Social Care

Anne Marie Morris Excerpts

Tuesday 25th February 2020 Commons Chamber

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

Thank you very much, Mr Deputy Speaker.

Devon is a wonderful place for people to come and retire, and as a consequence we have many older people. According to Age UK, we have 39,853 individuals over 65 who have unmet social care needs, and in my own constituency the figure is 3,614. We know that there is a problem. It is not just in my constituency, and it is not just in Devon. I think that there is already a strong chord of agreement in the House that this is no longer about talking, but about action.

Those listening will expect us to act for them. They will not expect us to get involved in political wrangles. We have already had political wrangles over Brexit, and look where that got us: three years of inactivity. This Government have a majority, and with that comes a responsibility to finally resolve this social care problem. We have to find a solution. No more reports. No more royal commissions. We have had Sutherland, Wanless and Dilnot, and no Government who commissioned any of those reports have accepted all their recommendations. What would be the point of another one? The Care Act 2014 was a great start, but part two has not been implemented. Frankly, I do not think it ever will be. The reason? It is not affordable. Certainly, how we would afford it has not been thought through.

What is the barrier to all this? Why do Governments of every colour fail to deliver? First, there is a reluctance to ’fess up and actually admit how much this is going to cost. Secondly, there is disagreement across the House as to exactly how that cost can be met. We have already seen examples of that in the contributions today. Even if we could agree, there are other things that need to be sorted out, as my hon. Friend the Member for Thurrock (Jackie Doyle-Price) mentioned. We need to agree as a nation on the standard of care that should be delivered. We are not there yet. Even LaingBuisson, which has set many of the standards, has not done that.

We need to accept personal responsibility to maintain and improve our own health. We do not yet do that. We need to reduce our own care needs, or at the very least delay them. We need to consider developing community resilience. Families are often widespread, and we need to take responsibility for our neighbours and plan together for our wellbeing. We need to drive forward a wellness and wellbeing agenda, which is much more a public health agenda. Too much time is spent on illness, and not on wellness. We need to change our mindset with regard to old age, and I would certainly recommend reading “Extra Time: 10 lessons for an ageing world” by Camilla Cavendish. Being old does not necessarily mean that we are past it and falling off our perch.

What is the roadmap to change? For me, first, we need to define what “good” looks like to the recipient. Secondly, we need to decide what resources we need to provide that. Thirdly, we must develop a proper training and recruitment plan, and motivate our staff. Fourthly, we need to evaluate the adequacy of the existing infrastructure for care delivery. Do we have the right model? No, I do not think so. The earlier references to housing were well made in that regard. Fifthly, we need to look at integrating not just health and care but the whole IT strategy and housing strategy. There is much more work to be done on that. Sixthly, we must bite the bullet and decide which of the nine funding models—because there are nine—suggested in the various reviews we are going to use. There will be a degree of mix and match, but we have to make a decision.

So, that is for the long term. In the short term, we need a fix, and it is not just about money. We need to ask the Care Quality Commission to set the minimum funding levels that we will expect local government to pay for the care of any client, and central Government should be obligated to pay for that. We must make local authorities accountable for both the quality and quantity of care provided. They are not at the moment, and we know that there is a bit of a postcode lottery. We must make the NHS and local authorities equally and jointly accountable for the health and care delivered in the home and in care settings. That is not the case now. I do not ever want to hear a clinical commissioning group telling me, when it is talking about closing one of my local community care hospitals when we have no nursing care in the area, that it is not the CCG’s problem but the problem of the local authority. That is not acceptable, and it is not responsible.

We also need to put in place a full review of nursing care outside NHS provider institutions, and provide ring-fenced capital funding to deal with it. We need to stop the practice of putting people who should be receiving nursing care into residential care homes. That is not responsible; it is not right for the care home or for the client. We must stop caring for dementia patients in hospitals. That is completely wrong. It is not right for their care and not right for them in the long term. We need to create the right provision.

I am afraid that we also need to increase general taxation and report annually as to how that money, which should be ring-fenced, is being spent. I believe that those who are working should carry on paying national insurance contributions even past retirement. I take the point about the older generation who have retired contributing, and that needs to be taken into account. We should raise the level of personal funds that an individual may keep before they contribute. I think it should be raised to £100,000, and we need to cost that. We need to include more people with lesser care needs in the state-funded system, and, as has been discussed, we need to develop a funding model with the private care sector and the insurance sector that combines personal and state contributions to care costs, looking at compulsory savings and risk-sharing mechanisms.

We have made a promise to the British people, and we must keep it. Now is the time for action. No more talk, no more reports and no more commissions. This is the time for this Government, who have a majority, to deliver.

NHS Funding Bill

Anne Marie Morris Excerpts

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[Patrick Grady]

I wholeheartedly agree, Dame Rosie. I have addressed the amendments that we have an interest in, and I am contextualising why they are relevant to our constituents, but points are being extremely well made by my colleagues. There is a simple solution to this, which we in the SNP have been promoting for 84 years, since 1934: Scotland can become an independent country and England can have the Parliament that it wants. As my hon. Friend the Member for Airdrie and Shotts (Neil Gray) says, with the greatest respect for the Speaker, it should not be for the Chair or for the Government to decide what does and does not apply to Members from different parts of the UK. My job and that of my colleagues is to look at each measure before this House and determine for ourselves whether it is relevant to our constituents and act accordingly. Today, we are being actively prevented from doing that. There are amendments and new clauses on the amendment paper that we deem to be of interest to people in Scotland, which would take forward commitments in our manifesto, but we will not be able to vote for them. That is not a precious Union. That is not a partnership of equals. That is not leading instead of leaving. It is not something that is going to be sustainable for much longer, and 52% of people in Scotland seem inclined to agree.

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

I rise to speak to new clause 9, tabled in my name and those of the hon. Member for Central Ayrshire (Dr Whitford) and my hon. Friend the Member for Broxbourne (Sir Charles Walker). I am pleased that Scotland will have its say, at least with regard to this new clause.

Conceptually, the Bill will absolutely do the right thing, because for long-term decision making we need some clarity as to how much money there will be. As I said on Second Reading, my concern is about whether or not the figures are right, and at that point I proposed a formula that would enable the figures to be flexed to properly determine the need and whether the figure would to be sufficient to meet it.

New clause 9 deals specifically with the issue of mental health. There is agreement among all parties that it is crucial that we get mental health right. It is crucial that it is properly respected and properly resourced. Members from all parties have talked about and supported parity of esteem between physical health and mental health. It might be useful—this is not in the new clause, but we are talking about the issue more broadly—if at some point the Government could give some clarity on, if not a formal definition of, what parity of esteem means.

--- Later in debate ---

[Dr Whitford]

We have discussed today, and on many other occasions, the issues relating to child and adolescent mental health and the pressure that young people are under right across the UK, and training for teachers to support them in schools was mentioned. In Scotland, we are putting 350 counsellors into schools. Does the hon. Lady recognise that putting that level of investment into education, where these young people are, would reduce the pressure on CAMHS, and that any assessment would need to include that? If children end up in CAMHS who do not need to be there and who could have been helped earlier, that is also a failure.

[Anne Marie Morris]

The hon. Lady makes an apposite and correct point. We cannot talk about mental health just within the health and care bucket, so to speak. What do we do to help young mums? What do we do in the school environment for youngsters, who are increasingly put under huge pressure, with cases of stress and depression growing daily? What are we doing in the workplace? Historically, mental health has been something that we do not talk about; indeed, people almost dare not to for fear of being demoted and losing their job. There are many aspects of mental health that need to be taken into account if we are truly to deliver parity of esteem. I would like to think that the Government, and perhaps the Minister when he responds to the debate, would acknowledge the breadth of the need to work together across Government Departments so that we look properly at the outcomes and at the different pieces that affect those outcomes, which go well beyond the Minister’s particular brief.

