North East Ambulance Service

David Anderson Excerpts

Wednesday 4th May 2016 Westminster Hall

[Mr David Anderson (Blaydon) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) on securing this debate.

I declare an interest as a former chairman of the northern region of the National Union of Public Employees and as a former president of Unison. For 15 years I had the privilege of representing ambulance staff. I first became their representative a year after they were described by the right hon. and learned Member for Rushcliffe (Mr Clarke) as little more than glorified taxi drivers. We were in the middle of an ambulance dispute at the time, so he probably did not really mean what he said, but there is one thing for sure: the staff are true professionals trying their hardest against insurmountable odds to try to deliver the quality public service that we all rely on, and it was to them I turned for this debate.

A constituent of mine retired from the ambulance service last year due to stress-related illness. I asked him, “What is the picture today? Can you give us some idea?” and he sent me an email this morning in which he said a number of issues have been going on for quite some time. He said that there is huge pressure on the services, especially over the winter period, and they ask the public to call only in genuine emergencies. Increased waiting times outside A&E hold up crews continually. The shortage of funding and paramedics results in long waiting times for patients. He goes on to say that they rely on charities to supplement the shortfall. They recently had to call on a charity to supply volunteer doctors over Easter to help with the response to the most urgent calls. There is a shortage of at least 15% of qualified paramedics and a large increase in the use of private companies, but the capabilities of such staff are not known. According to Unison, staff stress levels have increased and 90% of staff say they have suffered work-related stress owing to long hours and staff shortages. One member is quoted as saying that the levels are dangerous. There is also the ongoing issue of the Government continuing to put pressure on people whose morale is low by keeping in place an eight-year public sector pay freeze. People doing very important work are being penalised for doing it.

Like my hon. Friend the Member for North Durham (Mr Jones), I asked my office to give me a snapshot of the information that people have been feeding to us. I will quote from some emails. Pam, who lives in my constituency, wrote:

“Hi Dave, developed a problem with my left leg which according to 111 merits an emergency ambulance to take me to A&E. I have had a phone call from a paramedic apologising for the delay but please can you tell the Tory toffs that I have waited 2 hours for this ambulance and still no signs.”

Someone from Swalwell, near the very busy A1 in my constituency, wrote:

“An old man, aged 74, had to wait (lying bleeding on the cold ground in the rain) for 80 minutes for an ambulance. He fell just outside of my house...He was bleeding profusely throughout the entire 80 minute wait. Another neighbour repeatedly called for the ambulance and kept being told they were busy and that ambulances were being diverted to more urgent cases. We were unable to move the gentleman because of the amount of blood he was losing and also we weren’t sure if he had broken anything. He was cold and uncomfortable lying on the wet pavement. I brought out pillows and blankets. Other neighbours brought out bandages and towels and held umbrellas over him. I ended up calling a friend of mine who is a nurse, specialised in head injuries. She arrived very quickly and was able to work out that he was bleeding so heavily due to medication he was taking which was stopping his blood from clotting.”

She concludes:

“I understand there are limited resources but an old man lying in the rain bleeding heavily should not be left for so long. By the time the ambulance arrived, his wife was feeling dizzy and struggling with...shock.”

A 76-year-old went to a councillor’s surgery in my part of the world. She told the councillor that she had had to wait an hour and a half for an ambulance and that when she was contacted she asked why she could not go to the hospital in Hexham, which is closer and where she would normally go. She was told that she was not allowed to go there. She had to go to the Queen Elizabeth hospital, which is at the other end of the A1 and in rush hour is a nightmare to reach. However, they insisted, so she had an hour and a half of waiting and then went to a hospital that made the wait even worse.

Another constituent, Mrs Waller, wrote:

“I recently contacted your secretary...regarding my husband...who is a palliative patient, he had a fall in the bathroom 14th March at 10.05 am and it was 15.20pm before an ambulance arrived. I rang 999 which was the advice given if this ever happened, I had to make a further two calls and my husband’s palliative nurse also made a call as well”,

as did my secretary from my office.

“I do not wish to have a go at the ambulance service but this is the problem that Mr David Cameron has caused due to the cutbacks in the NHS. No one should have to spend almost five and a half hours on a cold wet room floor. There was no way I could get my husband up due to his reduced mobility because of his cancer.”

The North East Ambulance Service is in the Minister’s remit. Basically, she is presiding over unmanaged decline. A hands-off attitude is unacceptable and not worthy of such a cherished institution. My hon. Friend the Member for North Durham spoke about the people who created the health service: the people who can remember what it was like before 1948 and how desperate it was. They have paid into the service all their lives and it is a cherished institution in this country, yet it is being rubbished because of the failures of the service that is in place. We must give the people who run and work in the service the chance to get it back where it was. The Minister needs to talk and listen to the people on the frontline.

Also, we need to listen to the people who pay for the service and for all of us to stand here and talk about it. They are the people who are important in this debate and they are the people who are being let down. The Minister needs to take action and put the ambulance service right.

--- Later in debate ---

[Jane Ellison]

Indeed. I have very much taken that point on board and I will try to respond, but if I do not do so today, I will certainly write to the hon. Gentleman, because it is a fair point. The more general point is where the ambulance service sits in terms of our response and general position on urgent and emergency care. I will respond to some of the points made by my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan), because I think that this sits within a wider, systemic challenge and I want to touch on that.

Every patient should expect to receive first-class care from the ambulance service, but the nature of emergency response work means that there will always be incidents in which unfortunate timing leads to a person assessed as being in a non-life threatening situation calling 999 at the same time as several other people who are in life-threatening situations. I am sure that hon. Members are realistic about that, but clearly we do not want to hear about such problems occurring on a very regular basis. Where that does occur, obviously the life-threatening situations must be prioritised and resources focused on those calls. Very rarely—unfortunately, we have heard about such cases this afternoon—waits may be unacceptably long. I do not shy away from that, but it is important to remember that the vast majority of people receive a timely response when they dial 999.

I have already said, echoing the words of the hon. Member for Washington and Sunderland West (Mrs Hodgson), who led the debate, that although the NEAS has not met the performance targets, that does not reflect on the hard work, dedication and skills of the local staff. A number of speeches brought that out. I am advised that although ambulance delays are the main reason for patient complaints, the number of complaints received in 2015-16 fell, but we do not want any complaints; that would be the situation in an ideal world. However, the fall is indicative of the fact that the efforts of the local ambulance staff are paying dividends. Although the performance target is effective in driving improvements and maintaining response times to the most critically ill and injured patients, it does not, inevitably, paint the complete picture of how a trust is doing.

I will talk about some things that the North East Ambulance Service, has put in place to bring about improvements to service, because that is the focus of the debate and people want to hear that the direction of travel is positive. The NEAS continues to expand the number of specialist clinicians working in its clinical hub who can provide telephone assessment and advice, and who can prevent the dispatch of an emergency response if it is not deemed necessary. That goes to one of the points made earlier. The trust expects that that will have a positive effect on response times.

Last winter, the NEAS piloted an end-of-life-care transport service, which provided three dedicated ambulances that were on call to respond to transport requests from healthcare professionals to take a person to their final place to die. The scheme has meant that emergency ambulances are not tied up in transporting patients when they are needed for more serious cases, and that terminally ill patients are not waiting a long time for transport to their preferred place of death. Although we do not often like to talk about end-of-life care, the preferred place of death is an important part of reducing stress at an inevitably very difficult time for an individual and their family. Results from the pilot were overwhelmingly positive and eased pressure on vital services.

Hon. Members have raised valid concerns about handover times between ambulance crews and emergency departments in the local area, and that is an issue across the country. Patient handover needs to be as efficient as possible to achieve the best possible outcome for the patients and to free up ambulance resource, but more can be done and is being done. Measures include hospital ambulance liaison officers, which are being put in place by the NEAS. HALOs are present in hospitals across the trust territory and I am advised that the trust has sought to make use of dedicated ambulance resource assistants as well.

The urgent and emergency care vanguard programme in the north-east will include the development of a standardised handover process for all acute providers, intended to minimise delays across the patch. That goes to the shadow Minister’s point about looking at the wider system. That will be to the benefit of crews and emergency departments. I understand that, as part of the vanguard, the NEAS also hopes to secure funding for a new “flight deck” information system that will enable diverts by ambulance crews to other hospitals to be proactively managed and will prevent ambulances from stacking up outside already full A&E departments. The trust believes that those initiatives will help to distribute A&E workload evenly and will be welcomed.

Several hon. Members have rightly commented on the recruitment challenge. It is very much recognised that there is currently a shortage of paramedics nationally and the NEAS trust is no different. We recognise that front-line staff are the vital component of a safe, effective and high-performing service, and work is being done by the NEAS to rise to the recruitment challenge. The hon. Member for Washington and Sunderland West mentioned some things that are being done. Efforts include developing new advanced technician roles to support front-line services, and the trust is running a substantive recruitment of paramedics nationally and internationally.

The trust expects 77 student paramedics to graduate by February 2017, in addition to recruiting an additional 36 qualified paramedics in 2016-17. The trust has also recruited a total of 56 emergency care clinical managers, and that represents a significant investment in front-line clinical leadership. It also advises me that it expects to be up to full paramedic establishment by April 2017. I know that that commitment will be keenly watched by hon. Members.

[Mr Anderson]

Ambulance staff, along with other public servants, have effectively had an eight-year pay freeze. Their standard of living has gone down every year for the past eight years. Comparative jobs, particularly in the private sector, have not seen that level of control. There have also been pointers that the situation will not be alleviated in the next two or three years at least. Does the Minister not see that as a real reason that people will not come into the job? Yes, it is a vocation, but people have to put bread on the table.

[Jane Ellison]

Of course I accept that issues of pay are incredibly important. Although we cannot go into the wider economic picture, I gently say that the previous Government and this Government have made reducing the tax bill for some of our lowest paid public servants a huge priority. A huge amount of money is being spent on raising the threshold and that has made a huge difference to people’s take-home pay and standard of living. However, I hear the hon. Gentleman’s point.

