Oral Answers to Questions

Bob Blackman Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Jeremy Hunt]

We have tried to speed this up with the cancer drugs fund, which helped 84,000 people in the last Parliament, but we always keep the NICE procedures under review and I take on board what the hon. Gentleman says.

[Bob Blackman (Harrow East) (Con)]

We recently had an excellent debate in Westminster Hall on the Government’s tobacco control strategy. When will they publish the new strategy, which was promised for publication this summer?

[Nicola Blackwood]

The UK is a world leader in tobacco control and we have a proven record in reducing the harm caused by tobacco. We should be proud of the fact that smoking rates among adults and young people are at the lowest ever level, but my hon. Friend is right to push for the tobacco control plan because there is unacceptable variation. We are working on developing that plan, which we will be publishing shortly.

Tobacco Control Plan

Bob Blackman Excerpts

Thursday 13th October 2016 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

Thank you, Mr Brady, for calling me to speak; it is a pleasure to serve under your chairmanship.

It is also a pleasure to follow the speech made by my right hon. Friend the Member for Rother Valley (Kevin Barron), as I will call him in this context. I thought that it was thoughtful and, as always, well argued in its treatment of the data.

I place on the record my congratulations to the hon. Member for Stockton North (Alex Cunningham) on securing this debate, and I also congratulate my colleagues on the Backbench Business Committee on allowing it to take place. No doubt the Health Department considers itself extremely challenged by having to respond to a debate in Westminster Hall and to two debates in the main Chamber on the same day.

I also put on the record my congratulations to the Financial Secretary to the Treasury, my hon. Friend the Member for Battersea (Jane Ellison), on all the work she did for public health. Indeed, a lot of the reforms that have been made and that we are talking about today came under her stewardship.

I also congratulate the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), on securing her ministerial position. We are all looking forward to hearing her speak later on. As she is a former chairman of the Science and Technology Committee, I suspect that she will examine the scientific data and the important evidence before moving on; we look forward to that taking place.

On that subject, I echo what has already been said, namely that smoking is the No.1 public health challenge in the UK. As has been mentioned, there are almost 100,000 premature deaths every year across the whole country as a result of smoking. The fact that adding together the number of deaths caused by the next six biggest causes of preventable deaths would still not exceed the number of deaths caused by the No.1 cause of preventable death suggests that we have to address this matter. However, there is a risk that, because of the success of the tobacco control programme over the last five years, people will think the job is done. Well, I have to say that it is most certainly not done.

I declare my interest as the chairman of the all-party group on smoking and health and, as someone who has been an avowed anti-smoker all my life, I will continue to oppose smoking. I take the view that there are two categories of people here. We have to help people to stop smoking, but even more importantly we have to prevent people from starting to smoke, because we know that once people are addicted it is a very difficult job for them to give up their addiction.

As the hon. Member for Totnes (Dr Wollaston) said, we have been very successful. In the 1970s, more than 50% of the adult population smoked; that figure is now down to below 20%. That is good news. However, it still means that there is a stubborn minority and we have to get across to them how damaging it is to their health to continue smoking.

Success in this area has not happened by accident. Governments of all persuasion— including the current Government, the coalition Government before that and the Labour Government before that—have done enormous amounts of work to reduce the prevalence of smoking. Health professionals have also contributed to that, as have civil society organisations.

The position now is that the tobacco control programme finished at the end of last year. That is the reality and we need to see the new programme as soon as possible.

On this side of the House it is not unusual to hear people argue that the smoking habit is none of the Government’s business. Of course, it is an important source of tax revenue, but some people say—they are not necessarily employed or funded by the tobacco industry—that those who choose to smoke understand the risks, and have exercised their free consumer choice. I would say that informed choice and people understanding the damage they are doing to themselves is up to them, but that does not mean that we should not increase the pressure on those individuals to understand the damage they are doing to themselves and to others by continuing to smoke. I seek to make sure that we continue with the regulations and ramp up the tobacco control programme. We will soon see a situation where all cigarettes and hand-rolled tobacco are sold in standardised packaging, which has been a huge advance. We should take credit for that. Together in this Chamber, we changed Government policy through the force of our argument and the data that we provided in evidence.

I am sure that my right hon. Friend the Prime Minister is among the group that understands that the state and the Government have to interfere in this process. In her recent speech, she said that

“government can and should be a force for good…the state exists to provide what individual people, communities and markets cannot; and…we should employ the power of government for the good of the people.”

I say that she is absolutely right, and that, on tobacco control, the position is quite clear. In her very first speech as party leader, she promised to fight

“the burning injustice that, if you’re born poor, you will die on average 9 years earlier than others.”

That injustice is a clear issue for tobacco.

It would be very hard to find a more dysfunctional market than the one controlled by four of the most profitable companies in the world, who make their money selling products that they know will kill half of their lifetime customers—products that have been carefully designed to deliver a highly addictive drug, as fast as possible, to the brains of their users. If anyone were attempting to invent such a drug today, they would not get away with it, but these companies are quite clear in what they set out to do. The estimates by the US National Center on Addiction and Substance Abuse of capture rates for both legal and illegal drugs demonstrate that point powerfully. Capture rates are the percentage of users who report that they have become dependent on the drug at some point. Tobacco has a capture rate of almost a third, more than for heroin, cocaine, alcohol and cannabis. It is clear that the tobacco companies deliberately set out to ensure that their customers are addicted to the drug.

Dependency is a combination of physical and psychological factors. Social and economic factors, such as the relative availability of different drugs, when and where they can be used in a socially acceptable way, and how affordable they are, all have an impact and smoking is therefore a major contributor to poverty and health inequality. As the Marmot review concluded in 2010, smoking in the UK accounts for about half the difference in life expectancy between different social classes, and so the important commitment that the Prime Minister has made to tackling what she rightly calls this “burning injustice” cannot be met without further action on reducing smoking rates.

In my borough, Harrow, analysis based on the 2015 integrated household survey shows that about 13% of the working-age population smoke, which is above the UK average, and equates to about 25,000 people. Of the roughly 15,700 households in Harrow that include a smoker, 2,700 fall below the poverty line. About 1,000 would rise above that line if all smokers in poor households were to quit. A lot of people refer to my borough as a nice, leafy borough, but it is important to understand that there are levels of deprivation all across the country—with respect to the hon. Members opposite, it is not confined to the north and the industrial cities.

Despite that fact, I am displeased that Harrow Council has decided to consult on stopping the smoking cessation services in an attempt to save money, but I am pleased that a large petition has been initiated by consultants at Northwick Park hospital with the aim of combating that and preventing it from happening. As my hon. Friend the Member for Totnes noted, stopping smoking cessation services would be a stupid move and would increase pressure on the health service and on individuals.

I would also add that, whatever one’s views on Brexit, the reality is that over the last five years more than 10,000 adults from eastern Europe have come to live in my constituency and almost all those of adult age smoke. The tobacco control programme needs to include encouraging people to give up by reaching parts that have not been reached previously.

One important lesson that we have learned from previous control programmes is that efforts to reduce smoking must be sustained and progressive; sustained because, as I have said, nicotine is a powerful drug, it increases dependency and requires powerful interventions to persuade people to quit; and progressive because people who continue to use tobacco after the control programmes are in place can be said to have discounted their effect. For example, many smokers quit after the introduction of the workplace ban in 2006, but most did not. The need for progressive steps is particularly important when it comes to tax and price policy, because the economic impacts of tax rises on reducing demand for tobacco products depend not simply on absolute price levels, but on affordability. If taxes rise more slowly than incomes, tobacco will become more, not less, affordable and consumption will tend to rise, not fall.

