and Lewisham council on child protection has been recognised across the country, and I would not want that to be compromised in any way if the proposals go ahead.

I fear that other A and Es will end up hopelessly overstretched, resulting in worse care for my constituents and many other people in south London. I am also concerned that although clinical evidence exists for centralising some emergency care, such as that for those who are involved in bad traffic accidents or who have suffered a stroke, I have seen nothing showing that better outcomes can be achieved by centralising care for other medical emergencies.

When I was in my 20s, my brother got bacterial meningitis. When he arrived in hospital, after an initial incorrect diagnosis by a GP, the hospital doctors said he had got there just in time—a few more minutes and he might not have survived. He had to have a lumbar puncture taken, and it was only after getting the results that he could be treated. It was one of the worst days of my life seeing a grown man lying in a hospital bed. We were unable to do anything, and we did not know what the problem was. That is why I worry about how long it takes people to get to A and E.

Closing the A and E at Lewisham will mean longer journeys for people who need access to emergency care. It is said that, in a real emergency, people will be in an ambulance, and that may be so, but anyone who lives in south-east London and who has ever been stuck in a traffic jam on the south circular will know how hard it can be, even for ambulances, to get through.

I have spoken at length about the plans to shut the A and E at Lewisham, but may I also raise the impact of the proposed closure of the maternity department? The A and E and maternity departments at any hospital are intrinsically linked. Sometimes things go wrong in labour, even with supposedly low-risk births, and emergency support needs to be available there and then to sort out problems.

More than 4,000 babies are born each year at Lewisham. There has been an 11% increase in the number of births at the hospital over the past five years, and the birth rate is rising. Unlike other health services, maternity care cannot be rationed or restricted. Nationally, we are witnessing the highest birth rate for 40 years—it is particularly high in areas such as Lewisham—and the Government want to close a popular and much needed maternity department.

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

Does the hon. Lady agree that the Government do not want anything at all at this stage, and that the Secretary of State has not made, and will not make, a decision until 1 February?

[Heidi Alexander]

I acknowledge that a decision has yet to be taken, and I take this opportunity to press the Minister to confirm that the decision will be taken on 1 February. If it will be taken before then, it would be useful to know. We are here to present the case for refusing the recommendation.

--- Later in debate ---

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

As ever, it is a great pleasure to serve under your chairmanship, Dr McCrea. I congratulate the hon. Member for Lewisham East (Heidi Alexander) on securing this debate. I have about 10 minutes to respond to all the points. In the normal terms of any debate, there is an airing of conflicting views, different ideas and different points of views, but today there has been no such disagreement; we have had an outbreak of complete agreement among all the speakers and all those who have intervened. Everyone who has spoken this morning has done so with great passion and sometimes with ferocity in defence of the maternity unit and the A and E department at Lewisham hospital.

Let me make it absolutely clear that we are not in this position because of a Government decision or proposal, or as a result of some set of Government cuts. I made that same point a couple of weeks ago in an Adjournment debate that was called by the hon. Member for Lewisham West and Penge (Jim Dowd). I hope that those in the public domain who report these matters make that point very clearly, too. Anyone who seeks to make political capital out of this exercise does so at their peril, because, in many ways, this transcends party political divide and should not be used for party political advantage.

The trust’s special administrator published his report on 8 January, and a decision will be made by the Secretary of State for Health on 1 February.

[Jim Dowd]

rose—

[Anna Soubry]

Will the hon. Gentleman wait one moment, because it is extremely important that I put this on record? The Secretary of State will consider whether to accept the recommendations of that report and will reach a decision by 1 February. As a result of that, bizarre as it may seem to those who do not know the House, I am in some sort of peculiar purdah where I am not allowed to give any opinion of my own. It might be that that is a good idea, I know not, but those are the rules and I stick by them. I am not in a place, as the hon. Member for Denton and Reddish (Andrew Gwynne) well knows, to be able to say whether or not the four tests have been satisfied or, as I have said, to give my opinion. Sometimes, it is extremely difficult for an MP such as myself not to give an opinion.

[Heidi Alexander]

rose—

[Dame Joan Ruddock]

rose—

[Anna Soubry]

I will give way, but please be brief, because I do not have much time.

