Covid-19: Response and Excess Deaths

Debate between Christopher Chope and Maria Caulfield

Thursday 18th April 2024 Commons Chamber

[Maria Caulfield]

Absolutely, and I thank my hon. Friend for his work during those difficult times. We did not have a vaccine in those days, and we did not know how long covid was going to last. I reassure the relatives who are listening to this debate that we treated every single patient in the best way we could. If they needed a ventilator, we often had to ship them out of hospital to get them to a ventilator, but they got one. If they did not need a ventilator, we treated them. We did not leave people to die, and I reassure relatives who might think that we did that it certainly was not my experience of looking after patients.

It is important to look at the data on covid vaccinations. The Office for National Statistics published data last August showing that people who received a covid-19 vaccination had a lower mortality rate than those who had not been vaccinated. Given that 93.6% of the population has been vaccinated with either one or two doses, or multiple does, it is almost impossible to determine correlation versus causation. Vaccinated people will feature highly in excess death numbers because most people have been vaccinated, which is why we need to go through the data really carefully and not just take the first data at face value.

The covid virus continues to circulate, and we are now living with covid. Some people are still very vulnerable to covid, although the current variant is obviously less severe than the initial variant. We have just had our spring vaccine roll-out, and those who are invited should please go to get their vaccine. We know that it makes a difference to the most vulnerable. Over this winter, after both the flu and covid vaccine roll-outs, we have seen a significant reduction in hospital admissions.

[Sir Christopher Chope]

When will the immunosuppressed have access to Evusheld? Will it be this week, next week, sometime or never?

[Maria Caulfield]

That is a clinical decision, but now that we have the omicron variant, the evidence for Evusheld’s effectiveness is not as compelling.

Returning to the crux of the matter, there are risks and benefits to every single medicine when the regulator or NICE is weighing up whether to license or fund a product. If the advice coming to us is that, with omicron, the benefits of Evusheld do not outweigh the risks, we have to take that advice. People are not currently being advised to shield, but I recognise that people are very nervous, particularly when they cannot have the vaccine. We are in constant touch with NICE and the MHRA on this, but we have to respect their decision if it is felt that a product will not benefit patients.

Covid-19 Vaccine Damage Payments Bill

Debate between Christopher Chope and Maria Caulfield

2nd reading
Friday 20th October 2023 Commons Chamber

[Maria Caulfield]

I cannot speak for Dr June Raine, but I can say that I take “enabler” to mean “enabler of patient safety”. The fact that, in a number of cases, the MHRA has stepped in means that it is advocating for patient safety and is not simply a body that processes applications for clinical trials or runs a yellow card system. It is willing to meet a range of groups, and indeed I suggested that the APPG invite it to one of its meetings.

Let me briefly touch on the issue of claims. As I said earlier, we have moved the scheme from the DWP to NHSBSA. The point of that was to speed up the claims, because the limiting factor in terms of turnaround time is obtaining clinical notes, and NHSBSA is much more able to gain access to them than the DWP. We have introduced the subject access request so that there is just one consent form to get notes from a variety of sources, from primary care through to secondary care.

To update Members on the latest figures, as of 6 October, 7,574 covid claims have been made to the vaccine damage payment scheme. Of those, 3,593 have been processed, with 149 having received a payment. On average, it is taking six months to investigate and process claims. Some will be outside that because of difficulties getting their clinical records, but the average is six months.

[Sir Christopher Chope]

Is my hon. Friend looking forward to the Government giving evidence to module 4 of the UK covid-19 inquiry? In particular, is she pleased that the inquiry will be looking into whether the VDPS is fit for purpose?

[Maria Caulfield]

The Government are always happy to give evidence to the inquiry. My hon. Friend makes a good point. I have had correspondence from constituents and from people around the country asking for the covid inquiry to cover vaccines, too. We have talked today about transparency and about being able to have an open and honest dialogue on vaccines. My right hon. Friend the Member for Tatton is right that to give confidence to vaccine programmes, people need to be able to raise concerns, to raise it when they have had an adverse event and to feel confident that those things will be investigated and not brushed under the carpet.

