Crohn’s and Colitis Treatment: England

Anne Main Excerpts

Wednesday 24th February 2016 Westminster Hall

[Mrs Anne Main (St Albans) (Con)]

I beg to move,

That this House has considered the treatment of people with Crohn’s and colitis in England.

It is a delight to serve under your chairmanship, Sir Roger. I am aware that there are different treatments in Scotland and Wales, but I want to focus on Crohn’s disease and colitis in England.

I am pleased to be leading this very important debate on Crohn’s and colitis, which affect more than 250,000 people in England and 300,000 in the UK. I have been working with the charity Crohn’s and Colitis UK, some of whose members are here today. They would be delighted to meet any hon. Members participating in the debate because they would like to get some publicity for that particularly wonderful charity, which is based in my constituency in St Albans. It does a tremendous amount of work for those who live with these challenging conditions.

I am also pleased to say that I have been reading the feedback from the digital debate on Facebook. That is a new concept, and I am very pleased that the House is offering it. I wish to express my thanks to Crohn’s and Colitis UK and the Westminster Hall digital debate team for arranging the online forum. We received 1,068 comments on the forum, and the posts were shared 258 times and liked 734 times, so it has been highly informative to this debate.

Crohn’s disease and ulcerative colitis are the two main forms of inflammatory bowel disease. Both are chronic lifelong conditions that cause inflammation of the digestive system. Ulcerative colitis affects only the large intestine, whereas Crohn’s disease affects the whole digestive system. According to the National Institute for Health and Care Excellence, it is estimated that in the UK 115,000 people have Crohn’s disease and 146,000 have ulcerative colitis. That is an estimated 460 people per constituency. I keep using the word “estimated” because there is no national database. At my last meeting with the charity, it stressed that it would very much like there to be a national database and better record keeping on those people who are presenting with the disease.

The most common symptoms of inflammatory bowel disease include diarrhoea, cramping pains in the abdomen, tiredness and fatigue, and loss of appetite and loss of weight. The exact causes of Crohn’s disease and ulcerative colitis are unclear, but there is evidence that IBD can cluster in families, and having an affected family member is a risk factor. IBD is a lifelong condition, but people can get it at any age. It most commonly first presents in the teenage years and early twenties—the mean age of diagnosis is 29.5 years. About 18,000 new cases of IBD are diagnosed each year, and that number is increasing. This is not a trivial complaint. IBD can be painful, disrupt normal activities and reduce quality of life, particularly during periods of active disease. These conditions can affect the individual’s ability to work, learn, socialise and form and maintain relationships.

We British are famous for our lavatorial sense of humour, and just saying the word “bottom” or “bum” is usually enough to bring on a fit of the giggles, so it is no surprise that we, the British public, are not good at discussing bowel problems or even seeking help for them—no wonder IBD has been described as a hidden disease. That reluctance can lead to sufferers feeling isolated and stigmatised.

According to Crohn’s and Colitis UK, the causes of IBD are a combination of factors. Those include the genes that a person has inherited, together with an abnormal reaction of the immune system to certain bacteria in the intestines, probably triggered by something in the environment. Viruses, bacteria, diet, smoking and stress have all been suggested as environmental triggers, but there is no definitive evidence that any one of those is the cause of IBD. That is why, as I know the charity would also say, we need more research and more evidence. We need IBD to have a higher profile, as it affects so many of our constituents.

There is currently no cure for Crohn’s or colitis. The main aim of treating IBDs is either to heal the inflammation and so reduce symptoms during a flare-up or to prevent flare-ups from happening. NICE has recommended a number of different medicines for IBD, which can be taken in different ways by patients, but if individuals do not respond to medication, surgery is considered as an option—20% of people with ulcerative colitis and about 60% to 70% of people with Crohn’s disease go on to have surgery. A large number of our constituents will be forced to have surgery as a result of the disease. The lifetime medical costs for IBD are comparable to those for other major diseases such as diabetes and cancer. It is estimated to cost £900 million per annum, UK-wide. Crohn’s and Colitis UK currently funds about £500,000-worth of research every year into the causes of IBD, and treatments and care for people with IBD. Although that sounds like a large amount of money, in terms of the number of sufferers it is not a large amount.

There is a new research study under way from the National Institute for Health Research, called the IBD BioResource. The aim is to accelerate research into Crohn’s disease and ulcerative colitis and build on recent major advances in the understanding of the genetic basis of these conditions. The IBD BioResource is being launched for roll-out nationwide through 2016. I ask my hon. Friend the Minister how much support the Government are giving to the IBD BioResource study.

Crohn’s and Colitis UK says that there is a low level of awareness of IBD among the public, policy makers and even clinicians. It says:

“Public awareness of IBD is lower than for Parkinson’s and MS”—

multiple sclerosis—

“respectively, despite more people being affected by IBD than both diseases combined.”

Most of us will be very familiar with those two diseases.

At this point, I want to include some of the comments from the digital debate on Facebook. One contributor said:

“I’ve had Crohn’s for 18 years. For me it’s pain, fatigue and always having to explain to people what’s wrong with me and why I can’t come to work or do things.”

Another referred to:

“The Stigma of having a bowel disease. People not believing you and belittling how you feel because they can’t see it.”

Another said that we need:

“To raise more awareness of the illness! Make people more aware of what we go through on a day to day basis!”

Another talked about:

“Having to try, and try, and TRY to make people realise that it’s a disability and that just because you ‘don’t look ill’ (in a wheelchair) you still have issues that they will never understand.”

Many made the point that the illness controls and disrupts their lives to such an extent that they are in fact disabled by it. It is a hidden disability, and many call for it to be recognised as a disability. Therefore my question for the Minister is this: what are the Government doing to increase awareness of inflammatory bowel disease, and what are they doing to measure accurately the number of people living with IBD in England?

The charity tells me that early diagnosis of Crohn’s and colitis can prevent emergency hospital admissions, which have a cost to the NHS, and can help to avoid clinical complications. Unfortunately, in a substantial number of cases that is simply not happening. Studies have shown that 35% of people with Crohn’s and 16% of people with colitis had three or more emergency admissions before they received their diagnosis.

In the digital debate on Facebook, a sufferer said:

“I was treated for 6 months by my GP for food poisoning and/or anorexia before eventually ending up hospitalised as an emergency. The hospital did biopsies that day and confirmed Crohn’s. My Crohn’s turned out to be particularly aggressive and unresponsive to treatment and numerous surgeries.”

Another said:

“GPs need to be more up to date with IBD and stop saying it’s just a virus or IBS”—

irritable bowel syndrome. They continued:

“It took quite a few years of pain and complaining before I was diagnosed with Ulcerative Colitis.”

There is clear guidance from NICE on referral. The NICE quality standard for IBD states that people who have been experiencing abdominal pain or discomfort, bloating or a change in bowel habits, such as diarrhoea, with or without rectal bleeding, for at least six weeks should be suspected of having IBD. However, the feedback is clear that for many that is currently not happening and the guidance is not being followed.

NICE recommended faecal calprotectin testing as an option to help doctors to distinguish between inflammatory bowel diseases, such as Crohn’s and colitis, and non-inflammatory bowel diseases, such as IBS. That testing should enable quicker identification of suspected IBD and referral to a specialist, and reduce the number of unnecessary endoscopies carried out. Therefore more effective use of faecal calprotectin testing in primary care should enable quicker and more economical diagnosis of IBD patients, ensuring better and more efficient care in England.

What steps will the Minister take to improve the identification of suspected IBD? What are the Government doing to increase awareness of IBD in general practice among GPs? What steps will she take to improve the rate of referral of people with suspected IBD from primary care to the experts in secondary care? Will the Department undertake an evaluation of the uptake of faecal calprotectin testing by clinical commissioning groups, which NICE recommends, and the time taken by labs to process the results?

The IBD standards have been widely recognised throughout the IBD community, and later rounds of the IBD audit have benchmarked IBD services directly against them, but there is still a lot to do. Some 14% of services are still unable to provide people with Crohn’s or colitis with access to an IBD specialist nurse. Many of us would think of having access to a Parkinson’s specialist nurse, but IBD specialist nurses are few and far between, and many that have them struggle to maintain that vital service. Nearly one in four—23%—of all services have no access to specialist nutritional support despite the high level of malnutrition experienced by people suffering with IBD. Only 12% of services have a clear process to enable people with IBD to see a psychologist or a counsellor with a particular knowledge of IBD, and IBD has been described on many occasions as being a traumatising disease that leaves many people feeling isolated and unable to discuss with anyone—sometimes even their partners and closest friends—the reasons why they are often ill.

Sufferers complained online of a postcode lottery with IBD nurses. The lack of nurses was cited by many, who also said that GPs needed more training to identify people with Crohn’s and to assist in providing faster referrals or appointments when treatments need adjusting. Some sufferers found that their GP even seemed reluctant to make those referrals. Many sufferers said that employers need to have a greater awareness of the impact of IBD on their employees, especially given that flare-ups can occur at any time.

What is the Department doing to ensure the implementation of the IBD standards in England, and can the Minister give assurances to those living with IBD that they will not be forgotten on a strategic level by the NHS? What action is the Department taking to ensure that the NICE quality standard for IBD disease is being implemented across England? For those living with IBD, debilitating symptoms such as diarrhoea can occur instantly and unpredictably. Crohn’s and Colitis UK has been championing quick access to suitable toilet facilities. I hope the Minister will encourage all local authorities to evaluate the public toilet provision in their locality.

