Southern Health NHS Foundation Trust

David Nuttall Excerpts

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

I agree with the hon. Lady. It was also a recommendation of the Francis report that the coalition Government committed to implementing. We will tell the House shortly what our plans are on this front.

[Mr David Nuttall (Bury North) (Con)]

People will be both saddened and dismayed that after Mid Staffs and the new CQC inspection regime such problems can still arise. Does the Secretary of State agree that, although there is no simple solution, the solution certainly does not lie in trusts adopting and relying on a tick-box approach to safety?

Cities and Local Government Devolution Bill [Lords]

David Nuttall Excerpts

Monday 7th December 2015 Commons Chamber

[Mr Graham Brady (Altrincham and Sale West) (Con)]

I shall be brief. I am pleased to follow the Chair of the Select Committee, not least because I thought one of his closing lines summed up our objective here this afternoon: we want devolution to happen, but we want it to work. I want to speak to new clause 8 and amendment 57 in my name and also touch on amendment 2 in the name of my hon. Friend the Member for Hazel Grove (William Wragg), all of which share exactly that objective.

Dealing with the question of consent and the referendum contained in amendment 2, it seems to me that if this process is to work it is essential that it should have the consent of the people who are going to be governed under these new structures. If the argument can be made for the new structures and new form of governance, the Government ought to have the self-confidence to give people a direct say on the changes that are about to be introduced. From a Greater Manchester perspective, I think it is entirely possible that the Government could put a case that would persuade people that the new arrangements should be approved in a referendum, but the very act of withholding that opportunity for them to express their will and to show real consent for what is being done in itself sows the seeds of difficulty and discord and makes it less likely that the new arrangements will work.

[Mr David Nuttall (Bury North) (Con)]

In his speech on 14 May, the Chancellor of the Exchequer said:

“I will not impose this model on anyone.”

Does my hon. Friend agree that the best way to demonstrate that local people want the new system would be to hold a referendum?

[Mr Brady]

I agree wholeheartedly. I devoutly hope that Ministers even at this late hour will recognise that it is very much in their own interests and those of the Government, and entirely in the interests of the people of the combined authority areas which may face these new arrangements of governance, to accept the point. I am especially hopeful given the sterling work my hon. Friend the Minister did in the last Parliament trying to ensure that people had the opportunity to give consent on the arrangements surrounding our membership of the European Union. I know he will recognise that, given his deep commitment to democracy, it would be entirely consistent for him to recognise the wisdom of the proposal.

New clause 8 is in tune with the essence of the Bill and the essence of the Government’s intentions. There are very few of us on either side of the House who would argue with the proposition that it is generally better for power and decisions to be exercised as close to the people as possible. It is almost invariably better for decisions, including spending decisions, to be taken more locally, and new clause 8 seeks to place an extra protection in the Bill: a safeguard seeking to limit the occasions on which the legislation could be used to permit devolution in the wrong direction. That is not really devolution at all, of course. Rather, it is the opposite of devolution: it is the capacity that exists in the Bill as it currently stands for powers to be moved up, away from the people and away from local authorities which currently exercise powers, to the combined authority or to mayoral authority level. It is a very modest measure—[Interruption.] My hon. Friend the Member for Bury North (Mr Nuttall) endorses that view, and I was surprised at just how modest my aspiration had become during the course of this process, perhaps due to the endless courtesy and charm of the Secretary and State and the Minister.

All new clause 8 seeks to do is ensure that, if a local authority decides to transfer a power to the mayoral level, there would be a cooling-off period before it became permanent, and crucially that a local election must be held before such time that that transfer of power away from the people in the wrong direction—this anti-devolution—can become permanent. That is a modest but important safeguard, and I hope Ministers will accept it would be in their interests and the interests of good governance to incorporate it.

Perhaps the most important measure in this group is amendment 57, which sits, almost naturally, as a part of a couplet with the proposition for a referendum. In a way, if we do not have one of them, it becomes even more important that we have the other. If the Government are not going to consult the people directly on the new governance arrangements that will apply to them by allowing a referendum, it is even more important that the arrangements set out in amendment 57 should be incorporated, which would allow a local authority, in the event that the new arrangements do not work in the interests of that local authority area, to seek at a future date to leave, with a fair distribution of both the liabilities and assets of the combined authority.

I have sought to ensure proper fairness and a reasonable arrangement in the unlikely eventuality that a local authority would reach the point where it was convinced that the new arrangements were not in its best interests. That would provide the necessary reassurance to people that this is not an irrevocable step, and that if it does not work, there is a way out of it. Perhaps most importantly, it would also place a real discipline on an elected mayor and ensure that the holder of that office would at all times seek to behave reasonably and reflect the interests not just of the majority of the area of the mayoral authority, but of the whole of it. The risk that an elected mayor may at some point in the future seek to govern in a way that is clearly contrary to the interests of any one part of a conurbation would be massively greater if the Bill were to proceed unamended. Again, I very much hope Ministers will recognise that the Bill would be strengthened and improved by amendment 57.

[Norman Lamb]

I want to speak in support of new clause 10 and to make a brief comment on amendment 7. The new clause seeks to reinstate in the Bill, as brought from the Lords, the provision to allow votes for 16 and 17-year-olds in local government elections. As a matter of principle, I support the idea of votes for 16 and 17-year-olds, whether in national elections, local government elections or referendums. I supported the case for 16 and 17-year-olds to vote in the Scottish referendum. I have also argued the case, along with many others, for them to be able to vote in the European Union referendum, because it is their future that we will be debating.

In the context of the Bill, I strongly support the case for 16 and 17-year-olds having a say, for goodness’ sake, in the election of their local councillor. I find it extraordinary that the Government oppose the proposal so strongly. I appreciate that the Secretary of State has indicated that there is a debate to be had on the subject, and that we might explore it more fully on other occasions, but how long does this have to take? Those 16 and 17-year-olds can join our armed forces to defend the country, they can marry and they can pay taxes on their income if they are in work, yet they cannot have a say on how those taxes might be raised, on the extent of them or on how they might be applied. As citizens they ought to have the same rights as the rest of us enjoy, and I urge the Government to think further on this.

We often make points about the low turnout among those young people who are entitled to vote, and about the low engagement in the political process. I made the point in our previous debate on the issue that young people are very interested in a range of political issues, but there is no doubt that in many cases many of them are disengaged from the political process. If we are to seek to change that, surely giving these young people the right to a say in the political process would help. The turnout among 16 and 17-year-olds in the Scottish referendum, at about 75%, is indicative of a level of interest in the issues, which the Government ought to recognise.

David Willetts, the well respected former Minister in the coalition Government, has made a point about the breaking of the generational contract. This is a serious concern. Political parties tend to focus a lot of their attention on the interests of older people, who of course tend to vote. I would argue that there is a lack of attention being paid to the interests of young people, particularly 16 and 17-year-olds, who have no vote at all.

[Mr Nuttall]

I am getting confused. A few seconds ago, the right hon. Gentleman was trying to convince the House that 16 and 17-year-olds should be allowed to vote because such an enormous number of them had turned out to vote in the Scottish independence referendum. Now we are told that we are ignoring them because they do not turn out to vote. Will he just clarify which of those two arguments he would like us to accept?

[Norman Lamb]

We saw in the Scottish referendum that, if you seek to engage with young people, they will respond. They turned out in record numbers. I understand from the study that took place following the referendum that the turnout was 75% among that age group. I also made the point, however, that there is a lack of engagement with the political process as a whole among young people. I am sure that the hon. Gentleman would agree with me on that. I believe that it is incumbent on all of us to change that by getting young people to feel part of the process and to participate in it. If we give 16 and 17-year-olds the right to vote, it sharpens their minds and focuses their interest because they have an opportunity to participate in the political process.

Junior Doctors Contract

David Nuttall Excerpts

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

The impasse was not created by the Secretary of State. The impasse was created by the BMA walking away from negotiations last year and not returning to negotiations after the recommendations of the independent body came through. That is not an impasse; that is one side deciding it does not want to take part. The Secretary of State’s response has been to say: keep the negotiations going, the door is always open.

The hon. Lady asks where the Secretary of State is today. He is working on the spending review plans for the support the NHS needs—a financial commitment the Labour party did not make at the general election. He is also working on contingency plans to make sure the NHS is safe if action takes place. I think that is pretty important work that he should be doing.

[Mr David Nuttall (Bury North) (Con)]

As the Minister previously represented my constituency for 14 years, does my right hon. Friend agree that when the Government have guaranteed no junior doctor working within legal limits will see their pay cut and that none will be required to work longer hours, the hardworking residents of Bury, Ramsbottom and Tottington will find it difficult to understand why strike action has been voted for?

[Alistair Burt]

My hon. Friend puts it very well. The people of Bury, Tottington and Ramsbottom have long experience of very good health services provided by excellent family doctors, as well as through good secondary medical care, not just in their own constituency but around and about. They will find it surprising that, with the guarantees given by the Secretary of State and mentioned by my hon. Friend, anyone should be contemplating strike action. Equally, they will find it incomprehensible that anyone from any political party is giving that strike action any support.

Male Suicide and International Men’s Day

David Nuttall Excerpts

Thursday 19th November 2015 Westminster Hall

[Mr David Nuttall (Bury North) (Con)]

I start this afternoon by congratulating my hon. Friend the Member for Shipley (Philip Davies) on securing this historic debate. This is the first time ever that International Men’s Day has been marked by a debate in this Parliament. I also thank my right hon. Friend the Member for Basingstoke (Mrs Miller), as well as the hon. Members for Bridgend (Mrs Moon) and for York Central (Rachael Maskell), for bringing their individual perspectives to this debate.

Under the International Men’s Day heading, the debate gives us an opportunity to consider a range of issues that particularly affect men, but in my opinion none is more worrying than male suicide, so I will restrict my remarks today to that issue. The subject is all too often swept under the carpet. It was said at the outset of this debate that one of the problems facing us today is underachievement by white working-class boys from the north of England. Well, as a white working-class lad from the north of England, I am very proud to take part in this debate. Indeed, as a member of the Backbench Business Committee, I was pleased to play a very small part in granting this debate.

I listened with interest to the comments about why the debate is being held here in Westminster Hall rather than on the Floor of the House. However, as right hon. and hon. Members will be aware from the Order Paper, two debates have been scheduled for the Floor of the House this afternoon, one on the forthcoming Paris conference on climate change and the other on the new cancer strategy. It was felt that those debates needed to take place on the Floor of the House. Personally, I would have liked to see this debate take place on the Floor of the House as well, but we are where we are. It was also felt that we should try to hold this debate on International Men’s Day itself if at all possible, which is what we have achieved today.

As I say, I will try to restrict my remarks to the subject of male suicide. It is a subject that no one really wants to talk about.

[Mrs Moon]

To illustrate how important this debate is, let me tell the House that the first piece of evidence from professionals that the all-party group on suicide and self-harm prevention took was from a suicide prevention worker in London, who was also a mental health worker, and he said, “If I call a meeting to discuss mental health problems, I can fill a room. If I call a meeting to discuss suicide, I am there on my own.” That says everything. I thank everyone who is here today to take part in this debate for generating the conversation that is so vital.

[Mr Nuttall]

I am very grateful for that intervention, because that vignette highlights a lot of the problems. The mere fact that we are holding this debate—it may not be in the main Chamber, but it is here in Westminster Hall—and are able to discuss the subject will hopefully generate some wider debate outside Parliament. It might make it just that little bit easier for the debate to take place in wider society.

As I was saying, I approached the debate today with some trepidation, because, as has just been amply demonstrated by the hon. Lady, who is chair of the all-party group on suicide and self-harm prevention, many organisations and people seem to be looking at this problem—governmental bodies, other public sector bodies, charities in the independent sector and academics—and all have greater experience than I have, but I have looked at it with fresh eyes. Part of the reason why I am here today is that I am staggered by the intransigence of the problem. Clearly, there are many people looking at it, but the reality is that the number of male suicides has remained pretty stubborn over decades. This is not a party political point. It does not matter whether there was a Conservative Government under Mrs Thatcher or a Labour Government under Mr Blair; the numbers for male suicide have stayed pretty much the same. That made me think that there is something serious going on here that is wider than just the typical argument about party politics.

I pay tribute to the charity CALM—the Campaign Against Living Miserably—because it has provided some helpful briefing and figures for this afternoon’s debate. CALM says that in 2014 more than three quarters —76%—of suicides were men. That is 4,623 deaths. It is worth repeating that suicide is the biggest single killer of men under the age of 45. For deaths registered in 2013, the last year for which the Office for National Statistics has figures, my own region—the north-west of England, in which my constituency is situated—had a male suicide rate of 21.2. That is the second highest rate in the country, second only to the north-east. The experts will be aware that the rates are invariably quoted in the statistics as a rate per 100,000 of population, so that is 21 people out of every 100,000. As always with these statistics, there is a host of caveats and technical details that could be explored, but I do not think we should let the minutiae obscure the big picture, which is that while the suicide rate in the north-west among men was 21.2, the rate among females was 6.3. A rate of 21 against a rate of 6 is a big difference indeed.

[Liz McInnes]

I thank the hon. Gentleman for talking so sensitively about this issue. I, too, am greatly concerned about male suicide, and that is why I came to this debate. He speaks very knowledgably about the rates of male suicide, but is he aware that young gay men are six times more likely to take their own life than their straight male counterparts?

[Mr Nuttall]

I have heard that statistic twice today, the first time in the Chamber, when the shadow Leader of the House made that point. I do not know whether the statistic is correct, but I am prepared to accept what the hon. Lady and the shadow Leader of the House say. I am sure that of those more than 4,000 deaths, some were gay men and some were young gay men. That may well be one of the contributing factors.

The charity CALM has set out four areas where it thinks action should be taken. First, and quite understandably, it states that there is a need for timely and accurate information. That could be applied to many things across Government. It always amazes me how long it takes for what, on the face of it, are fairly simply statistics to be collated and reach the public domain. Secondly, and again understandably, CALM says that we need to understand the reasons why people take their own life, because there is a strong element of contagion, which the hon. Member for Bridgend mentioned. Thirdly, CALM wants all local authorities to develop and implement a suicide prevention plan, and says that those that do not should be named. Fourthly, it states that if national and local suicide prevention plans are to be effective, there must be some accountability—there is no point having a plan unless something is done if that plan is not adhered to.

It is worth noting that in its own way, CALM has tried to give the issue some publicity through social media and the #BiggerIssues campaign, which is an advertising campaign to draw attention to the fact that as a society we tend to pay an inordinate amount of attention to perhaps relatively trivial topics, such as the weather and the sort of coffee we are drinking, rather than to male suicide, which is a real problem in society. The campaign has created digital posters featuring the hashtag #BiggerIssues, which were posted across the UK. Those posters changed every two hours to reflect the fact that every two hours, a man takes his own life. The campaign was run in association with the men’s grooming brand Lynx, and I think we should pay tribute to whoever it was who took that brave decision to link a men’s grooming product with the campaign. Others perhaps looked at it and thought, “The issue is a bit too touchy for us. We’ll leave that one alone.” Whoever was involved at Lynx, we should publicly thank them for being able to associate their brand with that particular campaign.

I was surprised to find that this phenomenon is not unique to this country. Right across the world and in almost every country, there is the same stark difference in the suicide rates. Lithuania, Russia, Japan, Hungary, Finland—almost everywhere we look, the picture is the same: male suicides considerably outnumber female suicides. Apparently that is not the case in China. I am not an academic; I have not spent time looking into this, but it seems to me there may be something in the fact that in one country, China, it is the other way around that may in years to come offer a solution to the problem.