I am encouraged that the trust is looking to the future by doubling the number of places on its two-year in-house graduate training programme. Hon. Members have made several thoughtful points regarding some of the wider issues around recruitment and retention. Maintaining staff morale has been mentioned. That is very important and the trust is looking at whether things could be done, other than pay, to attract and retain paramedics. We are looking at that nationally. The debate sits in the context of urgent and emergency care.

Junior Doctors Contracts

David Anderson Excerpts

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. Indeed, if we look at the change happening in global healthcare, the big movement is towards putting patients in the driving seat of their own healthcare. If we want the NHS to be the best in the world, we have to be confident that we are giving patients the best care in the world. That is why I completely agree with him and why I said in my statement that there is no reason why this could not be something the whole House can unite behind. What we cannot do, however, is look at eight studies in five years and say that we will act on this just as soon as we can get a consensus in the medical profession. We have been trying to get that consensus now for over three years. There comes a time when you have to say, “Enough is enough” and do the right thing for patients.

[Mr David Anderson (Blaydon) (Lab)]

I know the Secretary of State does not usually listen to people with a bit of experience, but, as somebody who has spent 40 years dealing with trade disputes and their aftermath, may I ask him how he expects industrial relations to improve when he has imposed a contract, accused the negotiators of lying, and effectively said that the members were fooled by their own negotiators? He has now told us today that he will build into the contract a differential between the antisocial payments paid to these professionals and those paid to other professionals working next to them. That is a recipe for disaster. Will he put in the Library a full list of what he believes are the so-called lies that were told by the leaders of the BMA? Will he explain how he expects to get things back on an even keel, something that was asked for by the Chair of the Health Committee?

[Mr Hunt]

As someone who I fully concede may have more experience of industrial relation disputes than me, let me just say this: it is very clear that we are able to progress when there is give and take from both sides; when both sides are prepared to negotiate and come to a deal that is in the interests of the service and in the interests of the people working in the service. That was not possible. It is not me who is saying that; that is was what Sir David Dalton, a highly respected independent chief executive, said in the letter he wrote to me last night.

Some of the things that the BMA put out about the offer—for example, it put up on its website a pay calculator saying that junior doctors were going to have their pay cut by 30% to 50%—caused a huge amount of upset, anger and dismay, and were completely wrong. I do not think it would be very constructive for me to put in the House of Commons Library a list of all those things, when what I want to try to do is build trust and confidence. The differential between doctors and other workers in hospitals is what the BMA was seeking to protect. It still exists, but we have reduced it from what it was before because we think it is fairer that way and better for junior doctors.

Drugs: Ultra-rare Diseases

David Anderson Excerpts

Tuesday 16th June 2015 Westminster Hall

[Greg Mulholland]

Indeed. It was a pleasure to meet the right hon. Lady’s constituent, Archie, and his parents. These young people are inspiring us to campaign. She is absolutely right. We are debating the European Union Referendum Bill today in the Chamber. Other EU countries, and some non-EU countries, regard these treatments as effective and affordable, yet we do not.

I will fast-forward from the scrapping of the previous body to October 2014, when NHS England came out with the scorecard system. That is despite one of the clinicians involved, Dr Chris Hendriksz, saying on 22 October in an email:

“I would suggest the scoring is not used at all for decision making this round and I would rather have people acknowledging that they are making random decisions than to try and give some credibility to a process that was deeply flawed.”

That is from one of the senior clinicians.

NHS England none the less went ahead with the scorecard system to decide which funding should be prioritised. Suzanne Mallah and her 10-year-old boy Kamal, who has Morquio and is another inspiring young person whom I have been delighted to meet, saw that that was not only haphazard but discriminatory. With the help of the MPS Society, they threatened legal action on 28 November against NHS England on the basis that the scorecard was clearly discriminatory, that there was no policy explaining it and that there had been no public consultation on its use. Just one week after that, on 2 December, NHS England announced that it was suspending use of the scorecard because the MPS Society and Kamal were right and it was wrong.

[Mr David Anderson (Blaydon) (Lab)]

The hon. Gentleman makes a good case. Is it not also the case that clinicians have not been listened to all the way through this, in the same way that they were not listened to when the Health and Social Care Act went through? That is what has led us to where we are. I have been the chairman of the all-party group on muscular dystrophy for 10 years. We had a very good working relationship with the specialised commissioning groups, which were effective in getting medication of this type to people, but the bureaucracy created by the Act was against clinicians’ wishes, which is why we are here today. NHS England has a lot to answer for. The Government’s decision to ignore the voice of professionals has put us in this position.

[Greg Mulholland]

It has been a pleasure to work with the hon. Gentleman and the APPG on muscular dystrophy on the Translarna part of the campaign. He is absolutely right. We want not only an acknowledgment from the Minister that the current processes are not fit for purpose and not fair on those with ultra-rare diseases, but a drive to overhaul them.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

First, I congratulate the hon. Member for Leeds North West (Greg Mulholland) on bringing this matter to Westminster Hall for consideration. Westminster Hall is well filled today because we all have constituents who are suffering and do not have access to the drugs needed to combat these rare diseases. I also congratulate the hon. Gentleman on his hard work on this issue, for which he is well renowned; we have all said that, but it is the truth, and we all want him to know that we know it.

I am glad this debate has occurred, because it is on a subject that affects many people in my constituency. We have heard some stories and we will hear more before this debate is over.

The diseases we are considering may be rare, but collectively they affect the lives of 3 million people across the United Kingdom. That emphasises that everything must be done to create a comprehensive initiative for providing care to those affected by these difficult and challenging diseases.

Rare diseases tend to be life-threatening or chronically debilitating. There are between 6,000 and 8,000 rare diseases. Each one affects less than 0.1% of the UK’s population, but Rare Disease UK calculates that 75% of these illnesses affect children.

We are here today on behalf of our constituents, but we are also focusing very much on young people across the United Kingdom of Great Britain and Northern Ireland who have these problems.

The ultra-rare diseases that have been mentioned include Morquio disease, Duchenne muscular dystrophy and tuberous sclerosis. I would also add Prader-Willi syndrome, which some of my constituents suffer from.

The chance of improving people’s quality of life depends very much on a narrow timescale. It requires quick diagnosis, treatment and drug provision, so that drugs can be accessed when they are proven to be most effective. In other words, as every Member who has spoken has said, time is of the essence—the people who are suffering need help now, not in six or 12 months. It is our duty to make that timeline as transparent and effective as possible within the finite resources we have, and I understand the problems the Minister has. There must be adequate assistance for practitioners, to allow for timely diagnosis and the timely provision of drugs and treatment.

[Mr Anderson]

The hon. Gentleman has been very consistent on this issue, and he is right: as those of us in the all-party group on muscular dystrophy have found, one of the main reasons for delays is that clinicians—particularly GPs—do not see these diseases very often, and when they do, they are sometimes lost as to where to go. Once a disease is diagnosed, the people suffering from it should have no worse access to treatment than people with much more common diseases—surely that is the issue that has to be addressed. Once a disease is identified, we have to get to grips with it, and people have to get the medication and the support they need, so that they can get on and live the best life they can.

[Jim Shannon]

I agree wholeheartedly. I am sure the Minister has heard us all say that time is of the essence and that we should strike right away. That is what we are about.

The health and social care professionals involved in the diagnosis, treatment and care of these patients face difficult tasks. As I was saying, there must be adequate assistance for them, to allow for timely diagnosis and the timely provision of drugs and treatment. There also needs to be sufficient funding UK-wide.

In Adjournment debates and other debates about these issues, I have always referred to Queen’s University in Belfast and to the importance of research and development. Queen’s University is one of the universities that do research, and it works in conjunction with the Health Department. Perhaps the Minister could therefore give us some idea what the Government are doing on research and development to ensure that new drugs are found.

NHS Success Regime

David Anderson Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

I thank my hon. Friend for her question. I am delighted to see her in her place. She has experience and expertise in this area. She will know that elsewhere in the country, before 2010, local commissioners, doctors and providers often came up with good solutions, but then strategic health authorities would come in with a completely different answer and override all of them. That is what we are seeking to avoid.

[Mr David Anderson (Blaydon) (Lab)]

The Minister is right that patients are key to this, but so are the people who deliver hands-on services. He has mentioned the role of clinicians a number of times, but what about the voice of care workers, nurses and other people on the front line? Will they be listened to, and will their representative bodies, such as trade unions and colleges, be listened to, or will they be completely and utterly ignored, as was the case with the Health and Social Care Bill?

[Ben Gummer]

I am glad that the hon. Gentleman has made that point. The success regime will not work unless every single part of the local health economy contributes to it, including the vital component of local care workers.

Nurses and Midwives: Fees

David Anderson Excerpts

Monday 23rd March 2015 Westminster Hall

[Mr David Anderson (Blaydon) (Lab)]

I beg to move,

That this House has considered the e-petition relating to proposed increase in fees for nurses and midwives.

It is a great privilege to serve under your chairmanship today, Mr Havard. I thank hon. Members for coming to this serious debate, and I thank my colleagues on the Backbench Business Committee for agreeing to it. I also thank the various trade unions and representative organisations in the national health service that have provided support and given me background material for the debate.

I start by reading out the petition and thanking Mr Stephen Iwasyk and the other 113,795 people who signed it, demonstrating their interest and concern about this vital issue. The petition states:

“We would like the Government to Review the Nursing and Midwifery Council (NMC) with regard to the fees charged to registered nurses and midwives, and the processes through which those fees are decided. The Nursing and Midwifery Council (NMC) recently discussed a further increase in registration fees for Nurses and Midwives from £100 to £120. The fees were increased 2 years ago from 76 to 100 following a consultation that was overwhelmingly against the rise. The NMC are, of course, obliged to consult before any further rise. However 96%+ of individuals voted against the rise last time. The Health Committee in their report earlier that year said ‘We would urge the NMC to avoid further fee rises and to consider fee reductions for new entrants to the register.’ Approximately 670,000+ Nurses and Midwives contribute £67+ Million annually to the NMC. Please sign the petition to encourage a review of the NMC and the charging of annual fees to Nurses and Midwives.”