[Christina Rees (Neath) (Lab)]

Increasing access to toilets away from home is of benefit to all groups in society but it is especially crucial for those living with Crohn’s and ulcerative colitis, who have concerns about not reaching a toilet in time. Does the hon. Lady believe that other nations in the UK can learn from Welsh Labour’s Public Health (Wales) Bill, which treats access to toilets as a public health issue?

[Mrs Main]

It certainly is a public health issue. In the first Parliament I was in, from 2005 to 2010, I was on the Select Committee on Communities and Local Government and we looked into the issue of toilet access. I do not think that much has improved since then and that was under a Labour Government. I am sorry to say that we have not made a lot of progress. At the time, ordinary businesses were showing and displaying signs reading, “We welcome people using our public facilities.” The evidence that came out of that Communities and Local Government Committee report was that toilet provision was not just needed for people with things such as Crohn’s and colitis—there was a vast spectrum of other conditions for which people would welcome toilet provision, but that is for another debate.

It is very obvious that more focus on the cure and cause of IBD is urgently needed. I hope the Minister will give sufferers of this debilitating disease a cause for hope and a better future. I look forward to her answers—I hope she can give them today—to a large number of the questions that I have raised on behalf of those who have responded to the online debate and on behalf of the charity Crohn’s and Colitis UK, which is doing such a lot of good work. Look for the purple badge.

[Several hon. Members rose—]

NHS Trusts: Finances

Anne Main Excerpts

Monday 1st February 2016 Commons Chamber

[Ben Gummer]

I accept the case for the “Five Year Forward View”. Simon Stevens was very clear that the relationship between social care and the NHS needs to be transformed. That called for an additional £8 billion into the NHS, which we have provided, and it required additional money for social care. We have provided that in the better care fund and the council tax precept.

[Mrs Anne Main (St Albans) (Con)]

West Hertfordshire Hospitals NHS Trust has been struggling for a very long time. For five of the 12 years from 1998 to 2010, it registered a deficit, which peaked at £27 million in 2005-06. It is struggling because of a backlog of repairs and maintenance to its elderly estate, through a lack of investment from the previous Labour Government. What more can be done to help hospital trusts that are struggling with a massive backlog of ongoing maintenance?

[Ben Gummer]

My hon. Friend is entirely right. I went to Watford a few weeks ago, and the buildings are in a poor state of repair. They do not enable clinicians to provide the high standards of care that they all aspire to; in many cases, it is difficult to do so. West Herts trust requires additional capital expenditure. I have talked with the trust about how it might realise that, and I am discussing that in the Department at the moment.

Care Homes: England

Anne Main Excerpts

Wednesday 13th January 2016 Westminster Hall

[Paula Sherriff (Dewsbury) (Lab)]

I recently took part in a conference organised by the GMB trade union along with carers and people who run care homes. Those who run care homes expressed specific concerns about the fact that they were aware of people—and particularly older people—sometimes being kept in hospital when there was no real medical need for them to be. If we compare the costs, it costs a couple of hundred pounds a day for them to be staying in hospital—

[Mrs Anne Main (in the Chair)]

Order. The hon. Lady’s intervention is becoming a speech.

[Paula Sherriff]

Okay. Does my hon. Friend agree that we should speed up the transitional process and put pathways in place, so that the move between hospital and care homes can happen much more efficiently?

--- Later in debate ---

[Andrea Jenkyns (Morley and Outwood) (Con)]

I have been a councillor, so I know that budgets have been quite tight in local authorities over the years. A care home in my constituency, Siegen Manor, is possibly due to close. Does the right hon. Lady agree that we need to look at the way councils spend money? In my new city council, there is a lot of wastage. We need to look at how councils spend their money, because I could give a lot of examples of how they could—

[Mrs Anne Main (in the Chair)]

Order. I call Joan Ryan.

[Joan Ryan]

It is always important that we have a weather eye on how any public authority is spending its money and that we get the best value for money; that goes without saying. However, I think—I do not believe the hon. Member for Morley and Outwood (Andrea Jenkyns) was disagreeing with me on this—that we need to hear from the Government how local authorities can be expected to cope with the size of cut that has been happening and is continuing to come their way. I thank the hon. Lady for her intervention.

Spending reductions of the size that my local authority is facing will almost inevitably result in cuts to the services that Enfield delivers to some of the most vulnerable people in the borough. Given the huge pressures on shrinking resources, I commend Enfield Council for its nationally recognised standards of best practice and the gold accreditation that it has received for its safeguarding work. Enfield has a wide range of care homes, which provide support to older and disabled people not only from the local area but from other areas. However, the deep cuts from central Government have already seen care homes close, and a significant increase in the number of people placed in the borough by other councils has meant that nursing home provision, particularly for people with dementia, is under severe strain. As a result, an ever increasing burden has been placed on our local NHS services and family carers. In those circumstances, it can be no great surprise that there is difficulty in recruiting and retaining staff to work as care providers.

Front-line care workers are all too often grossly undervalued. They offer vital support to people with ever more complex conditions, yet in return they often receive very poor wages. So although I welcome the introduction of the national living wage of £7.20 from April 2016, that figure is nowhere near the current London living wage of £9.40. Many care workers working in Enfield and elsewhere in London need that hourly rate just to get by. However, the Government have yet to explain how the care sector will be able to cope with the increased pressures on payrolls when funding has been so drastically cut. It is estimated that the introduction of the national living wage will add at least 5% to payrolls from 2016-17 and a further 7% every year until 2020. That will drive even more front-line care providers out of business and make a bad situation even worse.

I would like to draw to the Minister’s attention a letter I received from the Enfield Carers Centre in August last year. It read:

“Dear Joan Ryan

I am writing to you on behalf of Enfield Carers Centre to ask if you will support us in an urgent call that we are issuing to the Chancellor George Osborne in advance of the 2015 Spending Review.

In the Summer Budget, the Chancellor announced that, as of 2016, there will be a new compulsory National Living Wage of £7.20 per hour. We welcome support for care workers who deserve decent pay. However since we are dependent on local authorities paying us enough to pass this on to our valued care workers this increase therefore has to be reflected in the hourly rate paid by local authorities for care and support.

A report by the UK Homecare Association (UKHCA) has found that councils are going to need an additional £753 million to ensure their local care providers can meet these new pay requirements. Without that funding, care services risk closing down entirely…Care services have been badly affected over recent years by cuts and this is a financial stretch which we cannot meet. Quite simply the home care market, is at risk of collapse.”

I do not think that the Enfield Carers Centre got the answer it was looking for from the Chancellor, and I hope that it will hear some better news today from the Minister. I agree with the National Care Association when it states:

“UK Care Services are an irreplaceable part of the fabric of the NHS. There should be no doubt that what is under threat is a UK support service which is essential to local government and NHS care provision.”

I would like to know how the Minister will address those concerns and what steps the Government intend to put in place to provide a transparent and sustainable funding settlement for social care. The older and disabled people who rely on the service, their families and the all too often unsung heroes who work in it deserve no less.

--- Later in debate ---

[Anna Turley (Redcar) (Lab/Co-op)]

It is a pleasure to serve again under your chairmanship, Mrs Main. I thank my hon. Friend the Member for Hove (Peter Kyle) for obtaining this important debate with his customary determination to tackle the big challenges of the day and his concern for the most vulnerable in society. As everyone on both sides of the House has agreed during the debate, older people deserve the right to live with dignity and decency; but, as has also been discussed, too often that is not the case, and I am afraid the situation seems set only to get worse.

Eighty-six per cent. of care home places are run by the private sector for profit. Local authorities are the largest single purchasers of those places across the country. Because of intense budgetary pressures, which my right hon. Friend the Member for Enfield North (Joan Ryan) and my hon. Friend the Member for York Central (Rachael Maskell) clearly explained, local authorities reduced their fees by an average of 5% between 2010-11 and 2015-16. According to the sector analysts LaingBuisson, the care home sector is closing more beds than it is opening for the first time since 2005, with a net loss of 3,000 across the UK last year. In the north-east we expect to have a substantial crisis in social care as a result of the Government’s failure to grip the issue.

As my hon. Friend the Member for Hove said, the homes most at risk are those dependent on residents paid for by local councils at rates far below those paid by self-funding residents: proprietors say rates are actually below break-even point. In the north-east, only 18% of people requiring care are self-paying, compared with 54% in the south-east. In Surrey, by contrast, only 1% of people in residential homes are paid for by the state.

The Financial Times has noticed that the care home market is highly polarised between lucrative self-pay homes, mostly in south-east England, and those with local authority residents, such as Redcar and Cleveland, which are struggling. Given that disparity between areas such as Surrey and areas such as mine, and since there is a crisis in the funding not of residential care but of state residential care, it is probable that the market will not collapse nationally, but will fall over in areas such as mine where the state is the main payer. If a major provider struggles it is likely to mean that it will close its homes in the north but not the south.

There is no capacity in local government to take over those homes. Any private sector supplier that did so would be taking an unsustainable risk, because they are currently loss-making businesses. At the moment there appears to be no plan B for the Government. I want to ask the Minister whether he accepts the scale of the impending crisis. Crisis point will be reached shortly in our region as demand continues to increase while spending is drastically cut back. The Government’s care legislation will further increase the burdens on councils in England. The only way in which providers can make any money is by cutting services and by squeezing workers’ pay and conditions.

