Covid-19 Update

David Davis Excerpts

Tuesday 24th March 2020 Commons Chamber

[Matt Hancock]

On the last point, there was an urgent question about exactly that issue. It really is a matter for the Treasury. The hon. Gentleman is right that contact tracing is incredibly important, and the amount of contact tracing that we have done is one of the reasons why we have managed to be behind other European countries in the curve. At this stage in the epidemic, it is not possible to have contact tracing for everybody, as we can when there is a very small number. We are looking at how we can do that better and enable individuals to contact trace, including by using technology.

The hon. Gentleman asked about refugees. I do not know whether he was in the Chamber yesterday, but that subject was brought up and I said that I would look into it. I will get back on that as soon as I can.

The hon. Gentleman asked about the number of ventilators. We started with around 5,000 and we now have more than 12,000, which we have bought. We have also made the call to arms for manufacturing capability to be turned over to ventilators, and that has been very successful.

I strongly endorse and support the backing of the Scottish Government and the SNP in the UK-wide approach to getting the message out to everybody that the most important thing anybody can do is stay at home.

[Mr David Davis (Haltemprice and Howden) (Con)]

I commend the Secretary of State for his heroic efforts in our defence so far. Given that the proscription on travel is now legal and not simply a recommendation, will he give us some clarification on what is meant by the care exemption, and confirm that it does not apply just to professional carers? At the moment, and since special schools have been closed in the last week, a great deal of support has been given from one family to another, for example in providing respite care for special needs children. That is very important and the people doing it are often being very responsible about self-isolation, which they are already applying to their families. Will that continue to be possible, and will my right hon. Friend enable it in future?

[Matt Hancock]

I will say three things in response to my right hon. Friend’s questions. On special schools, one of the carve-outs in the closure of schools was keeping open schools for those who are vulnerable, including those with special educational needs. The Bill includes a power to enable us to move from that position, but we do not propose to exercise it unless absolutely necessary. The position therefore is that if someone wishes to send their child to a special school, that is fine. It was one of the specific carve-outs. In the same way, if a key worker needs to send their child to school and cannot look after them at home, schools are available.

My right hon. Friend asked about care. I want to make it clear that for people who are volunteering in response to covid-19 and those who are caring, even if their responsibilities are unpaid or informal, they are okay to do that and should do that. They should stay more than 2 metres away from others wherever possible, but that has to be a practical instruction, because of course we need to care for people. As I said in the statement, travel allows for caring, and I want to make it clear that volunteering in the response to covid-19 is a legitimate reason to travel. For example, the increasing numbers of volunteers in the NHS are important. Although it is not paid work, it is work in the national effort to respond to covid-19.

My third point is that the Patient Safety, Suicide Prevention and Mental Health Minister is sitting next to me and close to me, because she has recovered and all the evidence shows that people cannot catch covid-19 twice, at least not in quick succession. I welcome her back to her place.

Coronavirus Bill

David Davis Excerpts

2nd reading & 2nd reading: House of Commons
Monday 23rd March 2020 Commons Chamber

[Matt Hancock]

We have other ways to enforce that with care homes, not least contractually through local authorities. I understand the hon. Gentleman’s concern; people in care homes need to be protected, and many of them shielded, from the virus, because many of the most vulnerable people are in care homes. I will take away the point and look at whether more needs to be done, but we do have other powers available to deliver on what he and I—I think—agree is needed.

[Mr David Davis (Haltemprice and Howden) (Con)]

I commend the Secretary of State for accepting the six-month review that he has just announced, but in the event that the House decides that one element of the Bill is working badly, will we be able to amend or strike out that element, or will we have to take the whole thing or reject it at that six-month point?

[Matt Hancock]

As discussed with the Opposition, we are proposing a six-month debate and vote on the continuation of the Bill, and before that debate we will provide evidence and advice from the chief medical officer to inform the debate. There is also a reporting mechanism for a report every eight weeks on the use of the powers in the Bill.

--- Later in debate ---

[Jonathan Ashworth]

My hon. Friend makes an excellent point. I represent an inner-city seat, and I appreciate that her seat is on the outskirts of London but, none the less, our seats have similar demographics. I know full well that many, many families are living in cramped, small flats. There are intergenerational families living with elderly mums, elderly grandmothers and so on who have various comorbidities and who need to be shielded.

If we enter a situation in which we force people to stay at home, I hope the Government will look at how to support such families, because it is quite outrageous that, in many parts of the country—especially in London, but also in my constituency—there are flats with families of nine or 10 people sleeping on the floor, and so on, while property developers have flats standing empty. Why cannot we take over some of those empty flats to house some of these very vulnerable families and to help us get through this national crisis?

[Mr David Davis]

I commend the hon. Gentleman for the stance he is taking in this debate. The whole House will respect him for it. The series of interventions that he has just taken demonstrates a wider point: the need for the Government, sadly—and I did not think I would ever say this in this House—to get into intrusive levels of planning that we have never seen before, because every time we have a change in the level of ferocity or intensity of our dictating what the state and society should do, we run into a new set of problems, whether that is crowding on tube trains overwhelming our desire for social distancing, or young mothers with children at home finding it very difficult to get to supermarkets and therefore literally running out of food, which is even more fundamental than running out of money. We need to think forward, and I say that because we have seen in Europe—between Germany, Italy and Spain—very similar policy actions but with completely different outcomes. I suspect that it is because of a different approach taken by the German Government and society from that taken by the Italians or the Spanish, and we have to think about that as we go into the next stage.

[Jonathan Ashworth]

The right hon. Gentleman is absolutely right. We are asking people, and are probably on the cusp of probably of forcing people, to radically adjust their behaviour in a way in which we have not been used to for more than 70 years. The last time that we asked people to radically adjust their behaviour was in the second world war. We have generations who are not used to this. We are a society who are used to going where we want, buying what we want, doing what we want and socialising when we want, and clearly, for a lot of people, it is not dawning on them that they will have to change the way they behave. That has huge knock-on effects for how public services will be organised, how the criminal justice system will have to work and how food distribution systems are going to work. It is right that we as parliamentarians continue to ask Government Ministers serious questions about that, but we also have to be aware that we have a responsibility to set an example to the country. We have to socially distance ourselves, so I really hope that the good offices of the Speaker, the Leader of the House and everyone who is involved in House business can quickly find a satisfactory set of procedures for us to continue having our discussions and asking Ministers questions, but not setting the example that we are unfortunately setting today. I am not making any personal criticism of any Member, because it is the situation we are in—we have to debate the Bill today—but we are going to have to hold the Government to account on the far-reaching, extensive powers that they are taking.

--- Later in debate ---

[Jonathan Ashworth]

Absolutely. That is why these particular clauses must be scrutinised so carefully by Members across the House.

We have tabled amendments to schedule 11. We recognise that there will be difficulties delivering social care over the coming weeks and months, but it should not be possible for local authorities to immediately drop care packages to a lower level. As long as it is reasonably practicable to do so, they should continue to meet people’s care needs. The presumption should always be that services will be disrupted as little as they can be under the circumstances. Nothing in our amendments would stop a local authority cutting back care hours if it had to, but they would mean that disabled and older people could be reassured that any reductions in their care will be a last resort, and that their independence will not be the first sacrifice to be made.

There are particular concerns about people who live alone or are being held in in-patient units and care homes. We have seen visits to those settings stopped as part of the Government’s shielding approach, and the CQC has halted all inspections, but we know from incidents such as Whorlton Hall that is too easy for abuse to go unnoticed—something the current situation could make worse. How will we ensure that in-patient units and care homes do not become hotbeds of abuse of human rights over the coming months?

