Oral Answers to Questions

Caroline Lucas Excerpts

Tuesday 21st October 2014 Commons Chamber

The Secretary of State was asked—

[Caroline Lucas (Brighton, Pavilion) (Green)]

1. What progress he has made on negotiations relating to the potential effect of the Transatlantic Trade and Investment Partnership on the NHS.

[Mr Dave Watts (St Helens North) (Lab)]

6. What assessment he has made of the potential effect of the Transatlantic Trade and Investment Partnership on NHS services.

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

The Government’s aim and my central mission as the new Minister for life sciences is to accelerate access for NHS patients to the very latest diagnostic devices and drugs by making the UK the best place in the world in which to develop innovative treatments. The US is a world leader in medical technology and TTIP will help NHS patients get faster access to those innovations. Let me be clear: the treaty excludes the NHS from binding commitments. Parliament will retain sovereignty over how we organise and fund our health system and NHS England is free to decide how best to commission NHS services in the clinical interests of local patients, as it does today.

[Caroline Lucas]

I thank the Minister for his answer and I welcome him to his new post. If his assurances were remotely credible then surely the British Medical Association would not have called for health to be excluded from TTIP entirely. Will the Minister confirm that under the investor-state dispute mechanism, US corporations will be able to challenge our national health policy decisions for ad hoc arbitration tribunals and potentially sue us for millions of dollars in damages for loss of profit in the event of any moves to reverse the coalition’s privatisation agenda and bring the NHS back fully into public hands?

[George Freeman]

No, I will not confirm that, but the hon. Lady does not have to take it from me. She can take it from the people who are doing the negotiations. The US chief negotiator confirms that the United States has no provision in its trade agreements on health. The EU chief negotiator says:

“I wish… to stress that our approach to services negotiations excludes any commitment on public services, and the governments remain at any time free to decide that certain services should be provided by the public sector.”

Type 1 Diabetes (Young People)

Caroline Lucas Excerpts

Wednesday 30th April 2014 Westminster Hall

[Caroline Lucas (Brighton, Pavilion) (Green)]

It is a pleasure to serve under your chairmanship, Mr Havard. Like other Members, I congratulate the right hon. Member for Knowsley (Mr Howarth) on securing such an important debate. It is interesting how much cross-party agreement there is on this issue—I hope that that clear message is reaching the Minister.

I shall be repeating some points that other Members have made, but first I want to say a little about a young constituent of mine in Brighton with type 1 diabetes, with whom I have been working closely. We have been focusing particularly on good practice support for young people in schools. As a result, the local authority in Brighton and Hove is now convening separate groups of parents, teachers and young people to talk through ideas. My constituent, Izzi, is especially keen to develop a system of mentors, where older pupils with type 1 can support younger pupils in school, particularly at stressful times such as transition or during exams.

Some of the proposals we have been discussing are not rocket science—they are very simple, but would make a huge difference. For example, young people should have a safe and pleasant place to go and inject. That place should not be locked, as sometimes such places have been; it has meant that young people have had to inject in the toilets. That gives the impression that people are trying to push the issue away. As many others have already said, we must address stigma, and one way to do that is to make injection far more normal and provide much greater support for it in schools.

As others have said, it is important to stress that type l diabetes is not just a medical condition. It can have severe psychological and educational implications and affect people in very different ways. Type 1 young people need to have medical and educational support tailored to their individual needs. Just because a person does not look ill, that does not mean that they are not juggling a vast number of factors to try to keep themselves well.

Izzi has warned that, increasingly, type 1 young people are being refused disability living allowance, despite the massive extra burden on them and their families to maintain their health. She had a DLA application turned down when she was 16, and it was obvious from the assessor’s comments that there was very little understanding of her condition and how it needs to be managed. For example, the assessor judged that Izzi’s age and the fact she has had her condition for many years meant that she was able to deal with taking her medication without help. Izzi very much wishes that that were the case, but when she is severely hypo or hyper, it simply is not.

