Coronavirus

Bill Wiggin Excerpts

Thursday 25th March 2021 Commons Chamber

[Bill Wiggin (North Herefordshire) (Con) [V]]

It has certainly been a challenging time for my constituents in North Herefordshire, but their fortitude and community spirit must be highly commended. It is a triumph that vaccines were produced and approved in record time, and this was the silver bullet I have been asking for in all my speeches to this House for so many months. We are all so proud that ours is one of the world’s most successful vaccine roll-outs. Therefore, it is disappointing not to see more justification from the Government as to why the Coronavirus Act needs to be extended for as much as another six months. People must be able to understand the exit from lockdown and understand that these powers are for their own good. This is especially true when the most vulnerable in society have been vaccinated with the first of two jabs against this dreadful disease. Thanks to the work of the vaccine taskforce, the pharmaceutical companies, NHS staff and volunteers, and the regulators, we should all be truly proud of our world-beating vaccine roll-out programme. Herefordshire continues to top the list as one of the areas with the highest vaccination rates. More than 91,000 people in Herefordshire have now received their first dose; nearly 100% of the first five categories laid out by the JCVI have been jabbed, as have more than 61% of the 55 to 59 category. Some 28.6 million people have now been vaccinated in this country, saving nearly 6,000 lives. Nearly 850,000 people received a dose on Saturday alone, and I had my first injection today.

Now we must capitalise on this success and the global opportunities it creates for the UK. The roll-out of the vaccine was always going to change the game, and it is doing the job required of it. Let us not now miss the chances that this golden opportunity presents. We are free from the EU, and we can manoeuvre economically and commercially, safe from covid-19. Globally, this is an almost unique advantage for our businesses, which have been supported throughout the crisis. Now, let us make sure that we can collect on our investment. From 9 March to 15 March, Herefordshire had a covid case rate of 34 per 100,000. When we entered the latest set of restrictions, the county’s rate was at 254 per 100,000. Now, there are only 58 cases in the county. On 10 May 2020, the Prime Minister announced a relaxation of some of the lockdown measures. At that time, the R rate was between 0.5 and 0.9, whereas on 15 March the county had a rate of between 0.6 and 0.9. On 10 May 2020, the seven-day average for hospital admissions was 987.3, whereas now it is 426.1.

The country had restrictions lifted the first time around in very different circumstances last year. Given that children are back at school and the vaccine roll-out is so successful, we are actually in a safer place than we were last May, and because of the good behaviour of the people of this county, we need to capitalise on this. We are doing so much better than Europe. When we look at the statistics, we see that our record is fantastic. That is why I will dig deep into the loyalty vault and today vote with the Government, but we need to remember that we need to keep the people properly informed as to why these restrictions are necessary. I would love to hear the Government do more of that.

Covid-19 Vaccine

Bill Wiggin Excerpts

Tuesday 10th November 2020 Westminster Hall

[Bill Wiggin (North Herefordshire) (Con)]

I beg to move,

That this House has considered covid-19 vaccine.

Is locking down the nation the only way of combatting covid-19? Whatever suggestions emerge from this debate, we must continue to protect the vulnerable and at-risk individuals. I was briefed by three leading vaccine manufacturers to discuss their work in the fight against this disease. Following those calls, I wanted to have this debate to see what can be done to accelerate the licensing and deployment of vaccines, and the immediate extension of vaccine and therapeutic trials, and how we can ensure that people can take up these vaccines when they are approved.

According to the Department of Health and Social Care website, the Government’s preferred route to enable deployment of the vaccine remains through the usual licensing routes available. It goes on to say that temporary licensing can occur only in “exceptional circumstances.” The recent report of the Tony Blair Institute for Global Change has been helpful in bringing further attention to this issue. It highlights four ways to avoid further lockdowns, of which two are of interest: expanding the trial of therapeutic drugs and shortening the process for approving vaccines. The report is helpful, although it has its limits, and I believe that we can go further and do better, first, by seeking volunteers to extend trials on a larger scale and to those who are most at risk.

We do not really know what scientists and the pharmaceutical industry can accomplish, and there are ethical and responsibility issues that we need to address, but at the moment the risk/reward ratio is out of kilter and we need to do far more to address the possibilities. There are 258 candidate vaccines worldwide, around 50 of which are in clinical testing and 11 in the final regulatory approvals process. Between the three candidates that I mentioned, the Government have forward purchased a total of 190 million doses. The most publicised of these are the joint enterprises between, first, AstraZeneca and Oxford University, widely seen as the most advanced in the world, and secondly, Pfizer and BioNTech, also much publicised after their promising announcement yesterday. The third is Valneva. All three companies emphasise the support and help that the Government have given them. Let us not make another massive communications error by failing to remind the people that these decisions by the Government have helped provide stability and confidence, which have accelerated the whole testing process.

None of the vaccines is the same and all three are unique in their approach. AstraZeneca and Oxford are pursuing an active vaccine. That type of vaccine uses a weaker and smaller amount of the virus to create immunity in the body. Examples of active vaccines are those for MMR––measles, mumps and rubella––and yellow fever. The former provides immunity for the rest of an individual’s life, but it is not known whether that would be the case with covid-19. Valneva is pursuing an inactive vaccine, using a killed version of the germ that causes the disease. Such vaccines are less able than active vaccines to provide immunity for life; typical examples are the flu jab and the rabies injection. Pfizer and BioNTech are pioneering an mRNA vaccine. This is a relatively new type of vaccine that uses a short segment of genetic material to make a harmless version of a target protein or immunogen. This activates an immune response and generates antibodies that fight off the virus.

The development of vaccines is typically a long and drawn-out process, but in response to the pandemic, the Government have helped to speed it up. There are usually three phases. The first involves producing a small amount of vaccine for use in a controlled study with a small number of healthy adults. Tests are performed on participants, half of whom are given the vaccine, the other half a placebo. This ascertains whether the vaccine generates the expected immune response and if it is safe. This stage usually takes only one or two years, yet all that has been passed by all three vaccine candidates already. Scientists at this time will work to provide the data, and a deal will be made with manufacturers to produce whatever amount is required.

Phase 2 sees the data from phase 1 scrutinised to determine whether those who received the vaccine had any adverse reactions. Again, this phase can take up to two years, yet it has already been completed by all three candidates. A larger group of people—several hundred—will then be given the vaccine to broaden the data set. Until that phase is over, scientists and patients will not know who has received the vaccine and who has had the placebo. That prevents the data being deliberately altered and manipulated. At the same time, work will continue to define the manufacturing methods and ensure consistency in the process.

Phase 3, the final phase, will include tens of thousands of study participants who represent a similar demographic to the population, including important factors such as age and ethnicity. As is the case with other phases, the scientists, the patients and those collecting the samples or checking the results do not know who has received the vaccine and who has received the placebo. Getting to phase 3 demonstrates a confidence in the safety, efficiency and efficacy of the vaccine candidate.

During this accelerated process, independent regulators have continued to monitor the trials, as they would with any other vaccine. Safety and accountability have not been compromised or relaxed in any way. As I call for a further acceleration of this process, I do not wish to see those standards dropped. Instead, we need better and faster collaboration between Governments and regulators internationally, because at the end of phase 3 the regulator will investigate the data and decide whether the vaccine candidate is effective enough for mass production.