We are a Parliament with different political parties, and for our own reasons we try to make party political points. When I have previously raised this issue, people immediately say, “Of course, it’s all the Government’s fault. The fact that there are lots of men committing suicide is all your Government’s fault, because you are making cuts to public services and you are cutting the NHS”—which is not true; more money is being spent on the NHS than ever before, so that argument immediately falls. Those arguments are easy to make. It is simple to throw out that it is all the Conservatives’ fault, but as I will demonstrate, the statistics—the facts—from the Office for National Statistics simply do not bear out that argument.

In the 1980s, under the Conservatives, the number of male suicides each year was somewhere between 4,000 and 5,000. It did vary a little bit—it got down as low as 4,066 in 1982 and it went up to 4,370 in 1987—but every year it was between 4,000 and 5,000. Between 1997 and 2010, under the Labour Government, the number of male suicides was somewhere between 4,000 and 5,000. Again, it varied—some years it was down, and some years it was up—but every year it was somewhere between 4,000 and 5,000. What is noticeable is that the gap between male and female suicide rates has been increasing steadily in almost every single year since 1981. At the start of this range of statistics, the male rate was a bit less than double the female rate—about 1.78 male suicides for every female suicide, I think.

[Mrs Moon]

Will the hon. Gentleman give way?

[Mr Nuttall]

I certainly will, but I will come back to my point, because I have not quite finished it.

[Mrs Moon]

This gets terribly technical. If I can explain, suicide is recorded under an international definition. To get the statistics, researchers are often required to go into coroners’ records and read individual narrative verdicts. The records therefore are slightly skewed; they are indicative, rather than totally accurate, because there is a difference between a clear suicide verdict that says that a death was a suicide and a narrative verdict that would need to mention intent. We have a problem with the accuracy of our recording. I thought it was important to clarify that.

[Mr Nuttall]

I am grateful for that. I think I mentioned that there is a host of caveats and technical details. I spent some time looking at the statistics and working out how they had been arrived at. As the hon. Lady rightly says, there are a number of difficult issues for researchers that could skew the figures, but whatever difficulties there might be, they apply equally to males and females and would not affect the overall point that I am making here which is that at the beginning of the 1980s, the difference was about double, and today it is about treble. It has gone from a ratio of about 2:1 to about 3:1 today. I do not think this change can simply be put down to Government policy. It was happening under a Conservative Government and continued to happen for 13 years under Labour Governments.

[Andrew Rosindell in the Chair]

Public Health England, which produces a raft of figures on this subject, states:

“Suicide often comes at the end point of a complex history of risk factors and distressing events.”

With other right hon. and hon. Members this afternoon, I pay tribute to the Samaritans, which is perhaps the best known charity in this field for its work in trying to help and to prevent men and women who are feeling depressed from taking their own life. In its review of 2012, the Samaritans found that men from working-class backgrounds were at a higher risk of suicide. The Samaritans stated that suicidal behaviour results from a complex interaction of numerous factors, including bereavement, divorce, unemployment and the historical culture of masculinity. It is a huge and complex subject. Many people will be grateful that we have highlighted some of the issues involved.

I hope that people who are feeling depressed—there are often many reasons and not just one—feel that they can tell someone about their worries. One thing we can all agree on, from whichever political viewpoint we approach the subject, is that suicide—taking one’s own life—is never the right answer. I hope the debate today will help break down the stigma that prevents many men from seeking the help they need.

--- Later in debate ---

[Lucy Allan (Telford) (Con)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I pay tribute to the hon. Member for Caithness, Sutherland and Easter Ross (Dr Monaghan) for his thoughtful comments. I suggest that he, too, strayed somewhat off the topic in talking about the work capability assessment, because today we are talking about International Men’s Day as well as male suicide. I particularly want to pay tribute to my right hon. Friend the Member for Basingstoke (Mrs Miller), who adopted a measured and helpful tone. The issue is sensitive, and it is helpful to address it in a calm and measured way, as the hon. Member for York Central (Rachael Maskell) also did.

I thank my hon. Friend the Member for Shipley (Philip Davies) for securing the debate. He worked hard to do that, and International Men’s Day is a day when we should celebrate male role models and their contribution to society and family. It is also an opportunity for us to work towards improving gender relations. I do not agree with many things that my hon. Friend said. In particular, I do not agree with him on what he described as an obsession with increasing the number of women in Parliament. In fact, I consider that a noble cause, and I am passionate about it. Nor do I agree that equality means putting more women in prison. We may have to differ on that one.

[Mr Nuttall]

I am sure that my hon. Friend is capable of speaking for himself, but I think he said that he wanted to be sure that more women who were convicted of serious offences went to prison.

[Lucy Allan]

I am sure that my hon. Friend is correct, and I apologise if I misunderstood the remarks of my hon. Friend the Member for Shipley.

I declare an interest because, like many of those present, I have many men in my life. I have a partner, a father, a son and brothers. It is the supportive men in all our lives who enable us to do what we do, and to be the best we can be at it. I wanted to take part in the debate because I believe that I should speak for all the people whom I represent. We have 191 women in Parliament, representing men and women. It is right that we should talk about issues that affect the people we represent. Too often we polarise the gender debate to depict men as aggressors and women as victims. Many women who, like me, have a passion for gender equality and who identify as feminists feel deeply uncomfortable about the increasingly negative caricatures and gender stereotyping of men. My son said to me, “I don’t like feminists, mum.” I said, “Oh, why’s that?” “Well, they don’t like men, do they?”

It is wrong to blame today’s men for the patriarchal society of yesterday. It does not enhance equality for women to antagonise and create hostility towards men. We should all bring up our boys and girls to believe in equality for all; but certainly we should not bring up our boys to be ashamed of their sex. For me equality is not about forcing men to wear a white ribbon. My hon. Friend the Member for Brigg and Goole (Andrew Percy), who has left the Chamber, mentioned that campaign, which is wonderful, but men do not need to be shamed about the violence of other men towards women, and to demonstrate their shame with a badge. Nor is equality about forcing an elder statesman of this House—a man from a different era—to say the word “tampon” in the Chamber. Equality is always about having the same chances in life, and that is what today should be about.

I spent last Friday evening on patrol in Telford with police. We were talking about violence against men. We had just attended a domestic violence incident and I asked about the incidence of domestic violence against men. I was told that it is rarely reported and that the police are fully aware that the figures skew reality, particularly in relation to those under 30. There are many reasons why men under 30 would never admit to their girlfriend having smacked them or given them a shove; we do not talk about it. Today is an opportunity to focus on all the issues that adversely affect the life chances of men and boys and their ability to be the best that they can be. The cause of extraordinarily high rates of male suicide is simply that men feel unable to vocalise their emotions. They bury them. Should society, or indeed Parliament, say that it is not appropriate to discuss those issues? I say not.

In my constituency, a particular area of concern is the underachievement of boys at school. By any measure of attainment, boys from disadvantaged socioeconomic groups perform less well at school. Only 28% of white boys on free school meals in Telford achieved five A to C GCSEs, whereas girls from a similar background were doing significantly better. More boys than girls experience behavioural difficulties; they have more exclusions from school and more admissions to pupil referral units. I used to be involved in a pupil referral unit, and there were very few girls there. Boys then start to self-identify with a bad boy image. It becomes a self-fulfilling prophecy, with all that goes with it—the anger, frustration and self-harming—and then their life chances are kind of set in stone. We see that more young men are engaging with the criminal justice system, are in the prison population, or are in gangs and involved in knife crime. Then we wonder why those same young men have violent relationships with the women in their life.

It is deeply simplistic to characterise men as either violent or chauvinistic. Most men are neither. I did not come to Parliament to talk only about women’s issues, and I definitely did not want to find I could not talk about issues of fundamental importance to my constituents. We talk a lot about hedgehogs, UK sea bass stocks and trees, and various other topics of constituency interest, but I want to talk about issues that are important in Telford. In Telford the male suicide rate is higher than the west midlands average and the national average. However, what does Telford and Wrekin Council talk about? It, too, has embarked on an elaborate social media campaign parading photographs of men on Facebook holding up signs saying “I support the white ribbon campaign”. The poor men can hardly refuse, for fear of being labelled anti-women. I really wanted to know what the council was doing about men and boys in Telford.

The fact that no one wants to talk about the issue is the crux of it. I am on the Select Committee on Education. We talk about getting girls to do STEM subjects—science, technology, engineering and maths. That does not mean much in Telford, particularly for a boy from Brookside who struggles with maths and English and is getting into trouble at school, becoming angry and frustrated, being excluded and then getting into trouble with the police. So men feel they must talk about women’s issues and wear white ribbons, and women feel that they do not want to be disloyal to the sisterhood. Today I thought twice about coming along. I did not want people to take to Twitter and attack me for wanting to talk about men’s issues. Then I remembered why I came to Parliament. It was to talk about issues that matter to people in my constituency. I am glad that I am here, along with everyone else who has come along—and I am glad about the valuable contributions they have made. I feel that I owe it to the failing boys in Telford, and the young men they will turn into, to be here today to put their case.

The men in my life talk a lot. They talk about sport and work, and sometimes politics. They definitely know how to get their voices heard; but they do not always say what they are feeling or what is worrying them. They feel the need always to be strong, brave and the breadwinner—the man with the chiselled jaw in the Gillette advert, if anyone remembers that. Men are uncomfortable expressing their feelings and talking to someone about how distressed or desolate they feel. That is because society has embedded the social expectation for men to be strong at all times. Failure to do that is considered weakness, or failure as a man. We need only look at society today to see the pressures that the workplace and providing for their family place on men’s shoulders. Not feeling able to talk about the issues only makes things worse. I echo what many hon. Members have said—that the impact of suicide on children and the families left behind is indescribable: the guilt, the sense of abandonment and rejection, and the loss, which a child can never quite fathom. A family member left behind does not recover from suicide.

I want to finish on a positive note. Today is about men’s health. It is about improving gender relations, promoting gender equality and highlighting positive male role models, so I am delighted that this debate has been held. We definitely need a more collaborative gender politics. I am not sure whether my hon. Friend the Member for Shipley quite achieved that, but I am sure that was his intention. Let us make sure that it is okay to talk about all these issues. Let us remember that women have men in their life whom they care about deeply. Seeking help is hard, and it is harder still for men, as an admission of weakness. It is even harder still if society generally will not talk about these issues. I am grateful to the Backbench Business Committee for allocating time for this debate, and I am extremely grateful to my hon. Friend for being brave enough to call for it. I particularly thank him for urging men to seek help, and letting them know that they are not alone. If this debate has achieved that, he is to be congratulated.

Oral Answers to Questions

David Nuttall Excerpts

Tuesday 17th November 2015 Commons Chamber

[Alistair Burt]

Looking at mental health services is just part of what we intend to do, and more money is going into mental health. The hon. Gentleman is absolutely right about male suicide. Men are three times more likely to commit suicide than women. It is also a particular cause for concern among young men. Overall, our national suicide rates remain relatively low in comparison with others, but they have been rising, and I am worried. I am interested in the theory of zero suicide, with more work to try to ensure that suicide is not seen as inevitable and more work in detail with particularly affected communities. The work that we are doing with people at a younger age, using child and adolescent mental health services more effectively to deal with depression and similar issues before suicide becomes a greater risk, will also be important. I am really interested in this area, and I think we are going to have a debate on it later this week.

[Mr David Nuttall (Bury North) (Con)]

As my right hon. Friend says, we will indeed be having a debate on this matter later this week, on Thursday in Westminster Hall. It will be the first time that we have been able to mark international men’s day and consider the whole issue of male suicide in more detail, and it will give us the opportunity to look at why the proportion of male deaths to female deaths has increased steadily since 1981.

[Alistair Burt]

I am grateful to my hon. Friend for raising the subject and for mentioning the forthcoming debate. The subject deserves to be looked at extremely carefully. As I have said, there should be neither complacency nor a sense of inevitability about suicide, and I am very interested in what more can be done. I have met one or two of the families who have experienced these tragedies and I am deeply impressed with their commitment to doing something for those age groups particularly affected. This afternoon I will meet a gentleman who is well known for having been involved in a suicide prevention incident. We are doing work to reduce stigma and to find places for people to talk about their concerns, and the more people are prepared to talk about things that might cause suicide, the better. This is an issue that we can give a higher profile to and do more work on, because every time there is a suicide it leaves a trail of damage for families and friends that is truly distressing to behold.

Off-patent Drugs Bill

David Nuttall Excerpts

Friday 6th November 2015 Commons Chamber

[Mr David Nuttall (Bury North) (Con)]

I was delighted to be a co-sponsor of the Jonathan Evans version of this Bill. I am equally delighted to be a co-sponsor of this Bill, and I very much look forward to hearing what the Minister has to say.

NHS (Charitable Trusts Etc.) Bill

David Nuttall Excerpts

Friday 6th November 2015 Commons Chamber

[Keir Starmer (Holborn and St Pancras) (Lab)]

I support the Bill and I am grateful to the hon. Member for Aldridge-Brownhills (Wendy Morton) for the discussions she has had with me about its background and the reasons she is putting it forward in the way she does. I shall confine my comments to the second main subject matter in the Bill, Great Ormond Street hospital, which I have the great privilege of having in my constituency.

As has been said, the hospital was set up in 1852 with just 10 beds. It is now one of the leading hospitals in the world. I had the privilege of working in the next street for 20 years as a lawyer, and the little daughter of close family friends of ours is currently being treated at the hospital, so I know almost first-hand the great work of the hospital. I, too, have visited the hospital as the MP for Holborn and St Pancras.

Like the hon. Member for Aldridge-Brownhills, I was very taken by the work that was going on there. On the afternoon I went to the hospital, I left here fed up and a bit glum for various reasons, and when I was shown round the hospital and saw babies one day old fighting for their lives and receiving the most professional care, it was a most uplifting experience for me and a reminder of what goes on out there in the real world, in hospitals such as Great Ormond Street.

In 1929, the hospital received from J.M. Barrie the copyright to “Peter Pan”, which has provided significant funding for many years since then.

[Mr David Nuttall (Bury North) (Con)]

Does the hon. and learned Gentleman know why J.M. Barrie picked Great Ormond Street hospital, as opposed to any other?

[Keir Starmer]

I am grateful for that intervention. I do not know, but I assume that J.M. Barrie picked that hospital because it was the first in the country dedicated only to children. If I can find out more, I will write to the hon. Gentleman and tell him.

Since 1929 the hospital has pioneered the medical treatment of children and there has been breakthrough after breakthrough, underpinned by a very deep commitment to professionalism among all the staff at every level in the hospital and those who run the hospital. Only yesterday came the news that a baby girl with incurable leukaemia was saved by Great Ormond Street hospital, with surgeons performing what was described as a miracle operation, the first of its kind in the world. She is just the latest in a long line of children who literally owe their lives to Great Ormond Street hospital and its staff.

The hospital has lost none of its ambition. In 2002 it commenced a redevelopment programme to expand capacity, deliver an ever-improving trip service and reduce unnecessary in-patient admissions. I think that everybody in the House was very proud when the hospital featured in the opening ceremony of the London Olympics in 2012 as a symbol of everything that we in this country are proud of.