After a great deal of extra work, she appealed against the decision and was awarded the lower rate of DLA for a further year—she had previously been on the middle rate. Many people would not have challenged that decision and might therefore be missing out on vital support. Izzi will still be only 17 when her DLA stops—not legally classified as an adult, but still supposed to be able to totally self-administer a potentially lethal drug several times a day, without any help or supervision—even when she is not able to concentrate because of high or low blood sugar levels. On behalf of many other type 1 teenagers who are or have been in the same position, she wants Ministers to understand that reality.

Izzi also wants to raise the issue of plans to scrap the national peer review programme, which the previous speaker mentioned. There are real concerns about the risk that that programme will end, as NHS England has committed funds only until September. Across the country, there is a huge difference in the provision of care for children with diabetes, in terms of both patient experience and outcomes. The peer review system provides important information and opportunities to help improvement. I would like to draw my remarks to a close by identifying a couple of areas in which peer review is important and working for children, and the benefits that it brings to families, as set out by the Families with Diabetes National Network.

Peer review measures the extent to which teams can provide 24-hour cover as prescribed under the best practice tariff. That cover is essential for families because it avoids expensive hospitalisations, and serious concerns have been raised where cover is inadequate. Peer review highlights the extent of paediatric ward staff training to ensure that children with diabetes who are admitted to hospital can be looked after safely. That is a huge issue for families, and the peer review programme has helped teams to understand better how to achieve ward staff training. Peer review also highlights the ongoing training of team members, ensuring that they are all trained to an appropriate level, which is key to the provision of good care for children.

Peer review measures the extent to which teams review patient feedback and take action accordingly. Families can help teams to improve by providing that feedback, and peer review ensures that it is both used and acted on. It also measures the extent to which teams provide self-management education to families. Self-management education is essential in keeping children out of hospital and enabling them to achieve good control and avoid complications.

Peer review measures the extent to which teams support children in school, which is an essential pillar of good self-management, and the programme has enabled teams to share strategies and documents and therefore to disseminate best practice. Finally, peer review examines arrangements for the transition to adult care—arrangements that, as we know, are key to ensuring that young people do not fall out of the system and develop complications at such a critical age. The peer review programme has encouraged teams to work together to address the issues relating to transition.

For all those reasons, along with the many others raised by Members this morning, I hope that the Minister can assure us that he will look again at peer review. There is real concern about it, as well as about the level of research funding, and I would like to add my voice to those who have said that the UK must do more research, particularly for type 1 diabetes.

In conclusion, I welcome the opportunity to have this debate and very much hope that it will increase awareness of the needs of young people with diabetes. There are more than 25,000 young type 1 sufferers in the UK, and, like Izzi in my constituency, they all deserve the very best chance.

Care Bill [Lords]

Caroline Lucas Excerpts

Tuesday 11th March 2014 Commons Chamber

[Dr Poulter]

rose—

[Caroline Lucas (Brighton, Pavilion) (Green)]

rose—

[Andy Burnham]

I give way to the hon. Lady.

[Caroline Lucas]

Does the right hon. Gentleman agree that as well as being profoundly undemocratic, the measure is likely to be incredibly counter-productive? Any Government who try to use a trust special administration to impose sweeping change without proper local public engagement will face a barrage of opposition because, as he says, change should be driven by clinical arguments, not imposed top-down.

[Andy Burnham]

The hon. Lady is absolutely right. The measure risks damaging, rather than building, public trust in the whole process of changing hospitals. In the end, that is probably the most powerful argument against what the Government are seeking to do.

By any reckoning, the proposal is a major change of policy from the one set out in the coalition agreement; yet there has been no Green Paper, no White Paper, no policy document, no statement to Parliament, no proper explanation of the Government’s intentions and no justification of the extreme measures sought. Instead, on the back of a court defeat, the Secretary of State has rammed a new clause into the Bill, asking the House to give him sweeping powers over the NHS in all our constituencies without even having the courtesy to come to the House to make the argument for the changes himself. How arrogant to expect us just to rubber-stamp the powers, without even coming to explain himself. That really shows the House a major discourtesy.

