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.

NHS Reform

Bob Blackman Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

A lot of the efficiency will come from seven-day working, and I do not agree with the hon. Lady that there will be a simple cost increase. The cost to a hospital of cranking down all its services on a Friday afternoon and then having to crank them up on a Monday morning is huge, and it is not efficient. Part of the savings will come from having more streamlined services that operate to a consistently high standard across the week.

[Bob Blackman (Harrow East) (Con)]

Many of my constituents complain about the lack of availability of GP appointments at weekends and outside normal hours. The consequence of that is that people who are ill turn up at A&E, causing pressure on it. I know that my right hon. Friend is taking action on that, but what is he doing to ensure that we have proper seven-days-a-week working across the NHS in primary care as well as in hospitals?

[Mr Hunt]

My hon. Friend is absolutely right to draw attention to the fact that our manifesto commitment was to a true seven-day service across hospitals and general practice. That is why, a few weeks ago, we announced in our new deal for general practice plans to recruit 5,000 GPs so that we can increase capacity and make sure that people can get routine appointments in the evenings and at weekends.

Royal National Orthopaedic Hospital (Stanmore)

Bob Blackman Excerpts

Wednesday 4th March 2015 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

It is a pleasure to serve under your chairmanship, Sir Alan, in this vital debate that is important not only locally in my constituency, but nationally. The Royal National Orthopaedic hospital in Stanmore is a national and international institution par excellence. I will use a quote that I gleaned when doing some research. The RNOH delivers

“Outstanding clinical outcomes for patients”

in premises that are

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

I and the staff of the hospital could not have put it better. That is a direct quote from the most recent inspection by the Care Quality Commission in August 2014.

The hospital premises were built during the second world war to house airmen who were defending our shores and to ensure that facilities were available to treat our brave soldiers, airmen and seafarers returning home. Sadly, we still have the same premises that existed during the second world war. I want to put on the record my tribute to the brilliant work that is done by all the medical staff, all the clerical staff and the entire team who provide facilities and services at the hospital. Many charities that are associated with the work of the hospital also operate from the site.

I wanted this debate today because I took the then shadow Secretary of State for Health to Stanmore in January 2010 to see the hospital at first hand. He gave a commitment to the board, the staff and everyone associated with the hospital that, were there to be a Conservative Government after the election in May 2010, the hospital would be rebuilt.

Just before the election, in March 2010, the then Secretary of State for Health, who is now the shadow Secretary of State for Health, announced funding for the redevelopment. It is fair to say that immediately after the election, when hon. Friends discovered there was no money left at the Treasury, I had to work very hard with civil servants and elected politicians at the Treasury to ensure that the promised funding for the rebuilding of the hospital was safeguarded in the emergency Budget that took place immediately after the election.

Here we are now, four and a half to five years on, and there has been very little progress on the rebuilding work. The trust that runs the hospital—I have worked with the board of the trust and others—has responded to every question posed by the trust development authority. It seems almost impossible to get through the positively Kafkaesque process of repeated reviews. The only beneficiaries of that process are the management consultancy firms. Patients and the medical staff have not benefited one iota.

I believe—I stand to be corrected if this is not so—that some £75 million has been spent on management consultants. It has not been spent on the consultants who treat patients, but the people who come and do management studies. I think that that is a disgrace and a waste of public money. All 13 independent reviews have concluded that the orthopaedic hospital offers excellent, high-quality, world-class care. The CQC has rated outcomes as “outstanding”, and the trust is regularly in the top 10% of all hospitals in respect of infection control and friends and family tests.

All independent reviews concerning the hospital’s geographical location have concluded that there are no better alternatives to having the hospital on the Stanmore site. All independent reviews concerning the financial risks associated with the redevelopment have concluded that the Stanmore site development offers the best value for money and that no “more affordable” option is available.

In the meantime, the future of the trust continues to be reviewed, debated and deferred. As I have said, more than £70 million of costs have been incurred, with a severe waste of money on project fees of £20 million, maintenance costs of keeping these rotten buildings going of some £15 million and the lost efficiency opportunity of some £35 million. In this modern day and age, that cannot be right.