Several factors affect the effectiveness of a vaccine. For example, the higher the number of patients in the trial who test positive and require medical assistance, the more data manufacturers and regulators have to use. This is referred to as “an event” and it allows scientists and regulators to determine and prove the efficiency or efficacy of the vaccine—in other words, how likely it is to be effective. The more events that occur within the placebo patients, the more it helps scientists come to their final conclusions on how well the vaccine is working. In statistical figures, one hopes to achieve a p-value or confidence quantifier lower than 0.5. That would mean there is a lower than 5% chance that the figures in the test are wrong, giving the scientists 95% assuredness that the test results are reliable and the vaccine is effective. I hope that in a matter of weeks it will be announced that the phase 3 trials have been completed, and then the regulators will study the data before pronouncing whether the vaccine is fit for the public.

The problem is that different regulators around the world have different demands and requirements. This is plainly an area where we can assist the manufacturers, by ensuring that the process is accepted as safe globally and that the different demands, which delay the final outcome, can be agreed by the experts and the approvals process can become smoother.

The pandemic reminds us that we are all people with the same biological make-up, and to defeat the virus we need to unite rather than specialise. Of course, the sooner we can vaccinate those most at risk—the elderly, care workers and frontline staff—the sooner we can begin to rebuild the country and the economy. When the common flu or influenza arrived, it was very likely to result in death. Nowadays, we give those most vulnerable in our society a flu jab to ensure that they remain safe, and we can beat covid-19 in the same way. By reaching phase 3, these vaccines are deemed to be safe.

The question of how effective the vaccine is remains unanswered, but that should not deter us from getting on with vaccinating more people. For example, yesterday’s announcement by Pfizer was a promising step forward on this front. Normally, scientists strive for 70% to 80% efficiency, meaning the vaccine is 70% to 80% effective in reducing the likelihood of contracting the virus. Therefore, even if it was lower, say 40%, we should still look at beginning the roll-out, because 40% could be the difference between life and death for thousands of people. That is why the existing Human Medicines Regulations 2012 contain a provision, regulation 174, that enables the temporary authorisation of the supply of an unlicensed medicine in response to a public health emergency.

With over 200 vaccines in development worldwide and 50 clinical trials, 11 of which are in final phase 3 trials, the Government could look at incorporating as many of those candidates as possible into further trials. We could also have more of the public participating in trials, and not only healthy people but volunteers—they must be volunteers—who are vulnerable and at risk. The Pfizer and BioNTech candidate is already incredibly close to completion, with footage of its full-flowing production line shown in the media only a couple of weeks ago, and yesterday we had the announcement that the safety monitors had found no problems and that it was 90% effective. Now we have to wait for the final data, but the Government could apply the same parameters for therapeutics and their wider use.

Therapeutics are medicines that help people who already have the disease, treatments that are improving to help reduce the fatalities from covid-19, and we have learned a lot about them since March. They are typically used when someone has a disease for which they have been hospitalised. They can both relieve pain and fight back against the virus, reducing its effect on patients. For disease treatment, therapeutics are generally in the form of a drug, and there is substantial evidence to suggest that the use of therapeutics when administered can alter and halt the spread of the virus. Vaccines help prevent people from catching the virus, but therapeutics work for those who already have it. The fear of overwhelming the NHS with covid cases prompted our Prime Minister to lock us down again, but therapeutics can prevent the NHS from being overwhelmed and keep people off ventilators.

Therapeutics come in a variety of forms, and the type being trialled for covid-19 is antibody treatment, of which there are three types: single monoclonals; cocktails of monoclonals, which most covid-19 trials are using; and polyclonals, such as plasma. Only four have so far been approved worldwide, and the only one currently approved in the UK is dexamethasone. Eli Lilly, an American company, is proving to be close with two separate antibody treatments, LY-CoV016 and LY-CoV555, the latter of which is being tested in America as a preventative therapy for residents in care homes.

Another therapeutic is Regeneron, which President Trump famously claimed cured him of his own bout of covid-19, and AstraZeneca is in phase 3 trials for its candidate, AZD7442. The UK Government have agreed to an unspecified amount of the AZ candidate. Pfizer also has advanced therapeutic trials under way, being developed in Sandwich in Kent, and 50 of these trials are going on worldwide. I think the Government could reach out to manufacturers currently in trials and look to extend the trial in this country as soon as possible. Therapeutics could significantly reduce the number of deaths, and these trials could be extended to those who are on ventilators or on oxygen, working not only with regulators but with medical bodies to agree on the ethical stance of compassionate use.

Therapeutics have another huge advantage: their cost. A treatment course of dexamethasone can cost as little as £5. Those courses are largely available and work well with the rapid testing trials that are going on in Liverpool, bridging the gap until the vaccine is approved. I have written to the Prime Minister and the Health Secretary, urging them to extent trials of vaccines for those people who are at risk. During my call with AstraZeneca, I asked, “What more could we do to test safe medicines for people who fear for their lives, who at the moment can do nothing but hope?” I expected to be told that nothing more could be done, but instead AstraZeneca’s team suggested that we ask them for suggestions on what they think they could do. I have faithfully passed on that request, because I think that, for all of us, this stems from the need to save lives.

Of course, I understand that people are concerned about the new vaccines. However, despite the social media opportunities, less time should be spent on the anti-vaxxers and more on those who want to protect their parents and grandparents. Given the guidance from the Joint Committee on Vaccination and Immunisation, the current advice is that vaccines will be administered not to children but to adults, starting with the most elderly and working down to the over-50s.

Detractors and anti-vaxxers believe that vaccines can be unsafe, and it is true that vaccines can run the risk of causing side effects in some people, just like driving a car or riding a bike can pose risks—nothing in life comes without a degree of risk. Those people want to wait for the one-in-a-million or even the one-in-10-million event to occur before we deploy. Those arguing against rushing the vaccine cite examples such as the H1N1 swine flu vaccine. Those shots reportedly caused Guillain-Barre syndrome paralysis in 6.2 people per 10 million who received the vaccine. If we cast our minds back to that pandemic, 284,000 people died of swine flu globally. Undoubtedly, the vaccine did more to halt the spread of the virus as opposed to the damage it caused. Indeed, as outlined in a 2010 article in Neurology Reviews, GBS was associated with the seasonal flu shot at a rate of 10.6 cases per 10 million doses. That did not stop more than 14 million people from receiving a flu vaccine last year alone without incident.

There must be a balance in this argument between covid-19 and the risk to the 194 people who were killed by it in the UK yesterday—eight people every hour. This virus has killed over 49,000 people in this country alone. There is untold damage to people’s wellbeing, mental health, livelihoods and the economy. Unemployment is rising and small businesses are closing. Social isolation inflicts vast damage, particularly on the old and the poor, but if someone is vaccinated, the likelihood of their dying from this disease is significantly reduced. Vaccination could also prevent people from passing the disease on, often unknowingly, to those they love, such as parents or grandparents. The Government and the World Health Organisation should address not just how we vaccinate, and the therapeutic trials and approvals; in addition, lessons need to be learned and procedures changed.

The suffering and death of so many people can be reduced, with collaboration and a reduction in bureaucracy. There must be a balance, weighing up the positives against the risks. The World Economic Forum gauges that coronavirus has cost at least $8 trillion globally, and possibly as much as $16 trillion, and the cost is only increasing. There is a way out and I hope that the Government in this country and Governments abroad, the manufacturers, scientists, medical professionals and regulators will all work together to strive for a final resolution and a better way of addressing the threat of viruses in the future.