That point is well understood by the four major tobacco companies, which routinely use what they call “overshifting” as a pricing device. When the Government put up taxes, the companies raise the price of their so-called luxury brands by more than the amount required by the tax increase, while raising the price of the economy brands by less than the tax increase, or in some cases not at all, so that as many low-income smokers as possible are encouraged to continue with their habit or to start smoking in the first place. That has resulted in increasing brand segmentation in the tobacco market, and was cheerfully admitted by the companies in written evidence in their recent unsuccessful court challenge against standardised packaging. One of the most important secondary benefits of standardised packaging, over and above the removal of the last permitted form of advertising and marketing of tobacco products, is likely to be the gradual collapse of this approach to marketing. The brand value of a luxury packet of cigarettes is likely to be greatly reduced when it can no longer be highly designed, but instead must consist of drab, olive colours and large photos of diseased lungs and eyeballs. It is likely to mean that future tobacco tax prices are more effective in encouraging smokers to quit, as the different brand values and prices collapse towards a middle price. If we increased tobacco prices above the escalators and ensured that the money was given to public health for prevention and cessation measures, it would be welcome.

Tobacco control policies work best in combination and should not be planned and assessed in isolation. For example, standardised packaging will no doubt encourage many smokers to try to quit, but most quit attempts fail. Smokers who try to quit have a much greater chance of success if they can get help from stop smoking services and a prescription for nicotine replacement products, whether that is patches, gum or electronic cigarettes. That will all help towards people quitting, and so it is extremely disturbing to see the results from Action on Smoking and Health’s latest survey of tobacco control work in local authorities.

ASH asked control experts from 126 local authorities about their smoking policies and budgets. Its evidence shows that funding is being cut back in two out of five areas and that half of all services are being reconfigured or commissioned, which largely seems to be with the intention of saving money, not saving people’s lives and improving their health. I completely understand the need to control public expenditure, and I know that that often requires local authorities around the country to make difficult decisions, but if that leads to closures and reductions in this vital area of public health work, there is definitely a need for some very urgent rethinking.

[Alex Cunningham]

Colleagues in clinical commissioning groups in my area tell me that they would love to spend much more money on preventative services, but they are too busy spending money on treating and curing people to invest in the longer term. Does the hon. Gentleman think there is a case for providing ring-fenced funding for public health and saying, “Let’s spend this great tranche of money now and do the preventative stuff, and get the benefits 20 years down the road”?

[Bob Blackman]

We should remember that when public health was devolved to local authorities, the money was ring-fenced. I pointed out to Ministers at the time that removing that ring fence would put at risk all public health expenditure, which can be squeezed. I think that is precisely what is happening. We are in danger of undoing all the good work that local authorities have done on public health by allowing that to happen. I, too, would welcome a ring-fencing of money for purposes such as this. We can see clearly that this is a particularly good, important service.

I am also concerned about the progressive reductions in the money spent on mass-media campaigns. As has already been mentioned, the money is going down. In 2015 we spent less than a quarter of the amount that was spent in 2009, and it looks like the spending is going to fall again this year. As has been mentioned, the Stoptober campaign is now only going to be online, with no television advertising. The benefit of large-scale television advertising is that it reaches people who are likely to smoke, so we need to look at that again.

Given the appalling damage that the tobacco industry causes, and given that those major companies are vastly profitable, I cannot see why they should not be asked to make a greater financial contribution to help solve the public health disaster that they worked so hard to create. I cannot imagine a more obvious application of the principle that the polluter should pay. I would very much like to see that commitment included in the new, overdue control plan for England.

Colleagues will remember that last December, when we had a Backbench Business debate on this subject, the previous Health Minister, my hon. Friend the Member for Battersea, announced that the tobacco control programme would be published this summer. I know that spring extends as far as November in some Government quarters, but in this case summer seems to be extending into next year. I am seriously worried, because we have reached the autumn and there is no plan in place and no date for publication. The previous plan was an excellent means of combating the appalling diseases, including cancer, pulmonary diseases, vascular diseases and various other things that are caused by smoking. It helped to improve matters and added many years to the lives of thousands of people across the UK.

Some colleagues may think that an intervention in the market is not required, but I think one is needed more than ever before. Since the programme was first published in 1998, the fall in our smoking rates has been similar to that of Canada and Australia, as has been mentioned. In France and Germany, which do not have comprehensive strategies, the rates have hardly changed in 20 years. The evidence shows that these programmes work, and that where there is no programme there is no movement forward.

The UK has an excellent record on tobacco control. The Department of Health was rightly given the prestigious Luther L Terry award last year by the American Cancer Society for its global leadership on the issue, and the UK was ranked as the world’s most successful country on tobacco control by the Association of European Cancer Leagues. We should never forget that two of the biggest tobacco firms in the world, British American Tobacco and Imperial, are based in the UK, along with Gallaher, which is now an important part of Japan Tobacco International. We simply cannot sit back and watch smoking rates fall in the UK while the tobacco industry puts more time and money into increasing consumption in developing countries.

The next conference of parties of the World Health Organisation Framework Convention on Tobacco Control takes place in India in November—next month. We are in an Indian summer, and the tobacco programme will be published in the summer, so what would be better than publishing the plan in advance of the conference in India? That would set the UK, once again, on the world leadership level.

I hope that my hon. Friend the Minister, in her response, will give a firm and early date for publication. I hope that the plan will set ambitious targets to cut heath inequalities, deal with the funding crisis affecting tobacco control work in local authorities and set specific targets to reduce smoking among vulnerable groups, including, as my hon. Friend the Member for Totnes said, pregnant women and people with mental health problems. The targets for the past five years of the programme seemed difficult, but they have all been achieved, so we should set challenging targets now that will lead to a smoke-free Britain. That has got to be our ultimate aim.

I strongly believe that tobacco control is an essential part of policy. It will enable the Prime Minister to achieve her commitments on good government and reducing health inequality. I pay tribute to the work of colleagues from all parties and in both Houses, who pressed the need for tobacco control legislation on sometimes reluctant Governments, which I consider to be one of the most important political and social advances during my time in Parliament. I hope that that work will continue until the death, disease and misery caused by smoking is finally consigned to the past. I look forward to hearing positive news from my hon. Friend the Minister about when we are going to set out the new challenges for the industry and the Department.

Defending Public Services

Bob Blackman Excerpts

Monday 23rd May 2016 Commons Chamber

[Nick Herbert]

My point is that the EU has trade deals with more than 50 other countries, whereas the US has only 14. I thought the narrative was that we want the EU to have more trade deals.

The issue is this: any modern international trade deal will involve some kind of binding arbitration mechanism. My right hon. Friend is clear that he opposes the Canadian free trade deal, but that has been championed by my hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson), who leads the leave campaign, as a model that our country should adopt if we leave the EU. It is also true that the Trans-Pacific Partnership, the North American Free Trade Agreement and even the World Trade Organisation all involve some kind of arbitration panel that takes decisions out of the hands of elected Chambers. If we are to take the position that any trade deal of that kind should be resisted if decisions can no longer be taken by elected Members, none will be acceptable. We would then be in the position of trading without any such arrangements, at potentially enormous cost to our country.

My right hon. Friend the Member for Wokingham spoke with characteristic passion about parliamentary democracy and described this place as a puppet Parliament. I note that none of the Bills in the Gracious Speech that are of interest to me and my constituents are restricted or affected by our membership of the EU. That goes to a central point: we can vote on and discuss much of our legislation and domestic affairs without the encumbrance of the EU. I therefore find it difficult to accept that the 650 Members of the House of Commons are puppets, and that our views and votes on those matters are entirely irrelevant simply because of our membership of the EU. That strikes me as an exaggeration, legitimate though the concern about parliamentary sovereignty might be.

I welcome the proposed prisons and courts reform Bill, having been the author of “Prisons with a Purpose” before the 2010 general election. The document urged the rehabilitation revolution and a transformation of the way in which we run our prisons. The radical reforms proposed by the Government are welcome in respect of reducing reoffending.