[Dame Joan Ruddock]

Will the Minister confirm that the four tests are relevant? Will she also note that the Secretary of State has said, “on or before” 1 February? It would be good to have clarity.

[Anna Soubry]

I agree. In such cases, it is imperative that a decision is made sooner rather than later. What is most important—

[Jim Dowd]

rose—

[Anna Soubry]

I have not finished my sentence; do forgive me. What is most important is that the right decision is made after careful consideration. I am pleased that the Secretary of State was true to his word and had a meeting with Members who are rightly concerned about the future of Lewisham hospital on 14 January. I know that it was effectively a listening exercise, because he could not express an opinion. That meeting was held with Matthew Kershaw, who is the TSA, and his officials.

[Jim Dowd]

The Minister mentioned that a decision is to be made on 1 February, which is a sitting Friday. Statements can be made on a Friday, as we saw with the urgent matter last week. Sometimes, statements about issues relating to London can be made, but will the Minister accept that this is an issue of national import? Will she prevail on the Secretary of State to ensure that, whenever the statement is made, it is not on Friday 1 February? Will she give us that assurance now, or seek one from the Secretary of State?

[Anna Soubry]

That is a good point well made. I will ensure that the Secretary of State is fully aware of the hon. Gentleman’s views.

Why are we in this position? That was a question posed by the hon. Member for Lewisham East. Let us be absolutely clear about it. South London Healthcare NHS Trust has six PFI schemes. It is not as simple as putting all the blame on the PFI schemes, as some Members have suggested. The two largest schemes are at the Princess Royal university hospital in Bromley with a £30 million PFI scheme, and at Queen Elizabeth hospital in Woolwich with a PFI scheme of £29.1 million. The PFIs were signed off in 1998, but they certainly do not help the situation.

The trust is losing £1 million of public money a week. That £1 million could be better spent on improving and providing services to all whom these trusts seek to serve. This is a trust that has a £65 million deficit, the largest in the country, so doing nothing is not an option. No Government of whatever political colour would stand by and see the haemorrhaging of £1 million a week. When hon. Members gather again on Saturday for their protest, I hope that they make it absolutely clear to all the good people who attend to support their local hospital that that is the real financial situation. Often, when faced with such realities, difficult and tough decisions have to be made. The simple truth is—and I am sure that the hon. Member for Lewisham East will agree with me—that we cannot continue to have that haemorrhaging and a deficit of £65 million.

[Heidi Alexander]

No one disputes the existence of financial problems, but the closure of A and E and maternity departments affects people’s lives and health. Will the Minister confirm that, were the Secretary of State minded to agree to the proposals put before him, the four tests set by her own Government will be applied?

[Anna Soubry]

I am happy to remind us all of those four tests and principles; they remain as firm as ever. First, any reconfiguration should have the support of GP commissioners. Secondly, there should be full public and patient engagement and proper consultation. Thirdly, there should be a clear clinical evidence base. Fourthly, any reconfiguration should be in support of patient choice.

The hon. Lady comes to the House to represent her constituents and to put forward their views, which she undoubtedly shares, and their anger and concern about their hospital. In her speech, she understandably uses the words outrage and disbelief to say that those four tests, in all or in part, have not been made. She speaks with passion and with detail about the lack of support from GP commissioners and consultants at Lewisham and beyond. She says that this is a hospital that has had many successes and a long-standing investment. She makes the point that, given all the arguments that have been advanced by her and other hon. Members, the decision clearly has no merit.

Let me mention here the interventions by the right hon. and learned Member for Camberwell and Peckham (Ms Harman), my hon. Friend the Member for Dartford (Gareth Johnson), the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock), who speaks in accord with others in support of the hospital, and the right hon. Member for Greenwich and Woolwich (Mr Raynsford). There were speeches by the hon. Members for Lewisham West and Penge and for Eltham (Clive Efford) and by my hon. Friend the Member for Beckenham (Bob Stewart).

This is a very serious subject and I do not want to be flippant. The views of all are certainly taken on board. In due course, the Secretary of State will announce his decision. Therefore, as I said at the outset, I cannot be of great assistance in addressing the various comments that have been made, because I am not allowed to give my opinion. I should, however, mention the contribution of my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes)—I think that I missed him off my list. He gave a thoughtful and frank speech in which he talked about his concerns about the legislation that brought about the appointment of the administrator. He has looked at an alternative and he advanced that.