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[Bill Wiggin]

I hoped I had been clearer that I was not calling for a curtailment of any of the safety steps. However, with eight people dying every hour, delay has consequences too. What is not acceptable is that the standards for safety in the UK may be slightly different from the standards around the rest of the world. I was asking for a coming together so that we can have that agreed consensus on safety.

[Neale Hanvey]

I thank the hon. Member for that helpful clarification. I certainly hope that there would be a concordance of agreement to ensure not only that similar standards are followed, but that research can be worked on across all countries that have the capacity to do so.

I will make some progress. In our collective hope that there is indeed light at the end of the tunnel, the darkness of our shared journey through this pandemic must not be allowed to obscure our important public duty to act in good faith and with financial probity. That responsibility is not only of value in and of itself; we must do that out of respect for the many who did not make it through and who succumbed to covid-19, and in memory of those key workers who did so for the most selfless of reasons.

I want to refer to comments made by the hon. Member for Strangford (Jim Shannon). I agree with him that this has been a long, dark six months; it has been incredibly difficult. There is a need to feel optimistic, but it almost feels too good to be true. We hope that we will see this through, but again, I urge patience so that we can move forward collectively.

We must not emerge from this dark period with an “at any cost” attitude. We must ensure that the burden was shared equally and we acted together. In the spirit of co-operation alluded to by the hon. Member for Henley (John Howell), during Prime Minister’s questions on 18 March I asked a question about scientific support and I concluded:

“Does he agree that the prize on this occasion must be the victory and not patents and profits?”

In response the Prime Minister stated:

“I endorse completely the sentiment that the hon. Gentleman has just expressed about the need to do this collectively.”

And he concluded that

“everybody is working together on the very issues that the hon. Gentleman raised.”—[Official Report, 18 March 2020; Vol. 673, c. 1001.]

With regard to the spirit of togetherness, it is deeply concerning that we repeatedly hear of cronyism at the heart of this Government, particularly in relation to their less than rigorous approach to appointments and procurement. This morning on the BBC’s “Today” programme, the Secretary of State was challenged about the costs surrounding the vaccine taskforce’s work and its processes. Rightly or wrongly, the appointment of Kate Bingham has proven controversial, and there are no doubt questions to be asked about the absence of any clear recruitment process. However, when she appeared before the Health and Social Care Committee last week, I was very impressed by her performance. She has a very real command of the work that she has been leading, and the relevance and depth of her skillset were clearly in tune with the demands of such a position. However, that does not negate the Government’s or, indeed, any appointee’s responsibility to act ethically and in good faith and, most importantly, to transparently account for their actions.

Concerns about passing on company names that the Government favoured in the pursuit of a vaccine is not a matter for me to pass any judgment on, but they do need to be scrutinised fully. The most recent concerns, set out in The Guardian this morning, are also significant. In simple terms, how can a job be considered unpaid when the postholder holds a position of influence or control in the process of awarding a £49 million investment in a company that they remain a managing partner of? That Ms Bingham is married to a Treasury Minister should have set off the ethical alarm bells well in advance of the matter appearing in the media.

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[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

Thank you, Mr Dowd. I will try to be concise. We have covered an awful lot of ground, and to give my hon. Friend the Member for North Herefordshire (Bill Wiggin) his two minutes—

[Bill Wiggin]

I don’t need two minutes; just tell us everything.

[Jo Churchill]

Right—bless you!

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate my hon. Friend the Member for North Herefordshire on securing this debate—and on such a timely day, as the hon. Member for Nottingham North (Alex Norris) said. It is almost as if my hon. Friend had planned it. I agree wholeheartedly with his comment that we must continue to protect the vulnerable as a priority. I also agree with much of what he said about making sure that we are moving at pace, while never sacrificing safety or efficacy, to drive forward and make sure, in therapeutics and particularly in vaccines, that we are delivering as fast as we can.

Many of those doing the work are involved not only in vaccine development but in vaccine manufacture. That means that they are ready to deploy once regulatory approval has been received. But the process has to be properly and ethically done, and people have to be secure in the knowledge that the vaccine is safe.

As everybody has mentioned, yesterday’s news excited us. However, as my hon. Friend the Member for Henley (John Howell) mentioned, there is not a golden bullet. We need to carry on with the non-pharmaceutical interventions and with driving down the R number, as we are doing. But we have had good news, and we can all afford a little moderated optimism to give ourselves a little bit of cheer. It is promising progress that takes us one step closer to finding a vaccine and, as has been much mentioned in this debate, to helping protect millions of people across the world as well as in the UK.

We need to make the vaccine clinically safe. We know that it will not by itself bring the pandemic to an end, but an assured vaccine would be a huge step forward towards resuming a normal way of life. After clean water, vaccination is the single most effective public health intervention. As my hon. Friend the Member for North Herefordshire said, the benefits are enormous. Working with the Department for Digital, Culture, Media and Sport and social media platforms, we are making sure that the message of vaccination hesitancy is worked on. We are doing that across Government and, more broadly, across companies. This is a national effort, and we have to work together to make sure that we give the right message that gives people confidence.

There is enormous collaboration across science, medicine, industry and government, here and internationally, to find a safe vaccine. Our aim of rapidly developing a mass-produced vaccine means that we are striving to do something that has never been done before. Progress is being made at an extraordinary pace.

My hon. Friend the Member for North Herefordshire took me back to my degrees by mentioning p-numbers and statistical significance, and as he said, although access to the vaccine should be given as quickly as possible, we must ensure that it is safe. I congratulate the vaccine taskforce, which has been mentioned, on its hard work leading the UK’s effort to find and manufacture a vaccine. It has successfully secured early access to 350 million doses through agreements with six separate vaccine developers.

My hon. Friend spoke of several of the vaccines, but not all of them. We have four different types: the Oxford-AstraZeneca vaccine, which is in phase 3 trials; the BioNTech-Pfizer mNRA vaccine, about which we had the excellent phase 3 trials news yesterday; and inactivated whole virus vaccines and protein adjuvant vaccines, which are all in phase 1, 2 or pre-clinical trials. The vaccine taskforce makes a call on those most likely to be effective, because we need a rational approach. The vaccine candidates are all in different stages, and extraordinary progress is being made with the phase 3 clinical trials underway in the UK, the USA, India, Brazil and South Africa. I reassure all hon. Members that the Government are prioritising developing, acquiring and deploying vaccines as soon as they are safely available.

The NHS covid-19 vaccine research registry has been developed in partnership with NHS Digital to help facilitate the rapid recruitment of large numbers of people into further trials over the coming months, so that an effective vaccine for coronavirus could potentially be found. It is important that we spread the net and encourage as many people of both genders and from as many different backgrounds as possible to take part, because we know that there is often a degree of over-representation in clinical trials in certain areas. I know that my hon. Friend is particularly interested in ensuring that we do not dismiss any potential vaccines, but he also said that he is very interested in seeing things sped up, so that bench to patient is much quicker. I could not agree more.

Experts from the NHS, academia and the private sector have worked closely with us to explore and establish human challenge trials in the UK, backed by more than £33 million-worth of investment. The studies offer a chance to accelerate the development of promising covid-19 vaccines in a safe and controlled environment. They are being considered by regulators and ethics committees and, if approved, would start in January with results expected by May 2021. Almost £20 million more is being made available to scale up capabilities to process blood samples from clinical trials.