I am grateful for the opportunity to debate an important issue that faces many of our constituents who are nurses and midwives. The petition, which had reached 113,796 signatures by the time it closed in February, relates to the proposal of the Nursing and Midwifery Council to increase registration fees for all 670,000 nurses and midwives by almost 60% in two years. The e-petition opposed the proposed fee increase and called for a general review of the NMC, and a review of the charging of annual fees to nurses and midwives.

[Ms Margaret Ritchie (South Down) (SDLP)]

I congratulate my hon. Friend on securing the debate. Does he agree that there is an urgent need for the Government to enter discussions with the Nursing and Midwifery Council with a view to reducing fees, in order to sustain the profession and keep people in it?

[Mr Anderson]

That is absolutely what the debate is about. I will point out some glaring worries that have been described to me about the capability and the effectiveness of the NMC. It is not that people do not want to pay a subscription fee; people are forced to pay a fee to be registered, and if they do not pay it, they cannot work. If they cannot work, obviously, they will not make money. The question is whether they get value for money. I am pleased that my hon. Friend the Member for Easington (Grahame M. Morris) is here, and I hope that he will talk about the findings of the Select Committee on Health, which published a report a couple of years ago that was—to put it mildly—quite critical of the NMC.

I will provide some background about what the NMC stands for, what its objectives are and why it proposed a fee increase. I will explain why the NMC fee increase was so strongly opposed by the overwhelming majority of nurses and midwives. The reasons for that opposition included the NMC’s historically poor financial oversight and management, which was highlighted in a damning report by the Council for Healthcare Regulatory Excellence in July 2012. The council criticised the NMC’s lack of focus on preventive measures to reduce fitness-to-practise referrals, the real-terms pay cut imposed by the coalition Government on hard-working nurses and midwives and the catastrophic impact that a fee increase would have on workplace planning. Finally, I will talk about the impact of future fee increases on nurses and midwives and on the care that patients will receive.

Despite heavy opposition from professional bodies and trade unions representing registrants’ views, the NMC chose to increase fees, effective from the end of last month. I want to talk about how fees could be reduced, which comes back to the point made by the hon. Member for South Down (Ms Ritchie).

[Grahame M. Morris (Easington) (Lab)]

I congratulate my hon. Friend on securing the debate, and I congratulate those who supported the petition. Does he agree that one of the fundamental problems is that the Nursing and Midwifery Council is spending a disproportionate amount of its budget—about 75%—on 1% of the register through the fitness-to-practise cases? There must be a more cost-effective way for it to carry out its obligations.

[Mr Anderson]

That is the core of the debate. I am concerned about the fact that more and more cases are being referred. It appears that there has been a failure on the part of hospital management or health management in general, who are, in some cases, referring nurses and midwives to the NMC instead of using their own disciplinary procedures. They are giving away their responsibilities, and in doing so they are adding to the cost and the work load of the NMC, which should be dealing with other issues of equal importance.

Believe it or not, the NMC is the world’s largest regulator, with 670,000 nurses and midwives on its register. It is in the unique position of having a guaranteed income of £71 million a year. What other business or organisation has such a luxury nowadays? The NMC’s primary purpose is to protect patients and the public in the UK through effective and proportionate regulation of nurses and midwives. It is required to set and promote standards of education and practice, maintain a register of people who meet those standards, and take action when a nurse or midwife’s fitness to practise is called into question. By doing so, the NMC seeks to promote public confidence in nurses and midwives, and in the regulation thereof. However, the fee rise has done little or nothing to raise the confidence of the nurses and midwives whom the NMC regulates. Many, including some in my own constituency, feel that when they voiced their opposition to the fee increase, they were opposed or—even more worryingly—completely ignored.

For a nurse or midwife to practise in the UK, they must be on the register. They have no choice. It is illegal to work as a nurse or a midwife in the UK without being on the NMC’s register. To join and to stay on the NMC’s register, all nurses and midwives must pay the annual registration fee.

[Ann McKechin (Glasgow North) (Lab)]

I congratulate my hon. Friend on securing the debate, especially as I tried for about three months last year to secure a debate on this subject. Does he agree that, particularly given the 60% increase in the fee over the past few years, the fact that there is no fee reduction for nurses and midwives who work part time is becoming a much greater concern and is discouraging people from coming back to work part time?

[Mr Anderson]

That is central to the discussion. I have been struck by the fact that nurses who are relatively well paid and work full time will have to pay exactly the same registration fee as those who work short hours. That may make things quite comfortable for the NMC’s bureaucracy, because the organisation will know exactly how much money it will have, but it does nothing for people who are worried about where the next pay packet is going to come from. My hon. Friend is right to say that it is a real problem.

[Sir Alan Meale (Mansfield) (Lab)]

From my hon. Friend’s contribution to the debate so far, it is clear that a poll tax model has been adopted in respect of the gathering of funds for the Professional Standards Authority. Doctors and dentists will be paying the same fee as nurses. Does he not think that that is quite unfair, given the wage structure in the national health service?

[Mr Anderson]

That seems unfair to me, as it does to the nurses. As I will try to bring out in the debate, the important thing is not only the money that people are paying—for some, that is a real issue—but the value for money that they receive. Two years ago, the Government had to step in and give the NMC £20 million to prevent a fee increase. Of course, the nurses and midwives welcomed that, but it means that the taxpayer is subsidising the NMC because it has failed to do its job properly. My hon. Friend is right to say that there is an imbalance in what it is doing.

[Sir Alan Meale]

It is about not only the position but the numbers. There are far more nurses and midwives than doctors and dentists. The fee increase is disproportionate and quite unfair.

[Mr Anderson]

The fee increase is disproportionate, but the numbers of disciplinary and fitness-to-practise cases are also disproportionate. As we will hear, the number of nurses facing fitness-to-practise issues is grossly more than the number of doctors facing such cases. That means there is less money to spend on education and training to increase registration standards for nurses, which is what we all want.

Nurses lose at every level through the way in which the system is run. The review was not just about people saying, “Please don’t make me pay more money”; it was about, “Can we have a root and branch investigation into how this organisation is run? Can we make it run better? Can we make it run in everyone’s interest?”

[Grahame M. Morris]

There is a valid point about nurses and midwives who are returners and working part time. This burden is falling on the profession at a time when wages have been cut in real terms by between 8% and 10% over the past five years because of the Government’s failure to implement the recommendations of the pay review body. This is a double travesty.

[Mr Anderson]

My hon. Friend is right. He will not be surprised to learn that I share his view. The Government are treating nurses and other public sector workers appallingly. At the same time as saying, “We will give you no pay rise,” the Government are saying, “We want 60% more off you, and if you don’t pay it, you won’t be able to work.” As my hon. Friend the Member for Mansfield (Sir Alan Meale) said, these people are being pole-axed.

To join and stay on the register, all nurses and midwives must pay the annual registration fee. The fee is tied to their employment contract, which often stipulates that anyone who fails to pay the fee will face disciplinary action by their employer and a temporary lapse from the register. Since the NMC was established under the Nursing and Midwifery Order 2001 on 1 April 2002, there have been a number of increases in the annual registration fee. Historically, nurses joined the register for life and there was no annual fee increase. The order changed that, however. In 2004 the NMC annual registration fee was £43, which increased to £76 in August 2007.

In 2011, the Council for Healthcare Regulatory Excellence was tasked with investigating the NMC. It published a damning report that criticised the NMC’s lack of leadership, poor communication, inadequate governance and poor financial management. A new chairman and chief executive were appointed and, critically, the NMC accepted the report’s findings in full—the NMC accepted that it was not doing what it was supposed to have been doing as well as it should have been doing it.

In May 2012, the NMC indicated its intent to consult on a 58% fee rise from £76 to £120 a year. Following pressure from Unison, the Royal College of Midwives and the Royal College of Nursing, the Government offered a £20 million grant to the NMC. The Secretary of State for Health agreed to the grant because he was also appalled by the regulator’s poor financial management—and he would know about poor financial management, given the state into which he has got the health service in general. The result of that grant was that the registration fee was kept down to £100 a year, although we should remember that it had gone up to £76 only a few years earlier, so there was a big increase at a time when people were not receiving pay rises.

[Grahame M. Morris]

Is there not an argument for placing a moral obligation on the Government to make a contribution in the wake of the Francis report, which identified failings in a number of organisations, including the Nursing and Midwifery Council? Surely the Government have an obligation to help to meet the costs in order to put things right.

[Mr Anderson]

I am happy to say that, although I do not completely agree with my hon. Friend. A review would allow us to have a discussion and get people involved. If the Government are too involved, some people will worry whether the NMC will lose the independence of which it should be proud, if it is running properly. I have no problem in principle with the Government helping out in any way they can, because that is part and parcel of ensuring that nurses are able to do the job that we and the public want.

The fee increase was significant because nurses and midwives have been subjected to a Government-imposed pay freeze while, outside in the real world, everyday items and household bills are increasing dramatically. As we know, figures from the Labour party and others show that people are £1,600 a year worse off than they were five years ago. It is a double whammy, to put it mildly, for hard-working nurses and midwives to be told, “You are going to be worse off—and by the way, why don’t you pay more for your registration?”

In May 2014, the NMC consulted again on increasing the fee from £100 to £120, an increase of almost 60% in two years. The Government could have offered another bail-out to allow the NMC more time to address the challenges it faces from fitness-to-practise cases, but they chose not to. The proposed annual registration fee increase was heavily opposed by all the professional bodies and trade unions that represent the views of registrants. Ninety-nine per cent. of respondents to the Unison survey opposed the proposed increase to £120 a year. In the RCN survey, the same proportion of respondents disagreed with the proposed fee rise. The anger felt by registrants is demonstrated by the e-petition condemning the proposed fee increase, which was signed by almost 114,000 people. Their feelings are reasonable and understandable.