Finally, the hon. Member for Eltham calls for a review of A and E, but he should do so with great caution. There might be merit in that, but when one embarks on such a review, we have to make it clear that, in those circumstances, some tough decisions might be made, and everyone involved in that would have to sign up to it on that basis.

East Midlands Ambulance Service

Anna Soubry Excerpts

Monday 21st January 2013 Commons Chamber

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

I congratulate the hon. Member for Bassetlaw (John Mann) on securing this debate. Were it not for the fact that I now sit on the Front Bench, I would have put in for a similar debate—there is no doubt about it—such is my concern, as the constituency MP representing Broxtowe, about the situation with East Midlands ambulance service. It is important that I recognise that interest, because I, too, have had many concerns about EMAS, although they are perhaps slightly different from those the hon. Gentleman has described. As a result, I had a meeting with the chief executive of EMAS, Mr Philip Milligan, a week last Friday. I believe that he has since met the hon. Gentleman, so he will have heard about many of the issues that the hon. Gentleman raised in the House today, and rightly so.

I do not believe that this is simply a matter of finance—that is certainly not where my concern lies—or about the “Being the Best” scheme, which has been out for consultation, as the hon. Gentleman described. My concern, and that of many other hon. Members whose constituencies are covered by EMAS, is about poor response times, notably for elderly people who have fallen. My hon. Friend the Member for Loughborough (Nicky Morgan), for example, has had difficulties in her constituency, and I have had half a dozen problems in mine, with frail elderly people with suspected fractures having to lie on the floor, sometimes for up to four hours, despite being less than 10 minutes from the Queen’s medical centre in Nottingham. My hon. Friend the Member for South Derbyshire (Heather Wheeler) is nodding in agreement, as no doubt she has heard of similar experiences in her constituency. That situation is unacceptable, and I hope to offer some insight as to why that is the case.

[Heather Wheeler (South Derbyshire) (Con)]

In South Derbyshire we have had numerous cases of elderly people falling over in a park and having to wait hours for an ambulance. Residents have come to put blankets on them because they know that they should not be moved. We are 15 minutes from Burton hospital, but we cannot do anything because we rely on the professionals.

[Anna Soubry]

I am grateful to my hon. Friend for her intervention, but I think that it is also important to pay tribute to the ambulance staff who work for EMAS and the outstanding work they do. It is also important to point out that between October 2010 and December 2012 EMAS recruited 65 new front-line staff, so something is going on that is not right. Many people are of the view that unfortunately it is the way that EMAS is being run that is at the heart of the problem.

[Mr Mark Spencer (Sherwood) (Con)]

I wonder whether my hon. Friend is aware that Nottinghamshire fire and rescue service, if it has to be the first responder, is often left to look after patients until an ambulance arrives, which could be up to an hour, so the fire engine is not available to deal with a much more important issue.

[Anna Soubry]

As ever, my hon. Friend makes an important point, and it is one that I will certainly look at further. I hope that those in EMAS who are listening to the debate will take that comment on board.

In response to the points made by the hon. Members for Ashfield (Gloria De Piero) and for Chesterfield (Toby Perkins), I do not think that it is as simple as saying that the closure of an ambulance station will de facto reduce the service available. Ambulances do not sit in ambulance stations waiting to respond to a local incident. They spend most of their time out of ambulance stations on the road so that they can respond to emergency calls. EMAS reported—these are important facts that should be widely publicised; I am sure the hon. Member for Bassetlaw will ensure that they are—a total turnover of £169.5 million in its 2011-12 final accounts and a £1.4 million surplus. It has also reported surpluses in the previous three years. I understand that for 2012-13 the trust received £3.5 million funding as its share of the EMAS contract from Bassetlaw primary care trust. As I have said, my concern is not so much about the money, but about the way the service is being operated.

Let me turn to the “Being the Best” review. EMAS tells me that it recognises that its response times in rural areas do not match the response times in city centres. In response, EMAS published its “Being the Best” change programme in 2012, which outlined plans designed to ensure that response times and the service provided to all the people of the region were improved. As the hon. Member for Bassetlaw described, EMAS has consulted clinical commissioning groups, overview and scrutiny committees and local people on its proposals. As we have been told, it received substantial feedback from the people of Bassetlaw, with a petition from some 9,000 people. The business case should be presented to the board on 25 March, allowing the trust additional time to review alternative options and develop final proposals for the board to consider.