The fact is that the Secretary of State has not adequately made the case for what he wants to do. Instead, Members are asked to take a leap of faith and to trust him, but that is very hard to do when we see what happened to the people of Lewisham. In standing up to this Government, they won a victory for everyone; without them, we would not be debating clause 119 today. I pay tribute to my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friends the Members for Lewisham West and Penge (Jim Dowd) and for Lewisham East (Heidi Alexander), who provided superb leadership when the people of Lewisham felt incredible outrage at their trusted and valued local hospital being prised out of their hands.

Accident and Emergency

Caroline Lucas Excerpts

Wednesday 18th December 2013 Commons Chamber

[Andy Burnham]

The Government are tearing up the social fabric of England’s most deprived city. This is a city in which people struggle to feed their kids and to make ends meet. Council services are utterly crucial in helping people to cope. The Government do not understand, or they do not care, and they just rip up the fabric of an entire city. It is disgraceful.

[Caroline Lucas (Brighton, Pavilion) (Green)]

Does the right hon. Gentleman share my concern about the impact of the fines that are being levied as a result of delays in ambulance handovers? Many hard-working staff at the Brighton hospital say they are incredibly demoralising because they punish A and E for a problem that is actually hospital-wide, and it is hospital-wide because of cuts to the national tariff and because of the top-down reorganisation that nobody wants and that is hugely costly.

[Andy Burnham]

As the hon. Lady says, ambulance services and A and E are often now not working well together. I mentioned the paramedic held at the door, and we are hearing of queues at A and E. What we cannot have are perverse incentives in the system. The Secretary of State needs to look at the issue that she raises.

Oral Answers to Questions

Caroline Lucas Excerpts

Tuesday 26th November 2013 Commons Chamber

[Dr Poulter]

My hon. Friend makes some important points about the funding formula. He will know that for the first time this year, it will be set independently by NHS England, and I am sure that it will take on board the points that he has made. He will recognise, however, that there are many other determinants of the funding formula, such as deprivation, which it will want to look at and take into account.

[Caroline Lucas (Brighton, Pavilion) (Green)]

T5. The last time I asked the Secretary of State about the £30 million-worth of cuts forced on hospitals in Brighton and Sussex, he said that it was all down to local discretion. Does he admit that behind his rhetoric about protecting the NHS budget there still lies a real 4% cut to the centrally dictated national tariff? Does he acknowledge, therefore, that hard-working nurses and doctors have to do more with less money while patients suffer? Will he reverse those cuts?

[Mr Jeremy Hunt]

Can I explain to the hon. Lady that the reason for the 4% efficiency savings is that, although we protected the budget in real terms, demand for NHS services has gone up by 4% year in, year out, so we need to find those efficiencies? Within that, it is incredibly important that we do not make false economies in relation to the number of nursing staff, which is why last week’s announcement on our response to the Francis report will make a big difference, and we have already begun to see more nurses.

Urgent and Emergency Care Review

Caroline Lucas Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

That is the tragedy of what happened in 2004, when the personal link between doctor and patient was broken because the previous Government abolished named GPs for every patient. My hon. Friend speaks very wisely, as that is exactly what most members of the public want—they want to be able to get in and see their own GP quickly and easily. That is at the heart of the problem that tomorrow’s review of A and E will seek to address.

[Caroline Lucas (Brighton, Pavilion) (Green)]

Notwithstanding the brilliant local work of nurses and doctors, hospitals like those in the Brighton and Sussex University Hospitals NHS Trust face real challenges, including bed shortages and people having to wait for many hours for tests such as X-rays and so on. Sometimes, people wait in A and E for 12 hours for a bed. Does that not demonstrate how reckless and dangerous it is for the Secretary of State’s Department to impose cuts of £30 million on that hospital trust this year and next year, and will he reconsider?

[Mr Hunt]

Let me gently remind the hon. Lady that we have protected the NHS budget—we took a very difficult decision—but how the NHS budget is spent in local areas is a matter for local discretion. It is challenging for all hospitals, because if we are to address the long-term stability of the NHS we need to spend more money out of hospitals, which means finding efficiency savings in hospitals. We do not want to duck those challenges, which is why we are having the review that will be published tomorrow.