The comprehensive spending review in December 2015 gave councils the option of adding a social care precept of up to 2% to annual council tax bills to raise extra money to pay for adult social care. However, as well as being regressive, as we have already discussed, the precept will at best raise £2 billion by 2020, against a predicted funding gap of closer to £8 billion. Indeed, the King’s Fund estimates that at best the precept will raise £800 million.

I want to use this opportunity to raise some contributory factors to the crisis, which the Government need to address, and I will begin by talking about the care workforce and national minimum wage compliance. The Resolution Foundation has estimated that care workers—both those in care homes and those providing home care—are already collectively cheated of £130 million a year because of sub national minimum wage pay. That is driven by chronic underfunding of the care sector, poor employment practices, poor commissioning practices and the ineffective enforcement of the national minimum wage by Her Majesty’s Revenue and Customs.

One employer, which will remain nameless at this stage, has put to its workforce a set of proposed changes to terms and conditions, to prepare for the introduction of the national living wage. Those include withdrawing all bank holiday and overtime enhancements, removing contractual sick pay, scrapping the meal allowance for workers when they are eating with clients, asking workers to pay for their own registration with the Disclosure and Barring Service, enforcing eight hours per annum of unpaid training time, introducing new duties and making changes to existing duties. In care homes non-payment of the national minimum wage is driven by a failure to pay for actual hours worked, such as when staff are not properly recompensed for overnight sleep-ins or time spent training; failure to pay for uniforms; and deduction of money for accommodation that does not form part of an employment contract.

The Financial Times has said that,

“businesses that run care homes for the elderly are at risk of going bankrupt, especially those reliant on revenues from local authority funded places, from a double blow of the imminent increases in the minimum wage and tighter immigration rules, making it harder to recruit from overseas”.

That is the issue I want to discuss next. The care sector is particularly dependent on migrant labour. The latest estimates suggest that nearly a fifth of the workforce are non-British. Unison has highlighted a particular problem in the care home sector with regard to the treatment of migrant workers. In a recent round-table event, a group of Filipino workers reported that they were paying £300 a month each to share a flat with only one toilet and no lounge at the residential care home where they worked. The rate paid for the work they did was £7.02 per hour, but there were then monthly deductions. The deductions were for their uniform—they got one per year but had to pay every month—and for training; that is a breach of national minimum wage law. The cost would normally be more than £200 a month, and it transpired that the workers were not necessarily getting the uplifts in the minimum wage that they were entitled to.

The round table also heard that a working week for the staff could sometimes be as long as 60 hours, depending on staffing levels, despite the fact that they were contracted for 36 hours. They could also find themselves working a 10-hour night shift for a paltry £35, way below the national minimum wage, and with no sleeping permitted. The employer extorted £500 each from that group of workers as their initial five-year period in the job came to an end, on the basis that payments were needed to retain a licence to hire foreign workers and to protect their immigration papers. The staff were also subject to body searches before meeting the employers. To compound matters, they were then obliged to pay fees of £2,000 each for a solicitor to renew their work permits—in cash. The work permits are for work with that one employer, so if the workers lost them they would lose their visa and have to leave the country. Not only is the exploitation of immigrant workers immoral, but it drives down terms and conditions across the sector for all workers and reduces the number of job opportunities for local people.

I want to discuss some wider problems in the care home sector. The social care workforce are predominantly female, with the latest estimates suggesting that 82% of care workers are women and that the percentage is broadly similar across all types of care. Social care is a highly gender-segregated sector, with low pay and poor conditions reflecting, as my hon. Friend the Member for York Central has mentioned, the historic undervaluing of what is deemed to be women’s work. Compared with other sectors, the workforce are also particularly concentrated in the 45 to 60 age bracket. Government-backed attempts to move away from that disproportionately middle-aged demographic have foundered, largely on the basis that the quality of work, pay and conditions is simply not attractive enough to bring in younger staff.

Residential care tends to be based on shift work and there are often problems with short-staffing, with care workers being called on at short notice to cover shifts. That can be particularly problematic for night shifts, where the compensation is often insufficient. There may also be pressure from care providers to work beyond a 48-hour working week. Vacancy rates and staff turnover are high across the sector. Councils are struggling to retain social workers in the face of high caseloads, a blame culture and competition over pay. High turnover has damaging implications for the continuity and quality of care.

There is no English language requirement for care workers whose first language is not English. The overall level of training and qualifications across the care sector is low. There are expectations of induction training for staff but the nature and quality varies considerably. There is less training available in outsourced services, and there are particular concerns about agency staff not receiving training. There are increasing expectations for care workers to carry out medical treatments that have previously been the preserve of nurses or other NHS professionals, but there is no concomitant expansion in training. There are no longer any universal standards for providers to meet benchmarks for percentages of trained staff in their workforces. Without obligations it makes no business sense for providers to do that training voluntarily, because of the high turnover of staff. There is also no central quality assurance mechanism for training, which leads to a lack of faith in qualifications, and no incentive—

[Mrs Anne Main (in the Chair)]

Order. I ask the hon. Lady to bring her remarks to a close in the next few seconds.

[Anna Turley]

I will. In summary, the Government’s crisis in funding for care homes has pushed the sector to the brink. Terms and conditions for the workforce are being squeezed, and the current funding structure for local authorities is simply unsustainable. The Government must get a grip.

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I thank the hon. Member for Hove (Peter Kyle) for securing this important debate. As Members might imagine, I have listened with great interest to the debate, albeit from a Scottish perspective. However, it is in all our interests and, indeed, in the interests of a decent society that those who require care can access the care they need, and are treated with dignity and respect wherever they live in the United Kingdom. There are challenges, many of which have been debated this afternoon, as our ageing population grows in number and as needs become more complex, requiring additionally trained and supported staff, and bringing all the pressures outlined by the hon. Member for Hove.

I declare an interest in the issue as my mother-in-law, Iris Gibson, is fortunate to receive wonderful care at the marvellous Haylie House, which is located in the lovely Ayrshire coastal town of Largs in my constituency of North Ayrshire and Arran. Hon. Members might be interested in the approach taken in Scotland under the Scottish National party Government, who have been working hard to ensure that as many people as possible who need care in Scotland receive care in their own homes. Indeed, the number of older people receiving personal care services in their own homes in Scotland has increased from 36,000 in 2004-05 to 47,810 in 2013-14.

Since July 2002, local authorities in Scotland can no longer charge for those personal care services. In addition, payments for free personal and nursing care have been increased in line with inflation annually by the SNP Government since April 2008, improving the lives of about 7,000 to 8,000 vulnerable older people in Scotland, but, of course, funding continues to be a challenge in Scotland and across the UK.

As for carers, Scotland’s First Minister, Nicola Sturgeon, has pledged to increase carer’s allowance to the same rate as jobseeker’s allowance, which is a clear recognition of the very important job that carers do. I want to pick up on something that has been highlighted by several Members, which is what I would call the so-called national living wage because it is, in fact, nothing of the sort. It is a minimum wage, unlike the Scottish living wage that actually relates to the cost of living. The Scottish Government are a living wage employer and continue to encourage Scots-based businesses to become living wage accredited employers.

The hon. Member for Hove is correct that the caring sector has become associated with low pay. That is a scourge on that important sector, and must be acknowledged and tackled in any discussion about the future of the whole care sector. I agree very much with the hon. Member for Rochdale (Simon Danczuk) that the provisions of the social care precept are not enough. What is needed is more investment in the care of older people from central Government. Many private care homes argue that they will struggle to pay the national living wage, as outlined by the Chancellor, of £7.20 an hour from April—never mind the living wage that the Scottish Government are encouraging employers to pay, which currently stands at £8.25 an hour.

We have heard from the hon. Member for Redcar (Anna Turley) about some shocking employment practices. The SNP is committed to improving the quality of care in Scotland and will consider carefully the impact of the living wage on the care sector. Make no mistake: any discussion about how to improve the quality of care must include a discussion about the scourge of low pay. Indeed, the Scottish Government are taking forward the recommendation of the residential care taskforce to undertake financial modelling of the costs of paying the living wage.

[Mrs Anne Main (in the Chair)]

Order. I ask that the hon. Lady sticks as closely as possible to the subject of the debate, which is care homes in England. I have given her some latitude but she is somewhat straying off the point.

[Patricia Gibson]

I was simply going to ask the Minister to ensure that the scourge of low pay is tackled as far as possible under the Chancellor’s arrangements to ensure that the wage levels are at least enforced. As we have heard from the hon. Member for Redcar, that is not even currently the case.

It is clear that there are urgent concerns about care homes, which must be addressed. I look forward to the Minister’s taking the opportunity to do so. The urgency of the concerns are apparent as care home margins are squeezed by a lack of investment and a failure to deal with the funding of long-term care to an acceptable and sustainable level with local authorities facing even tighter budgets. We should recognise that care services are a vital component of the fabric of the NHS.

What happens in the care sector in England has a direct consequence for the care sector across the UK. Caring for our older population and caring for our carers is an issue of social justice. Of course there is a price tag and a cost for supporting older people, but politics is about choices and the challenges of our ageing population will only increase. We must make the choice to treat them with dignity, and to support carers and our older population as much as we can. We cannot afford not to.

