NHS Dentists: South-West England

Anne Marie Morris Excerpts

Wednesday 24th May 2023 Westminster Hall

[Anne Marie Morris (Newton Abbot) (Con)]

Healthy teeth are a critical part of a healthy body; we cannot really separate one from the other. It has always surprised me that when the NHS was established, the concept of free at the point of delivery excluded dentistry, for which there has always been a charge. There is something about dentistry, because it is either too complex or too expensive, that has led it to be somewhat second class.

As the decades have gone by, Governments have recognised how important teeth are, and I am pleased to say that there is a much more enlightened view as to their inclusion. There has also been a recognition over the years of the importance of healthy teeth for children particularly, hence the free care for the under-18s. That is why it is particularly worrying that colleagues say—I have heard exactly the same comment—that although children need to be prioritised, they are not being prioritised as things stand. Indeed, on one of my more recent visits to one of my local practices, I came to understand that dentists cannot take on private patients and only child NHS patients; if they go for NHS, they have to do everybody. That is a fundamental piece that ought to be changed.

As colleagues have already said, covid has effectively exposed a pre-existing weakness in the system. There is a shortage of dentists. We have heard a lot—it is absolutely true—about the cap on training numbers and the challenge to which that has given rise. We have heard about how, year on year, more dentists are moving away from the NHS into private. Across the country, the NHS has lost 10% of its dental coverage.

In Devon, in my constituency, there are no NHS dental appointments. The situation is at least as bad in Devon as it is in Dorset. Indeed, on that same visit to the dental practice, I asked how long people would have to wait to get on the patient list—the answer was seven years. That strikes me as even worse than the position in Dorset. Our proportion of dentists, which appears to be accepted, is extraordinarily low. In Devon, there are 51 dentists for every 100,000 patients. That seems very low, but, believe me, it is actually quite good—many places are worse than that. If that is the starting point, it is the wrong starting point and needs to change.

Dental health is absolutely fundamental to the whole body. Reference has already been made to hospital admissions for children. As I understand it, certainly in my part of the country, most admissions for children between six and 10 are caused by the health of their teeth. It is not just that they happen to have a problem with their teeth that is spotted when they are in hospital.

What has to change? Clearly we need more recruitment. The cap has to go. I know that it costs £230,000 to train a dentist, but, frankly, that is good value for each dentist. We need better retention, and the contract, which has been referred to, is clearly one of the biggest reasons why we do not have the retention that we need. We need to broaden the profession. The Government have taken steps, such as the “Advancing Dental Care” review in 2017 and a dental education reform programme. But that is too slow. The ambition is right—more flexible entry, more apprenticeship, new centres of development and putting the training together as dentists get to the secondary stage of their training—but it is not enough. My hon. Friend the Member for Totnes (Anthony Mangnall) suggested that dental therapists should be better used, which is absolutely right. 

The trouble with the contract is, as we have heard, the challenge of how it is constructed. Dentists are not paid per patient, nor for all the work done; they are paid for the most complex work, and that decides the amount paid, which generally does not cover the value of the work they have done. The second problem is that when someone enters into the contract, if they do more work, they do not get paid for the extra, but if they do less they have to give a refund. Effectively, the challenge for dental practices—certainly, for the one I recently visited—is that they cannot use all their contracted hours because they cannot get the dentists to fulfil them.

There is work to be done. The Government absolutely need to deal with the backlog, the contract and the payments. They need to deal with the children issue and to allow individuals to treat children in the NHS, even if they cannot treat adults.

Branded Medicines Voluntary Scheme and the Life Sciences Vision

Anne Marie Morris Excerpts

Wednesday 3rd May 2023 Westminster Hall

[Mr Virendra Sharma (in the Chair)]

Before we start, I remind hon. Members that the debate can last until 6.13 pm. There will be five minutes for the SNP to wind up, five minutes for the official Opposition and 10 minutes for the Minister.

[Anne Marie Morris (Newton Abbot) (Con)]

I beg to move,

That this House has considered the voluntary scheme for branded medicines and the Life Sciences Vision.

It is an honour to serve under your chairmanship, Mr Sharma. The “Life Sciences Vision”, which was agreed and published in 2021, was a very ambitious document of which the Government should be rightly proud. It looks at further investment and development in neurodegenerative disease, kick-starting diagnostics, treatments and novel vaccines, more investment in cardiovascular disease and obesity, morbidity or mortality from respiratory disease, the biology of ageing and mental health conditions. That is an ambitious and worthwhile list. However, its delivery can only be a joint endeavour; it has to be a partnership between Government and industry. Both parts need to do what they can to drive this forward.

If industry is to play its part, it needs from Government good research facilities, first-class universities and academics who are attracted to this country. It needs efficient an effective systems for clinical trials, phases 1 to 3. I am aware that the Government are currently looking at how that might be improved and that James O’Shaughnessy is spearheading a report that will hopefully be out shortly. I sincerely hope that its findings will be implemented.

Industry also needs a regulatory regime that is fit for purpose across both the Medicines and Healthcare products Regulatory Agency, which evaluates whether a medicine is fit for purpose and safe, and the National Institute for Health and Care Excellence, which looks at whether a medicine is value for money. Industry also needs to ensure that whatever medicines finally come through the regulatory system are used—that there is an uptake among patients and that they are prescribed. There is clearly a moral imperative for that, but there is also clearly a financial one.

From the Government’s perspective, if they are to invest in ensuring that we are most attractive and efficient place to launch a medicine, they need to ensure that UK patients have quick access to both old and new innovative medicines. They need to ensure that industry is there, ready and waiting, with the new initiatives and ideas absolutely raring to go. That said, the Government need to manage the overall cost of the medicines budget, and they need a commitment from industry to invest. Fundamentally, it is a contract—an agreement—and both benefit if the deal is right.

One of the mechanisms that sets out the terms of that arrangement in practice is the voluntary scheme for branded medicines pricing and access. Most of us refer to it in shorthand as VPAS, as I shall for the purposes of this debate. So what is VPAS? Effectively, in this agreement the Government set out what they will do for the industry. In the last iteration of VPAS, commitments were made about reforms to NICE, some of which have been met and some of which have not. At the same time, industry agrees that it will cap the growth of Government medicine spending. The consequence is that all over-prescribing beyond the agreed and expected rate of growth is at the risk of the pharmaceutical industry. It is a very complicated formula.

The current scheme was devised in 2019. It replaced the PPRS—the pharmaceutical price regulation scheme—and was originally conceived such that the medicines budget could grow by 1.7%. That figure is now 2%. Any prescribing over that figure would effectively be paid for by the pharmaceutical companies by way of a reimbursement to Government of a percentage of their turnover, but it is a very complex and uncertain calculation.

One of the reasons for that is that the figure is anchored at a 2013 growth point, and it is not re-based each year. The consequence is that there is great uncertainty for any investing company about what the rebate will be year on year, which makes it difficult to budget. The compounding effect of the lack of re-basing is that the effective rebate is currently 26%, and left unaltered it would go to 30% for the next iteration, which is currently being negotiated to start in 2024.