Oral Answers to Questions

Caroline Lucas Excerpts

Tuesday 16th July 2013 Commons Chamber

[Caroline Lucas (Brighton, Pavilion) (Green)]

10. If he will take steps to ensure that people affected by muscle- wasting conditions in the South East Coast NHS area are adequately supported after September 2013; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

NHS England commissions some elements of neurological services through specialist services commissioning arrangements, while clinical commissioning groups commission general neurological services. I am informed that the Muscular Dystrophy Campaign and the Surrey and Sussex area team are considering funding the care pathway adviser post for a further six months.

[Caroline Lucas]

I thank the Minister for her answer, but an exploration just for the potential of a mere six months’ reprieve is not good enough. As things stand, for people with muscular dystrophy and their families in the South East Coast region, from September, that is set to be the only part of the country without access to a local care and support advocate. Therefore, will the Minister agree to meet me as a matter of urgency to discuss what can be done to ensure long-term funding for that vital post, which sufferers and their families want to see continue?

[Anna Soubry]

The simple answer is absolutely yes. My hon. Friend the Member for North Thanet (Sir Roger Gale) has also raised this matter through parliamentary questions and the like. I am more than happy to have that meeting.

Accident and Emergency Waiting Times

Caroline Lucas Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

The Government have more to say about badgers than about the current crisis that NHS staff up and down the country are dealing with. That says a lot about this Government.

[Caroline Lucas (Brighton, Pavilion) (Green)]

I absolutely agree with the right hon. Gentleman that there are no simple answers. Does he agree that one of the pressures that is adding to the problems in A and E is that £3 billion has been taken out of the NHS to fund a reorganisation under the Health and Social Care Act 2012 that nobody needs and nobody wants?

[Andy Burnham]

I agree entirely. That decision was catastrophic for the NHS. Not only did it siphon £3 billion out of the front line to pay for back-office restructuring; it took people’s eyes of the ball. When they should have been focusing on the front line and patient care, they were worrying about their jobs and which organisations they would work in. The Government were warned about this reorganisation and I will come on to that. I have new evidence, which I will put before the House today, that says that this Government were explicitly warned about the risks to A and E of proceeding with their reorganisation at a time of financial stress. It is pretty damning and I will come on to it later.

What I want to do today is achieve something for NHS staff watching this debate. Let us try to reach some agreement about the causes and the practical steps that now should be taken. First, on social care, which my hon. Friend the Member for Warrington North (Helen Jones) has mentioned, the survey of NHS financial directors says that this is the single biggest cause of the pressure. More than £1 billion has already been taken out of budgets already by this Government, and the Association of Directors of Adult Social Services says that councils are planning further spending and services cuts this year. This is simply not sustainable. It is a false economy. Social care is the preventative part of the care system. If the Government continue to hammer councils, the problem will simply end up on the doorstep of the NHS and it will get bigger and bigger. The human cost will be huge.

We heard at last week’s summit that more and more people with dementia are presenting at A and E. That is intensely sad and it is the wrong place for them to be.

Antibiotics (Intensive Farms)

Caroline Lucas Excerpts

Wednesday 9th January 2013 Westminster Hall

[Zac Goldsmith]

Again, I absolutely agree with the hon. Gentleman’s point, and I thank him for making it. I will come to that in more detail shortly.

There is no argument against treating sick animals with antimicrobials but, surely, not the most modern and medically important ones, especially when other antibiotics, which are not as critically important in human medicine, are available. I recognise that this topic does not lend itself easily to tabloid news, but there is a real, worrying chance that that could change. By overusing antibiotics, we risk ruining for future generations one of the great discoveries of our species. In short, we risk entering the post-antibiotics age.