Anti-TNF Drugs

Anne Main Excerpts

Wednesday 9th December 2015 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this issue to Westminster Hall. The Minister will be seeking to improve the success rate of anti-TNF drugs. Many universities across the United Kingdom are looking at how to improve medication for those with eye ailments. We have two in Northern Ireland, which are Queen’s University Belfast and, in particular, Ulster University—

[Mrs Anne Main (in the Chair)]

Order. Will the hon. Gentleman keep his intervention brief, please?

[Jim Shannon]

Does the hon. Gentleman agree that that is a good idea?

--- Later in debate ---

[Oliver Dowden (Hertsmere) (Con)]

The Minister talks about need. In a similar vein to other Members, I would like to highlight the need of a constituent of mine—a young lady called Olivia, aged 15, who is totally reliant on self-funded anti-TNF treatments to retain her eyesight. She is very concerned that when she reaches adulthood, she may no longer have access to that, which is why her parents, also constituents, have created a charity called Olivia’s Vision. Again, I ask—

[Mrs Anne Main (in the Chair)]

Order. Interventions must be brief. I call the Minister.

[George Freeman]

My hon. Friend has eloquently raised his point. I am happy to look into that with him afterwards.

NHS England will consider individual funding requests for treatments not recommended by NICE to treat individuals whose clinician can demonstrate clinical exception. The NHS constitution states that patients have the right to expect local decisions on the funding of drugs and treatments

“to be made rationally following a proper consideration of the evidence.”

If an NHS commissioner decides not to fund a drug, it has a duty to explain that decision to the constituents of the hon. Member for Leeds North East and others.

I want to turn quickly to the hon. Gentleman’s specific questions and then deal with a couple of questions that really sit under this whole debate. Let me respond to his four questions. I completely agree that time is of the essence to anyone in danger of losing their eyesight and, yes, people should have the chance to have a family and we need to make sure that we are supporting patients in the appropriate way. We are working to speed up the process, so that effective medicines get to patients much more quickly, but we need to know that they work and to make sure that the benefits they bring to patients are commensurate with their cost to the NHS, which is why we have NICE, a world-leading expert in health economics.

I must clarify that NICE is not currently appraising either adalimumab or infliximab for uveitis. However, it is consulting stakeholders on a proposal to include adalimumab within the scope of the technology appraisal guidance that it is developing on its two other drugs for the treatment of uveitis. A final decision on referral will be taken once NICE has concluded that consultation. I am aware that evidence is emerging on the use of these drugs on the treatment of uveitis in adults. When the full evidence is available, both NICE and NHS England will be able to take that into account when considering whether anti-TNF treatments should be made routinely available on the NHS.

In the remaining moments, I want to touch on the underlying issues that this debate has helpfully flagged up. The pace of change in the biomedical space, the rate at which new drugs are being discovered and the power of genomics and informatics, giving us a new insight into diagnosis and treatment, is putting pressure on our traditional methods of assessing drugs. Traditionally, NICE has worked on a one-size-fits-all, health benefit, “yes or no”, quality-adjusted life-year basis. I have launched the accelerated access review partly to look at how we can better use the genomics and informatics in our health system and give NICE more freedoms to be able to fast-track treatments to the patients who we know will benefit.

That touches on the question of off-label use of drugs. When there is a proven benefit outside of an on-label indication, we need to be much better at getting that information to clinicians, so that they can prescribe drugs in an off-label indication more quickly. The burden of proof needs to be not only right, but appropriately set, so that where there is clear evidence, the system can respond more quickly.

The hon. Gentleman made an important point about the cost of benefits. The system at the moment is not great at measuring the full cost of a condition downstream, which is partly why we are putting such efforts into the digitalisation of the health service and into being able to measure the cost of treatment and a disease condition. When we have a benchmark of what the cost is to society after a diagnosis, we will have a much better benchmark for rewarding innovation.

I will happily deal with any other questions offline. We have had a very short amount of time, but I hope I have tackled the hon. Gentleman’s specific questions. I am grateful to him for raising the issue, and I hope I have given some signal as to where in the coming weeks and months we may be able to expect some helpful progress.

Question put and agreed to.

Cities and Local Government Devolution [Lords] Bill

Anne Main Excerpts

Wednesday 21st October 2015 Commons Chamber

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

I beg to move amendment 32, page 9, line 15, at end insert—

‘( ) See also section 19 of the Cities and Local Government Devolution Act 2015 (devolving health service functions) which contains further limitations.”

This amendment inserts a new subsection into section 105A of the Local Democracy, Economic Development and Construction Act 2009 which alerts the reader to clause 19 of the Bill which contains limitations on the power to make an order under that section.

[The Temporary Chair (Mrs Anne Main)]

With this it will be convenient to discuss the following:

Government amendments 33 to 38.

Clause 19 stand part.

Government new clause 8.

Government new schedule 1.

Health and Social Care

Anne Main Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Andy Burnham]

My hon. Friend raises an important point. Again, the Secretary of State is quick to lecture about openness and transparency, but a report compiled at huge cost to the public purse by Lord Rose, former chief executive of Marks & Spencer, was not published in the last Parliament even though it was submitted to the Department months before. What possible justification can there be for that? The Secretary of State is avoiding my gaze right now. I would be very interested to hear his answer on why that report was not published, and if he wants to take to his feet now—[Interruption.] He says from a sedentary position that it was not finished. Well, if you believe that, Mr Speaker, you will believe anything. Even though Lord Rose says it was finished, the Secretary of State sent Lord Rose’s homework back and said it was not good enough. People will draw their own conclusions from what we have just heard.

We have seen a staggering deterioration in the NHS finances on the Secretary of State’s watch and a loss of financial grip across the whole system. If we are to see the finances brought under control, it means we will see more of the cuts mentioned a few moments ago.

The warning lurking behind the front page of The Daily Telegraph will not be lost on NHS staff today. The Secretary of State knows the NHS is facing very difficult times and this is an early attempt to shift the blame on to NHS staff. Basically, he is saying, “If things go wrong it’s not my fault, it’s yours because I gave you enough money.” It is the classic style of this Government and this Secretary of State in particular: “Get your blame in on somebody else first.”

[Mrs Anne Main (St Albans) (Con)]

I have been listening with a great deal of interest to the right hon. Gentleman, but I have to tell him that the country rejected Labour’s plan for the NHS. Will he now pledge to support the NHS’s own five-year plan, so that we can make some progress in the debate instead of hurling abuse across the Dispatch Box?

[Andy Burnham]

I must point out to the hon. Lady that Labour had a 20-point lead on the NHS going into the general election, which suggests that the public believed what we were saying about the NHS rather than what the Conservatives were saying. We do support the five-year forward view, and I have said as much, but it needs money now. If that plan is to be made real, it needs investment now. The NHS will not be able to deliver it while it has a £2 billion deficit this year; instead, it will go backwards. It will be unable to make the progress it needs to make.

Let us look at why the grip has been lost. This all goes back to the disastrous decision during the last Parliament to ignore the pleas of patients and staff and to force through the biggest-ever reorganisation in the history of the NHS, which nobody wanted and nobody voted for. Back then, a financially solvent NHS was turned upside down and, just when the service should have been focusing on making savings, it was instead firing and rehiring staff, abolishing and recreating organisations and making front-line nursing staff redundant. That destabilised the NHS, and it has never recovered since.

--- Later in debate ---

[Mrs Anne Main (St Albans) (Con)]

Thank you for calling me, Mr Deputy Speaker. It is a pleasure to serve under your chairmanship today. I congratulate the hon. Member for Ashton-under-Lyne (Angela Rayner) on her maiden speech. It was a very thought-provoking speech and one thing I will take from it was her passionate wishes for her young son, who she said survived at 23 weeks’ gestation. I wish her well in that and some of my right hon. and hon. Friends and some Opposition Members who tried in the last Parliament to revisit the gestational age for abortion may well wish to remind her of that if she is present for any such debate. I would like that subject to be revisited at some point in the future, as I know would other colleagues.

There is some unfinished business from the last Parliament and I want to touch on some of that as well as speak about the proposals on health and social care in Her Majesty’s Gracious Speech.

I was reminded quite forcefully by a constituent that we are still waiting to hear the outcome in respect of some of the rendition that may or may not have occurred on Diego Garcia. This year marks the 50th anniversary of the lease with America and it can now potentially be renewed. Colleagues in previous Parliaments have looked at this and asked about our role in this potential rendition of torture victims. This year, the first year of this Parliament, is an opportune moment to look at our renegotiation of the lease with America. I hope that we perhaps might take time to reflect on the Prime Minister’s commitment in 2010 to have some form of inquiry into whether or not the previous Labour Government dragged us through unfortunate circumstances whereby we were complicit potentially in torture and rendition.

Another topic that will come back to us is in this Parliament is the need to tackle bovine TB. In the last Parliament I was pleased to lead a debate on our ineffective tackling of bovine TB through our unfortunate slaughter of badgers. I know that this is not high up on everybody’s agenda, but it will be coming back because we will potentially be rolling out our TB strategy. I want to see TB controlled and I know that farmers have suffered greatly because of it but, now that the British Veterinary Association has said that our strategy to free-shoot badgers was totally flawed and inhumane, we have to come back with something better.

During the election period I spoke to quite a few people about Equitable Life. I hope that we can revisit that topic at some point given the grave injustices that were done to all those who were caught up in that saga. It was a scandal that they lost the pensions that they had banked on for their future.