[Dr Poulter]

I thank my hon. Friend for giving way. She is making some very good points. An interesting amendment has been tabled by the hon. Member for Twickenham (Munira Wilson) on the need for greater transparency more generally in mental health funding. It is difficult to understand properly what level of investment is currently going into mental health services, be it CAMHS or general adult mental health services. Would it not be a good thing if the Government took on board the spirit of that amendment and published data on mental health spend on an annual basis across all mental health services, from CAMHS and general adult to older adult and learning disability services? That would help to make the argument that money is actually going into what has been a Cinderella service for far too long.

[Anne Marie Morris]

My hon. Friend is right in that the things that are relevant to mental health cannot exclude the budgets in other parts of the system. He is absolutely right, as the hon. Member for Twickenham (Munira Wilson) is, that these things need to be looked at together. Yes, I certainly agree that a written report that sets out what money is being spent where would be very welcome, but I guess that my amendment goes beyond that and says that we should be sure that we are getting something for that money, rather than simply putting in that money and not having any grasp as to whether it is actually making a difference, which is crucial.

[John Redwood (Wokingham) (Con)]

I should like to reinforce that point. I in my constituency, as she in hers no doubt, have need that should be tackled and that requires support and treatment, but it is important that it is worthwhile treatment under the right protocol so that things get better. I would value much more information on who is being treated and whether the treatment is working rather than more information on money.

[Anne Marie Morris]

That point is extremely well made. Let me say, if I may, that there is also a challenge for any Government to be able to properly ascertain what the actual need is. There is a lot of hidden need. In rural communities such as mine, the real challenge lies with isolated elderly people and with lone workers—whether it be a farmer or a policeman. We know that farmers have the highest rate of suicide of any profession. Much of that mental health challenge is not understood or measured, which makes it critical that we look at that need and then, as my right hon. Friend sets out, make sure that what we do properly meets that need. He is absolutely right.

[Munira Wilson (Twickenham) (LD)]

I agree with the hon. Lady’s point about measuring outputs as well as inputs, but does she agree that one of the big challenges with CAMHS is the real dearth of data? There are many gaps in the data that is collected. I make this point advisedly, because there is another challenge in gathering more data. I have been lobbied in my own constituency by a charity supporting children and young people with mental health issues. Its funding has been put under threat by NHS England unless it starts to report the date of birth of the young people accessing its service and other information, which then undermines the anonymity that it guarantees to those children and young people, so reporting on the outputs is not actually that straightforward.

[Anne Marie Morris]

The hon. Lady makes a very good point—I think there are probably two points there. The first is what we should be measuring and when, and the second is about data and the privacy issue. The points are related, but separate. The first one, which is about measurement, is a point very well made. Certainly, the point at which my constituents are counted as being in the box and in need and being referred for mental health can be very far down the line from their first presentation. The figures will often not properly represent the number of people who are actually in need, so I think she is right that we need to be clear at what point we measure an individual coming into the system. I am not clear from what I have heard anecdotally that it is. Some clarity and perhaps an investigation into that would be very helpful. The hon. Lady’s point about privacy is a much broader issue, and I think it would be beyond the scope of this debate to look at it now. The point was well made, but it is a much bigger point for another day.

Through new clause 9, I am asking for an annual report that would show how mental health provision has improved. Such a report would state how we identified what we included in the mental health bucket that I mentioned; how we identified who is in need; how we measured whether that individual received an intervention, and whether any such intervention was timely; whether the individual’s condition has improved or got better; and how any improvement has been assessed, because that can be a very difficult question. I appreciate that for many individuals with mental health concerns, these are lifelong conditions. We would therefore not simply be measuring whether somebody is “cured”, but looking at the level of improvement and the extent to which the intervention has helped—or not helped—that particular individual. It is very complicated.

My new clause would require the Government to look specifically at how we are going to measure the extent to which we have been able to prevent mental health problems. Specifically, we need to start looking at the support we give in schools, to pregnant mothers and in many other situations. This provision would also require information on how we have diagnosed mental health problems. Too often in constituents’ cases, I find that it is only when a diagnosis is finally and formally made that there is any intervention or help. I have heard from a number of parents of young children and teenagers who have faced problems such as eating disorders and attempted suicide, but much to my concern and that of the parents, as no diagnosis has yet been made—because they cannot get an appointment and so on—the individual youngster who is self-harming is not yet considered to have a mental health problem. The consequence is that they do not get the support and assistance they need, so diagnosis is very important.

[Steve Brine (Winchester) (Con)]

I support what my hon. Friend is saying in her new clause about outputs. This is an issue that I tried to address—and failed, I readily admit—when I was the primary care Minister. She will be aware of the NCT’s Hidden Half campaign, which aims to improve the six-week postnatal check. Does she agree that there are opportunities for the NHS to make an intervention and assessment, but that those opportunities are currently missed? For example, we should be changing the GP contract so that when new mums go for the six-week check with their babies, they get a maternal mental health check at the same time. There are already opportunities, but we are missing them.

[Anne Marie Morris]

My hon. Friend makes an excellent point. Just like physical health checks, which are very much part of the standard GP system, mental health checks should equally be a part of the standard checks that take place when people present at surgeries. I entirely agree.

[Dr Whitford]

Does the hon. Member recognise that we all know what we should be doing to look after our physical health—there is a handful of five key points—but that most of us have no idea what we should be doing to look after our mental health? As well as talking about primary care in schools and workplaces and public campaigns, we should all be being taught how to develop our own resilience and how to look after our own mental health better.

[Anne Marie Morris]

That is one of the best points that I have heard in this debate, and it is extremely well made. However, it is a real challenge trying to help individuals to accept even that they might be vulnerable to mental health problems, because it has been such a taboo—let alone the second stage of learning what we can do to try, as the hon. Lady says, to make ourselves resilient. I am pleased that we are having mindfulness classes across the House, not just for MPs but for our researchers. That is not the total solution, but it is at least a step in the right direction. However, her point is about something much bigger than just an intervention—it relates to a big piece missing from this whole agenda. We spend a lot of time talking about illness and not enough time talking about wellness.

[Dr Whitford]

Is it not particular to mental health that when we use the phrase “mental health” we actually mean illness? We all have mental health, sometimes good and sometimes bad. If we changed the language, it might be easier for people to talk about.

[Anne Marie Morris]

The hon. Lady is absolutely right. The challenge, as she recognises, is how we change the language in a way that is accepted and becomes the norm. Part of this is having a much greater focus, as I hope the Secretary of State and his team ultimately will, on wellness, because that is absolutely as important as dealing with the illness when it happens.

We need to remember that in terms of stages of intervention, the whole lifecycle is not just about birth, education and the workplace; it is also about the elderly and veterans, for whom there is often not as much done to identify need and provide support. An older person in a rural area will often have the need but because they are simply out of scope—under the radar—they will, for a very long time, suffer in silence to a point beyond which they cannot be helped. The challenge of mental wellness/illness for older people needs to be a specific focus.

For all that we say, and rightly, about the importance of ensuring that our veterans are properly diagnosed and properly supported, I am certainly conscious of veterans in my constituency who are struggling to get help and support, or even an initial diagnosis. Sometimes the support they need is so complex that they can only get it in London. For somebody who does not have good mental health, the journey from Devon right the way up to London is something they simply cannot conceive of and make a reality.