We have invested significantly through UK Research and Innovation to provide unique capability for process, development and scale up. Once an effective vaccine is ready, we must be able to manufacture it at an unmatched and hitherto unseen speed. We will then move on to deployment. I am running out of time, but I am sure that the usual routes will give us a chance to talk about that deployment and other pertinent issues at another date.

The global co-operation was mentioned by several hon. Members. Globally accessible vaccines, treatments and tests are needed for all of us. No single country holds the key; it is a worldwide pandemic, and we are stronger when working together. The UK has taken a strong role in global leadership and in collaborating with other countries. Our commitment to international collaboration is clear, and we were proud to work through multilaterals—such as the G7 and G20, and with the WHO and other international partners, including industry —to agree collaborative approaches to supporting vaccine development, manufacturing scale-up and future distribution to meet domestic and international needs, including for the world’s poorest countries, which touches on points that were made earlier.

I thank scientists and clinicians around the world for their remarkable efforts in working at pace to develop covid-19 vaccines. I thank my hon. Friend for securing this debate. The vaccine will not be a silver bullet—we have to keep trying—but it will be one of the several tools that help our fight against the virus and allow us to have a more normal way of life.

Question put and agreed to.

Resolved,

That this House has considered covid-19 vaccine.

Covid-19 Update

Bill Wiggin Excerpts

Monday 5th October 2020 Commons Chamber

[Matt Hancock]

I am very happy to work with the team to see what we can put in the public domain. However, the challenge of a maximum file size error is that it would not necessarily have appeared on that sort of flow chart and, given the massive expansion of the availability of data storage over recent years, would not, I expect, be a feature of the system that is already in train to replace the one that caused the problem this weekend. However, I wholeheartedly agree with what the hon. Lady has said about the civil servants in the Department and the staff at PHE, who are working so hard during this pandemic.

[Bill Wiggin (North Herefordshire) (Con)]

My right hon. Friend gave an excellent answer to our right hon. Friend the Member for Tunbridge Wells (Greg Clark). The JCVI report is indeed most helpful and reassuring because it prioritises the vulnerable, the elderly and, of course, our health workers. However, it last met on 1 September, and the report is dated 23 September. Can my right hon. Friend confirm that if there is more information on the progress of the vaccine, that committee will meet again and we will get another excellent report?

[Matt Hancock]

Yes, absolutely. People are asking questions about how the vaccine will be rolled out and of course I understand why people are so interested in that. We will of course protect the most vulnerable first and we will do that on the basis of clinical advice. The JCVI brings together the best clinicians in this area and it meets very regularly. Decisions of the JCVI will not be on the critical path to the roll-out of the vaccine—I have been assured of that.

Covid-19

Bill Wiggin Excerpts

Monday 28th September 2020 Commons Chamber

[Steve Brine (Winchester) (Con)]

I want to cover just three things. I will start by making a plea to Members of the House, to elements of our beloved media, and indeed to the great British public: step back at times, understand a little more, and possibly condemn a little less. We must remind ourselves that there is nothing normal here. This is an unusual event; this is a pandemic. Today we have heard calls for clarity—indeed, we hear that from the Opposition all the time—but in my experience of sitting on the Front Bench in a public health job, all too often calls for clarity are calls for certainty, and that is not how it is in a pandemic.

Just this weekend we heard that the university experience is not as billed. No, it is not—it is awful for freshers going to university and away from home for the first time, in a strange city with people they do not know. On the whole, however, universities are doing their best in an impossible situation. This will not be universally popular, but we should take great care about saying that universities should be refunding all those tuition fees, because those fees will keep universities in business, and keep them going so that they are there once this awful business is over. When we change the quarantine rules for this country or that on a Thursday, especially during the summer months, we see news bulletins full of people saying, “There was no notice.” No, because it is a pandemic. Of course there cannot be two weeks’ notice, because things change quickly in a pandemic.

I sit on the Digital, Culture, Media and Sport Committee and we hear the arts sector say, “Give us a date. We want a date for reopening.” We would love to give people a date for reopening, but it would mean very little. We cannot be sure of where we will be in a month, let alone in three months when a big west end performance could be ready. We hear this all the time, but I ask Opposition Members to please think before they scream “U-turn!” Do they really want a Government who are not prepared to change their mind when the facts change? The previous Labour Government U-turned many times when the facts changed, and they were right to do so.

Policy making in normal times—I have done it—takes time. It is a slow process, and it is meant to be. We go through consultation and scrutiny—that is how normal policy making works—but in a pandemic that is not possible. In March some quick decisions were taken, and they are still being taken as the facts change. It will not be perfect, but that is what a pandemic will do.

[Bill Wiggin (North Herefordshire) (Con)]

Does my hon. Friend think that what we were doing in March was very different from what the Government are dealing with today?

[Steve Brine]

Unquestionably. The quick decisions that we had to make back in March were about whether we should have a national lockdown or not. We had to make those quick decisions, but we now know an awful lot more about the virus, and we have much better treatment. The only effective treatment that we know of comes from scientists in this country. My point is that we are not doing any of this to upset our constituents; we are doing this to try to keep people safe.

My second point is about Parliament. He is no longer in his place, but I agree with much of what was said by the hon. Member for Rhondda (Chris Bryant). This is about consent, and as I said to the Prime Minister last Tuesday when he made his big announcement in the House, we must have the ongoing consent of the British public, or we are in trouble. I fear that that is slipping away. I am getting a constant stream of emails from constituents, questioning the decisions being made because they cannot see the evidence or logic behind them. They do not know where we are going or what is the destination. Yes, we have had a lot of statements from the Health Secretary, and I give him credit for that, but statements are not debates which, like tonight, become an exercise in how many Members the House can accommodate, and then the poor Minister of State on the Front Bench will probably get five or six minutes to wrap the whole thing up.

There is an old adage in this place that one should never ask a question to which one does not already know the answer, but I will ask two questions to which I genuinely do not know the answer. Perhaps the Minister can help me when he sums up the debate. Why are young children included in the rule of six—of course, they are not in Scotland? I do not know the answer to that, although many of my constituents have been asking me. Please can we hear the evidence behind that?

What is the evidence for the 10 pm curfew? I agree with what Andy Burnham, the Mayor of Greater Manchester, said today about the knock-on effects. If we are going to have a 10 pm curfew in our pubs and restaurants, we will have to have a 10 pm curfew on selling alcohol in our off-licences and supermarkets. I would just say this on alcohol, as a former public health Minister: if people are so desperate to drink until 10 pm and then to get loaded with more booze in the off-licence so that they can carry on until 3 in the morning, what does that say about the unhealthy relationship that this country has with alcohol? It is an elephant in the room and we overlook it at our peril.

Finally, on the vaccine, when it comes, if it comes—and I pray to God that it does—could we please, Minister, consider the economic case for the vaccine? Yes, of course we have to give priority to our health and social care workers, but there is a covid generation that I mentioned with regard to university. They have had a rotten deal in the last six months and they are going to have a rotten deal in the next six months. I think that we should consider our young people—as the earners and the backbone of our economy—as the economic case for the vaccine when we get there.