By way of background, the hospital is a centre of international expertise in the diagnosis and treatment of neuromusculoskeletal conditions, which include acute spinal injury, bone tumour and complex joint reconstruction. This centre of expertise is not replicated anywhere else within the national health service. It has the largest spinal surgery service in Europe, with a third of UK spinal scoliosis surgery and two thirds of specialist nerve injury work being carried out on the site.

Some 95% of patients rate the care as “good” or “excellent”, and 90% of staff and patients would recommend the hospital to their friends or relatives. The hospital was the longest-standing in London with no MRSA infections in the past five years. Without question, this hospital delivers services and medical treatment that are the best in class. The clinical excellence and innovation are beyond doubt. The problem is that the buildings were built to last for a limited period, but that has stretched to 70 years. It cannot be right that we insist on brilliant medical staff operating in substandard conditions that would shame the third world.

We need to ensure that the rebuilding takes place. I understand completely that the health service has a process for business cases and has to offer value for money. We would all support that in principle. However, as this is a specialist hospital of international renown, it has a special place within the national health service. Successive Governments and the health service have prevaricated on the future of the RNOH for decades—literally 30 years. We have to have a different, more proactive approach to resolve the problem. It is clear that the board that runs the trust will have to conclude at some stage that it can no longer offer safety to patients in the substandard conditions in which it operates.

The creditability of the Government, the national health service and everyone involved is on the line here. Political leadership is required to ensure the best interests of patients and taxpayers. I look to my hon. Friend the Minister for some suitable answers, because this has been going on publicly and privately for the past five years that I have been involved, and, before that, for the past 30 years.

So the RNOH has a track record of delivering financial and performance targets. It responds time and again, updating and revising financial plans and risk assessments and refreshing commissioner support. Every time the board responds, it appears that we do not move forward, but backward. That cannot be allowed to continue and we must reach an appropriate arrangement. We need an innovative and alternative financing option—that is not encouraged through the current NHS process—to ensure that the hospital is delivered.

We should be clear that the key to resolving this matter is the top-up of public money by capital or a loan of some £20 million. It should be understood that the board will build a private hospital alongside the NHS hospital, and that will generate income. The board will also sell off land for housing development, which the area needs, but the board takes the sensible view that it will realise the land receipts gradually as the need arises for the programme’s funding. That will maximise their value and provide a decent level of housing in the local area. Both those things have been positively embraced. The RNOH and the trust development agency have been developing the outline business case since September 2014. In March 2015, we are still waiting to see whether it will be approved and action taken, so that the redevelopment can take place.

It is time that the Department of Health acknowledged that highly specialist hospitals and providers such as the RNOH need a different approach from that taken with the generality of NHS providers. It cannot be right that a super, specialist organisation with such excellent results is denied facilities for the want of a relatively small amount of public money.

In summary, the RNOH is a vital national provider of treatment for the most complex orthopaedic conditions and the rehabilitation for people with life-threatening conditions, such as spinal cord injuries. It does vital work on the innovation of new treatments, leading-edge research and development, the manufacture of state-of-the-art prosthetics and the training of future orthopaedic specialists. The hospital has treated many famous individuals, including Lord Tebbit’s wife after the Brighton bombing and Princess Eugenie. Moreover, the RNOH recognises the financial constraints it operates within and has continuously demonstrated that mitigations to affordability risks are available. Demand for services grows every day. Major land sale receipts will be available. Planning permission is in place; there is no hold-up on that. Housing and employment for the local population will be increased by the proposal, and major private patient income will come in.

The RNOH has a track record of delivery against every target that it has ever been set. It has responded time and again to the requirements of the TDA and every other aspect of the health service. It is clear that every time there has been a step forward, there have been two steps back. Every time proposals have come forward on alternative financing options, we have just ended up spending more public money. If that £75 million had been invested in the project, we would now be looking at new hospital facilities on the site. We would have first-rate, world-class facilities for world-class medical professionals.

No one believes that anyone wants to see the facility closed down, but the reality is that the Department of Health has to move forward and instruct the TDA to abandon the position that it has adopted, so that the RNOH can move forward to development. If we do not do that, we might as well close the hospital. That would be an absolute tragedy for all the specialists, medical staff and patients. By bringing those services together, the medical professionals have developed world-class techniques and an ability to cure individuals of very serious problems. Indeed, the medical staff of the RNOH provide national and international services way beyond the bounds of the hospital. I urge the Minister to give us some good news and to ensure that we get the funding required for the hospital to be rebuilt and for facilities to be provided for the brilliant staff, who do a brilliant job for the patients.