I will now address the NMC’s poor financial management, which was highlighted in the 2011 report. The fee increase was felt to be inappropriate because it placed too big a burden on individual nurses and midwives to make up for the NMC’s poor management. The £20 million grant from the Department of Health was meant to contribute to the cost of clearing the backlog of historical fitness-to-practise cases. Despite that help, some 50 cases have been outstanding for three years or longer. The issue was reinforced by the report, and 50 cases have been on the books for the three or four years since then. In 2009, the NMC had a relatively small number of such cases, and had it taken appropriate action at that stage, there would never have been the need to increase the registration fee to such a level.

The NMC’s consultation paper on registration fees recognised that the key driver of increasing costs is the massive increase in fitness-to-practise referrals. Since 2008, the number of fitness-to-practise referrals has increased by 133%. The NMC holds two and a half times as many hearings as all the other regulators combined. Last year, the NMC spent £55 million of its £71 million budget on fitness-to-practise issues, which means that 77% of its budget is spent on fewer than 1% of registrants. In comparison, the General Medical Council, which my hon. Friend the Member for Mansfield mentioned, spent only 56% of its resources on fitness-to-practise cases involving registered doctors in 2013-14. The people who helped me to secure this debate support my contention that the NMC model is unsustainable and detrimental to the majority of registrants.

Employers are the largest group making fitness-to-practise referrals. In 2012-13, however, 40% of fitness-to-practise referrals were closed during the initial assessment. Employers were making referrals that were not fit to be heard but that had to be heard, and the cost of those hearings comes directly out of the purses and wallets of nurses and midwives. It has been suggested to me that, following the Mid Staffordshire NHS Foundation Trust public inquiry, employers have become increasingly risk- averse and are using the fitness-to-practise referral process instead of internal processes and procedures to address performance and disciplinary issues. Instead of taking cases on themselves, employers are referring them to the NMC at unsustainable cost.

Inappropriate referrals block the system and add to costs, which is why it is important that the NMC assesses whether it is appropriate for employers to refer so many cases. The NMC could do that by including employers in reviewing the reasons for the dramatic increase in referrals since 2008. Is there a crisis? Is there a problem? Is there something wrong with the practice? If employers sit around the table with the NMC, perhaps they will get to the bottom of the situation.

The NMC should also take a more proactive approach to the promotion of education and standards as part of a preventive measure that could contribute to reducing the number of fitness-to-practise cases referred to the regulator. There should be an equally strong commitment to public protection, because that will prevent harm in the first place.

I have a quote from a full-time officer from Unison about his experience in dealing with NMC cases:

“The NMC pursue allegations against registrants that have little or nothing to do with patient safety and could not be said to have a public interest element. Despite the recommendations of the Law Commission review and its apparent endorsement by the NMC and the Department of Health, the NMC continues to bring cases relating solely to inter-employee and other issues wholly unrelated to their nursing practice. In addition the NMC insists on taking any cases with an apparent ‘public interest’ to a full hearing or meeting even where the registrant wishes to be voluntarily removed from the register. The lack of any clear definition of what is meant by the public interest makes the issue wholly subjective.

At a recent NMC hearing an NMC panel decided that a registrant’s apparent failure to approve staff applications for flexible working amounted to serious professional misconduct and was a public interest issue! This hearing lasted 10 days and probably cost well in excess of £30,000. It is absurd that nurses and midwives should be asked to foot the bill for such folly with ever increasing registration fees.”

That is the experience on the front line—that is what people are paying £120 a year for.

In an attempt to convey the affordability of the proposed fee increases, the NMC consultation paper compared subscription fees for professional bodies and those of trade unions with the NMC. However, that is not valid comparison. Unlike the NMC, trade unions and professional bodies are organisations that nurses and midwives can join voluntarily.

I would be delighted if the Government said that we could have a closed shop for trade unions and professional bodies. I am sure that you would agree, Mr Havard, but I have got a feeling that they may not be keen. Come 8 May, the next Government will be led by that wonderful gentleman, my right hon. Friend the Member for Doncaster North (Edward Miliband), but I have a feeling that he also might not be too keen on closed shops in the health service or anywhere else. However, that is what we have got with the NMC.

I understand why that is the way it is, but for the NMC to pretend that, somehow, a comparison can be made with joining trade unions is completely unfair. It would be much more suitable to compare the NMC’s registration fees with Health and Care Professions Council registration fees. Under “Agenda for Change”, both regulate professionals in similar pay bands, but when we compare a nurse at the top of band 5 with an occupational therapist on the same band, we see that the nurse would pay £120 a year in registration fees while the OT would spend £80. That goes back to the point raised earlier about why on earth part-time workers and those on different bands should pay the same subscriptions.

Although the NMC recognised the economic difficulties nurses and midwives face in its consultation paper, it proposed the fee increase regardless. Effectively, it ignored the reality of how those people are struggling.

[Ann McKechin]

I was astonished to find that the NMC has not instigated any efficiency programme to try to control costs and those of tribunal hearings in particular—even things such as booking hotels and accommodation for tribunal members—to try to ensure the most efficient cost basis, given current restrictions. Does my hon. Friend agree that, given that the NMC has a captive audience, it needs to spend more time showing that it is getting maximum efficiency for its costs?

[Mr Anderson]

My hon. Friend makes a valid point, which again comes back to what the review can look into: whether members are getting value for money. That is what we are talking about here. The NMC might think, “If we need more money, we can get it because they have got no option other than to pay.” It can hold people to ransom and, unfortunately, that is what it is surely doing. That is clear, because it has ignored the legitimate claims of those who have said, “Please, give us some relief here.” It appears that those people were told, “We’re going to ignore you, anyway.”

During a time of continued pay restraint for hard-working nurses and midwives and ever-increasing costs of essentials such as child care, household bills and everyday items, the proposed fee increase left many registrants feeling that that was yet another attack on their standard of living.

[Ms Ritchie]

My hon. Friend is making a good point. By and large, the NMC’s members are women and some of them are in part-time employment. Does he agree that the disproportionate payment to the Professional Standards Authority for Health and Social Care will have an adverse impact on equality and could infringe equality regulations?

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[Mr Anderson]

My hon. Friend is obviously reading my mind, because that is the point that I was going to come on to next. She is absolutely correct that part-time workers, who are mainly women, are being hit disproportionately because they are in part-time work, and there could well be equality issues around that.

The decision to increase fees will have a catastrophic impact on nurses’ and midwives’ future decisions, which will have a direct result on work force planning and patient care. At present, 30% of nurses and midwives in practice have protected pension rights, so they are eligible to retire at 55 with their full pension. Many do that, and, after a brief period of absence, return to part-time practice. That has gone on for decades and is something that the health service has welcomed and plans for.

I have been told by many people who work in nursing and midwifery that it would not be economic for them to return to work after they retire if registration fees rise and continue to do so. That was borne out by the Unison survey, which found that 51% of respondents would not return to practice if fees increased. That would be a double whammy for the health service. We would lose people with experience who were prepared to come back to work part time; they will not do that because of that block put in front of them.

We already have a chronic shortage of supply of nurses and midwives in the UK, which is made worse by the Government’s decision to cut the number of nurses and midwives in training. That shortage is demonstrated by the increasing numbers being recruited from Europe. A reduction in those returning to practice will have a devastating impact on patient care. It is essential that service and staff implications are taken into account by the NMC and the Government. Without that, it will be impossible for the NHS to plan its work force properly.

On revalidation, the NMC ignored the heavy opposition it received and decided to go ahead with its proposal to increase fees regardless. For any nurse or midwife whose registration payment is due by the end of February 2015 or later, the new fee applies. The bodies and unions sought reassurance from the regulator that fees would not increase further, but the NMC has offered no guarantees about coming years.

Later this year, the NMC will introduce a new revalidation process for registrants, which will place additional requirements on those who wish to stay on the register and continue to work. I support the work on revalidation, and I know colleagues on the Health Committee have been critical of the failure to move faster on that, but many nurses and midwives are concerned that those changes could result in further fee increases. It is not clear what the cost impact will be.

[Sir Alan Meale]

The papers that I have read make it clear that the NMC gathers most of the PSA’s funds, yet it seems to have little say in its budget. Does my hon. Friend agree that that is probably the main reason for the re-evaluation?

[Mr Anderson]

Absolutely. I will come on to discuss the PSA before I sit down, which my hon. Friend will be glad to hear will not be long now.

Professional bodies and trade unions are working hard with the NMC to ensure that the development and introduction of the new process is as successful as possible and that lessons are learnt from the pilot sites. That process will be extensive and require significant efforts from registrants, but it surely cannot lead to further unjustifiable fee increases for hard-working midwives and nurses.

The NMC could take measures to prevent future fee rises for registrants, but it is not the only one that should beheld responsible. The Government could have taken measures to reduce further fee increases, but they chose not to.

First, the NMC has the most unwieldy legislation of all regulators despite being the largest. By contrast, the General Medical Council and the Health and Care Professions Council have more flexible legislation, which allows them to be more efficient and cost-effective. That prompts the question: why should midwives and nurses be treated differently from doctors and occupational therapists?

In April 2014, the Law Commission published a draft regulation of health and social care professionals Bill, which included reforms that would have helped the NMC keep costs down. If implemented, the draft Bill would offer the NMC the opportunity to speed its processes up and give it flexibility to amend rules without having to seek Parliament’s permission.

The Mid Staffordshire NHS Foundation Trust public inquiry called for regulators to focus on promoting safe, compassionate care, rather than intervening only after patients have suffered harm. The draft Bill would have allowed the NMC to focus more resources on education, effective registration and promoting professional standards, which would have done exactly what the inquiry called for. Currently, it is impossible for the nine health regulators to work together: there are nine different pieces of legislation, nine different codes of conduct and nine different fitness-to-practise procedures. It is not clear to me why we are treating health workers differently when the main objective of all health regulators is surely the same—public protection.