--- Later in debate ---

[Bill Wiggin (North Herefordshire) (Con)]

Since covid-19 began, sadly in Herefordshire we have seen 128 deaths and 1,008 people have tested positive. However, looking to France as an example of where we could be in just a matter of weeks, there have been 14,412 new cases in the last 24 hours, compared to just 5,693 in the UK. In the past week, 4,102 people in France were admitted to hospital, 763 of whom needed intensive care; here, there were some 1,727, with 262 on a ventilator.

Should the UK experience a similar fate, we must restructure how the Coronavirus Act works. In March, we did not know what we were dealing with and how best to manage a fast-spreading virus. The Italian handling of the crisis made us believe that it threatened to overrun the NHS. Parliament granted the Government emergency powers, which at the time was a sensible course of action. Six months on, things have changed. The NHS has been saved and Parliament is sitting.

The press report further covid plans that, as a Conservative, I find possibly draconian, curtailing freedoms, but I am sure we would give parliamentary approval for life-saving precautions. We need to remember that both sides of the House are united in wanting to beat this disease. I know we would be complaining if we sat on the Opposition side of the House, so we need to involve all MPs to get the necessary actions approved. Decisions are being made at ministerial level, such as closing pubs at an early hour, despite Public Health England saying that only 5% of outbreaks occur at pubs and restaurants, based on the advice from SAGE and various other experts.

Let us get those experts approving vaccines. We are only three months away from the final approval of the first vaccine. That is why we do not need a six-month extension to the powers granted by the Coronavirus Act. Vaccines for covid-19 are the key to eliminating the virus. The faster one is distributed, the more likely we are to protect the most vulnerable in our society, and that is the area we should be working on. Do we really need to wait till the end of the year? Do we need to follow the existing testing regime so religiously? Is there an opportunity to hurry things up? Perhaps we can look at people who feel most at risk and may be willing to volunteer for an early vaccination—and do not tell me it is impossible, because that is what we are always told just before it becomes possible.

Worldwide, there are a total of 320 possible vaccines in development. Today, roughly 280,000 trial participants across 470 sites in 34 different countries are racing to find a vaccine for covid-19. It is a global search, but we should be rightly proud of the British institutions at the forefront of these efforts. The UK Government have pledged £250 million to the Centre for Epidemic Preparedness and Innovations, the largest contribution of any nation.

In total, four vaccine candidates have entered the final steps of the regulatory approvals process. The leader is the joint AstraZeneca and University of Oxford team. They have reached phase 3, which makes it the most advanced vaccine in development, and the study should be complete by December. The speed at which that is being done is outstanding, but we need to do more. The Government have invested £131 million to support vaccine development at the University of Oxford and Imperial College, on top of the £2.3 billion to GAVI and the wider international effort to fight the virus. In doing so, the Government have secured early access to a total of 190 million doses of covid vaccine candidates.

[Steve Brine]

That is all true, but is it not the point that, in the same way as we are all dependent on each other doing the right thing at the moment in the absence of a vaccine, we have a responsibility, as a country that leads on GAVI, to take on the anti-vaxxers and those who will deny a vaccine to themselves and thereby put others at risk? When the vaccine comes, we need to roll it out and we need to roll it out everywhere.

[Bill Wiggin]

My hon. Friend is right, but everybody who takes the vaccine reduces the risk proportionately for everybody else. It is all about the R number, as he knows. That is why the Government have been right to pre-book the vaccines: 100 million doses of the AstraZeneca and University of Oxford vaccine, 30 million doses of the Pfizer and BioNTech vaccine, which is the next one in evaluation stage 3—we should have doses by the end of 2020 for that—and 60 million doses from a company called Valneva, whose vaccine will be provided in the second half of 2021.

The Government have a great story to tell on the work that they have made possible. We are all doing all we can to save lives, and we should now restore parliamentary democracy too. In these difficult times, my constituents want hope. After the sacrifices they have made, the vaccines that we have funded and the lives that have been saved, we all deserve it. We need to start voluntary vaccinating now, and we need to get life back to normal.

Points of Order

Bill Wiggin Excerpts

Tuesday 14th July 2020 Commons Chamber

[Mr Deputy Speaker (Mr Nigel Evans)]

I am grateful to the hon. Member for her point of order and for giving me notice of it. While it is not for the Speaker or me to advise individual hon. Members or Select Committees how they may wish to carry out their work during recess, we may be able to help by emphasising again what the Speaker has said about the importance of correspondence from hon. Members receiving prompt replies. I agree that this will be of particular importance during the recess, while the country is still facing a major public health challenge. I hope that Ministers will give careful consideration to how they can support all hon. Members carrying out their duties during this recess by providing prompt and helpful replies to correspondence.

[Bill Wiggin (North Herefordshire) (Con)]

Further to that point of order, Mr Deputy Speaker. Thank you for that answer. You will be aware that 72 people tested positive in my constituency this weekend. I did apply for an urgent question. I put my name down to be on the call list today. Could I ask you to gently thank Mr Speaker for all he has done to make our hearings possible, but to make sure that constituency cases can be heard by the Minister, because I have tens of thousands of migrant workers in my constituency who probably need to be tested as well?

[Mr Deputy Speaker]

Thank you for that point of order. The Secretary of State for Health and Social Care is still sitting in his place and will have heard that point of order.

Coronavirus Bill

Bill Wiggin Excerpts

2nd reading & 2nd reading: House of Commons
Monday 23rd March 2020 Commons Chamber

[Bill Wiggin (North Herefordshire) (Con)]

It is a pleasure to follow the maiden speech of my hon. Friend the Member for High Peak (Robert Largan).

May I say to colleagues across the House that being angry with the public for what they are doing wrong is no way to proceed? In Fownhope in my constituency, a community that was hit very badly by flooding, we are seeing the most phenomenal community spirit and wonderful behaviour blossoming as people reach out to those who are lonely and self-isolating. Young people are writing to people in care homes to make sure that they feel valued. A wonderful sense of community spirit is shining forth. For me, that is worth so much more than being cross with people who may be getting their self-isolation or shielding wrong.

I want to talk about the most important thing we have here: our parliamentary accountability. That accountability is a baby worth saving no matter how toxic, dangerous or infectious the bathwater, so two years calls into question the advice the Government have been given. China has had 81,307 cases and 3,254 deaths, yet it has managed to shut down the disease in six weeks from its epicentre—a much more difficult task than we have—with flights still coming in from countries such as Iran three times a day. How is that possible when we are looking at such draconian legislation today?

It is not necessarily perfect legislation. Under clause 23, which relates to powers on food—I was naturally drawn to it—a person may be required to provide “relevant information” to the authority in subsection (1), and yet subsection (6) states:

“A requirement under this section may not be imposed on an individual.”

That does not look quite right, so perhaps the Government could look at that before Report.

In my last few seconds, I want to reiterate how much the public need to understand that what we are sacrificing, both economically and in terms of our freedom, is worth it if we are protecting the professionals in the health service, local authorities and all the caring services that are reaching out and providing the sort of community that we all hold so dear. I am seeing it every day in my constituency, and I want to make sure we never forget that it is the goodness of the British people that makes all these sacrifices worth it.

Coronavirus

Bill Wiggin Excerpts

Monday 9th March 2020 Commons Chamber

[Matt Hancock]

We are, of course, working with Public Health England on making sure that we have the right answers should this happen. Looking into what happens on cruise ships and what advice will be given with respect to people going on future cruises is a critical piece of work that we are undertaking.