Hospital Parking Charges (Exemption for Carers) Bill

David Nuttall Excerpts

Friday 30th October 2015 Commons Chamber

[Philip Davies]

I agree that that part of the Bill is clear, but as the hon. Member for Worsley and Eccles South (Barbara Keeley) has just said that there are 6 million carers but only 1 million will gain any benefit from the Bill, some people may consider that there is an unfairness there.

[Mr David Nuttall (Bury North) (Con)]

These exchanges have completely overlooked clauses 4, 5 and 6. Those clauses refer to eligible carers, who are defined in clause 5. I shall not go into the definition now, but it could bring in millions more carers, rather than just the 1.1 million who we have just been told are covered in the Bill.

[Philip Davies]

My hon. Friend has made a very good point, and I hope that he will expand on it in his own speech. I do not want to steal his thunder.

--- Later in debate ---

[Mr David Nuttall (Bury North) (Con)]

It is a pleasure to follow the hon. Member for Birmingham, Perry Barr (Mr Mahmood), who gave us his take on the Bill, although I feel the matter is a little more complicated than he would have the House believe.

I congratulate the hon. Member for Burnley (Julie Cooper) on coming fourth in the ballot for the right to bring in a private Member’s Bill—as a new Member entering the ballot for the first time, she has done very well indeed—and on choosing such an important topic. I do not know if she does the national lottery, but if she does—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Obviously, congratulating the hon. Lady is a good way of taking up time, but actually I did the draw, so if the hon. Gentleman is going to congratulate anybody, I think it should be me. However, I do not want us to get bogged down in that, because I know he wants to get straight into the Bill, on which I would welcome his comments. I know he would rather talk about the Bill.

[Mr Nuttall]

Of course, you were there, too, Mr Deputy Speaker, doing the draw, and very well you did it as well. As you know, however, because it is done in reverse, coming first actually means coming 20th.

[Mr Deputy Speaker]

Order. Let us leave it there for today.

[Mr Nuttall]

I will move on.

This is the first Bill to come before the House for its Second Reading since the new Standing Orders were introduced last week on what generally is referred to as “English votes for English laws” but what I prefer to call, more accurately, “English vetoes for English laws”. The new Standing Orders make it clear that the new procedures do not apply to private Member’s Bills, but it is worth noting—

[Mr Deputy Speaker]

Order. They do not apply to private Members’ Bills, so we do not need to discuss them. Seriously, a lot of Members still wish to speak, and I do not want any filibustering. I know that people are interested in the Bill and want to concentrate on it.

[Mr Nuttall]

I am grateful for the work carers do in my own constituency, particularly at the carers centre I visited recently, which provides a wide range of activities and support for those who undertake the often unsung job of caring for a loved on. I also pay tribute to the work that Carers UK does, as the principal national charity for carers. Of course, it very much supports the Bill, in this its golden jubilee year.

The aim of the hon. Lady’s Park the Charge campaign, which has resulted in the Bill, is to improve the financial position of carers who have to use hospital car parks by exempting them from car parking charges. Without doubt, the Bill is well intentioned, and no one from across the House would disagree with the proposition that helping those who selflessly care for others is a worthy aim. The first difficulty, however, facing anyone determining the size and nature of a group is that of definition, and that applies to carers as much as to any other. Carers UK says there are 6.5 million carers in the UK, with 5.4 million of them living in England. As I tried to mention earlier, the Bill only applies to England so that is the relevant figure.

Carers UK goes on to state that these people are providing unpaid care for their loved ones, saving the economy an enormous £119 billion each year, yet its research found that 48% of carers were struggling to make ends meet, and 45% said that financial worries were affecting their own health. It is no surprise, therefore, that Carers UK and the Bill seek to alleviate one of the financial pressures on carers—hospital car parking charges. However, I have several concerns, ranging from the Bill’s drafting to its financial implications and potential impact on other groups.

It is not clear to me how we can objectively determine who should and should not be expected to pay for car parking, as we would be doing if we started centrally exempting one particular group as being more deserving than another group. It would seem preferable to allow individual NHS trusts to continue making such decisions locally. Otherwise, on the face of it, we seem to have here a fair and reasonable proposal. Indeed, my initial thought was that it sounded like a good thing to do, and I suspect that most people’s instinct would be to support the Bill simply because of the title.

I know that the hon. Lady has campaigned on this issue with the best intentions, but I want to deal precisely with the exemptions she seeks to introduce. The Bill would exempt two groups of carers. The first is defined in clauses 1 to 3. Clause 2 states that beneficiaries of an exemption would either be in receipt of carer’s allowance or have an underlying entitlement to it. Carer’s allowance is a taxable benefit currently set at £62.10 a week to help a carer look after someone with substantial caring needs, and it is paid to the carer, not the recipient of the care. To qualify, the applicant must be over 16, spend at least 35 hours a week caring for someone, have been in England, Scotland or Wales for at least two of the last three years and not be in full-time education or studying for 21 hours a week or more. The person in receipt of care must receive qualifying benefits, such as the daily living component of the personal independence payment, the middle or highest care rate of the disability living allowance, attendance allowance or the armed forces independence payment.

That is the first group to which we can start to put a number. According to Department for Work and Pensions figures, as of February, 721,000 people were receiving carer’s allowance, so these people would be the first group that would clearly qualify under the criteria. However, the Bill would go further, by also including within the first group all those who have what is referred to as an underlying entitlement to carer’s allowance. The term “underlying entitlement” refers to the fact that a claimant cannot usually receive two income-replacement benefits together—for example, carer’s allowance and the state pension. This is called the overlapping benefit rule. If a person is not entitled to be paid carer’s allowance because of this rule, they are said to have an underlying entitlement to carer’s allowance instead. This might mean they could get the carer’s premium in jobseeker’s allowance and income support, the extra amount for carers in pension credit or the carer’s allowance element of universal credit. The importance of including those people is that the Bill would otherwise exclude carers in receipt of other benefits, such as the state pension, bereavement allowance, contribution-based employment and support allowance, contribution-based jobseeker’s allowance, incapacity benefit, industrial death benefit, maternity allowance, severe disablement allowance, universal credit, war widow’s or widower’s pension or widow’s pension.

Not surprisingly, the inclusion of these people significantly increases the number of those eligible under the Bill. DWP figures, as of February, estimate this group to number 409,000. Taken together, therefore, clauses 1 to 3 could exempt approximately 1.13 million people. These people are either receiving carer’s allowance or have an underlying entitlement to it. As the hon. Lady will be aware, in the north-west, where both our constituencies are located, there are 163,000 such people. To give some idea of the massive increase in the number of carers in recent years, I should add that the figure of 1.13 million is up from 451,000 in February 2000.

If, however, the definition of entitlement is applied in strict accordance with clause 2, the Bill would exclude, a university student caring for a disabled parent, for example. I suspect that the second group of potential beneficiaries was defined for people in such a position. The Bill therefore draws a distinction between a “qualifying carer”—someone caught by clause 2—and an “eligible carer”, as defined in clauses 4 to 6. My hon. Friend the Member for Shipley (Philip Davies) touched on this, and I pointed out in an intervention that the figure of 1.13 million—the figure quoted by Opposition Members as being the total number involved—seemed to ignore completely those included under clauses 4 to 6.

Clause 5(1)(a) defines the eligible carer as someone who

“has been assessed for free hospital parking”

by virtue of an amendment to the Care Act 2014, which this Bill would insert. The Bill proposes to amend section 10 of the 2014 Act, which deals with carer’s assessments. A carer’s assessment is made by a trained person either from the council or another organisation that the council works with. The Bill will make it a mandatory requirement for the assessor to assess

“whether the carer should be eligible for free hospital…parking”.

This is in addition to assessing, as outlined in the rest of section 10—

“(a) whether the carer is able, and is likely to continue to be able, to provide care for the adult needing care,

(b) whether the carer is willing, and is likely to continue to be willing, to do so,

(c) the impact of the carer’s needs for support on the matters specified in section 1(2),

(d) the outcomes that the carer wishes to achieve in day-to-day life, and

(e) whether, and if so to what extent, the provision of support could contribute to the achievement of those outcomes.”

It is not clear at all on what basis the assessor is expected to make this decision. If only eligibility or underlying eligibility to carer’s allowance is going to be checked, this provision is superfluous, as such people would be covered in the first group. If some other criteria are to be applied, there is nothing in the Bill or in any guidance notes—no such notes have been issued—to suggest what that might be.

Returning to my example of the student who is caring for a parent but cannot get carer’s allowance because of their studies, clause 5(1)(b) perhaps comes to the rescue. It says an “eligible carer” is a person who

“provides or intends to provide substantial care on a regular basis, other than by virtue of a contract or as voluntary work and has been certified as such by an appropriate clinician.”

I believe that the meaning is ambiguous. What does “intend to provide” mean? How far into the future is it expected that the care will be delivered—within the next week, the next month, the next year, or what? The Bill does not say. Or is a fixed timescale not required; is consideration of caring enough? What constitutes “substantial care” in this provision? Is it the 35 hours a week required to be eligible for the carer’s allowance, or is it fewer than 35 hours a week? We need to know, because the Bill is asking an assessor to be the ultimate arbiter of whether someone is entitled to free hospital parking charges.

Suddenly, the number of people who might benefit from free hospital parking becomes a lot less certain. The first group gave us 1.13 million people. How many more of the 5.4 million carers estimated by Carers UK to be living in England would be included in the second group? We simply do not know.

[Mr Rees-Mogg]

Does my hon. Friend agree with the further point that clause 5(1)(b) might provide an incentive to increase the total number of carers because people would have a strong need to say that they were carers or had the intention to be carers—even if the reality were completely different, which would mean falsely inflating the figures?

[Mr Nuttall]

There is always a danger with any scheme, as with the blue badge scheme, that some people will try to use it for their own ends. I hope it would be only a minority, but that danger exists. The assessors would need to be aware of that; they would need to be constantly on the lookout for people who were not genuine cases. That is what I think my hon. Friend is getting at—that some people might “try it on” to their own advantage.

Given that there are no explanatory notes and no impact assessment for the Bill, it is worth considering what has been done in the past. Fortunately, under the last Labour Government, an impact assessment was done—the NHS car parking impact assessment, which was published in December 2009. It estimated that there were 46 million in-patient visitors a day. We do not know how many of them are carers, but as we shall see, car parking charges vary significantly around the country. Regardless of the precise number, it is inevitable that one consequence of the Bill would be to divert part of the healthcare budget that could otherwise be used for front-line national health services—potentially life-saving services—to cover car parking maintenance and all the associated costs ranging from maintenance to administration and dispute management.

The Bill places Members here in the unenviable position of being asked to single out one particular group of people as being more deserving of financial assistance than any other. Without an exact number of those eligible for exemption, it is difficult to know how much money we are talking about in each area that the Bill would take out of the healthcare budget.

At the Bill’s heart is the principle of whether it is right to charge for parking at a hospital or other healthcare facility and, if so, which if any group should be exempt from those charges. I appreciate that some of the public—perhaps virtually all the public—take the view that charging to park a car at a hospital is simply an attempt to make a profit for greedy hospitals or, worse still, for nefarious parking companies. If that were the case, I suspect there would be universal condemnation of such a practice, but of course it is not the case.

Hospital car parking charges in our national health service are what are called “an income-generation scheme”. They are not just an extra-revenue scheme for hospital managers to provide comfier chairs or profit for private parking company executives to fund their jollies to the Seychelles. In 2006, the Department of Health issued guidance called “Income Generation: car parking charges —best practice for implementation”, which was subsequently revised in the same year. This guidance clearly states that to qualify as an income-generation scheme, the scheme

“must be profitable and provide a level of income that exceeds total costs. If the scheme ran at a loss it would mean that commercial activities were being subsidised from NHS funds, thereby diverting funds away from NHS patient care. However, each case will need to be assessed individually. For example, if a scheme is making a substantial loss then it should be stopped immediately.”

If a scheme such as car parking charges at an NHS hospital ran at a loss, it would not be acceptable. The Department of Health’s guidance goes on to state that

“the profit made from the scheme, which the NHS body would keep, must be used for improving the health services”.

The current guidance therefore prevents public money that should be used for patient care from being used to subsidise a loss-making scheme.

Clearly, if the Bill became law, it would inevitably affect the amount of income that a scheme would generate, meaning either that there would be knock-on effects for other users of the car park who are paying for it or that the health authority would be faced with the question of whether to start to subsidise it. It cannot do so because of the guidance, thus raising the question of whether the guidance would need to be revised in the regulations anticipated in the Bill. It is a principle that the Bill could reverse or it could open a door to making such a change.

[Julian Knight]

My hon. Friend is providing a forensic discussion of the Bill and all its parts. Does he agree that we could end up with hospital trusts seeing staff members taken off the front line in order to administer these schemes, or even with administration staff, who would be better deployed in the hospital, being brought in to ensure that the right people get the free hospital parking?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I think we have heard this question before. Mr Davies was asked whether staff would be taken from the front line. We are going over ground that has already been covered. This is about a Bill, about car parking, and about the benefit of carers. What I do not want to do is become involved in speculation. We are not here to speculate about the future.

[Mr Nuttall]

I was about to say exactly the same thing, Mr Deputy Speaker, but I do not think that my hon. Friend the Member for Solihull (Julian Knight) was in the Chamber when someone made what I agree was a very similar point. I will merely say that, undoubtedly—I think that Members in all parts of the House will agree with this—the scheme will have to be administered somehow. It is not going to run itself. Someone, somewhere, will be required to run it, either someone new who has been brought in or someone who is currently doing another job in the hospital.

I do not know whether, as part of her preparation for the Bill, the hon. Member for Burnley ascertained how many national health service trusts in England might have to alter their price structures—that is, increase their parking charges to avoid falling foul of the income- generation principle—if the number of exempted carers were to be as significant as it appears. I do not know whether she proposes to scrap the principle of not running a scheme at a loss, as required by the 2006 guidance from the Department of Health. The NHS Confederation, which is the membership body for some 500 organisations that plan, commission and provide NHS services, says:

“NHS principles and Government policy are clear that healthcare is funded through taxation, not through patient charges. Surpluses from parking charges should only be a by-product of covering costs and managing space fairly.”

Most trusts make it clear that the income they receive from car parking charges goes towards covering the maintenance of the car park: for instance, the security, facilities and staff. To be specific, we are talking about the ongoing costs of anything from lighting to CCTV, footpath and cycle path maintenance, car park surfacing, and the employment of enforcement and security staff. If there is any money left over—and some trusts have no surplus from their car parking—it must, in accordance with the guidance, be used to improve local health services.

The Government have already been active in ensuring that information about parking is made very clear to members of the public, and I think it perfectly fair and reasonable to require trusts to ensure that that information is clearly visible on websites and in patient information in, for instance, letters. Patients are entitled to the reassurance of knowing that the purpose of the car park charge is not to provide the NHS with an additional, excessive income stream, but to provide for the car park in the first place. Charges, therefore, are used primarily to cover the running costs of the car park, and if there is a surplus, it cannot be used for other pet projects.

I referred earlier to the 2009 NHS car parking impact assessment. The then Labour Government commissioned the detailed, 61-page assessment of the costs of introducing free car parking. It concluded:

“On the available evidence there is scope for this policy to have both a positive and negative impact, both for older people and the disabled.”