The draft Bill would enable and require regulators to co-operate more closely with each other, which would ensure consistency. It would help the NMC and all the regulators to keep their costs down collectively. However, this Government failed to include it in the Queen’s Speech, which meant it could not be debated or passed into law. It would be interesting to hear from the Minister what he thinks of that decision.

Registrants should not be punished for the Government’s failure in that respect. Likewise, the NMC should not use it to justify or push through any future fee increases. The NMC has joined representatives of patients’ groups, nursing and midwifery professional bodies, and trade unions to call on politicians, such as us here today, to commit to introducing the draft Bill to reform health care and its professional regulation.

In addition, following a review in 2010, the Government decided that the Professional Standards Authority, the body responsible for the oversight of the health professions’ regulators, would no longer continue to be funded by the Government and the devolved Administrations. Instead, the review recommended that the PSA should be funded through a compulsory levy or fee on the regulatory bodies that it oversees. So, rather than consult on whether there should be a levy or on who should pay it, the Government decided to consult on how the PSA levy on the regulatory bodies should be calculated. Rather than saying, “Should we do it?” they said, “How will we pay for it?”

Professional bodies and trade unions quite rightly argued against this levy; it is another hammer blow for the people working in the service. However, their concerns were ignored by the Government who, in their response to the consultation, decided to determine the fee based on the number of registrants that a regulator has. Again, this unduly disadvantages the NMC, which will bear a disproportionate amount of the cost because, as I said earlier, it is the largest regulator in the world. Based on the current size of the NMC’s register, the first £1.7 million levy to the PSA equates to £2.50 per registrant. The upcoming fee rise has already resulted in 12.5% of this additional sum effectively going straight to fund an external organisation, which is doing nothing to protect the public or to help to educate or protect the staff working in the service.

Because the NMC has no other source of income, these costs will almost inevitably be passed on to registrants, who include some of the lowest-paid professionals regulated by the health regulators. As I said before, approximately 90% of the NMC’s registrants are women, so the PSA levy will have an adverse impact on equality, as the hon. Member for South Down said. Also, many NMC registrants work in part-time roles, and so frequently they are not high-income earners. If the NMC is forced to increase the annual registration fee in order to pay the PSA, which in some respects it already has, that will have an impact on equality, as those in this group will be financially worse off. The poorest will pay the most, which is not unusual under this Government.

Over the years, all the NMC’s efforts have been directed at dealing with fitness-to-practise cases. This has had a detrimental impact on the level of service provided by the NMC to its registrants. For example, the NMC has failed to provide effective and up-to-date guidance on key issues, and there has been a lack of professional advice to registrants who have queries or concerns about how to interpret the requirements of or guidance on the code of conduct. Given the overwhelming, and appropriate, focus of professional regulation on public protection, and the diminution in professional advice, it could be argued that it is unfair to expect registrants to continue to bear the sole financial burden of the NMC’s professional regulation activities.

Furthermore, if the body overseeing the regulators is funded by the regulators, the public will lack confidence. Consequently, the funding arrangement for the PSA, which is based entirely on registrant funding, is flawed. At a time of ongoing financial austerity, the additional bureaucracy is undesirable, particularly when there are already existing mechanisms to scrutinise and hold regulators to account, for example, the annual accountability hearing by the Health Committee, which enables the people in this building to scrutinise what the regulators are getting up to.

For these reasons, I urge the Government not to implement the levy on the nine health regulators, and for the Government and the devolved Administrations to continue to fund the PSA until it is included in the draft Law Commission Bill.

It is appalling that the NMC decided to increase its fees despite the heavy opposition from hard-working nurses and midwives. It is tough enough to be a nurse or midwife without having to be penalised for coming to work. They are working in an increasingly difficult environment, which has been made worse by public sector cuts, chronic understaffing and continued pay restraint that means their pay is lagging well behind cost of living increases. If the NMC’s fees continue to increase, it will result in nurses leaving the profession, exacerbating existing problems in the health system, which is already struggling to cope.

To ensure that future fee increases are not made, it is essential that the following steps are taken. First, the NMC should undertake a full review of all fitness-to-practise referrals that do not proceed to a full hearing, and use that information to sit down with the employers and trade unions to ensure that all referrals to the NMC are in the interest of patient safety and public protection, and not just an excuse for employers to carry out internal disciplinary procedures. That would have a positive impact by reducing the number of referrals and the overall cost thereof.

Secondly, the NMC should shift resources into promoting awareness and the development of guidance that would help registrants to understand better how to act within the NMC’s code of conduct in their practice. That would help to reduce the number of fitness-to-practise referrals, which would be a win-win for everybody concerned.

Thirdly, the NMC should consider a reduced fee for new registrants, part-time workers and those nearing retirement age, to reflect better registrants’ income throughout their careers. There should be a phased fee for all concerned.

Fourthly, the Government should not implement the PSA levy on regulators and should continue to fund it centrally, at least until it is included in the draft Law Commission Bill.

Finally, the draft Law Commission Bill must be given adequate parliamentary time by the next Government to be debated and passed, to enable the NMC and other health regulators to reduce costs, in the interests of all concerned.

We count on nurses and midwives every day.

[Grahame M. Morris]

I wonder if we can get clarification on that last point; perhaps the Minister can provide it. Given the dearth of legislation, especially in the last Session, why was not parliamentary time found for something on which there could have been cross-party consensus, such as a draft Bill based on the Law Commission’s report?

[Mr Anderson]

My hon. Friend makes a very good point, and I am very interested to hear whether the Minister will respond to it when he sums up and say exactly why we have not been discussing this issue during the past two or three years, when we have been going home at ludicrous times, such as 5.20 pm on a Monday, week after week during the past few months.

We count on nurses and midwives every day. Our families count on them; the people of this country count on them. I have heard loud and clear from my constituents that the fee increases are unaffordable and my fear is that people will start to vote with their feet.

The NMC is subject to parliamentary scrutiny by ourselves and the Health Committee, but we have little opportunity to comment on fee rises such as this one. We need to get the NMC to work together with the employers, the trade unions and the representative bodies, to review what it is doing and to provide a better service for all concerned.

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[Mark Durkan (Foyle) (SDLP)]

As other Members have said, it is a pleasure to serve under your chairmanship, Mr Havard. I commend the hon. Member for Blaydon (Mr Anderson) on securing this debate. I suppose he is a gamekeeper turned poacher on the Backbench Business Committee. He ensured that the e-petition, which gathered a significant number of signatures, would be debated before the close of this Parliament.

It is a pleasure to follow not only the opening speech from the hon. Gentleman, but also the insights from the hon. Member for Easington (Grahame M. Morris). His teasing out of where some of these issues could go are reinforced by his experience as a member of the Health Committee. It was also a pleasure to hear from the hon. Member for Congleton (Fiona Bruce), who talked about a particular constituency case that has given strong, more than anecdotal evidence that corroborates some of the issues raised by other Members on how the NMC is having to work, because of the position it is in. It is important that we consider issues relating not only to how the NMC works and whether its cost burdens should be alleviated in different ways or apportioned, but to the Professional Standards Authority, the funding source and scheme of which seems to be fundamental to the inequities we are discussing.

Many people wonder what Parliament’s role is in all this. They think Parliament is meant to oversee the health service and strong public service ethics, but it appears to wring its hands when these changes come along but everyone seems powerless to do anything. I tabled a prayer of annulment against the order that has brought about the increase in fees—early-day motion 697 if any Members want to scrabble in and sign it before Dissolution. However, it is only a prayer of annulment. As the hon. Member for Easington said, many people have written to MPs in all parts of the UK, but they are left bemused by the responses they receive. At least now we are having this debate, courtesy of the hon. Member for Blaydon. I look forward to hearing the Minister respond to it.

The point has been made that those who have to register with the NMC have faced pay restraint for a number of years. They are locked into pay freezes, and many are coping with the perverse and inequitable outcomes of the “Agenda for Change”. That has been the case for many professionals in my constituency in Northern Ireland, who have not only questioned where they are in relation to particular bands and how their responsibilities have been correlated with others, but found themselves at odds with what has been decided in neighbouring health trusts.

If people are already facing so many frustrations relating to their pay and conditions, they are particularly aggrieved when they are hit with what is essentially a vocational tax. They are being told that because their vocation is so important and sensitive and is subject to a registration process that is open to fitness-to-practise procedures, they have to pay more for the privilege of continuing to work. They are not being paid any more—they are actually being paid less—but they are having to pay more to register to turn up to work. Surely that is unfair and inequitable.

The fees have gone up from £76 to £100, and now to £120. That is just shy of a 60% increase in a small number of years, and people are rightly aggrieved. If that has been the form over a couple of years, they will ask whether it will be sustained—will it project into the future? There is a proper question for us to ask in Parliament and for Ministers to answer. It is not enough simply to say, “Well, this is the process we have. The NMC has to make the decisions and there is nothing we can do about it.” A couple of years ago, because of the pressure of the number of fitness-to-practise cases, the Government saw fit to use a £20 million subvention to help to relieve the situation, so why could not a further subvention be used? That would at least provide cover while other changes were introduced.

There are questions about the PSA’s funding being sourced on a per-registrant basis, which seems to line up the NMC for a particularly undue hit in terms of its source funding to the PSA. I will not go through it all again, but hon. Members asked about the cost burden that will arise and the procedural length of fitness-to-practise cases. Other hon. Members asked whether there might now be impressionistic evidence that health service management is using fitness-to-practise cases as a crude management tool. Perhaps they allow management to abscond from some of its more subtle and intelligent responsibilities by transferring crude enforcement to someone else. The cost in such cases is clearly giving rise to what seems to be a completely disproportionate working burden on the NMC.

[Mr Anderson]

I related to what a trade union representative told me about taking people through a fitness-to-practise hearing that lasted 10 days and cost £30,000. Employers may well be trying to prevent exactly that sort of thing from happening and tying up their HR staff—all the witnesses and people they have to suspend. Instead of taking responsibility, employers are parking such issues with the NMC, which has hugely increased its work load and the related costs.