I am extremely grateful to the Minister for sitting and listening to my thoughts, and for understanding my approach in terms of looking at this in a much more holistic way and seeing how we might measure and report on it so that we can demonstrate to people that we are making progress on parity of esteem. We should look at inputs as well as outputs. I look forward with a great deal of interest to his reply on the points that have been made, particularly on outputs in mental health.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

I rise to speak to the amendments in my name and the names of my colleagues.

As we have all heard, our NHS needs to be properly resourced in both physical and mental health, but far too often patients are losing out under this Government, with longer waiting times, a huge increase in cancelled operations, and crumbling hospitals. Colleagues have already raised these important issues. I urge the Government to accept the amendments in the name of the Leader of the Opposition as a real signal of their intent to reverse the damage that their party has done to our national health service over the past 10 years.

My amendments focus specifically on mental health. The Government have made much of the need to ensure parity of esteem. This would mean us valuing mental health equally with physical health and adopting an approach that tackles it using the same standards that we expect for physical health patient treatment as a template for treatment that we provide for mental health patients.

I have heard warm words from the Prime Minister, the Secretary of State and Ministers about the importance of mental health and the growing need to tackle mental ill health as an urgent priority, but I have not yet seen that wholehearted commitment manifest itself in actions to tackle the situation we are in. The British Medical Association found that the mental health workforce has had little growth over the last 10 years. The Royal College of Psychiatrists found that the rate of unfilled NHS consultant psychiatrist posts in England has doubled in the last six years. The first briefing paper from the Centre for Mental Health’s Commission for Equality in Mental Health found that mental health inequalities are closely linked to wider injustices in society. Far too many patients with a mental illness are still being sent hundreds of miles away from home.

By accepting the amendments in my name, the Government would show that they are willing to be transparent about the way they go about achieving their long-stated aim of parity of esteem. The Government have already shown, with the presentation of this Bill, that they think it is a good idea to commit, in law, to a minimum allotment that the Secretary of State will make to the health service in England in each financial year for the next four years. That is designed to show that their promise is legally binding and can be scrutinised by Parliament and the public if they do not reach those targets.

To ensure that our mental health services are properly resourced and truly responsive to the various complex conditions that people present with, the public need to know how much is being spent, including how much is being proposed, and what happens in practice. That is all my amendments seek to do—they would provide Parliament and the public with the opportunity to compare the proposed allotment with the final allotment across different years.

Of course, that is not enough, and it is clear that additional resources for mental health services are only one part of the answer to tackling the mental health problems in this country. We know that education and training services are essential to bring about the necessary increase in the workforce. We know that local government provides significant elements of mental health support through public health, youth services, housing and social care, and two thirds of schools fund their own mental health support. We also know that the Government’s roll-out of universal credit will exacerbate mental health inequalities, which all too often relate to people’s economic and social circumstances. This is not the time to go into those in detail, but I urge the Government to remember the need for those essential services to have a long-term funding settlement and, in the case of social care, an agreed basis for future financing. With ambitious targets to meet in the long-term plan, there is a risk that resources will be diverted from other areas of mental health support to achieve compliance.

I would like to invite colleagues across the House to join me on Thursday for my adjournment debate on Children’s Mental Health Week, which is this week, to discuss these issues further. I know what a commitment to transparency on mental health spending would mean for all those suffering mental ill health and those fighting for them. I hope that the Secretary of State will accept amendment 1 and new clause 1, to ensure that mental health services get a fair deal from the legislation and that pledges made by the Government and NHS England are realised in practice.

Oral Answers to Questions

Anne Marie Morris Excerpts

Tuesday 28th January 2020 Commons Chamber

[Caroline Dinenage]

My hon. Friend has already been a really good champion of collaborative health and social care work. He has made some excellent suggestions, and we have seen how things such as the better care fund, through which health and care pool their resources, can have a positive effect for local communities. I encourage his local area to look closely at how that sort of work can be maximised and moved forward.

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

As the Minister will know, the particular problem in rural areas is that need is not just unmet, but unseen. What steps has the Minister taken, or what does she have in mind, to fix the situation and find that need so that it can be met?

[Caroline Dinenage]

My hon. Friend is right to draw attention to rural sparsity and the challenges facing rural communities. We are committed to undertake a review of relative needs and resources, and it will be a thorough evidence-based review of the costs facing all authorities, including how factors such as rurality, sparsity and other geographical features affect the cost of delivering services across the country and how to account for them in a robust manner.

NHS Funding Bill

Anne Marie Morris Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

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

It seems to me that the NHS Funding Bill is really just the beginning. If the Government are serious about identifying specifically how much money they will commit to particular parts of the NHS budget, that is to be welcomed, and certainly any increase in any part of NHS spending is welcome. A 3.4% increase compared with what we have had during the very challenging period of the past three to four years is therefore very welcome. I believe that it actually is a floor, not a ceiling. I totally understand the interpretation, which I think is correct, of the money resolution, but that relates specifically to amendments to this Bill. My reading of the money resolution is that we can, in further Acts, expand and increase these amounts.

My real concern is trying to get to the bottom of how these figures have been arrived at. There has been an assumption that it is all about inflation and looking at comparative figures, but there are three pieces to this. What are the assumptions underlying the decisions that have come to these figures? What assumptions have been made about inflation, because Brexit has changed much since these figures were first arrived at? How are we looking at demand and need? Do the Government really understand what the unmet need is? Certainly, reports by the Public Accounts Committee indicate that the Government do not really have a grasp of that. That then leads me to question whether these are the right figures to do what everyone in this House wants, which is to meet the needs of all our citizens for good healthcare and, ultimately, good social care, which is not part of this Bill. I think the Government have missed a bit of an opportunity here. It would be helpful if they had set out how they will flex if the assumptions with regard to savings and efficiencies changed, if the inflation rate changed, or if demand changed. The bits missing from this Bill are a formula to calculate the increase and some honesty about the basis on which the Bill has been put together.

As we have heard, some specific promises have already been made in a five-year plan. We have said that mental health spending will go up by £2.3 billion, which is a 4.6% increase a year; that mental health spending for children and young people will grow faster as a part of that budget; and that there will be an increase in primary and community healthcare spend in the areas of highest health inequalities. But as yet we do not have any mechanism for an annual statement on exactly where we are on this spending. In addition to a formula that explains how we got to this magic figure, there should be an annual statement on these figures so that we can see how the 4.6% a year increase for mental health has actually been delivered and whether children and young people are actually getting the biggest chunk.

It has been said, quite rightly, that in this Bill we are looking at only part of our total health and care ecosystem. We must look at what we do about infrastructure—hospital—spending. The £2.8 billion hospital infrastructure promise in the spending review last year was very welcome, but, as the hon. Member for Central Ayrshire (Dr Whitford) pointed out, what about the repairs? With regard to the training budget, the spending review refers to a 3.4% increase. Is that really going to cover it? How are we going to measure whether it is actually spent? The hon. Lady referred to the 1% increase in public health grant. Can that really be enough? For me, what is really needed is an annual report on all health spending. The biggest challenges to getting this right—I am not the first and I will not be the last to say it in this Chamber—are stopping the slippage from revenue budgets to capital budgets and the slippage that will inevitably occur if social care is not properly funded. We absolutely have to fix the social care challenge, and this Bill is not enough, and cannot stand alone, in terms of solving these issues.

This Bill is welcome, but it is in many ways a missed opportunity. We need to see the total picture. We need to have proper accounting. We need to have proper visibility of the numbers so that we as a House can demonstrate clearly to the great British people that we are delivering on what we have promised and what they need.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Does my hon. Friend accept that the purpose of the Bill is not to set out the absolute detail of every single possible thing that could happen over the next few years, but simply to provide assurance to the NHS in England of the minimum funding that it could possibly receive, and the massive increase that we are giving it, so that it can continue to plan for the future?