We need to get that pricing in context. Effectively, when pharmaceutical companies go to NHS England and the regulators, there is a process of price-gouging. The first gouge, effectively, is by NICE. It looks at the market price and discounts it by an average of 55% to 65% under the patient access scheme. After that, NHS England may require a further cut to meet the affordability criterion of £20 million. The VPAS slice is after that, and, as a consequence, many pharmaceutical companies are saying, “Frankly, the pips are being squeezed too hard, and we simply cannot afford to invest in the research and launch our medicines here.” The current rate is uncompetitive internationally, and unless we change our approach to rebasing and to the growth cap, I fear we will lose much-needed investment here.

Pharmaceutical companies have a choice, and they can research and launch anywhere in the world. We are now a single-country regulator, rather than part of a European system, and that makes us, from the start, much less attractive. Industry is already voting with its feet. Indeed, in this morning’s Science, Innovation and Technology questions, a number of questions were about disinvestment decisions by pharmaceutical giants in this country. It is clear that many are simply no longer investing in research here or in UK regulatory approvals. That is a loss not just to the economy but to patients, because every drug prescribed to patients has to go through that regulatory approval process. Indeed, the Association of the British Pharmaceutical Industry has done some analysis and believes, based on the evidence, that our global share of research and development declined from 4.9% in 2012 to 3.3% in 2020. It advises that the number of initiated industry clinical trials fell by 41% between 2017 and 2021. Across leading European countries, the UK saw the largest decline in new medicine launches between 2010 and 2021.

However, it does not have to be like that. The ABPI and PricewaterhouseCoopers confirmed in a report that the life sciences sector is one of the most valuable for the UK: it creates £36.9 billion in gross value added, 584,000 jobs and 18% of all the UK’s R&D. They say that if the life sciences strategy was implemented in full, there would be £68 billion of additional GDP over 30 years from R&D investment, 85,000 additional jobs and a 40% decrease in disease burden. So VPAS could and should be part of a solution, not a problem.

The approach needs fundamentally to change; it cannot continue to be a question of who blinks first on what the pricing figure and the size of the reimbursement will be. This has to be looked at holistically in the context of what is in the best interests of UK plc and our health outcomes. The approach needs to be a collaborative one in which risk is shared. The solution proposed by the ABPI is a cut in the rebate to 6.88% and the creation of a two-pot system under which one pot continues to go the Treasury while the other—a separate 1.5% premium, if you like—goes specifically towards clinical research, genomics and so on.

The challenge with the second pot is, first, that it is quite small in terms of making significant changes; secondly, that it is a bidding pot, so there will be winners and losers; and thirdly, that although the ambition is to use it to level up, that will create all sorts of problems in relation to the Barnett formula. So although the system is well intentioned, I am not sure it would actually work in practice. It has had much support from patient groups and others, and I understand why, because delivering a fairer relationship is the direction of travel.

However, we have to bear in mind the political and economic reality of where we are, and we must not lose the prize of providing a much stronger link to, and a driver of, the life sciences vision, which seems largely to have been orphaned. That agreement needs some tangible benefits and obligations. There need to be key performance indicators for both sides—industry and Government—and there need to be deliverables for both sides.

The all-party parliamentary group on access to medicines and medical devices, which I chair, set out an alternative proposal to try to find a more collaborative approach. I believe in the free market and that, ideally, there should be no cap; sheer market growth through investment would result in our growing the economy and the Government tax take funding new medicines and producing money for the NHS. However, I am clear that I have to be grounded in reality, and if we are to find a way forward, there needs to be a risk-sharing solution, because no cap is the inverse of where we are now—it puts all the risk on Government rather than on industry.

How can we find this risk-sharing solution? First, we can increase the cap. It is currently at 2%; 4% would allow quite a lot of headroom. We could ensure that, each year, the system is rebased, so that we do not end up with a complex way of compounding what the rebate figure will be year on year.

One of industry’s real concerns is that a big chunk of money goes straight into Treasury coffers, and there is no evidence of how it is recycled to benefit pharma or health. In its paper, the APPG suggests that we ringfence a large part of that rebate, though probably not all. Part of it would probably still have to go back to the Treasury, but a significant enough amount would enable those seven life science missions to be driven forward, and industry, academia and clinicians could look at what we can do to drive this vision forward with a sensible amount of money.

The current scheme could also be simplified by excluding some of the six categories of medicines included in the VPAS scheme. Biosimilars and branded generics, where the branding is mandated by the regulator rather than choice, could sensibly be excluded. I appreciate that that increases the cost, but given that those products represent such a large chunk of medicines used in the NHS, that must be a no-brainer. Some of those are older products that are of great benefit to the NHS.

There has also been concern that the negotiation needs to be across all Government Departments, whether the Department of Health and Social Care, NHS England, the Treasury, the Department for Business and Trade or the new Department for Science, Innovation and Technology. Similarly, although the Association of the British Pharmaceutical Industry represents all the sectors, some very specific interests groups, such as the Ethical Medicines Industry Group and the British Generic Manufacturers Association, believe they need the opportunity to put their case forward. What is the downside of listening? Surely, think-tanks, academia and those groups all have something to say. If we want the right answer, that is the right way forward. We need a two-way commitment and two-way investment.

What could the Government do to help themselves manage their medicine budget cost? First, they could streamline regulatory activity. Currently, we have the Medicines and Healthcare products Regulatory Agency and the National Institute for Health and Care Excellence. That is a sequential system, which means we have to go through different sets of appraisal to satisfy both regulators. Much of the data and many of the questions, while not the same, are similar. Other jurisdictions are looking at running the two processes in parallel. Why do we not steal a march on others and integrate them? We could do that and have a state-of-the-art regulatory body. To do that, we would need to take out the budget impact test and put it back into NHS England, where it started. That strikes me as the right place for it to sit.

How could we monetise that regulator? First, as the Government already recognised in the last Budget, we should look at mutual recognition of approvals in the USA, Japan and the EU. That will not be easy, and I suspect it will be possible only in some limited areas of medicine. None the less, that is the way to go. Many developing countries would be delighted to have a quality regulator such as the MHRA and NICE. Why can we not charge to be their regulator?

The real call from industry, however, is to make uptake real. Although the theory is that any drug approved by NICE will automatically be taken up in the integrated care system budgeting system, the reality is that that is not the case, because there is no enforcement mechanism. That is very important for financial and moral reasons, and uptake is an issue that the Government could sensibly agree to look at. It is about implementing many of the new suggestions coming forward and, hopefully, the clinical trials and recommendations from James O’Shaughnessy. Because we would have a large pot for life sciences, we could create a long-term working partnership through the VPAS to deliver the life sciences vision.

If this is going to work, the industry needs to identify, in principle, investments that it would make in the UK. I know that such discussions take place, but what can the industry bring to the table to generate growth in the economy, increase skilled jobs and attract research academics and practising physicians? How can it identify ways in which it can support the Government in other parts of the life sciences vision delivery pipeline? Ultimately, much of this is going to be based on trust and good will. Sadly, that is not there at the moment, so the most important thing is to get it back.

For the VPAS 2024 to work, we need something that is fair to the industry and the Government and that will deliver what we absolutely need: the most innovative medicines for individuals living in this country, which they want and deserve. It can be done, and I am absolutely confident the Minister and his team will do their level best to try to achieve that. I am conscious that he is limited in what he can say, because of ongoing consultations, but I would welcome some reassurance that he agrees we should move to something that is more of a partnership—where there is true commitment and collaboration, and where there is a true link between the VPAS payment by industry and its use for life sciences development—so that we can actually see the life sciences vision live.