A number of measures are of special interest to my constituency of Arundel and South Downs in West Sussex. The neighbourhood planning and infrastructure Bill will address a problem that I spoke about in the House recently. The welcome reform of neighbourhood planning introduced under the Localism Act 2011 empowers local communities to make plans that benefit their local area, but they must not be undermined by speculative developments that call into question the legitimacy of plans that have been voted on democratically in referendums. It would be very welcome if the neighbourhood planning and infrastructure Bill addressed those problems and prevented those speculative development applications. We should remind ourselves that neighbourhood plans have had the effect of producing more and not less housing than was originally intended. Therefore, the proposal will not reduce house building, but will properly empower local communities.

The digital economy Bill is welcome—I am delighted to see my hon. Friend the Minister for Culture and the Digital Economy on the Front Bench. He will know of the concern that many in rural areas have to close the emerging digital divide. We want to ensure that the Government’s welcome proposal to extend superfast broadband throughout the country reaches those in hard-to-find rural areas—they, too, are entitled to fast broadband speeds. That is important for rural employment, but it is also important on the ground of fairness. It will take new means, and I hope the Bill sets out measures that will future-proof broadband provision to ensure that the speeds obtained in those areas meet tomorrow’s as well as today’s needs. Many areas in my constituency currently cannot get broadband at all.

I welcome the education for all Bill and its promise to meet the Conservative party manifesto commitment to a fair funding formula for our schools. West Sussex schools are unfairly disadvantaged in that respect.

I also welcome the modern transport Bill. I should like to refer to two crucial infrastructure issues that affect my constituency. First, on the A27 upgrade, I am delighted that the Government have announced that that major route will be upgraded to include the Arundel bypass and that funding has been provided. I hope the plans continue to timetable, so that work on the bypass begins by the end of the Parliament, as has been set out.

Secondly, the rail service to my constituency is a concern to a large number of hon. Members on both sides of the House. The performance of the Govia Thameslink Railway franchise has simply been unacceptable over the past year, hugely inconveniencing passengers. It must be said that 60% of the delays are the responsibility of Network Rail and result from infrastructure failure. It should also be acknowledged that the Government are embarking on major infrastructure investment, including the £6 billion London Bridge upgrade, which will improve services. Nevertheless, GTR is not meeting the self-set targets in its performance improvement plan. Those targets were low in ambition, but the company is falling below its original performance thresholds set one year ago to improve performance for customers. That failure is exacerbated by the entirely misconceived industrial action of the RMT on driver control of doors. It cannot be a safety issue when drivers rather than guards already control the doors on 40% of Southern services. Industrial action has exacerbated existing problems with the service, meaning a very serious level of disruption for passengers over the past few weeks. This is now causing real anger among my commuting constituents and many others in the area covered by the franchise.

First, there is no justification for the industrial action and it should not continue, and nor should the unofficial industrial action caused by drivers and guards who seem to be suffering from an unusual level of sickness. Secondly, the management of the GTR franchise must recognise that, while the proposed measures to reform how it runs the trains may be justified, its management of the franchise as a whole has been absolutely lamentable. It has brought the Government’s rail policy into disrepute. It is essential that the company and Network Rail are held to account for their poor performance and that they meet their own self-set performance improvement standards.

[Bob Blackman (Harrow East) (Con)]

Does my right hon. Friend think that the licence to operate this service should be taken away and a new supplier found to ensure it is delivered properly and in line with what he would expect?

[Nick Herbert]

My hon. Friend raises a fair point. The ultimate sanction available to the Government for the failure of a franchise to perform effectively is to withdraw it. Indeed, that has been suggested by the Prime Minister. The franchise has only just been awarded. One problem is that the company failed to plan for enough drivers, so for the past year there has been a driver shortage. There has literally been an inadequate number of drivers available for the trains and there is a very long training period. The company assures the Government that it can improve its performance. The Government are reluctant to withdraw the franchise and find themselves in the position of running the railway, but unless the position improves more radical measures will have to be taken to deal with the underperformance of this service. Frankly, it has been simply appalling. It is unacceptable for the rail-travelling public in this area. It is time that both Network Rail and Southern recognise that it is no longer acceptable to deliver a low-standard performance of this kind.

--- Later in debate ---

[Bob Blackman (Harrow East) (Con)]

It is a pleasure to follow the hon. Member for Washington and Sunderland West (Mrs Hodgson). I also place on the record my appreciation of the memorable maiden speech of the hon. Member for Sheffield, Brightside and Hillsborough (Gill Furniss). The connection between those two hon. Members is that I look forward to visiting their football teams next season and not having to suffer attending St James’ Park.

The Queen’s Speech contained some 21 Bills. I do not intend to refer to all of them in the time available to me, but I want to mention some and to express my views about some that appear to be missing. It is almost de rigueur to discuss the EU referendum in our speeches, and I look forward to the Government needing to bring forward legislation to disentangle us from the European Union once we, the British people, have set ourselves on to the path of freedom and democracy.

As for today’s debate, I particularly want to talk about the national health service and not only some of the key issues contained in the Queen’s Speech, but some things that do not require legislation. The Bill to ensure that people who do not pay taxes in this country have to pay their way when using the NHS should be welcomed across the House. We all recognise that the NHS requires additional funding and needs resources, but it is a national health service that the people who live, work and play in this country rely on for their health; it is not an international health service to treat the rest of the world. I hope that that Bill will receive support right across the House, including from the Opposition.

I congratulate the Health Secretary on achieving an end to the negotiations with junior doctors that paves the way for a proper seven-day NHS. I went looking around my constituency at the weekend on behalf of constituents who want a weekend GP service, but no GP surgeries were open at all. That is the reality. GPs widely advertise as being open Monday to Friday, but no GP service is available in my constituency on a Saturday or a Sunday. If someone is ill or needs medical treatment, there is no choice but to attend A&E, leading to increased pressure on the emergency services. Equally, it is important that the Health Secretary negotiates terms with GPs that ensure that a service is available for people needing routine medical procedures at the times of day and on the days of the week when people want the service to be provided and not just when it is convenient for GPs.

The NHS’s cumbersome investment decision-making process must also be disentangled. The Royal National Orthopaedic hospital, which I am proud to champion, has been making a case for its rebuilding for some 30 years. Six years ago, we received confirmation from the coalition Government that money was available to do exactly that. However, despite draft outline business case after draft outline business case and so on, we are still waiting, six years on, for the business case to be signed off. It is ridiculous in this day and age that our NHS is spending more money on management consultants to make decisions than on consultants to deliver medical treatment. I hope that our health team can resolve the problem without the need for legislation by ensuring that we cut through red tape and enable decisions to be made—a business-like approach to running the NHS without introducing any form of privatisation whatsoever.

I warmly welcome the proposed sugar tax, because it is a great means of driving behaviour. For most people, the sugar content of many drinks is masked, which is clearly unhealthy for people of all ages, young people in particular. The change is a sign of the way things are going. Something that seemed to pass without too much celebration last week was that we finally got clearance to introduce standardised packaging of tobacco products when the court case brought by the tobacco companies collapsed in the High Court. That is good news. I was also pleased by Axa’s decision to remove the £1.7 billion of its policyholders’ money that was invested in the tobacco industry. It quite rightly said that investing in tobacco products was destroying its customers’ health and it then had to pay out on insurance claims to support those customers. That shows the way things are going. I hope that the Chancellor will consider not only the sugar tax, but a levy on tobacco companies through increasing the cost of a packet of 20 and then ensuring that all the money raised goes directly to funding local health initiatives to stop people smoking and to prevent them from starting.