[Mark Durkan]

I thank the hon. Gentleman for making that point and for giving colour to the concerns we feel when we look at the number of cases, the cost burden, the wider impact on the NMC and the costs faced by those who have to register with the NMC. We must remember that the NMC does not only work to service its members’ professional standing. It is there to safeguard not only professional standards but public assurance and the wider public interest.

There is a case for asking whether anything can be done to alleviate and re-profile the NMC’s costs and whether those costs can be better shared so that they do not fall only on nurses and midwives but are spread more widely among all of us who rely on the work and good standing of the regulators of such services.

A number of hon. Members mentioned the proposals in the offing that might allow some of these issues to be addressed. It is not a case of some of us just screaming against a fee increase and saying, “Something should be done about it”—there have been opportunities. Reference has been made to the Law Commission’s draft Bill on the regulation of the health and social care professions. It is disappointing that that has not been taken forward in this Parliament, but it should be soon, because it would provide a context for addressing some of the structural and operational questions about the NMC, as well as other issues of fairness and standards.

When the hon. Member for Easington referred to some of the issues arising from the Francis report, the hon. Member for Blaydon got sensitive about that, but we should recognise that as something else that is affecting nurses’ and midwives’ morale. As well as facing pay restraint and bigger fees, they are facing the wider issue of morale relating to their professional reputation, what with some of the headlines that have come out of the Francis report. No doubt the Minister will pay great tribute to the work of nurses and midwives, but we must listen to their concerns and worries. That is why so many people—not just nurses and midwives—signed the e-petition. They want to hear Parliament speak on this issue, which is why this debate is so welcome. I look forward to hearing the Minister’s response.

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[George Freeman]

The hon. Gentleman makes an interesting point. As the challenges for the NMC’s members and for it as a professional body change, adapt and evolve in the new landscape of greater transparency and accountability in the public interest, one issue for the NMC as a professional body is how it deals with that internally. Members across the House have raised a number of concerns about that, and I will touch on some of those later.

The intention is that in future the PSA will be funded by a fee raised on the nine professional regulators that it, in turn, serves. It is important to note that the fee is raised on the professional regulators—the regulatory bodies—not on registrants. The formula for calculating what contribution each of the nine regulatory bodies should pay was subject to consultation. It has been based on the number of registrants, simply because it was judged that that would most fairly equate the fee to the amount of service that the PSA provides to each regulator.

The NMC has nearly 50% of the total number of registrants so its contribution to the fee equates to nearly 50% of the overall costs of the PSA. However, it is important to remember that the fee per registrant is likely to be in the region of £3, which represents only 2.5% of the NMC’s overall registrant fee of £120 a year.

[Mr Anderson]

I am trying to understand what the Minister is saying. Is it that the regulators have to pay a fee but the registrants will not, and if they do, it will be £3? Where else are the organisations going to get the money from?

[George Freeman]

My point is that it is important to understand that the reforms mean that the PSA is funded by the nine regulatory bodies. How the bodies seek to cover that cost is up to them. In this case, the NMC has decided to apply it equally across all its members.[Official Report, 25 March 2015, Vol. 594, c. 3MC.] A number of hon. Members have raised a number of issues connected to that; the point about part-time nurses and midwives was an interesting one. There are issues with how the NMC chooses to allocate the cost internally. However, I repeat the key point that the fee increase is likely to be in the region of £3 per registrant. That represents 2.5% of the NMC’s overall registrant fee, which covers a whole range of other services.

It may be helpful to the House if I set out some details about the services that the NMC provides. It is the independent regulator for nurses and midwives in the UK. Its primary purpose is to protect patients and the public through effective and proportionate regulation of nurses and midwives. It is accountable to Parliament—not Ministers—through the Privy Council for the way in which it carries out its responsibilities. It sets and promotes standards of education and practice, maintains a register of those who meet those standards and takes action when the fitness to practise of a nurse or midwife is called into question. It also has a role in promoting public confidence in nurses and midwives and in regulation.

Members from all parties would agree that we welcome the growing sophistication of the role of nurses and midwives and the extra responsibilities reflected in salaries and professional standards. That is part of the evolution of the professionalisation of standards that we all welcome.

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[George Freeman]

It is a fair question, which I will come to, but it has nothing to do with the importance of getting this right; it is merely a matter of the regrettable constraints of parliamentary time. One reason why I very much hope my colleagues and I will be returned in May, Mr Hollobone—I was about to call you Mr Havard; I welcome you to the Chair—is that we will be able to get on with that important reform.

For the benefit of the House, let me finish summarising some of the important information about the NMC. The NMC’s total income for 2013-14 was £65 million. Its fee income was £62 million, which is quite a substantial sum. It received a grant of £1.4 million from the Department of Health and investment income of £1 million. Its expenditure totals £70 million, with £24.18 million, or 34%, going on staff. Its permanent headcount has been going up year on year. The average for the year 2014-15 was 496. The NMC had 521 permanent staff on the payroll in March 2014 and 577 in March 2015. The permanent headcount for March 2016 is projected to be 606. I merely point that out to highlight that the NMC faces some important considerations in driving productivity and efficiency internally to deliver the service it is statutorily required to deliver to its members, who fund it through subscription.

Let me turn now to the relationship between the PSA and the regulations we have introduced. The proposed change will be introduced in the Professional Standards Authority for Health and Social Care (Fees) Regulations 2015—or S.I., 2015, No. 400, with which you will be intimately familiar, Mr Hollobone, as an assiduous observer of these things—which have already been laid in Parliament. The NMC’s council meets this week to decide its policy towards them, so this debate is, again, extremely timely.

The NMC has decided to increase its fees for nurses and midwives from £100 to £120. The rise was effected through the Nursing and Midwifery Council (Fees) (Amendment) Rules Order of Council 2014, which came into force on 1 February. Although the NMC is an independent statutory agency, the Government have made it clear that they expect the NMC council to have clear justification for, and to consider nurses’ and midwives’ financial constraints when making, decisions on fees. I will say a little more in a moment about that and about the importance of the Bill to modernise the NMC’s constitution.

The NMC has consulted its registrants on the proposed fee rise, but I am aware of the strong body of opinion among those who opposed it, and that has been expressed in the debate and in the number of people who have signed the petition. The NMC says that it has not taken its decision lightly and that it has considered the responses to the consultation in detail and carefully listened to the issues raised, and I have no reason to doubt that. However, I remind hon. Members that the NMC’s first duty must be to deliver its core regulatory functions and to fulfil its statutory duties to ensure public protection, and the fee rise must be justified against its core duty.

Let me touch now on the Government grant, which is important. I appreciate that, since the NMC was established in April 2002, there have been a number of increases in its annual registration fee, and I appreciate the impact that that has had on dedicated nurses and midwives working long hours in difficult roles to provide excellent care. That is why, in February 2013—more than 10 years after the increases started in 2002—the Government awarded the NMC a substantial, £20 million grant to ease the pressure.

One purpose of that grant was to allow the NMC to protect nurses and midwives—particularly lower-paid nurses and midwives—from the full impact of a proposed annual registration fee rise. The grant meant that, in 2013, the NMC was able to raise its fee from £76 to £100 and not to £120, as originally intended. With a week before Parliament dissolves, the Government have no plans to give the NMC a further grant to subsidise the 2015 registration fee increase. Given that we continue to have to make tough decisions to put the economy back on track, and that we have given the NMC £20 million, it now needs to work out internally how best to allocate the fee increase, which I should remind hon. Members is equivalent to £3 per member if it is spread equally among them.

I am pleased to say that, as part of the broader package of measures the Government are putting in place to support the lowest-paid workers in the NHS, all the major NHS trade unions accepted the Government’s pay offer on 9 March. It will be implemented from 1 April, giving more than 1 million NHS staff, including most nurses and midwives, a 1% pay rise, without risking front-line jobs or costing the taxpayer more money. That means our lowest paid staff will receive the biggest rise.

I want to update hon. Members on the changes, because they are an important wider consideration against which to view the impact of the fees. For the lowest- paid, the 1% rise will mean an increase of up to 5.6%, or an extra £800 in their pay packets. I have looked at the salary figures, and the average, ending March 2014, for nurses, midwives and health visitors—the people we are talking about—is £31,000. They will get the 1% rise, which is an extra £800.[Official Report, 25 March 2015, Vol. 594, c. 3MC.] Importantly, staff earning between £15,000 and £17,000 will get an extra £200, which is equivalent to 2.3%. Nursing staff earning up to £40,558 who are not at the top of their pay band are still eligible to receive an incremental increase.

Let me take issue with the point that the Government are not looking after the lowest-paid. The pay offer specifically makes sure that the increases the system can afford are targeted at the lowest-paid. Those earning more than £56,000 are more able to cope with the challenges of pay restraint. We are supporting the poorest in the system most, and we are making the highest-paid bear more of the burden. Finally, the bottom pay point will be abolished, seeing the lowest pay rise from £14,300 to £15,000, with about 45,000 on the lowest two pay points benefiting.

[Mr Anderson]

I am interested in the average figure the Minister cites. Obviously, if he could give us his figures now, I would be happy to look at them, but could he also put them in the Library? The average he gave seems very high, when we are talking about the lowest point on the scale being £14,500. The average is more than double that—the scale must be heavily loaded at the top, which is not my experience from working in the public sector.

[George Freeman]

I will happily make those data available to the hon. Gentleman and put them in the Library. They are from the NHS staff earnings survey’s provisional statistics by staff group in England.

It is worth noting that UK taxpayers can claim tax relief via Her Majesty’s Revenue and Customs on professional subscriptions or fees that they must pay to carry out a job. That includes the registration fee paid to the NMC. Nurses and midwives on a salary of £30,000, confronted with a fee increase of £3, can therefore claim tax relief on it. A basic rate taxpayer would be eligible for £24 tax relief on the £120 fee.

[George Freeman]

I note with relish and interest what I assume is official Opposition policy—that they do not support the Chancellor’s announcement about funding for the RAF museum. The point that I am trying to make is that he already set out in the autumn statement a serious pay commitment to the lowest-paid staff in the NHS, which I was summarising.