[Mr David Davis]

That is precisely why I asked the Secretary of State whether, when we get to the six-month review and renewal of this legislation, we will be able to amend it. If there is oppressive behaviour in one part or another of it while the rest is all very important to the survival of our people, what stance will the Labour party take?

[Jonathan Ashworth]

The right hon. Gentleman is right: we cannot just have a take-it-or-leave-it approach to these things. Tonight, the House will give the Government extraordinary powers, like we have never seen before, and it is right that we parliamentarians are given an opportunity, after the appropriate timeframe, to look at how those powers have been used and hold Ministers to account. I agree with the spirit of the point he makes, although I cannot at this stage—I suppose it may emerge later in the debate—give him a commitment one way or the other on a particular amendment. We will see how the discussions proceed throughout the afternoon, but I certainly endorse the spirit of what he says. As I say, these are extraordinary powers that the House will grant the Government this week.

We have tabled a new clause related to schedule 11. We propose that a relevant body, such as the Equality and Human Rights Commission, should be tasked with overseeing the Bill’s impact on the provision of social care. That body would have to report every eight weeks on the operation of these changes and whether they should be amended. It would provide the oversight that is needed to prevent people’s rights from being undermined.

One of the ways the Bill seeks to free up medical staff is by relaxing the requirements of the Mental Health Act 1983. Specifically, only one medical professional will have to agree to someone’s being sectioned, rather than the two it currently takes. The scale of that change should not be underestimated. No longer will a decision to section a person have to be taken in consultation by two doctors. There will be no requirement for anyone involved to have had prior involvement with the patient. Medical professionals are going to be under huge pressure in the coming months, and mistakes may well be made.

The Bill says that a decision should be taken on the basis of one signature if requiring a second signature would be

“impractical or would involve undesirable delay.”

That seems to be too vague and potentially open to misreading. I hope Ministers can tell us what exactly that means and what safeguards will be put in place to prevent the change from being misused. Our amendments to schedule 7 would narrow the provision so that a second signature could be left off only if acquiring it would mean an undesirable delay. If something is impractical, it will by definition create an undesirable delay. By narrowing the wording in the Bill, we can avoid the potential misuse of powers.

We propose changes to ensure that private mental health hospitals cannot detain someone solely on the single recommendation of one of their employees. That could create a conflict of interest whereby a doctor comes under pressure to sign a detention authorisation because doing so will provide their employer with income from the NHS. No medical professional should be put under that kind of pressure, and our amendment would ensure that they cannot be. [Interruption.] Is the hon. Member for Bracknell (James Sunderland) seeing to intervene?

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[Ian Blackford]

That is the height of irresponsibility, and Amazon and anybody else who would behave in that way needs to think again. Of course there are companies that are engaging in best practice. I have had a number of complaints from people in the highlands about those who have not been doing the right thing, but let me thank Highland Experience Tours, which has suspended all its activities and sent its drivers home. The hon. Member for Ilford North (Wes Streeting) mentioned Sykes Cottages, and I have to disagree with what he said, because its behaviour has been absolutely reprehensible. Let me read to Members what Sykes Cottages sent to me on Saturday. It said, “Given concerns surrounding the current outbreak, it is understandable that people want to arrange private accommodation in more remote locations to distance themselves from larger towns and cities. The latest Government advice does not prohibit travel in the UK. We are continuing to provide a service for customers.” That is a service to customers to come from the urban areas; it is deliberately creating the circumstances whereby their customers should come to self-isolate in an area where we have limited public health capabilities. That simply is not good enough.

I am delighted to say that, under pressure, the site has now relented and is stopping new bookings in the highlands and islands over the next few weeks, but it has sent a considerable number of people up to the highlands who are there today. The site should be delivering immediate advice to all those guests that they should return home to their place of origin.

I give the same message to those with holiday homes and second homes in the highlands: “Do not come to the highlands. Do not put additional pressure on our public services. We will welcome tourists back to the highlands once this emergency is over, but do not threaten the health of our constituents.” In my district, like in many rural areas, 35% of the population is aged over 65. We have to think about the needs of those living in such areas.

In addition to the sites I have mentioned, Cottages.com is refusing to allow cottage owners to cancel bookings without a penalty, which is simply not good enough. As this is now in the public domain, I hope all these providers will now think about their responsibilities.

As I have mentioned, some providers are behaving more responsibly. HomeAway has guidance on its booking site for giving refunds to those who cancel, but I will read one last email from somebody living in the Lake district:

“My family and I were due to take up a holiday home rental from the 28th March. We will stay away and remain in the Lake District where we live.

However you might be interested to learn that the owner of this holiday home, let through HomeAway, is refusing (at present) to cancel my booking, refund my payment of £957 or move my reservation to next year. He maintains that Skye is an ideal place to self-isolate…and as the home is available he is refusing to refund the total of my booking fee.”

[Interruption.] I can hear an hon. Member shout, “Shocking.” Skye, or anywhere else in the west highlands, is no place for anyone to self-isolate, and I hope this cottage owner, and others who are behaving in such a reprehensible manner, changes their ways.

Of course, it is not just those who are providing accommodation. Everyone knows about the Harry Potter films and the attractions of the rail line from Fort William to Mallaig. The steam trains, which operate on a regular basis, are due to start on 6 April. What on earth is the Jacobite steam train company thinking? These train trips, along with every other visitor attraction in the west highlands, must close, and they must close today.

This is my message to anyone thinking of coming to the highlands: “You will be made welcome when this is over but, for the time being, stay at home. If you are in the highlands now, please go home. The Scottish Government have already announced that ferry traffic will be prohibited for those on non-essential journeys, but you have the ability to return home today. Please do so.”

This Bill includes badly needed powers to allow more health and social care workers to join the workforce. That includes removing barriers to allow recently retired NHS staff and social workers to return to work, as well as bringing back those on a career break and bringing in social work students to become temporary social workers. It has to be said that the number of doctors, nurses and carers already seeking to re-register to help in this emergency has been one of the most uplifting stories of this crisis. The Bill allows that process to become much easier. Its provisions also allow for the relaxation of regulatory requirements within existing legislation to ease the burden on staff who are on the frontline of our response.

The next few weeks and months need simply to be about saving as many lives as possible. Try as we might to save these lives, unfortunately the truth is that this virus will inevitably end up with many of our people dying before their time. That terrible reality is why it is right that this legislation includes special arrangements and provisions to manage an increase in the number of deceased persons with respect and dignity.

Finally, something my party has raised repeatedly since the early stage of this crisis is the economic interventions required to help our people though this emergency period. I note that the legislation includes provisions to support the economy, including on statutory sick pay, that are aimed at lessening the impact of covid-19 on small businesses. While we have welcomed many of the measures brought forward by the Chancellor, we have put it on record that more needs to be done. The self-employed and the unemployed, whom we talked about earlier, need to be considered. They are under pressure and they need to know that we have got their backs. They need the security of a guaranteed income. We now have an opportunity to overhaul and fix the universal credit system—ending the delays, uprating the level of support and scrapping the bedroom tax. If we are to fight this virus together, we must ensure that everyone is supported equally and that no one—no one—is left behind.

The emergency and extensive powers in this legislation have rightly raised questions and concerns, many of which we have heard this afternoon. The imposition of measures that will significantly alter individual liberties deserves full and frank scrutiny, no matter the context. We know that the Bill sunsets after two years. However, there are serious concerns over the two-year period and the scrutiny of this measure. I know that aspects of the Bill and amendments to it will be discussed at later stages. I hope that the Government will look carefully at the safeguards of regular reporting, review and renewal if it is required.