I also welcome the digital economy Bill. For the unaware, I had the honour of working for BT for 19 years before being elected to this House. Back then, I promoted the idea of BT having a universal service obligation to provide superfast broadband. In fact, broadband full stop would be a start, and speed could be increased thereafter. My constituency is on the edge of London, yet it has a series of housing estates, built more than 20 years ago, in which it is impossible to get broadband—that is outrageous. We have people who work in the City of London, in very responsible jobs, who would like to work from home but are unable to do so because BT fails to provide broadband of a reasonable speed. In this day and age, it is outrageous that they should be deprived of that fundamental service, on which we all rely. As we ask more and more people to work from home, so that they do not congest the roads and do not have to travel to an office to do their work, they should have the facilities to be able to work from home, if they so wish. I look forward to that becoming more and more a focus of attention for the Government.

I also welcome the neighbourhood planning Bill. As hon. Members on both sides of the House have said, we need to build more houses in this country for people to live in. I strongly supported the Bill that became the Housing and Planning Act 2016, which creates the environment in which houses can be built. The neighbourhood planning Bill clears up the issue and prevents the process whereby plans are clogged up and development is prevented from taking place. We should set out our plan, and I support the Government’s plan to generate more and more housing for younger people to be able to purchase and so get their foot on the ladder of property ownership.

One of the most fundamental local services is refuse collection. Although localism is welcome, it cannot be appropriate that, right across London, and probably across the country, people who move, probably every six months, because of private rental arrangements suddenly find that the refuse collection systems and the colours of the bins are totally different depending on the borough. They are therefore totally confused as to what should happen. As a fundamental service to people, we should seek to ensure that we have a sensible waste-collection service in this country; we should sort out who pays for it and how it is collected. At the moment, it is one area where local decisions can be made but clearly there are vast differences in the quality of services being provided.

I am also pleased that the education Bill will be coming forward, and I am glad that the Government have wisely dropped their decision to force schools to become academies. I welcome academies being created, but forcing schools to do that would be the wrong thing to do. Finally, I will just mention the counter-extremism and safeguarding Bill, in the short time I have left. I have—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Unfortunately, that short time ran out.

Junior Doctors Contract

Bob Blackman Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

I understand the concern. The short answer is that we need to increase the NHS workforce, which we are doing. We will see more doctors going into training during this Parliament, as indeed we did during the previous Parliament. More doctors in the workforce will be an important part of the solution.

[Bob Blackman (Harrow East) (Con)]

It appears that at the start of the recent negotiations the payment for Saturday working was the main sticking point for the BMA, but now the issue of weekend pay has been resolved. Will my right hon. Friend confirm that, now, the doctors who work extended hours over the weekend can get extra pay, and patients can get the seven-days-a-week NHS we all want?

[Mr Hunt]

My hon. Friend is absolutely right. This is not just a safer deal for patients, but a system that is much fairer for doctors than the current one. We are giving a pay rise of between 10% and 11%, for which we say that people are expected to work one weekend day a month, but doctors who work more than that get more, and it goes up, so more weekends worked means more extra pay. I think that is one of the reasons why the BMA was prepared to sign up to the agreement: it values the people who give up the most weekends.

Oral Answers to Questions

Bob Blackman Excerpts

Tuesday 10th May 2016 Commons Chamber

[Alistair Burt]

I thank the right hon. Gentleman for all the work he did in relation to this. I can assure him that the £1.25 billion committed in the 2015 Budget will be available during the course of this Parliament. As I said to the hon. Member for Liverpool, Wavertree (Luciana Berger), it is absolutely essential to me and to us that we make sure that that money does get through to CCGs. The regime will be more transparent, but there will be a determination to expose it to make sure that the money is spent on child and adolescent mental health services, as it needs to be.

[Bob Blackman (Harrow East) (Con)]

My right hon. Friend will be well aware that the business case for the rebuilding of the Royal National Orthopaedic Hospital has been dragging on within the NHS for more than six years. We now seem to have a decision for the Trust Development Authority to make. Will he put pressure on the TDA to approve this business case so that work can begin this summer?

[Mr Jeremy Hunt]

As my hon. Friend knows, I have done a shift as a porter in that hospital and seen for myself just how much it needs the extra investment to transform its facilities. I will happily look into the matter for him, and I am keen to see it progress as fast as possible.

Junior Doctors Contracts

Bob Blackman Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

I totally agree with that. That is why, since then, junior doctors’ hours have been reduced, and under the new contract we are reducing yet again the maximum hours that junior doctors can be asked to work. Every doctor should welcome the new agreement, but because, unfortunately, the BMA has not chosen to negotiate sensibly despite exhaustive efforts, we are left with the very difficult decision as to whether we proceed with our plans for a seven-day NHS or whether we give up. I think that elected Governments should never give up on manifesto promises.

[Bob Blackman (Harrow East) (Con)]

Junior doctors went into medicine to save lives, not to place them at risk. Does my right hon. Friend agree that by striking, junior doctors are putting people at risk? Can he confirm what the position would be if he had allowed contracts to lapse, and what the effect would be on the national health service?

[Mr Hunt]

I agree that the strikes are putting patients at risk. I think that what my hon. Friend means by the second part of his question is: what would have happened if we had just allowed the current contracts to roll over? The answer is that we would not have made progress towards a safer seven-day NHS, which will be of enormous benefit to his constituents and mine.

NHS in London

Bob Blackman Excerpts

Thursday 24th March 2016 Westminster Hall

[Dr Huq]

Yes, I certainly do. I do not know the St Helier hospital well, but I believe it is renowned as a teaching hospital. The business plans must account for such things; there is often too much short-termism.

The implementation of the closures listed is well under way. The A&E departments at Central Middlesex and Hammersmith shut their doors in September 2014, despite assurances from the Conservative party during the 2010 general election campaign that that would not happen. The closures have negatively affected waiting times at Northwick Park hospital in Harrow. That hospital is a considerable distance away from a lot of my constituents; as the crow flies, it is pretty far from East Acton to Harrow. I do not like to churn out loads of statistics, but Northwick Park does have the dubious distinction of the worst A&E waiting times on record in England—

[Bob Blackman (Harrow East) (Con)]

Will the hon. Lady give way?

[Dr Huq]

May I just finish this sentence? The partial sentence might not make as much sense as if I am allowed to complete it. In six out of the 15 weeks that immediately followed the closure, Northwick Park had the worst record in the country. There were anecdotal stories of ambulances backing up at that hospital.

[Bob Blackman]

I congratulate the hon. Lady on securing this debate, but we must get to the facts of the matter, particularly when we refer to specific hospitals, their standards of performance and what they are achieving. It is true that before the opening of the new A&E at Northwick Park hospital, it had the worst record in London and one of the worst in the country, but since the new A&E opened in November 2014, it has had the best record in London and one of the best in the country.

[Dr Huq]

There is a target of 95% of patients being seen within four hours. Immediately following the closure, at that hospital the proportion was 53%. We should not just brush that away.

[Bob Blackman]

Will the hon. Lady give way?

[Dr Huq]

I have already given way to the hon. Gentleman once. I want to finish because a lot of Members want to speak, so I shall crack on for the moment. We should not just brush these things under the carpet and say that they did not happen.

The Independent Healthcare Commission for North West London was set up because of the public distrust of the “Shaping a Healthier Future” programme, known among locals as “Shafting a Healthier Future” because it does not do what it says on the tin. One reason why it was further discredited by the Mansfield commission is that it was based on demographic forecasts from 2012 that massively underestimated the population in north-west London, which has increased at a much faster rate than was foreseen. Perhaps the Minister can clarify this, but there has been no clear indication that the programme has been adjusted to take account of those demographic changes.

Reforms have to make sense economically as well as clinically. Last week, we heard in the Budget about the continuing drive to control expenditure, but this ill-advised reorganisation seems to have been given a blank cheque. The Mansfield report states:

“There is no completed, up-to-date business plan in place that sets out the case for delivering the Shaping a Healthier Future…programme”.

