Cosmetic Surgery

Dan Poulter Excerpts

Thursday 5th July 2012 Westminster Hall

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to follow my hon. Friend the Member for Bosworth (David Tredinnick), and, indeed, all the hon. Members who have spoken. I pay tribute to my right hon. Friend the Member for Charnwood (Mr Dorrell), who has worked very hard on putting together a good Select Committee report, championed the cause diligently over the past few months in Parliament, and helped to bring about this debate.

One thing that came across from the remarks of all right hon. and hon. Members, but which was highlighted particularly by the right hon. Member for Rotherham (Mr MacShane), is the concern, which unites the House, for the women who have been exploited and, in many cases, treated badly by some private sector cosmetic providers.

The expert group appointed by the Department of Health published its report on 6 January and concluded that there was no causal link between PIP implants and cancer, and on 1 February the European Commission’s Scientific Committee on Emerging and Newly Identified Health Risks published its report on the matter, which reached similar conclusions. Although there may not be a risk of cancer, we know that PIP implants are not of good quality, and their rate of rupture is six times greater than that of other implants. It is because of that inferiority, and the concern and worry that it has caused many women, and because of wider issues about the cosmetic surgery industry, that we are having this debate; and those are the issues that I want to talk about.

To me, the primary issue is duty of care. NHS providers, whether traditional ones or private providers commissioned by the NHS, have a duty-of-care relationship with their patients, whether women or men. Clearly, in the cases that we are considering, the cosmetic industry has not shown that duty of care because of the contractual relationships that women were in.

My right hon. Friend the Member for Charnwood highlighted the problem of the Medicines and Healthcare products Regulatory Agency failing to keep a sufficiently vigilant eye on PIP or other implants, and I do not want to dwell on that. However, the cosmetic industry’s wider role, and the governance and culture of not only plastic surgery and cosmetic clinics, but the surgeons and others in the industry, are key to how we improve—how we take matters forward and make things better for women in the future.

On the duty of care, all the women whom we are talking about are patients. If an invasive procedure is performed on someone’s body, they must be considered a patient—someone to whom a duty of care is owed. It does not matter if the procedure is done by the NHS or a private provider outside the NHS, as in the cases we are considering. That duty of care should exist. Yet with the cosmetic industry, because there is a contractual relationship, it is clear that that duty of care does not exist and that many of the women have been exploited, potentially, and misinformed by the cosmetic industry. The relationship has not protected women or acted in their best interest.

[Mr Dorrell]

I hope that my hon. Friend would agree that the mere existence of a contract between the provider and the patient does not in any way undermine the duty of care that the one owes the other. As I said, a surgeon who provided the service without giving proper advice to the patient would be in violation of their professional duty of care to the patient, and the provider would not be providing the service required by the contract, either.

[Dr Poulter]

I fully agree. Unfortunately, although a contractual duty should inherently also be a duty of care, in this case there has been poor medical practice and poor medical accountability on the part of some surgeons in a number of clinics—a point highlighted by my right hon. Friend, and by the right hon. Member for Rotherham. Some providers have not behaved with the kind of responsibility and care for their patients that we would expect of anyone offering a service, particularly one involving invasive bodily procedures.

My right hon. Friend the Member for Charnwood was right to highlight the doctrine of top-up charges, because women have, in some cases, been forced to have two operations in order to have their implants replaced with better ones. That is not only unacceptable medically, but also on the basis of the duty of care. Given that many cosmetic surgery clinics that work under a contractual arrangement cannot claim back money under their insurance when the data do not necessarily show a risk from PIP implants, they are not in a position to offer the replacement procedures without going bankrupt. Although they have a moral duty to offer those procedures, they are not always in a financial position to do so, and that goes to the heart of the matter.

When people take up private procedures outside the NHS, and a contractual duty is in place, there needs perhaps to be a levy on the private providers to ensure that when things go wrong, other providers—either in the private sector or the NHS—can ensure that things are put right. I would be grateful if the Minister could reply on that suggestion of a course of action that the Government could look into. We want our primary concern to be the care of the women affected, and there are providers that, as my right hon. Friend the Member for Charnwood says, consider themselves to have a duty of care, but are, because of the financial consequences, perhaps unable to put things right. We might, therefore, need a levy or some kind of insurance to safeguard against such a situation occurring again.

I want to touch on the governance of the plastic surgery industry. The professional responsibility of plastic surgeons and everyone involved in the industry should be no different from that in other parts of medicine, but we have seen some very bad practice by some cosmetic surgeons. Earl Howe’s report states that under General Medical Council guidance and rules for good governance, there is a duty on doctors and other medical professionals to have good auditing and record keeping, but far too often, data on the care of the women affected have not been properly kept. Good medical records do not exist, and there has been a neglect of duty by some medical professionals. As my hon. Friend the Member for Totnes (Dr Wollaston) pointed out, that is something for the GMC to look into, and I am sure that the Royal College of Surgeons will look into that in further reviews.

We need to ensure that regardless of whether a procedure is carried out in the NHS or the private sector outside the NHS, good medical practice as regards audit and record keeping is always maintained. When things go wrong with the cosmetic industry and private operators outside the NHS, it is always the NHS that picks up the pieces, and NHS doctors therefore need to be put in the best position from which to look after the patients.

Finally, the exploitation of women in many of these situations has been talked about widely. The Committee has heard of many cases of women having gone in good faith to cosmetic providers and having received at best inducement, and at worst poor information, at the moment of consenting to an operation. The basis of all medical treatment is informed consent. A patient should understand the consequences of any operation, be fully availed of the facts, and together with a medical professional, make an informed decision about the right way forward and about how they should be treated. Far too often, the evidence has shown that women do not give informed consent and are not fully availed of the facts. That is bad medical practice and, as my right hon. Friend the Member for Charnwood pointed out, it is an issue for the cosmetic industry. The Royal College of Surgeons and the General Medical Council should investigate surgeons who have not done things in accordance with good medical practice, as set out by the GMC.

We need to consider the wider consequences, and to move the cosmetic industry from a purely contractual arrangement towards one involving a duty of care. We need to consider ways of properly looking after women when things go wrong and, given the doctrine of top-up charges, we must ensure that money is available to look after women. Perhaps there is a role for a levy on private operations. We must also ensure much greater accountability of medical professionals and better record taking, so that we can have proper patient care, which is what we all want. I am pleased to have taken part in the debate, and I look forward to the responses of the Minister and the shadow Minister.