I also want to pay tribute to a little girl I met during my campaign in St Albans. Her name is Bessie and she and her parents, Mike and Abby, were shocked to discover that she had a serious condition called neurofibromatosis. She went from being a little girl running around to a little girl in a wheelchair. Thankfully, following treatment, she regained some use of her limbs and is now making good progress, but she will always have to tackle the condition. I said that I would like to look into that topic if I was returned to this place.

That brings me to the health and social care aspect of the Queen’s Speech. A week after the general election I was shocked to read an article on the front page of my local newspaper in which a coroner was calling for a resolution in co-ordinating social care and NHS care. As we know, if one pot in the health and social care budget is raided, the other is somehow slightly better off. There is a real problem of people being kept in hospital beds and not receiving care packages. When they do receive a care package, the hospital cannot wait to get rid of them. There is no linking up in the system.

The coroner was really unhappy about this, and I want to use some of his words to describe the situation. He criticised what he called the bureaucratic hurdles that result from the lack of joined-up thinking. He said that the Government needed to tackle this, as it was difficult to know who to contact for reports. When someone dies, it is difficult to know whether that has been the result of poor healthcare or poor social care. We all have what are considered to be bed-blockers. At the inquest, the coroner asked Ms Reynolds, who was asked to explain what had happened, whether there were bed-blockers. She said that some patients

“may not be quite ready to go home, because there is a delay in their social care package”.

This is something that we see over and over again.

We must stop these delays in social care packages. It is too easy for patients to languish in hospital beds while the local authority drags its feet, for whatever reason. I accept that there are lots of reasons, but these care packages are not being put in place quickly enough. In St Albans, which is covered by the West Hertfordshire Hospitals NHS Trust, up to 48% of all acute beds at any one time have been occupied by patients who could have been dealt with in an alternative way. Some patients could have been discharged to their own homes or perhaps to a less acute bed service. We need to tackle this problem, and I welcome the fact that it is a priority for the Government.

We also need to have a big think about how we deliver care, and there is a review taking place in my hospital trust at the moment. I make no secret of the fact that I am arguing for an urgent care centre in St Albans. Unfortunately, we lost our accident and emergency department under the Labour Government, but that is history and there is no point in going over it again now. We must look forward to the future, and I would like an urgent care centre to take the pressure off the Watford A&E. People who do not know what to do in a stressful situation will go to A&E rather than risk not being seen locally. I will be fighting to those acute services. I also want us to get people out of their hospital beds and into their own homes, with a care package.

I am sorry to have to end on a sour note, but Labour must also be held accountable. Labour’s spokesman threw a lot of bricks in his opening speech, but when my mother died in Wales, she was told that she would not receive a care package for six weeks. She died before she got one. So let us not pretend that this is something that only we in England have to deal with. It is also happening on Labour’s watch in Wales. Having been a carer myself, I know how important it is to get that support in place. When carers are supported, it takes a burden off the NHS. I welcome the announcement in the Queen’s Speech that this Government have made this matter a priority. Let us have some co-operation from the Opposition to help us to deliver this, so that all those carers out there, many of whom are elderly, can know that they have the support of a Government who truly want to join up the services for the good of all.

--- Later in debate ---

[Mrs Main]

The hon. Lady listed an awful lot of bodies. Obviously, she thinks that there are far too many or that it is too confusing. Will she tell me which ones she would like to scrap?

[Liz Kendall]

Why is the hon. Lady not talking to her Ministers about the problems created in the NHS? Why do the Conservatives never talk about their reorganisation? I will tell you why: it is because they know it has been a mistake. Far from putting power into the hands of clinicians, let alone patients, it has put power into the hands of bureaucrats.

This Government’s addiction to broken promises goes on. Five years ago, patients were promised that they would be able to see a GP from 8 am to 8 pm, seven days a week. That may sound familiar—well, it should. The Prime Minister has had to make the same promise again in the latest Tory manifesto. It is no wonder that he has had to do that, because, under his watch, it has got harder to see a GP. Two million more patients now say that their surgery is not open at a convenient time, and a quarter say that they cannot get an appointment in a week, if at all, let alone on the same day.

The list of broken promises goes on. The Prime Minister said that, under his leadership, we would never go back to the days when patients waited for hours on trolleys in A&E, or months for vital operations. Yet the number of patients kept on trolleys for more than four hours has quadrupled, and the waiting lists are at a seven-year high. Why is that? It is because the Government wasted three years on reforming backroom structures rather than front-line services. They slashed the very social care and community services that should help to keep elderly people at home, piling further pressure on our hospitals instead.

The Government want us to forget their mistakes. But Labour Members will not let them run away from their record. We will hold them to account for their failures every week, every month, every year. I am talking about their failure on NHS finances and the deficits that have soared to more than £800 million and are set to get worse. Those deficits are predicted to be £2 billion by the end of this year.

Contaminated Blood

Anne Main Excerpts

Thursday 15th January 2015 Commons Chamber

[Alistair Burt (North East Bedfordshire) (Con)]

I beg to move,

That this House supports a further review of the circumstances surrounding the passing of infection via blood products to those with haemophilia and others during the 1970s and 1980s; notes the recent report from the All Party Parliamentary Group on Haemophilia and Contaminated Blood into the support arrangements provided for those who contracted blood-borne viruses as a result; also notes that the Penrose Inquiry into these events will shortly be publishing its findings in Scotland; further notes that those who contracted viruses and their partners and dependants continue to be profoundly affected by what happened; therefore welcomes the Prime Minister’s commitment to look again at this issue; and calls on the Government to respond positively to the APPG report and engage actively with those affected with a view to seeking closure to these long standing events.

I will do my very best to stick to the rules, Mr Speaker, as I know other colleagues wish to speak. There is a lot to say and interventions matter, but I will do my level best. My first task is to express my thanks to a number of people. First, I thank members of the Backbench Business Committee for being good enough to allow this debate. Secondly, I thank the large number of colleagues who supported the calling of the debate: those who attended the Backbench Business Committee last week; the many others who have signed today’s motion; those who have been in contact with me; and those other colleagues closely involved. Thirdly, I give a big thanks to the all-party group on haemophilia and contaminated blood, particularly my hon. Friend the Member for Colne Valley (Jason McCartney) and the hon. Member for Kingston upon Hull North (Diana Johnson), not only for their support today, but for the immense amount of work they have put into this issue over a number of years.

Fourthly, I thank a small group of colleagues who have worked particularly closely with me: my right hon. Friend the Member for Cardiff Central (Jenny Willott); the hon. Member for Foyle (Mark Durkan); my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), who has been immensely helpful through his company; and a number of others. May I also welcome the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison) to her place on the Front Bench? She and I have had a number of conversations about this issue since she was appointed to her role and she has been concerned and engaged with it. We have worked with No 10 and the Prime Minister’s advisers directly, of which more later.

I am also acutely conscious that all of us follow in distinguished footsteps we alas hear no more, from Peter Archer or Alf Morris, or, most recently, our friends Jim Dobbin and Paul Goggins, who respectively chaired and led the last debate held in Westminster Hall in October 2013. Paul, who had supported his constituents over a 16-year period before his death, is a particularly hard act for any of us to follow. In this regard, Paul’s great friend the shadow Secretary of State for Health is here to speak for the Opposition, and that is particularly welcome and important, emphasising how personally many of us have become engaged with the issue and how it has become one where both the Government and the Opposition feel a collective burden of responsibility for the events of the past. I hope they share a similar determination to reach a more satisfactory conclusion.

Like almost any of us here today, I could fill most of the three hours allocated with ease, but that is not the way this debate must proceed. I will therefore briefly outline a history that we and those watching are wearily familiar with, and move on to discuss why the debate is taking place today, what our main issues are and what our hopes may be. I will, where possible, illustrate with some of the words of those who have been in contact with us, as this is a debate for them and for their voices.

First, let me read from the opening to Lord Archer’s report, just to set the scene. He said:

“Throughout the 1970s and the first half of the 1980s, many in the UK who suffered from haemophilia were treated with blood and blood products which carried what came to be known as Hepatitis C, and some 4,670 patients became infected. Between 1983 and the early 1990s some 1,200 patients were infected with HIV, also through blood products. These infections had caused at least 1,757 deaths in the haemophilia community by the time this Inquiry started in February 2007, and more have occurred subsequently.”

Those figures can, of course, be updated for current circumstances. He continued:

“By the mid 1970s it was known in medical and Government circles that blood products carried a danger of infection with Hepatitis and that commercially manufactured products from the USA were particularly suspect. By the mid-1980s there were warnings of a similar situation in respect of HIV. But the products continued to be imported and used, often with tragic consequences. The reasons for the chain of decisions that led to this situation, and the alternative options which might have given rise to a different outcome, have been debated since that time.”

Yes indeed they have.

[Mrs Anne Main (St Albans) (Con)]

It is fantastic that my right hon. Friend has brought this debate before the House, and I was pleased to support him at the Backbench Business Committee. Does he recall that when we made our presentation to the Committee its members were surprised that this was still going on, after such a long time? That is the crux of today’s debate: now is the time.

[Alistair Burt]

My hon. Friend is right about that. I will go on to say why this debate is happening today, and that is one of the reasons. This issue has not gone away, and even more colleagues are now aware of it.