There is nothing that demonstrates that the programme is affordable or deliverable, so serious question marks remain regarding its value for money. We are told that we are living in a time when every pound of taxpayers’ money spent has to be justified. Initially, the programme was supposed to deliver £1 billion of savings and cost £235 million, but the costs are ballooning. So far, there has been £1.3 billion of capital investment. Lots of that money has gone to external consultants such as McKinsey and on people’s jollies to America to see how it works there—quite a scary idea. The independent commission concluded that the likely return on the investment is insufficient, based on the strength of the existing evidence.

On the subject of finance, The Independent reported last year that London North West Healthcare NHS Trust warned its staff to limit their use of stationery and stamps, as it is aiming for a £88.3 million deficit this year, and it might miss even that target. Some 95% of NHS acute trusts, which run hospitals, were in deficit in the second quarter of this financial year. The hospital sector is heading for an overall £2.2 billion deficit this year. My hon. Friend the Member for Lewisham East (Heidi Alexander) has warned that the £3.8 billion of extra funding for the NHS next year that was promised in the spending review is going to get lost in the black hole that has emerged in NHS finances; it will be swallowed up in all that debt.

I am a new MP, but since my election I have seen the maternity unit at Ealing hospital join the list of closed departments. That was one of the “Shaping a Healthier Future” recommendations.

--- Later in debate ---

[Bob Blackman (Harrow East) (Con)]

It is an honour to serve under your chairmanship, Mr Turner. I congratulate the hon. Member for Ealing Central and Acton (Dr Huq) on securing the debate on London’s NHS. The subject is vital to people not just in London but nationally and internationally because we provide a health service for not just people resident in London but those who work in London and those who come to London for specialist treatment. I apologise that I may not be here for the winding-up speeches; I must attend the debate in the Chamber where I am the lead speaker. My apologies if I have to scuttle off before other contributions.

I want to speak about three issues in my contribution: primary care; the position at Northwick Park hospital; and the Royal National Orthopaedic hospital. In terms of primary care, without doubt, one problem we experience in London is that people have difficulty getting on to a list for a GP and then getting appointments when they are ill. As a result, when a person is ill, they immediately say, “Well, if I can’t get an appointment with my GP, I will go to A&E or the urgent care centre or whatever facilities are around.” That means that people turn up at A&E and at urgent care centres who should be seen by GPs or even by nurses at GP surgeries—they do not necessarily need to be seen by doctors.

We all have anecdotes we can share, but at the health centre to which I go the GP appointments system is now such that people can only register for appointments 48 hours in advance—it is always quite difficult to know whether one will be ill in 48 hours—or walk in and wait; however, how long will it take to be seen after all the appointments? That leads to a challenge. Immediately, people say, “I’m not going to do that, because I can turn up at A&E or the urgent care centre and make sure I am seen.” Therefore, the all-party parliamentary group on primary care and public health, which I co-chair, has pointed to the need for better signposting in the national health service to point patients to the right place and to ensure that primary care in particular can provide care for those who need it.

I will move on to Northwick Park hospital. As I said in my intervention on the hon. Member for Ealing Central and Acton, who led the debate, its A&E performance was truly dreadful. I can speak from personal experience: I waited in A&E for some eight hours before I was seen on an urgent care basis and received medical intervention. It was a disgrace. People were waiting for far too long and never, ever were the targets achieved. However, in November 2014, the Government invested in the new A&E at Northwick Park hospital and since then there has been a complete transformation.

One of the problems we had with Central Middlesex hospital having an A&E was that its brilliant doctors and nurses were sitting around, waiting for patients to arrive; patients would go to the A&E at Northwick Park because it was nearer and more convenient. The consequence of the A&E at Central Middlesex closing and those doctors and nurses transferring to Northwick Park was that performance transformed overnight.

I have the latest figures. When we talk about stats, we should talk about what is going on now in reality, not what happened in the past. At Northwick Park, in January, 89% of patients were seen within four hours and—[Interruption.] I accept that the target has not been reached, but the key issue is that that is far from the dramatic underperformance that the hon. Lady described. The reality is that 90.3% of patients were waiting less than 18 weeks to start treatment at the end of January, and we all accept that January is probably the hardest month for the NHS because of difficulty with the cold weather.

Cancer waiting times are a vital aspect, and Northwick Park hospital meets the targets: 94.1% of patients with suspected cancer were seen by a specialist within two weeks. I would much rather see that figure at 100%, but that is above the target of 93%. Of patients diagnosed with cancer, 99.2% began treatment within 31 days—the target is 96%, so that is an outstanding performance. Finally, 86% of patients began cancer treatment within 62 days of an urgent GP referral; the target is 85%. It is therefore fair to say that Northwick Park hospital—it is not in my constituency but virtually all my constituents use it—has transformed itself under this Conservative Administration. It is important to get the facts on the record, so that people can congratulate the health providers, who are delivering an excellent service. Of course, there are always challenges. We know there is a deficit, but the key is that Northwick Park hospital’s funding from the CCG will see a 6.01% increase this year. That is a good performance; we can see that money is being invested.

Just before the 2010 election, when I was elected for the first time, under the previous Labour Government, there was a review of accident and emergency services in north-west London. We heard not a squeak from Labour MPs about the fact that as part of that review they wanted to close down five of the A&Es in north-west London. [Interruption.] Oh yes. The incoming Health Secretary said, “We are going to stop that review in its tracks, and any review of A&E services will be clinically led, not driven by particular elements or arguments.” The reality is that this is nothing new; this is being driven by the NHS and the NHS bureaucracy. That is what I want to move on to finally.

[Andy Slaughter]

The hon. Gentleman needs to substantiate both elements of what he just said. To go back 10 years to try to defend the current crisis in the NHS in his constituency is a bit unnecessary. The fact is that promises were made by his party about specific hospitals as well as about A&E generally and it has gone back on almost every single one of those. A little less hubris from him would be appropriate.

--- Later in debate ---

[Bob Blackman]

I am going back not 10 years but to 2009 when a report was produced under the previous Labour Administration that would have decimated us in north-west London in terms of A&E. The incoming Health Secretary froze that and said, “No, we’re not going to implement this. We want a clinically led review of what provision should be provided.” In certain instances, it is clear that some of those areas have been led in that way. I am going to talk about Northwick Park hospital because through better investment and better provision it has been transformed and it treats people better.

[Dr Huq]

Will the hon. Gentleman give way?

[Bob Blackman]

I will give way briefly to the hon. Lady, who made a very long oration.

[Dr Huq]

The hon. Gentleman will know that the most recent Care Quality Commission report on Northwick Park hospital says that it requires improvement. Several shortcomings were found. Does he appreciate why Northwick Park strikes fear into the hearts of many of my constituents?

[Bob Blackman]

I will come on to a CQC report on the Royal National Orthopaedic hospital in my constituency in a minute. The reality is we can pick and choose from CQC reports, but I want to ensure that the brilliant doctors, nurses and support staff who work in Northwick Park hospital are recognised for the work they do and not the fear, uncertainty and doubt created by Opposition Members about the performance of an outstanding hospital.

I will move on to the Royal National Orthopaedic hospital in my constituency. The Minister knows about this subject extremely well. The reality is shown in the most recent CQC report, which I will quote directly. It said that the hospital has

“Outstanding clinical outcomes for patients”

in premises that were—and are—

“not fit for purpose—it does not provide an adequate environment to care and treat patients.”

I could not have put it better myself. The reality is that, over the past 30 years, under Governments of all persuasions, we have heard promises to rebuild the Royal National Orthopaedic hospital. The medical and support staff there do a brilliant job; if I took you to that hospital, Mr Turner, you would see for yourself. They are treating patients in Nissen huts created during the second world war. It is an absolute disgrace that staff have to operate in such dreadful facilities. They do brilliant work to rehabilitate patients who come in crippled and leave much better able to live a decent-quality life.