EU Working Time Directive (NHS)

Dan Poulter Excerpts

Thursday 26th April 2012 Westminster Hall

[Charlotte Leslie (Bristol North West) (Con)]

It is a pleasure, Mr Brady, to serve under your chairmanship. We have heard a lot during the past few months about structural reform of the NHS, but today I want to concentrate on something that underlies the success of any structural reform now or in future: safeguarding the expertise and professionalism of our medical work force, and our future consultants. I think we all agree that the NHS is not a system; it is the people who work within it. The expertise, dedication and professionalism of our clinical staff are what give the NHS its tremendous robustness to adapt to and, dare I say, withstand political restructuring. That is largely what has enabled it to meet the ever-increasing demand being placed on it by an ageing population, rising expectations, and all the other factors that we so often talk about. If the NHS loses that clinical expertise and professionalism, it will no longer exist as we know it. Under our watch, doctors are warning with increasing urgency that that professionalism and expertise is being severely eroded, and the expertise of our future consultants is being jeopardised, so patient care is being compromised daily.

What is having such a damaging effect on the future of our NHS? With the previous Government’s very badly structured new deal, the threat to the NHS is the European 48-hour working time directive. It was introduced with the reasonable aim of putting an end to junior doctors having to work 100 hours or more a week. Obviously, that was bad for junior doctors, and dangerous for patients. No one wants to be operated on by someone who has had a ridiculous lack of sleep. We do not want to return to those bad old days, but the effects of this well-meaning directive are devastating, and it would be utterly wrong and immoral to dismiss the arguments about the 48-hour working time directive simply by presenting a simplistic either/or argument: either a 48-hour working time directive, or a return to 100-hour weeks. That argument would be misleading, it has no strength, and it is wrong.

Doctors have been making the case strongly, and trying to get the political class to hear. They have warned that the working time directive is devastating the NHS in three ways. First, on doctor training, it is eroding the professional ethos that upholds the NHS, and beginning to replace it with a clock on, clock off culture. New generations of junior doctors will know only that. They will never know the old ethos that sustained our NHS. Secondly, the safety of patients—our constituents—is being seriously jeopardised daily. Thirdly, I am sure the Minister appreciates that the financial cost is absolutely massive. I will deal with those three issues in turn, before concluding on the final, biggest blow, which is that the directive does not achieve its aim of a better work-life balance for doctors, and in some cases it makes matters worse.

The previous Government estimated that the introduction of the European working time directive, given the existing new deal limitation of a 56-hour working week for doctors, would be the equivalent of taking 4,000 doctors out of circulation. The Royal College of Surgeons estimated the loss of surgical time per month to be 400,000 hours. To put that into perspective, that is equivalent to 45 years of surgical time per month being lost to the NHS. That means that doctor training is limited in two ways.

The first is simply the amount of time that doctors have to train, and we can all appreciate that. It is important to appreciate that the quality of the training that doctors can access has also been severely eroded. Hospital trusts have had to adopt a shift rota system to incorporate the working time directive. Under the old on-call system of working, a medical specialist—an expert—was always on call in case a problem arose, or there was an emergency out of hours. A specialist was always on hand to help any doctor on duty, but with the new system, that is not always the case, so patient safety is jeopardised.

Doctor training is also jeopardised. Trainees complain that they do not get the training they used to receive because they are increasingly meeting the demands of staffing hospitals out of hours and at night without the training and accompaniment of a consultant. The team-working relationship between trainee and consultant is what is so valuable to trainees, and its breakdown is detrimental to the quality of and amount of time for training. The Association of Surgeons in Training reported that two thirds of trainees believed that their training had seriously deteriorated since the introduction of the directive. Sadly, most doctors report that they break the rules—I will return to that—to access the sort of training they want. We are dealing with a work force that values clinical excellence and the welfare of their patients.

My second point is about the welfare of patients. From the patient’s point of view, the directive massively damages continuity of care. Under the shift system, we are seeing a clock on, clock off system, with a dramatically increased number of handovers between doctors. That is clinically risky, because handovers are when vital information may be missed, and under the directive those handovers take place under increasing time pressure. As with Chinese whispers, messages are distorted down the line.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

My hon. Friend makes an excellent point, but is it not also the case that medicine is traditionally about providing continuity of care for patients through having a dedicated team of doctors looking after them? If we move towards a clock on, clock off culture, as we now are, and a shift-based job, continuity of care will be lost, patient care will be damaged, and bad things will happen to patients.

[Charlotte Leslie]

My hon. Friend makes an extremely good point, and I know that he has first-hand experience in this area.

Professional expertise and intuition, not looking at a list of tick boxes, enables doctors to spot that something is wrong with a patient. If doctors are not able to make a subtle comparison between how a patient was yesterday and how they are today, their intuition and expertise will be undermined. We have all seen constituents who have felt that they have been subject to an endless conveyor belt of doctors, and have been made to feel like a product on a conveyor belt instead of the focus of a dedicated team looking after them. The move to treating patients as products on a conveyor belt is worrying, and undermines the very good ethos of our NHS. Clinicians back that up. One third of surgeons in a recent survey said that handovers had been inadequate and, worryingly, the Royal College of Physicians found that three in 10 thought that their hospitals’ ability to deliver continuity of care was poor or worse. A similar survey of GPs found that one third thought that their hospitals’ treatment was dangerous. I cannot emphasise enough the urgency of the matter.

--- Later in debate ---

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is a great pleasure to speak under your chairmanship, Mr Brady. I pay tribute to my hon. Friend the Member for Bristol North West (Charlotte Leslie) for securing this debate on an important issue in medicine and in improving front-line patient care that affects every MP’s constituents, whatever the constituency. I also pay tribute to the hon. Member for North Antrim (Ian Paisley) for a real tour de force in his speech just now. In my contribution to the debate, I will touch briefly on some of the points that he made, but I will try to expand on some of the points made by my hon. Friend.

My hon. Friend made a couple of very good points. Early in her speech, she pointed out the effect of the European working time directive, saying that it has effectively taken 4,000 doctors out of circulation. Effectively, therefore, hospitals throughout the country have to recruit an extra 4,000 doctors as a direct consequence of the EWTD. That is a huge financial burden, but it is something that hospitals have effectively had to do in many cases and in many specialities in a very quick fashion—indeed, almost overnight. That has been very difficult to do.