Since the Archer report there has been some positive recognition by the state of its responsibility. Over the years, efforts have been made for financial provision, but a complex and incomplete patchwork has been the result. Some people have been left behind—those bereaved and dependants in particular. Treatments for the severest infections have improved markedly, which has, in general, of course, been good news, but they also bring their own ironic consequences in giving longer life to those with originally no expectation of it and not always a quality of life for which we would all hope.

Efforts by the state to redeem itself have been hampered by a chronic inability to admit the past, to ensure that all the material was available for public scrutiny, and to give an opportunity to family members to ask the question that any one of us would need to ask: why and how has my loved one died? Its evasion of a public inquiry, the loss of key papers, the slow drawing out of what paperwork there was, and the failure to submit to questioning have left a mark of suspicion that lasts to this day.

Before I turn to the why-now question, let me dwell a moment on the scale of this tragedy. One of the most moving speeches heard in this or any other Session of Parliament was when the hon. Member for Liverpool, Walton (Steve Rotheram) read out, unforgettably, the names of the Liverpool 96. He did so to let the world know that behind the tragic statistics that the 96 had become were people with names, lives and hopes. Consider this: for me to do the same would mean that I would be reading out nearly 1,800 names. We will hear some of their stories today, but I ask the House to reflect on the scale of this. In terms of death toll, this is the 15th biggest peacetime disaster in British history in which the black death, at 3.5 million, is the worst. The awful Aberfan, the name of which we all know, is but the 142nd, with 144 lives lost. Contaminated blood has killed 12 times more.

--- Later in debate ---

[Mrs Anne Main (St Albans) (Con)]

Today’s debate has been very well informed, and I pay tribute to my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) for bringing it to the House. This is about justice, and justice delayed is justice denied. Justice that has been delayed for such a long time is really no justice at all.

It has been noted that we are coming up to the general election, and I know that the NHS will be on the front of many of our leaflets. Our political literature will talk about the NHS and what it means to us and to our families, and about our hopes for it and the amount of money that we hope to spend on it. I do not want contaminated blood to be a subject of debate only for today.

This is about the trust that we and our families put in the NHS, but that trust was broken many years ago for many families, including one that I want to talk about today. It is important to recognise that we expect the NHS to give us the best medical treatment and advice available at the time. Many Members have pointed out that that advice was often ignored or pushed under the carpet; it was covered up even though it was known about. That is simply not good enough.

This tragedy has affected multiple members of many families. It has affected the quality of people’s lives and their aspirations over many years. People have described the situation to me as being forced by the state to join a club of whose existence they were unaware with rules that they did not understand, and being denied the ability to call it to account. People, including children, were unaware that they were being subjected—that is the right word—to treatment that was not in their best interests or appropriate for their condition. That failure by the state has been left to fester for too long, and it has left them with a legacy that is a disgrace and a stain on this House and on the NHS. Whoever is in the next Government, if they have used the term “NHS” on their leaflets, they must bear in mind that this debate today has joined the House in saying that we want better for those families.

I concur with what my right hon. Friend the Member for North East Bedfordshire said about reading out 1,800 names. In fact, we could read out the names of all the family members and carers involved. They are all victims; they have all lost a huge amount. We should not read out all those names, however, because many people do not want their names linked to the debate and made public. I am going to talk about my constituent, Nicola Enstone Jones. I asked her permission to use her name today, because I know that many people do not wish to have the stigma of being associated with all this, and with having to go cap in hand to get their rights recognised. I should like to give the House a flavour of some of the hardships that Nicola’s family have had to endure, and of the unfairness of a system that has no transparency.

Like many other Members, I have campaigned for Equitable Life victims. We have had many strong debates in the House about whether people’s estates should be included when the compensation payments were being made and about coming up with fair formulas. I have not heard the same zeal applied to this subject, although this is about people losing their lives, not their livelihoods. This is about people losing their hopes and dreams—just as the Equitable Life people did—but often losing them at a very young age.

I want to give Nicola’s story a brief airing today. It mirrors many of the stories that we have heard today, and it is important that we record as many of them as possible, because they show the unfairness, the anomalies and the degree to which families have to scrape to get a degree of justice. We have heard mention of very young children being affected, and Nicola was diagnosed with haemophilia at the age of seven or eight. In 1978 and 1979, she had tooth extractions—not exactly a hazardous thing—and treatment for a broken arm. In 1980, after a tonsillectomy, this young child was given factor VIII. It was by then known to be contaminated. Since that very day, her health has deteriorated, with symptoms associated with hepatitis C. Despite her mother’s concerns, she was told at the time that her daughter’s problems were psychological. Things were covered up. Throughout the years she continued to receive factor VIII for other operations and her health was always poor.

Over the years Nicola has lobbied me, as other hon. Members have been lobbied. When the Skipton Fund was announced, she was told that she could apply, but because in 1997 a consultant had stated that the virus had cleared, 17 years after she had been infected, she suddenly did not seem to meet the criteria. She has been turned down “on the balance of probabilities” by the Skipton Fund because her condition had been cleared for six months. Her mother, Mrs Enstone Jones, lived with that all those years, but because of a brief period when the virus was thought to have cleared, Nicola did not meet the criteria. She has been let down by the Skipton fund.

The report which has been mentioned so many times in the Chamber today stressed that the fund—the “third arm”, as I think it was called by the hon. Member for Wythenshawe and Sale East (Mike Kane), whose predecessor, Paul Goggins, worked tirelessly on the issue—is creating a barrier to justice, not facilitating justice. We must have a better system so that people do not feel that they have to jump through hoops, justify themselves, or make early applications in order to be able to go on holiday or get essential funding. The funds set up to deal with the issue are not dealing with it and, if anything, are trying to avoid dealing with it if they can and keep money back.

We do not wish to save the state money because, as the right hon. Member for Cardiff Central (Jenny Willott) said, we are speaking about a relatively small number of people. Let us get the matter sorted. Let us put in place a fair system. Let us make sure that all the other Enstone Joneses and all the other names that we cannot mention today for reasons of privacy do not feel that they have somebody acting against them, instead of acting for them. If nothing else comes of the debate in the House today, we should remember not just the NHS, but what the NHS means to those affected and their families. They trusted their health to the NHS many years ago, and the issue is as relevant today as it was then. Any of us who campaigns on the NHS in a few months’ time should remember that and pledge to do something about it if they are part of the next Government.

A and E (Major Incidents)

Anne Main Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I have spoken to the hon. Member for Swansea West (Geraint Davies) about his Bill. Part of the long-term solution is to give people better information about sugar consumption. We will certainly look at what the Bill proposes.

[Mrs Anne Main (St Albans) (Con)]

My right hon. Friend will be aware that the Minister for Policing, Criminal Justice and Victims, my right hon. Friend the Member for Hemel Hempstead (Mike Penning), and I were very unhappy that the A and E was closed and moved to Watford. Since then Watford hospital has had a turbulent time. This morning the chief executive resigned, having got part-way through a process of consultation. May I ask for the consultation to be put on hold until the new chief executive is in place and has their feet under the table? We do not need more turbulence in our hospitals in west Hertfordshire.

[Mr Hunt]

I am sorry to hear the news about the chief executive at Watford. I am aware of the pressures there and I agree with my hon. Friend about the need for stability in management as much as possible over the next few months.

Children and Families Bill

Anne Main Excerpts

Monday 10th February 2014 Commons Chamber

[Jane Ellison]

This is a matter for the Chantler review; it is one of the things we have asked Sir Cyril to look at. I am not going to second guess the outcome of his review.

[Mrs Anne Main (St Albans) (Con)]

Will the Minister clarify a point that she has just made? I understood, perhaps wrongly, that she said that the Government were getting these powers into their armoury in case they needed to be used. Are the Government putting these measures into legislation for potential future use, rather than because there is evidence of a need for them now?

[Jane Ellison]

This question came up in the other place, and we have always made it clear that we are seeking the power to make regulations in the event that the Government should decide to proceed with standardised packaging, having received the Chantler review and considered everything in the round. Making the decision on those powers now would enable us to proceed apace at that point. I hope that that clarifies the matter for my hon. Friend.

As I was saying, the Government would not necessarily use all the powers I have just described, and if we proceed, we will need to decide which aspects would be included in any regulations. The House would have the chance to comment further on the matter, through the affirmative resolution procedure, were the Government to decide to go ahead. It is prudent to take a comprehensive approach now, however, so that we can be prepared for the future.

--- Later in debate ---

[Jane Ellison]

That is a good point, to which I will return, if my right hon. Friend will allow me. I will consider that and we will have an answer for him.

[Mrs Main]

How does this affect 17-year-olds who have already taken up smoking and wish to try to stop through using e-cigarettes? How would they manage to buy this product?

[Jane Ellison]

My understanding is that if a nicotine-containing product is licensed for medicinal use—licensed as a quit-smoking tool—it can already be prescribed by doctors. Some e-cigarette manufacturers have already indicated that in order to make a medicinal claim about their product’s ability to help people quit, they will seek to use the medicines regulations. If such a product becomes licensed as a medicine, it will be able to be prescribed as a smoking cessation aid in the same way that other nicotine-containing products can be. I hope that answer is helpful.