[Sir Alan Meale (in the Chair)]

Before you begin, Minister, I want to pass a message on. Generally when debates are answered in this place, the Parliamentary Private Secretary is present. There was not a PPS in the last debate or this debate, and that might happen in the next debate, because I see the Minister for it standing by. When a PPS for the Minister is not present, it is usual for someone from the Whip’s Office to be involved. Sometimes mysterious pieces of advice appear from other places and have to be passed forward to the Minister. When those people are not present to do that, we have to rely on House of Commons staff. They have enough to do, and we should try to help them where possible. I am not saying that it is anything to do with the Minister, but I would be grateful if he could pass that expectation on to the Whips or the PPSs.

Five Year Forward View

Bob Blackman Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

Not at all—I take full responsibility for the NHS. Given the pressures created by having nearly 1 million more over-65s than we had four years ago, and the fact that the Government have had to cope with the deepest recession since the second world war, I believe that the NHS is doing remarkably well, and this document gives it a blueprint for the future that we can all welcome.

[Bob Blackman (Harrow East) (Con)]

Under this Government, the number of young people taking up smoking has fallen dramatically to some 3% and the number of people giving up smoking has increased. I welcome that very good news. We can now aspire to a smoke-free Britain over the next five years. Personally, I would like to see the tobacco companies taxed out of existence, but is it not irresponsible to base future spending plans on the basis of a tax on companies that will cease to exist?

[Mr Hunt]

That is a very good point and I agree with my hon. Friend that we should aspire to a smoke-free Britain. We are making remarkable progress. The point the report makes—this goes alongside what my hon. Friend has said—is that we need to integrate our thinking about public health with our thinking about the services the NHS delivers. The better care fund has shown how it is possible to get excellent collaboration between local authorities and the local NHS for the delivery of social care. Transformational things are happening up and down the country right now. I would like to see the same thing for public health as well.

Hospital Car Parking Charges

Bob Blackman Excerpts

Monday 1st September 2014 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

It is an honour to follow my hon. Friend the Member for Harlow (Robert Halfon), who has been at the forefront of this campaign. I trust that, now that he has the ear of the Chancellor, he will use that power to persuade our right hon. Friend of what needs to be done. Earlier this year, I went to see the Chancellor with a delegation led by my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski), and we put it to him that hospital parking charges should be scrapped altogether. I note that it is now estimated that the cost of doing so would be £200 million. At the time, it was £90 million.

We should look at this matter strategically and say that anyone who is going to hospital for treatment or to visit people who are suffering in hospital and who need to be there for an extended period of time should be exempt from all charges. It is difficult to introduce such a policy across the country for the simple reason that hospitals are in different locations. Some are co-located with stations, for example, and have decent public transport links. Others do not, however. We need a policy whose presumption is that anyone using the hospital car park because they are using the hospital services as I have described should be able to do so free of charge.

Such a policy could be implemented by requiring people to pay on exit. They could obtain a ticket on entry and have it stamped by a ward sister or a similarly appropriate medical person in order to exempt them from paying the charge. That would prevent commuters and others from abusing free hospital parking places.

I trust that we can look at this matter as a sensible investment. We clearly cannot expect the Department of Health to find the money itself. We expect it to provide the funding for treating people who are sick. We should look to the Treasury to provide the health service with the necessary funds to enable this initiative to take place.

[Mr Marcus Jones (Nuneaton) (Con)]

I completely agree with my hon. Friend that hospital parking charges should be scrapped. In the meantime, however, does he agree that when a hospital is at fault for delaying or cancelling an appointment, the patient should not have to pay more for their parking as a result?

[Bob Blackman]

I thank my hon. Friend for that intervention.

I was just coming on to the specifics of my area. My constituency and others now have centres of medical excellence, which means that people have to travel long distances for the treatment that they need. Many of them have to use their cars, because public transport is not an option. Over the past 18 months, I have witnessed people suffering when their appointment was delayed and they had to rush out to the car park to pay more at the pay and display machine. Such an encumbrance is unfair on people who need to receive important medical treatment, and it should without doubt be scrapped.