Many hospital services in many parts of the country, particularly the more remote rural areas, are reliant on locum doctors, who are often not necessarily trained in Britain—not that that is a bad thing, because a huge contribution is made to the NHS by overseas workers. However, as has been very publicly highlighted by the Dr Daniel Ubani case, some overseas doctors are not necessarily familiar with the British medical system.

The failings of the EWTD and its implementation go further than just increasing the strain on doctors and the loss of continuity of care for patients. They relate to the way that hospitals have been forced to deal with the shortfall in their rotas and the problem of how they will look after their patients and to the fact that the system that is used to employ locum doctors is not fit for purpose. The General Medical Council and the British Medical Association are looking into those matters. Nevertheless, the failings of the EWTD have exposed a very important issue, and patients are suffering.

My hon. Friend also said that medicine is a profession and a vocation; I know that, too, and I obviously speak from personal experience. Medicine is not about clocking on and clocking off. It is about looking after patients effectively, whenever that may be. The result of introducing the EWTD has been to encourage hospitals, through fear of litigation, to encourage doctors to have a clocking-on and clocking-off culture. That is wrong; it is against the duties of the doctor, as laid down by the GMC; it is against what medical professionals want to do, because they care about their patients; and it is actually bad for patient care, for all the reasons that were outlined earlier by my hon. Friend.

My hon. Friend said that we do not want to go back to the bad old days of 100-hour weeks. I worked those 100-hour weeks, and I am sure that the other medical doctors who are in Westminster Hall today did so, too. It was certainly not ideal to work 100-hour weeks; it was not good for patient care. However, the point that was made earlier is that there is actually a happy compromise between doctors working a rota pattern—one that allows for training, continuity of care and proper treatment of patients—and ensuring that doctors have proper rest and are in a fit state to look after their patients. That happy compromise can be achieved. As has been highlighted already in speeches and interventions, it has been achieved in many countries within the European Union, and we should be able to achieve it effectively in this country, too.

The point that has been highlighted is that the previous Government dressed up the introduction of these reforms in the idea that they would be better for doctors with families and better for doctors’ training. In fact, neither of those things have actually come to pass. Doctors’ training has suffered as a result of the introduction of the EWTD in this country. Doctors do not get enough on-the-hour time with patients, and because many hospitals are forced into looking at service provision—in other words, having enough doctors on the ground as a direct consequence of the EWTD—the time allocated for junior doctors to receive proper training has been reduced massively. Given the rigid nature of the rotas introduced under the EWTD, they are often less family-friendly than rotas were in the past when doctors were asked to work more hours than now.

My hon. Friend highlighted the increased rates of sickness, particularly among physicians but also in other specialities where—quite rightly—an increasingly high proportion of women are entering the medical profession. In many cases, the reason why those women are finding things difficult and taking time off work is that they are unable to meet the demands of looking after their family properly. The fixed rotas are damaging to family life. My hon. Friend has made some excellent points.

I will now talk about a few other issues that are important to highlight in this debate. The Minister is working hard on our behalf to address the EWTD issue, by raising it in Europe for the Government and ensuring that we can put right what the previous Government got wrong. The issue of locum doctors goes to the heart of out-of-hours care. Many hon. Members, particularly those of us with more rural constituencies, have experienced the previous Government’s reforms of out-of-hours care by GPs. Thanks to those reforms, we now have a system that is not fit for purpose. We have locum companies running local out-of-hours care on the basis of care models that are, in many respects, not fit for purpose. Many locum companies often employ out-of-area doctors who do not understand local patients to run those services.

[Andrea Leadsom (South Northamptonshire) (Con)]

I am grateful to my hon. Friend for giving me the opportunity to make my point. Does he agree that there is also a great concern about the fact that other European legislation means that the GMC cannot systematically check locum doctors’ ability to speak English and communicate with their patients and that that is also putting patients’ health at risk?

[Dr Poulter]

My hon. Friend makes a very good point and the issue that I was just raising—that of locums and out-of-hours care—ties in very well with it, because those checks and balances very much occur in the sector of locum work. To fill staff vacancies in GP rotas in primary care and in hospital rotas, doctors are often rushed in at short notice from locum firms, even though we have not necessarily got the proper checks that would be in place when doctors are working in hospitals.

As I have said, doctors from overseas make a huge and valuable contribution to the NHS, but they do so when they have been familiarised with the British medical system and they are embedded in our hospitals up and down the country. However, there is a real danger: when we have an over-reliance on locums, which is a direct consequence of the EWTD, the problems that my hon. Friend has highlighted occur, and that has damaging effects for patients.

The key issue for me in this debate is the continuity of care. The point has already been made in interventions that bad things happen to patients at weekends and out of hours, because there are fewer doctors, nurses and members of staff working in the hospital. If we have a system in place whereby doctors are clocking on and clocking off and they are encouraged to do so because hospitals are worried about the dangers of litigation and that encourages the handover of information to another professional because people think, “I’ve finished now; it’s not my job anymore,” that will encourage bad things to happen out of hours.

[Rebecca Harris (Castle Point) (Con)]

On that critical point, is my hon. Friend aware of the effect that that is having on patients and their relatives? They know that something is going on. People are saying, “How is it that highly qualified doctors did not recognise that my relative, who was chatty, friendly and bright eight hours ago, is now distant and uncommunicative?”—something as simple as that. Without years of medical training, they know something is going very wrong.

[Dr Poulter]

My hon. Friend makes a very good point. Continuity of care really matters in terms of what is good medical practice, good for relatives and good for patients. Traditionally, one team took responsibility for looking after a patient and providing holistic care to their family, particularly end-of-life care or when a patient took a turn for the worse. It is not acceptable for a doctor with no previous knowledge of that patient or their family to deal with sensitive circumstances. Indeed, it is very difficult to have any sense of good care when care is continually handed over, in a pass-the-parcel fashion, to the next person who picks up the baton after a shift is timed out—that is not good care. It is bad for patients, bad for families and particularly bad for distressing end-of-life care and the care of the elderly.

For all those reasons, we need to sort out the EU working time directive. It is bad for medicine. It is bad for doctors. It is bad for doctors’ training. It is bad for patients. I know the Minister is on our side and that the Government are working hard. I look forward to hearing the Minister’s comments, and I pay tribute again to my hon. Friend the Member for Bristol North West for securing the debate.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 27th March 2012 Commons Chamber

[Mr Burns]

With regard to the transfer of patients, we are seeking to give greater choice to patients under the modernisation programme so that they can move from one GP, or one GP practice, to another in a way that they cannot do at the moment. That will help to enhance the power of patients to get the GP of their choice and preference.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I am sure that the Minister would agree with me about the importance of addressing alcohol misuse through the alcohol strategy announced last week. On the performance management of GPs, however, does he agree that we need to do more than just monitor how much people drink, and that we need to ensure that GPs are incentivised to tackle the problem drinkers who attend their surgeries?