--- Later in debate ---

[Anne Marie Morris]

I apologise for interrupting the Minister’s flow. He is right that there was a forecast, but my understanding is that it was wrong and that there was an under-growth in all those years bar one. The consequence was that it was not possible for industry to have the predictability that he outlines. Forecasting will clearly always be a challenge, but, as I understand it, in this case it did not give industry what it needed.

[Will Quince]

I hear what my hon. Friend says, but we are talking about what is now history. I do not think anybody is realistically advocating any kind of change to the existing VPAS scheme—in effect, we would be saying that there would be a retrospective rebate to big pharma, despite what was agreed and negotiated. I do not think anyone here is proposing that today. What we are proposing is something that we get right—something that is totally transparent and open for the future in the new VPAS scheme. I know that getting this absolutely right will be at the forefront of the minds of the ABPI and industry as we approach new negotiations.

I want to briefly touch on international comparisons. While direct comparisons of rebate rates can be misleading —as has rightly been pointed out, they are not necessarily as clear internationally and there are differences in the structure of systems between countries—we none the less continue to monitor and consider UK spending on medicines in an international context. It is important to point out that the UK is around the median for spending on medicines per capita among comparable countries in Europe. We tend to spend the same as or more than Denmark, Sweden, Portugal, Spain and the Netherlands, and less than Germany, France and Italy. It is important to provide context.

I come back to the initial point: as important as medicines pricing is, it is part of a wider bricking-up of a UK environment on which global boards will make a decision as to whether the UK is a good place to invest. Yes, we take this matter very seriously. However, as important as VPAS is, I am equally concerned by and keen to address some of the other issues that industry is rightly pointing out. Understandably, given that we are just about to start negotiations and its importance to industry, the issue of the day is VPAS. However, I know how interested industry also is in getting our regulation right, in our speed in setting up clinical trials and our ability to get patients on to clinical trials, and the uptake of new and innovative medicines and medtech into our NHS. Those are huge issues for industry too, and they are areas I am focusing on.

I am conscious of the need to give my hon. Friend the Member for Newton Abbot time to wind up, so I will conclude by once again reassuring her and Members from across the House that the Government are committed to a mutually beneficial voluntary scheme that supports patient outcomes, a strong, thriving life sciences industry here in the UK and—vitally—a financially sustainable NHS. We can all agree that this scheme is vital to keeping the branded medicine bill affordable for our NHS and ensuring that the UK life sciences industry can earn the money it needs to fund research and development into the new and improved medicines of the future. We cannot overestimate the impact that the scheme has had for thousands of patients by ensuring that they have rapid access to new life-saving and life-extending treatments. We remain firmly committed to VPAS and to working with the industry to deliver a new branded medicines agreement. I will ensure that we put patients’ needs at the forefront of these discussions and at every step of the process.

[Anne Marie Morris]

As has been rightly said, we are encroaching on recess time, so I am grateful to all contributors for still being here. This has been an important debate, and one thing is clear: there is more agreement than disagreement on what we want to achieve. We all want growth in the UK economy and to see medicine prices set in such a way that they are affordable; however, we also want to ensure that the system is a partnership and that we do not disincentivise the very investment that makes all this possible.

I am heartened by what the Minister has said. I understand, of course, that this is not a simple, binary negotiation about medicine prices as against the life sciences vision. Indeed, in my proposals, all the things the Minister set out as issues for industry are things that should and could be part of the VPAS debate. The reason is that it is the only debate where Government and industry agree between them what they are going to do—there is no other opportunity. I urge the Minister to make the most of it by ensuring that all the things he says, and I agree, that industry wants—quite apart from the specifics of what the medicine pricing mechanism will be—are debated in the round. I am sure that Sir Hugh Taylor will do a first-class job supervising that, and I am delighted to hear that we have somebody independent. I will close on that note, and thank you, Mr Sharma, for your indulgence in allowing us to sit into recess.

Question put and agreed to.

Resolved,

That this House has considered the voluntary scheme for branded medicines and the Life Sciences Vision.

Oral Answers

Anne Marie Morris Excerpts

Tuesday 25th April 2023 Commons Chamber

[Maria Caulfield]

We are spending an additional £2.3 billion a year on mental health services, and we have recently announced £150 million for crisis community support, because we are trying to reduce the number of people being admitted in the first place by treating them at an earlier point in their mental health illness. That will free up beds, but it will take time. Community crisis intervention is the way in which we want to make progress.

[Anne Marie Morris (Newton Abbot) (Con)]

Investors need certainty and the British people need access to more medicines. The growth cap in the voluntary pricing agreement for branded medicines between the pharmaceutical industry and Government makes the size of the medicines rebate unpredictable. Will the Minister remove the growth gap from the 2024 voluntary scheme for branded medicines pricing and access, to supercharge investment that is currently leaking to Germany and Ireland?

[The Minister for Health and Secondary Care (Will Quince)]

I can certainly ensure the House that we are seeking a mutually beneficial voluntary scheme that supports patient outcomes, a strong life sciences industry and a financially sustainable NHS. We have been working directly with industry to understand the impact of changes to VPAS on investments into the UK life sciences sector, and we remain firmly committed to VPAS, which, it is important to say, has saved the NHS billions of pounds and saved millions of lives by supporting patients with life-threatening conditions and giving them rapid access to new medicines.

Oral Answers to Questions

Anne Marie Morris Excerpts

Tuesday 1st November 2022 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

2. What recent discussions he has had with relevant stakeholders on tackling health and care workforce shortages in rural areas.

[The Minister of State, Department of Health and Social Care (Will Quince)]

Ministers and officials regularly engage with a wide range of organisations to ensure that we are alert to the staffing issues facing the NHS and care sector across our country. We have increased training places for doctors, nurses and allied health professionals and increased access to clinical placements across a wide range of settings. We have also developed apprenticeships and blended learning opportunities to improve access to training that supports remote and rural communities.

[Anne Marie Morris]

In Devon, workforce shortages are acute. One in 10 nursing places remains unfilled, one in eight mental health roles across the south-west is vacant, and there are no dental practices taking on new NHS patients. That gap is too big to be bridged through current training and recruitment plans. Will the Minister create as a matter of urgency an innovative new career pathway, reducing the time to get new staff to the frontline?

[Will Quince]

I thank my hon. Friend for her question. She is a passionate campaigner on this issue. I recently responded to a debate on this issue led by her. She also chairs the all-party parliamentary group on rural health and social care. She is right, and we have developed an apprenticeship route for almost all professions in our NHS, allowing people to join the health and care sector immediately on an earn-as-you-learn basis. We continue to work hard to develop pathways into health and care professions, including via our groundbreaking blended online learning programmes.

Rural Healthcare

Anne Marie Morris Excerpts

Wednesday 12th October 2022 Westminster Hall

[Julie Elliott (in the Chair)]

I will call Anne Marie Morris to move the motion and then I will call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention in a 30-minute debate.

[Anne Marie Morris (Newton Abbot) (Con)]

I beg to move,

That this House has considered rural healthcare provision.