On proxy purchasing, we believe we must take action to address both the supply of and demand for tobacco products among young people if we are to reduce the uptake of smoking. Many retailers over the years have felt a little left alone to bear the burden of enforcement in this area, so I welcome both the work of responsible retailers to ensure that tobacco is not sold to people under the age of 18, and the support provided to them by retailer bodies such as the Association of Convenience Stores. There is support in both Houses for creating a proxy purchase offence for tobacco, and the Government have carefully reflected on the arguments that have been made. Retailers feel it is unfair that it is an offence for retailers to sell cigarettes to children and young people, yet there is no offence of proxy purchasing on behalf of children and young people. Retailers also feel it is inconsistent to have a proxy purchase offence for alcohol but not for tobacco. The Government want to continue to tackle the access that young people have to tobacco, which is why we have proposed this amendment.

The provisions would make it an offence for an adult to buy, or attempt to buy, tobacco for someone under the age of 18. That will be enforced by local authority trading standards officers, who will be able to issue a fixed penalty notice if they believe an offence has been committed, rather than taking prosecution action in the first instance. Local authorities will not be required to carry out regular programmes of enforcement in the way they have to on age of sale of tobacco, so we do not believe that this offence will bring into place any significant new regulatory burdens. Local authorities know their communities better than anyone and will know how best to address their public health priorities. We have devolved wide public health responsibilities and ring-fenced budgets to local authorities, and this amendment allows them to take targeted enforcement action on proxy purchasing where they consider it is needed.

The arguments relating to effective enforcement have been well rehearsed in previous debates. Experience in Scotland suggests that we should not to expect a vast number of convictions, and we should not measure the success of this new offence by the number of prosecutions or fixed penalties issued. I expect, however, that the new offence will generate worthwhile deterrent effects. As I said, in a new public health landscape where more powers are devolved to directors of public health there may be opportunities to explore work where there is a particular local problem.

Finally, I will address the issue of smoking in private vehicles carrying children. In another place an amendment was agreed to enable the Government to make regulations to make it

“an offence for any person who drives a private vehicle to fail to prevent smoking in the vehicle when a child or children are present”.

The amendment we are debating today was drawn up by the Government, with the support of the peers who tabled the initial amendment, to deliver the intention of the amendment in a legally workable way. We have a responsibility to be sure that any amendment that could make its way on to the statute book should work in practice. The technical amendment was agreed on Third Reading in another place.

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[Mrs Main]

I shall keep my intervention brief because many hon. Members wish to speak and we do not have much time. The Minister and the hon. Lady have talked about smoking in cars, but Lords amendment 125 refers to smoking in a “private vehicle”, which means that it will cover any vehicle, including motorised homes. We need to be absolutely clear that any vehicle will be affected, not just cars.

[Luciana Berger]

I shall come on to talk about measures on vehicles that were introduced in the 2006 Act. Lords amendment 125 refers specifically to private vehicles.

I also welcome Lords amendments 122 and 123, which deal with nicotine-containing products. I agree with the Minister that it is sensible to prohibit the sale of e-cigarettes to under-18s. E-cigarettes can help smokers who are trying to quit, but they should not be available to children, especially when there are so many question marks about the long-term health effects of nicotine and when concern has been expressed that e-cigs might act as gateway products that could lead some young people to take up tobacco smoking.

I am especially pleased to support Lords amendment 121, on proxy purchasing, which will prevent adults from buying cigarettes on behalf of children. Labour proposed that policy by tabling amendments in the other place last year. It is already illegal to buy alcohol on behalf of under-age children, so it does not make sense that the same offence does not apply to tobacco products given that, if they are used as directed, they kill half of all lifetime smokers. I am glad that the Government now agree with us, but I hope that the Minister will be able to share with hon. Members the Government’s rationale for introducing a maximum fine of £2,500, given that the equivalent penalty for the alcohol offence is £5,000.

Let me turn to Lords amendment 125 and the question of protecting children from adults smoking in cars. I pay tribute to everyone who has campaigned for such a measure, especially the British Lung Foundation and my hon. Friend the Member for Stockton North (Alex Cunningham). I also applaud my noble Friend Lord Hunt of Kings Heath, who tabled the original amendment. Since that amendment was successfully passed, the Government have laid out how that Labour proposal could be written into law. In the final analysis, the decision before the House comes down to a simple question: if we know beyond doubt that passive smoking in an enclosed space can do serious harm to a person’s health and that hundreds of thousands of children are being subjected to passive smoking in a car every single week, and if we know from our experience of similar laws passed in this country and others that legislation can have a major impact by changing behaviour and improving public health, should we act and do something, or stand by and do nothing? We say that we cannot afford not to act.

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[Bill Esterson (Sefton Central) (Lab)]

Protecting children is one of the most important responsibilities that we have. We know that smoking kills, we know the dangers of passive smoking and we know that children are more at risk than adults from the effects of smoke.

Half a million children are exposed to potentially toxic levels of second-hand smoke in family cars each week, according to the British Lung Foundation. Children’s lungs are smaller and children have faster breathing rates. They are therefore particularly vulnerable to second-hand smoke, especially in a confined space such as a car.

Children have no choice but to travel in a family car. Would it be good if car drivers, including parents, chose not to smoke when children were present? Absolutely. However, in the case of seat belts, it took a change in the law to ensure that there was a change in behaviour. The proportion of people wearing seat belts went up from 25% to more than 90% after legislation was introduced.

As I said, protecting children is one of our most important responsibilities. We can exercise that responsibility today. We have to choose between the right of an adult to do as he or she chooses in the privacy of his or her car and the protection of the health of children. Throughout the passage of the Bill, Government Members have rightly agreed that the protection of children is paramount. I hope that all Members will agree that we should make it an offence to smoke in a vehicle when children are present.

[Mrs Main]

I have never heard of a more illiberal, nonsensical and unenforceable proposal than Lords amendment 125. I am sorry that it is being proposed by the Government and that Members are being asked not to consider the detail, because the devil is in the detail.

As has been said, the word “vehicle” refers to a broad spectrum of containers, if I may put it like that, including motor homes, Traveller caravans and, potentially, narrow boats. The proposal suggests that smoking while driving an open-top car, to which my hon. Friend the Member for Shipley (Philip Davies) referred, is more injurious to health than a mother smoking while pregnant. I find that impossible to accept.

I do not know how the police will arbitrate between two 17-year-olds in a car if one of them has been smoking. I do not think that we should be considering using this resource if we are not banning cigarettes, full stop. I do not smoke and have never smoked. I am a mother of four children. I fundamentally believe that we should not make bad, unenforceable law.

If the Labour party represented the working class far more than it suggests it does, it would be making a very different argument, because a huge tranche of the population will see itself criminalised. We should be advising people not to smoke in front of their children. We have been winning the argument on smoking. The Government have adverts on the television that show a mum blowing the smoke out of the door and then say, “What if you could see what it does to your child’s lungs?” We will not stop those adverts because we are trying to educate people.

Under the proposal, we will be saying that a child can get into a fog-filled car after their mum has been smoking in it. As long as she is not still doing it, that will not be an offence. We will be saying that it is an offence to smoke in a van if Traveller children or others who live in transit are sitting in the back. However, if I sit in my kitchen and people can see me through the front window, fag in hand and baby over my shoulder, comforting the child, that will not be an offence. It would be easy to track down such behaviour, so why do we not say that smoking in front of children should be banned or that smoking should be banned? It is because we think that it would be illiberal to go into people’s homes. However, some people’s homes are vehicles. I look forward to people explaining that to the communities that will be affected disproportionately.

I cannot believe that we are not supposed to inquire about the detail.

[Andrew Percy]

Will my hon. Friend give way?

[Mrs Main]

No, I will not give way because many colleagues who have been here from the very beginning wish to speak. I am sorry if my hon. Friend is one of them.

I cannot think that this proposal will be enforceable. We all want to protect children. In that case, perhaps we should get out the fat callipers when we see very lardy children walking down our high streets because their parents feed them junk of an evening. Perhaps we should ban fattening foods because there are more than a million people with type 2 diabetes, as has been said in the media today. Where will it stop? We need to educate people. We need to ensure that parents do what is best for their children because they believe in doing what is best for them. We cannot legislate every single risk and danger out of existence.

[Mr Steve Reed (Croydon North) (Lab)]

I met the school council at Broadmead primary school in Croydon last Friday and I took part in a school assembly at Norbury Manor primary school this morning. I asked the children what they thought of the proposal to ban smoking in cars that are carrying children like them. Every single child supported the ban. When I asked how many of them had been inside a car when an adult was smoking, nearly half the children put their hands up. I asked one little girl what she did when she was in a car and an adult was smoking. She held her nose and told me that she tried not to breathe.

Although those children hated the experience of being forced to breathe in cigarette smoke, they did not understand the damage that it does to their health. The Royal College of Paediatrics and Child Health and other professionals estimate that up to 160,000 children a year develop lung diseases, including asthma and bronchitis, as a result of breathing in second-hand cigarette smoke. Developing lungs are far more susceptible to smoke-related disease than those of adults. That raises the question of why we protect adults in the workplace, on public transport and in pubs from the dangers of second-hand smoke, but subject children to it in cars.

I have listened carefully to the arguments against this proposal, but I find very little merit in them. The idea that this measure is an example of the illiberal nanny state is misguided. Law making is often about striking a balance between competing rights. On what balance of rights does the right of a smoker to smoke outweigh the right of a child to grow up healthy? I do not accept that an adult should have the right to harm a child who is powerless to protect him or herself. An adult who is in a car with a smoker can get out if they want to. Often, a child cannot.