[Anne Marie Morris]

My hon. Friend is absolutely right that we should provide a long-term plan and a long-term budget. However, if we are to be honest with the public and with ourselves, we need to measure what we are doing and be clear and accountable to the public that what we have said we will spend delivers the outcome we have promised.

This is about openness, transparency and accountability, and that is the missed opportunity. It may well be that this sum is right and that the savings that have been promised can be made to enable it to be adequate, but there is some serious doubt about that. Without openness, honesty and the figures being reported on each year, we cannot put our hand on our heart and say that we are doing what we promised the British people we would do. There is a saying that what gets measured gets done, so let us measure this. Let us get to the crux of this spending and prove to the British people either that we have got it right or, if not, that we have a formula to get it right so that we can do what is right. We need a plan to monitor the10-year plan, which is great in ambition but needs to be properly scrutinised and properly monitored so that not just the Government and the Conservative party can be held accountable, but all of us in this House can be held accountable, because it is for all of us to get this right. It is not just down to the Government: it is for all of us to ensure that we deliver what people, frankly, need and deserve, and what we have promised.

Health and Social Care

Anne Marie Morris Excerpts

Thursday 16th January 2020 Commons Chamber

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

That was a very thought-provoking, emotional and personal contribution from the hon. Member for Vauxhall (Florence Eshalomi), who I very much welcome to this place. She made some very important points about the NHS and knife crime, and I look forward to her working with all of us in this House to deliver exactly what she rightly says we must. I congratulate her.

It is right that health and care are a substantial part of this Gracious Speech, but it must be about action, not just words and promises. Across the House, whichever party we represent, we must deliver on what our constituents need and want and what we have promised them. I welcome the inquiry into social care. My concern is that this has been promised by Governments for years, and it seems to be taking forever and a day. This is urgent—it cannot wait. We must talk cross-party and look at the work that has been done, rather than do it all over again. Let us look at what works and does not work, take the good and move forward. I would like to see a Bill on social care in this Parliament.

Integration is another key issue. Members across the House have pushed for integration, and we need to make it happen. NHS England has proposed legislation to unblock the things preventing this from working. I am pleased to see the Bill to implement the NHS long-term plan, but I would like it to be more ambitious. It is right to address the commissioning challenge, but the Bill does not address the overlapping regulatory system, the conflicting accountability between health and social care or any of the legal relationships. Where are we with sustainability and transformation partnerships and integrated care systems? They have no legal status, yet we look to them to deliver a solution on integration. More must be done, and we must be bold.

Across the Chamber, we agree that mental health is a priority, but again, where is the ambition? Dealing with detention is crucial, but we must also look at parity of esteem. It is not defined. We talk about mental health representing something like 23% of the burden on the NHS, but how is that measured? Is that really the totality of the issue? We need to define parity of esteem, be clear how we will measure the need and address that need as a matter of urgency. We talk about achieving parity of esteem over the next 10 years, but that seems an incredibly long time. I would like to see a proper plan, and I would like to see parity considerably sooner than 10 years from now.

There was an extremely well-made speech a little earlier about wellbeing. For so long, we have talked about the NHS and health, but actually we talk about illness, not about wellness. When we talk about Public Health England, that is not the only part of trying to ensure wellbeing. Professor Dame Sally Davies, the former chief medical officer, has said that wellness is as important as dealing with illness. I would like to see that fully addressed, and I very much hope that those on the Front Bench are listening and will take that seriously.

The assets that we have to address our problems are not infinite. We have some wonderful people, we have some wonderful infrastructure—buildings and hospitals—and we have some wonderful technology.

[Neil Parish (Tiverton and Honiton) (Con)]

My hon. Friend is making a really strong speech. Talking of assets, in my constituency we have community hospitals in Honiton, Axminster and Seaton, which could be used to much greater effect to take some of the pressures off the acute hospitals. Honiton does good work with Ottery St Mary and others in the neighbouring seat of East Devon. Can we actually get these assets working better for us? I welcome what the Secretary of State said in his speech earlier.

[Anne Marie Morris]

My hon. Friend makes a very good point, and I was very pleased to hear the Secretary of State say that community hospitals were valuable. We must have a fundamental rethink of the infrastructure and look at what we really need. In rural areas, where we cannot get to the best stroke centre, say, we must think seriously about how we use or reuse such facilities.

[Dr Whitford]

Talking about assets, do we not also need to sweat the assets that are in the community? In Scotland, we have had community pharmacies with minor ailment services since 2005, and we now have the same for optometrists, to the point that only a tiny percentage of people ever need to go to A&E if they have an eye injury, a red eye or another problem.

[Anne Marie Morris]

The hon. Lady—I almost said my hon. Friend because we share some common issues, and she is a great spokesman from the SNP Benches—is absolutely right. I think we would actually all agree that we need to look at the people who deliver these services and at the breadth we have, and involve them all appropriately.

We must also look at the new professions with the new associate levels. Physician associates take a huge part of the burden, and have a great career across the whole of primary and secondary care. Let us be innovative and creative, and provide the training, the financial support and the respect that I think many people working in our health system feel they do not necessarily receive from this place, although clearly they feel they have it from their patients. IT has always been the call of the Secretary of State, but again, let us be more imaginative. It is not just about communication; it is also about diagnosis and the delivery of care. There is much that can be done.

The Queen’s Speech refers to a medicines and medical devices Bill, which it is absolutely critical to get right. I am very keen to look at the speed of getting medicines to patients, but we need to do more than deal with clinical trials. There is much that has to be done with regard to the Medicines and Healthcare Products Regulatory Agency and NICE and their systems. I would like to see the approach to access to medicines be more ambitious.

Finally—I am getting the evil eye, I think, Madam Deputy Speaker—I am very pleased that in the NHS Funding Bill we are now committing to enshrine increased spending in law. My concern is: do we have the right level of spending, how will we be measuring need and is that spending matching the increase in demand? That is a good promise, but it needs considerably more work.

This Government have done a good job in setting out some of the key issues and priorities that we as a House need to address, but we must look at the detail, we must implement this and we must deliver.

Social Care Funding

Anne Marie Morris Excerpts

Tuesday 1st October 2019 Westminster Hall

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

Today, we are looking at a question that is certainly as vexing as that faced by Nye Bevan when he looked at how we would fund health. As has been said, the need for social care is increasing across our population—for older people, younger people, working people and retired people. It is a good thing that we live longer, but we have to recognise that that fundamentally changes how we as a society might address that need. The answer, in my view, is not simply to throw money at it. Money is clearly part of the solution, but this is a complex puzzle, and when we consider that our system has remained largely unchanged for 50 years, I think it is time for another Nye Bevan moment.

We therefore need to identify the true scope of the issue. There is much hidden need, particularly in isolated rural areas such as mine in Devon. What is the best way of delivering? I chair a national inquiry into rural health and care. It is taking two years to deliver, and it is clear that there are issues with different geographies that can be dealt with more efficiently and effectively with different methodologies. We need to look at how technology can be better used. We should look at how we might train and motivate people across both health and social care, and there has to be parity of esteem between the two.

We need to look also at how the community can be engaged. That is not, in this case, just about money. Sometimes, it is not about money but about a willingness to be part of that community. North Devon was cut off during the extreme winter two years ago, but people survived because they pulled together as a community. That is the sort of resilience that we have to build in.

We have to find something efficient and effective. We have to be honest about the cost. I agree that we need to help society to understand that, and we therefore need to understand what the right contribution is from the individual, family, community and taxpayer. We talk about integrating health and social care, but right now the challenge is that we have two systems that are funded in very different ways. The five reports that we have had so far have looked only at the social care problem, but it is naive to think that we can look at it in isolation. What we need now is a report on integrating both the provision and commissioning of health and care. That we have not done.