Despite that rather mixed finding, Labour’s 2010 manifesto pledged to scrap hospital car parking charges. Five years later, however, at the time of this year’s May general election, Labour appeared to reverse its view, and to decide that the policy was unworkable. I look forward to hearing from the shadow Minister later whether that is still the position of the official Opposition. In fact, the Bill runs contrary to the principle that individual trusts feel that it is right to set parking charges according to their own financial situations. Only yesterday it was reported that the Oxford Health NHS Foundation Trust was consulting on the introduction of parking charges at its community hospitals.

What are hospital car parking charges actually paying for? That is a perfectly legitimate question for people to ask. It is reasonable to say that visitors and patients do not generally have a great deal of choice when it comes to parking at a hospital. There is usually just one car park operator, and patients, staff and visitors are therefore a captive audience. In some town centres, one might be fortunate enough to have the choice of a cheaper place in which to park, but for hospitals there is no market incentive to keep costs under control.

In December 2010, the British Parking Association, which is the largest professional association in Europe representing parking and traffic management organisations, released a charter of best practice for parking in hospital car parks. Understandably, given the large number of disabled users, it set high standards. The Charter for Hospital Parking stated that hospital parking operators should provide

“good lighting, high standards of maintenance for structures and surfaces, payment systems and equipment that are easy to use and understand, signs that are clear and easy to understand”

and

“clearly marked parking bays.”

Patients and visitors will understandably want a safe and secure environment in which to park when they go to their local hospital, or, potentially, a hospital that is out of their immediate area if they are receiving specialist treatment. As Carers UK points out, attending hospital can be a stressful experience for patients and visitors. The last thing they want is to have their car broken into, or to spend 20 minutes driving round in circles because entrances and exits are not marked properly, or to be stuck facing a ticket machine that does not work with the threat of an unfair penalty charge looming. Patients, and their carers, visitors and staff, will quite reasonably expect a properly maintained car park with proper lighting and adequate security, along the lines of what is set out in the charter, whether the purpose is to guide a daytime visitor with proper and effective signage or to protect the doctor or nurse who gets into the car at 3 am in the dark after a long shift.

The charter also states:

“Parking charges can help to pay for maintenance and management services, and prevent these from becoming a drain on healthcare budgets. Therefore, we encourage NHS Trusts and car park operators who manage hospital car parks to sign up to this charter and to abide by its letter and spirit.”

So far, 24 hospital trusts have signed up to the charter.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. This is very worthy, and it is great to acquire this extra knowledge, but it is not really anything to do with carers. The hon. Gentleman has got on to nurses and lighting, and I understand all that, but, worthy as it is, it is not in the spirit of what we are meant to be discussing.

[Mr Nuttall]

Parking places are finite, Mr Deputy Speaker. If the Bill encouraged more carers to visit hospitals, which is what I think would happen, it would make it easier for them to gain access to car parks, and one consequence of that might be a knock-on effect on the income that would—

[Mr Deputy Speaker]

Order. I understand the point that the hon. Gentleman is trying to make, but it has already been well thumbed. As the hon. Gentleman knows, it was covered very thoroughly by Mr Davies, and I do not want him to repeat everything that Mr Davies covered. I think that, in his hour and a half, Mr Davies did not leave a lot of scope, but this is one point that he made sure we were well aware of.

[Mr Deputy Speaker]

Only in your opinion.

[Mr Nuttall]

The problem with selecting a group to exempt from parking charges is the necessity of considering other groups, and deciding which groups it is fair to charge and which groups should be exempt. Is it fair to exempt a particular visitor, albeit a carer, but to charge a clinical support worker who parks at the hospital every day? It could be someone with children or other dependants, working and acting as a carer but not in receipt of carer’s allowance.

Fairfield general hospital in my constituency comes under the Pennine Acute Hospitals NHS Trust. According to figures from the northern commissioning region for the latest available year, I understand it is one of the trusts that charges on average 11p per hour for staff to park. I have to say that the trust sets out very clearly what its charges are for hospital car parking, and it provides a range of concessions. I take note of your stricture, Mr Deputy Speaker, so I will not read them out, but it is fair to say that it has obviously looked at this question and considered the various groups that should be entitled to a concession. For example, it has picked out blue badge holders, patients and visitors who need to attend on a frequent or regular basis and those who need to visit because they have suffered the bereavement of a loved one.

Such a scheme would be put in danger, and the trust would have to revisit it, which would undoubtedly have an effect on the viability of that scheme. Is it fair to charge a spouse or partner of a cancer patient who is still working and does not get carer’s allowance if they are too busy to get certified as eligible for hospital parking charge exemption, as required under clause 5 of this Bill? The Bill would require them to be approved in advance, and there will be many other deserving cases not covered by the Bill. The Bill does not seek to exempt people because of their low incomes, which is one a weakness. Some of the carers may well be in straitened circumstances, but there may be others who would be able to pay the charge, whereas some members of other groups would not be in that position.

The conclusion may well be that the fairest answer is not to exempt any groups but to make car parking free for everyone, as has happened in Scotland and Wales. Aligning us with those countries would be a popular idea with many people, but we must not forget that it would mean taking hundreds of millions of pounds out of the healthcare budget. The 2009 impact assessment suggested that the cost then would be between £140 million and £180 million. In six years’ time, it is reasonable to assume that cost would have increased enough to pay for 13,000 band 1 clinical support workers or 9,000 band 5 nurses. We have to ask what we think it is right to spend the healthcare budget on: patient care or free or reduced car parking.

[Mr Rees-Mogg]

Perhaps my hon. Friend intends to mention it, but he is ignoring the reduction in the availability of spaces that would come about without charges—people would be able to park all day, and there would be much less control. It is not going to make it easier for carers to park if all the spaces are taken and they are blocked.

[Mr Nuttall]

My hon. Friend is right. The fact is that in September 2014 the then Health Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), noted in a debate that 40% of hospitals now do not charge for hospital car parking. They are likely to be in rural areas where there is less demand for parking—where it is easier to provide parking and there is less pressure on it. I suspect the reality is that a hospital with a car park in a central location in a busy town or a major city centre has no choice but to have a car parking charge. That is the reality of life. If it were be free, there would just be chaos; essentially, it would mean that those who really needed to get close to the hospital would not be able to do so. There has to be some system in place to protect the spaces that are close to the hospital for those who need them. Whatever system we have, there is no simple answer to that.

What we do know is that the present system of having local decision making is working. Fairfield hospital allows 30 minutes of free parking for everyone; then it costs just £1 for up to one hour. In the constituency of the hon. Member for Burnley, by contrast, people would pay £1.90 for up to three hours’ parking. There is a huge disparity across the country. We heard earlier—in an intervention from the hon. Member for Streatham (Mr Umunna), I think—about the costs in central London, which are understandably very much higher than in the provinces.

While the Bill does explain the generality of what is required, it does not explain how the system would work in practice. In the opening remarks of the hon. Member for Burnley, she mentioned that the system would work by way of having a badge in the car window. I am happy to be corrected if I misheard. That is the first time I had heard that. It would perhaps have helped all of us if that had been in an explanatory note saying this was how the scheme would work. She also mentioned that in some hospitals people have to pay on entry—I think the hon. Lady is nodding. That is all very well, but I am not quite sure how simply having a voucher in the car window would help in that scenario. It must be more complex than that, and some sort of token would be needed in order to get through the barrier.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. The question is not how people get into a car park; it is whether there is free concessionary parking for carers. We are dealing with that, not the detail of how we get there. Obviously if the Bill were to go into Committee, these would be the areas that Members would want to cover there. I want to concentrate on where we are now and how we keep to where we want to be within the Bill.

[Mr Nuttall]

I will move on from that detail. I accept it is a detail, but it is an important detail.

[Mr Deputy Speaker]

Order. I agree, but we have heard about all the different scenarios previously and in detail. That is what worries me. We can get bogged down in repeating details, and I know the hon. Gentleman does not want to do that.

[Mr Nuttall]

I want to move on to the devolution of healthcare. It was only very briefly touched on earlier, but it is of particular significance to my constituency, because, as Members will be aware, it is proposed to devolve healthcare to Greater Manchester. From April next year, it will be the first English region to get full control of its health spending. The situation in this regard is not at all clear. The Bill states that it will apply to the whole of England, but if healthcare is devolved, will Greater Manchester be exempt on the same basis that Scotland and Wales are exempt? Healthcare spending has been devolved to those countries and they are then excluded from this Bill.

[Julian Knight]

It is very interesting that my hon. Friend mentions devolution in this context. Should there be devolution from next April in the Greater Manchester area and if this legislation were introduced soon afterwards, could the numbers that devolution has been predicated on no longer be correct? Could we have to go back to the drawing-board in terms of Manchester devolution and how the finances are worked out in respect of hospital parking charges?

[Mr Nuttall]

I will not go down that road, Mr Deputy Speaker, although my hon. Friend has made a good point. His area could well be affected by any future devolution.

[Philip Davies]

I did not get a chance to talk about this earlier. Does my hon. Friend know whether, under the Bill, the Government would reimburse the hospitals for the lost revenue, or whether the hospitals’ balance sheets would have to take a hit?

[Mr Nuttall]

The Bill is silent on that point. It might well be that, in the mind of the hon. Member for Burnley, some mechanism would be put in place to reimburse the trusts, depending on the number of carers registered with them. Or perhaps she would simply say to them, “Sorry, if you’ve got a lot of carers in your area, you’ll just have to suffer the consequences.” It is not clear what would happen.

I want to turn to a drafting matter that has not been touched on. Clause 1 is entitled “Duty to exempt qualifying carers from hospital car parking charges”, and subsection (1)

states:

“Health Care providing bodies shall make arrangements to exempt qualifying carers engaged in any of the qualifying activities listed in section 2(2) from charges for parking their cars”.

The question that arises is how wide the scope of healthcare facilities actually is. Clause 1(2)(b) states that the duty in that previous subsection is the responsibility of “any private hospital”. I personally believe it would be a step too far if we were to legislate on what private companies were allowed to charge for and to whom they should give exemptions.

Clause 1 provides for “arrangements” to be made for “qualifying carers”, while clause 4 provides for a “scheme” for “eligible carers”. Why does there have to be a difference? Why does one set of carers get arrangements while another get a scheme? It appears that schemes are more complicated than arrangements. Clause 1(4) requires the arrangements for qualifying carers to be in place within 12 months, whereas in the case of eligible carers, 12 months are allowed for a scheme to be submitted to the Secretary of State, and it does not have to be implemented until a year and a half after the Bill becomes law. If the matter is so urgent, why will it take a year and a half for carers to become entitled to the exemption?

It is a pleasure to welcome you to the Chair, Madam Deputy Speaker. I think there has been an error in the printed version of the Bill. In the printed copy that I have, clause 4(1) states:

“Health Care providing bodies shall establish schemes to exempt eligible carers engaged in any of the qualifying activities listed in section 2(1)(b) from hospital car park charges and submit such schemes to the Secretary of State within 12 months of this Act coming into force.”

However, clause 2(1)(b) states:

“A qualifying carer under section 1(1) is a person who…has an underlying entitlement to the Carer’s Allowance.”

The provision in clause 4(1) has been amended online to refer to section 2(2), which is the correct subsection. Section 2(2) is indeed the subsection that sets out what a qualifying activity is. It states:

“A qualifying activity under section 1(1) is transporting, visiting or otherwise accompanying or facilitating”—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. As the hon. Gentleman has drawn my attention to a matter concerning the activities of the House—namely, the printing of the Bill—I will for the sake of clarity make it clear that the Bill that I have, and that I assume other people have, clearly refers to section 2(2) and not section 2(1). I am happy to clarify that point as the hon. Gentleman made his point directly to me.

[Mr Nuttall]

rose—

[Mr Chope]

Will my hon. Friend give way?

[Mr Nuttall]

Certainly.

[Mr Chope]

Further to what you have just said, Madam Deputy Speaker. At the top of the Bill of which you and I have a copy, it states:

“This is a corrected copy and is being issued free of charge to all known recipients of the original publication.”

[Mr Nuttall]

Madam Deputy Speaker, I think we have a solution. It does not say that on my copy. I must have a first edition, and it might be more valuable! It is priced at £3, but now we have discovered that it is a rare first edition, it might be worth a lot more. I am willing to raffle it and donate the proceeds to Carers UK. I am glad that the matter has been corrected, Madam Deputy Speaker, and I am sorry if I inadvertently addressed my comments to you personally. I was not trying to suggest that you had had any involvement in the preparation of the Bill.

[Madam Deputy Speaker]

For clarification, the hon. Gentleman has done nothing wrong. The printing of material such as this is a matter for the House and a matter for the Chair.

[Mr Nuttall]

I shall bring my comments to a conclusion. Given the real likelihood that the effect of the Bill will be to reduce the income from car parking, it must be a possibility that the legislation would increase the cost of the NHS to the public purse. In the first year of the abolition of parking charges in Scotland, the sum of £1.4 million was given to Scottish health boards by the Scottish Government, so I wonder whether the Bill might require a money resolution in due course, as my hon. Friend the Member for Shipley has suggested.

It is a worthy aim to try to help carers with their hospital car parking charges. In reality, however, there are a number of problems. Fundamentally, we are faced with this question: what should £200 million be spent on—healthcare or free parking? The answer might be to say that we will exempt only one group, but if we exempt carers, should we not exempt staff, for example, or armed forces personnel? The list soon expands. However well-intentioned the Bill is, we have to look at the problem in the round. No one likes paying parking charges, but the fact is that, alongside general taxation, income from car parking ultimately supports front-line services.

I commend the hon. Member for Burnley for her work on the Bill but, for the reasons I have outlined, I cannot support it today.

[Liz McInnes (Heywood and Middleton) (Lab)]

I should like to declare my support for the Bill, and I congratulate my hon. Friend the Member for Burnley (Julie Cooper) on bringing it to the House today. We have had an interesting debate. It has been enlightening for me; I am not often here on Fridays, and I have been intrigued by the way in which the discussions have gone on.

My hon. Friend made a good point about the amount of money that carers save the NHS as a result of the unpaid voluntary work they do, attending hospitals, caring for friends, relatives and loved ones and relieving the pressure and stress that our support workers, nurses and doctors are under. When we talk about money resolutions and finance, we need to remember that not everything has a financial cost. We cannot put a price on everything, and the amount that carers save our NHS is priceless. It is not something we can quantify. However, I certainly agree with my hon. Friend that the amount of money that carers save our NHS is far over and above what they might bring in in car parking fees.

I am speaking from the point of view of a former NHS worker. I used to work at North Manchester general hospital, which is now part of Pennine Acute Hospitals Trust to which the hon. Member for Bury North (Mr Nuttall) referred. He spoke about the trust as something of an exemplar in the way that it advertised car parking to patients and visitors. Having worked there for a long time, my experience is that its policies caused a lot of confusion. Frequently, when I turned up to work, visitors asked me whether they should pay, whether I had any change for the parking machines, and whether I could help them with where they were going. Not wanting to be too critical of my ex-employer, I have to say that I do not think that Pennine Acute is a shining light when it comes to dealing with car parking for patients and visitors.

[Mr Nuttall]

I do not know when the hon. Lady left the employ of that particular trust, but it seems from its website that it has tried to simplify things by having different coloured signs for different groups—green signs for patients, blue signs for blue badge holders and pink signs for staff. It seems that it is making an effort. I am sure that the hon. Lady knows more than me whether its system is working in practice.