--- Later in debate ---

[Sir Christopher Chope]

We have had a preview of the Government’s response to the UK covid-19 inquiry module 4, which will take place next July. All I can say is that I hope the Government improve their performance before then, because I do not think the arguments put forward today will be very well received. Basically, the Government are saying, “It’s all hunky-dory. There have been a few delays, but we are sorting that out. We are not going to change anything, whether in relation to the £120,000 limit, the eligibility criteria, the 60% disablement threshold or all the rest of it. And don’t worry, the vaccine damage payment scheme deals with other vaccines as well.” That was how the Minister started her response. She said there were other claims being made under the vaccine damage payment scheme, but I do not think she has really comprehended—or certainly did not give an indication that she comprehended—the gravity of the difference. She talked about the importance of flu vaccines. There have been, between 1 October 2021 and 1 September 2023, 35 claims under the vaccine damage payment scheme in respect of flu, nine claims in respect of HPV, and 6,809 claims in respect of covid-19. Surely the Minister can see there is a disparity between those figures.

[Maria Caulfield]

I did not address the point my hon. Friend made on that. The difference is that around 93% of the population received at least one dose of the covid-19 vaccine—tens of millions of people. HPV and flu vaccines are targeted at a much smaller group; they are not open to the whole population. That is why, naturally, we will see fewer claims coming forward.

[Sir Christopher Chope]

If that is the explanation, I am sure that also covers the fact that only 15 cases have been referred to the vaccine damage payment scheme in relation to MMR vaccines, compared with 6,809 in relation to covid-19. If the Minister thinks they are all equivalent then so be it, but all I can say is that the evidence suggests otherwise and there are serious questions now about whether the VDPS is fit for purpose. That is why it is great news the inquiry will be looking into that issue.

New Covid Variants: Government Preparedness

Debate between Christopher Chope and Maria Caulfield

Wednesday 28th June 2023 Commons Chamber

[Maria Caulfield]

There are several ways, and I did try to set some of them out. As I said, UKHSA tests samples from covid-positive patients around the country every week and does genomic sequencing to identify new variants or variants of concern.

We are not currently doing international border checks, but we are working with international partners, so should a new variant emerge in another country, we can step up that capability. We introduced border controls on new arrivals a couple of months ago due to the risk of a new variant from China, but that was stepped down because testing showed that there was no risk to the general population. Waste water testing is also still available should it be required, so there is a range of testing capabilities to identify variants of concern and respond quite quickly.

Moving on to vaccines, we are developing mRNA capability, but not just in covid-19 vaccinations. That is one way of delivering covid vaccinations, but that capability is also being used for respiratory illnesses and cancer vaccination trials. There is the potential for that technology to be used in a range of vaccines, not just for covid-19. A range of different vaccines are available, and should a variant of concern or change of variant emerge, we will take advice from the JCVI as to which vaccine is best to use and which group of the population is best to vaccinate. That is an ongoing piece of work.

On some of the hon. Gentleman’s other points, the covid inquiry is obviously ongoing. As the Minister responsible for pandemic preparedness, I am keen to learn the lessons about testing capability, PPE, and vulnerable groups that may need greater protection in future pandemics. But we also need to be live to the fact that a pathogen could emerge that is completely different from covid, flu, or avian flu, which we are also monitoring actively. We need to be nimble in our response to any future pandemic. My concern is that we may just look at covid as the only future threat, but that is absolutely not our policy; we are looking at a wide range of threats, both in the UK and abroad.

[Sir Christopher Chope]

The Minister referred to mRNA technology. Are the Government absolutely convinced that the technology is safe and effective? Are they in danger of putting all their eggs into that particular basket?

[Maria Caulfield]

We are certainly not putting all our eggs in the mRNA basket for covid, or for any other use of mRNA technology. Such vaccines must still pass the MHRA assessment in order to be licensed for use. As mRNA technology develops for other clinical conditions, whether cancer or respiratory illnesses, those vaccines will also have to be awarded a licence by the MHRA. It is not the case that mRNA vaccines are given carte blanche because they have been used in covid; they will have to pass the necessary research hurdles to gain licences for future use. We are certainly not just relying on mRNA for covid—although it has been effective and the technology means that it can react to variants and be altered depending on the variant. We are using other vaccines for covid, and working with other partners. I reassure my hon. Friend on that.

I am very happy to continue updating Members on the progress that we are making and any future booster vaccination programmes for covid-19 that will be running, and to update the House on the work of UKHSA regarding monitoring, surveillance, and future testing capabilities.