I am glad that the hon. Member for Easington (Grahame M. Morris) has raised the issue of the Budget. The reporting on it has made it clear that for a pre-election Budget it was, far from making give-aways, surprisingly light on them, and was very much “steady as she goes”, continuing to pare down the deficit with fair tax reform. The truth is that we have cut income tax for 27 million people, and particularly for the lowest-paid nurses and midwives. The impact of that is nearly £900 a year from changes to the personal allowance. That is not fashionable stuff that captures the top line in red-top newspapers, but nurses and midwives do not exist in isolation. They have the NHS pay deal but also the important tax allowance changes introduced by the Chancellor. The Government are taking pressure off the lowest-paid workers in the NHS and elsewhere. Viewed in the round, those changes give us a record that we can be proud of, albeit within a difficult set of funding requirements.

[Mr Anderson]

Will the Minister give way on that point?

[George Freeman]

I really need to make progress.

[Mr Anderson]

We have got an hour and a half.

[George Freeman]

I happily give way.

[Mr Anderson]

The Minister made a point about tax, and that is welcome, but does he deny the fact that overall, people, including those we are talking about, are worse off under the present Government as a result of VAT rises and other rises across the economy? People are worse off than when they came to power.

[George Freeman]

I am glad, again, that the hon. Gentleman raises that, because fortunately the Chancellor was able to confirm that the Office for Budget Responsibility has confirmed that finally people in this country are better off, after a very difficult period. I am not going to pretend that it has not been difficult. The reason was that we inherited a chronic legacy of debt, deficit and structural deficit, which was tackled by the previous Government nowhere less than in health care. That created a situation in which, despite a growing economy, we face a huge structural challenge, exacerbated by demographics.

This year there are 1 million more pensioners in the system—1 million more people needing and generating high health demand. I do not hold the Opposition responsible for that. However, the lack of reform and the structural issues at the heart of the health service, which mean that the health structural deficit is growing faster than the general economy, have left us with a challenge. We need to tackle that.

As the hon. Member for Blaydon pointed out, the NMC has stated that there has been a significant rise in its costs, because of fitness-to-practise referrals, which are up more than 100% since 2008-09. Since 2008-09 it has raised its fee by only 63%, making up the bulk of the difference in cost through a programme of efficiencies. Without those it would have had to scale back its fitness-to-practise activity, or generate additional costs earlier. The NMC has provided assurances that it is committed to continuous improvement in carrying out its regulatory functions and will continue to deliver more efficient ways of working to maximise the value of registration fees and to keep them at the lowest level possible while enabling it to fulfil its statutory duty. The NMC is a £70 million-a-year organisation with substantial opportunities to put efficiencies in place, to reduce the cost of the £3 extra cost on its members.

As to the need to update the NMC constitution, the Government have worked with it to make changes to its legislation. We have made good progress with legislative change to reform the way it operates. On 11 December 2014 an order made under section 60 of the Health Act 1999, amending the Nursing and Midwifery Order 2001, came into force. Those changes to the NMC’s governing legislation will enable it to introduce more effective fitness-to-practise processes, while not lessening the public protection it provides.

A key amendment to the NMC’s governing legislation enables it, through its rules, to delegate the decision-making functions currently exercised by its investigating committee to its officers known as case examiners. The intended effect is to speed up and therefore reduce the cost of early-stage fitness-to-practise proceedings, as it will not be necessary to convene the full investigating committee to consider every allegation of impairment of fitness to practise. That should result in financial savings to the NMC as well as greater consistency in decision making. I think we would all welcome that. The rules that bring those changes into effect come into force on 9 March.

The section 60 order has helped the NMC by providing a degree of modernisation of its legislation. However, there is still much to do and that is why we asked the Law Commission in 2011 to review the whole framework of legislation underpinning professional regulation. The report was published last year and we published the Government response in January. I am aware that the decision not to progress a professional regulation Bill to take forward the thinking in the report in the current parliamentary Session was a disappointment to the NMC, as it was to us. We want to move on, but parliamentary time, as you know, Mr Hollobone, is an eternal constraint on Government’s ability to implement. However, that decision provided an opportunity to invest time in getting that important legislative change right, for the benefit of those who will be affected by it. Of course, it will not restrict the NMC’s ability to implement its own internal modernisation and efficiency programme, or to decide how to deal with the internal allocation of its fee obligations to the PSA. It is free to do that.

--- Later in debate ---

[Mr Anderson]

Thank you, Mr Hollobone; nothing would give me greater pleasure than to take the pith with you any time you like.

I thank my hon. Friends for speaking in the way they have. My hon. Friend the Member for Easington (Grahame M. Morris) is hugely respected across the House, particularly for his work on the Health Committee. I assure him and the hon. Member for Foyle (Mark Durkan) that when I said that I was not sure about accepting Government money to support the NMC, that was not to say, “Don’t do it.” I am not in a position to say it should not be done; it is down to the professionals to work out what their view is.

The intervention from the hon. Member for Congleton (Fiona Bruce) was absolutely brilliant. She spoke about the real world. The big issue is not so much about people paying the registration fees; it is about what they are getting for their money, and the hon. Lady showed exactly what they are getting. Her constituent was breaking the law by working without being on the register, in genuine ignorance. She could have been brought up on disciplinary or, potentially, legal charges. That is real the worry: what are people getting for their money?

It is always a great privilege for me to work with the hon. Member for Foyle, as I have done over almost 20 years. Some of the greatest work I did before I came into the House was with health service workers in the north of Ireland, who really were at the cutting edge at some of the worst times in this country’s history. It is brilliant to work with him, and he more than anybody else pressurised the Backbench Business Committee to get this debate held today.

My hon. Friend the Member for Denton and Reddish (Andrew Gwynne), as always, robustly defended our NHS and our party’s plans going forward. I thank the Minister for his words, but warm words do not put bread on the table. The health service workers who I represent, who I spoke to on the picket lines before Christmas, told me that they were organising shoebox collections for their members in their workplace at the same time as the chief executive of their trust was getting a 17% pay rise and the foundation trust members were getting an 88% increase in their allowances. That is the real world out there; that is the world where we are “all in this together.”

The Minister said that the regulatory bodies would have to pay the PSA, but ultimately it would surely be the registrants who cough up. It is like the brewery saying to the landlord of a pub, “You’re going to have to pay me more for your beer,” and then where does the landlord get the money from? Obviously he puts the price on a pot or a pint. Talk about having a “pith up” in a brewery—well, this is clearly one of those things. It is quite clear that the cost will fall on the people on the front line.

I am not sure whether I lost track of the Minister, but I do not believe he answered the question he was asked a number of times about why the Government did not introduce a Bill. He mentioned that something happened in December, and perhaps that is related—I am quite happy for him to come back and put us right—but I am not sure whether what happened in December gave the same rights to the NMC to do what it would have done if the Bill on the regulation of health and social care professionals had gone through. I asked him to reflect on that, as did my hon. Friend the Member for Denton and Reddish, but I do not believe that happened.

I do not want to repeat what the Minister said in his speech, but it did not address the issues. He said that £3 on people’s registration fees is not a crisis—he said that to me and my hon. Friend the Member for Denton and Reddish. We did not say that, but I will tell him who did: the 114,000 people who signed the petition; the people out there who are struggling to get by in the health service; the people we all owe a duty to. We should be putting this right. We are not necessarily calling for the fees to be stopped, but for the system to be reviewed to make sure that it is working properly. Let us sort out the fitness-to-practise issues. Seventy-seven per cent of the time is spent on that, but the problem is that they are all after-the-event interventions. If the job was done beforehand, that would not only save money, but stop incidents that have an impact on the professionals concerned and the people they look after.

Question put and agreed to.

Oral Answers to Questions

David Anderson Excerpts

Tuesday 24th February 2015 Commons Chamber

[Dr Poulter]

As my hon. Friend will be aware, 90% of patients receive free prescriptions either because they are older—over the age of 60—or because of long-standing or other factors. If his constituents are running into difficulties and have problems with renewing their certificate, I am very happy to look into that and to meet him to discuss it further.

[Mr David Anderson (Blaydon) (Lab)]

Despite assurance from the Prime Minister, it is now clear that the drug Translarna will not be available until after NHS England has concluded its internal consultations. The Secretary of State and others have told me repeatedly that they have no control over the issue, but can the Minister give the House any idea when the drug will be available for young boys suffering from Duchenne muscular dystrophy in this country, in the same way as it is across Europe? The drug is saving young boys from going into wheelchairs earlier. Does the Minister have any idea when it will be available?

[George Freeman]

I have had a number of meetings with patient groups, campaigners and charities over recent months, and the hon. Gentleman will appreciate that due process is important. NHS England is looking at whether to make an interim ruling on the drug in advance of a decision by the National Institute for Health and Care Excellence, and I have worked with NICE to ensure that its process is accelerated. We should get a decision from NICE this summer, and I hope that NHS England will make a rapid decision based on that judgment.

National Health Service

David Anderson Excerpts

Wednesday 21st January 2015 Commons Chamber

[Andy Burnham]

I shall give way in a moment.

Another recent case symbolises just how bad things have got. Michael Steel, a dad of two, aged 63, was moved from his ward to a store cupboard while being treated for an inflamed liver. Mr Steel was unable to sleep because he was wheeled in and out of the cupboard while staff went to get drugs from the fridge. One nurse apparently told him it was “absolute chaos”. His son Tom took pictures of the ordeal, including a photo of the ward’s whiteboard where nurses listed his dad’s location as “stock room”. This is the NHS on the Secretary of State’s watch.

[Mr David Anderson (Blaydon) (Lab)]

I agree with the Chair of the Health Committee that the Secretary of State and his Ministers should listen to the professionals on the front line. If they had listened three years ago, we would not have been lumbered with the Health and Social Care Act 2012, because everyone at the professional end of the health service said, “Do not do it.” But they were ignored by the Secretary of State.