Dilnot looked at one side of the problem, and we have had other inquiries looking at integrating commissioning and provision, but that is not enough. It seems to me that we need to commission an integration report across health and social care. We need to deliver parity of esteem. We need to identify the barriers to integrating those systems, and remove them. Duplication of regulators and organisations does not work. What is the true cost? What is the best way to share that burden? How do we look at insurance, savings and taxation? But that will take time, and I support the view that in the short term we need to look at domiciliary care. I believe that we could integrate that into primary care and that it should be free, whether it is funded through tax, savings or some other mechanism.

Oral Answers to Questions

Anne Marie Morris Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Stephen Hammond]

I met the hon. Gentleman recently to talk about ambulance provision in his constituency and the Morecambe bay area, and I hope he is now satisfied with the progress we are making on that. I will look into the individual case he mentions and respond to him.

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

3. What steps his Department is taking to ensure the accessibility of health services for rural populations.

[The Minister for Health (Stephen Hammond)]

The long-term plan that the Department published in January commits to delivering fully integrated community-based healthcare in primary and community hubs. It confirms that the standard model of delivery will be developed for use in smaller acute hospitals that serve rural populations.

[Anne Marie Morris]

I thank the Minister for his answer, but some rural villages, including some in Devon, have no ambulance service at all—a fact masked by high-level statistical reporting. Will the Government work with me and the National Centre for Rural Health and Care to expose the real rural healthcare deficit, which is so masked, and work with us to rectify the situation and provide the appropriate care and medical support necessary by putting in place a robust and accountable rural health and care strategy and plan?

[Stephen Hammond]

I know that my hon. Friend has worked with the National Centre for Rural Health and Care and chairs the all-party group on rural health and social care. She is right to mention the fact that there are particular challenges in the delivery of the best-quality healthcare that we want to see in rural areas. I would be delighted to work with her and the all-party group on the matter.

Children and Mental Health Services

Anne Marie Morris Excerpts

Tuesday 16th July 2019 Westminster Hall

[Andrew Griffiths]

My hon. Friend is absolutely right, not only about the impact on schools—I will say more later about what we can do in schools—but about the pressure on CAMHS and the massive importance of getting children seen as soon as possible. Just imagine if one of us were having a mental health episode and were told that we could see someone in 12 months who would then refer us for treatment. CAMHS are not the doctors or the psychiatrists who see the patient. They are not the help; they are the doorkeepers to getting help—the triage, as it were. Even when someone gets through the CAMHS door and jumps over the very high bar for getting treatment, it could be many months before they receive it.

It is a great challenge. I know that the Government take it seriously; their 2017 Green Paper “Transforming Children and Young People’s Mental Health Provision” outlined their ambitious new plans for delivering mental health support in schools, and the announcement this week of the mental health services trailblazers is a welcome part of that strategy. I am delighted that my area, Burton, is to be in the second phase of those trailblazers, which I genuinely believe will make a difference. However, figures from the Children’s Society suggest there has been little expansion in the provision available in schools since 2015, so we are starting from a low base. In particular, the figures point to a worrying lack of awareness among parents about the counselling offered in their children’s schools: just under a third are not aware of what is available at all.

I am pleased that the Government have announced that every school, college and alternative provision across England will be offered training as part of the £9.3 million mental health services and schools and colleges link. However, even though my area is one of the trailblazers, priority access to mental health training for schools and colleges will not be available in my constituency until next year. It is clearly needed now. There are so many MPs, constituencies and constituents who want access, so how can we roll it on quicker? To use my “Oliver!” analogy again—

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

My hon. Friend is making an excellent speech. May I ask him to reflect for a minute on the particular issues for rural communities, including the distances? The lack of broadband means that the opportunities for dealing with those distances are missed. It seems to me—perhaps we will hear more from the Minister about this—that the Government could use technology more effectively in rural areas. We will certainly not get the help we need in time otherwise. My schools will not be getting help under the new scheme any time soon—we are not even one of the pilots. My teachers are very concerned that they will have more burdens, rather than an added resource.

[Andrew Griffiths]

My hon. Friend, who is always a champion for rural communities, makes an important point about rural isolation. We have known for a long time about the mental health challenges of farmers and rural communities, but it is all the more difficult for young people who are isolated from their friends. We talk about the social media pressure on young people with Facebook, Twitter and so on, but it is even more difficult for kids in isolated rural communities, because they are even more separated. That social media connection is often their only chance to talk to their friends.

--- Later in debate ---

[Andrew Griffiths]

The hon. Lady is absolutely right. Trauma in young people’s lives is often the trigger, whether it is sexual abuse, domestic abuse, violence perpetrated by other young people, or bereavement. All those triggers set off a train of deterioration in young people’s mental health that is often lifelong. It is so important that they get the access they need.

Several hon. Members have mentioned waiting times for CAMHS. I have certainly found that my constituents cannot get on Facebook quick enough to tell me about their CAMHS experiences. I do not want to denigrate CAMHS, which have great people doing great work; the problem is that there are just not enough of them and they are under too much pressure. As the hon. Member for York Central (Rachael Maskell) noted, CAMHS are turning away nearly a quarter of children who are referred to them. In 2017-18, they turned away 24.2%, meaning that at least 55,800 children were not accepted for treatment. Of those who were referred, the average waiting time was 34 days for an initial assessment and 60 days for treatment—significantly longer than the four-week standard set out in the Government’s Green Paper. We can all point to examples of much longer waiting times in our constituencies.

One constituent contacted me to say that her son had been self-harming for years. It took them months to get an appointment with CAMHS, and when the appointment happened, her son suffered a meltdown. That is not unusual, due to the pressures that those appointments put on young people. Because he is 15, their GP cannot prescribe anything for him. My constituent has had to watch her son throughout the night to make sure he does not do any permanent damage to himself. Another parent told me how her daughter was discharged from CAMHS, with it saying there was nothing more it could do to help with her anxiety.

Young people have told mental health charity Mind—I am very lucky to have Burton and District Mind in my constituency, which does a great job—that the wait for support is one of the most difficult issues they face. They say that sometimes, they find that their mental health deteriorates while they are waiting; the wait actually makes it worse. In England as a whole, half of those accepted for treatment during 2017-18 were still waiting for treatment at the year’s end. That proportion was lower in my area, east Staffordshire, where it was just over one third. However, that is still a substantial figure.

A school counsellor from my constituency contacted me to say that the waiting lists for referrals to child services outside of school can be months long. She believes that when it is established that a child needs help, a counselling session needs to happen within 48 hours. She goes on to say that too much red tape is preventing children from getting the help they need. I think we all recognise, as the Government have done, that support in school, delivered in a way that is accessible to young people—they feel comfortable asking for it, and know of other young people who have accessed it—is a real help.

One parent told me that she decided to fight to get her son’s care commissioned outside of the county they lived in because of her disappointment with the support she had received. She says that early intervention is key, and that there have been too many endless reports and not enough action has been taken. Another parent in my constituency said that she took her daughter to the GP two years ago. She was referred to That Place in Burton, which is a fantastic facility; she took her for assessment, only to be told that her daughter was not old enough to be accepted. Yet another constituent told me that after a referral for her daughter, aged nine, it took three years for them to see a psychiatrist. That kind of wait is difficult, and all the time, the young people are getting worse.