[Liz McInnes]

What the hon. Gentleman said was very telling. He said that he had looked at the website. Not every patient or visitor has access to the website, however. I agree that the system is clear on the website, but it is not clear in reality. When someone turns up with a sick relative or a distressed patient, they do not have time to go through the colour coding. Pennine Acute could improve its signage, but that is not why we are here, or why we are talking about this Bill.

The hon. Gentleman asked how long I had worked at the hospital. I started at North Manchester general in 1987, and I was there when hospital car parking charges were first introduced. I remember the disquiet that was caused to staff, who have always had to pay those charges. Many people do not realise that staff have to pay car parking charges at hospitals.

[Mr Nuttall]

I mentioned it.

[Liz McInnes]

I appreciate that, but it always comes as a surprise to the wider public to hear that staff have to pay to park at their own place of work. I am sure that there would be an uproar if such charges were introduced for our exclusive car park facilities in this place. I know that the staff’s objections to having to pay to park at their place of work have been ignored. We have been protesting about it for many, many years. However, I am not here to talk about staff; I just wanted to make people aware that that practice still goes on. I have always seen it as a tax on coming to work.

We are here to talk about carers. I want to use Pennine Acute as an example. Most recently, it has engaged a private parking company, the income of which comes solely from administering fines to people who have parked incorrectly or who have not paid the right amount of money. The business of this private parking company depends on people contravening parking regulations; it actually wants people to contravene parking regulations, because that is the only way that it gets any income.

When I worked at the hospital, I was a workplace rep for Unite the union. I dealt with a lot of staff who were very, very distressed about the letters they had received from this company, demanding a fine that had to be paid by a certain day, and if they did not pay it by that day, the fine would go up. They were given the opportunity to appeal. If the appeal was not successful, some people found that they had to pay an inflated fine because they had had the temerity to appeal.

With regard to my hon. Friend’s private Member’s Bill, my main concern is about carers. What would happen to them if they were to get one of those bills? At least members of staff, if they are in a trade union, can go to a rep and get some help to deal with the situation. I worry about private parking contractors, because they exist solely to make money out of people. Exempting carers from car parking charges would bring much needed clarity to the matter. It would stop these exploitative companies from making money out of them.

--- Later in debate ---

[Julian Knight]

Thank you, Madam Deputy Speaker. I will now address only the Chair using that particular word.

I congratulate the hon. Member for Burnley, but unfortunately I cannot support the Bill. However, like my hon. Friend the Member for Shipley (Philip Davies) and many other Members who have spoken, I support the fairer hospital parking that she is trying to achieve. I want to share my experience in Solihull as a campaigner for fairer hospital parking, as it has direct relevance to how we approach the issue as a country and to the Bill.

Many hon. Members have mentioned their hospitals and the experience they had when parking charges were introduced. For my constituents in Solihull, parking charges were introduced not only to bring extra revenue into the NHS and front-line services but to ensure that hospital car parks were free for the use for which they are intended. We have had many difficulties in Solihull because the hospital is located near the town centre and, as that is a popular area, people have used the car park all day while they have been shopping. Many people who needed to use the facility at the hospital were therefore unable to do so and might have parked illegally, receiving fines at a later date. Hospital parking charges, although very unpleasant, are in many cases necessary, particularly at sites close to town centres. As we live in a very densely populated country, there are not many hospitals that are so far from town centres that it would be an easy win not to have any charges whatsoever. The car parks might still be misused in the way that I have explained.

Over time, hospital parking charges have grown exponentially. At the moment, in the three hospitals that make up the Heart of England NHS Foundation Trust—Solihull, Good Hope and the Heartlands—charges can be up to £5.75, but for just one hour they can be £2.75. Again, people have to guess how long they will stay, which is unfortunate. I have looked at the contracts that our local hospitals have signed and in my view there is an excessive charge on the provider from the private companies involved. I am not happy with many aspects of these contracts.

[Mr Nuttall]

My hon. Friend says that he has looked at these contracts. Has he noticed how long they were for? I am rather concerned that if the Bill is introduced, it would affect the viability of those contracts.

[Julian Knight]

My hon. Friend makes a good point. There are often penalty charges which would mean unintended consequences if the Bill came into law and a real hit to the bottom line for our hospitals.

--- Later in debate ---

[Mr Nuttall]

Does my hon. Friend not fear that the Bill might make things worse for members of the group?

[Julian Knight]

My hon. Friend makes a good point. The wording of the Bill and the fact that it covers just one narrow group could mean that charges go up for other groups that are not covered by it. That is an unfortunate and unintended consequence.

I have helped to lead the way with the campaign in Solihull, but it has been about individual engagement with the hospital trust rather than introducing national legislation and a one-size-fits-all policy. As we have explored in our discussions, hospitals have a great deal of discretion in the charges they can put in place. The August 2014 NHS patient, visitor and staff parking principles are much broader than the Bill in allowing people from different groups to have free or reduced hospital parking. As I see it, individual engagement is the way to go.

In Solihull, we have had many achievements through discussion and through highlighting particular issues. For example, earlier in the debate we discussed advertising and websites and it was pointed out that many people did not know what monthly or weekly concessions there are. I have urged my local hospital trust to improve the provision of that information and they have put the concessions up front and centre on their website, so it is now easy to see that information.

[Mr Nuttall]

The hon. Member for Heywood and Middleton (Liz McInnes) made the point that not everybody has access to the internet, particularly many elderly people. Does my hon. Friend agree that we should perhaps consider ensuring that information about car parking charges is included in every letter sent out offering an appointment at a hospital?

[Julian Knight]

My hon. Friend makes a good point and I have urged my hospital trust to make the information available not only online, which always seems to be the catch-all approach of any organisation, but in the hospital, so that patients and visitors do not have to come into the hospital and take up the time of staff and administration staff to clarify something that could easily be set out in a leaflet, a letter or a small poster by a desk.

In Solihull, a reduction in the price of monthly tickets and concessions was the direct response to the lobbying done by me and local councillors. We have also seen a doubling of the free parking time at Solihull hospital from 15 minutes to 30 minutes. At the hospital it can often take up to 15 minutes just to find a space, so I urged the trust to increase this time, and the Heart of England NHS Foundation Trust kindly saw fit to double the time. These are small wins, but they are an example of what can be achieved through individual engagement, by putting our case and understanding that there is not an endless supply of money and that we have to be sensitive to the bottom line—the finances of the NHS—because if we are not careful, we may end up depriving the NHS of vital cash.

My own Heart of England NHS Foundation Trust has a deficit—this is in the public domain—of £29 million for the first five months of the financial year. So seriously is this viewed that the management of the University Hospitals Birmingham has been brought in to help close the black hole in the finances. I welcome that move, but it shows that this is no time to destabilise NHS finances or those of individual hospital trusts in our areas.

--- Later in debate ---

[Julian Knight]

I agree that we must value carers. However, the Bill is very narrow in its focus, whereas a much greater number of people could be covered by the guidelines and the NHS patient, visitor and staff car parking principles. There are opportunities to engage in our localities with our local hospitals and local hospital trusts in order to encourage them to expand existing provision. There is the possibility of working on a case-by-case basis, rather than by means of a rather blunt instrument. I take the hon. Lady’s point, but we should look at hospital car parking charges in the round, not just as they affect carers. [Interruption.] The Bill is about carers. The subject matter, though, is a much greater variety of people who use hospital car parks, including many vulnerable people, as we know.

I suggest that other hon. Members follow what has been done by my right hon. Friend the Member for Harlow (Robert Halfon), the Minister without Portfolio, and my hon. Friend the Member for Wellingborough (Mr Bone) and engage with the local hospital trust, put pressure on the trust and get it to reduce the complexity of charges and to ensure that when it puts charges in place, they reflect the local area. For example, I made a case to my hospital trust that we have three hours’ free parking at council car parks in Solihull, so why do people have to pay £2.75 for just one hour at the local hospital? Why is that not in tune with the local economy and the local environment?

More widely, on the people who are not covered by the Bill, I have mentioned those who may be covered by the NHS patient, visitor and staff car parking principles, but what about people who do not have a car? What about carers who travel by public transport? I was involved in a campaign in Solihull to help save the No. 73 bus service, which was a lifeline to Heartlands hospital. If it had been cancelled, people in Shirley in the west of my constituency would have had to travel by three buses in order to attend hospital appointments. If there is any extra money, surely it would be better for it to be directed at them as they are more likely to be on a lower income and potentially in a more vulnerable position than those driving and using the car park.

In conclusion, I welcome the sentiments of the Bill and I applaud the hon. Member for Burnley for introducing it. We have had a vigorous debate. There is a patchwork of provision and it is up to us as individual Members of Parliament, as well as local councils and bodies such as chambers of commerce, to come together in order to try to get the best possible deal for our area. That, in some instances, may include many more people than are the subject of the Bill.

[Mr Nuttall]

My hon. Friend touches on a key point, which I mentioned briefly—that is, there are competing pressures in different parts of the country, depending on whether a Member represents a rural area or an inner-city area.

[Julian Knight]

My hon. Friend makes a valuable point. In his speech he also touched on devolution. In my area we have the West Midlands combined authority coming to the fore. Although it does not currently have responsibility for NHS provision, that may come down the track towards us, as in the case of Manchester, which takes charge of its NHS in April 2016. The concern is that although these devolution packages are very tightly costed, if we suddenly add an extra expense in the form of NHS provision and take away a valuable income stream, that may damage the devolution project and other services may end up being cut.

I support the intention of the Bill and the heartfelt efforts of the hon. Member for Burnley, but it does not take account of an approach that I prefer—local engagement and following the guidelines, which are much more wide ranging than those in the Bill.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

I congratulate my hon. Friend the Member for Burnley (Julie Cooper) on her important private Member’s Bill from which, thanks to Conservative Members’ contributions, a somewhat epic debate has ensued. I am pleased to speak in favour of the Bill. I have broken my usual rule of Fridays in Ealing Action and Bedford Park to be here since 9.30 am. The Bill is an important piece of legislation, which we need. I shall be brief.

It is important to point out that we are talking about carers who are in receipt of carer’s allowance of £62.10 a week. To receive this, they have to do at least 35 hours of caring for an older or disabled person, and they are not allowed any extra income above £110 a week. The state is paying these people in recognition of their caring duties, which take a burden off the health service. If all that is going on car parking fees, then it is a false economy. Waiving their car parking fees alone would pay dividends for the future.

I have elderly parents; in fact, I lost my father a year ago.

[Mr Nuttall]

Will the hon. Lady give way?

[Dr Huq]

I need to do a TV interview that I am late for, so I wish to make progress; I will not be giving way.

My parents have had all sorts of ailments. We lost my dad a year ago last September so I have been in and out of Ealing hospital as a visitor, and I have grumbled that it seems to cost no less than £4 for an in-and-out visit. People on carer’s allowance can be there for days on end, or hours on end, and the cost for them can rack up into the hundreds. This is even more punitive given that they are on £62.10 a week and bear a heavy burden as it is.

For these carers, the stress of parking is at best, the last thing they need, as my hon. Friend the Member for Burnley said, and at worst, on a more generous interpretation, bordering on a slap in the face. They are people who negotiate difficult situations. My own mother has dementia, and people with such conditions can fly off the handle and be quite erratic. If someone is negotiating that, or, say, dealing with someone’s incontinence pads, they do not want to be fumbling about for the correct change, as my hon. Friend so graphically described. This is the least we can do, as a decent society, in recognition of the enormous contribution that carers make. They are almost the social glue of the NHS; it would fall apart without them.

Yesterday in this Chamber we discussed benefit changes and how the safety net is tightening. It is important to consider these parking charges, which are sky-high in any case. In 2008, my hon. Friend the Member for Ealing, Southall (Mr Sharma) said to the local press that they are a stealth tax on the poor. They are already steep, but disproportionately so for carers. We heard research quoted earlier. Leeds University and Carers UK have estimated that £119 billion a year is saved on the adult social care bill through having these unpaid carers who just receive an allowance.

Conservative Members have said that it is fine to exercise discretion. At Ealing hospital, that amounts to a handful of spaces, and there are quite strict criteria. Often, a situation that would result in an unpaid carer taking the person they care for into hospital would arise from sudden things that cannot be predicted, and the four spaces, or whatever, that some London North West Healthcare NHS Trust hospitals reserve as part of their discretionary allocation may be gone.

Members on both sides of the House are lobbied all the time from powerful groups with identical emails that clog up our in-boxes, but this is about people who are the unsung heroes of our system. It should not be those who shout the loudest—the powerful lobby groups—who get their way. According to the figure I got from the House of Commons Library last night, there are 944,000 of these unsung heroes, but I have heard different figures here today. Anyway, on the basis of a cost-benefit analysis, a substantial number of people are saving the NHS money in this way. It is a matter of respect that as a country we should be saying thank you to these carers and we should appreciate their vital contribution. We have the power to change all this today and to deal with the fact that they are being penalised.

We would not want carers to be put off going to hospital because of these charges. That is the logical extension of the 81% rise in NHS West London CCG’s car parking charges. When I lobbied it and said that this is a constant issue in my postbag and my in-box, I was told, “It’s the commercial car parking providers you should take this up with.” Does the House want to be seen to be siding with commercial car parking providers or with carers in our society?

Campaign groups such as Contact a Family, the Alzheimer’s Society and the Multiple Sclerosis Society are all supporting this Bill. Even The Sun, which is not usually a newspaper that supports Labour, is backing the Park the Charges campaign.

[Mr Nuttall]

It has supported Labour.

[Dr Huq]

Not in recent times. It has not supported the Labour party in any recent general election. Historically, Rupert Murdoch’s politics are not aligned with ours.

I urge Members in all parts of this House to do the decent thing and support this Bill in the strongest possible terms. I congratulate my hon. Friend the Member for Burnley on leading this extraordinary debate. I suppose I should also congratulate some Conservative Members on the show of stamina to which they have subjected us.

[Mr Christopher Chope (Christchurch) (Con)]

It is a great pleasure to serve under your chairmanship, Madam Deputy Speaker.

It is a pleasure to follow the hon. Member for Ealing Central and Acton (Dr Huq). Like many speakers, she made some good points, but I am not sure that the conclusions she drew from her analysis were the correct ones. We are all full of admiration for the people who do the caring—the carers—across our country, some 6 million of them. If we want to help them more than we already do, we should do it in a general way rather than by supplying free benefits in kind in specific areas, because that inevitably creates a distortion in the marketplace. The hon. Lady says that some carers in her constituency are being put off going to hospital by these charges, and her solution is to provide them with free parking, but what about the carers who do not have cars and go to hospital using other forms of transport? What are we going to do to help them? As soon as one introduces some sort of exemption, it creates a distortion in the marketplace.

In this debate, we have heard, if nothing else, how complex this issue is. One of the great benefits of Friday debates is that we are able to get down to the nitty-gritty of proposals like this, which, on the face of it, seem ever so attractive. I would not wish to criticise The Sun in any way, but sometimes it does not get down into enough of the detail and just goes for the broad-brush approach without looking at, in particular, the unintended consequences flowing from this sort of legislation.

The hon. Lady said that there is stress in parking in difficult situations, and so there is, but there is even greater stress if one cannot find anywhere to park at all. Many of my constituents have for years complained of a lack of parking facilities at Royal Bournemouth hospital. The hospital has been trying to increase its parking facilities but has encountered difficulties from the local council, which takes the view that creating more car parking spaces generates more traffic and therefore more congestion on the roads. The trust itself has invested a lot in improved car parking, and if the proposals to consolidate healthcare provision on the Royal Bournemouth site in Dorset go ahead, it will need a heck of a lot more car parking provision. It is by no means clear how that would be affordable unless the hospital itself is able to put in place funding arrangements so that the capital provision can be paid off through the income generated from charges. The hon. Lady’s speech raised some real issues that underline the Bill’s weakness.