My hon. Friend the Minister will know that some antibiotics have already been lost to resistance: for example, penicillin for staphylococcal wound infections, ampicillin for infections of the urinary tract and ciprofloxacin for treating gonorrhoea. Many more are under threat, and new antibiotics are increasingly hard to find and license. We are now using our reserve antibiotics, and worryingly, seeing the spread of resistance to them as well. For example, rises in resistance, such as those seen for E. coli, force doctors to use carbapenems, which were previously the reserve antibiotics for use when other treatments had completely failed. However, we are now using carbapenems much more and seeing the spread of resistance to them as well.

University of Cambridge researchers revealed the first cases in UK livestock of a new strain of the multi-resistant superbug MRSA. It is called ST398, and it has become endemic in European and north American pig populations and has spread to poultry and cattle. It is significant because, unlike most strains of staphylococcus aureus found in farm animals, it is readily able to transfer to humans. If not checked, that is likely to lead to rising community-acquired MRSA, just at the time that hospital-acquired MRSA is falling, due to sterling efforts by health professionals.

[Caroline Lucas (Brighton, Pavilion) (Green)]

I congratulate the hon. Gentleman on securing this important debate. In the light of the very real health risks and the strong words from a former chief medical officer, as the hon. Gentleman has said, about the unnecessary use of antibiotics being nothing less than

“a death warrant for a future patient”,

does he agree that we need a legally binding timetable for the phased ending of all routine, prophylactic, non-therapeutic use of antibiotics in animals?

[Zac Goldsmith]

I do, and I will be coming to that point as well, but I absolutely agree with the hon. Lady’s intervention.

Clearly, we need to continue with efforts to reduce the inappropriate use of antibiotics by doctors, but the European Food Safety Authority was spot-on—I do not often say that—last year when it warned that

“it is…of high priority to decrease the total antimicrobial use in animal production in the EU.”

To date, the UK Government’s antibiotic resistance strategy, as I have said, has focused exclusively on over-prescribing by doctors, with zero mention of antibiotics in the livestock industry. Although they have spent money trying to understand why we are seeing a rise in bacterial infections, they are spending nothing, as far as I know, to understand the rise in resistance, which is clearly the issue of importance.

The Department of Health is currently developing its new cross-Government, five-year antimicrobial resistance strategy and action plan for 2013 to 2018, so I ask the Minister these questions today. Will she promise that it will give significant consideration to the use of antibiotics on farms and to the link between farm use and resistance? Will the Government work with the veterinary profession and the agricultural industry, as they have done in recent years with the medical profession? Does she agree that we need better data on antibiotic use, published by antibiotic family and by animal species, as is already done in France? If we do not know the type and quantity of antibiotics used and how they are used, there is very little chance of our being able to understand the emergence of resistance.

Furthermore, will the Minister lobby vigorously her ministerial colleagues at DEFRA to take urgent action to restrict the prophylactic use of antibiotics, to limit the prescription and use of antimicrobials for the herd treatment of animals to cases in which a vet has assessed that there is a clear clinical justification and to limit the use of critically important antibiotics to cases in which no other type of antimicrobials will be effective?

Will the Minister call on DEFRA to ban the use of fluoroquinolone antibiotics in poultry production to reduce the risk of antibiotic resistance in E. coli, campylobacter and other infections in humans? Incidentally, it is worth pointing out that campylobacter is the most common cause of food poisoning in the UK, affecting some 350,000 people a year, and poultry is the source of between 50% and 80% of those cases. A ban of that sort would bring the UK into line with the US, where the Food and Drug Administration stopped the use of those antibiotics in poultry in 2005, because of increasing resistance in campylobacter. Denmark, Finland and Australia also do not use fluoroquinolones in poultry. All those countries have lower levels of resistance in humans.

I mentioned Denmark, and it is worth taking a moment to consider the Danish situation. The latest Danish disease surveillance report showed that, although the presence of antibiotic-resistant bacteria in the country’s pig population had decreased since the tighter restrictions came into effect, including the banning of cephalosporins, the level of antibiotic-resistant bacteria in meats being imported into the country is higher than in its domestic meat. Nearly half the tested samples of chicken meat imported into Denmark in 2011 contained resistant bacteria. The Danish Government, quite rightly, have taken their concerns to Brussels, complaining that their national approach has been undermined by other EU states’ continued overuse of antibiotics.