There is also a problem with the transition from childhood to adulthood. According to the British Psychological Society, about one in six 17 to 19-year olds have a mental health disorder; according to the Children’s Society, 16 to 17-year-olds are the biggest service users of mental health services. However, young people often face barriers to accessing support, and end up falling through the cracks of adult and children’s services as they transition. Some young people who are discharged from children and young people’s mental health services at 18 find it can be very difficult to get a referral to adult mental health services at all, and can end up completely isolated. In some circumstances, young people are not accepted into either children and young people’s or adult mental health services, due to them falling between the gaps.

Again and again, I hear that CAMHS discharges young people on their 18th birthday, and that there is no provision at all for them. The challenges those young people are facing do not magically disappear when they become adults. Just last Friday, I met with a constituent who was getting ready to leave CAMHS and had been left to organise her future on her own. She was not automatically transferred to adult services, and had to organise a private therapist in order to get the ongoing treatment that she needs.

One of my constituents sums the problem up better than I could:

“All the time the kids are getting no support, becoming suicidal, becoming adults with even more complex issues, families are breaking up because of the pressure, parents quitting work to do the job of education/social care/health, and all of this causes more and worse financial pressure later on. No one sees the bigger picture because they can’t afford to. No one sees long term because that’s too expensive. Early interventions are crucial but they aren’t funded. We will reap the whirlwind then wring our hands and say ‘how could we have prevented this’”.

That is absolutely pertinent.

The Government have set a five-year forward view for mental health, which is for one in three children and adolescents with a mental health disorder to access NHS mental health community services by 2020-21. In the new long-term plan, they have set a target that 100% of children and young people who need specialist care will be able to access it by 2028-29. However, that is so far down the track.

[Anne Marie Morris]

I totally agree with my hon. Friend: it is so far down the track. Does it not further concern him that in that same 10-year plan, the NHS talks about “parity of esteem”, but that is in 10 years’ time, and it is very unclear what will be done about the timelines for getting there? As my hon. Friend has said, 10 years is much too long to solve the problems we have today.

[Andrew Griffiths]

My hon. Friend is absolutely right. During that time, babies become children, children become adults, and the problem gets worse and worse. I do not deny the Government’s commitment and determination in this, but it is just not happening quickly enough.

The other thing we need to bear in mind is that, although we have heard about CAMHS and the pressures on the workforce, a huge number of brilliant voluntary sector organisations are also delivering these services. I am very lucky to have in my constituency an organisation called Youth Emotional Support Services, which delivers in schools in Uttoxeter, as well as Burton and District Mind. There are so many great organisations. However, even in my own patch, I have heard that a tendering process is currently going on in which the bar is so high, the requirements so difficult and the boxes to tick so numerous that third sector organisations simply feel unable to compete. The challenge is that the tender to provide the facilities goes to a private company, and the experience, dedication and benefits of those voluntary sector organisations are lost.

I was staggered to learn that some of the children’s mental health charities operating in my constituency are providing 85p of frontline services for every pound they receive. That is tremendous value, representing help for young people, and few businesses could get anywhere near matching that. However, the tender process that we go through makes it impossible for voluntary sector organisations to compete. I hope the Minister will look into that; I will be raising with her my particular issue in Staffordshire.

I think the Minister recognises that in this place, we are simply voicing the real concerns and fears of parents up and down the country. Like a snowball coming down a hill, young people’s mental health is under greater pressure than ever before, and as a result they are self-harming, committing suicide, or getting themselves into a situation in which they will, in future years, suffer from greater mental health disorders, addiction, and so many other long-term problems. I hope that the Minister will go away feeling that she has great support across this House for her campaign to get even more resources and focus on mental health services, particularly for children, because quite frankly our children’s lives depend on it.

Human Medicines (Amendment) Regulations

Anne Marie Morris Excerpts

Monday 18th March 2019 Commons Chamber

[Jonathan Ashworth]

My hon. Friend raises a very important point. There have indeed been reports of shortages in certain medicines. In recent weeks, we have heard of shortages of Naproxen, an arthritis medicine, with similar reports about EpiPens a few weeks ago. I have heard from some community pharmacists, directly themselves, that there is even an shortage of aspirin. I emphasise that these are anecdotal reports rather than information based on any national reporting that I have seen—this is what community pharmacists have told me when I have been in their pharmacies discussing this with them—but yes, there are shortages now as a result of the uncertainty in the pharmaceutical market.

Diabetes UK has warned that

“despite reaching out directly to the Department of Health and Social Care in December, we still have not seen the concrete detail needed to reassure us—or people with diabetes—that the UK Government’s plans are robust enough to guarantee no impact on insulin and medicine supplies in the event of a no-deal Brexit.”.

It was a similar story from the epilepsy bodies, who said:

“We do not have confidence in the current arrangements to ensure the continuity of life-saving medications for people with epilepsy.”

The Government have sought to reassure patients that their contingency plans are failsafe, but the report in The Lancet that I referenced earlier also said that

“stockpiling arrangements cannot cope for more than a few weeks.”

It also noted that some affected products, such as radioisotopes needed for treating some types of cancer, simply cannot be stockpiled. This chimes with the Royal College of Radiologists, which last month issued staggering concerns about the supply of medical isotopes, spelling out how the expected disruption would force clinicians to alter treatment plans and mean the prioritisation of some cancer patients over others. That is why the Government are proposing the serious shortages protocol contained in this statutory instrument and effectively using Henry VIII powers to enable Ministers to issue a protocol to pharmacies for them to follow.

As I said, this is an extraordinary power grab. It will effectively mean that a GP’s prescription can be changed by a pharmacist. No longer would a medicine be prescribed by a doctor who knows the medical history of the patient but instead by a pharmacist acting in accordance with a protocol drawn up by the Government. That is why these emergency measures have, quite rightly, raised alarm among various patient groups—because these changes could cause real problems for people with long- term conditions.

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

Does the hon. Gentleman accept that it would be sensible if there was a sunset clause, because clearly giving that much power to a pharmacist as opposed to a physician who knows the patient is very dangerous if it is to be used for the long term or perpetually and not just to deal with the current crisis?

[Jonathan Ashworth]

The hon. Lady makes an entirely reasonable observation. I trust that the Minister took note of it and look forward to her reply to that point.

--- Later in debate ---

[Jonathan Ashworth]

My hon. Friend is right. That is exactly the point that community pharmacists put to me in Loughborough about three weeks ago when I visited them to discuss this. Echoing her point, the BMA has said that it does not support a “blanket approach” to allowing pharmacists to provide therapeutic equivalents where a prescribed drug is not available. The National AIDS Trust has said:

“The only person qualified to safely alter the medication prescribed to a person living with HIV is that person’s HIV consultant.”

SUDEP Action, alongside a broader coalition of epilepsy charities, is particularly worried about these proposals.

After facing pressure from those groups, the Government accepted that replacement drugs were unsuitable for epilepsy patients, but they have left it open to pharmacists to reduce the strength or dosage of epilepsy medication. I am not convinced that that will eliminate the big risks faced by these patients. As the right hon. Member for North Norfolk (Norman Lamb) said, many patients with epilepsy—especially the elderly—are on other medications, and any changes require careful management because of the interaction between different medicines. Up to 90% of people with epilepsy state that even a deterioration in their mood can have a negative effect on seizure control. Anti-epileptic medications have more significant interactions than any other group of drugs.

There are situations where the specific brand, type, form or strength of a treatment must be carefully tailored to the individual based on their responses, which is done by the prescriber and the patient over time. If that is changed by a professional who does not know the patient or their individual risks, some have warned that the consequences could be a loss of control of the condition, failed treatment and an unnecessary emergency, with very serious consequences indeed.

[Anne Marie Morris]

The hon. Gentleman is making a first-class point. This puts patients at risk, and it is not appropriate for the pharmacist to make that decision. People think that generics are the same thing as branded drugs, but they are not. For some, a particular brand is crucial. I commend him for what he is doing.