[Bill Wiggin (North Herefordshire) (Con)]

Today, we had the first acknowledgement that there was a case in Herefordshire and yet I am still waiting to hear from the Government about the 70 children who are planning to go to northern Italy to ski. Can we make sure that airlines are giving these parents their money back?

[Matt Hancock]

We advise against all but essential travel to northern Italy, and I do not regard skiing as essential.

Adult Social Care in Shropshire: Government Funding

Bill Wiggin Excerpts

Wednesday 22nd January 2020 Westminster Hall

[Daniel Kawczynski]

I am extremely grateful for those interventions from my hon. Friends and neighbours. I could not agree with them more. Shrewsbury is listed as one of the top 10 places to retire to in the whole of the United Kingdom because of the beauty of our town—we have more listed buildings than any other town in England. We have a larger number of senior citizens as a percentage of our total population, and that percentage is growing much faster than the national average. Governments of all political colours have poured money disproportionately into inner-city, metropolitan areas while leaving us in the rural shire counties as the poorer cousins, and it is vital that we now start to take action.

[Bill Wiggin (North Herefordshire) (Con)]

Will my hon. Friend give way on that point?

[Daniel Kawczynski]

I will give way for the last time, very quickly.

[Graham Stringer (in the Chair)]

Order. In half-hour debates on the Adjournment, people who speak have to have the permission of the proposer and of the Minister, and it is not good form to come in after the proposer has started speaking. I ask the proposer and the Minister whether Bill Wiggin has had permission to intervene.

[Bill Wiggin]

I am happy to withdraw my intervention, Mr Stringer.

[Daniel Kawczynski]

I will follow your lead on that, Mr Stringer.

In the financial year 2019-20, the social care budget for Shropshire Council was £103.1 million. That represents 48.2% of the council’s net budget, up from 32.6% in 2015-16, which is extraordinary: our council’s budget for just dealing with adult social care costs has gone up from a third of its net budget to practically a half. I find those figures staggering, and my colleagues from Shropshire agree. Since 2015-16, Shropshire Council’s adult social care budget has risen by an average of £7 million per annum. In the coming financial year, it is projected to rise by approximately £10 million; £6 million of that is inflationary, meaning that only approximately £4 million is due to increasing demand.

As has been said, Shropshire’s senior citizen population is rising at a much faster rate than the national average, and Shropshire Council has become more efficient, which is the point that my right hon. Friend the Member for Ludlow was making. The Local Government Association has assessed our council as being very well managed, and as implementing new and innovative policies in this regard. Shropshire Council has become more efficient and innovative in an attempt to control rising costs in social care. Of all initial inquiries into adult social care, 85% are signposted to external support, and of the remainder, only 14.8% enter paid services. In total, 2.25% of all inquiries enter paid services; in 2014-15, the comparable figure was 32%. The financial pressures on Shropshire Council go beyond single-year budget increases. The most recent available analysis shows that if our council were funded at the English average per head of population, it would have an additional £20 million in its base budget.

I am grateful to have had the opportunity to raise this issue, and look forward to hearing the Minister’s answers. I am pleased that all the MPs from the Shropshire Council area have attended this debate, and I am very grateful for their support. They know as well as I do the huge pressures that our council is under at the moment because of its lack of funding, and will share those pressures with the Minister. Our hon. Friend the Member for The Wrekin also mentioned serious problems with our local hospital acute trust, which we are trying to raise with the Secretary of State for Health and Social Care.

We in Shropshire are experiencing a unique combination of problems at the moment, meaning that our constituents are given services that are creaking at best. That is not something I feel comfortable with. We are the fifth-largest economy in the world; I read today that last year, we reduced our debt as a percentage of GDP by 0.9%, and I am delighted and thrilled that the International Monetary Fund is now forecasting that our country will grow at a faster rate than the eurozone over the next three years. We have turned a corner, so we can start to loosen the purse strings a little bit. We as Conservatives must demonstrate that we have a long-term solution to this issue, which affects so many of our constituents.

Orkambi

Bill Wiggin Excerpts

Monday 4th February 2019 Commons Chamber

[Bill Wiggin (North Herefordshire) (Con)]

Last week, one of my constituents, whose daughter suffers from cystic fibrosis, came to see me. He explained that every year that access to Orkambi or other such similar drugs is delayed takes 10 years off the life of his daughter.

My constituent explained how the long hours in hospital and in treatment mean that cystic fibrosis defines his daughter’s life. However, clinical trials by Vertex seven years ago marked the start of a new hope. Vertex’s amazing progress suggested that he might not outlive his daughter, that she could have the fullest life now possible, and that he would not have to tell her that she was likely to die when barely into adulthood. The whole House will understand that never in his worst nightmares did he consider the fact that these drugs would succeed yet be unavailable to his daughter.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Is the hon. Gentleman aware that Orkambi, which is manufactured by Vertex, is licensed and available in Ireland and the Netherlands where there are only 1,000 cystic fibrosis sufferers, but not available in the UK where there are more than 10,000 sufferers? Does he agree that that is a terrible shame?

[Bill Wiggin]

I suggest that the hon. Gentleman hears the rest of the speech before he expects to draw any conclusions.

Cystic fibrosis is a life-limiting genetic disorder. Patients with cystic fibrosis experience a build-up of thick mucus in their lungs. This can have a wide range of effects on their respiratory, digestive and reproductive systems. The disease is widespread in the UK. One person in 25 carries the faulty cystic fibrosis gene. Statistically, that is 26 Members of this House whose future generations could be affected by this cruel disease.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this debate to the House; there is such a good crowd in the Chamber tonight due to the importance of the issue. I also thank him for being an advocate of Orkambi not because I have had any dealings with the company, but because I have many constituents who are affected. One grandmother in particular has asked me to make a plea because the life not only of their grandchild, but the lives of the whole family, have been turned around by this drug. I want this drug to be available for families throughout Northern Ireland and the whole United Kingdom. Does he agree that this Crown licence is a way to get around the stalemate that is preventing CF sufferers throughout the United Kingdom of Great Britain and Northern Ireland from accessing this drug, which is proven to deliver tremendous improvement in quality of life?

[Bill Wiggin]

I am sure that the hon. Gentleman’s constituents will be grateful to him for raising the issue in the House this evening.

Every week, five babies are born with the disease, according to Great Ormond Street Hospital, and every week two young people die as a result of cystic fibrosis. The disease accounts for 9,500 hospital admissions and over 100,000 hospital bed days a year. There are two main ways to treat cystic fibrosis: conventional treatments target the symptoms, and precision medicines such as Orkambi tackle the cause of the condition. For conventional treatment on the NHS, the average waiting time to be admitted to hospital is 45 days.

Orkambi presents a relatively safer, more effective and clinically meaningful alternative. In treating the root causes, it reduces lung damage and cystic fibrosis-related diabetes, and improves pancreatic function. The drug has been approved by the European Medical Association, and the Food and Drug Administration in the United States. It avoids the high risk associated with organ transplants.

Orkambi treats the F508del mutation, which around 50% of people with CF in the UK carry. Essentially, the drug permits more chloride ions to pass into and out of the cells. This helps to keep a balance of salt and water in affected organs. Ivacaftor is one of the active substances in Orkambi. It increases the activity of the defective cystic fibrosis transmembrane conductance regulator protein, thereby making the mucus less thick. Decline in lung function is the most common cause of death for people with cystic fibrosis and, although not a cure, Orkambi has been found to slow the decline in lung function by 42% and reduce hospitalisations by 61%.