Oral Answers to Questions

Debate between Christopher Chope and Maria Caulfield

Tuesday 6th June 2023 Commons Chamber

[Sir Christopher Chope (Christchurch) (Con)]

Has my right hon. Friend the Secretary of State read the report “Safe and Effective?” produced in April by a group of senior clinicians, which is very critical of the work of the Medicines and Healthcare products Regulatory Agency? If he has not yet read it, will he do so, please?

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

I thank my hon. Friend for his question. I feel that we had a very productive meeting yesterday with the all-party parliamentary group on covid-19 vaccine damage about the vaccines for covid and the issue of the MHRA. He raised a number of important points during that meeting, including that on the MHRA, and I will be responding to him shortly.

Vaccine Damage Payments Act 1979

Debate between Christopher Chope and Maria Caulfield

Friday 24th March 2023 Commons Chamber

[Maria Caulfield]

I am happy to write to the MHRA to get a response for the hon. Gentleman on that point, but I hope he will be reassured that the Government are investing in research on vaccine safety both at the University of Liverpool and at the National Institute for Health and Care Research, because we want to reassure people about the safety of vaccines.

On the VDPS, I want to reassure those making claims that the Government want to support them through the process. I have not touched on it much in my response, but I am keen to reassure those who feel they have suffered and who are struggling to get healthcare for their symptoms that we are looking at this.

[Sir Christopher Chope]

As I understand it, the Minister’s time will be up at eight minutes past 3, so can she now explain whether the Government will accept that post-vaccine syndrome is clinically recognised? Will she divert resources specifically to that issue?

[Maria Caulfield]

I am not going to commit to that specific point on the Floor of the House, but I will commit to this: if people who feel that they have symptoms from the vaccine—that includes a range of symptoms—are struggling to get the healthcare they need, when I come to the APPG I will want to look at the sort of symptoms they are experiencing and help them to get the care and support that they are struggling to get at the moment. It is the same with long covid: there is such a range of symptoms. What we have found in setting up specific long covid clinics is that they have not always been able to cover the wide range of symptoms that people have had. I am very happy to discuss that further with my hon. Friend at the APPG.

[Sir Christopher Chope]

My hon. Friend refers to long covid clinics, but people who are suffering from the consequences of vaccine damage feel that they are being treated differentially and in an inferior way. If we have clinics for long covid, why do we not have clinics for post-vaccine syndrome?

[Maria Caulfield]

I thank my hon. Friend. The point I was trying to make is that we have set up long covid clinics, but they have not always addressed the needs of those who are suffering long covid, because they have such a wide variety of symptoms. What I can say to those who feel that they have experienced side effects from the vaccine is that I am very happy to meet them, hear about those symptoms and see what more we can do to support them in getting the care and services that they find they are struggling to access at the moment. I just want to reassure my hon. Friend that I have taken his points seriously—we do not have our head in the sand. I am very happy to meet the all-party parliamentary group and those who are concerned about their experience.

We will continue to prioritise improving the operations of the VDPS: six months is the average time taken, but ideally we want to make it quicker and more efficient for those who put in a claim. We are working alongside the BSA team, who are doing an amazing job to turn around so many claims as quickly as possible within the limits of getting notes and access to information from a variety of sources. That is often challenging, particularly when there are different computer systems and some paper notes are still in operation across healthcare settings. They have a very tough job, but they are trying to do it as speedily as possible by modernising and scaling up operations to improve the experience for those who are claiming, as well as helping those who want to make a claim.

Question put and agreed to.

Children's Mental Health Services: Lincolnshire

Debate between Christopher Chope and Maria Caulfield

Tuesday 7th February 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank my hon. Friend the Member for Grantham and Stamford (Gareth Davies) for securing this debate and for the way he continues to champion children’s mental health services. I recently discussed many of the issues with him and some of his constituents. The experience that they brought to me has helped to influence the work we are doing. I reassure my hon. Friend that there is a huge focus on improving children’s mental health services, both nationally in terms of funding and, as he indicated, in terms of staffing. In his local area, much of the work will be in the major conditions strategy, which includes mental health, and also in our suicide prevention strategy—[Interruption.]

[Sir Christopher Chope (in the Chair)]

Order. There is a Division in the House, so the sitting is suspended. If there is one vote, it will be for 15 minutes; if there are two votes, it will be for 25; and if there are three votes, as expected, it will be for 35 minutes. I look forward to seeing Members back here then.