[Andy Burnham]

What we can see is that this decline began when the Government made the monumental misjudgment of bringing forward a top-down reorganisation that should never have happened, that nobody voted for, and that took 1.5 million eyes off the ball in the NHS. The Government should have been looking at the front line and maintaining standards there, instead of which they looked backwards, and focused on the reorganisation and the jobs merry-go-round that then carried on. It is really disgraceful that they did that and plunged the NHS into the chaos that it is today.

NHS Specialised Services

David Anderson Excerpts

Thursday 15th January 2015 Westminster Hall

[Mr David Anderson (Blaydon) (Lab)]

I congratulate you, Sir David, on your knighthood, which is well deserved. I also congratulate the hon. Member for St Austell and Newquay (Stephen Gilbert) on the very good way in which he introduced this serious issue; I disagree with nothing that he said.

I apologise, Sir David, because as I told you earlier I am one of the co-signatories of the debate that is to take place in the main Chamber. I think this is the first time since the setting up of the Backbench Business Committee, which we both sit on, that proceedings in the Chamber have not been extended by questions or statements, so they will run to time for the first time. Unfortunately, I will have to leave, although I will get back for the wind-ups, if possible, or even before.

I want to pick up on three things: the work that I am involved in as the chair of the all-party group for muscular dystrophy; issues brought to my attention by the Northern Neurological Alliance in the north-east; and some specific concerns about NHS England and what it is involved in.

The APG for muscular dystrophy has in effect been carrying out an investigation for more than a year into national commissioning. We worked closely with various groups before the change in the law, developing good working relationships and trying to ensure that people with these relatively rare diseases are looked after properly and that the commissioning works properly in their interests. We have had full engagement and good commitment from patients, carers, the NHS professionals, politicians—and, it has to be said, health service Ministers.

What has become clear, as will come up in the report that will probably be launched in the House on 24 March, is that there are many gaps in specialised neuromuscular care, which will be highlighted, at least, by the inquiry, but will need addressing by people such as the Minister, although hopefully under another Administration a few weeks later.

For example, in my region, the north-east, we have world-class, cutting-edge neuromuscular specialists working in multi-disciplinary care at the specialist muscle centre in Newcastle. On the grounds of urgent need for more support, however, we need additional neuromuscular care, advice and support to provide essential services to people living at home with such problems. We need an additional neuromuscular consultant and the psychological support necessary for people who live with these problems. Will the Minister meet me and the rest of the APG for muscular dystrophy to discuss not only the issues in the north-east, which are examples of the type of cases being brought before the investigation, but the problems throughout the country, to see what we can to do to improve care for these people?

The hon. Member for St Austell and Newquay expressed concerns about co-commissioning and the provision of specialised services between NHS England and the CCGs. That is a real worry. Problems have been identified and raised with us in the implementation and interpretation of the neuromuscular annex of NHS England’s neurosciences service specifications. Some commissioners and hospital trusts appear to believe that the neuromuscular annex is a wish list, rather than a requirement. We are clear: it should be a requirement, not a wish list. Will the Minister address those points, if he can, in winding up? What action will he take to ensure that the neuromuscular annex of the service specification is fulfilled by NHS trusts listed in the specification as a compulsory requirement? If he can make that clear to the people on the ground, that would be a great step forward with the problems.

I also want to raise some issues brought to me by the Northern Neurological Alliance, a charity that operates in Northumberland, Tyne and Wear and County Durham. It aims to improve the lives of people with long-term neurological conditions, or LTNCs, and their carers. It does so by seeking their views on the quality of services received and then campaigning for improvements where necessary. The charity calculates that in the north-east of England at least 50,000 people are living with one of the 15 most common LTNCs, such as multiple sclerosis, Parkinson’s disease and acquired brain injury. Many LTNCs, however, are less common.

Many people experience reductions in their quality of life as a result of such conditions. Many examples have been given of loss of independence, poor mobility leading to social isolation, and, clearly, financial challenges. In addition to those who have such conditions, there are the many family members who act as carers. As a result, the total number of people in the north-east affected by LTNCs is much greater than the 50,000 who actually have the conditions.

Without doubt, services for such people need to be improved. In 2011 the National Audit Office published a report that looked at the services provided for the some 2 million people who are assessed to be suffering with a neurological condition. They found evidence of poor co-ordination of services between health and social care, and a nationwide postcode lottery of specialist services. Unfortunately, it would appear that things have not improved a great deal.

The Neurological Alliance has contacted the CCGs for information about how they target resources for people with neurological conditions. The findings show that only 14.7% of CCGs have assessed local costs for the provision of neurology services; that only 20.4% and 26.2% of CCGs have assessed, respectively, the number of people using neurological services and the prevalence of neurological conditions within their area; and that such issues have a significant impact on patient care, with 58.1% of patients having experienced problems in accessing the services or treatment they need—clearly, a big group of people.

LTNCs have not attracted the same national priority as conditions such as cancer or heart disease, which is possibly understandable because of the greater prevalence of such diseases. However, for people who live with LTNCs, it is equally important to get looked after properly, too. They clearly wait much longer for services to come through. The impact can be serious for many of them. The need for clear and determined national leadership is urgent to achieve the requisite improvements that I hope everyone in the Chamber agrees we should be seeking.

Finally, I want to pick up an issue that has arisen in the past few days; I spoke about it yesterday with the Prime Minister. It involves some of the problems with NHS England. A new drug called Translarna can treat a small group of young boys who suffer from a strain of muscular dystrophy known as Duchenne muscular dystrophy. In August 2014, the European Commission granted conditional approval for Translarna. It is the first licensed drug that can treat an underlying genetic cause of Duchenne ever to have been approved anywhere in the world. It was a landmark decision for the community of those suffering from Duchenne.

Translarna treats boys whose Duchenne is caused by what is known as a nonsense mutation—if anyone wants me to explain that, I had better leave now! The mutation accounts for 10% to 15% of the boys who suffer with Duchenne. The truth is that those young men have no chance of being cured of the disease once they have it, but we try to enhance and extend their lives. Some great work has been done in this country and even better work done in countries such as Denmark. Translarna will have a huge impact on that 10% to 15% of the boys suffering from the disease. To qualify for the treatment, however, young boys must be aged over five and still walking. Clinical trials indicate that Translarna could slow the progression of the condition and keep the boys walking for longer. It has already been made available in European countries such as Spain, Germany, France and Italy.

We understand that there are different regimes and that we have to go through our regime. Translarna was being assessed by NHS England, which has the final decision on whether the drug will be approved and, as we hope, funded for boys in England. The families understood clearly that a decision was to be taken last September, making the treatment—really important for the young people affected—possibly available from April. Unfortunately, however, due to the threat of a legal challenge, NHS England has stopped the assessment of the drug while it reassesses its process. An internal debate within NHS England has stopped the assessment of a drug that could mean at the very least that a number of those boys could be walking for much longer than was otherwise thought possible.

Yesterday, more than 100 families, along with a lot of colleagues from both this House and the other place, came together to lobby and deliver a petition of over 23,000 signatures to the Prime Minister in Downing street. To his credit, he answered my question yesterday positively and also met us outside Downing street, where he gave a commitment to the families that he would do all he could, adding that he would speak to the Secretary of State before going to America. He was supportive of what we are trying to do.

The reality is that we cannot allow an internal discussion within NHS England to stop the treatment. The difference could literally be that the boys concerned will stop walking when that does not have to happen. I could not personally live with that. We must do something about it.

I ask the Minister to give us an assurance today that the Department of Health and NHS England will work together to see whether they can move the situation forward. Yesterday, the Prime Minister said—he did not mean it disrespectfully—that he had given NHS England a lot of work to do recently. We all understand that. Although we might kick around in here and have an argument between ourselves about it as if it was a political football, the NHS is about helping people such as the young people I am talking about. It cannot save their lives, but their lives can be improved and, we hope, extended. Translarna could do that, so I hope that between us we can find a way to make things work.

Oral Answers to Questions

David Anderson Excerpts

Tuesday 13th January 2015 Commons Chamber

[Dr Poulter]

I very much welcome what the hon. Gentleman’s constituent is doing locally. For many patients the pharmacy is often the first point of contact with the NHS, so the more we can do as a Government to support local pharmacists in delivering community services, the better.

[Mr David Anderson (Blaydon) (Lab)]

Despite all the warm words we hear every week from the Government about their support for the staff of the NHS, which I welcome, the Government still refuse to pay the award recommended by the independent review body. At the same time the chief executive of the trust in my part of the world has had a 78% salary increase and the people who set the allowances, the board of governors, have had an 88% increase in their allowances. Is this what is meant by “we are all in this together”?

[Mr Hunt]

I believe that NHS managers have a responsibility to be sensible about their own pay. This is not decided centrally, but when we are asking NHS staff to make sacrifices in their own pay to make sure that we can recruit enough staff, NHS managers should set an example.

NHS (Five Year Forward View)

David Anderson Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. For every hospital in difficulty—he has had many discussions with me about his hospital, which is going through a very difficult period—there is another with the same funding settlement that is able to deliver good care with motivated staff. Leadership is extremely important for motivating staff, and the one thing that staff say matters most to them is having leaders who listen to what they say and, when they have concerns, take them seriously. That is a change that we are beginning to see throughout the NHS.

[Mr David Anderson (Blaydon) (Lab)]

On that subject, I can advise the Secretary of State that last week I spoke to nurses in the hospital near my constituency, and they told me that as a result of the cuts in their pay, which have been going on for many years, they are seriously considering setting up shoebox collections to help their members get through this Christmas. At the same time, the chief executive of that trust has had a 17% pay increase, and the governors have had an 88% increase in their allowances. Is that what he means by all being in this together?

[Mr Hunt]

I am afraid we will not take any lessons from the party that increased managers’ pay at double the rate of nurses’ pay when in office. I will tell the hon. Gentleman what this Government have done: because of our increases in the tax-free threshold, the lowest paid NHS workers have seen their take-home pay go up by £1,000 a year.