[Jonathan Ashworth]

I am flattered to receive such commendation from the Conservative Benches, and I commend the hon. Lady for her extremely well-made point, with which I agree entirely. I hope that the Minister will respond to the second good point that the hon. Lady has made.

The stakes are too high to get this wrong, yet there has been no impact assessment or risk assessment undertaken on serious shortage protocols for this statutory instrument. This is an unacceptable risk to anyone with a long-term condition and should be recognised by anyone making contingency plans. I was particularly horrified to read in the explanatory memorandum for this SI—it is quite shocking:

“The main benefits of the protocol would be the NHS cost savings associated with GP time.”

In the same breath, it casually goes on to say:

“There may be some risks to patients”.

That is in the Government’s own paperwork. It is astonishing. How can the Government seriously prioritise NHS cost savings over patients’ lives and allow an explanatory memorandum to go out with that sort of wording in it? I hope that the Minister can explain how that got in there and at least reassure us that it is not the Government’s position. If it is the Government’s position that there may be some risks to patients, that suggests that the Government should have come to the House sooner to explain why they are making this regulatory change and not left it to the official Opposition to table a prayer motion to get this debate.

I would like clarity from the Government on a few things. It is not entirely clear from the legislation exactly when these powers would be used. I would like to hear from the Minister whether these powers will be introduced in a no-deal Brexit scenario only or whether we can expect them to be more permanent. I am also concerned that there will only be a review of new powers one year after a serious shortage protocol is issued by Ministers. This speaks to the point made by the hon. Member for Newton Abbot (Anne Marie Morris). One year is too long to wait if this causes serious problems for patients and the wider sector.

Considering that the stakes are so high, it is be essential that the Government deliver extensive communication and training to GPs, pharmacists, other healthcare professionals and the public, to help them understand any new protocols and manage expectations and any dissatisfaction. I would be grateful if the Minister outlined the Government’s plans. I talk and listen to frontline NHS staff all the time, and I know that there is a well-founded fear about the implications of a no-deal Brexit for hundreds of thousands of people in need of life-saving medicines. I am interested to hear from the Minister what information about these protocols has been shared with the health sector and professionals involved.

When the Secretary of State gave evidence to the Health and Social Care Committee a few weeks ago, he informed it that he will prioritise medicines over food. That glib assertion from the Secretary of State hardly offered the reassurance that patients deserve. Brexit should not compromise patient safety in any way. It is up to the Minister to allay the widespread concerns, but if she is not able to do so, we will test the opinion of the House. I commend our motion.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I am grateful for the opportunity to address the House and reassure Members on both sides of the House about the purposes of the regulations. I have been asked a number of questions, and I will try to answer all of them as best I can.

I want to start by saying that there is considerable misinformation out there about these regulations, which are designed to most efficiently manage the supply of medicines in the event of a shortage. I should also make clear to the House that this is not just a Brexit regulation; it will apply in any case, not just in the case of no deal, not least because recent events have shown the challenge in managing medicines. The regulations on how pharmacists will be able to apply this protocol are designed to minimise not only the demand on GPs but the risk to patients, because pharmacists will only be able to use their powers under these regulations according to very clear criteria, and we will still encourage them to speak to prescribers where there is any element of doubt.

[Anne Marie Morris]

Will the Minister give us some details about what those criteria will be, so that clear decisions can be made by pharmacists and so that when a particular brand is really important for a patient, there is no possibility that a generic will be substituted?

[Jackie Doyle-Price]

The circumstances will be different from protocol to protocol, which is not a very clear answer—but we would have to look at each incident. The hon. Member for Leicester South (Jonathan Ashworth) mentioned HIV medicine. Another example is antipsychotic medicines, where there is a clear relationship with the patient: obviously, it would not be appropriate to unilaterally change those items of medication.

When a prescription is issued, the pharmacist has to dispense that medicine according to strict instructions under the terms of the prescription. For example, if the prescription was for packets of 200 mg tablets and there was a shortage of those, they could be substituted with a different measurement. All those issues would be dealt with from protocol to protocol, having been considered by a pharmacy panel who can properly and rigorously challenge what an appropriate substitute would be in the event of a shortage of any medicine.

[Anne Marie Morris]

Is the Minister not concerned about the challenge that, however qualified the pharmacist, they do not have the patient’s notes? She has referred to an amount, and I understand how having two smaller pills will equal what should have been prescribed, but when it is a generic versus a specific branded medicine, that is a very difficult and challenging decision to make.

[Jackie Doyle-Price]

I come back to what I said to my hon. Friend earlier. The terms under which pharmacists will be able to exercise their discretion will be clearly set out in each protocol, and there will be full consultation by an expert panel, with ministerial approval in such an event.

--- Later in debate ---

[Jackie Doyle-Price]

We are talking about a protocol that can deal with an immediate shortage, but we would not expect that shortage to continue indefinitely. It enables us to manage the shortage, while trying to secure the ongoing supply.

Reference has been made to EpiPens, and that is exactly what happened in that context: we knew that we had a shortage and that there was a supply coming, so steps were taken to manage the supply so that everybody who needed EpiPens had a supply of two, with dispensaries managing that supply. We would expect the same to happen. Where we issue a protocol, we would expect prescribers to go back to their normal supply of medication once we had corrected the supply problem, and this is to get us through that period. It is also to encourage people not to stockpile medicines in the event of worries about a shortage. This is about giving people the reassurance that we will manage such shortages effectively.

The hon. Member for Leicester South mentioned that there had been criticism about a lack of consultation. It is worth noting that the Government have been challenged by the Good Law Project on a number of grounds, but it is also worth telling the House that the High Court decided last week that permission for judicial review would not be granted on the issue of lack of consultation.

I want to clarify the purpose of the regulations. First, they implement the EU falsified medicines legislation on certain safety features on the packaging of medicines. They also extend the exemption for the supply of naloxone hydrochloride, so that drug treatment services can supply all dosage forms of that medicine; at the moment, we can only supply injectables, but we now know that nasal administration is more efficient. In addition, and this is obviously the main crux of the debate today, they enable retail pharmacies, where appropriate, to supply against a serious shortage protocol, instead of against prescriptions, if such a protocol has been issued.

Not implementing this statutory instrument would have dire consequences. Not only would the Government lose this tool to manage shortages of medicines, but we would also deny drug treatment services the ability to supply all dosage forms of naloxone hydrochloride. Without this SI, we would not be able to introduce UK-specific flexibilities for the falsified medicines safety features scheme, meaning that a disproportionate burden would be put on the supply chain.

On the safety features, I would like to say that we are committed to stopping falsified medicines from reaching patients. Our No. 1 priority is safe access to medicines in the most efficient way. I can also say that we want to retain a close working partnership with the EU on medicines regulation, for all the reasons the hon. Gentleman outlined, and we wish to ensure that patients continue to have timely access to safe medicines and medical innovations.

The new safety features measures under the EU delegated safety features regulation are directly applicable, and they already require UK manufacturers to place a unique identifier and tamper-evident features on packaging for almost all prescription-only medicines. These medicines need to be scanned on supply to the patient to verify their authenticity. Our position is clear that, as a member state, we were obliged to implement these requirements. We worked extensively with stakeholders to understand the detail and to develop the best approach on the flexibilities and enforcement specifically for the UK, and this was tested through a formal consultation process.

It is worth noting that the UK has a very complex supply chain. Without the national flexibilities in this statutory instrument, the burden on industry would be disproportionate and it would risk patients not getting timely access to medicines; nor would we be able to enforce the requirements already in place. The reputation of UK medicines, the UK pharmaceutical industry and regulators could be seriously undermined. I have already mentioned the issue of naloxone hydrochloride. It is administered in the event of a heroin overdose, so we clearly want to make that available in the most efficient way possible.