[Mr David Davis]

The right hon. Gentleman is making a powerful speech. As he knows, I have an amendment in Committee to change two years to one year. I asked the Health Secretary whether we would be able to amend or delete an element of the legislation at the six-month review; otherwise, we will perhaps be faced with eight good bits of legislation and one or two bits that are doing badly, and we will be forced to vote the whole thing through, rendering it a rubber stamp. Does the right hon. Gentleman agree that either my amendment or a variant of the amendment tabled by the right hon. and learned Member for Camberwell and Peckham (Ms Harman), which would allow us to change the Act, would be a better way forward?

[Ian Blackford]

I agree with the right hon. Gentleman that that would be a very good way forward. It is important that we enact the Bill, but the House must have oversight of it in the period ahead. I commend him for his approach.

The Scottish Government have pledged to have appropriate reporting on how and when they will use the powers in the Bill. They will embed such reporting and renewal in law. They have stressed that the creation of these additional powers does not mean we will automatically be required to use them. I hope the UK Government follow that lead and give assurances in the remaining stages this evening.

The emergency powers and the extent of the legislation demonstrate what all of us are faced with. This is not a normal time. Unfortunately, the truth is that none of us will live normally for some time to come. As the First Minister has said, if individuals are continuing to live normally, they need to ask themselves if they are following all the scientific advice. The sheer speed of the spread of this deadly virus has shocked us all. It has naturally made us reflect on the way we live and the vulnerability to which we are all exposed. Equally, it has demonstrated our dependence on one another. We live in an ever smaller world and the major challenges we all face are the same; we can only face them together.

The provisions in this legislation are about saving as many lives as possible during the biggest health emergency this planet has faced in 100 years. If we do not take immediate and unprecedented actions, we will be responsible for putting people at risk. If we act fast, we know that we can save thousands of lives. It is as simple and as clear as that. Never has a more important responsibility been placed upon all of us. Saving these lives must be our sole focus.

Oral Answers to Questions

David Davis Excerpts

Tuesday 10th March 2020 Commons Chamber

[Jo Churchill]

We are committed to providing those extra 6,000 GPs across the country. We have also made sure that incentive schemes are in place in areas where it is difficult to recruit, and they have been found to be very effective in driving additional GP numbers into challenging areas such as the hon. Lady’s constituency. We are working on the matter.

[Mr David Davis (Haltemprice and Howden) (Con)]

3. What assessment his Department has made of the risks to public health of antimicrobial resistance.

[The Secretary of State for Health and Social Care (Matt Hancock)]

The UK is a world leader in tackling the global challenge of antimicrobial resistance. Since 2014, we have invested £615 million in the area, over half of which is in research and development, as part of our vision to contain and control AMR by 2040.

[Mr Davis]

Regrettably, the coronavirus outbreak has demonstrated the susceptibility of global society to pandemics and antimicrobial resistant organisms. Lord O’Neill, who chaired the review, estimated that some 10 million people a year could die by 2050 because of AMR. The previous chief medical officer said that we could easily get to a state where fully half of people die from untreatable infectious diseases. Is my right hon. Friend content with the level of work and research being done in his own Department with respect to novel approaches such as genomics, combination drugs and new sorts of vaccinations? Will the importance of those things be reflected in the forthcoming spending review?

[Matt Hancock]

Yes, absolutely. My right hon. Friend is right to highlight the threat of AMR, because microbial illness and disease is just as much of a threat as viral disease and we must ensure that we retain the tools that we currently have through antibiotics to tackle it. We are investing in that space with more to come.

Oral Answers to Questions

David Davis Excerpts

Tuesday 29th October 2019 Commons Chamber

[Jo Churchill]

Clinicians should be in charge of the process, and I have been assured that the change, using genomic testing, is better for patients and better for outcomes, but I would of course be happy to meet the hon. Gentleman and discuss it further.

[Mr David Davis (Haltemprice and Howden) (Con)]

I commend the Minister for the progressive approach the Government have taken to genomics, but for a large number of genetic diseases the symptoms do not manifest themselves until after developmental damage has been done. Will the Government consider whether we should extend genomic testing to all neonates—all newborns—at some point in the future?

[Jo Churchill]

The Government are very open to such an approach. Genomics is transformative, and the early detection of disease means that we can treat patients from birth better and more efficiently.

Oral Answers to Questions

David Davis Excerpts

Tuesday 5th July 2016 Commons Chamber

[George Freeman]

I am delighted to assure the hon. Lady that as part of the accelerated access review, we are considering how we can ensure that the £1 billion commitment to the cancer drugs fund is used to accelerate through the most effective treatments, and, through the new system that NHS England is putting in place, to make sure that patients get access to better drugs more quickly.

[Mr David Davis (Haltemprice and Howden) (Con)]

T9. The Royal Free London NHS Foundation Trust recently signed an agreement to share 1.6 million patient records with Google’s DeepMind subsidiary. The data include medical history, HIV status, past drug overdoses, abortions, and all pathology, radiology and visit records. It is claimed that the data are anonymised, which is impossible given the nature of the data, and no permission was obtained from patients. It is also claimed that the agreement was made under the Secretary of State’s guidelines. Will he tell the House what he is doing to protect the privacy of such information?

[Mr Jeremy Hunt]

I am very happy to do so. My right hon. Friend has campaigned long and hard, and rightly so, on such issues. The truth is that the guidelines under which the NHS operates for the sharing of patient-identifiable data are not as clear as they need to be. That is why I asked the Care Quality Commission to undertake an independent investigation into the quality of data protection by NHS organisations and Dame Fiona Caldicott to update her guidelines. I hope that we will have news on that soon and certainly before the summer recess, which will please my right hon. Friend.

Health Service Commissioner for England (Complaint Handling) Bill

David Davis Excerpts

Friday 27th February 2015 Commons Chamber

[Mr Arbuthnot]

Given that I spoke for four and a quarter hours, my hon. Friend is very kind to make that generous observation, but I am not sure that I share his view.

Over my political life I have often been asked what I would choose for a private Member’s Bill. In my early political life I would usually say something frightfully worthy, such as bringing in a Bill to improve the national health service. In my later political life, as my cynicism has grown, I have said that I would bring in a private Member’s Bill to abolish private Members’ Bills.

[Mr David Davis (Haltemprice and Howden) (Con)]

The guidance that I took in determining which Bill I would present to the House, given that I was No. 19 in the batting order, was the guidance of my old friend Eric Forth, whose ghost still haunts these proceedings. Eric believed that private Members’ Bills should be essentially uncontroversial. He thought that the private Members process existed not to put controversial Bills through, but to allow things that were fairly obvious to be done. That was my guidance in choosing this Bill in this form, and I will come back to that later.

--- Later in debate ---

[Mr Arbuthnot]

I like my hon. Friend’s suggestion. In Committee on Tuesday, he and I discussed the value of having legislation that is comprehensible to the people whom it affects, and this Bill will affect everyone in the country. The laws we make should not be written in gobbledegook that is not comprehensible to the people who own and enforce the law and who have it enforced upon them. It would be an improvement if the legislation referred to an ombudsman, because that is what everybody calls them, so I hugely support my hon. Friend’s suggestion.

[Mr David Davis]

I return to the Eric Forth principle. As I have said, Eric was a friend of mine. Indeed, I successfully nominated him for a knighthood, but he died before he could receive it. I took his views seriously and he believed in simplicity in these matters. The difficulty conjured up by the suggestion made by my hon. Friend the Member for Bury North (Mr Nuttall) is that a proposed law must be enforceable according to the terms of the law it seeks to amend. This Bill seeks to amend an Act about national health service commissioners, so if it referred to an ombudsman it would run into a problem of legal conflict. My hon. Friend makes a very good point, with which I agree—Eric Forth would have, too—but we had to compromise.