I am told that a number of options are being considered. They include the “do nothing” option, which involves making no changes to the configuration of ambulance stations; the “do nothing-plus” option, which involves making no changes to the configuration of ambulance stations, but making an additional resource investment in more ambulance vehicles and staff; and the “do minimal” option, which involves making the minimum changes necessary to deliver current service standards in a safer and more effective manner. That option would retain all the current stations and introduce the 118 new community ambulance posts. The fourth option would establish 13 hubs, plus 118 community ambulance posts—I know that my hon. Friend the Member for High Peak (Andrew Bingham), along with many hon. Members, has expressed his concern about that option. The fifth option—a new option—would establish 27 hubs, plus 108 community ambulance posts, and is being considered as a direct result of the consultation feedback.

[Andrew Bingham (High Peak) (Con)]

Does my hon. Friend think, like me, that although the hub and spoke model has merit, the key is where the hubs go? High Peak is very rural; we need a hub, as I am sure the hon. Member for Bassetlaw (John Mann) feels he does.

[Anna Soubry]

That is a very good point. My hon. Friend has summed it up—we are having an outbreak of cross-party unity. As he says, the key point is the positioning of the hub. One of the attractions of the hub approach is that the mechanics would be in place to ensure that the vehicles were ready at the beginning of a shift. At the moment, paramedics are responsible for that, which does not seem to be a very good use of their time. There is therefore much merit in establishing 27 hubs in the right areas to ensure that we have a service that is fit for purpose.

There is something else that needs to be, not so much explored, perhaps, as exposed. The hon. Member for Bassetlaw has quite properly commented on the difficulty of having targets, and I could not agree with him more. This debate is a good example of where top-down, Government-led targets have blighted an ambulance service—no doubt there are many other examples in the NHS. That is why, when this Government were elected, for many of us it was on the basis that these targets, far from freeing up services and making them better, were strangling them and making them worse. This debate is an example of targets doing all the things they were designed not to do, constricting a service and making it worse. It is worth bearing it in mind that it was in 1997, I believe, that the ambulance service suffered from such targets. I hope that there will be more cross-party agreement and moving forward, so that although there are laudable aims that all services should have, we should not necessarily set rigid targets, which then create exactly the sort of horribly sad cases that the hon. Gentleman told us about.

[John Mann]

Is the Minister saying that she is going to get rid of them?

[Anna Soubry]

No, the Minister is not saying that she is going to get rid of them; what I am saying is that I take the view—as the hon. Gentleman does—that targets are not particularly improving services. I think there is a case for re-examining targets, and I hope he would join me in saying to the ambulance service, “Let’s look again at these targets in the NHS to see whether they’re doing the job we want them to do,” because it is precisely because of these targets that elderly people in my constituency have been lying on floors for up to four hours while ambulances have to go to meet a target.

[Toby Perkins]

The hon. Lady seems to be saying that the ambulance service is so focused on targets that it is incapable of recognising that leaving an old lady lying on the floor for four hours is reprehensible and appalling. She is letting the ambulance service off tremendously lightly to suggest that that is reasonable.

[Anna Soubry]

I am not saying that it is reasonable at all. What I am saying is that this was the system introduced under the last Labour Administration— a Government whom the hon. Gentleman supported. These are the precise consequences of that system; it is the perversion of that system that has led us to a situation in which targets have to be hit. I can assure hon. Members that I explored this matter with Mr Milligan, and an elderly lady lying on the floor with a suspected fractured hip does not fall into the category of an emergency life-threatening situation. These are not definitions imposed by this Government; these are the consequences of the 13 years of the previous Administration. I take the view that the situation needs urgent review, and I will certainly be making that recommendation in the Department that we need to look again at the ambulance service.

[Mr Dennis Skinner (Bolsover) (Lab)]

Does the Minister agree that a lot of people in the east midlands, including many of the Members who have spoken here tonight, are dealing with pretty much the same kinds of characteristics in the old mining areas and rural areas? In my area of Bolsover and mid-Derbyshire, it seemed as though the 17 control centres were going to be reduced to two. I get the impression that the Minister is saying that most of the 27 would be likely to remain. It is hard for me to say this, but do we have a cross-party agreement to save those in mid-Derbyshire that cover Bolsover as well?