The guidelines should also stress strict adherence to a policy of paying on exit for the appropriate length of time spent in the car park, as opposed to using pay and display arrangements that involve people guessing how long they are going to spend in the hospital. I have witnessed at first hand people having to guess in that way and then finding that they do not need all the time they have paid for.

In my own area there is Northwick Park hospital, which is the centre at which many people from north-west London are treated, and Central Middlesex hospital, which is in the middle of an industrial estate and almost inaccessible by public transport, so anyone going there has to drive. There is no pay-on-exit facility available. In fact, the trust took away that facility and insisted that the parking area that was built for it be replaced with pay-and-display parking. It was a nonsensical decision, and I trust that the trust will review it and revise it accordingly. We also have Ealing hospital, which has a similar problem of not being anywhere near any public transport facilities. The tube lines run into the centre of London rather than radiating around the outside, so people travelling locally have to drive and use the car parking facilities.

I wish to touch on a specific case that I came across recently: Mr Francis Bacon, a registered disabled driver suffered a serious puncture while driving to a hospital appointment. He was unable to move his car, which some good samaritans pushed on to the pavement while he went to get help to change his tyre. He got his tyre changed by some good people who came and helped him and put him on his way. Sadly, a parking operative from Ealing council had come along and put a penalty notice sticker on the car, because Mr Bacon had had the temerity to park on the pavement. He could not move his car—his car was disabled, and he was disabled—yet he still got a parking ticket. Despite protestations from everyone concerned, Ealing council refused to cancel the ticket, which is typical of the wrong attitude of both local government and hospital trusts themselves. We need them to work in harmony to promote parking arrangements that suit and protect everyone. I trust that we can use this opportunity to encourage the Chancellor to provide extra funds so that we can do away with car parking charges once and for all.

NHS Investigations (Jimmy Savile)

Bob Blackman Excerpts

Thursday 26th June 2014 Commons Chamber

[Mr Hunt]

We are having an overarching independent inquiry—that is what Kate Lampard is doing—but on whether we need to have further inquiries, we need to wait until we get the response, which we are hoping for this autumn, because at the moment, we have published individual reports, but we have not drawn any wider lessons for the NHS system-wide. One of the things that I hope will be a consequence of today is that if there are any victims who were abused at the RVI, they will use today as some encouragement to come forward. I have given instructions and I am absolutely clear as Health Secretary that I want every single one of the concerns of anyone who comes forward to be investigated thoroughly—as thoroughly as all the ones that are tragically coming to light today.

[Bob Blackman (Harrow East) (Con)]

It is astonishing that this catalogue of abuse was allowed to happen and that no action was taken at the time. I commend my right hon. Friend for his statement, both for the way he has delivered it and for the content, but can he elucidate for the House what specific changes he foresees in legislation, although legislation has moved forward, and any specific changes to procedures that now need to be taken as a result of the publication today?

[Mr Hunt]

I hope my hon. Friend will forgive me if I do not try to predict Kate Lampard’s recommendations before she makes them, but I think the obvious question to ask is whether we have the procedures in place that ensure that someone like Savile would not be given the keys to an institution in the way that he was. I do not believe that would happen today. My understanding of the way that NHS organisations work is that it would be impossible for someone to be given the freedom of a trust in the way that he was at Broadmoor, but I do not want to take that as a fact. I want Kate Lampard to look at that, so that we can be absolutely sure that it would not happen. I think the other obvious area for her to consider is the functioning of the disclosure and barring scheme, and to make sure that it really is set up in a way that would make it more likely for us to catch someone like Savile. Again, I think it is likely that he would be caught by the DBS, but I would like Kate Lampard to look at that and give me her views.

Oral Answers to Questions

Bob Blackman Excerpts

Tuesday 1st April 2014 Commons Chamber

[Jane Ellison]

The hon. Lady is right to say that pharmacists have a great role to play, and she has given a good example of their helping people to manage long-term conditions and helping people with their medication. NHS England’s community pharmacy call to action has stimulated the debate about where community pharmacies should sit. We see them as a vital part of front-line services, and I am glad that the NHS is looking at their role in the round, because it is a really important one.

[Bob Blackman (Harrow East) (Con)]

What representations has my hon. Friend received in relation to the sale of e-cigarettes in community pharmacies, given that they form part of the smoking cessation process?