[Mr Arbuthnot]

My riposte to my right hon. Friend is that perhaps he could have promoted a slightly bigger Bill to amend the Acts that introduced the parliamentary ombudsman in 1967 and the health service ombudsman in 1973 and combined them in a way that made them accessible to the public, which, as my hon. Friend the Member for Bury North (Mr Nuttall) has said, they currently are not. They see the words “commissioner” and “ombudsman” and wonder where the two meet.

[Mr Davis]

That runs into another Eric Forth rule, which is that that would cost money.

[Mr Arbuthnot]

My right hon. Friend has got me there, so I will subside.

The Bill would give a complainant to the ombudsman a statement of explanation if there was a delay. That seems a very small suggestion, but the humanisation that such a statement would bring to a process that would inevitably be a little intimidating for complainants, however well the health service ombudsman does her work, may well make the difference to whether a complainant will trust the process or not. If a complaints process is not trusted by complainants, we might as well not have the complaints process in the first place.

The Bill would also require the ombudsman to include in her annual report details of how long investigations of NHS complaints have taken to be concluded, how many of those investigations have not been resolved within a 12-month period following receipt of the complaint by the ombudsman, and the action being taken with a view to concluding all investigations within a 12-month period. That process of openness would lead to an improvement of trust between those who use the NHS and have the misfortune of needing to complain about it and the ombudsman given the task of looking into such complaints. As a by-product, the Bill might also act as a further spur to the national health service commissioner to ensure that even more cases are concluded within a 12-month period. As I understand it, about 99% of the cases she takes on are concluded within a 12-month period.

My new clauses are probing amendments. I do not intend to go to the wall or to die in a ditch for them, if that is an appropriate juxtaposition of metaphors. They state that the

“Health Service Commissioner shall make available to anyone considering making a complaint, an estimate of the period within which investigations are to be completed”

and that once a complaint has been made the

“Health Service Commissioner shall make available to the complainant, at the outset of an investigation, an estimate of the period within which the investigation is likely to be completed.”

I have tabled the new clauses simply in the interests of transparency. It might be thought reasonable for people to be aware of how long they would have to wait for a response if they complained to the ombudsman.

[Mr Davis]

My right hon. Friend makes a very good point. In a perfect world, one would want to be able to tell every complainant to the health service ombudsman that they would get an answer within three months. However, in the case which initially led to such concerns the errors were manyfold in an area—it was sepsis, which I shall talk about on Third Reading—in which it took some time to develop an understanding of treatment and of the best approach. It is very difficult to know in advance how long it will take to resolve a problem, which may sometimes be medical as well as managerial, with a proper answer.

[Mr Arbuthnot]

I have to say that I find that argument extremely persuasive. However, it is reasonable for the ombudsman to give some idea of how long an investigation is expected to take. After all, it is only an estimate, not a hard and fast guarantee. I accept that the estimate may turn out to be woefully wrong—I think my right hon. Friend was referring to the Sam Morrish case, a huge tragedy that was highlighted in Committee by all parties—but I am just suggesting that it would be helpful to give an estimate. People may be put off complaining if they do not know what will happen, and they will be less frustrated if they are kept informed during an investigation.

[Mr Arbuthnot]

My hon. Friend has spotted a deep lacuna in my new clause, of which I am conscious. He is quite right, as I would expect of someone with his forensic skills. There is not, however, any need for legislation, in the way my hon. Friend suggests, to require the ombudsman to keep the complainant informed because, as far as I can tell, the ombudsman already does her best to keep complainants informed. In relation to the changes that the ombudsman is making in modernising the ombudsman process, which we will no doubt discuss on Third Reading, she is going out of her way to start a public consultation to ensure that the changes are as friendly to the public as possible.

[Mr Davis]

Eric Forth’s principle No. 4 is that laws should be minimalist: there should be the absolute minimum amount of law that there can possibly be to get the outcome one wants. In considering the Bill, I was concerned that we must not tell the ombudsman how to manage her business, as it were, particularly since the current ombudsman is doing an extremely good job of accelerating the process, dealing with more cases and dealing with them more quickly. I wondered for a while whether even this Bill was too much in terms of putting a force up behind it, but then I thought that there is not always the same ombudsman with the same energy level. The Bill will give a guarantee to the public and is therefore worth while. I was careful not to give instructions to do it in this way, that way or the other way. It is much better to leave good management to the service, but to put a public guarantee into law.

[Mr Arbuthnot]

It is worrying that my right hon. Friend is persuading me that I am wrong. It is very worrying, while one is on one’s feet, to be persuaded out of one’s own arguments. If he will allow me to cling on for just a few moments, I will get to the dregs of my argument.

The ombudsman might be the only champion of someone who is already vulnerable because they have been incapacitated to one extent or another by their health needs. Therefore, it would be a good idea to encourage the ombudsman to give as much information as possible to the complainant at the outset of the complaint, although my right hon. Friend is right, given his fourth or fifth Eric Forth principle on keeping laws as minimalist as possible, that we possibly should not put it into law.

As I said, 99% of complaints are completed within 12 months—that is, those that are taken on by the ombudsman. We will have to come back on Third Reading to whether the ombudsman takes on enough of the complaints that are made to them, because that issue arose in the evidence sessions of the inquiry of the Public Administration Committee into the ombudsman. If my new clauses were accepted and the ombudsman had to make an estimate of how long it would take, it is quite possible that they would simply have to tick a box to say that it would take less than 12 months. Therefore, the new clauses might, as my right hon. Friend might say, add very little but a formality. As I have said, I do not think that this reflects the way in which the health service commissioner operates. If there is an issue, she does as much as she can to keep people informed about what is happening.

The new clauses are probing amendments and, as I say, I will not die in the ditch for them. However, I look forward to hearing the views of my right hon. Friend the Member for Haltemprice and Howden, my hon. Friend the Minister and the Opposition spokesman about this minor attempt to be helpful.

--- Later in debate ---

[Mr David Davis]

My hon. Friend the Member for Bury North (Mr Nuttall) has presaged Eric Forth’s principle No. 5, also known as the law of unintended consequences, for which reason I hope that my right hon. Friend the Member for North East Hampshire (Mr Arbuthnot) will treat his new clauses as probing rather than substantive. One of the risks has already been talked about—that of imposing more work on and therefore slowing down the process of the ombudsman—but there is another one that my right hon. Friend and I, having been in the House for some time, will be used to: where legislation sets prices, targets or whatever, the minimum can become the maximum and the maximum can become the minimum. If an ombudsman’s staff member has to provide a prediction of the likely time it will take to resolve a complaint, not only are they likely to be cautious and, as my hon. Friend said, tick “12 months”, but they might say, “Well, until 12 months comes up, maybe I shouldn’t issue the report at all, in case I discover something I didn’t think of before.” It could thus have exactly the opposite consequence to that which my right hon. Friend intends.

[Mr Arbuthnot]

Would my right hon. Friend like to reflect on the strange coincidence of the number of Eric Forth’s laws we are looking at and the fact that he hated laws of all sorts?

[Mr Davis]

Yes, there are laws of nature and there are laws of man, and in Eric Forth’s case, there are forces of nature which sometimes are the forces of man. It is a wonderful paradox, but given that it was my right hon. Friend who provoked me to conjure the five laws, I blame him, not myself.

My right hon. Friend made a very thoughtful speech, and perhaps met Eric Forth’s sixth law, which is that all this has to be tested—that is the point of this House, and it was Eric Forth, more than anybody, who insisted that we did not just shovel through, sausage-like, a set of laws because the Administration or some pressure group wanted them, but that we tested them, and my hon. Friend the Member for Bury North has been doing that this morning.