I want to pick up on some of the points that have not been addressed. Clause 1 would provide a duty to exempt qualifying carers from hospital car parking charges, and clause 2(2) sets out the qualifying activities, including

“transporting, visiting or otherwise accompanying or facilitating a person to whom the care…is provided and who has been admitted to, or is attending, a health care facility for diagnosis, testing, treatment or other appointment relating to their health.”

It is very difficult to police such things. If somebody who was entitled to an exemption parked in the Royal Bournemouth car park and then, for part of their stay, went over to the Crown court, which is within easy walking distance and has a similar parking problem, how would that be policed? It would be policed only by having more personnel, who cost money, and that, as often happens, could result in confrontational situations. It is incumbent on the Bill’s promoter, the hon. Member for Burnley (Julie Cooper), to explain how that will be dealt with.

[Mr Nuttall]

Does my hon. Friend agree that it would have been helpful if we had been given an explanation of the costs of administering the proposed scheme? We could then have based this debate on some actual figures.

[Mr Chope]

The costs may vary from one hospital to another, but it is clear from the debate that the hon. Member for Burnley does not have the first clue about what the costs would be. We have established that they would be significant, but we have not established who would pay them. Would they be borne by the taxpayer through subventions to hospitals? The Scottish health boards were given £1.4 million to implement a similar policy.

If the money does not come from the taxpayer, would it come from increasing the charges of those who will continue to pay them? My hon. Friend the Member for Shipley (Philip Davies) made some really good points about that. According to the Government’s guidance, they believe that concessions should be disbursed more widely than just to carers. The perverse and unintended consequence of the Bill—this would be inevitable, in my view—would be that higher charges would be borne by people who are worse-off. To take a topical example, a working family on tax credits may be a lot worse-off financially than a carer affected by this Bill, but they would have to pay higher charges to use the hospital car park. That is an example of the perversity of the Bill.

[Mr Chope]

I hear what the hon. Lady says. I will not go down that route, Madam Deputy Speaker, because we have had enough debate about tax credits and I do not think you want time taken up on them. My point is that many people less well-off than the carers exempted under the Bill will actually pay for the cost of such exemptions. Interestingly, the hon. Lady did not disagree with that point in her intervention, but that is one of the Bill’s perverse consequences.

There is another problem. Clause 1(1) states:

“providing bodies shall make arrangements to exempt…carers engaged in…the qualifying activities…from charges for parking their cars in spaces provided for service users at hospitals”.

It does not state by whom the spaces are provided.

[Mr Nuttall]

I apologise that I did not cover that point in more detail earlier. My hon. Friend is absolutely right. The implication of the clause is surely that other car park providers may be affected, not just NHS hospitals that provide car parks.

[Mr Chope]

Exactly. Public bodies increasingly decide to delegate non-specialist responsibilities to other specialists; for example, they delegate to car parking companies the supply and building of car parking facilities close to a hospital. It is unclear from the clause to what extent the people providing the spaces—the spaces may not be provided directly by the hospital, but are designed to be used by those visiting it—will be caught by the provision. Their investment and their business plan may therefore be compromised by the Bill. The hon. Member for Burnley did not make that clear.

Perhaps that matter could be dealt with by amendments in Committee. Many other amendments have been suggested in this debate, particularly during the hon. Lady’s speech. She said that such matters could be dealt with by amendments, but a lot of them would not actually be within the scope of the Bill. That problem arises because the Bill is very narrow in scope. It proposes to exempt carers from hospital car parking charges and is for connected purposes, which seem to be centred around facilities similar to hospital car parks. It is very worrying that, even during this debate, the sponsor of the Bill has suggested that it is far from perfect and said that she would like to amend it. In fact, some of the amendments she has in mind would go beyond the Bill’s scope.

Clause 1(2) extends much further than national health service hospitals. There has not been much discussion of the other facilities mentioned in paragraph (a), such as a

“walk-in centre, GP practice or other health care facility to which patients are admitted, or which they attend, for diagnosis, testing, treatment or other appointment”.

Without exception, GP practices in my constituency provide free car parking for everybody. The last thing a GP practice wants is not to have the flexibility to respond to an increase in demand by introducing charges or restrictions. It is inherent in the clause that a qualifying carer who parks beyond the limit would be exempt. However, at a motorway service area, for example, if people stay for longer than two hours, they can no longer park for free and are subject to a charge. If GP surgeries, walk-in centres or other facilities are subjected to a lot of illegal parking—people taking advantage of their car parks but not using the facilities or using them for only a short time—they might choose to impose charges on people who are there for more than two hours. To what extent would people be exempt from those charges under the Bill? How difficult or easy would it be to enforce against them?

[Mr Nuttall]

My hon. Friend is touching on an important point that has not been covered this morning. We have blithely said that about 40% of hospitals do not charge at all. Given what he has just said, does he agree that the Bill would be likely to result in some of those hospitals being required to introduce charging or some other restriction?

[Mr Chope]

My hon. Friend is absolutely right. That brings home the point that this Bill has not really been thought through. To what extent has it been discussed with GP practices? I doubt whether it has been discussed with them at all.

If one wanted to bring forward a Bill under the private Members’ Bill procedure and give it a good chance of success, I would have thought that one would ensure that it was very narrowly focused, specific and precise. If the hon. Member for Burnley had discussed her Bill with me before she presented it, I would have given her the same advice that I have given to many other hon. Members from both sides of the House who have aspired to make progress with their Bills: it is better to have a small, modest measure that is carefully thought through than something that is general and easily open to different interpretations, which makes it unlikely to make progress.

On that theme, the inclusion in clause 1(2)(b) of private hospitals is completely absurd. Why do we want to drag private hospitals into the issue of whether to impose car parking charges on carers? I am happy to give way to the promoter of the Bill so that she can explain why she wanted to bring private hospitals into the Bill. Most of the discussion has been about NHS provision. Why does she want to interfere in the private sector? In my experience, most private hospitals do not have any charges for parking.

--- Later in debate ---

[Mr Chope]

Of course, it does not say that in the Bill. That is a point of detail that I am sure was just overlooked in the drafting. I am grateful to the hon. Lady for making that clearer.

The provision applies to

“car parking spaces provided directly or indirectly, including under contract, by or on behalf of a health care provider…for patients and other users to whom car parking charges would otherwise apply.”

Again, my submission is that that goes far too wide because it drags in contractual provisions in the private sector and could impose directly on hospitals that have contracted out by agreement to private providers. They might have said, “Please build this car park and provide spaces for our patients, and in return we will allow you to charge patients,” and a business plan will have been drawn up accordingly. Clause 1(3) would effectively drive a coach and horses through that contractual arrangement. It could result in a compensation bill being payable by the hospital concerned to the private provider because of a breach of contract. That is another example of why clause 1 is far too wide.

On clause 2, which is about qualification for the parking charge exemption, I am indebted to my hon. Friend the Member for Bury North (Mr Nuttall) for explaining the number of people who have an underlying entitlement to carer’s allowance. In my constituency, where there are a large number of pensioners, a significant number would be subject to the overlapping benefit rule and would therefore be included as carers under the Bill by reason of having an underlying entitlement.

The bigger problem is that the Bill would not help unpaid carers. The vast majority of the 6 million carers in this country do it voluntarily and do not get any help from the state or the taxpayer, yet the Bill would not help them at all. Indeed, it could perversely make them worse off.

[Mr Nuttall]

One point that we have not covered is that for some reason, under clause 5(1)(b), people who are caring as part of their voluntary work are specifically excluded.

[Mr Chope]

That is a very good observation by my hon. Friend, who always looks assiduously at the details. Perhaps the hon. Member for Burnley would like to intervene again to explain why those engaged in voluntary work are specifically excluded under clause 5(1). That problem shows that the hon. Lady needs to reconsider the Bill.

As you know, Madam Deputy Speaker, the first stab at getting a private Member’s Bill on the statute book often fails, but there is then an iterative process whereby somebody else is successful in the ballot and brings forward a revised Bill for the House to consider. I believe that Lord Steel’s Abortion Bill, which got the House’s approval, was the sixth iteration of that Bill. I wish the hon. Lady luck in improving her Bill, having considered the points that have been made, and perhaps bringing forward one in the next Session that meets the concerns that have been expressed today.

I have always been concerned about new bureaucratic burdens being placed on organisations, so I am particularly concerned about the job that local authorities would have to do under clause 5(1) and (2), which provide that there would have to be an assessment of

“whether a carer should be eligible for free hospital car parking.”

No criteria are set out for the basis on which such a decision would be made, and there is nothing about how long that process might take. People often need quick decisions, but there is nothing about that. Would there be an appeals system if an applicant believed that the wrong decision had been taken? That would add to the bureaucracy and administration, and the time taken to deal with cases. It would cut across the discretion that hospitals and other organisations have to decide on their own parking charges.

Let me refer briefly to what happens at a few hospitals in my locality, because it shows that current discretionary arrangements are full of common sense and enable individual hospitals and hospital trusts to meet the needs of their communities by using available local expertise and experience.

In Royal Bournemouth hospital, all blue badge holders pay to park, and the only exemption is for disabled blue badge holders with tax-exempt vehicles. That is in line with neighbouring hospitals and other local authorities, and reflects the fact that the Christchurch and Bournemouth area has a large number of blue badge holders. If they were all able to avoid paying to park, relatively few people would have to pay, but they would have to pay a lot more. Sensibly, the Royal Bournemouth hospital offers exemptions for certain visitors and patients, and can arrange exemption certificates for specific patients and their visitors. Surely that is sensible.

Poole hospital has a similar arrangement, and a seven-day parking permit costs £16—a reasonable charge considering that parking normally costs £9 a day. Hospital governors recognise that if those with a long-term need to use hospital car parks have to pay £40 or £50 a week—those are the sorts of figures we have heard—that is not reasonable. Poole hospital chooses to exercise the discretion available to it, which is sensible.

Southampton General hospital is further away, but it is used by my constituents who have severe heart conditions and need surgery that often involves a long spell in hospital. It has a system of free parking or transport for patients who receive certain benefits, and concessionary parking for patients who are receiving certain treatments. A patient can be eligible for free parking or transport if they receive income support, hold an NHS tax credit exemption card, or an HC2 or HC3 certificate, which is a low-income support scheme that covers prescription, dental and healthcare travel costs.

Such sensible arrangements rely on the principle of localism and the idea that the best people to decide on such matters are the local community. Much hospital provision in this country, and too much of the NHS, is far too centralised, and the Bill would further centralise and remove discretion from individual hospitals and healthcare providers. I know that the Bill sounds good and is superficially attractive, but when one looks below the surface one finds that it does not stand up to detailed scrutiny.

I hope that when he responds the Minister will clarify whether—this is on a par with the issue of free school meals—the Bill, if enacted, would have Barnett consequentials. Barnett consequentials are a cost to the taxpayer. There is already free provision in Scotland, and my constituents are already subsidising the Scots to the extent of £1,600 a head, but if my reading of the Barnett consequentials is correct, another hidden cost would be that Scotland would have to be paid more money from the national Exchequer to compensate for the fact that the Bill does not apply to Scotland. That is another example of why proposed legislation can often turn out to be a lot more complex than it might appear on the surface. I hope my right hon. Friend the Minister will be able to help on that point when he responds to the debate.

[Mr Nuttall]

Does my hon. Friend think the Bill requires a money resolution?

[Mr Chope]

That is obviously a matter for the House authorities, but the Bill is bound to cost taxpayers money and would therefore need a money resolution to proceed. It is possible to bring forward legislation which, although prima facie makes exemptions that impose costs on the taxpayer, contains compensating provisions to ensure that those costs are borne not by the taxpayer but by somebody else. It may be that the promoter of the Bill thinks we do not need to seek a money resolution because the costs arising from it will actually be borne by a lot of other people who do not yet know they will have to pay that cost.

I am not sure, however, who would meet the costs of the Barnett consequentials. I do not think there is any provision yet in statute to enable Barnett consequentials to be passed on in the form of higher car parking charges for users of hospital car parks. I am sure that that can be addressed in due course. I am sorry there is nobody here from Scotland today. I am a member of the Scottish Affairs Committee, which enables me to be briefed on issues relating to Barnett consequentials. I know hon. Members from Scotland are always keen for us to pass legislation in this House that would give them more money through the Barnett consequentials. I imagine that if they were here today and voting on this private Member’s Bill—although it extends only to England—they would be rather enthusiastic about it, because it might deliver some more money for them through the Barnett consequentials.

We all think that carers do a great job, but I am not sure that it is only the paid carers we need to think about. We need to think about the unpaid carers, and the Bill does nothing at all for them. It extends a lot of bureaucracy and interference to our already over-regulated hospitals and healthcare sector. It would inevitably impose additional costs on those who are not exempted under its provisions and add additional bureaucracy and administrative burdens.

In summation, the Bill contains elements that may well make progress in this House, but I would not be keen for it to make progress today. There is so much work that needs to be done on the Bill in its present form that the Committee stage would be far too prolonged. I congratulate the hon. Member for Burnley on introducing the Bill. She is a new Member and I am sure that in the coming years she will be able to perfect the Bill, so we can get something on the statute book that meets some of the concerns she has expressed in this debate.

Cities and Local Government Devolution [Lords] Bill

David Nuttall Excerpts

Wednesday 21st October 2015 Commons Chamber

[James Wharton]

It is up to local areas to make proposals, and we will look at the offers and deals. Thirty-eight proposals were submitted before the 4 September deadline by areas interested in being part of this process. We will seek to ensure that any proposal makes economic sense, and that the deal takes account of all interested parties and their views, but we are not going to prescribe in this Bill, nor set out centrally, the geography that devolution should follow, because to do so would go counter to the bottom-up process that we envisage driving forward long-lasting and successful devolution in this country. I recognise my hon. Friend’s important question, but flexibility is the intention and it is what the Bill contains. We want agreement and to work with areas to deliver on their objectives.

We are open to discussing devolution proposals from all places. We have been clear that our approach is for areas to come forward with proposals that address their specific issues and opportunities. The Bill is therefore enabling legislation that will provide the legislative framework to give effect to the different aspects of devolution deals. The Government have not specified a list of functions that may be devolved, and there is good reason for that approach. It means that we can consider any area, idea or proposal. Perhaps more significantly, if we started to specify lists of functions or kinds of areas, those whose ambitions fell outside these ideas might be reluctant to come forward. The reality is that, as decades past have shown, if the man in Whitehall is asked to specify what might be devolved, the list is going to be pretty cautious.

It would not be right to restrict our ambition by taking such an approach, so I hope Opposition Front Benchers will accept and understand the position the Government are taking. In short, specifying functions or kinds of areas is simply not consistent with a genuinely bottom-up approach. We will therefore not be supporting amendment 59, or new clauses 23 and 25, and I hope hon. Members will not press them to a vote. I also hope that, with my explanations and assurances, the Committee will be able to support clause 1 and reject clause 2, accepting the consequential amendment to clause 1.