It is an absolute pleasure to serve under your chairmanship, Ms Elliott. I have already provided the Minister with a copy of the report by the all-party parliamentary group on rural health and care, which followed a three-year inquiry that we undertook with the National Centre for Rural Health and Care. It contains a lot of detail about the issues and suggested solutions. It looked far and wide across the world, not just across the United Kingdom, and I certainly hope that the Minister will give it more time than I suspect he already has in preparing for this debate.

The number of people living in rural settings is not small—9.7 million people live in rural England—and they have very different needs, so the current one-size-fits-all approach simply does not work. We have a different demographic. Generally, our constituents are older, they have complex comorbidities, they live in isolation, and many are in severe deprivation, but much of that is often hidden because the data collected is at such a high level that the issues are simply not identified. If levelling up, which is a commitment of the Government, is to mean anything, that has to change.

Covering everything in the report would take me more than the time available, so I will limit myself to the Government’s alphabet. Let me go through A, B, C and D. On ambulances—A—I absolutely applaud the Government’s position that the current situation is unacceptable and that we need shorter response times, particularly for category 1 and category 2 emergencies, but I am sure the Minister is well aware that the data shows that rural and coastal areas have some of the worst response times across the country, often because it is simply not possible to reach particular parts. In Devon, there are some areas where it really does not matter how many ambulances there are and how fast the roads might be—they are not—as there comes a point where it is not possible to get further.

We have not looked at a different approach. We have not looked at how we triage this differently so that we improve, rather than reduce, health outcomes. A one-size-fits-all approach means that those in rural areas are at much greater risk than those in urban areas. There is not a specialist centre of excellence for strokes that people can get to very quickly by being popped into an ambulance.

Money is clearly an issue, but if we properly integrated our use of fire services, police, ambulances and first responders, we would get a better outcome. Let us triage the calls as they come in differently, and then let us use those individuals and organisations better. Currently, the barriers are different pay for different forces and the fact that those organisations—fire services, police and ambulances—have different lines of accountability to different Departments, which means that they do not work together.

We could find a much better and more efficient way of doing this. Fire services are vital, because they are often physically located in some of these very rural areas. There is not a lot of point trying to get an ambulance in every rural village; that would be completely inappropriate and unaffordable, and it would not work. Let us look at how we can deal with those blockages and do this differently.

B is for backlogs. The Government’s aim to reduce the backlogs is commendable, and the plan to get waits down to one year by 2025 is fabulous. However, those of us who have rural constituencies know that the resources right now are simply not available, and rural areas have a real challenge to recruit. They are seen as unattractive. Youngsters want to be near the nightlife and the fun when they are off duty. The idea of coming to a rural area is not attractive. That is well known to the Government, because there have been various planned pilots and initiatives to pay individuals more to attract them to rural areas. It simply does not work.

[Tim Farron (Westmorland and Lonsdale) (LD)]

The hon. Lady is making an important point. When it comes to waiting times for cancer treatment, 41% of cancer patients in south Cumbria and 59% in north Cumbria are waiting more than two months to get their first treatment after diagnosis. We know that is certainly costing lives. Does she agree that tackling the cancer backlog has to be the absolute priority for this Government?

[Anne Marie Morris]

More than that, we need to look at the different pathways in rural communities for heart, cancer and stroke treatment. I agree with the hon. Gentleman, but there is a lot more than just cancer, and the rural pathway to care has to be reviewed to see what is realistic in a rural area.

All of this has been made worse by a funding formula that is not fit for purpose. Although there is provision to uplift for rurality, it is not enough and it has been done without any real understanding of some of the challenges.

[Cherilyn Mackrory (Truro and Falmouth) (Con)]

Cornwall has more visitors outside of London than anywhere else in the country, so we have our winter pressures and then there is no respite in the summer months for our staff. We have issues with housing so we cannot recruit staff. Does my hon. Friend agree that there is a case to be made for extra funding for places such as Cornwall, and perhaps the wider south-west, to ensure that we have enough funding to treat all our visitors as well as our residents?

[Anne Marie Morris]

That is an exceptionally fine point. I have no issue with it because we have a similar problem in Devon. The solution is not just about more recruitment and doing things in the same way, because the people to be recruited do not exist. We need to look at doing things differently, by creating new career paths with shorter training periods and trying to train, so we can then recruit, locally. Generally, people will follow a career where they are trained. We need more rural training for doctors and nurses, and that training needs to be not in the local city, but in the rural areas. For example, in Plymouth we have a fine medical school— Peninsula Medical School—but the challenge is that the experience that the individual trainee doctors and nurses gain is not rural, and it needs to be.

[Dr Luke Evans (Bosworth) (Con)]

My hon. Friend is making a fine point. From my experience, there is an opportunity: young doctors who are becoming GPs tend to be between the ages of 27 and 35. At that time, most people are looking to set up their family, go to school and get married. If we extend some of the career opportunities by extending training in those areas, they are more likely to bed down roots and gain a skill to become a GPSI—a GP with a special interest—in those areas. Does she believe that is a formula that the Government should look at?

[Anne Marie Morris]

I absolutely agree, and it is an excellent suggestion. In a similar vein, when we are asking primary care networks and others to deal with the backlog, it is important that we try to give them much more freedom in how they address the problem. I talk to many of my local commissioners, and they say that they are having to make decisions that they know are right, even though they are not currently in the guidebook as best practice. We need to give them that trust to be able to do the right thing.

C is for care. Members will not be surprised to hear that the adult social care discharge fund, although welcome, is not going to be enough. The reality is that the bed count is often low in rural areas. In the south-west, we have the lowest bed count per head of population; I think it is the lowest in western Europe, although I am happy for the Minister to correct me. It seems to me that we used to be moving towards saying, just in time, “Let’s have care in the community.” However, because of the shortage of care in the community, and the lack of proper validation that it works other than whether people are readmitted, we need to put a halt to closing community hospitals and to look at how they can be used. Some could be repurposed. Perfection can often be the enemy of the good.

Teignmouth Community Hospital in my constituency is on the closure list, but to me that is not a wise decision. There are no nursing care homes in the area. Without that residential care, and without adequate care in the community, removing the only other source of beds is not the way to solve the backlog problem.

[Bob Seely (Isle of Wight) (Con)]

I thank my hon. Friend for securing the debate and this important conversation. I also thank the Minister for the community diagnostic centre announced for the Isle of Wight this week. That is great, but we still have a problem similar to that of my hon. Friend the Member for Newton Abbot (Anne Marie Morris): unavoidably small hospitals. There are dozens of those in England and Wales, of which St Mary’s is the most isolated. We were able to work with the Government to improve the funding formula in 2019, so unavoidably small hospitals have got some more money. My concern—the same might be true for hospitals in my hon. Friend’s area—is that that is not enough to cope with the health needs and the demographics in our communities. It would be great if the Minister could meet some of us to discuss the future of unavoidably small hospitals in places such as Devon, Cornwall, Cumbria, Northumberland and the Isle of Wight to see what more we can do to support these important community centres.

--- Later in debate ---

[Anne Marie Morris]

A point very well made, which I support.

Care, as we all know, is one of the biggest challenges. If we fix care, we will fix the backlog, so we also need to look at how we train and professionalise not care on its own, but care with health. We need to give care professionals the same respect as we give others—and, frankly, for the same sort of skill, we need to pay the same salary. That is crucial if we are ever to get this to work.