[Rachael Maskell (York Central) (Lab/Co-op)]

Before coming to this place, I was a respiratory physio and worked with many people with cystic fibrosis. The cost of hospitalisation and treatment far outstrips the cost of this drug for many people with cystic fibrosis. Should not the National Institute for Health and Care Excellence change its criteria and look at the value of life, instead of only the day-to-day cost of this drug?

[Bill Wiggin]

No, I do not agree. The purpose of this debate is to a show an alternative that allows NICE to spend taxpayers’ money on drugs for other conditions while still allowing cystic fibrosis sufferers to have access to this vital drug—and not just to Orkambi, but to the next generation of the same sort of drugs. Bear with me because we have not got to the good bit yet.

In July 2016, NICE recognised Orkambi as an important treatment, yet was unable to recommend the drug for use within the NHS on grounds of cost-effectiveness. The drug is estimated to cost around £104,000 per patient per year and must be taken for life. Orkambi is not provided by the NHS, except in rare cases on compassionate grounds. It remains patent to its manufacturer, Vertex Pharmaceuticals, under UK patent law. In July 2018, NHS England made what it said was its best and final offer to Vertex of £500 million over five years. This was described by the NHS as the “largest ever financial commitment” in its 70-year history. Tragically, Vertex rejected the offer.

We all know that it is essential that a solution is found as soon as possible to make the drug available, as every day counts in slowing the progress of the disease. In an email to me, Vertex states that it

“is committed to finding a sustainable solution for access to our medicines for Cystic Fibrosis patients, including Orkambi”.

That is not quite the impression I have received so far. I sincerely hope that that is indeed its highest priority.

The drugs that constitute Orkambi—Ivacaftor and Lumacaftor—can be synthetically developed at low cost, yet their price remains inaccessibly high.

[Kerry McCarthy (Bristol East) (Lab)]

As some of my colleagues will know, I have a 14-year-old niece with cystic fibrosis, as well as many constituents who have it. I obviously know people within the community, too. Is the hon. Gentleman aware that in 2017 Vertex earned £2.5 billion from the sale of Orkambi and the chief exec was paid more than $17 million? I think that the Department of Health and Social Care probably has to go some way towards meeting Vertex on this, but it seems to me that there is an awful lot of money sloshing around and both sides are in a position where they could compromise.

[Bill Wiggin]

First, let me say how sorry I am to hear about the hon. Lady’s niece. We should take this very seriously. The figures that I have are even worse than the ones that she has laid out.

The price remains inaccessibly high, and this is entirely due to the powerful patent laws that allow pharmaceutical companies to monopolise drug production. Vertex expects to retain monopoly intellectual property protection on its cystic fibrosis drugs well into the 2030s. Analysts conservatively estimate that it will generate profits of $13 billion on Orkambi and another related drug, Kalydeco, alone. This could be used to fund further research and development—to reward its shareholders for its brilliant breakthrough and perhaps to encourage it to do more. But no, Vertex has spent $500 million on buying back its own shares. Well, that should certainly boost executive remuneration.

I am aware that provisions exist under the Patents Act 1977 for the Government to take independent action against Vertex. Crown use licensing is a powerful legal tool that can be used to safeguard public health. It can ensure the availability of fairly priced medicines in a competitive pharmaceutical market. Section 55(1) of the Act states that the Government can be granted non-authorised use of patents

“for the services of the Crown”.

That can be granted at all stages of manufacture, use, importation, sale and retention of a product. This is a legal opportunity to break the lethal deadlock that eats away at the youngest sufferers who stand to gain the most from this medicine. Crown use licensing has been used by the UK Government before, to great effect. They can suspend a patent and thereby force down the high price of particular pharmaceutical or medical equipment. For example, in 1991 the Government authorised the supply of machines known as lithotriptors for treating kidney stones. More recently, breast cancer patients have lobbied the Scottish Government to implement a Crown use licence on the drug Pertuzumab. Crown use licensing could similarly be used to overturn the patent monopoly on Orkambi by Vertex.

[Mr Stephen Hepburn (Jarrow) (Lab)]

I applaud the hon. Gentleman for his initiative and guarantee him my 100% support. Does he not agree that this drug should be supplied on the NHS? We are all born equal in this country, but unfortunately if you are a millionaire you can pay for it but if you are working class like my constituents you cannot get it. I have constituents—Emma and Chris Corr and their young daughter Harriet—who are considering leaving England so as to be able to get the care that they need. Does he agree that this country is unfair?

--- Later in debate ---

[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.

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

I am grateful to the hon. Gentleman for giving way. He is making an excellent case. Those of us who have been active on this issue—it is wonderful to see so many of them in the Chamber—have faced the argument from the company that it wants to have a licence for a whole class of these medicines, so that it can plan that future investment. He seems to suggest that that is not necessarily a valid argument. I wonder if he could respond to that argument, which has been used against those of us who have suggested that there should be a fairer way of proceeding.

[Bill Wiggin]

I am not quite sure I follow. I would have been much more sympathetic to Vertex if it had not been doing share buybacks. If a company expects to make $13 billion of profit, it will have factored into its calculations a reasonable profit margin. I believe that Vertex has an unreasonable profit margin. I support the private sector, and I like the idea of that R&D going on to benefit the shareholders, but I also recognise that we have a responsibility. As people who want to see patients cured, we want to see this deal done ideally by Vertex and NICE. This is a £500 million gamble for Vertex, because it will not get the money if it does not do the deal.

[Liz McInnes (Heywood and Middleton) (Lab)]

I am grateful to the hon. Gentleman for giving way. He mentioned the R&D that is going on. That R&D does not exist in a vacuum; it is done on patients, with input from doctors. Does he agree that the company, no matter how much profit it might want to make, has a moral obligation to cystic fibrosis patients?

[Bill Wiggin]

I absolutely agree, which is why I am suggesting that the Crown use licence ought to be used and taken seriously. I imagine that people working for Vertex are listening closely to this debate. They will have heard the hon. Lady’s point, and I think they need to move on from this attention to profit margin.

As a Conservative, I understand the importance of managing the expectations of private companies. We in Parliament have a responsibility to people with cystic fibrosis to stand up to the greed. That is what we are doing now, and it is lovely to see so many Members here. I urge the Government to consider enacting a Crown use licence, to break the deadlock on this patented drug and reduce the price of Orkambi and the suite of medicines that go with it, which are so desperately needed not only by our constituents, but by their children.

Health and Social Care

Bill Wiggin Excerpts

Monday 27th February 2017 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

Today’s debate on the supplementary estimates and the financial position of health and social care matters, first and foremost, because of the impact of that financial position on patient care. I start by paying tribute to our health and care staff across the country and, at this particular time, by noting and thanking those who have come from across the European Union to work in this country.

The current financial position is of great concern. As a result of the wider economic downturn, we are now in the seventh year of the longest financial squeeze in the history of the NHS. Although the Department of Health’s budget has been protected in relation to many others, we cannot escape the fact that over the previous Parliament the average annual increase in its budget was 1.1%, which is far lower than the increase in demand and, of course, far lower than the historical increase of 3.8% since the late 1970s. All that is in the context of an extremely challenging position for social care. Between 2009-10 and 2014-15, there was a 10% real-terms reduction in social care spending by local authorities.