Almost certainly, excessive antibiotic use on farms is linked to the intensive manner in which animals are kept. Improving animal health and welfare by limiting overcrowding and the worst excesses of factory farming must therefore become key components of the Government’s antibiotic resistance strategy. Disease prevention should be achieved through good hygiene, husbandry and housing, without recourse to the regular prophylactic use of antimicrobials—a point that has been made by two hon. Members. I recognise that factory farming interests have wielded enormous influence on Government policy for many years and that any move to restrict the use of antibiotics today will be fiercely resisted by them.

--- Later in debate ---

[Anna Soubry]

I am more than happy to do all those things. As my hon. Friend will appreciate, I am no expert in this field and would not pretend to be for one moment. I shall make a very important point: my briefing does not come from the Department of Health only; we work in collaboration with the Department for Environment, Food and Rural Affairs.

One important thing about this debate is that my hon. Friend rightly asked for a Minister from the Department of Health to respond, so I am not, as others might have thought, someone from DEFRA. Many people are concerned about whether how an animal is treated has an impact on them if they consume some or part of it. Although we might not always make too many friends in the farming industry, we are all responsible for ensuring that we know what we are putting into our bodies and feeding our families. We bear that responsibility, so we need good, informed advice. Many people, but often those with the financial means to do so, will not buy fresh meat unless they know its antecedents—that it has come from a good butcher and a good beast.

[Caroline Lucas]

I am grateful to the Minister for her openness to looking at more of the evidence that the hon. Member for Richmond Park presented. Having examined the greater body of evidence, will she also consider the need for legally binding measures as well as more information and awareness raising? The trends are going in the wrong direction, and we therefore need legally binding measures.

[Anna Soubry]

I am sort of grateful for that intervention; I fear that I could be in terrible danger of agreeing to do almost anything, and so would be able to do nothing else, because I would spend most of my time on this. I will do all that I can. It is very important. As individuals and parents, we all should be concerned, as many of us are, about what we eat and what we feed our children and loved ones. This is as much a public health issue as an animal welfare issue.

The Government have published a code of practice on the responsible use of medicines on the farm and a leaflet on antibiotics, which, like the above code, is on the Veterinary Medicines Directorate’s website. We just have to hope and pray that such things are read, but in my experience, responsible producers pay heed to all such advice. There are also regulations.

We continue to work actively with the farming industry to promote the responsible use of antibiotics in farmed animals, and industry organisations have also developed guidance. Furthermore, I am pleased to say that the Veterinary Medicines Regulations 2011 will be changed this year to prohibit the advertising of antibiotic products to professional keepers of animals. In addition, as my hon. Friend the Member for Richmond Park mentioned, from January 2012, the British Poultry Council introduced a voluntary ban on the use of certain critically important antibiotics in chick production, which should be welcomed.

Veterinary use of antibiotics is also being addressed at a European level. It forms a significant component of both the 2011 EU action plan against the rising threats from antimicrobial resistance and the 2012 EU Council conclusions. The EU legislation on veterinary medicines is currently under revision, and the UK, with other member states and the Commission, is examining the available evidence to establish whether there is a need for additional controls on antibiotics used in animals. The Government will continue to press for measures to strengthen controls on antibiotics that are critically important for human health, to make it clear that they should be used for animals only when no effective alternatives exist.

The Veterinary Medicines Directorate at DEFRA closely monitors the use of veterinary medicines in the UK. It analyses samples from food producing animals and their products for residues of veterinary medicines and environmental contaminants. There is no conclusive scientific evidence that food-producing animals form a reservoir of infection in the UK. Food is not considered a major source of infections resistant to antibiotics. Any bacteria associated with food or the environment can be reduced by thorough washing and cooking.