--- Later in debate ---

[Maria Caulfield]

Thank you, Sir Christopher, for allowing me to continue what I was setting out to my hon. Friend the Member for Grantham and Stamford, who has been campaigning so eloquently on the issue of children’s mental health, particularly from a constituency point of view. He is quite correct that we are investing record levels of funding into children’s mental health services. We are trying to recruit as many staff as possible to expand those services, which are being extended to support children’s mental health. I will touch on how that is happening, both at a local level in Lincolnshire and nationally across England.

Lincolnshire’s children and young people’s mental health services have always been rated as outstanding by the Care Quality Commission. Pre-pandemic, the average wait for child and adolescent mental health services assessments was 4.4 weeks, and the Healthy Minds Lincolnshire early-intervention service helped to reduce referrals to child and adolescent mental health services by 5%. Lincolnshire has always had an excellent track record in delivering services and supporting young people in particular with their mental health, compared with the figures nationally. I know that is not necessarily much consolation for those parents and children waiting for services, but Lincolnshire mental health services have traditionally been very good.

However, the pandemic has had an impact, as it has across the country. In Lincolnshire, referrals to CAMHS have increased by 15.7%; nationally, the increase was 35%. Although Lincolnshire has not had the same increase in the number of referrals as other parts of the country, it has still had a significant increase. Lincolnshire has had 15% more clinical contacts than the national average, and 92% of children who sought an emergency telephone response received one within four hours as a result. We can see, then, the scale of the pressures that services are facing. Lincolnshire has performed relatively well compared with most other parts of the country but is experiencing challenges. That was very much the point that my hon. Friend made: his constituents are now struggling with waiting times, the sheer scale of the number of referrals is putting pressure on the service, and although a lot of work is going on to improve things, his constituents are feeling the pressures on the service.

The loss of workers in this field is particularly high in my hon. Friend’s area, as it is in other parts of the country. I assure him that we are recruiting more staff, but it takes time to train them up and get them providing services at a local level. Lincolnshire does not have a children’s and young persons’ in-patient unit, and I have heard from his constituents about the impact of that and the difficulty of a child being placed out of area. We fully recognise that and want to work with his local team on it. His local integrated care board is standing up to the challenge—it has increased funding to CAMHS by £1.2 million in this financial year to help to reduce waiting times, which has had a positive impact—but the workforce is probably the single biggest issue in terms of trying to improve services further.

By September of last year, 67% of children and young people who were assessed for CAMHS were assessed within six weeks. If early-intervention and emotional services are included, 72.5% of young people who were assessed were assessed within four weeks, with the national average being 68%. The big concern for Lincolnshire is the length of time that children are waiting for support and the workforce capacity to change that, so I am committed to working with my hon. Friend’s ICB to see how we can address that concern.

My hon. Friend touched on the out-of-hours service. Such services are available throughout the country—there are 24/7 helplines available—but he is quite right that many people do not know how to access those services, and that applies in respect of emergency services as well. We hear from ambulance trusts throughout the country that very often ambulances have to attend to someone with a mental health crisis, and they are not always able to access a 24/7 service. It is not because it is not there but because sometimes it just not clear how it can be accessed. There is, then, a lot of work to do.

Let me reassure my hon. Friend about what we are doing from a national perspective; this will be replicated in Lincolnshire. We are on course to deliver 399 mental health support teams in schools and colleges, and we already have 287 of them in place. They are making a significant difference to children and teachers. They are able to support children who have mental health concerns, mental illnesses or conditions at an earlier stage and get young children into the system much more quickly, before they reach a crisis point, to get them the help and support they need. They also take the pressure off teachers, who until now have done a significant amount of the heavy lifting when it comes to children’s mental health.

We are providing £79 million to boost capacity in children’s mental health services and to help 22,500 more children and young people to access those services. Also, we are specifically expanding access to services that address eating disorders. The funding has increased significantly to try to match our level of ambition, with £53 million of support in 2021-22, which will rise to £54 million in the forthcoming financial year. All that work sits on top of record levels of investment in NHS mental health services in England and the unlocking of support for an extra 345,000 children and young people.

I recognise from the points that my hon. Friend made that where we are making a difference that is great, but for the children and parents who are waiting it is still very difficult. Although Lincolnshire is probably performing better than most parts of England, it is facing some significant pressures with workforce capacity and the lack of an in-patient facility, which also puts pressure on community services.