[Mr Burns]

Yes, my hon. Friend raises an important issue. We must ensure that every contact counts, and that there is greater working between GPs and patients to help to deal with what is a significant problem among certain sections of the community.

Health and Social Care Bill

Dan Poulter Excerpts

Tuesday 20th March 2012 Commons Chamber

[Mr Speaker]

Order. The Secretary of State has indicated that he wishes to speak later in the debate—[Interruption.] Order. That is his absolute prerogative. In view of the level of interest in the debate, it will be helpful for the House to know at this point that a five-minute limit on Back-Bench speeches is to be imposed immediately. I call Dr Daniel Poulter.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

indicated dissent.

[Mr Speaker]

He was in, on the list and at the top. If he does not wish to speak, so be it.

Health and Social Care Bill

Dan Poulter Excerpts

Tuesday 20th March 2012 Commons Chamber

[Liz Kendall]

No, I am going to proceed.

Let me remind hon. Members that the Bill started out without any requirement for GP consortia—as they were then called—even to have a board to govern their work, let alone any measures to deal with potential conflicts of interest. On 3 March last year, in the first Commons Committee stage, Labour Members called for effective corporate governance and robust measures to deal with conflicts of interests in clinical commissioning groups.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

rose—

[Liz Kendall]

I am going to finish this point.

The Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow), said that all and any changes to those provisions were “unnecessary”, and denied that there was any lack of effective governance. I would remind Liberal Democrat Members that the Minister argued that putting a board in place or dealing with conflicts of interest would mean that clinical commissioning groups would fail to be “liberated”. Those criticisms were among the many issues that were supposed to be dealt with when the Government embarked on their now infamous “pause” in the Bill’s progress last spring, but they were not. The Government were therefore forced to return to the issue in the other place. However, the amendments before us are still weak, incomplete and ineffective.

The Government say that clinical commissioning groups will have to include in their constitutions how they intend to manage conflicts of interest. However, I am afraid the Government are deluded if they think that the national NHS Commissioning Board will be able adequately to scrutinise whether hundreds of clinical commissioning groups are properly implementing the measures in thousands of contracts, particularly when the board has already taken on so many other huge responsibilities for managing the Government’s new system. Giving Monitor powers to scrutinise clinical commissioning groups is inadequate for the same reason. Saying that Monitor can deem a clinical commissioning group’s contract to be ineffective, if it thinks that conflicts of interest have not been dealt with, will in effect mean closing the stable door once the horse has bolted. Indeed, there could be huge problems on the ground, as a provider may have already started delivering services to NHS patients by the time Monitor takes its decision.

Labour’s Front-Bench team in the other place tabled a comprehensive amendment to deal with conflicts of interest in clinical commissioning groups. It would have ensured a code of conduct for how clinical commissioning groups register, manage and report on conflicts of interests among its members and employees, and imposed a duty on CCG members to abide by the code. The amendment would have ensured that no member of a clinical commissioning group could take part in discussion or decisions concerning any provider of services with which that person had a registrable interest, and allowed the Secretary of State to appoint an adjudicator to investigate complaints about any breaches of the code, with a range of financial and other sanctions available, including the ability to suspend or remove a person from the clinical commissioning group. However, the Government rejected that comprehensive amendment, saying that such sanctions were unnecessary.

The Government have agreed to Lords amendment 31, which at least says that there must be a register of interests for a group, along with its governing body, sub-committee and employees, and that the register must be kept up to date, with information updated within 28 days. That change is welcome, but it does not go anywhere near far enough in ensuring that conflicts of interest are robustly dealt with. That is why our amendment (a) to Lords amendment 31 would ensure that members of a clinical commissioning group would not be able to take part in discussions or decisions about services in which they had declared a registered interest, which is the same format as in local government.

--- Later in debate ---

[Grahame M. Morris]

I have concluded my remarks, so perhaps the Minister can address those points in his summing up.

[Dr Poulter]

I shall make some brief remarks, but I first want to welcome the renewed focus on integrated care, as outlined by the Minister this afternoon. He clearly outlined the importance of mental health services and clarified that the primary duty in commissioning will be to ensure that there is integrated care.

We all know the importance of dealing with the biggest challenge facing the NHS, which is how we are going to look after our ageing population. How are we going to improve the care for the increasing numbers of people living longer, which is a good thing but poses a big financial challenge for the NHS as well as a big human challenge in how to look after them? How are we going to address the challenge of looking after people living at home with diabetes, heart disease and dementia?

This Bill goes a long way towards meeting those challenges, and I believe that the renewed focus on integration is key and vital. It is only by different services and different parts of the NHS working together effectively—with primary care working effectively with hospitals, as well as with social services—that we are going to meet the big financial and human challenge of improving the care of older people. That is why I am reassured—I hope that my Liberal Democrat colleagues will also be reassured—by this renewed focus on integration, which is at the heart of the debate and at the heart of the way in which we will make our NHS meet future challenges.

Let me deal briefly with the Opposition amendment 31, which deals with what they believe is an inherent conflict between people involved in delivering care—health care providers or GPs—and others when it comes to involvement in the clinical commissioning groups. The amendment ignores the fact that, at present, good commissioning involves a partnership with primary care trusts that were set up by Labour when they were in government. GPs who are engaged in the provision of health care in local communities are involved in PCTs and involved in the Government arrangements for PCTs, working in partnership with local managers. So, if it was good enough to have that inherent partnership in the current structures set up by the previous Government, I do not see why, when we all believe that clinical leadership is a good thing in the NHS, a conflict of interest should suddenly be created under the Bill. That does not make sense; it is not intellectually coherent. For that reason, we must oppose the amendment.

We have before us more reassuring amendments to promote integrated care, to focus it on more joined-up thinking between the primary and secondary care sector, and to ensure that we do not have to deal with patients with mental health problems only when they get to the point of crisis. The focus on integrated care will mean that they are better supported in their communities. Opposition amendment 13 is, as I have explained, inconsistent with how they managed the NHS when they were in government.