This reform is likely to be the first of a number picked up by the Executive, not by us. The Public Administration Committee is looking at this, the Department of Health is looking at it, the ombudsman’s office itself is looking at it, and the Cabinet Office is also looking at the issues raised by my right hon. Friend and my hon. Friend. The Executive will be aiming to minimise the number of times complaints are turned down out of hand; to minimise the number of times people are told, “You’ve got the wrong department. Complain to somebody else”; and to minimise the constraints on the ombudsman’s office that might not permit it to intervene; and they will also be aiming to deal with the resource issue. It seems to me that we do not need to solve those problems. It is for the Executive to do so properly in Executive time, with debate going on across the Front-Bench teams. It is for them to deal with that; we are dealing with a simple problem here.

[Mr Chope]

When my right hon. Friend discussed the Bill in Committee, he contemplated the prospect of introducing amendments at this stage to reflect the outcome of the deliberations taking place in government and elsewhere. In the light of the Government’s failure to deliver a timely response, how much confidence does he have that they have the will to do this?

[Mr Davis]

A lot of confidence. I do not wish to pre-empt the Government’s forthcoming announcements, but neither do I want to push them into doing anything ill thought through. If the law of unintended consequences applies to anything, it applies to Government legislation—more than anything else. I am confident that this will happen, and in a way that will command support across the House. As my hon. Friend knows, it may be dangerous to make a prediction, but I think there will be agreement. Whatever happens in the general election, I believe these reforms are coming.

--- Later in debate ---

[Mr Nuttall]

I am grateful to my hon. Friend for that clarification. He suggests that the amendment is purely about transparency, which means it has more merit than I had accorded it.

[Mr David Davis]

Following that point from my hon. Friend the Member for Christchurch (Mr Chope), I think there is a risk that the amendment would transform the role of the Public Administration Committee, which currently provides oversight and acts as the guardian of ombudsmen, turning it into a champion for more money. I think that would be quite dangerous. I do not want to see the Committee go from being a regulator, comptroller and holder-to-account to a champion for more money.

[Mr Nuttall]

I am grateful to my right hon. Friend for that point, which I suspect adds weight to my opposition to amendment 5. I appreciate what my hon. Friend the Member for Christchurch has said about transparency, but I suspect that in press releases and in evidence given before the Committee the ombudsman would be able to do that anyway. When questioned about the reasons for delays, they would feel that they could easily say whether it was down to resources, either in public utterances to the media or more formally in evidence to the Committee.

[Mr Davis]

I started off being flattered by the suggestion from my hon. Friend the Member for Christchurch (Mr Chope) that I had been in some way seduced into mitigating the Bill, but I think that I am far beyond the point at which seduction, either metaphorical or real, is an option. Perhaps that is why, when it comes to new clause 3, which I think is the most substantive amendment in the group, I am not as much of an expert as the hon. Member for Ealing North (Stephen Pound) and my hon. Friend the Member for North East Somerset (Jacob Rees-Mogg) appear to be on the subject of corsets. As I understand it, corsets constrict things at one point and let them out at another. The risk in new clause 3 is that it would put such constraints on the ombudsman that problems would be created elsewhere.

There have been two problems with the operation of the ombudsman over the past few years: not meeting timetables and making mistakes. On a number of occasions the ombudsman has got things wrong, which has made things even more acutely painful for the people seeking help and support, because the ombudsman has had to go back and correct mistakes. Indeed, that happened on a number of occasions in the very case that is at the centre of this piece of legislation. Were we to go down this route, we might create a series of problems arising from the ombudsman making erroneous recommendations and proposals, which would of course lead to the issues being multiplied down the generations, rather than dealt with straightaway.

We must also remember that some of the issues that the ombudsman deals with not only require information from other Departments and other parts of Government, but sometimes involve contested arguments and may have legal liability associated with them, so we should not forget that there is a natural justice aspect to this. Finally, these issues are very often on the edge of science. The sepsis problem was one such issue, for which the medical profession is still seeking new solutions. We should be wary of going so far on this that we cause another set of problems. That is why I think the Bill as printed strikes the right balance.

[Mr Chope]

My right hon. Friend refers to potential legal liabilities, but my understanding is that anybody who comes before the ombudsman with a complaint has to give a guarantee that they are not intent on taking legal redress.

[Mr Davis]

I am not sure that the legal liability relates simply to the person bringing the complaint. It could relate to other people too, such as those contracting services. It also relates very much to reputation. Someone may, in effect, be asked to make a confession according to a timetable, which is not a good idea in a statute.

I agree with my hon. Friend the Member for Bury North (Mr Nuttall) in his critique of amendment 5. On amendment 4, I would leave that to practice guidelines, rather than putting it into law. It is dangerous, as I said earlier, to create lots of onerous responsibilities in law. The aim of the Bill is to exert pressure and give a degree of public guarantee, not to try to tell the ombudsman how to cross every t and dot every i.

The one amendment with which I felt some sympathy but am still uncertain about is amendment 3. I presumed from the Bill that the ombudsman’s department would respond close to the 12-month point when it knew that it might go past it. Earlier, it is likely to have to adjust the timetable; later is not tolerable. I am uncertain whether it may lead to perverse or unintended consequences if we do exactly what my hon. Friend the Member for Christchurch has proposed. I will have to think about that. The Bill has to go through a Lords stage. I ask my hon. Friend not to press the amendment today, but I give him an undertaking that I will look at the matter closely and see if I can come up with a form of words that I can suggest as a change in the Lords; I will let him know if I am not able to do that.

[Luciana Berger]

I shall not speak for long, but I think it right to respond to the contributions, and to speak on the options proposed by the hon. Member for Christchurch (Mr Chope). As we know, new clause 3 proposes to make it a statutory duty for complaints to be resolved within 12 months. We do not think that that is necessary. It is clear that the Bill sets out sufficient steps to achieve that. I agree with the right hon. Member for Haltemprice and Howden (Mr Davis) that, as we know, the overwhelming majority of cases are dealt with within that time, but there are obviously reasons why it may sometimes take longer. As hon. Members suggested, there may be complex cases, other agencies may be involved, or there may be a historical or long-running case that requires the extraction of data from decades past, which it may take a long time to collate. It is often not the ombudsman’s fault that these things take time. We therefore do not think it appropriate to make meeting the 12-month deadline a statutory duty.

On the amendments, it is proposed that when the ombudsman contacts complainants, she gives them an estimate of how long the investigation might take. We discussed the point earlier in relation to new clause 2. We Members of Parliament can get updates from the ombudsman on the progress of cases and share those with our constituents if they want further updates. To be fair, if we think about all the processes in which we support our constituents, this is one in which updates are provided, and complainants are provided with information about how their complaints are progressing and when an outcome might be provided.

Amendment 1 would require the commissioner to keep the complainant informed of progress. There is nothing wrong with this in principle. We should encourage the ombudsman to do this anyway. As I mentioned, as Members of Parliament supporting those complaints, we can receive updates. On the point about financial resource, I have looked closely at the amendment and listened to the debate this morning, and think that where delays occur in the progress of complaints, more often than not that is down to the complexity of the cases, rather than a lack of financial resources, so amendment 5 is not necessary. We do not believe that new clause 3 or the five amendments are necessary.

--- Later in debate ---

[Mr Chope]

I am grateful to my right hon. Friend for putting that suggestion, which could help, on the record.