The Government hope to reform the Mental Health Act 1983 fairly soon. That will support mental health services and make them much more community and crisis team-led, rather than letting people get into crisis and their needing much more extensive services. We have recently announced our major conditions strategy, which includes mental health, and we will also publish our national suicide prevention strategy, in which we will focus on children and young people in particular, because we recognise that significant work needs to be done for them.

It is also about ensuring that we have the workforce capacity in place. The Chancellor and his team will specifically include mental health in the workforce strategy, which is being worked on. We know that when we expand community services to get people seen much more quickly and avoid crisis situations, we will absolutely need the workforce at a community level to meet the demand.

I hope I have been able to reassure my hon. Friend. The Government recognise that there are challenges, particularly with things such as out-of-hours support and rapid access into services. I thank my hon. Friend for the work he is doing by constantly raising the situations his constituents face, because it does make a difference. It means that we are able to assess whether we are making progress in supporting not only children and young people in particular but everyone who wants to improve their mental health or has a mental illness and is in need of support.

Our ambition is that children and young people, wherever they are from in England, whatever their background and whatever their mental health condition, will be able to get the support that they need in a timely manner. I know that my hon. Friend will be holding our feet to the fire to make sure that that happens, particularly in Lincolnshire.

Question put and agreed to.

[Sir Christopher Chope (in the Chair)]

Because the Minister responding to the next debate is not present, I have to suspend the sitting until 5.7 pm. We will then have one hour in which to debate the next motion.

Vaccine Damage Payments Act 1979

Debate between Christopher Chope and Maria Caulfield

Wednesday 2nd March 2022 Commons Chamber

[Maria Caulfield]

My understanding is that it does, but I will clarify that for the hon. Gentleman as I do not want to inadvertently mislead the House if I have got it wrong.

The NHS Business Services Authority has taken over the process and is looking to improve the claimant journey on the scheme through increasing personalised engagement and reducing response times, which was one of the points made today. A difficulty we have with the covid-19 vaccines is that they are new; we are still learning about them and the scientific evidence on potential causal links between the vaccine and instances of disablement is still developing. That is part of the reason for the delay in claims being addressed.

[Sir Christopher Chope]

My hon. Friend will not have time to answer all my questions, so will she meet me to discuss the issues I have raised that she is unable to deal with now? Also, on this issue of evidence, does she require more evidence than a coroner’s verdict to enable the relatives of somebody who died following the vaccine to get compensation?

[Maria Caulfield]

The ruling on a causal link between a medicine and an adverse event, and whether that has led to death or injury, is made by the Medicines and Healthcare products Regulatory Authority. A process has to be followed—the process is independent of Government —and that has started on this range of vaccines. It remains vital that decisions are made on the evidence presented. Currently, the MHRA is going through the notes of affected patients to gather that evidence and look for causal links.

If these vaccines were perhaps five, six or seven years old, we would be in a very different place. However, as of 18 February this year, there have been 920 claims to the vaccine damage payment scheme related to covid-19. The work currently going on is establishing whether there is a causal link between the vaccine and the adverse events that people have been suffering. The yellow card scheme, which we have for all medicines, helps us to gather information, and I encourage people, whether they have had severe or minor symptoms—whatever they are—to report them, because that is how we gather evidence on medicines.

For all the claimants who have applied to the VDPS in relation to covid-19, while we are gathering evidence from their medical records, the approach will be to look at the assessment criteria and ensure that we are in the strongest possible position before we put the evidence to the medical examiner. That in turn will help ensure that claims are assessed as quickly as possible. We think that will take about six months. I will certainly meet my hon. Friend and ensure that we hold people’s feet to the fire so that there is not a longer delay than is needed. The NHSBSA is working as quickly as possible to progress claims. I understand that it has been in touch with claimants to update them on progress and will continue to update them as it has news.

We estimate that the process will take on average six months. It requires gaining access to people’s medical notes and their previous medical history, because, while someone may have had a reaction on the day, we cannot say for sure until we have looked at all the evidence that that is a causal link between the vaccine and the adverse event, even though there may be a strong suggestion that it is. It is therefore important to follow that process correctly.

My hon. Friend touched on payments. The payment was set originally at £10,000 in 1979, and it is currently £120,000. We have not made any payments in relation to the covid vaccine, but we are working at pace through all applications to the scheme and, once a causal link is established in those cases, we can look at those claims more swiftly.