--- Later in debate ---

[Mr Simon Burns]

rose—

[Dr Poulter]

I thank the hon. Lady for her intervention, but I will give way to my right hon. Friend the Minister before I respond to it.

[Mr Burns]

The hon. Lady may not fully appreciate this, but the regulations refer to a minimum of two lay members. There is nothing to stop a clinical commissioning group from appointing more than two.

--- Later in debate ---

[Dr Poulter]

I thank my right hon. Friend for that clarification. The Government are clearly committed to the value that lay members bring to commissioning groups, and, as my right hon. Friend has said, two is the minimum. I hope the hon. Lady will accept that it is very disingenuous to suggest that lay members who are appointed to boards of hospitals or primary care trusts, or indeed to commissioning boards, show a lack of genuine care for patients in the way in which they commission services.

Given that the Opposition have tabled a bad amendment, and given the renewed focus on a commitment to integrated care for the benefit of older patients and people with mental health problems, I believe that we should support the Government this evening.

[Alex Cunningham (Stockton North) (Lab)]

I support the amendment relating to Monitor and NHS foundation trusts. The Government seek to amend the Bill to allow—[Interruption.]

--- Later in debate ---

[Andy Burnham]

I have answered the right hon. Gentleman’s question. It was an entirely different situation altogether.

On the suggestion that we are setting our face against reform, we have not said that, and I as Secretary of State initiated a review of the private patient cap, because the issue came up before the election. I was prepared to allow a modest relaxation of the cap if it could be demonstrated to benefit private patients, but I was talking about single percentage points: 1% or 2% becoming 2% or 3%. I was not in any way conceiving the possibility that 49% of a trust’s income might be made from the treatment of private patients—that half their theatre time, beds and car parking spaces could be turned over to the treatment of private patients.

[Dr Poulter]

I hope that the right hon. Gentleman will concede that those hospital trusts with a private patient cap that is set at perhaps 35%, such as the Royal Marsden hospital, do not necessarily do that much private work. The decision is at the hospital’s discretion, so the idea that raising the cap to 49% will mean that hospital trusts will per se undertake 49% private activity has been proven to be incorrect, on the facts as they stand at the moment in hospital trusts, because those trusts, the doctors and boards work for the benefit of their patients.

[Andy Burnham]

That is the ideological difference between us. The hon. Gentleman says that the decision should be at the hospital’s discretion, but the Bill essentially sets everybody on their own. Hospitals are being told, “You’re on your own. There’s none of the support from the centre any more, no bail-outs, as the White Paper said. That’s it, you’re out there, you’re competing in a market, and you’ve got to stand on your own two feet.” I differ from that opinion because I want systems regulation and a role for the centre in deciding whether a hospital should greatly increase its treatment of private patients.

This is not just a question of each individual hospital thinking about what it is going to do, because hospitals will have pressure on their bottom lines, as a colleague said earlier. They will be operating in a difficult financial context, and it might have a different effect on their individual interests. It might make sense for hospitals, individually, to increase the number of private patients, but it might not make sense for the NHS patients who live in that area, and that is the entire point: the Government are trading systems regulation for the individual decisions of local organisations, because that fits when we move to a competitive market in which every individual organisation is a competing business.

[Dr Poulter]

I am struggling to follow the coherence of the right hon. Gentleman’s argument. On the one hand he says that it was all right for non-foundation trusts, under the previous Government, to increase massively the amount of private work that they did, as long as the Department agreed with it; on the other hand he argues that it is very important to control the amount by which foundation trusts raise the private patient cap. He cannot have it both ways, and his argument is not intellectually coherent. Is this not about doing things for the benefit of patients and leaving it up to local hospitals to decide?

[Andy Burnham]

The hon. Gentleman should make a speech if he wants to make interventions of that length. We had a cap to protect the interests of private patients; he is getting rid of the cap, and he is going to have to explain to patients in his constituency, if waiting lists start getting longer, why that is happening. It is as simple as that. We had systems regulation, he is removing that with the Bill and we are moving to a more unregulated market, which is not what we want to see.

--- Later in debate ---

[Andy Burnham]

I am afraid that I am not at all reassured by that, or in fact by anything the Minister says. The letter that we have from the Deputy Prime Minister spoke of insulating the NHS from European competition law, but I am still waiting to see the amendment that delivers that. As I understand it, one of the Minister’s noble Friends tabled an amendment and then withdrew it, because they did not have the courage to press it to a vote, and accepted a statement on the record instead. This is different from what the Minister keeps saying that we did in government, because he is envisaging a huge expansion of the role of any qualified provider and the putting out to tender of commissioning support units. He has overseen a situation in which three community services have been compulsorily tendered.

The truth is that the Clegg-Williams letter, with the amendments that followed, does not only fail to deliver but sells out the national health service, as does so much of what the Liberal Democrats have agreed to. Our amendments, particularly amendment (b), would provide a measure of systems regulation in the best interests of the NHS, and that is why we will seek to press amendment (b) to a vote.

[Dr Poulter]

I rise to speak in support of the Government, and of what the previous Government did for the NHS. When the shadow Secretary of State was Secretary of State for Health—the same was the case with many of his predecessors—there was a consistent policy whereby the private sector should be used where it could add value to patient care in the NHS. That was done very effectively by the previous Government to bring down waiting times for operations, but it was not effective when it was not done in an integrated way. Very often, it was done without regard to post-discharge planning for patients but, as we heard earlier, the renewed focus on integration should help to deal with those problems.

We have some of the very best hospitals not only in this country but in the world, including the Royal Marsden and Moorfields eye hospital, where a relatively high proportion of activity is carried out by the private sector. No one doubts those hospitals’ commitment to their NHS patients or that they still provide those patients with the very high standards of care of which health care systems in other countries are very envious. We are very proud of what those hospitals do, and the Government would like to give other hospitals the same opportunity and freedom to follow their example. The Government believe that it is absolutely appropriate that we should use the private sector where it can enhance value to NHS patients. That is absolutely consistent with the previous Government’s policies, for which many Labour Members campaigned at the last general election. This Government are also committed to those policies.

[Andrew George]

I understand and respect the sincerity of the principle that my hon. Friend is describing, but can he reassure me, particularly given his understanding of the NHS and health systems, that under these proposals it would not be possible for a foundation trust to drive some NHS patients towards the private arm of the activities that they undertake, particularly in the case of procedures that are exactly the same in the private and the public sector?