That is why I am concerned about national health service bureaucracy. Previous Governments have committed to funding. The Chancellor stood up at the Dispatch Box during the emergency Budget in June 2010 and agreed and confirmed funding to rebuild the hospital. None the less, we still drag on. It is nothing to do with the Government; it is NHS bureaucracy. I will not go through all the details of everything we and the board have had to do to get to the point where the hospital can be rebuilt.

We have a plan. The hospital will be completely rebuilt. We will have a private hospital alongside the NHS hospital, so that consultants and medical staff will not have to leave the site to do their excellent work. We will sell off part of the land for much-needed housing. Instead of selling it off as a job lot, we will sell it off in tranches to ensure that we get the best value for money, and then the money can be reinvested in the national health service, in the hospital itself.

One would think that, if someone came up with a plan like that, the NHS bureaucracy would be leaping to say, “Yes, let’s get on with it.” Instead, we have had report after report, and business case after business case. I will not, as I did once in the Chamber, describe the 11 stages of the business case that a hospital must go through to get approval for finance. More money is spent on management consultants producing reports than on hospital consultants delivering health services.

[Heidi Alexander (Lewisham East) (Lab)]

I think I agree with the hon. Gentleman on that last point. In last week’s Budget, the Government shifted more than £1 billion within the NHS from the capital budget to the revenue budget. How does he think that helps deliver the kinds of building that we need to provide health services in the 21st century?

[Bob Blackman]

Clearly, the Government must balance the capital and revenue budgets and ensure that they and the national health service are fit for purpose. I believe passionately that it is wrong to expect our medical professionals and brilliant staff across the health service to operate out of substandard buildings. The more that we do to improve them, the better.

As the Minister will know, I have been agitating on this issue for the past six years. I will not stop until we get what we deserve—a rebuilt hospital of which we can all be proud. The reality is that the NHS Trust Development Authority, which seems to dictate finances within the national health service, is holding up this prestigious project. The hospital now has planning permission, and we are ready to go. Immediately on approval by the TDA, demolition of the existing buildings will start, and work will begin on the new hospital in June or July this year. However, the TDA has yet to approve. We now have a further eight-week delay while the TDA looks again at the business case to see whether it is justified. The staff, patients and everyone connected with the hospital are growing frustrated as a result of what has happened over not just the past six years but the 30-odd years before it as well.

We seek assurances from the Minister that the prevaricating TDA will be leaned on to give a decision, which will be to the benefit of the hospital, the patients and the health service in London and nationally, so that we can ensure that this brilliant hospital continues with its great work. I apologise that I will not necessarily be here to hear the Minister confirm the good news that she will do all that she can to make that happen, but I will sit down—

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

On that specific point, as I am conscious that my hon. Friend might not be back, my noble Friend Lord Prior in the other place took a debate on this topic this week and undertook to set up a meeting with the NHS Institute for Innovation and Improvement and interested peers should there be any slippage in the timetable set out today by NHSI for approval of this important project. I know that that invitation will be extended to my hon. Friend as well, to give him a little assurance on that.

[Mr Andrew Turner (in the Chair)]

I call the Minister—no, Mr Blackman.

[Bob Blackman]

Mr Turner, if I were the Minister, I would be ensuring that it was delivered, but that is another issue. I welcome the Minister’s remarks. Clearly, people will be watching and waiting. As she said, there was a debate in the other place only last week, and we had a good, positive answer during oral questions this week, assuring us that it is a key project for the health service. All those who are waiting with their pens poised could give us an Easter present of which we can all be proud on Maundy Thursday by signing off the business case, letting us get on with the project and ensuring that it is delivered for the benefit of all.

Junior Doctors: Industrial Action

Bob Blackman Excerpts

Thursday 24th March 2016 Commons Chamber

[Ben Gummer]

This is what the Liberal Democrats have come to: quoting the books of their own losing candidates—a very odd situation. I think it sad for the right hon. Gentleman to come to this House not having read Sir David Dalton’s letter, which refutes every single one of the points he quoted at the beginning of his question. The fact is that the contract will be fairer and safer—better for patients and better for doctors.

[Bob Blackman (Harrow East) (Con)]

Does my hon. Friend share the frustrations of a former Health Minister, namely Nye Bevan? The BMA battled against him when he was trying to set up the NHS, leading him to state in this place that it was not his fault he could not agree with the BMA as the Government had never appointed a Minister who could agree with the BMA.

[Ben Gummer]

Reading Bevan’s remarks from 1948, as from 1946, are a revelation. There is so much truth in them. The fact is that there are parts of the BMA that want to come to a good and constructive deal with the Government. The general practitioners have just done so. It is just very sad that this once-respected trade union is being dragged to this position by the junior doctors committee. It is doing great damage to the reputation of the BMA, and, in allying themselves to that part of the BMA, great damage to the reputation of the Labour party.

Tobacco Control Strategy

Bob Blackman Excerpts

Thursday 17th December 2015 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

It is an honour and a pleasure to serve under your chairmanship, Mr Betts, as I do weekly on the Select Committee on Communities and Local Government. It is also a pleasure to follow the right hon. Member for Rother Valley (Kevin Barron), who has almost a lifetime of experience of dealing with the tobacco industry and ensuring that the country wakes up to the fact that tobacco and the products that the tobacco industry produces will, if they are used in the way that is intended, kill us. They are the only legal product that will achieve that. I declare an interest in that I speak as the chair of the all-party group on smoking and health. I thank the vast plethora of organisations that have contributed to the debate by supplying me with facts, figures and determinations.

I remember in September 2013, on the first Tuesday back after the long summer recess, we held a debate in this place on standardised packaging for tobacco products. The predecessor of the Minister for Public Health was in post, and some 22 Members contributed to the debate. The Government’s position was that they would not introduce standardised packaging, and the Opposition’s view was that it would be the wrong thing to do. Less than two years later, however, it has come to pass. Government policy changed quite radically as a result of pressure from MPs on both sides of the House. I pay tribute to the work that has been done over many years on tobacco control. The key point is that we must continue to bear down on smoking prevalence, so that we see a reduction year on year.

High taxes on tobacco, to prevent people from starting smoking, are part and parcel of that strategy, which has continued for the past 25 years on a progressive and comprehensive basis. Action on stopping smuggling was started in 2000. We are the only country in the world to have smoking cessation services available free at the point of delivery to smokers. We were the first to introduce them, and we are the only country that has continued with them. I think we should be proud of that. We have been at the forefront when it comes to comprehensive laws prohibiting advertising, promotion and sponsorship by the tobacco industry of our sports and activities.

Over the lifetime of the current tobacco control plan, a substantial amount has been achieved, such as the prohibition of point-of-sale tobacco displays in large shops from April 2012 and in small shops from April of this year, and the ending of smoking in cars carrying children. That measure was introduced in the last Parliament, carried through at the behest of Back-Bench MPs and implemented with Government support. Some of the action is still to be implemented, including the introduction of standardised packaging for tobacco products. That, as the Minister is no doubt aware, is the subject of attacks in the courts by the tobacco industry, but it should come into place in May next year. The new tobacco products directive and the illicit trade protocol will also come into effect later next year.

The new measures together have been very effective in driving down the prevalence of smoking. For the first time since records began, fewer than one in five members of the adult population smokes, and we are seen as a world leader in tackling tobacco. Our leadership has been acknowledged internationally since 2007, and the UK has received the highest score and the top ranking in Europe from the European Cancer Leagues. This year, the Department of Health received the prestigious triennial Luther Terry award from the American Cancer Society. I know that the Minister was pleased to receive that award, and we must congratulate her and the Department of Health on it. We were only the second country in the world to pass legislation to implement standardised packaging for tobacco products. The legislation is being challenged in the courts, but we feel sure that the Government will win that challenge, as they have done in many other cases, including on smoke-free laws, advertising and point-of-sale displays.