D for doctors is the last letter in the Government’s alphabet. The Government are looking for the GP appointments system to improve, so that anyone who needs to see a GP can do so within two weeks. They want to provide data so that individuals may choose which doctor they go to see, and they want to increase the use of pharmacies.

Now, all that is very worthy, but unfortunately, when it hits reality, it becomes the problem. In rural areas, there are too few doctors. If we had data, choice would be great, but there is no choice, because there is not another GP practice. The problem in rural areas is not the level of data, and it is not choice—there is none. It is recruiting the doctors we need. Recruitment in rural areas is in crisis. Yes, we should make more use of pharmacists—that would be fabulous—but in many rural areas pharmacies are closing because they cannot get enough pharmacists. We have a real conundrum, and that is crucial.

If we are to address the issue, we need proper rural medical schools, shorter career courses, and proper training for new routes into medicine and care. Physician associates are a great start, but the reality is that that is only one route, and it is still quite a long training period. More broadly, primary care is mission critical; we know that training in generalist skills across the doctoring profession, if I can put it like that, is done very early but not continued. We need those skills so that we have a much broader range of doctors who, when we have something like the pandemic, are able to cope with the issue. We also need more geriatricians.

D also stands for dentists. The new contract is welcome, but it has been discussed for eight years, I think. It needs to get done. Doctors and dentists need a fair return for the work done and they need to be incentivised to provide the best treatment for the patient. As I understand it, under the existing contract, dentists are in effect encouraged to sub-optimise. They are only paid a relatively small amount, so they will do the minimum rather than what is in the patient’s best interest. We need fairness for the dentist and for the individual patient to be at the forefront of the contract.

We need to step up recruitment, we need to create rural emergency hubs, and I think we need to appoint school dentists. In the same way that a GP is in charge of a particular care home, I see no reason why we should not have a dentist who is responsible for a particular school. I am not suggesting that they should go in and do fillings, but they would at least go in and do regular checks.

[Cherilyn Mackrory]

My hon. Friend is being very generous with her time, and I appreciate that. I remember—she may too—that, as schoolchildren, we had somebody come into school to check over our teeth, just to see if there was anything going on. It is my understanding that someone does not have to be a dentist to be able to tell whether something is going wrong; dental technicians, hygienists and others can do this work. Does she agree that it would be worth doing pilots around the country, particularly in rural areas, to see whether that could cut down some serious dental issues with our children?

[Anne Marie Morris]

That is an excellent suggestion. There is quite a lot for the Minister to take away and think about.

Having gone through the alphabet, I think there are a number of things that we need the Minister and his team to do, including recognising that rural really is different and that the way we look at it now simply does not work. We need to properly understand and investigate the need in different rural communities, and then we need proper funding. We need to look at how we train locally, which will improve recruitment and retention. We need to create new, shorter courses and new professions—and we need to do that now; otherwise, we are never going to get on top of the backlog. Waiting for degree-qualified nurses and doctors will simply take too long.

We need to equalise the professionalism and pay across health and care, and we need to integrate emergency response across all resources—police, fire, ambulance and first responders. I am happy to volunteer the south-west, which I think would be up for it, as a pilot area. I hope that the Minister will go away and think about that, and that he may be willing to meet those who have raised issues today to see if we cannot find some solutions and to discuss the other issues in my rural report.

Oral Answers to Questions

Anne Marie Morris Excerpts

Tuesday 19th April 2022 Commons Chamber

[Edward Argar]

I am very grateful to the hon. Lady for her question. We are clear, and always have been clear, about how much we value the huge contribution that overseas workers in our NHS make towards keeping our health service up and running, and delivering first-class care every day. There are three strands to our approach to building and increasing our workforce. The first is increasing the numbers of people training in this country and the second is increasing retention. The third focuses on the workforce who come from overseas and who are incredibly welcome here. Indeed, the number of people coming from countries outside the EU into our NHS workforce has increased.

[Anne Marie Morris (Newton Abbot) (Ind)]

The Minister will be aware that I have highlighted the challenge for rural areas in developing a workforce plan on a number of occasions. Indeed, the last report from the all-party parliamentary group on rural health and social care made 10 recommendations, including for how we might address workforce planning in rural areas. Will the Minister advise me of what steps he has taken to put in place any of those recommendations to improve the plight of those living in rural areas?

[Edward Argar]

I am grateful to my hon. Friend, who takes a close interest in this issue, which she and I have discussed on a number of occasions. She is right to highlight the challenges that some more remote or rural communities can face in securing the workforce they need to meet their communities’ needs. The HEE work and the subsequent workforce framework will be looking at that across the whole range of different geographies and the challenges they face.

Covid-19: Forecasting and Modelling

Anne Marie Morris Excerpts

Tuesday 18th January 2022 Westminster Hall

[Anne Marie Morris (Newton Abbot) (Ind)]

I will try to be brief, Sir Edward. The hon. Member for Isle of Wight (Bob Seely) has raised a first-class, crucial issue. Clearly we cannot predict the future, but we can prepare for it. Traditional crisis management and risk management list the possible things that might happen and look at the severity and the likelihood, and based on that we produce a number of models. That is the old way of doing it.

The modern way of doing it, instead of creating models, is to create a playbook—a mechanism by which we can look at all the challenges that might face a country and at least put in place a mechanism for dealing with the crisis, whatever it is. Bizarrely, the US have taken that approach but, perhaps rather sadly and tragically, never used the playbook model that might have saved them.

We very much went down the model route and took out of our kit bag the one we had for flu. It was too rigid, did not fit and was too slow. The assumptions were not challenged; the real world evidence was not incorporated; and, worse, we limited how we looked at modelling absolutely to covid. We looked at the mortality of covid and the impact; we looked at the morbidity of covid and the impact, but we should have looked instead and as well at the impact of the crisis as a whole and the proposed solutions, including the lockdown and other restrictive measures, across the country, across society and across the economy.

We were told at the time—the Government were challenged on this—that it was too hard: we could not possibly do any modelling with regard to the mortality of lockdown and restrictions, the morbidity of lockdown and restrictions, or the economic impact. That was sadly relegated to second order, but we should never forget that there is a huge interaction between wealth and health.

The interconnectedness of the impacts of the steps that were taken was totally ignored. They were unexplored and unexplained for a good 12 months. So only today, as my hon. Friend the Member for Isle of Wight has articulated so clearly and eloquently, are we looking retrospectively at what happened. At last we are looking at the impact, not just on covid patients and those vulnerable to covid, but on those patients not subject to high risk for covid. We are looking at the impact on children’s life chances—not just on their education—as it is far more serious than just their education. We are beginning to look at the impact on society and communities and—at last—the economy. As my hon. Friend said, never again must we be faced with the question, “Did we unknowingly and unintentionally do more harm than good?”

Forecasting and modelling have a valuable place, but we must never forget that they are tools. Advisers advise; Ministers must ask for the right advice, the right variety of advice, and then decide. Never again should we hear, “We will just follow the science.”