[Anna Soubry]

I have to say that, for the first time, I am almost speechless. It is not for me to say what is my preferred option. That decision has to be made at a local level. As the hon. Gentleman might imagine, however, I may have a point of view on the preferred option, and I am entitled to make my view known to EMAS, as indeed I will. I take the hon. Gentleman’s important point about the former coal-mining communities —they are similar to my own, although mine is not on the same scale as Bolsover. I make the point again, however, to be fair to EMAS, that the reason it has gone through this process—which has been painful for many people—is precisely because it wants to improve its service. It recognises that rural areas do not receive the kind of service that urban areas do.

[Chris Heaton-Harris (Daventry) (Con)]

In the last couple of minutes, will the Minister address the concept of regionalisation of a service such as this? We have previously seen money being wasted on the regionalisation of the fire service, and many of us with constituencies on the periphery of the East Midlands ambulance service really worry about this. The hon. Member for Bassetlaw (John Mann) talked about the hospitals outside the region that his constituents go to. My constituents go to hospitals in Oxford, Coventry and elsewhere. Does this mean that those of us in the rural outreaches of the east midlands are the ones who have to pay for this centralisation?

[Anna Soubry]

My hon. Friend’s intervention raises a point that I hope I can help him with. There is absolutely nothing to prevent an ambulance in Daventry from going to whichever hospital offers the best treatment for that particular patient. Exactly the same applies in Bassetlaw. Under the new rule, there will be nothing to prevent a patient from going to Doncaster royal infirmary, or up to Sheffield, or indeed down to the Queen’s medical centre in Nottingham. The changes will not affect the ultimate decision of which is the best hospital for that particular patient—[Interruption.] The hon. Member for Bassetlaw is chuntering at me. Does he wish to intervene on me?

[John Mann]

I was saying that we need the ambulance to be there in the first place in order for it to take people to those hospitals. That is the whole point.

[Anna Soubry]

With great respect to the hon. Gentleman, he misses the more important and indeed more valid point that just because there is an ambulance station in a particular town or village, that does not mean to say that there is always an ambulance sitting there waiting to serve that town or village. What is important is—

Dementia

Anna Soubry Excerpts

Thursday 10th January 2013 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I congratulate right hon. and hon. Members on securing this important debate. The speeches have been moving and thoughtful. Today has demonstrated the best of Parliament, with MPs coming together and contributing to how we can resolve the dreadful issues around dementia. I am grateful to have the opportunity to speak today as, in addition to representing a constituency in Oldham where, in 2010, 2,318 people were diagnosed with Alzheimer’s, the most common form of dementia, I have personal experience of being the daughter and carer of someone with Alzheimer’s. I would like to bring that personal experience to the debate.

In September last year, my mother died of Alzheimer’s. She was only 74. In 1992, she remarried and moved to the US, and it was there, 10 years later, that she was diagnosed with the disease.

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

Does the hon. Lady agree that those who have experienced these sorts of incidences first hand can bring to debates a remarkable amount of insight to, and understanding of, these conditions? Does she also agree that it is important for us all, especially Government, to listen to those experiences, so that we might be able to learn from them?

[Debbie Abrahams]

I am very grateful to the hon. Lady for her intervention. I totally agree.

My mother was 64 when she was diagnosed and was still working. She told me that she stood in the middle of the office where she worked and could not remember why she was there. Not only did she find it abhorrent to be diagnosed with this devastating degenerative disease, but the financial consequences of having to give up her job were a severe blow too.

To watch her decline was nothing short of heartbreaking. Two years after she was diagnosed, the penny dropped for me when we went to a restaurant and she was given a menu. As my hon. Friend the Member for Bridgend (Mrs Moon) said, it is so important to make sure that people with dementia still have as much control over their lives as possible. She looked at the menu, and kept on looking at it again and again. She did not understand what she had to do with the menu—one of the practical consequences of the disease. She became a different person—not a better or a worse person, just different. As much as I loved my old Mum, I loved my new Mum too. I will remember until the day I die the first time she did not recognise me, which was about four years after she was diagnosed. She was very distressed, because she knew that I was someone of importance to her, but she did not know her relationship to me. Needless to say, the pain I felt was—well, I cannot explain.