Having said that, we must recognise that there is a lot more to be done. Almost one in five adults still smokes, and smoking remains the single biggest cause of preventable deaths and premature death. As we have heard, smoking kills almost 80,000 people in England every year. In London alone, more than 8,000 people die prematurely from tobacco-related diseases, and more than 51,000 hospital admissions can be attributed directly to smoking.

Smoking is the leading cause of inequality, and it is responsible for half the difference in life expectancy between the rich and the poor. As a general rule, those who experience disadvantage have smoking rates higher than those of the general population, and that fuels cycles of deprivation. We have heard that nearly eight out of 10 prisoners smoke, and that people who are homeless smoke. Rates of smoking are also much greater among those who live with a long-term condition, such as asthma or diabetes. That, in turn, has an impact on the national health service. We know that health interventions are less successful for smokers than for non-smokers, and non-smokers tend to have much shorter hospital stays and fewer complications as a result.

In my constituency, Harrow East, which is within the London Borough of Harrow, 13.1% of people still smoke. That equates to 24,855 people who still smoke. That is lower than the national average, but in Harrow 209 people still die from smoking-related diseases every year, 1,410 hospital admissions a year are caused by smoking and 80 people die from lung cancer each year. We know that 90% of lung cancer is attributable directly to smoking. Every year, 55 people in Harrow die from chronic obstructive pulmonary disease, which is also known as emphysema, and 60% of those deaths are caused by smoking. Although smoking rates have fallen significantly among children, from 10% in the early 2000s to just 3% last year, we must not become complacent. It has been estimated that 207,000 children—11 to 15-year-olds—start smoking every year. In Harrow, that is 551 young people starting smoking every year.

Government and public sector action to cut smoking rates is still, clearly, necessary. As such, I was delighted to hear the Minister announce earlier in the year that there will be a new tobacco control plan. The current plan runs out in just two weeks, at the end of the month, so we look forward to hearing from the Minister when the new strategy will be in place. For the new strategy to be successful, it needs to be properly funded. In July this year, the Chancellor announced an in-year cut to public health funding of £200 million, which amounts to some 6.2% of the total budget. That has been compounded by further cuts of 3.9% each year to 2021, which were announced in the Treasury’s spending review. That, according to Public Health England, translates into a further cash reduction of 9.6%, in addition to the £200 million of savings this year alone. Those cuts are already having an impact on local authority spending. I am very disappointed that the local authority where my constituency sits is cutting its public health funding by 60% over the next three years. That has had a severe impact on the stop smoking services, for which funding is being cut from £299,000 in the current financial year to just £20,000 in 2017-18. My local authority is not the only one making such reductions and that is deeply concerning because there may be a return to young people starting to smoke and fewer adults taking the opportunity to give up.

According to the National Institute for Health and Care Excellence, stop smoking services are some of the most cost-effective healthcare interventions—far more cost-effective than the drugs needed to treat smoking-related diseases when they start to develop. Stop smoking services are considerably cheaper than treating long-term conditions caused by smoking, such as lung cancer and coronary heart disease. There is considerably stronger evidence for the effectiveness of stop smoking services compared with many prevention interventions such as, for example, NHS health checks.

What is more, smokers are four times more likely to quit successfully with the combination of behavioural support and medication provided by services compared with unsupported quit attempts. In the previous financial year, more than 450,000 people set a quit date with stop smoking services in England and 51% had successfully quit after four weeks. Those figures include nearly 19,000 pregnant smokers, 47% of whom successfully quit. I was pleased to see in the official statistics released yesterday that the Government have reduced their ambition to cut smoking in pregnancy to 11%. If support available to those women is cut, it raises the question of whether such achievements can be sustained and built on in the future.

Services play an important role in reducing health inequalities. Poorer smokers, who find it more difficult to quit as they tend to be more heavily addicted, are more likely to be successful with the support of those services. More people from routine and manual groups use the stop smoking services than any other socio-economic group and, as such, the services can help reduce health inequalities. They also help to prevent the uptake of smoking among children, although assisting adults to quit is their most important element. Children growing up with both parents who smoke are three times more likely to start smoking compared with children whose parents do not smoke. The cuts to public health funding, which I referred to, have been described, unsurprisingly, by the King’s Fund as the “falsest of false economies”. The reductions do not only affect my constituency, but people all over the country. For example, Manchester City Council, which is part of the new devolution deal, has already announced that it will not fund such services in 2015-16, and there are numerous reports of planned reductions in other local authorities—and that was before the announcement of further reductions in the spending review.

As well as reductions in budgets, a great deal of change is taking place in local services, and it is not clear that new approaches are properly evidence-based. A recent survey conducted by ASH for Cancer Research UK found that more than half the respondents—53%—described some form of restructuring of local smoking cessation services. One in five described a shift to an integrated approach, in which smoking cessation is delivered as part of a wider lifestyle package, including, for example, measures to tackle obesity and reduce the harm of alcohol. This has meant the loss of important specialist support.

The changes taking place within services raise questions about their efficacy and outcomes. In particular, the shift to integrated services or lifestyle choices has limited support from the evidence base. An authoritative Cochrane review did not find a significant effect in reducing smoking from those interventions. Will the Minister tell us what steps the Government will take to ensure that smokers continue to have universal access to stop smoking services that meet NICE standards and are free at the point of delivery?

Given the pressure on local budgets, and reductions to funding for local authorities, it is crucial that the NHS picks up the baton and does more to support reductions in smoking prevalence. Not only will this support local authorities, but it is essential for the viability of the NHS and the long-term impact that taking no action against smoking would have.

The NHS five-year forward view rightly states:

“The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

The forward view also notes that this has long been a policy objective, stating:

“Twelve years ago, Derek Wanless’ health review warned that unless the country took prevention seriously we would be faced with a sharply rising burden of avoidable illness. That warning has not been heeded—and the NHS is on the hook for the consequences.”

It is important to note that even after additional Government funding of the NHS, there is still an estimated potential shortfall of £22 billion by 2020. That is likely to be closed through some efficiency savings, but there will still be a funding gap, which will have to be met through reductions in services, longer waits for treatment or reductions in demand for NHS services. Clearly, the latter possibility requires a much more sustained effort to improve public health and to tackle the major causes of illnesses, particularly smoking, but we have seen a reduction in NHS activity to tackle smoking over the last few years.

The number of GPs recommending that smokers quit and directing them to further support has declined markedly. In addition, services to support people to quit smoking in secondary care—already far from universal—are also under threat. For example, the reductions in specialist stop smoking services in Manchester have resulted in the end of funding for smoking cessation services at the city’s world famous cancer hospital, the Christie. The service will now only continue through charitable funding made available by the hospital.

Smoking places a significant burden on the NHS. Getting smokers to quit can prevent diseases from developing but there is also great value in supporting smokers who are already sick to quit. Many diseases are improved if a person quits. For conditions such as cardiovascular disease, smoking can be a major risk factor in further illness or exacerbation. For people who have developed cancers, including lung cancer, quitting improves the effectiveness of treatments, the likelihood of successfully treating the cancer and five-year survival rates. Even when smokers have an illness that is not related to smoking, quitting can improve the outcome of their treatments. Those who have quit have much better surgical outcomes and reduced recovery times in hospital.