[Sir Christopher Chope]

I am grateful to the Minister for agreeing to a meeting to discuss the further issues that she cannot cover tonight. On the £120,000 payment, that has not increased since 2007, so in effect it should now be worth £177,000. Why will the Government not give in on that point? That would be a great victory tonight.

[Maria Caulfield]

I am not going to commit tonight to increasing the payment—I think that is above my pay grade. Perhaps we can discuss that further when we meet.

I reassure people watching the debate and right hon. and hon. Members that the safety of the covid vaccine and its benefits outweigh any adverse events that may be caused by it. With any medicine—even a simple paracetamol—if people look at the yellow forms and the side effects mentioned on the leaflet in the packet, they will see that there are always side effects. We want to reassure people that the vaccine is still a safe and effective way of protecting them and their loved ones from the virus. However, where there have been concerns, we need to identify causal links and, if they are established, as my hon. Friend the Member for Rutland and Melton (Alicia Kearns) pointed out, we must be better at supporting people. I am very keen to do that.

Although these vaccines have been with us for nearly two years, they are still new in the lifespan of medicines and we are still learning about both their efficacy and their side effect profile. Each vaccine is assessed by a team of scientists and clinicians on a case-by-case basis. We are acting at pace, although it can feel like a long time for people affected by side effects. I will meet my hon. Friend the Member for Christchurch to discuss the matter further. I am keen to get support and payment in place for those affected, if we can, as quickly as possible.

Question put and agreed to.

Tenant Fees Bill

Debate between Christopher Chope and Maria Caulfield

3rd reading: House of Commons & Report stage: House of Commons
Wednesday 5th September 2018 Commons Chamber

[Maria Caulfield]

I will not give way, simply because of the time constraints on us.

If tenants are found to be in breach of those requirements, they will be liable to penalties and to prosecution, so I am more reassured than I was at the start of the debate. I welcome the fact that the Minister has listening ears, because he has really tried to listen to all Members on this matter.

On the enforcement issue, I am still concerned—not because of this legislation, but because of the failure to enforce the existing legislation requiring letting agents to publish their fees. I welcome the fact that, under clause 7, district councils will be able to keep the penalties charged, and I very much welcome the Minister’s announcement today that there will be £500,000 of up-front loading for councils to enable them to invest in staff and to start taking on enforcement. I want to pursue this, however, by asking what will happen if that still does not result in enforcement, because we will be no further forward with this brilliant legislation if enforcement does not happen. I also put on the record my interest as a vice-president of the Local Government Association, which asked for the up-front loading.

If we are giving councils the money in advance and they are able to keep the penalties, they really must step up to the mark and enforce the legislation. It will make such a difference to tenants’ lives if they know in advance what fees they will have to pay and that those fees are evidence-based, and if they know that if those fees are abused, there will be prosecutions and severe penalties. I cannot support the Opposition’s amendment 3, simply because schedule 1 sets out which fees will or will not be payable, while the Opposition have only given some examples of such fees. That is not really strong enough, and the amendment would severely weaken the legislation.

I congratulate the Minister, who has done a fantastic job in listening to everyone. I still have some slight concerns about enforcement and the default payments, but I am very happy to support the Bill.

[Sir Christopher Chope]

It is a pleasure to be able to speak in this debate. I am neither a landlord nor a tenant, but I am the chair of the all-party group on the private rented sector, and that sector is under substantial pressure on issues relating to regulation and interference by the Government.

The Residential Landlords Association has estimated that, in the past nine months alone, there have been over 25 consultations across Whitehall proposing changes that will have an impact on the private sector. More than 140 Acts of Parliament and more than 400 regulations affect landlords in the private sector already. That is why many of those landlords choose to get help from letting agents, and this Bill is a direct attack on the profession of letting agents. As my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) has said, this is not a Conservative measure at all, and I despair at the fact that so many people seem to want to support this exercise in socialism and control.

Why should a Conservative Government be engaged in preventing professionals from charging a fee for services rendered? Doctors in my constituency charge those aspiring to become social tenants £15 a time to get a medical certificate in support of a social housing transfer. That—in response to my hon. Friend the Member for Harrow East (Bob Blackman)—is not a cost, but a charge. It is a charge, and it is an arbitrary charge: it is imposed, but payable. As I understand it, the Government are not proposing to abolish the right of doctors to charge for writing letters, so why are we proposing to prevent letting agents from charging for the services that they provide?