On the issue of excuses, I fear that we are entering the territory of double standards. When my constituents who are company directors are required to submit their company accounts by a particular day and fail so to do, or when other constituents are required to submit their tax return by 31 January and fail to do so, that failure incurs a penalty of £100 and there is no room for excuses such as family bereavements, delays by accountants or third parties and all the rest of it. In relation to the excuses made by Departments, or the ombudsman in this case, on which we want to place similar obligations, we are not consistent.

[Mr David Davis]

My hon. Friend has made a minor slip. The ombudsman is not a Department; it oversees Departments, responding to and being overseen by a parliamentary Committee.

At the end of the day, my hon. Friend may have a very good point about the timing of amendment 3. If he is right, the alternative would be for me to make it very plain to the ombudsman that that is what Parliament expects. It is certainly what I expect and what I intended in drafting the Bill. Rather than jeopardise the Bill, we should make sure, as is very easy to do, that the ombudsman understands that point, as does the parliamentary Committee overseeing it, which is our final recourse.

[Mr Chope]

My right hon. Friend is right to say that we are talking not about a Department but about a parliamentary sponsored organisation that tries to hold the Government to account. Yesterday, the House discussed the whole saga of Equitable Life, and what a long drawn-out saga it was. We know that the ombudsman tried desperately to get timely responses from the Treasury and other Departments, and was frustrated at every turn. Looking back at that, we can see that being able to say that she had a statutory obligation to deliver the result of an inquiry within a particular period would have helped rather than hindered her in the work she had to do.

[Mr Chope]

I hear what my hon. Friend says. In essence, the more usual scenario in cases of bereavement is that people want what they describe as closure sooner rather than later. The Bill has been introduced to emphasise that it is the will of the House that such matters should normally be dealt with within 12 months.

[Mr Davis]

My hon. Friend is wrong about one thing: the ombudsman’s power rests on trust in the accuracy of the case that he or she makes. Equitable Life’s problems did not arise from that, but from the complexities of moral hazard and other such issues. A better example was the case of the state earnings-related pension scheme, in which the ombudsman, the Public Administration Committee and the Public Accounts Committee, under my chairmanship, was able to get the Government to pay out what turned out to be billions of pounds because of errors identified from accurate—though not, as it turned out, fast—investigation. The things we must not jeopardise are the accuracy and effectiveness of the ombudsman’s investigations.

[Mr Chope]

My right hon. Friend gives an example of which he had direct experience. All I can say is that it is a pity that people who present their tax return late are not allowed the same indulgence—saying that their affairs are very complex, or that their accountant let them down—to avoid a penalty. There is an issue with ensuring consistency in the rules.

We have had a good run round the circuit on this matter. As in the previous debate, this again emphasises that, as Eric Forth said, Bills should never go through on the nod without proper discussion. Although people may have looked at the Bill and thought it a pretty minor piece of legislation, even such a Bill—I have not seen many that are more minor—is worthy of discussion to work through its implications. Having said that and thanked hon. Members for their contributions to this short debate, I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.



Third Reading

[Mr David Davis]

I beg to move, That the Bill be now read the Third time.

I am delighted that the Bill has reached this stage. My hon. Friend the Member for Christchurch (Mr Chope) may think it is minor, but I do not think it will be minor for the people whose lives it will affect, whose complaints are dealt with more quickly and who will get closure more briskly as a result.

I want to take this opportunity to thank colleagues who have been supportive throughout the process, especially those who helped me to take the Bill through Committee. I thank colleagues who have helped me to meet some or all of Eric Forth’s six rules of good legislation, which is important and should particularly be borne in mind with private Members’ legislation.

As other Members have said, the original raison d’être of the Bill was the Sam Morrish case. However, it is not only about that case; all of us have had constituents with cases involving such important and recurrent issues. It is worth recounting the Morrish case because it highlights those issues very well.

In June 2014, the health service ombudsman published the report on an investigation into the care and treatment provided to Mr and Mrs Morrish’s son, who tragically died of septic shock on 23 December 2010, at the age of three, after a series of avoidable errors. In the three days before he died, his family dealt with the Cricketfield surgery, Devon Doctors Ltd, NHS Direct and the South Devon Healthcare NHS Foundation Trust. We have talked about the involvement of different organisations—all those organisations were involved, and they all failed in their duty to young Sam. His septic shock was misdiagnosed several times as he passed through the system. At each of the stages, what went wrong should have been corrected straight away, or as soon as possible thereafter.

In the report on Sam’s death, the ombudsman highlighted the lack of action taken to save the lives of people suffering from sepsis. The key point is that the ombudsman’s investigation is not just to address the complaint, but to prevent such cases happening again. She stated that the case demonstrated that the failure to diagnose and treat sepsis rapidly can have tragic consequences. Crucially, she found that Sam failed to receive appropriate care and treatment, but that had he done so, he would have survived.

The contents of the eventual report were commendable, but it took the ombudsman more than two years to investigate and report on the national health service’s handling of Sam’s case. During that time, a series of factual errors were made, which Mr and Mrs Morrish repeatedly had to correct; that must have been awfully painful, but we cannot address that aspect of the issue in this Bill. As a result, the Patients Association, which supported the Morrish family in their complaints, said that the ombudsman was not “fit for purpose”. The ombudsman apologised to the family personally:

“We took too long to investigate this case and made errors in the draft report. I recognise the family’s experience of us has contributed to their distress”,

which is to put it mildly.

As my right hon. and hon. Friends are only too aware, Sam Morrish’s case is not a singular instance, but something that comes up time and again. The stringing out of complaints in the NHS only causes further distress to patients and their families. There is a danger that such delays will lead to the underlying problems remaining unaddressed and uncorrected. When things go wrong, it is vital that lessons are learned. By improving the ombudsman service, we will take a small step towards ensuring that they are.

Although the ombudsman service is committed to changes that will require it to meet a timetable and, if it does not, to explain why, the future management of the service might not be as good as its current management. That is why the legislative backing is being provided. The Bill is just legislative backing; it is a guarantee. It will give the organisation the power to meet what should be a self-evident aim.

The Bill is straightforward, simple, not that minor and absolutely non-partisan. It has wide support across the health service, the ombudsman service and both sides of this House. The simple aim is to improve the effectiveness of the health service ombudsman, who is the final tier of the national health service complaints system and often the last port of call for distressed patients and families. The Bill achieves that goal primarily by requiring that when the health service ombudsman takes action, they do so with a view to concluding the investigation of complaints within 12 months. If that time scale is not met, they must explain why to the complainant.

The Bill is a first step. I expect that in the new Parliament, there will be a complete review of the ombudsman service and the complaints mechanisms that feed into it. That will be an unalloyed good because too often, as my hon. Friend the Member for Christchurch said, Departments are too slow, too unaccountable, too prone to excuses and not sufficiently committed to delivering the service our constituents want. The Bill intends to rectify that.

The current ombudsman, Dame Julie Mellor, has done a very good job. The Bill intends to reinforce that and to ensure that it is continued in the generations to come.

[Mr Arbuthnot]

rose—

--- Later in debate ---

[Mr Nuttall]

There is a haulage contractor in my part of the world who bears the name James Nuttall. I am sure that he will be flattered that his name has been mentioned.

I congratulate my right hon. Friend the Member for Haltemprice and Howden (Mr Davis) on piloting the Bill through to Third Reading. Although he came 19th in the ballot, had the draw been done in the traditional way, he would have come second and piloted the European Union (Referendum) Bill, which would have been a slightly weightier task.

[Mr David Davis]

Weightier and more futile!

[Mr Nuttall]

Yes, I am afraid so. That Bill is not going to reach the statute book.

I hope that this Bill does reach the statute book. It is a short Bill. As the promoter said, it is simple and straightforward. It aims to set a clear target for the ombudsman to operate within. When the target cannot be met, it requires that reasons be given.