[Dr Poulter]

My hon. Friend makes a valid point, and he is right to raise it. That happened in the past when, under the previous Government, private sector providers were paid 11% more for the provision of services than NHS providers, which created an incentive for the private sector to be used ahead of NHS services. This Government are committed to ensuring that that does not happen. My hon. Friend the Minister and my right hon. Friend the Minister and Member for Cheltenham—[Interruption.] I mean Chelmsford; I apologise, particularly as I get the train through his constituency on the way home every Thursday night. They have clearly stated that the Bill is about making sure that we use the private sector when it adds value for money. The hospital that uses the private sector the most—the Royal Marsden—does not have a two-tier service for NHS patients and private patients. The involvement of the private sector at that hospital greatly enhances the work of the NHS and the quality of service and care available to its NHS patients because of the increased research that is performed, the high quality of care, and the high standard of clinicians who are attracted to work there. That works well for the private sector and for the NHS.

I agree with the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) that, where possible, we should be using NHS providers. The Royal Marsden, where there is a high potential cap on private sector involvement, does not use the full capacity of that cap, and there is less private sector activity than it could undertake. That is because the Royal Marsden says, in effect, “Yes, the private sector is good, but it is not only about maximising our cap and maximising our profits but taking into account the best interests of our local patients and striking a balance.” That works very well.

[Andrew George]

As I understand it, the majority of the private work at the Royal Marsden is in areas such as research and development that are not in any way similar to the services it provides to NHS patients. I asked my hon. Friend whether he agreed that where the private sector and public sector were providing the self-same services for NHS patients, there was a risk that patients might be driven from the NHS towards the private sector.

[Dr Poulter]

I hope I reassured my hon. Friend with my earlier answer. Yes, he is right that that has happened in the past. However, there is a presumption in the Bill—particularly for rural areas such as Cornwall and in Suffolk, which I represent—that the renewed focus on integrated care that we heard about earlier is the primary focus and purpose of commissioning, over and above the use of any willing provider or private sector providers. That has given me great reassurance regarding our ability to take on and deal with the big demographic challenges of looking after older people better.

I am reassured by what the Minister has said, and I urge Government Members to support the Government.

[Alex Cunningham]

I rise to support the amendment and to speak against anything that will allow 49% of the capacity of our local hospitals to be used for private patients.

Along with other measures in the Bill, the Government have accepted various amendments that will result in lengthening waiting lists for NHS patients. The Government’s relaxation of NHS waiting times targets means that hospitals are free to devote more theatre time to private patients, and they will have a clear incentive to do so in order to maximise income, given the move towards full financial independence and a “no bail-outs” culture whereby hospitals in financial trouble are allowed to go bust with no help from the Government.

The Health and Social Care (Community Health and Standards) Act 2003 placed a cap on the level of income that a foundation trust could earn from private patients. It was based on the level of a foundation trust’s private income in 2003—the year when foundation trusts first came into being—which was typically about 2%. The Bill in effect sets trusts free to deploy as much as 49% of that capacity to generate income from private patients who can afford the fees to jump the queues, which ordinary hard-working people, and the most vulnerable in our society, cannot do. This is not what patients want, not what the professionals want, and not what the NHS needs.

The Government amendments must be changed to ensure that any increase in the proportion of patient income has the approval of Monitor. Allowing individual trusts to make the decision alone means that there is no strategic overview, which Monitor would offer, and so in theory it would be possible for all the trusts in a locality to make that increase to 49% if their individual boards approved it. I wonder what that would mean on Teesside. We have two major hospitals, so half the capacity for NHS patients could go. Labour’s amendment would set a tougher cap on private patient income. Without the amendment, the NHS will take a huge step towards privatisation and we will fail to put in safeguards to ensure that the needs of the general public are met. Rather than the NHS being free at the point of delivery, more and more people will be pushed towards insurance schemes, thereby putting money in the pockets of the insurance industry and denying the exceptionally important right to have free, high-quality health care when it is needed.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Burns]

It is a bit rich for the former Secretary of State to bleat about that. What I want is the finest health care for patients so that they are treated more effectively and quickly and their long-term conditions are managed in a way that enhances the patient experience.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

4. What steps he is taking to address underperforming hospital management teams.

[The Secretary of State for Health (Mr Andrew Lansley)]

The performance of hospital management teams is the responsibility of their boards. Those are accountable to strategic health authorities for NHS trusts, and foundation trusts are accountable to their governors to ensure that they comply with Monitor’s framework. As part of our work to strengthen NHS trusts so that they can reach foundation trust status, we have published guidance on strengthening trust boards, their clinical leadership and management. We are further strengthening accountability through quality accounts and open reporting so that the public can see the absolute and relative performance of all NHS service providers.

[Dr Poulter]

I thank my right hon. Friend for that answer. It is absolutely right that managers take responsibility for the decisions that they take at a local level on behalf of patients and are held accountable for them. A doctor or nurse who fails in their duty can be struck off, so there is clear accountability, but there appears to be no clear accountability or traceability for the decisions of hospital managers. Who will hold those people properly to account when they have failed?

[Mr Lansley]

My hon. Friend knows that the management of trusts should be accountable directly to their boards. As I said, the management of foundation trusts are accountable, through their boards, to their governors. An important point that arose in relation to Mid Staffordshire NHS Foundation Trust is that we should ensure—we are looking at how to fulfil this—that there is also a code of practice to which managers are held accountable. He knows, as I do, that management must be accountable through their boards.

NHS (Private Sector)

Dan Poulter Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

The Minister of State says that is right, and he is free at any point to get up and challenge what I say or to prove how he can make that statement. I will give him the opportunity to do so soon.

The Prime Minister could not have been clearer—“no privatisation”. Similar statements were made during the pause by the Deputy Prime Minister. On the Marr programme on 8 May, he promised that safeguards would be brought forward in the health Bill. He said:

“What you will see in this legislation are clear guarantees that you are not going to have back-door privatisation of the NHS.”

He followed that up on 14 June with this promise:

“Patients, doctors and nurses have spoken. We have listened. Now we are improving our plans for the NHS. Yes to patient choice. No to privatisation. Yes to giving nurses, hospital doctors and family doctors more say in your care. No to the free market dogma that can fragment the NHS.”