As I mentioned, the scientific consensus is that veterinary use of antibiotics is not a significant driver for human multiresistant infections. However, we are keen to see greater improvements in prescribing in all sectors and are actively working to encourage that. A wide programme of work to tackle antimicrobial resistance has been under way across the UK in the human and animal health sectors for several years. Although much has been achieved, I fully acknowledge that there are a number of areas that require attention and more radical thinking, if we are to have an even greater impact. I am confident that the new UK strategy will move us forward in that respect.

I undertake to write to any hon. Member who raised a question in the debate. Again, I congratulate my hon. Friend and assure him that I will answer all his questions. It now seems that I will read a great many documents and other evidence, but it is important work. If I feel that there is any need to make any changes, I will make them.

Health and Social Care Bill

Caroline Lucas Excerpts

Tuesday 20th March 2012 Commons Chamber

[Andy Burnham]

Members shout “Scaremongering” from the Government Benches, but the Government will not publish the evidence to back up their claims. We have read the local and regional risk registers which warn precisely of the case that my hon. Friend mentions—of damage to the continuity of care, risks to patient safety, longer waits for cancer patients, risks to child safeguarding. Those are the facts in the regional risk registers and they are the facts that Ministers are trying to withhold from the public.

[Caroline Lucas (Brighton, Pavilion) (Green)]

Does the right hon. Gentleman share my surprise and sadness that the Liberal Democrats, who were once the defenders of freedom of information, are now trooping through the Lobby in support of a dangerous Bill shrouded and protected by the restriction of information?

[Andy Burnham]

I am grateful to the hon. Lady for her point. The Liberal Democrats once derided the Freedom of Information Act as too weak. Today they cower behind it, trying to use any scrap of protection they can find within it to prevent the publication of the information that patients and the public deserve to have. That says everything that people need to know about today’s Liberal Democrat party.

--- Later in debate ---

[Caroline Lucas (Brighton, Pavilion) (Green)]

I am pleased to follow the hon. Member for Totnes (Dr Wollaston), for whom I have great respect. I am glad that she recognises that the risk register should be published, and I greatly regret the fact that her Whips did not allow her on to the Bill Committee, where her views might have had more influence. However, I think that the coalition insults those of us who oppose the Bill by suggesting that we would mistake a worst-case scenario for a prediction. I think that opponents of the Bill know what a risk looks like, and I think that we could be trusted with the risk register. We want to be able to study the Bill with the benefit of that information, and to be able to represent our constituents properly on it.

This is a very sad day for our health service. Although the Bill returns to the Commons today following a tangle of more than 1,000 amendments, the Government have done little to alter its direction, which remains fixed on the ideology of driving commercialisation into almost every corner of the NHS. [Hon. Members: “Have you read it?” ] Yes, I have.

The risks were made plain at the weekend. Dramatic warnings by leading doctors featured in an assessment by the Faculty of Public Health, which was mentioned by the hon. Member for Easington (Grahame M. Morris). It has also read the Bill, and it represents more than 3,000 public health specialists in the NHS as well as local councils and academia. It says that the Bill poses

“significant risks… to patients and the general public”.

It goes on to say that the Bill could well damage people’s health and experience of care—[Interruption.]—and adds:

“It is likely that the most vulnerable who already suffer the worst health outcomes will be disadvantaged as a result of the enactment of the Bill.”

Let me repeat that. Members may not have been able to hear it over all their heckling. The poorest,

“the most vulnerable who already suffer the worst health outcomes will be disadvantaged as a result of the enactment of the Bill.”

That is precisely the point. That is why an extraordinarily wide cross-section of people are deeply concerned about the commercialisation that the Bill brings. Yet despite their concern, and despite two rulings demanding the release of the risk register, the Government maintain their arrogant dismissal and refuse to make the register public. Why? Because they know that were they to make it public, we would know what they already know, which is that it drives a nail into the coffin of the NHS. The Bill is hugely damaging, and that refusal to come clean speaks volumes.

So many parts of the Bill are still hugely flawed. The 49% private income cap and the fact that more and more beds will be used for the private sector will massively undermine our NHS. That is why so many constituents are writing to us: they are deeply concerned. However, this is not the end of the road, because the campaigning will continue throughout the country.