--- Later in debate ---

[Mr Jeremy Hunt]

The review the hon. Gentleman refers to is a consultation by NHS England to ensure that we commission specialist services better. There has been a 23% increase in the number of cancer sufferers getting treatment under this Government. We want to improve on that record even more, which means having sensible discussions on how to improve specialised commissioning, and that is what is going on.

[Bob Blackman (Harrow East) (Con)]

T6. In 2010 the Chancellor specifically set aside funding for the rebuilding of the Royal National Orthopaedic hospital in my constituency. The site has planning permission. Will my hon. Friend update the House on progress so that we see work on the ground before 2015?

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

My hon. Friend will be interested to know that the NHS Trust Development Authority is reviewing the trust’s business case and is working with the trust to ensure that its plans are affordable. I know that my right hon. Friend the Secretary of State has visited the hospital and is a great champion of it. I will ask the TDA to keep my hon. Friend fully up to speed.

Cancer Priorities

Bob Blackman Excerpts

Thursday 13th February 2014 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

It is a pleasure to follow my hon. Friend the Member for Salisbury (John Glen). On behalf of the Backbench Business Committee, I thank my hon. Friend the Member for Basildon and Billericay (Mr Baron) not only for securing this important debate, but for agreeing to host it on such a difficult day—the last day of term before we break up for the recess.

I speak as someone who has a personal, family experience of cancer and I speak on behalf of my constituents. As I have said in the House before, both my parents died of cancer, as did three of my immediate family—uncles and aunts. They died many years ago, when the treatments now available were not available. Had they been, there is no doubt that they would have survived far longer. The good news is that progress has been made over many years in cancer treatment.

Most of this debate focuses on health matters, but I want to flag up an issue that can also affect people who suffer from cancer. A constituent came to see me. He had worked all his life, for 40 years, in a particular industry, doing quite heavy work. He was suddenly diagnosed with life-threatening cancer. He went to the jobcentre to get benefit while he received treatment. He was denied any benefit, for the simple reason that his doctor’s letter stated that his treatment was likely to last six months. He was therefore disqualified from receiving benefits. He was down to his last few hundred pounds to sustain his family. Fortunately, I was able to intervene and it was found that his treatment would last a minimum of six months, and more likely a year or longer, so he would be out of work for that period. Unfortunately, in many respects the way benefits are dealt with is not helpful to cancer sufferers. I do not expect the Minister to respond to that point today, but it is something we should flag up for Ministers in the Department for Work and Pensions.

I also speak from another perspective. When I was a local councillor, St Luke’s hospice in north-west London was founded in my ward. It has gone from strength to strength. It started out as an outreach service for people suffering from life-threatening diseases or who were at the end of their life; it helped them at home. It has now moved to its own headquarters, which is also a headquarters for Macmillan nurses. It treats many thousands of cancer sufferers across north-west London in an excellent way. St Mark’s hospital, which is world-renowned in the treatment of bowel-related diseases, particularly cancer, is also in my constituency.

As some Members may know, over the past year, I have been under the care of St Mark’s hospital following medical treatment, and I have personally witnessed the terrible distress that individuals go through when they are told that unfortunately they are suffering from some form of cancer. It is not until you see those people and see the terrible effect not only on them, but on their relatives and friends, that it really comes home to you what a terrible thing this disease is and how important it is that we continue to treat people in an appropriate and sympathetic manner. However, the good news is that just because someone has been diagnosed with cancer, that does not mean it is the end. There is treatment available and the capability of a full recovery, but often people do not realise that until they are thus affected.

Of course, as we all live longer and live healthier lives, there is a greater risk of suffering from cancer. As my hon. Friend the Member for Basildon and Billericay said, within six years, one in every two people will be diagnosed with some form of cancer. That means that every family in the country will experience the terrible problem of having a relative diagnosed with cancer and the impact that that has on the whole family. We need to understand that this will not go away but get worse as a potential problem.

I congratulate the Government on the introduction of the cancer drugs fund, which categorises money and makes it available for treatment of cancer-related diseases. The sad fact is, however, that it is time-limited; it will end in 2016. Concerns are being raised—they are raised very strongly in the report by the all-party group—about what will replace it and what the impact will be on funding for treatment of the various diseases.