Public Health

Anne Marie Morris Excerpts

Tuesday 14th December 2021 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

The heart of these regulations is all about slowing transmission and reducing demand on our limited NHS capacity, so there are two ends to this telescope. The first is about prevention and making sure that people do not get covid. The second is about making sure the capacity is there so that if they do get covid we can cure not just them, but other patients who have non-covid-related illnesses. These regulations are very focused on the prevention end of this telescope. Clearly, vaccination uptake is crucial, and the Government are to be commended on that, but this has to be a matter of choice. Given others’ contributions, the point has been well explained already. Mask wearing and covid passports have not been subject to the rigour of proper assessment. A proper analysis has not been undertaken here and I fear that they will do more harm than good to society taken as a whole. They generate fear in those who least need to be fearful, they increase mental health problems, and they reduce non-covid admissions and treatments.

However my real concern is that the Government have not focused sufficiently on the other end of the telescope. We have not looked adequately at what we do about the adequacy of our resources. Despite promises and numbers of new doctors and nurses coming forward, even the Government have admitted that that will not be enough to fill the huge number of vacancies we have. If we can reduce vaccine development from 10 years to 100 days, surely to goodness we must be able to find a way of undertaking a laser-like review of a patient journey to make a better and more efficient use of the limited resources we have—and, indeed, to increase them. I call on the Government before Christmas to put in place an emergency resilience taskforce, which needs to have a laser-like focus on the capacity issue, which has not been fully addressed—frankly, it has hardly been addressed at all. We can work smart; there are very good brains within our health service. We see that when we look at what Sir Ara Darzi has done in the Accelerated Access Collaborative, with new drugs and “faster patients”, in a way never seen before, or at what our own Kate Bingham, the vaccine tsar, has done to do what was supposedly impossible. When this taskforce is created, and it must be before Christmas and it should be asked to report by the end of January, it must look at better use of emergency services. We must use the fire and police services better. It must look at proper triaging of accident and emergency arrivals, and better use of medical professionals. We are using the wrong people to do the wrong jobs. We must expedite training, look at whether some of our training takes too long, and use the Nightingales and other resources to deal with non-covid backlogs and convalescing to deal with the healthcare problem. Finally, if we cannot have covid passports, testing must be the right way forward in social care and health.

[Several hon. Members rose—]

Covid-19 Update

Anne Marie Morris Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

The UKHSA has removed many so-called providers of PCR tests from the listing on the Government website. It has set a minimum price that must be met to try to avoid misleading prices. Unlike some other countries, we have not chosen to subsidise the cost of private PCR tests, because we have rightly concentrated our resources on the PCR tests that are available for people domestically if they have symptoms.

[Anne Marie Morris (Newton Abbot) (Con)]

The extended vaccine roll-out is welcome to prevent infection, but given that this puts even more pressure on resources, what steps have the Government taken in tandem to increase capacity in the NHS to address the increasing demand from both covid and non-covid patients? I know that the Army is being brought in, but what about Nightingale hospitals? Might they be reinstituted? Will we look again at the pension challenge, which stops senior people staying in the profession? Will we look at accelerating the training programmes for our health professionals, as other countries have? Will we create new health professionals with shorter training programmes? Action is needed now to deal with the capacity issue.

[Sajid Javid]

My hon. Friend is right to talk about the importance of increasing capacity. The pandemic has brought that acutely to the front of our minds. There has been significant investment since the pandemic started, particularly in certain types of capacity, such as intensive care units, PPE and oxygen, as well as personnel, with some 10,000 nurses and 3,000 doctors added over the last year. As a result of the omicron emergency, we are revisiting the issue of how we can further increase the temporary capacity.

NICE-Approved Products: Patient Access

Anne Marie Morris Excerpts

Tuesday 30th November 2021 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

I rise to address the challenging issue of access for patients to medicines and medical devices. We all believe absolutely passionately that we should have access to doctors and nurses, good hospitals and operating theatres, but I think the pandemic has shown beyond question that access to medicines and medical devices goes hand in hand, and without that we do not have the NHS that I think we all believe everyone deserves.

What is the problem? The problem, I shall explain, is as follows. When a medicine is approved, it goes through two processes: first, with the Medicines and Healthcare products Regulatory Agency, which checks whether or not a drug is actually safe and does effectively what it says on the tin; and then it goes to a separate process run by the National Institute for Health and Care Excellence, which looks at cost-effectiveness and value for money. The theory goes that, once those two hurdles have been passed, the medicine is then accessible to anyone. It is very clear in the NHS constitution, which explains that there is a legal right for people to have NHS NICE-approved drugs if it is right for their particular circumstances. Indeed, the NICE guidelines say that there should be automatic adoption, if clinically appropriate and relevant, within 90 days of approval. So where is the problem?

The problem is partly in the system and partly in the words. The words in the constitution are effectively caveated: people can have a medicine if it is right for their particular circumstances. Likewise, according to the NICE guidelines, it will be automatically adopted if clinically appropriate and relevant. The challenge is that, in the current system, NICE will approve medicines for the condition for which they are most cost-effective, so in this country we do not have the ability to approve a medicine for multiple conditions—multiple indications, in the jargon. It is what is most cost-effective that gets approved, and others do not, and there is not a system, either than paying privately, to ensure that the medicine that has been approved for the condition for which it is most cost-effective is available to those with other conditions, but that medicine may in fact still be the only possible solution.

Assuming we get over that hurdle, there is a second hurdle, because not only must NICE have approved the drug, but it has to go on the approved list of drugs locally in the local health authorities—now integrated care systems. The problem is that to get on those formularies, somebody has to put it on those formularies. Currently, while in theory under the NHS NICE guidelines there is a system, it does not actually happen. There is currently a drug for multiple sclerosis, and research shows that people are still waiting after 150 days for it to go on the formularies in something like 25% of the local health systems across the country. So the system, fundamentally, does not work.

What does this result in? It results in a postcode lottery. If someone has type 1 diabetes, it is absolutely crucial that they monitor their condition. There is a device, a flash monitor, that is state of the art, and research shows that the uptake across the country varies between 16% and 65%. What is most worrying is that those parts of the country with the greatest levels of deprivation have the lowest levels of uptake. We all think we have access to medicines for cancer given that we now have the highly innovative and very welcome cancer drugs fund. However, that drugs fund is only relevant when the particular drug is approved for a particular type of cancer. So there will be some drugs—Avastin, for example—which those with the appropriate cancer can get through the CDF, but those with a different type of cancer or who do not fit the profile again have to pay for it privately, costing £252 to £1,088 per cycle, which is every three months.

Sadly, NICE does not approve much for those with skin conditions. For those with mastocytosis—blotches on the skin and boils causing vomiting and diarrhoea—the only solution is usually NICE-approved food allergy drugs, but they are approved for NICE allergies not skin conditions so they have to be paid for privately. For cystinosis, the accumulation of amino acids, which gives rise to kidney problems and kidney damage, the drug Procysbi has been approved by NICE but, bizarrely, there seems to be no uptake of that to date at all. That is important because that drug is, unlike the existing drug, a slow-release drug and therefore mums and dads do not have to keep waking up their kids in the middle of the night to give them the next dose, which, as we can imagine, takes a real toll on family life.

For those with an obesity problem there is a good solution in Saxenda, but that is approved for diabetes. So those whose obesity does not give rise to diabetes will not get access except by case-by-case approval. I am pleased to say that Imperial has finally accepted and approved.