As was mentioned at the outset this morning, this is the first time the Bill has been debated on the Floor of the House. The exploration of the matters that were raised on Report was therefore useful, because it teased out matters that could usefully be considered in the forthcoming review and examination of the ombudsman’s procedures. I am sure that those who conduct the review will read this debate and reflect on those matters.

I wish the Bill well this morning. I am sure that it will receive a Third Reading. I also wish it a speedy passage through the other place in the days that remain before the Dissolution of this Parliament.

Antibiotic Resistance

David Davis Excerpts

Wednesday 15th October 2014 Westminster Hall

[Julian Sturdy (York Outer) (Con)]

I am delighted to have been given the opportunity to host a vital debate on antibiotic resistance. As ever, Mr Chope, it is a pleasure to serve under your chairmanship.

Many people will be aware that the 20th century discovery of antimicrobial drugs, a class of medicine that includes antivirals, antimalarials and antibiotics, such as penicillin, is among the greatest medical breakthroughs of our time. However, we have failed to heed the warnings of such people as Alexander Fleming, who, when collecting his part of the Nobel peace prize in 1945, warned:

“there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant”.

There has never been any doubt about the link between the misuse of antibiotics and resistance to them, but despite this antibiotics have been misused and, as a consequence, we now face the prospect of losing modern medicine as we know it. If people take a moment to think about the consequences, they will find them frankly horrifying.

In 2013, the chief medical officer, Professor Dame Sally Davies, told Parliament of an horrific scenario, where people going for simple operations in 20 years’ time could die of routine infections because

“we have run out of antibiotics”.

To some, this scenario may still seem too far in the future to warrant any immediate action, but for me the clock started ticking on this issue a long time ago. Yet we are no further forward.

In 20 years’ time, my children will be in their late 20s. Parents and families around the country will all want their children, and the next generation after that, to have the medical guarantees that we have the luxury of being afforded today, so inaction is simply not an option.

Antibiotic resistance is already changing clinical practices in this country, For example, in recent years complication rates for prostate biopsy, which carries a risk of septicaemia, have increased from less than 1% in 1996 to nearly 4% in 2005. Due to this, doctors are now carrying out the biopsy in a different way, changing clinical practice.

The rise of antibiotic resistance is widely seen by organisations such as the European Food Safety Authority and the World Health Organisation as a consequence of the use and overuse of antibiotics in both veterinary and human medicine. However, in this debate I will focus on the continuing overuse of antibiotics in human medicine, where considerable improvements could still be made in many countries.

[Mr David Davis (Haltemprice and Howden) (Con)]

I congratulate my hon. Friend on securing a debate about one of the great threats to modern civilization: the prospective failure of antibiotics. Since he is not going to focus on agriculture, might I ask whether he agrees that, because some 50% of antibiotics are used in agriculture in this country, and 80% in the United States, if we are to take an international lead, as the Prime Minister would wish us to, we have to clean up our own act at home, in the way that the Dutch have in agriculture?

Medical Records (Confidentiality)

David Davis Excerpts

Tuesday 11th February 2014 Westminster Hall

[Mr David Davis (Haltemprice and Howden) (Con)]

Importantly, the fear is not only of professional hacking, but of amateur hacking, which can break into major databases. The problem about the medical database is that someone’s medical data are almost as strong as a fingerprint. If people were looking for me, for example, I have five broken noses on my medical record, which probably reduces the numbers that they are looking at from 60 million to about 100; they could also probably work out my age, if that is removed, from when I had my diphtheria jab and various other early jabs. It is still possible to reverse engineer from so-called anonymised data. In the States, that was done with an anonymised data system—the record of the Governor of Massachusetts was picked out by an academic, to demonstrate how weak such systems are.

[Mr Mudie]

I read with interest about the right hon. Gentleman’s unfortunate nose. He makes an important point.

My point is that there will eventually be a breach of security. It is inevitable, given the size of the database and the information stored in it. The human cost to the patient whose identity and medical history are made public is potentially disastrous. Careers could be ended, jobs lost, insurance refused and relationships destroyed if sensitive medical facts are made public or used by private firms, other people or, indeed, the media.

--- Later in debate ---

[George Freeman (Mid Norfolk) (Con)]

I congratulate the hon. Member for Leeds East (Mr Mudie) on raising this issue for a debate that I think merits a bigger attendance. I hope that the subject will be debated subsequently on the Floor of the House.

This is an important issue. We have seen in recent months and years in the House that data sit at the heart of so much of the transparency revolution that is taking place in health care, not least in the Francis report, which was indeed in part driven by a revolution in transparency, with outcomes data revealing differences in outcomes across the UK. That has highlighted that, within our precious and beloved NHS, there is huge variability in standards and outputs. The genie is out of the bottle, in terms of the public interest in the power of those data to drive both transparency on outcomes and patient empowerment—a theme that the hon. Gentleman rightly touched on.

I declare an interest in that I come to this matter after a 15-year career in biomedical science and research, in the last seven years of which I helped to create partnerships in the national health service between NHS clinician scientists, research charities, industry and university scientists to try to accelerate the process by which modern medicines are discovered and developed. My experience is that, over the past 10 years, this country has quietly come to lead in the appliance and use of anonymised cohort datasets and, indeed, specific patient datasets in particular disease areas to drive and accelerate the development of modern medicines, with extraordinary benefits for patients in the NHS.

The truth is that the traditional model of medicines development, on which we and the NHS have relied for nearly 50 years, in which the pharmaceutical industry goes away and spends hundreds of millions—or increasingly, billions—of pounds and comes back to us with a perfect drug that suits everybody, is a model that it cannot afford, and we cannot either. The more we learn about genetics and genomics, and patients and disease, the more we know that your disease, Mr Hollobone, will be different from mine: our susceptibility to it will be different, as will be our response to drugs. The revolution in research data offers an extraordinary opportunity for the NHS to be the place in the world where we develop and design 21st century medicines targeted at the patients who need them and generate extraordinary opportunities for our NHS patients and clinicians.

I want to mention an example that brings this matter to life. The last project that I worked on was here in London, at King’s college, with Professor Simon Lovestone, the head of research at King’s academic health science centre and professor of psychiatry. The project was funded by the National Institute for Health Research, an NHS body, and looked at the catchment population for the South London and Maudsley NHS mental health trust—250,000 patients suffering from a range of mental health ailments. As Members will be aware, in mental health, there is no magic bullet drug; there is a huge cocktail of some very difficult drugs, with hugely traumatic experiences for patients, who often have to change dosage. It is an unsatisfactory area of modern health care, in which we are really failing a large number of patients. The system that was put in place, funded by the NIHR, created an anonymised dataset of the 250,000 patients, which allows researchers to look across that cohort at relationships between medicines and outcomes, disease and MRI scans, and really shines a light on which drugs are working for which patients. That gives extraordinary opportunities to us here in London and in Britain to lead in the field of developing treatments for a whole range of mental health ailments, from Alzheimer’s to a range of other indicators.

The truth is that these data are utterly key to the quiet revolution in 21st century health care and medicine that we are beginning to see for three reasons. The first is research, as we have discussed. The second is accountability, as we saw in the Francis report most traumatically, but across the board. My constituents want to understand and to see that their patient journey from care is properly tracked. I have power of attorney for my mother, and last summer I wanted to be able to log on quickly to see what she had been prescribed and what her diagnosis was when she was unable to do that for herself. The younger generation particularly want and are beginning to expect to be able to use data to drive accountability.

The third and most important reason is empowerment, which the hon. Member for Leeds East touched on. We are moving from an age when health care and medicine was something that was done to us by the Government to something that we want modern 21st century citizens to take more responsibility for. Several concerns have been touched on, some of which are valid and important to discuss.