[Mr David Nuttall (Bury North) (Con)]

Given what has been said by my hon. Friends the Members for North East Somerset (Mr Rees-Mogg) and for Altrincham and Sale West (Mr Brady) about rural areas being swallowed up by urban areas and the Minister’s response thereto, does it all mean that the Minister would be minded to accept at least the thrust of amendment 43, which stands in the name of my hon. Friend the Member for Altrincham and Sale West and would give a predominantly rural area that has already been swallowed up the right to remove itself from the arrangement?

--- Later in debate ---

[James Wharton]

Let me be absolutely clear about this: this Bill does not allow this Government or any future Government to impose mayors on anybody. But where we make a deal it is a two-way process, and it is the Government’s clearly stated intention for those metropolitan areas that the accountability a mayor brings is desirable and we want to see it as part of those deals.

[Mr Nuttall]

Does the Minister accept that Greater Manchester is not just a single city? It is an area made up of a city—

[William Wragg (Hazel Grove) (Con)]

Two cities.

[Mr Nuttall]

Two cities, nowadays, and several very independently minded towns, which feel that they have been forced together into an artificial construct.

[James Wharton]

It is important to be clear about what the devolution we are talking about does. It takes powers that exist in Whitehall—powers that rest with public bodies—and transfers them to local decision makers. It does not affect the arrangements that are already in place for local government, which recognise differences and the communities within them. We will allow them, of course, to pool areas of policy if they wish to do so, but nothing in this legislation would allow us to compel them to do so.

In his Budget speech in July, the Chancellor was clear:

“The historic devolution that we have agreed with Greater Manchester in return for a directly elected Mayor is available to other cities that want to go down a similar path.”—[Official Report, 8 July 2015; Vol. 598, c. 329.]

All of that is reflected in our manifesto commitments to

“legislate to deliver the historic deal for Greater Manchester”

and to

“devolve far-reaching powers over economic development, transport and social care to large cities which choose to have elected mayors.”

--- Later in debate ---

[Mr Brady]

I should not speak for my hon. Friend the Member for Hazel Grove in this instance, although I will put on the record my gratitude to the Clerks for their assistance in drafting the amendments and explanatory statements that stand in my name. I will speak briefly to amendments 42, 43 and 44, allude to amendment 51—I am sure that my hon. Friend the Member for Hazel Grove will speak to it in due course—and comment on Government amendment 4.

[Mr Nuttall]

I want to try to clarify the point about the 50% threshold. In a referendum in which the electorate vote either yes or no, what we are trying to make clear is that it would have to have the support of over 50% of the people voting in the referendum. It is no more complicated than that.

[Mr Brady]

I am grateful to my hon. Friend, who expresses the matter clearly and succinctly.

We have already shed light on a number of important things. I particularly welcome the Minister’s reassurance, which is important to those of us who are evangelists for devolution for the Greater Manchester area, that in due course, when it has proved as successful as we all hope it will be, some of the neighbouring authorities such as Cheshire East Council—I am delighted to see my hon. Friend the Member for Macclesfield (David Rutley) here—might apply to be part of the journey to this great new world on which we are embarking. I am sure that he would not be alone in wishing to come and join us.

--- Later in debate ---

[James Wharton]

I agree with the hon. Gentleman that that engagement is important. My contention is that the Bill provides for it with the power to allow persons to attend and invite persons to be present to scrutinise the process. My argument is that defining a list of particular types of persons or bodies risks narrowing the interpretation. However, I understand what the hon. Gentleman desires to achieve.

I will now discuss the amendments that relate to requirements on the exercise of mayoral powers. Amendments 40, 41 and 45, which were tabled by my hon. Friends the Members for Altrincham and Sale West (Mr Brady), for Hazel Grove (William Wragg) and for Bury North (Mr Nuttall) would place requirements on mayoral powers. Amendment 40 provides that a function may only be specified as a function of the mayor with the consent of the combined authority prior to the creation of the post of mayor. We have concerns over the latter part of that amendment, because it appears to rule out a further transfer of functions to a mayor once the position has been established. It seems to mean that the deal that is reached initially is the deal, full stop.

Amendment 45 underlines hon. Members’ concerns that the constituent councils must be content with the list of functions to be exercisable by the mayor. I understand hon. Members’ concerns and agree that no local authority functions should be conferred on a combined authority, with or without a mayor, without the consent of the councils involved. We make provision for that in clause 5. I am happy to continue the dialogue with the hon. Members who have raised this point and I understand the deeper points that they wish to address. I hope, therefore, that we can reach a consensus that allows us to pursue the matter in a different manner to the amendments that we are discussing.

Government amendments 5, 6, 7, 8 and 26 will provide greater flexibility in how a mayor will be able to undertake their functions. The amendments are reasonably straightforward. Amendments 5 and 6 will provide greater flexibility and create greater capacity to enable a mayor to be supported in undertaking functions, where that is wanted locally. Amendments 7, 8 and 26 enable mayors of combined authorities, if it is specified by order, to exercise any of their general functions jointly with other authorities or combined authorities with the same functions, if they so choose. They enable a joint committee comprising the mayors of two combined authorities or a combined authority mayor and local authorities to exercise jointly shared functions across the area, thus providing greater flexibility in how mayors, combined authorities and local authorities can work together.

Finally, I will mention some minor and technical Government amendments. Amendments 30 and 31 insert provisions that enable an order to specify that local authority functions must be exercised jointly by the councils and the combined authority. Amendments 23, 24 and 25 relate to police and crime commissioners. They clarify the timing of an order that transfers PCC functions to an elected mayor; ensure that drafting on PCC functions is consistent; and ensure that, in line with the provisions for PCCs generally, a person acting in place of a mayor with PCC functions temporarily cannot carry out particular strategic functions, such as issuing a police and crime plan. Finally, Government amendment 15 will mean that the power to make regulations under clause 17 includes a power to make incidental, supplementary and consequential provision. Those are tidying-up amendments that are not controversial. I certainly have not detected that they are from the debate.

I hope that right hon. and hon. Members, in the light of those explanations, will not press their amendments and will feel able to support the Government amendments.

[Mr Nuttall]

With the authority of my hon. Friend the Member for Altrincham and Sale West (Mr Brady), and having listened carefully to the Minister’s comments, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 5

Functions

Amendments made: 5, page 4, line 26, at end insert “, or

(c) so far as authorised by an order made by the Secretary of State—

(i) for a person appointed as the deputy PCC mayor by virtue of an order under paragraph 3(1) of Schedule 2, or

(ii) for a committee of the combined authority, consisting of members appointed by the mayor (whether or not members of the authority),

to exercise any such function.

‘( ) An order under subsection (3)(c)(ii) may include provision—

(a) about the membership of the committee;

(b) about the member of the committee who is to be its chair;

(c) about the appointment of members;

(d) about the voting powers of members (including provision for different weight to be given to the vote of different descriptions of member);

(e) about information held by the combined authority that must, or must not, be disclosed to the committee for purposes connected to the exercise of the committee’s functions;

(f) applying (with or without modifications) sections 15 to 17 of, and Schedule 1 to, the Local Government and Housing Act 1989 (political balance on local authority committees etc).”

This amendment makes provision for a mayor to arrange for the person appointed as the deputy PCC mayor or a committee of the combined authority to exercise a general function which is exercisable by the mayor, if authorised to do so by an order made by the Secretary of State.

Amendment 6, page 4, line 39, leave out paragraph (b) and insert—

“(b) in accordance with arrangements made by virtue of this section or section 107DA.”

This amendment provides for a general function exercisable by the mayor for the area of a combined authority to be taken to be a function exercisable by a committee or by the deputy PCC mayor, where arrangements have been made under provision inserted by amendment 5 or new section 107DA, inserted by amendment 8.

Amendment 7, page 5, line 3, at end insert—

“() provide that functions that the mayoral combined authority discharges in accordance with

arrangements under section 101(1)(b) of the Local Government Act 1972 (discharge of local

authority functions by another authority) are to be treated as general functions exercisable by

the mayor (so far as authorised by the arrangements).”

This amendment enables the Secretary of State to provide by order that functions of a mayoral combined authority discharged in accordance with arrangements under section 101(1)(b) of the Local Government Act 1972 are to be treated as general functions exercisable by the mayor of the authority.

Amendment 8, page 5, line 16, at end insert—

“107DA Joint exercise of general functions

(1) The Secretary of State may by order make provision for, or in connection with, permitting arrangements under section 101(5) of the Local Government Act 1972 to be entered into in relation to general functions of a mayor for the area of a combined authority.

(2) Provision under subsection (1) may include provision—

(a) for the mayor for the area of a combined authority to be a party to the arrangements in place of, or jointly with, the authority;

(b) about the membership of any joint committee;

(c) about the member of the joint committee who is to be its chair;

(d) about the appointment of members to a joint committee;

(e) about the voting powers of members of a joint committee (including provision for different weight to be given to the vote of different descriptions of member).

(3) Provision under subsection (2)(b) to (d) may include provision for the mayor or other persons—

(a) to determine the number of members;

(b) to have the power to appoint members (whether or not members of the combined authority or a local authority that is a party to the arrangements).

(4) Provision under subsection (2)(c) may include provision as to the circumstances in which appointments to a joint committee need not be made in accordance with sections 15 to 17 of, and Schedule 1 to, the Local Government and Housing Act 1989 (political balance on local authority committees etc).

(5) In this section references to a joint committee are to a joint committee falling within section 101(5)(a) of the Local Government Act 1972 that is authorised to discharge, by virtue of an order under this section, general functions of a mayor for the area of a combined authority.”—(James Wharton.)

This amendment enables the Secretary of State to make provision by order enabling the combined authority to enter into arrangements to discharge general functions of the mayoral combined authority jointly with one or more other local authorities or combined authorities.

Clause 5, as amended, ordered to stand part of the Bill.

Schedule 2

Mayors for combined authority areas: police and crime commissioner functions

Amendments made: 23, page 26, line 33, leave out

“police and crime commissioner functions”

and insert

“functions of a police and crime commissioner”

This amendment makes a minor drafting change to paragraph 1(1) of new Schedule 5C to achieve consistency with the language used in new section 107E(1) as inserted by clause 5 of the Bill (to which sub-paragraph (1) cross-refers).

Amendment 24, page 26, line 34, at end insert—

‘( ) A duty under this Schedule to make provision by order is a duty to make such provision in an order made at any time before the first election of a mayor who, by virtue of an order under section 107E(1), is to exercise functions of a police and crime commissioner.”

This amendment clarifies that an order made under new Schedule 5C can be made at any time before the relevant mayor is first elected and makes it plain that a Schedule 5C order can be made subsequently to an order under new section 107E.

Amendment 25, page 30, line 12, at end insert—

‘( ) Subsections (5) and (6) of section 107C, so far as relating to the exercise of PCC functions, are subject to any provision contained in an order under this Schedule.”—(James Wharton.)

This amendment ensures that an order under new Schedule 5C can make provision to prevent a person who is acting in place of a mayor with police and crime commissioner functions from carrying out particular PCC functions such as issuing or varying a police and crime plan, consistent with the current position in respect of actin PCCs.

Schedule 2, as amended, accordingly agreed to.

Clauses 6 and 7 ordered to stand part of the Bill.

Clause 8

Other public authority functions

[The Minister for Community and Social Care (Alistair Burt)]

I beg to move amendment 32, page 9, line 15, at end insert—

‘( ) See also section 19 of the Cities and Local Government Devolution Act 2015 (devolving health service functions) which contains further limitations.”

This amendment inserts a new subsection into section 105A of the Local Democracy, Economic Development and Construction Act 2009 which alerts the reader to clause 19 of the Bill which contains limitations on the power to make an order under that section.

Access to Medical Treatments (Innovation) Bill

David Nuttall Excerpts

Friday 16th October 2015 Commons Chamber

[Chris Heaton-Harris (Daventry) (Con)]

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

Not a day goes by without those practising medicine in our national health service innovating. Talk to any doctor, and especially any surgeon—in fact any registered medical practitioner—and they will show how they have been innovative and, in being innovative, how they have helped those they are trying to treat. The levels of innovation are, without doubt, inspiring.

Let me give an example to demonstrate what I mean. An eminent surgeon was telling me only the other day of how he had helped a patient who came to him with a particular stomach tumour. At the time of surgery, he found this tumour to be so large that if he had continued with his original plan of removing it, it would probably have killed the patient. This surgeon had just a few nights before read about a drug called Glivec. Glivec creates a mutation called C-KIT, common in chronic leukaemia, where it is a succeeding treatment. Reports appeared indicating that the type of tumour this patient had carried had the same sort of mutation, so rather than trying to remove the tumour, a bypass operation was performed to overcome the obstruction and allow the patient to take the drug.

When the surgeon put his patient on this drug, the tablets were tolerated. The tumour disappeared. Years later that patient occasionally visits his surgeon to say thank you for being innovative and saving his life. In fact, as that surgeon will confirm, there is only one thing wrong with what happened that day. There was no way of recording the innovation on a database that could share it with other surgeons preparing for a similar operation and show how it had worked.

[Mr David Nuttall (Bury North) (Con)]

Will my hon. Friend confirm that the doctor in that particular case would have had to obtain his patient’s consent before proceeding with that innovative treatment?

[Chris Heaton-Harris]

I believe that the decision was taken while the patient was unconscious, but there would then have been a conversation, absolutely, because the doctor would have acted responsibly, as would any surgeon.

This was a life-saving decision, but there was no simple, quick way to tell anyone about it and, in so doing, perhaps save someone else’s life. Earlier this year, when we in this place were getting excited and building up to some sort of election campaign, the House of Lords was passing Lord Saatchi’s Medical Innovation Bill. It passed through all its stages in the other place and, as with many Bills, ideas were refined and concepts were introduced in Committee, on Report and on Third Reading. One of the new ideas that was introduced into the Bill is the central idea that I have plagiarised for my Bill—namely, the introduction of a database for innovative treatments conducted by registered medical practitioners.

--- Later in debate ---

[Chris Heaton-Harris]

I am not sure I do. I would like to think that this Bill completely clarifies how this database can be set up and builds a foundation on which the Secretary of State can do such a thing. My Bill does not build this database; all it does is confer on the Secretary of State the power, which the hon. Lady talks about, to build such a database. If the Secretary of State for Health chose to use the power, it would only be after detailed consultation. However, as we would all expect, when given the opportunity to take a private Member’s Bill through into law, any Member of Parliament, myself included, would endeavour to consult widely on the matter in hand. Thus over the summer I have met pretty much everyone who has expressed an interest in this Bill—either for or against—to endeavour to allay any concerns about its content and direction of travel and to listen to what they have to say.

[Mr Nuttall]

Is it the case that the introduction of the database into this Bill is really in response to the concerns that were expressed in the other place when Lord Saatchi’s Bill was being debated? There were concerns that, if his Bill was allowed to go through without the database, there would be difficulties? Is that not the case?

[Chris Heaton-Harris]

Absolutely, my hon. Friend is completely right.

The Minister will be pleased to hear that I have been working closely with some of the excellent officials in his Department to ensure that there is a little more detail in the Bill specifically to deal with some of the concerns that have been raised with me. First, after a great deal of thought and research, I suggest that the database is held by the Health and Social Care Information Centre. The HSCIC has experience of dealing with big data, and although a number of details would have to be worked out, it seems that it would be the obvious place in the existing health infrastructure to hold such a database.

How the database would work would be detailed outside my Bill by those best placed to do so. However, it is envisaged that a registered medical practitioner, having consulted with his or her patient, would flag up on the patient’s notes that they were innovating. I recognise the pressure that medical practitioners are under, so I am determined that this database should not add much to their already heavy workload, and, hopefully, through this system it would not.