There is another big challenge in relation to the clinical treatment of cancers: quality of life issues versus the age of the patient and their ability to recover from the treatment—whether the treatment will actually kill the patient is a concern. More importantly, such issues are balanced against the cost of the treatment to be provided. If a patient is going to have their life prolonged by a week, the clinician can be asked whether it is worth the huge amount of money that may be invested in doing so. However, if they will be given another five years, there is no question about what should be provided. Then the challenge is what to do in between those time frames. That is a direct challenge to our clinicians and to all those making decisions about funding the cost of treatment and the provision that we make for it.

During this debate, we have talked about early diagnosis. There is no question but that if people are diagnosed early, their treatment is less severe and the chances of recovery are far greater. Women, in particular, have had strong advice over many years to check themselves for breast cancer. Smears have been available, as have other forms of treatment and checks. Men often do not want to talk about the fact that they may be suffering from early signs of cancer. They do not go to doctors early enough. They do not consider themselves to need treatment, and of course, by the end, it may be too late for that treatment to take place.

A system of screening across the country for the most common forms of cancer needs to be available for every single patient on the NHS. However, there must be a word of warning—after screening, the patient may be shown not to be suffering from a form of cancer at the moment, but that does not mean that they will not suffer from it next week, next month or thereafter. The risk is that people may feel that they are safe as a result of screening, but they are not. Therefore, screening must take place regularly so that people can understand that early treatment can get them into a good position.

There is also the aspect of specialist treatment that must be available. There are a number of rare cancer diseases where the cost of treatment is quite high but the number of cases is relatively few. We should therefore ensure that the people who suffer from those rare forms of cancer have a good chance of recovery through proper treatment, proper drugs, and proper specialist care.

I want to highlight in particular the work being done at University College hospital on blood cancers. One of the problems is that, while treatment kills many cancer cells, it leaves behind small numbers that are very difficult to detect and that at some future stage may spring back into action and infect the whole body via the blood. University College hospital depends on donations from members of the public for the equipment it uses. In my view, there should be far greater investment from the NHS in that research, which enables experts to make diagnoses and produce the detailed treatment needed by those suffering from blood cancer in particular.

Another issue is the drug companies that produce the drugs that treat cancers, be they common or rare. It is clear that the cost of research is enormous, that the failure rate of the drugs is difficult to determine and that there is a challenge—this is particularly true of rare cancers—with regard to the number of patients who can be treated. Will the Minister consider an open-book policy for the drug companies whereby they would say, “We’ve spent this much money on research and this is how much it has cost us to develop these drugs, so this is how much we need to recover from treatment using these drugs”? At the moment, there seems to be a battle between the drug companies, the National Institute for Health and Care Excellence and the NHS with regard to the cost of treatment. It is clear that that needs to be addressed.

It would be remiss of me, during a debate on cancer, not to say that individuals also have a responsibility. If we can educate young people to have a better diet and not to start smoking in the first place, and if we can educate people who do smoke to give up, we have a chance of reducing the risks of contracting cancer. I congratulate my hon. Friend the Minister, who has been a Health Minister for only a short period, on the major change earlier this week to the Government’s policy on smoking in cars when children are present and on the issue of standardised packaging of tobacco products. She has made a huge impact.

We have not completed the job yet and we look forward to the regulations being introduced, but now we have another challenge, which is the treatment of cancers through the use of various drugs that assist people who suffer from those terrible diseases. It is a new challenge and a new opportunity, and I am sure that the Minister will take it up with gusto and zeal and that she will achieve the same degree of success as she has in relation to smoking.

Children and Families Bill

Bob Blackman Excerpts

Monday 10th February 2014 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

I speak as the secretary of the all-party group on smoking and health. There is only a brief time available, but the facts and figures have been presented to the House. The fact is that the younger people start to smoke, the more damage they do to their health and the shorter their lives as a result. The key point is that most young people start smoking because of their parents, siblings, friends or the media marketing of big tobacco. We need to take away the capability of big tobacco to market to young people, and I support wholeheartedly the measures on standardised packaging. Those opposing measures to stop parents smoking in cars carrying children should understand that a car contains 11 times more tobacco and nicotine than a smoky pub. Even more importantly, if a parent is driving a car with all four windows open, the level of pollution is treble the amount recommended by the US Environmental Protection Agency or the World Health Organisation. That is extremely damaging to children’s health, and I support the Lords amendment.