[Mr David Davis]

My hon. Friend is making a fabulously compelling case and I think that I agree with everything that he says except for one presumption: this is being advanced with one, all-singing, all-dancing database, instead of a set of tailored, directed ones.

[George Freeman]

My right hon. Friend makes an excellent point, as ever, and I was just coming to it.

The hon. Member for Leeds East raised several important points that I want to touch on. We should be clear that the data will be anonymised, and it might be worth looking at a framework to ensure that only anonymised data are released. No one is even beginning to think or talk about insurance or anything to do with insurance companies. That has not been mentioned, and it is important to say that here. That is not what the issue is about. We should all remember that it is illegal for pharma companies to contact any patient even if they have got hold of data.

On opting in and opting out, the evidence suggests that patients want their data to be used in research. The opt-in rate to the biobank project is 98%, and when patients are told that the data are not being used for research, they want to know what on earth is being done with them.

An additional point worth making concerns doctor-patient confidentiality. There are layers of data, and my right hon. Friend’s broken nose would sit quite high. More discreet information such as notes by a GP may not be appropriate for release, and we should acknowledge that we are talking about layers of data.

I will wrap up by saying that there is a huge danger in the Government’s laudable initiative to link their datasets together to drive the revolution: a clear statement of patient rights is needed. Patient data are involved, and patients should have a framework and the architecture to access them for themselves. We should encourage them to take responsibility for their outcomes, their health and their data. If we did that, I think that we would find much more public support for this important initiative, which I welcome.

Congenital Cardiac Services for Children

David Davis Excerpts

Thursday 23rd June 2011 Commons Chamber

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing this debate on the review of children’s heart surgery services. He has a strong record of campaigning on this issue and of bringing the concerns of his constituents to the attention of the House. I also congratulate him and the other hon. Members on the motion they tabled. The Government and I wholeheartedly support its contents, and I urge other hon. Members to do so as well.

I should also like to take this opportunity to pay tribute to the dedicated NHS staff who work in children’s heart services in my hon. Friend’s constituency and across the country. They do a tremendous job, for which we are all incredibly grateful, more often than not in complex and difficult circumstances.

I should like to confirm that the review is totally independent of the Government, and that it is clinically led. It is not driven by me, by other Ministers or by the Department of Health. It is therefore not appropriate for me to comment on the specific hospitals consulted during process. I do not wish to act, or to be seen to act, in a way that could influence or prejudice the process that is going on. As many hon. Members have said, this is a highly emotive issue, particularly for those whose children’s lives have been saved by the services under review. It is worth reminding ourselves why the review was conceived and planned and is now being carried out.

This is not a new issue. The provision of children’s heart surgery has been a cause for concern since the Bristol Royal infirmary inquiry in the late 1990s. Understandably, there has been considerable pressure from national parents groups and professionals to ensure that children receive the best treatment, and the sole purpose of the Safe and Sustainable review is to ensure that children with congenital heart problems receive the best possible care now and long into the future. To do that, we must be certain that the centres in which surgery takes place are as good as they can be.

[Mr David Davis (Haltemprice and Howden) (Con)]

The Minister will not be surprised to hear that my constituents, like all the others in Yorkshire, are in favour of Leeds, but I do not want to draw him on that. I would like him to help us in our argument by telling us what the clinical outcomes for Leeds are and how they compare with other centres. In particular, will he confirm that they are all safe?

[Mr Burns]

I am grateful to my right hon. Friend for that intervention. With regard to Leeds teaching hospital, he will know that this is a complex issue. There are 36 different surgical procedures listed on the central cardiac audit database, but the three most relevant ones in the context of his question are those that deal with atrioventricular septal defect, arterial switch and Fallot’s tetralogy. Over the past six years, 304 operations have taken place involving those three specialties. Sadly, the number of patients who died within 30 days was 12, and 18 died within one year. The results of surgery in all units are good, with no significant divergence. The issue, however, is the future. We need to prepare for units that can deal with these highly complex procedures and the intense technology needed, and provide the qualified doctors and nurses involved, in order to keep up with professional and public expectations of the high quality of care required. This is not so much about today’s figures as about how we meet the challenges of the future to provide the finest and safest possible care in this deeply complex area of medical treatment.

The consensus among professional associations is that there should be no fewer than four congenital surgeons in a centre, each performing between 100 and 125 procedures every year, for a centre to be optimally staffed. Over the past few years, the outcomes for the services have remained good, as the figures that I have just given to my right hon. Friend illustrate, but there have been several warning signs that the current arrangements are fragile. For many years, professionals and national children’s charities, including the Children’s Heart Federation and the British Heart Foundation, have urged the NHS to review services for children with congenital heart disease. They have consistently raised serious concerns about the risks posed by the unsustainable and sub-optimal nature of smaller surgical centres.

Many of the 150 types of operation undertaken by these dedicated teams are among the most complex, challenging and technically demanding areas of surgery. Success requires intricate surgery on hearts often no bigger than a walnut, coupled with finely balanced judgments drawn from a combination of advancing science, personal experience and compassion. It involves a range of highly trained individual team members—before, during and after the operation.

The risks posed by the complex nature of heart surgery include not just possible death after surgery, but lifelong complications such as brain damage and other disabilities. The judgments of any expert medical team caring for a particular child therefore have a direct and long-lasting impact not only the future of each vulnerable child, but on that of their families.

There is also the issue of recruitment. The fact is that smaller centres have problems with recruiting and retaining the very best surgeons. There is a risk that those working in smaller centres will find themselves working in isolation and in units that are not as up-to-date with techniques and clinical practice as the larger ones are.

Contaminated Blood and Blood Products

David Davis Excerpts

Thursday 14th October 2010 Commons Chamber

[Mr Clarke]

I am sorry, I do not have time.

My constituent also talked about the increased premium he faced in getting travel insurance. People are clearly being penalised again and again because they had the misfortune to find themselves with this condition of haemophilia and then found, as they approached the national health service, that their condition was made unacceptably worse.

I want to thank the organisations that have helped. With particular reference to Scotland, I want to thank Mr Philip Nolan, who spent several hours with my constituent and me, and who, it seems to me, has been in London almost every week for years, preaching to us the necessity to act.

My constituent referred yesterday to the position in Northern Ireland. I do not want to open up yet another party political debate, but the truth of the matter is that even with its economic difficulties, Ireland—if I said Northern Ireland yesterday, I should have said Ireland—has not abandoned its scheme.

[Mr David Davis (Haltemprice and Howden) (Con)]

rose—

[Mr Clarke]

I am sorry, but I do not have enough time to give way.

If the scheme means getting earlier acceptance on to the waiting list and getting problems recognised, and if our constituents should not be doubly penalised for something that is not their fault, I am with my constituent in saying that justice delayed is justice denied—and we have denied justice for far too long. Today provides us with an opportunity to put that right.

--- Later in debate ---

[Jenny Willott]

The hon. Gentleman is correct. This debate on the Floor of the House is something for which many of those affected have called for a number of years. For them, it is important that that has been recognised and that Ministers are now listening to Members of all parties expressing their views.

[Mr David Davis]

Like the hon. Lady, I would have liked the debate to be less partisan than it has been so far. Her example highlights what a tragedy this has been and what an injustice has been committed. Although we are in the midst of a massive financial crisis, we should all recognise that tragedies and injustices like this deserve priority in spending terms over everything else.

[Jenny Willott]

I agree with the right hon. Gentleman. I am disappointed that, as was announced in the statement earlier today, not all the recommendations will be reviewed.