Those statements from the Prime Minister and the Deputy Prime Minister were significant for two reasons. First, they revealed an understanding at the top of Government about how, more than anything else, fears about privatisation and the market in the NHS were driving professional disquiet about the Health and Social Care Bill—a Bill that was sold as putting doctors in charge but that had a hidden agenda of breaking up the structures of the national planned health system to allow a free market in health. Secondly, they implied that major changes to address those concerns would be made to the Bill and that there would be a return to the existing policy of the managed use of the private sector within a planned and publicly accountable health system.

Let me be clear. As our motion states, we believe that there is a role for the private sector in helping the NHS to deliver the best possible services to NHS patients, and that was the policy we pursued in government. Without the contribution of private providers, we would never have delivered NHS waiting lists and times at historically low levels, but let us put this in its proper context. Our policy was to use the private sector at the margins to support the public NHS. So, in 2009-10, 2.14% of all operations carried out in the NHS were carried out in the independent sector and spend in the private sector accounted for 7.4% of the total NHS budget. I would defend those figures, because that helped us to deliver the best health care to the people of this country.

Furthermore, we supported a system allowing foundation trusts to generate income at the margins of their activity from treating private patients but with a clearly defined cap to protect the interests of NHS patients at all times.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Does the right hon. Gentleman accept that the cap was not clearly defined but was very variable according to the hospital, and will he now say that it was wrong for the previous Government to set the cap at over 30% for the Royal Marsden hospital, which is a centre of excellence?

[Andy Burnham]

I agree that the cap varied according to historical levels of private sector activity within the different trusts. The hon. Gentleman is absolutely right about that, but he must agree that it was clearly defined in respect of every individual NHS hospital. They had a clear number and local people were able to hold them to account for that number. Where hospitals had large numbers, the cap froze their level of activity at the level when the cap was introduced.

--- Later in debate ---

[Andy Burnham]

There are a lot of questions there. The Secretary of State discusses the safeguards, but he has introduced them precisely because he has made a major break with 63 years of NHS history. He needs them because he wants a different health care system in this country, in which much more work is done by private providers and in which the commissioning of services is largely handed over to the private sector. That is why he has had to introduce those safeguards. We had a health service that was planned, managed and publicly accountable, but he is throwing all of that away.

[Dr Poulter]

I thank the right hon. Gentleman for giving way; he is very generous. Does he not agree that the two hospitals with the highest patient cap—the Royal Marsden and the Royal Brompton—use the money that they make through private income very effectively, and put it back in to make them centres of excellence for all patients, particularly their NHS patients?

[Andy Burnham]

That was the policy of the previous Government, but the cap was clearly defined. It was a tight cap, and it reflected historical levels of work. What we are talking about is a liberalising measure to enable the private sector to double if not quadruple the amount of work that it is doing, which is why we are debating the motion.

I shall pose a question for the Health Secretary, who mentioned safeguards. If it is all fine to create a different NHS in which we have many more private contracts, might not the NHS risk register have something to say about the risks of creating such an NHS and the additional challenges of delivering health care through a system based on commercial contracts? Might it not lead to a diversion of spending on lawyers and consultants, away from patient care? Is there not a great irony, as we have heard the Health Secretary bemoan a lack of ability to intervene in the recent situation while, at the same time, here he is promoting a Bill that removes his ability to do so on a much wider basis? He wants to hand over his ability to intervene to the independent NHS Commissioning Board. The irony of his position will not be lost on many people listening to the debate.

--- Later in debate ---

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is always a great pleasure to follow the right hon. Member for Holborn and St Pancras (Frank Dobson), but he was rather disingenuous about my right hon. Friend the Member for Charnwood (Mr Dorrell). My right hon. Friend said—I think we all agree about it—that where the private sector can add value for money and add value to patient care that always has to be a good thing, as well as something that I think Members on both sides of the House agree on.

My right hon. Friend made the point, which was also well made by the right hon. Member for Leigh (Andy Burnham), that this is not a debate about whether the private sector is a good thing or a bad thing in the NHS; it is a good thing, clearly, where it improves care for patients and offers high-quality patient care. The debate is about whether having a cap on the role of the private sector in foundation trusts is a good thing.

It appears that the private patient cap is set arbitrarily and varies from trust to trust. On the basis of what we know, it is difficult simply to argue that having the private sector heavily involved in the workings of a trust is necessarily a bad thing. We know that the 30% private sector activity at the Royal Marsden is hugely beneficial—not only to the private patients, but to those patients looked after by the Royal Marsden who are NHS patients. We see the same at the Royal Brompton, Moorfields and many other hospitals with a relatively high private patient cap. At those hospitals, the money raised from private activities and the private sector is pumped back into the hospital to improve research and to provide high-quality patient care for all NHS patients at those hospitals. Simply saying that having the private sector involved in a hospital to a larger extent is a bad thing because it compromises patient care is plainly not the case. Some of the best hospitals make the case that, in fact, a cap set at a high level is right. As my right hon. Friend the Secretary of State said, at hospitals such as the Marsden, even when they could set 30% private activity, they use only a proportion of that cap, because what they look at first is their primary duty to their NHS patients and their primary duty to provide high-quality care.

It is difficult to argue for a cap set at an arbitrary level, because what everyone in the NHS is interested in, and what we in Parliament are interested in, is producing high-quality patient care. In that respect, my right hon. Friend the Member for Charnwood was absolutely right. Tony Blair believed that, and it was at the heart of his health care reforms. In that respect, the Government are carrying forward the mantra of patients’ best interests.

I have discussed a little the fact that an arbitrary cap does not work, and is not in patients’ best interests. I have also discussed the benefits that involving the private sector in hospitals can bring to NHS patients. The good thing about those hospitals, particularly the Royal Brompton and the Royal Marsden, which are centres of excellence, is the fact that private sector involvement improves the quality and the output of medical research. That is another reason why those hospitals are pioneering examples of high-quality patient research, which benefits patients, particularly in the NHS. This is a good motion, as it endorses the role of the private sector, which can be a good thing as long as it is for the benefit of patients. However, it is a bad thing to impose arbitrary caps that do not benefit patients.

Breast Implants

Dan Poulter Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

For reasons that I have already explained, the hon. Gentleman is simply wrong about that. It is nonsensical to attempt—as the editor of The Lancet did this morning—to compare the regulation of private providers of private care with that of private providers of NHS care. There is no comparison at all.