How are we going to resolve some of these issues to make sure there is no longer a postcode lottery? First, let us look at the simple case of those drugs that are deemed to give the most health benefit and are therefore in theory approved and people can get hold of them. What can we do to make sure they do actually finally appear on those formularies and how can we then make sure the system for take-up is actually in place? One of the problems is that there is nobody sitting in these health bodies who monitors NICE drugs coming up, and therefore no one who looks to see whether in their health community they may be of benefit.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing a debate on this topic. As she says, this is about NICE-approved products as well as drugs. One of those products is cognitive rehabilitation therapy, an important intervention for those with dementia, enabling them to live independently for longer. However, despite being listed in the NICE recommendations there is a barrier to delivery. Occupational therapists and other staff in memory clinics do not have the capacity to deliver programmes that are National Institute for Health Research and Alzheimer’s Society-funded. Does the hon. Lady agree that the NICE recommendations must address not just drugs but also products?

[Anne Marie Morris]

I could not agree more. It is crucial to realise we are talking not just about medicines and drugs but also devices and, as the hon. Gentleman says, the processes, which are often the connection between the medicine, the device and the patient.

Within these health bodies, there is no training and nobody specifically focused on monitoring innovation, and there is no obligation to prescribe. Even more peculiarly, for these drugs there is an agreement between the industry and the NHS, the voluntary payment scheme or VPAS, under which manufacturers that are members of the scheme effectively agree with Government when the medicine or device is approved that it will be supplied at a well-discounted price. In addition, there is an agreement that sets a cap so that if, as it happens, more prescriptions are written for that particular drug, it is agreed that the extra cost that the NHS has incurred will be reimbursed by the manufacturer.

So if there is excessive prescribing—we assume that is why there is an attempt to limit how much goes on to formularies—why is that a problem when we have the VPAS scheme? It is a problem because the scheme does not the pass the benefit, other than the reduced price, down to the local health authority. The money is put into a separate pot, and that pot is then used generally to support the NHS writ broadly; it is not ringfenced, either for medicines or to be used, as it could be, to support local health authorities—integrated care systems—when their budgets are put under pressure, which is why they do not want too many things on their formularies. This would help them pay the price.

It seems to me, Minister, that there are some solutions here. You will be aware that I raised three of them in proceedings on the Health and Care Bill. To deal with the imperfections of the current arrangements, if those drugs that were approved by NICE—we are talking about the most cost-effective drugs—were mandated to be on formularies within 28 days automatically, so no one had to decide whether they went on or not, that would be a good system. It would also ensure that the decision was in the hands of the clinician and not of the bureaucracy of the health authority.

It seems to me, Minister, that the second suggestion I made—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. It is quite important not to address the Minister directly; he should be addressed through me.

[Anne Marie Morris]

Thank you for the correction, Madam Deputy Speaker.

My second proposal is that there should be an innovation officer specifically appointed to look at and manage these issues. Failing all else, there should be a final provision that specifically puts an obligation on the health authority to provide any NICE-approved medicine. Then, as a matter of practicality that is not a matter for the Health and Care Bill, there should be a new arrangement under which the NHS would agree that this pot, rather than going into the general NHS coffers, is put aside specifically to reimburse local authorities.

What about the second category—those drugs that are approved by NICE but not used for the most cost-effective indication? That is called off-label prescribing. We know that a drug in that category does what it says on the tin and we know that it is cost-effective, but it is not sufficiently cost-effective to have got a tick in the box from NICE. Access then is a matter for negotiation between the integrated care system, the NHS and the manufacturer. Often, the starting point will be the list price, but bear in mind that that list price is a lot more than the NHS is paying. The result is that in different health authorities and different hospitals, different patients are offered different costs to be able to access the drug.

There is a real problem on top of all this. To ensure that there is no gaming of the system between access to private healthcare and state healthcare, someone cannot mix the two—quite rightly, we do not want gaming of the system so that people can effectively jump waiting lists—so there is an agreement to enable people to do a bit privately and then jump straight back into the NHS. If there is an episode where someone takes a drug and pays for it privately, technically they cannot then have the ongoing monitoring of their cancer—screening and so on—on the NHS. Individual health authorities recognise that that is rather absurd when we are talking not about a private patient with health insurance but about someone for whom the only way to get the drug is to pay for it, but that recognition is not universal.

So what is the solution for this one?

We need to look at NICE, supported by NHS England, accepting multi-indication approvals. That means a drug company can take a drug and apply, at the same time, for the drug to be approved for different health issues that have different ranges of health benefit. Clearly, the NHS will say, “Hold on a minute. I am not going to pay the same price for something which delivers less health benefit.” That means we need a system of differential pricing, so that a different amount is paid by the NHS for the drug, depending on the use to which it is to be put. That is entirely possible. It is done all over the world.

The Office of Health Economics put out a report, an international study, just this month on “Payment Models for Multi-Indication Therapies”. It concluded:

“Inflexible uniform pricing does not optimally support innovation and access. The most important consequence is lost treatment opportunities for patients.”

I respectfully suggest that the NHS and the Department of Health and Social Care might sensibly look at that. I also suggest, given the clear importance of payment support through industry, that as we move to the next iteration and renegotiation of VPAS, the agreement under which the industry agrees reduced pricing for mass purchase above a certain cap, it will reimburse the Government. That renegotiation needs to include provision for the multi-indication approvals process and differential pricing. 2023 is not very far away and I urge the NHS and the Government to take it forward very quickly. Meanwhile, there should be agreed standard pricing which is effectively paid for and underwritten by the pot set aside as a result of the cap.

There is one final area that needs to be addressed: drugs approved by NICE through a managed access agreement. For some treatments—typically gene therapy, where you are taking body fluids out, effectively changing the genetic make-up, and then putting them back in again—a hub needs to be set up in a hospital. Often, when drugs are approved, exactly how they are going to be delivered is not approved at the same time. Those drugs and processes need to be agreed not just in principle, but together with a package that ensures they can be implemented. As things stand, it can often take three years and much argument before hubs are established and the funding can then flow.

In summary, I ask for a number of things. First, my three new clauses to the Health and Care Bill would require local health system formularies to include NICE-approved drugs within 28 days. Secondly, there ought to be included in the Bill an absolute obligation to provide NICE drugs. It would then be for the individual health authority to work out how to provide them, but there should be an underpinning payment mechanism provided by the NHS. Thirdly—again, I have tabled a new clause on this—we need an innovation officer to ensure the system runs smoothly and that the things that would give best benefit are put on those formularies.

Fourthly—forgive me, Madam Deputy Speaker, there are eight of these—I would like the Government to look very closely at a multi-indication approval system, fifthly, at a differential pricing system and, sixthly, at an appropriate VPAS agreement for 2023. My last asks are about how the money is used. Seventhly, the pot of money, an accumulation of money paid by industry because more of the drug was prescribed, should be made available to local health systems, the integrated care systems, to cover the costs that are not in their mainstream budget. Finally, we should put in place a formal delivery mechanism for every managed access treatment to ensure that it is not just a promise, but actuality. I wonder whether it might therefore be appropriate for this Minister, the life sciences Minister—the Under-Secretary of State for Business, Energy and Industrial Strategy, my hon. Friend the Member for Mid Norfolk (George Freeman)—and the innovation Minister, Lord Kamall, to meet me, because all three have a critical role, given their involvement in access, industry and licensing. I wonder whether it might be possible to persuade them to accept my three amendments to the Health and Care Bill.