My mother went from being a brilliant, vivacious, caring woman—a woman who invented the term social justice before it entered the lexicon—to a woman who gradually lost her ability to communicate, feed or toilet herself. In the last year of her life, she became wheelchair-bound and in her final month completely bedridden. She was unable even to lift her head and the end came shortly after she lost her ability to swallow.

In many ways we were very lucky because my mother remained physically well for so long, but also because up until the last year of her life she seemed relatively content, smiling and laughing, particularly around animals and children, as she had always been. I agree with my hon. Friend the Member for Bridgend that people with dementia understand far more and we have to find ways of communicating with them. My hon. Friend the Member for Liverpool, Walton (Steve Rotheram) also talked about different ways of engaging with people with dementia.

Unfortunately, the care arrangements in the final year of Mum’s life, and ultimately the circumstances around her death, can only be described as shameful. She was in the US at this stage. After much consideration, I have decided to talk about this now because dementia has such consequences for everybody in this country and across the world. Up until 2011, my stepfather, who is 81, had been Mum’s main carer, although he paid for a carer to help Mum get up in the morning in their New York home. I used to provide respite for him during my leave, but the physical and emotional toil and strain was taking its toll and he began looking for caring support.

That support was offered by an acquaintance of his who offered to provide care for my mum for an agreed fee. Over a few months, unbeknown to me or my family, the new carer moved into the house, got access to their finances, sold their home and drove them more than 800 miles away from my stepfather’s family in New York to South Carolina, where they knew nobody. Within a week of the move, my mum was admitted to hospital and we were told that she had days to live. When I arrived, I was shocked to see their circumstances: they had moved from a comfortable family home to what can only be described as a hovel, and the female carer had gained almost complete control over their lives. I alerted Adult Protective Services in South Carolina to my concerns for my mum’s and stepdad’s welfare on 24 August. After week’s of chasing it, including through the Governor’s office, I got a reply on 19 October saying that it deemed my father, whom it had never even met, to be competent and would not be taking it any further. Unfortunately, my mum had died by then.

My mum’s story is not unique. The stages in her decline and her and my family’s experiences are being replicated in this country and across the world. My story happened in the US and, based on my discussions with adult protection teams in this country, I am confident that the casual response from Adult Protective Services in South Carolina would not be reflected here, but there are still lessons to learn. We must ensure that the regime we set up around carers protects people with dementia from exploitation. I fear that, as has happened in other areas of the world where personal health budgets and individual social budgets have been introduced, some of the moves towards personal budgets here will lead to fraud and exploitation.

I could speak for hours about what I believe we need to do, but I would like to raise just a few points. First, as individuals, families and communities, we need to be more aware of the disease, as has already been mentioned. The odds are that most people will be affected by this disease. It might not be themselves or their family, but it might be their friends or neighbours, and we need to do more to protect ourselves against the disease. The Alzheimer’s Society is a wonderful resource, as we just heard, for information and support. We need to keep active and healthy, not smoke and so on—all the messages we know so well.

We need to do more on research. I fully support and recognise what the Government are doing in increasing research funding—it is such an important area—but the moneys being dedicated are paltry next to the scale of the problem. We need to address that. I was pleased to hear what my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said about the Wellcome Trust funding, and I hope that we can pursue that more.

Finally, we need to do far more at health and care service levels. As I said, 2,318 people in Oldham were diagnosed with Alzheimer’s in 2010 and more than 800,000 across the country. By 2020, it is estimated that this number will have increased to 1 million. Most worryingly, however, as we have already heard, that is an underestimate and is probably half the actual scale of the disease. Apart from the human cost, £23 billion is spent treating and caring for Alzheimer’s patients every year. This will rise to £27 billion by 2018 and will continue to increase. There is already a care crisis in this country, with cuts to adult care services in the NHS, and this will only get worse, not better. Care services are already at breaking point. How will families cope with Alzheimer’s? It is a ticking time bomb. I urge the Government and the Opposition to work together to reach a cross-party consensus on how we fund and deliver a national care service, and that must include the Treasury teams. We cannot afford to kick this issue into the long grass any longer.