The CQC will inspect a sample of providers of cosmetic surgery to check that they are meeting registration requirements, and will undertake a number of unannounced inspections as part of that. We expect the inspections to be completed by the end of the month, and expect the CQC to have published its report by the end of March. It has confirmed that it has enough resources to undertake the inspections within its existing budget.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I add my support and thanks to the Secretary of State for what he is doing on this very important issue which has caused so much distress to so many women. Does he agree that this episode flags up a wider issue in the cosmetic surgery industry, in that some practitioners performing medical procedures do not have any medical qualifications or knowledge of anatomy? Does he also agree that it is a problem that there is no psychological counselling and that a holistic look at patients is not taken, as this is an on-demand industry? Finally, does he agree that there must be a proper paper trail and record system in the industry, so that we can consider what is in the best interests of patients and so that there is proper accountability for all providers?

[Mr Lansley]

My hon. Friend makes a number of important and perceptive points. It is, and will continue to be, one aspect of NHS advice that psychological assessment can form an important part in the management of patients referred for low-priority procedures, including cosmetic surgery. However, although we will look at cosmetic interventions and their regulation more widely, we must recognise that the issue in this instance related to what was a criminal act—seeking to adulterate the material in the implants. Many private providers were using what they regarded as properly certified implants for a perfectly proper procedure. To that extent, they were not engaging in any improper behaviour. However, they have legal and moral obligations to their patients, and I am asking them to discharge those obligations.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 10th January 2012 Commons Chamber

[Anne Milton]

As I said, my colleagues in DECC are working closely with the energy companies. I point out to the hon. Gentleman that this coalition Government are the first to put in place the cold weather plan to reduce those 27,000 excess winter deaths. Perhaps his local paper would like to contact the Welsh Assembly Government to see what they are doing.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Fuel poverty clearly shows the link between housing, health care and well-being. Last week, the Prime Minister called for a merger of health and social care. Does the Minister agree with me that if we are to have a true merger of health and social care, housing—through health and wellbeing boards and other mechanisms—has to be a key ingredient of that?

[Anne Milton]

Of course, my hon. Friend is absolutely right that the integration of health and social care is critical, particularly for issues such as this. The changes we are making to public health and the movement of public health into local authorities will only ensure better integration, so that we can reduce those 27,000 excess deaths.

Organ Donation

Dan Poulter Excerpts

Wednesday 9th November 2011 Westminster Hall

[Paul Uppal]

I thank the hon. Gentleman for his intervention. No one in the Chamber would in any way, shape or form underestimate the suffering of those who need a transplant. I am a trustee of a Sikh temple, and I have been approached specifically about the matter and people’s real concern about it. I have felt the pain that many families feel. We may leave the main thrust of the debate today, but I am sure that we will revisit the issue. I accept completely what the hon. Gentleman says, but for the time being we must go along the path of sequential progress.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing this debate. He highlighted very well the fact that organ donation in urban areas is much lower than in more rural areas. That is partly due to population churn, but also because, as he rightly highlights, it is difficult to persuade people in black and ethnic minority communities to come forward and agree to organ donation. There are some cultural barriers to organ donation. How can we break down those barriers and focus on what really matters—ensuring that people have a chance of life?

[Paul Uppal]

I thank my hon. Friend for his intervention. As I said, I am a trustee of a Sikh temple, and I think it is important that we continue to spread that message in mosques, gurdwaras, mundas and temples in any shape or form. It needs to be consensual. It is about breaking down stigmas and prejudices that may be out there in certain communities. I would be very much in favour of anything that does that, and I have personally done that in my own constituency.

--- Later in debate ---

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate the hon. Member for Wolverhampton South West (Paul Uppal) on securing this debate, and on squeezing so much in. There were so many interventions that it felt almost as if a 90-minute debate had been fast-forwarded to include everything. I appreciate his approach, and the substantive contributions that we have heard during the short time in which we have debated this important issue. Transplantation is one of medicine’s great success stories, and I know that the hon. Gentleman has taken a keen interest in the subject for a considerable time. He is right to hold the Government’s feet to the fire when it comes to ensuring that we maintain progress in such an important area.

The coalition Government are absolutely committed to increasing the number of organs available for transplantation, and we believe that as many people as possible who need a replacement organ should be given the opportunity to benefit from a transplant. In many ways, the success of transplantation surgery and advances in technology have led to the current challenges of unmet need that have been described so powerfully and with personal examples.

Some 10,000 individuals now require a transplant, and tragically about three adults or children die every day either waiting for a transplant or after being taken off the list because they have become too ill. The hon. Member for Newport West (Paul Flynn) mentioned a blog that details the suffering and misery endured by families while they wait for a transplant, and that speaks volumes about why we must do more work in that area.

The Organ Donation Taskforce’s recommendations, published in its first report, “Organs for transplants”, in January 2008, were broadly based around the need for investment in the donation infrastructure. That is to ensure that the UK maximises its potential for donation rates, and makes organ donation a usual part of health care.

The Welsh Government’s recently published White Paper on organ donation has been referred to, and we will study their proposals carefully. In 2008, however, the independent Organ Donation Taskforce also examined the case for moving to an opt-out system but recommended against it, concluding that, although such a system might have the potential to deliver benefits, it would also present significant difficulties.

My hon. Friend the Member for Montgomeryshire (Glyn Davies) rightly drew attention to Spain, and the fact that, despite the enactment of a similar opt-out scheme in 1979, a significant transformation in the level of performance took place only after investment in infrastructure in 1989. The taskforce has drawn lessons from the Spanish experience, and it is right that we are guided by evidence.

I was asked about the taskforce’s intention that we achieve a rate of organ donation of at least 50% by 2013. That is certainly our aim, and we are on track to deliver it. Significant resources have been made available to implement the taskforce’s recommendations—largely through NHS Blood and Transplant—to increase the number of specialist nurses, who are a critical part of the system, and to appoint clinical leads, donation committees and donation chairs in acute trusts to drive improvement locally.

[Dr Poulter]

As the Minister will be aware, in 1994, there were 2,500 people on the organ donor waiting list, and last year there were over 7,500. Only 29% of the UK population are signed up to organ donation, which is woefully inadequate given that 552 people died last year while waiting for an organ transplant, excluding those who were taken off the list because they had become too unwell. It is a big problem; people are living longer, sometimes with multiple medical co-morbidities, which means that more people will need transplants. The problem will become an increasing challenge for health care providers and the Government.

Philosophically, I agree with the Minister and I am not in favour of compulsion. Does he agree, however, that we need a more targeted community-focused approach and, as with the cot death campaign that reduced cot deaths from 2,000 to about 300—

[Philip Davies (in the Chair)]

Order. Interventions must be brief.