All that has taken place in the face of an extraordinary increase in demand, because of not only a rising population but our changing demographics. To put that into context, over the decade to 2015 there was a 31% increase in the number of people living to 85 and beyond, and we estimate that over the next 20 years we will see a 60% increase in the number of individuals who rely on social care. Over the years there has been an abject failure of Governments to plan for that, although it was entirely predictable. We absolutely cannot just keep ducking the question. We need not only to address the immediate financial problems that face health and social care, but to come together as a House to address the problems for the future.

[Bill Wiggin (North Herefordshire) (Con)]

It occurs to me that this is not a uniquely British problem; it is in fact a global one. I have been trying to find out where in the world social care is best delivered and whether we can learn anything from those countries.

[Dr Wollaston]

My hon. Friend makes an important point. We are all looking forward to the publication of the House of Lords report on future sustainability, because of course we have much to learn from other systems. I pay tribute to the Public Accounts Committee, which today published its report on the financial sustainability of the NHS. We have also seen the final position of trusts at the end of the previous quarter, so we now know that 135 providers ended that quarter in deficit. We are on course for a financial deficit across trusts of between £750 million and £850 million at the end of the financial year.

--- Later in debate ---

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

May I pay tribute to the Chair of the Health Committee for her sterling work in this area and to the Chair of the Communities and Local Government Committee? Our three Committees are united in the view that we need to bring the agenda of how we fund health and social care to the front and centre of this House and this Government. It is important that we work together on that. It is quite unusual for three Select Committees to co-ordinate in such an effective way—at least we hope it is effective. Ultimately, the proof will be whether this view will bite with Government.

We are clear that integration of health and social care is vital. In fact, we rushed to the Chamber from Committee Room 6 where we were debating the first phase of the better care fund, which had been used as a way of taking health money to prop up the social care budget. Amazingly, the head of NHS England and the Department of Health, who were appearing in front of us, denied that there was any failure in the better care fund. They said that there were not really any targets; it was all about taking money from one pot to pay for another. If that does not underline the challenges that exist in the many initiatives that are coming forward and the lack of sustainability for long-term funding, I do not know what does. I echo the comments of the Chair of the Health Committee that we need a long-term generational shift in how we are going to deal with this matter. We cannot just keep lurching from crisis to crisis and funding situation to funding situation.

My Committee looks very closely at accounts for many Members of this House. It may not be the most enjoyable bedtime reading, but we lap up the accounts of different Government Departments. We were disappointed that the Secretary of State laid the NHS accounts on the last day of the parliamentary term in July. When we opened them, we realised why: those NHS accounts were within target only by a smoke and mirrors approach and a series of short-term, one-off measures to ensure that they balanced.

I remind the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), that last year the Public Accounts Committee, of which he is a former member and therefore is doubly thoughtful on this subject, gave the Department a yellow card warning that, if in 2016-17, these similar one-off measures and a similar approach to the Budget were carried forward, we would be giving it a red card. The Comptroller and Auditor General, Sir Amyas Morse, issued an unprecedented warning in those accounts, which had been audited by the National Audit Office, and laid out his serious concerns. As he told us, he walked down Whitehall to talk to the permanent secretary at the Department of Health to make it clear that he was concerned about those one-off measures.

To help the House, I will lay out how it was that, by some miracle, the Department managed to balance its books last year. First, £2.14 billion was set aside for sustainability and transformation funding, £1.8 billion of which was used to cover hospital trust deficits. The Department of Health did not notify the Treasury of the additional £417 million of national insurance receipts that it had received. It said that it was just a one-off reporting error. I am heartened to see that, in the current estimates, such a practice does not recur.

There was also a one-off super dividend of £100 million for the Department from the Medicines and Healthcare Products Regulatory Agency. That large cash balance was put into its capital departmental expenditure limit budget, which helped it to reach a final balance. Critically, it seems that this is becoming a long-term strategy for NHS budgeting—I hope the Minister will take this seriously and respond. As the Chair of the Health Committee has highlighted, we are seeing a trend of capital funding being pushed into revenue to keep the system going. That is not sustainable. Last year, in 2015-16, the Department of Health transferred £950 million of capital to revenue. The supplementary estimate that we are debating tonight shows that the Department will transfer some £1.2 billion of capital to revenue funding this year—so £250 million more than last year.

[Bill Wiggin]

I am particularly interested in the private finance initiative element of the capital funding, because certainly, for all the years that I have been a Member of Parliament, the PFI burden on Hereford hospital has always held it back. Has the hon. Lady’s Committee had a chance to look at that?

[Meg Hillier]

We have not looked at that directly, but we know that the biggest revenue cost for hospitals is staffing, which is followed, for some hospitals, by servicing a PFI deal. Early analysis suggests—I would not want the House to lay too much on this, because it comes from conversations I have had with auditors—that the challenge is that the cost of refinancing those PFI deals can swamp the potential savings. Perhaps Ministers could look into that further. A lot of technical work has been done to attempt it. The British Medical Association tells me that spreading the payback period over a longer time would reduce the day-to-day resource costs for hospitals, so that might be a way forward. However, I speak from work I have done outside the Committee Room, rather than strictly through the work of the Public Accounts Committee and the National Audit Office.

The supplementary estimate this year is worrying. The trend is going in the wrong direction for taking money out of the capital spend. As the hon. Member for North Herefordshire (Bill Wiggin) highlighted, a lot of the transformation in the NHS will require the reconfiguration of buildings and estate. Those sorts of capital expenditures are important to save money in the long term, so the estimate really is very short-sighted.

If we look at how NHS trusts are managing with their deficits, again we see a worrying trend. At the beginning of this financial year—2016-17—NHS Improvement committed to ensuring that the provider sector deficit did not exceed £580 million at the end of the year, which is now in a month’s time. However, NHS Improvement forecast a deficit of £644 million in quarter one. Its forecast declined further to a deficit of £873 million in quarter three. That pledge did not amount to very much, and it is moving very much in the wrong direction. NHS trusts have been overspending by approximately £300 million a quarter throughout this financial year. If that trend continues into the final quarter of the year, the overspend will be close to £1.2 billion. I have laid out the reality very starkly by picking out uncertain elements in the Department of Health’s consolidated accounts.

We hear a lot of discussion about how much money the Government are putting into the NHS. The Committee had an unedifying experience at a hearing on 11 January, in which the head of NHS England came before us on the very day that anonymous briefings in the national press from sources at No. 10 criticised him and NHS England. He defended his position in the Committee but, frankly, patients do not want anonymous briefings from people to save face when the Committee is actually looking at saving lives and treating patients. They do not want to see a ding-doing about the money. They need to know that the people running our health service, and the Government overseeing and channelling taxpayers’ money into it, are committed to long-term patient care and tackling future long-term challenges.

Let us be clear that protecting the NHS England budget is not the same as protecting the health budget. As the hon. Member for Totnes mentioned, Public Health England and Health Education England are being squeezed, and social care budgets—although not a direct national health cost—went down by 10% in the last Parliament. There are some clever measures by Ministers, saying, “Put up your council tax precept and it’ll all be fine.” That is still taxpayers’ money being found from somewhere to go some way towards solving the problem, but it will not solve it in the long term. Unless we tackle social care and health together, we will have an unsustainable future. There is too much robbing Paul to pay Paul—shifting money from one bit of the budget to another in a clever way that is not transparent to most people out there because it is buried in big numbers.