It might also be helpful if these matters were raised with the National Audit Office, which could review the current system and look at whether it offers value for money. That would be a very good use of their time. I am sure that the doughty hon. Member for Hackney South and Shoreditch (Dame Meg Hillier), who chairs the Public Accounts Committee, might also be interested in looking at this issue. After all, value for money is critical.

In conclusion, we have a world-beating system but, as it currently stands, it does not provide value for money for all. It does not serve the best interests of all patients, and it does not serve the best interests of delivering the UK life sciences strategy. Indeed, I have one constituent who moved house from Devon to Southampton so that he could get a medical treatment.

[The Minister for Health (Edward Argar)]

As ever, I congratulate my hon. Friend the Member for Newton Abbot (Anne Marie Morris) on securing this debate and I pay tribute to her work in this area. That work has been sustained for as long as I have been a Member of the House—I was first elected in 2015—but I suspect that this area was of interest to her long before then. I pay tribute to her for her continued engagement on this area, which is not always top of the news or top of the political agenda, but is hugely important none the less, so I pay tribute to her work in this space.

I reassure my hon. Friend that the Government share this priority. She is right—I characterise this in these terms and I hope that she will not demur from this—that although the NHS workforce is the beating heart of our NHS, it is beholden on us to give them the tools that they need to be able to use their skills to treat and support the maximum number of possible patients in the most effective way. I think that is a fair reflection of the point that she made at the outset.

[Anne Marie Morris]

indicated assent.

[Edward Argar]

That is an encouraging start. That is why NICE exists. It plays a vital role in supporting patient access to new treatments. Through its technology appraisal and highly specialised technologies programme, NICE makes recommendations for the NHS on whether all new medicines represent value for money for the taxpayer.

NICE aims to publish guidance on new medicines as soon as possible after licensing and is committed to publishing draft recommendations on medicines around the time of marketing authorisation, wherever that is possible. It has a well-earned reputation as a world leader in the field of health technology assessment and it is right that, where NICE recommends a medicine or a medical device, it should be available to patients who stand to benefit. Value for money is important and I will come to that. I suggest that whether the NAO or the Public Accounts Committee wish to look at this is a matter for them, but as my hon. Friend said, she may wish to take that up with the hon. Member for Hackney South and Shoreditch (Dame Meg Hillier), who may well share her interest—I would not wish to presume, but the hon. Member may well.

Making treatments available is why NHS England and clinical commissioning groups are already under a statutory obligation to fund any treatment recommended by NICE through its technology appraisal or highly specialised technologies programmes, usually within three months of guidance. I will turn to my hon. Friend’s point on timing shortly. This will also be a statutory obligation for integrated care boards. As my hon. Friend has set out, the NHS constitution states that patients and the public

“have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor”—

the treating clinician—

“says they are clinically appropriate for you.”

That is an important point, because we rightly rely on clinical judgment in such circumstances. As my hon. Friend will be aware, NICE recommends the vast majority of new medicines—indeed, in 2020-21 it recommended 100% of them, often thanks to commercial agreements negotiated between NHS England, NICE and companies in parallel with the NICE assessment process—but it is right that that clinical appropriateness filter is there.

I am conscious of time, but before I turn to specific points that my hon. Friend made, I would like to say a few brief words about the success of the cancer drugs fund in supporting patient access to new medicines. The cancer drugs fund was originally introduced to support patient access to medicines that NICE was unable to recommend as cost-effective. Since 2016, however, the fund has been linked to the NICE appraisal process and supports patient access to promising new medicines where the evidence is not mature enough for NICE to recommend routine funding at that point. This has benefited more than 73,000 patients, who have been able to access 91 medicines through the cancer drugs fund, treating more than 200 cancers.

We are building on that fabulous achievement with our manifesto commitment to extend the cancer drugs fund model to non-cancer treatments by creating an innovative medicines fund. I think that there are lessons that we can learn from the cancer drugs fund. NHS England has also recently launched a consultation on proposals for the establishment of the innovative medicines fund. I encourage anyone with an interest to engage; knowing my hon. Friend, I suspect that she has probably pre-empted me and done so already.

I turn briefly to medical devices and treatments. The hon. Member for Strangford (Jim Shannon) was quite right to highlight that, although debate often focuses on drugs and specific medicinal or therapeutic treatments, we also need to look more widely at medical devices and at treatments that take other forms than therapeutic treatment. I know that he takes a close interest in the treatment and support of those with dementia, as I did before I was a Minister; I am grateful, as ever, for his contribution to the debate.

As hon. Members will know, NICE can also make recommendations on treatments through its clinical guidelines programme. Guidelines provide authoritative, evidence-based guidance for healthcare professionals and play an important role in driving best practice in the health and care system and supporting improved patient outcomes. However, they often make dozens of recommendations that can be complicated to implement at a local level. For that reason, they are not mandatory, but I assure the House and my hon. Friend the Member for Newton Abbot that the Government expect the healthcare system to take guideline recommendations fully into account in designing services that meet the needs of the local population and in working towards their implementation over time. It is right, however, that that implementation reflects local circumstance and is done at a local level.

I turn to local formularies; time is getting short, but I may also turn briefly to the eight points that my hon. Friend made—let us see how we do. She has raised concerns, not only in this debate but during the Health and Care Bill’s passage through the Commons and in conversations with me, that despite positive NICE guidance, some medicines are not available to NHS patients because they are not included on local formularies. In addition to the statutory funding requirement that applies to NICE-recommended treatments, NICE’S guideline “Developing and updating local formularies” recommends that, when NICE approves the use of a medicine through a technology appraisal, it should be automatically adopted into local formularies.

The standard contract mandated by NHS England for use by commissioners stipulates that providers must ensure that formularies include all NICE-recommended treatments. That process should take place within three months, allowing services a realistic timeframe to prepare for the introduction of a new technology. I appreciate that my hon. Friend went a little further on tightening the timeframe and the compulsion element, but given the complexity of some new treatments, I think that three months probably remains an appropriate timescale. I suspect that she will continue to push me on it, but at the moment I believe it is the right approach.

My hon. Friend is right that the system needs monitoring. She called for an obligation on integrated care boards to report uptake of new medicines annually, which is effectively monitoring. I am pleased to say that the Government support the view that uptake of NICE-recommended medicines should be monitored. Since 2013, NHS Digital has published an innovation scorecard that reports, at a national and a local level, the uptake of selected medicines that NICE has recommended in the last five years. I believe that it is more appropriate and proportionate that that information is collected and published by a single national body using agreed methodology, rather than multiple organisations that may have different ways of measuring and presenting the data.

My hon. Friend made a number of other points. Given the time constraints, I fear that I cannot address them all, but I will reflect carefully, as ever, on what she has said. Given that neither of them are present in the Chamber, it is a pleasure, as always, to agree on their behalf that my noble Friend the innovation Minister and my hon. Friend the Member for Mid Norfolk (George Freeman)—the life sciences Minister—will be delighted to meet her to discuss the matter in more detail. I am very grateful to her for bringing this evening’s debate to the House.

Question put and agreed to.