About 1,260 hospital admissions a day in England are due to smoking—amounting to one in 20 of all admissions. It is estimated that smoking costs the NHS in England around £2 billion a year. In the local authority where my constituency sits, the NHS spends about £6 million on treating smoking-related diseases every year. Reducing the number of people who smoke delivers immediate as well as long-term savings to the NHS. Evidence suggests that if we could increase the rate at which smoking is declining by an additional further 0.5 percentage points a year above the current rate of decline—0.66 percentage points—the NHS could save at least £117 million a year by 2020. That estimate does not include the contribution that reducing smoking makes to conditions that are made worse but are not caused by smoking, such as diabetes.

In short, helping patients to quit smoking should be a core part of NHS business as a means to save lives, reduce costs and improve outcomes. What steps are the Government taking to ensure that the NHS does more to help smokers to quit in line with the implementation of the five-year forward view? To ensure that the radical upgrade in prevention and public health called for in the NHS five-year forward view is achieved, our tobacco control strategy needs to be properly funded. We know that tobacco remains the primary cause of preventable and premature death in this country. Despite that, we have already seen mixed services cut, and the impact of such disinvestment is only beginning to be seen. If we are to continue driving down smoking rates and ensuring that people do not die early from smoking having suffered years of disability, we need an ambitious and comprehensive strategy and to ensure that such a strategy is properly and sustainably funded.

We have already heard that public health and stop smoking services budgets are declining. We must conclude that that effect is likely to continue and is likely to be long term. There is clear evidence that reductions in public spending on tobacco control, together with less emphasis on new policies and on enforcement of existing policies, are likely to slow, halt or even reverse the long-term reduction in smoking prevalence rates. In New York, for example, sustained investment from 2002 led to a decline in smoking rates until 2010, when the decline ceased following funding reductions. Investment was reinstated in 2014, and the rates of smoking cessation began to improve again.

An early indicator of the effect of both national and local spending reductions on tobacco control is given by the smoking toolkit produced by Professor Robert West of University College London. The results for 2015 show a small increase in smoking prevalence over 2014, a fall in the proportion of smokers who made an attempt to quit—from 37.3% in 2014 to 32.4% in 2015—and a lower success rate for quit attempts, from 19.1% in 2014 to only 17% this year.

Clearly, the tobacco industry needs to fund the control of tobacco. As we have heard, the gains we have made run the risk of being reversed, so funding for tobacco control is a good investment by the Government. In advance of the spending review, the all-party group that I chair published a proposal to fund tobacco control with an extra £100 million a year to reduce smoking, combined with a 5% tax escalator on tobacco, which could deliver more than £11 for every £1 invested in the NHS. As we have already heard, spending on tobacco control is extremely cost-effective, but national and local resources for tobacco control and stop smoking services are far from secure, so the Government need to find an alternative, sustainable source of funding.

The report published earlier this year, “Smoking Still Kills”, was endorsed by more than 129 public health organisations and recommended the introduction of a new annual levy on tobacco companies to help fund evidence-based tobacco control and stop smoking services in England. In the United States, the principle of charging the industry for the specific costs imposed on the public purse is well established. In the US, the costs of the levy are apportioned to tobacco companies according to their market share in the country. That concept has received broad-based support in Congress because it is understood to be a charge related to a specific cost, rather than general taxation.

The Chancellor said in 2014:

“Smoking imposes costs on society, and the government believes it is therefore fair to ask the tobacco industry to make a greater contribution.”

His decision not to proceed with a levy on the industry in the 2015 Budget was disappointing. Rather, in the 2015 autumn statement, he suggested that future funding for local public health delivery could be met by returning business rates to local authorities. However, one of the primary purposes of public health interventions is to improve ill health and address inequalities. There is a fundamental flaw in his proposal because richer areas, which have higher business rates, have lower rates of smoking than poorer areas with lower yields from business rates.

Applying that principle, the Local Government Chronicle has highlighted that there will be clear winners and losers from returning the national share of business rates to local authorities. The five areas outside London that are the biggest winners from the proposal have an average smoking rate of 16%, whereas the five biggest losers have an average smoking rate of 20%. In Harrow, 138% of the national share of business rates would need to be returned to the council in order for it not to lose out if the revenue support grant is ended and the council instead has to rely on business rates. If that were to happen, Harrow would be the 35th worst-off authority in the country, out of 125 unitary authorities.

I have two more questions for the Minister. How will the Government ensure that tobacco control is properly funded locally and nationally so that prevalence rates continue to fall, with consequent benefits for the NHS and public health? Equally, what analysis have the Government undertaken to determine that using business rates to fund local public health activity will not further reinforce existing inequalities?

Despite being a lethal drug, tobacco products can be sold by anyone in England almost anywhere—a licence is not required. The sale of tobacco used to require a licence, and signs above pubs and shops from that period still state that they are licensed to sell tobacco and alcohol. Local authorities in England have powers to shut down a tobacco retailer, if necessary. However, that requires the local authority to take legal action against the retailer, which is both time consuming and resource intensive. What is more, reductions in local authority budgets are affecting the work of trading standards departments across the country, which could damage enforcement work on illicit tobacco in future years.

In 2013-14, there were only 34 convictions in England for selling tobacco products to young people, and there were no restricted premises or sales orders, yet 44% of young people who smoked said that they obtained tobacco directly from shops. We were pleased to hear in the autumn statement that, as part of the obligations under the illicit trade protocol, the Government will consult on the introduction of a licensing scheme for tobacco machinery and the possibility of licensing tobacco vendors. Licensing retailers is an important step that was recommended by ASH in the “Smoking Still Kills” report and endorsed by more than 120 public health-related organisations, and it would enable the Government and local authorities to promote higher standards in the retail market and clamp down further on illicit sales. Such a system would also protect legitimate retailers and simplify the action that local enforcement officers can take against those selling illicit tobacco both within and outside the retail setting.

I congratulate the Minister on the Government’s success throughout the last tobacco control plan in taking major steps to drive down smoking rates. Successes have been lauded, not just in the UK but internationally, but the plan has come to an end. We need to build on the achievements that have already been made by implementing another ambitious and comprehensive strategy. We have heard that, in recent months, some local services have been cut and that others are likely to follow. We have also heard about the impact of similar cuts in places such as New York. With that in mind, I urge the Government to think about how the strategy will be not only implemented but sustainably funded to ensure that the UK remains a world leader in tobacco control.

We should be ambitious in our outlook and look forward to a tobacco-free Britain much earlier than 2035 to enable our young people to live much longer and much healthier lives and to encourage people who have unfortunately become addicted to this lethal product to quit smoking much earlier so that they can improve not only their life expectancy but their quality of life.

Southern Health NHS Foundation Trust

Bob Blackman Excerpts

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

I am afraid that that probably does happen. We all, in all parts of the House, passionately believe in and support the NHS. It should never come down to lawyers. When there is a problem, we need a culture where the NHS is totally open and as keen as the families are themselves to understand what happened, whether it could be avoided, and what lessons can be learned. If nothing else, that is the big lesson that we need to make sure we act on as a result of today’s leaked report.

[Bob Blackman (Harrow East) (Con)]

It is clear from my right hon. Friend’s statement that there is a cultural problem in Southern Health and across the NHS. Does he agree that far too often NHS management and clinicians are far too defensive and end up arguing about the data rather than addressing the underlying causes, which would fix the problem in the first place?

[Mr Hunt]

My hon. Friend is right. It is quite heartbreaking that when these things happen we seem to end up having an argument about methodology and statistics, and whether it is this many thousand or that many thousand, rather than looking at the underlying causes. We have to ask ourselves why people feel that they need to be defensive in these situations. We have to recognise that everyone is human, but, uniquely, doctors are in a profession where when they make mistakes, as we all do in our own worlds, people sometimes die. The result of that should not automatically be to say that the doctor was clinically negligent. Ninety-nine times out of 100, we should deduce from the mistake what can be learned to avoid it happening in future. Of course, where there is gross negligence, due process should take its course, but that is only on a minority of occasions. That is where things have gone wrong.