To those who say that the measure is unenforceable, I say that we heard exactly the same about the seat belt law. Education in this case has clearly not worked well enough. We need to change behaviour. That requires a strong education campaign but, crucially, that needs to be backed up by law to show how seriously the country takes the issue and to create a sufficiently powerful deterrent.

We have taken many steps to protect people from passive smoking. Without this further measure, too many children will be left struggling to avoid breathing in smoke in the back of cars and, far worse, could find themselves struggling with lung disease in later life. It is our duty today to act to protect them.

NHS

Anne Main Excerpts

Wednesday 5th February 2014 Commons Chamber

[Mr Hunt]

I commend what is happening; it is very important that locally driven solutions are providing good alternatives to going to A and E. One of the most important things we can do for my hon. Friend’s constituents is make sure we have proper continuity of care so that for our most vulnerable patients there is a doctor who knows what is up with them at any time, whether they are in or out of hospital, and who can give them joined-up care and make sure they have a proper care plan wrapped around them. That is the kind of care we need to see.

[Mrs Anne Main (St Albans) (Con)]

My right hon. Friend is making a very pertinent point about transparency, because again what the Opposition refuse to acknowledge is how many patients were left off the books. It has been discovered in my hospital trust that a significant number of patients who were not discharged because there was not a link-up with social care were left off the books and so did not show in the statistics.

[Mr Hunt]

I think my hon. Friend is talking about the issues in West Hertfordshire trust, which I am extremely concerned about. The whole House will want to get behind the efforts of the outstanding chief executive there, who is sorting out those problems.

It is of course challenging when we read about these things in the media, but we have to remember that it is essential that poor care or cover-ups such as the ones that may have happened in that case are brought to the surface very quickly. That is the big change we want to make.

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[Paul Burstow]

I entirely agree that if there is any doubt about the figures, it needs to be resolved, but there seems to be a disconnect between what people think is happening and what the figures show. I have been to events at which clinicians have said that the problem is the local social services, but when they are shown the figures they are surprised. Perhaps that is why we need, as the hon. Lady says, to ensure that there is an agreed way in which such things are reported, which is what, I think, was put in place by the previous Labour Government. These figures have been collected for a long time, and they have consistently shown that social care is not the principal driver of delayed discharges.

[Mrs Main]

I am sorry to have missed the beginning of my right hon. Friend’s speech, but as he knows there is a big lobby going on. That was the point I was trying to make to the Secretary of State, although obviously I did not make it very well. Under the previous Government, West Hertfordshire Hospitals NHS Trust had a significant number of delayed discharges—although that is coming right down now—and the figures were not on the books, so to speak, thanks to a very creative form of accounting. It is nuanced and there have been problems on all sides. To try to paint it as one-sided is totally wrong and it certainly is not a new phenomenon; it has been going on for a considerable time.

[Paul Burstow]

That is absolutely right. For example, in continuing health care there is often a great deal of contestability that leads to discharge delays, but they are NHS-caused delays. I am not saying that the NHS should be blamed any more than social services, but I want some honesty about how the figures are presented as they do not bear close scrutiny in the argument made by the right hon. Member for Leigh. His solution is simplistic, too. It is good to have a debate about competition policy—I remember Labour Ministers trumpeting the introduction of the first competition policies in the NHS and the establishment of the competition and collaboration committee in the Department of Health. Labour established those policies.

Monitor’s role is to protect the interests of patients—that is what it says in the Health and Social Care Act 2012—not to promote competition. The idea that we can solve the problem by sweeping away Monitor opens the doors to competition red in tooth and claw. Of course, the Competition Act 1998, the EU’s competition legislation and procurement law would still apply without any of the fetters, barriers or protections that Monitor can and should be providing in its role as the regulator of competition in the NHS.

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[Priti Patel (Witham) (Con)]

I apologise to both Front Benchers for missing the opening statements due to a commitment I had at the Foreign and Commonwealth Office. Thank you, Madam Deputy Speaker, for calling me to speak.

I want to discuss problems with the NHS in my locality. My constituents have been affected by a number of difficulties in the NHS in recent years, predominantly down to the legacy and failings of the previous Labour Government, particularly the deficit of NHS local health care provision. Mid Essex has suffered as a result of the bloated bureaucracy of the primary care trusts and strategic health authority, which took money away from front-line care and patients. That is Labour’s legacy.

To put that in context, between 1997 and 2009 the number of managers and senior managers in the East of England strategic health authority more than doubled from 1,300 to well over 2,700. The number just kept increasing. The worst case involved Mid Essex PCT—I was so thrilled when PCTs were dismantled—and its predecessor trusts, whereby between 2001 and 2009 the number of managers and senior managers soared from 10 to 102, while the proportion of administrative staff working in the PCT itself doubled from 17% to 33%. That money should have gone to front-line patients in Witham and Mid Essex. That is the legacy we are trying to overcome.

When this Government came to office, those two PCTs were spending a combined total of £25 million on management costs alone, which is simply shocking and appalling. That is why the reforms are not just welcome, but vital to Mid Essex and my constituency: money can now be spent on providing care and investing in the health and care services that my constituents and patients desperately need. The actions taken by this Government mean that more of the record levels of spending on the NHS—which the Government are committed to and which the Opposition opposed—will be spent on patients in my constituency, rather than on administrators, managers and bureaucrats.

One of the most damaging aspects of Labour’s legacy in my constituency is the incredible health deficit in Witham town. Witham is a growing town and I am very proud of it—it is incredible. Despite the NHS deficits we have faced, our patients have campaigned and I have worked alongside them. My hon. Friend the Member for Suffolk Coastal (Dr Coffey) has been clear and consistent in making the point that this is about campaigning together, on a united front at a local level, to make the case for reform and change.

The town’s population is set to grow by more than 11% over the next decade, yet we have a chronic shortage of GPs and health services. That is well documented and I have raised the issue in the Chamber and in Westminster Hall on a number of occasions.

[Mrs Main]

Does my hon. Friend share my concern that Labour Members have made no apology for the fact that GPs were allowed to opt out of out-of-hours services? That resulted in many more people presenting themselves at A and E simply because they were unaware of where they could go. Surely Labour should have foreseen that that would happen when it made dramatic changes to GP contracts.

[Priti Patel]

My hon. Friend is absolutely right. This is a challenge we all face, particularly in rural constituencies. That deficit needs to be addressed.

There are about 2,200 patients per GP in Witham town, compared with the national average of 1,500. Patients would also like to see more out-patient services delivered locally in the community, rather than have to travel to Braintree, Chelmsford or Colchester. Colchester and Chelmsford both have hospitals that are undergoing major reviews at present. The challenge we face is to bring in new services to serve our expanding town. The prospects of achieving that objective are enhanced by the fact that this Government are putting record sums into the NHS and by the dialogue at community level between the town council and NHS England. I commend both, but specifically Witham town council for its support, and particularly Andrew Pike of NHS England and his team for working closely with me to examine the options, despite significant pressures and resistance in some quarters.

I know that we can count on the encouragement of Ministers, who have listened and been incredibly supportive. That brings me back to the fundamental point that if the Labour party, when it was in government, had bothered to take the issue seriously, more progress could have been made. The issue is of course about the allocation of resources: we need less on management and bureaucracy, and more on front-line patient care.

Another very significant health care concern for my constituents is that raised by my hon. Friend the Member for Suffolk Coastal about the East of England Ambulance Service NHS Trust. It has been a disaster, as the Secretary of State and Health Ministers are well aware. My hon. Friend the Minister of State has been part of our campaign. He was assiduous in his support of us all in pushing for and achieving the resignation of board members last year, and in relation to the trust’s poor performance in getting ambulances to patients efficiently and on time, rather than having four-hour waiting times and some deaths. We must not forget that deaths and casualties have resulted from that neglect.

I welcome Ministers’ involvement and support and, by contrast, we have now seen changes. The previous members of the trust’s board, many of whom, including a Labour councillor, were appointed under the previous Labour Government, ought to have provided strategic leadership—this is all about leadership—but they left the trust in an appalling state, under-staffed, poorly resourced and ill-equipped. They did not scrutinise the management of the trust, but left a serious black hole in its finances and a shortage of paramedics and ambulances that has caused my constituents and patients throughout the region to suffer unnecessarily.

As the House has heard, the trust is now led by Dr Anthony Marsh, and it is on a massive recruitment drive to bring in the paramedic numbers it needs to serve my constituents and the rest of the region. I commend him, because he is working incredibly hard: we are climbing Everest to deal with the legacy we were left. Collectively, local MPs are supporting him in his task to repair the damage to the structures left to us, including in relation to the formation of the trust, because in effect we inherited an appalling and devastating legacy.

It is quite clear from our time in government that if such problems had arisen under the previous regime, they would have been swept under the carpet. We have seen with the scandal of Mid Staffs and other trusts, to which the Labour party turned a blind eye, that there is no doubt that Labour closed its eyes and completely ignored the fact that patient care was neglected and the overall cost in lives, which is appalling. I therefore welcome the commitment from our Health Secretary and the Government to support us not only in facing the challenges, but in bringing transparency and shining a light on the NHS, which is vital.

To make one other point, the teams in our ambulance trust have been working so hard. We really commend and praise the front-line teams, because they have had an appalling time. We are now improving services for my constituents, which, frankly, was not possible under the previous Labour Government.