To come back to the serious shortage protocol provisions, these will provide the Government with an additional tool to deal with a shortage of medicines. Over 2.5 million prescription items are dispensed in primary care in England alone every day, and the vast majority are not subject to supply problems. However, we must have a robust system in place for when they are. We work closely with the Medicines and Healthcare Products Regulatory Agency, the pharmaceutical industry and NHS England in operating and managing the supply chain to help prevent shortages, and to ensure that the risks to patients are minimised when shortages do arise.

The issue of EpiPens is a very good example. Last autumn, we faced a serious international shortage of EpiPens. That shortage had a knock-on effect on other adrenaline auto-injectors and, despite efforts by the Department and the industry, there was not enough supply to meet the demand in the country. We were therefore forced to ration the available injectors so that the available supply could be spread out across all patients who needed them until more stock became available. To be able to do that, we put in place a dispensing protocol.

The protocol required pharmacists to check with patients how many adrenaline injectors, including expired ones, they had so that pharmacists could decide on the number of injectors to supply. Patients below a certain weight had to be referred back to their prescriber. Again, another risk management tool that we would apply in issuing a protocol would be to make sure that pharmacists were referring people back to their prescriber if there was such a question. This ensured that, throughout the duration of the shortage, we managed the available stock in such a way that each patient had access to at least two injectors. It was this incident with the adrenaline injectors, as well as our EU exit preparations, that led the Government to formalise that what was done in the EpiPen situation should be put in place to manage other serious shortages, should they arise.

I say again that this is not the Government’s plan for dealing with medicine shortages in a no-deal exit. That is simply not the case at all. We wanted to introduce these provisions before 29 March so that we would have the option of issuing protocols, but only as part of our multi-layered approach to minimise any supply disruption in a no-deal exit. We are confident that our other management plans will deal with that. These include securing additional roll-on roll-off freight capacity for goods; buffer stocks and stockpiling; extra warehouse space; and space on aeroplanes for products with a short shelf life or specific storage conditions. The questions raised about radioisotopes are clearly relevant to that. These regulations will ensure that companies can continue to sell their products in the UK. They will strengthen the process and resources used to deal with shortages in the event, despite everyone’s best efforts, that they do occur.

[Anne Marie Morris]

The Minister is being generous with her time. Will she explain what currently happens when there is a shortage? Of course I realise that patients need medicines, but why do we need this specific piece of legislation when, so far, the Government have dealt with many other shortages reasonably adequately, I should have thought?

[Jackie Doyle-Price]

As I explained, it was the issues regarding EpiPens that brought home to us the need to have a suitable protocol in place.

Hon. Members have expressed concern about the role of pharmacists in the system. At the moment, where the prescriber has prescribed a specific medicine, including a specific strength and quantity, the retail pharmacist must supply exactly what is on the prescription and cannot deviate from that. The pharmacist has no flexibility if the exact order cannot be supplied, for example, because of supply issues. The pharmacist has to send the patient back to their GP. Clearly that would not be an efficient use of GPs’ time if we could put in place a protocol that would enable the application of alternative medicines.

The serious shortage protocol enables retail pharmacists to supply in accordance with a strict protocol for a specific prescription-only medicine, rather than against a prescription, without going back to the prescriber. That will be done only in exceptional circumstances, in the event of a serious shortage of a medicine, when all other mitigation measures have been exhausted or would be likely to be ineffective, and all the clinical community think it is appropriate to issue such a protocol. The protocol may prescribe one of the following options: an alternative quantity, an alternative pharmaceutical form, an alternative strength, a therapeutic equivalent or a generic equivalent. However, as I said, each case will be considered on its merits, and of course the risk of various health conditions. We believe that therapeutic substitution will be extremely rare. It would need to be clinically appropriate, and a sufficient stock of any alternative would be required.

As I have said, any serious shortage protocol will be developed with clinician input. Which clinicians are involved will depend on the expertise required, but we would involve, for example, the relevant royal colleges and societies. We would also work closely with patient representative groups, as we did in the EpiPen shortage. Each protocol would clearly set out what action can be taken by the retail pharmacy, in what circumstances, for which patients, and during which period. I re-emphasise that this is not about pharmacists acquiring prescribing rights by the back door. It is entirely about ensuring that patients have access to the medicine they need by making the best possible use of highly qualified pharmacists and freeing up GP time for patients who need to see their GP. If a pharmacist is in any doubt about what they are prescribing, they can always exercise their professional judgment to refer an individual patient back to the GP, and if patients do not want the alternative under the protocol, they can always go back to their prescriber.

Let me be very clear: patients will not be given alternative medicines where this is not medically appropriate. This includes patients with complex medication regimes or conditions such as epilepsy or HIV. However, that does not mean that they are exempt from the protocols. For example, a protocol for a reduced quantity of anti-epilepsy medication could be issued, as we did for EpiPen. That would have to be considered against a backdrop of all the available stock being spread out across all patients, and there being time for patients to see their prescriber if the supply issues become long- term. Without the protocol, some patients would receive the medicines prescribed to them, but some would leave the pharmacy empty-handed. Clearly, we need to make sure that all patients have timely access to their medicines.

In the event of a serious shortage of any medicine, it is vital that patients continue to receive the treatment they need. The introduction of strict protocols, developed with specialist doctors, is a sensible step that will, in exceptional circumstances, allow highly trained pharmacists to provide an appropriate alternative or quantity, as set out in the protocol, to reduce the impact on patients. This ensures a co-ordinated response to a shortage and timely access to medicines.

Of course, I hope that we never have to introduce a serious shortage protocol, but there may be times when we have no other options, because all other measures have been exhausted or are likely to be ineffective. Not implementing the statutory instrument would put patients’ timely access to medicines at risk, first, by not enabling drug treatment services to supply all dosage forms of naloxone hydrochloride; secondly, by imposing much more burdensome implementation of safety features of packs of medicines with flexibilities to accommodate the specific characteristics of the UK supply chain; and thirdly, by denying the Government an important tool to manage shortages of medicines and to ensure that patients continue to get the right medicines in a timely manner. I hope that the motion is defeated.

Orkambi

Anne Marie Morris Excerpts

Monday 4th February 2019 Commons Chamber

[Bill Wiggin]

I tragically allowed the hon. Gentleman’s intervention one sentence too early. I was about to say that Crown use licensing would make the drug available to cystic fibrosis sufferers at a reduced price on the NHS, so I absolutely agree.

Those are just a few examples of how Crown use licensing can set the ball rolling on increasing public access to precision medicine. The UK Government have a powerful policy mechanism already behind them. They are now in a position to make a huge difference to many people’s lives. A bio-generic version of Orkambi manufactured at a lower price would save our NHS time, money and resources. The majority of medicines already in use by the NHS are generic versions of originator products.

I have a daughter whom I love unconditionally. Putting myself in the shoes of my constituent, I can only imagine the anguish that he faces, let alone the suffering of his daughter. We know that young children stand to gain the most from access to Orkambi, and I am sure that the Minister wants to give the taxpayer the opportunity to access this drug under the NHS and NICE.

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

Has my hon. Friend looked at the cost and time delay involved in producing the generic alternative that he describes? Has he factored into his argument the potential cost of litigation, which I assume Vertex would pursue? I wonder whether his proposal might actually be less cost-effective and speed-effective than trying to put a bomb under the two parties to reach agreement.

[Bill Wiggin]

I have. This drug would cost £104,000 if bought from Vertex and about £5,000 if it were made generically, so there is a huge saving.