The Health and Social Care Information Centre already has in place a strong set of legal safeguards to protect privacy and confidentiality, which, again, makes it an ideal organisation to host the database. Clearly, privacy issues will be a core part of any consultation that takes place on the detail of the database.

Importantly, the Bill stipulates that outcomes, not just the process of innovation itself, will be on the database. Successes and failures would be recorded on an ongoing basis. There are a number of very, very good reasons for doing that. Of course sharing success is simple to explain. Sharing ideas is in itself a great idea. Letting others see that a treatment has been a success when that treatment might not be widely known is clearly helpful, perhaps even lifesaving. When we know that treatments can differ between NHS trusts and between individual surgeries, it seems clear that we should be encouraging a spread of the good innovation that comes from every individual medical practitioner, such as the surgeon I mentioned earlier and his use of the drug, Glivec.

We must also realise the potential of transparently sharing all outcomes of innovation—not just successes, but failures too. Critics of Lord Saatchi’s Bill were rightly concerned about “quackology”—their term, not mine. There are some doctors who sell to desperately sick people treatments that do not work and that, in some cases, are dangerous. Having a database on which the whole of the registered medical practitioner community can see what an innovation is and then watch the results come in removes quackology from the database in a stroke.

I might well be on the lookout for someone who can cure my male-pattern baldness. Undoubtedly, it would require an innovative treatment; some would say a miracle cure. Currently, there are many treatments on offer to people such as myself. Many adverts will offer me an innovative cure, but there is no way of checking on the successes or failures of the treatments on offer.

--- Later in debate ---

[Mr David Nuttall (Bury North) (Con)]

As always, it is a great pleasure to follow my hon. Friend the Member for Shipley (Philip Davies), who has set out with his usual clarity the reasons why the Bill should receive the support of the House today. I too rise in support of the Bill.

I warmly congratulate my hon. Friend the Member for Daventry (Chris Heaton-Harris) on his success in coming second in the ballot for private Members’ Bills and on choosing such an important subject to bring before the House this morning. As we have seen, it is a Bill that is not without some controversy. Often, private Members’ Bills are technical and minor in nature and do not receive much public attention, but it is fair to say that this one very much has. It brings before the House—I think that I am right in saying that it is the first time that these issues have been debated on the Floor of the House—the issues that were considered in the other place when the Lords debated the Medical Innovations Bill, which was piloted through all its stages by the noble Lord Saatchi in the previous Parliament. I note, incidentally, that the noble Lord reintroduced his Bill on 8 June. I hope that he does not fear for the possible success of this Bill; perhaps he is just hedging his bets. I certainly hope that this Bill will proceed safely through this House and arrive in the other place.

The Bill builds on the work of Lord Saatchi’s Bill in that it deals, I think adequately, with some of the criticisms of it. The purpose of this Bill, as we have heard, is to promote the use by doctors of innovative medical treatments and it does that by allowing for the establishment of a database of such innovative medical treatments and by setting out the steps that doctors can take to demonstrate that they are acting responsibly in carrying out such treatments.

I have to admit at the outset that an impressive array of bodies have lined up either in outright opposition to the Bill or with at least some reservations about it. When I was considering the evidence, I had to take that into account. I had to decide whether in the light of that evidence I should simply go with the flow and decide that if all those people said that it is a bad thing, it must be a bad thing, or whether I should think about the other side of the coin. I did that, and on balance, I came down on the side of what I like to think of as my constituents’ view. I believe that the Bill has the potential to improve the lives of my constituents if they are struck down by a rare disease that means that they require innovative medical treatment.

It is appropriate to try to deal with the concerns that have been raised by so many eminent bodies in the medical world. As we have heard, last year, many organisations responded to the consultation on Lord Saatchi’s Bill. Like my hon. Friend the Member for Shipley, I shall try to deal with some of their concerns. The professional body for doctors, the British Medical Association, often described as the trade union for doctors, said in its consultation response to the Medical Innovation Bill:

“The BMA believes strongly in the value of innovation in medicine. Whilst the BMA would have concerns if the draft Medical Innovation Bill was to become law, if there was a need identified, we would support the exploration of other initiatives through which responsible, safe and effective innovation can be promoted to doctors.”

In its 2014 response to the consultation on that Bill, the AMRC, the Association of Medical Research Charities, a national organisation made up of 137 leading research and medical charities from across the UK that, incidentally, spends about £1.3 billion a year on research, welcomed the ambition of the Bill but was concerned about its unintended consequences. In February this year, it welcomed the idea proposed in the other place about the importance of collecting data. I am pleased to note that the Bill we are considering today appears to address that concern by establishing a database to collect the results of innovative medical treatment.

Without wanting to create confusion, I want to refer to another body that raised concerns, another AMRC—not the Association of Medical Research Charities this time, but the Academy of Medical Royal Colleges, a body that comprises 20 medical royal colleges and faculties from across the UK and Ireland. It agrees with the idea that research and innovation are vital to the NHS, but does not support the Bill as a whole because, in its words, it is not clear what it is trying to achieve.

It is therefore a considerable challenge for my hon. Friend the Member for Daventry and those of us who support the Bill to demonstrate the need for it. To put it simply, I believe that it will provide access to innovative treatments to best meet a patient’s desires and needs when other treatments might not achieve the best results. People might well ask why we need the Bill now. The law on medical negligence has not changed for decades and in those decades medical innovations have been made. The law might not have changed much, but society certainly has—it is more informed, less deferential and more litigious. The number of lawsuits filed against the NHS has doubled in five years and last year’s pay out, which has also doubled in that time, was £1.2 billion. The Treasury provision for claims against the NHS has now reached £26 billion, so it is no surprise that doctors increasingly feel frightened of being sued and therefore, understandably, feel less likely to be able to innovate.

It is worth noting that back in 2013 the Health Service Journal stated:

“It is a popularly held view that the NHS is resistant to innovation. Despite several laws and policy directives and many successful examples of innovative approaches resulting over the years, the NHS is still seen to a late adopter of innovation—inventive but not creative.”

I believe that the Access to Medical Treatments (Innovation) Bill has the potential to counter that problem by putting innovation on a statutory footing.

NESTA, the independent charity in the UK that works to increase innovation in the UK, considered the whole question of innovation in the healthcare system in its 2014 report, “Which doctors take up promising ideas?” It highlighted the early adoption of drugs by general practitioners since 2010 to treat conditions such as diabetes, chronic constipation in women and deep vein thrombosis as well as to prevent stroke in patients with atrial fibrillation as an alternative to warfarin. The study also found that 86% of doctors found out about other innovative treatments from other doctors. It is a crucial component of this Bill that it places a responsibility on any doctor wishing to undertake innovative treatment to talk to another doctor about the proposed treatment.

NESTA’S report also recommended that there should be clear instructions on innovation to encourage early adoption, which is what I believe that the Bill aims to do, to provide reassurance, and to provide instructions to doctors to allow them to adopt life-saving treatments only when it would be in the best interests of their patients. The Bill would extend and encourage the idea sharing that is already going on between doctors and give them confidence in that process.

One of the key objections made by bodies such as the BMA was the “unproven threat” of litigation against doctors. In the summer, it was reported in the press that between 2010 and 2013 there was a 64% increase in the number of complaints to the UK medical regulator, the General Medical Council, and a 42% increase in the number of doctors struck off or suspended from the UK medical register. Let me make it clear that I believe that patient safety must be paramount. It is right that patients have access to our world-class justice system if, sadly, things go wrong. It is, however, a curious observation to make that there is an “unproven threat” of litigation when the bill for legal fees paid out over clinical negligence claims in 2013-14 was £259 million, with many believing that there is an increasing culture of litigation.

The Royal College of Ophthalmologists expresses a common view:

“Without unequivocal GMC and NICE support, ophthalmologists are understandably concerned that they may be assuming unacceptable personal liability by using a unlicensed drug when a licensed alternative exists … Consequently, patients may not be getting treatment when they need it and not getting the best results.”

Of course, the Bill must not be seen as a licence to experiment on patients, which is one of the more sensational claims I have seen about the Bill. I believe it clearly preserves the existing safeguards of the common law, which protect the patient while giving the doctor the option to take steps to demonstrate that the action they have taken has been taken responsibly before carrying out any innovative treatment.

As the guidance notes make clear, if another qualified doctor expresses reservations, those would have to be taken into account or, quite appropriately, the prescribing doctor could be found negligent. I do not believe that this Bill is simply a “get out of jail free” card for negligent doctors. It does not override the Bolam test, which was first set out in the leading 1957 case of Bolam v. Friern Hospital Management Committee. In that case Justice McNair said in his judgment that a doctor

“is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art”.

Therefore, a doctor would be negligent under the current law if they treat or manage a patient in a way in which no responsible body of doctors would have acted. That test was extended to include a requirement that they must also act in a logical manner, which is called the Bolitho test, established in the case of Bolitho v. the City and Hackney Health Authority.

I believe the Bill contains the appropriate reassurances that doctors cannot use it to run roughshod over the existing law. The necessary reassurance is contained in particular in clause 3(5), which explicitly states:

“Nothing in this section permits a doctor to carry out treatment for any purpose other than the best interests of the patient.”

To ram home that point clause 4(1) clearly states:

“(1) Nothing in section 3—

(a) affects any rule of the common law to the effect that a departure from the existing range of accepted medical treatments for a condition is not negligent if supported by a responsible body of medical opinion, or

(b) is to be read as limiting the circumstances in which any such rule of the common law may be relied on”.

I do not believe, therefore, that the Bill would limit redress in the event of negligence. A doctor would still be negligent if they acted in a way that was not in the best interests of their patient. However, the Bill would put into legislation a workable framework to allow responsible innovation where that would serve the best interests of the patient when a conventional treatment or lack of treatment might not meet the same goal.

I turn to the concerns of the Royal College of Surgeons, a professional membership organisation and a registered charity, which exists to advance surgical standards and improve patient care, with 20,000 members in the UK and abroad. That body has issued a parliamentary briefing on the Bill and one of its concerns is:

“The wording of the Bill confers the decision-making power on the doctor rather than the patient. There is a risk it misunderstands the doctor-patient relationship.”

The RCS may think there is such a risk, but having read the Bill and the guidance notes I fail to see that. As I have mentioned, the Bill clearly states the importance of the doctor acting only in the best interests of the patient and consideration being given to the patient’s views.



Clause 3(2) states:

“For the purposes of taking a responsible decision to depart from the existing range of accepted medical treatments for a condition, a doctor must in particular . . .

(c) obtain any consents required by law to the carrying out of the proposed treatment”.

The guidance notes for clause 3 clarify that that means that

“the Bill does not affect the legal requirement for a doctor to obtain a patient’s informed consent to any treatment proposed”.

It could not be clearer. The Bill does not affect that legal requirement for a doctor to obtain the informed consent of a patient. Indeed, only this year in the Supreme Court was the issue of consent and a patient’s understanding of treatment considered in the case of Montgomery v. Lanarkshire Health Board, when it was held that it would be a mistake to view patients as uninformed, incapable of understanding medical matters, or wholly dependent on information from doctors. It was said that an adult of sound mind was entitled to decide which of the available treatments to undergo, and their consent must be obtained before treatment is undertaken. Doctors are under a duty to take reasonable care to ensure that their patients are aware of any material risks involved in proposed treatment, and of the reasonable alternatives available.

This seems to be in accordance with guidance from the General Medical Council which, as one would expect, provides lengthy guidance on the question of consent and outlines the steps a doctor should take to communicate in

“clear, simple and consistent language”

to a patient and to work on the presumption that patients have the capacity to make decisions about their own care.

The RCS is also concerned that

“the emphasis in the Bill is on proving the doctor’s decision was responsible. Courts are not asked to deal with whether a patient’s treatment has been negligent.”

I do not understand that comment. It seems to me that the courts would clearly be invited to deal with the question of negligence if something went wrong and the patient could establish that the necessary steps had not been taken by the doctor. I cannot see how the courts would not be asked to deal with whether a patient’s treatment had been negligent. As I hope I have demonstrated, the Bill makes it clear that it does not seek to override the law on negligence. The focus is all about providing a framework in which a doctor can act responsibly.

NESTA’s 2014 report found that 73% of GPs surveyed said that they would be most likely to collaborate with other doctors when adopting innovations. Therefore, three out of four doctors—the vast majority—are already familiar with talking to their peers and working with them in a collaborative manner in this area. The requirement for consultation is simply what for them would be the natural course of action.

With people becoming ever more inclined to look for someone to blame when things do not turn out how they had hoped, and therefore with the threat of legal action increasing, it must be right that this House looks across the board at ways of making the vital work that our doctors do easier. I believe that allowing for responsible innovation as a means of treating patients who wish to receive such treatment is a positive way to help them.

A further concern from the BMA is that it believes doctors can already innovate as much as they need to. It states:

“The BMA has received anecdotal reports from members that funding requests for innovative treatment are submitted and approved, often on condition that the results will then be distributed, adding to the wider body of medical knowledge.”

I think that the very use of the word “anecdotal” suggests that we need a much greater degree of standardisation of approach. As far as I can see, that is precisely one of the problems that the Bill seeks to address: the fact that, at present, there is no standard basis for the recording of innovative medical treatments.

I am pleased to see that one of the changes in the Bill, compared with Lord Saatchi’s Medical Innovation Bill, is the establishment and maintenance of a database, to be held and managed by the Health and Social Care Information Centre, because I believe that will provide an additional method of evidence-building for doctors. I note that the Royal College of Surgeons has suggested that a clinical society might instead manage the database, if it is limited to one area of medicine. Although that suggestion might warrant further examination, I have a couple of concerns about it.

First, taxpayers’ money has gone into the establishment of the Health and Social Care Information Centre, which is an executive non-departmental body under the care of the Department of Health. It is the national provider of information, data and IT services for commissioners, analysts and clinicians in the health and social care sector, so it seems to me to be the ideal body to carry out that function. I have no doubt that taxpayers would expect it to carry out that work.

Secondly, I believe that there are considerable advantages in having a single database that doctors can consult, as the Bill proposes, rather than several. A database that shares innovative medical treatments would help improve the spread of best practice. The Government’s competitiveness indicator report showed that medicines in the third year after launch were used in the United Kingdom at a level that was, on average, only one third of the average usage in the comparator countries, which included France, Germany and the United States. I believe that the creation of the database would go some way towards closing that gap.

The Academy of Medical Royal Colleges has expressed a concern that the database would be a substitute for research and might even sidestep clinical research. I take the view that the purpose of the database, which is to be a collection of reports on individual innovative treatments outside conventional methods, would not have that consequence. The academy has also expressed concerns about the complexity of establishing a database and maintaining confidentiality. There is no doubt that the confidentiality of medical records is something that we must all take seriously. However, I do not believe that just because something is complex is grounds for us not doing it at all. I appreciate those concerns, given the roll-out of the care.data scheme, but the database proposed in the Bill would be very different. It would be much smaller in scope, in terms of the number of people it would relate to, than the care.data scheme, which has the records of virtually everyone, unless they have opted out.

The Royal College of Surgeons accepts the need for research to be made available, but it does not see the need for the database proposed in the Bill. It states:

“Surgeons in England have been the first in the world to publish their individual outcomes from surgery. We support this level of transparency in all areas of surgery including research and innovation. The College expects all researchers conducting trials, including those we directly support, to register the trial in a publicly accessible database. However, we do not see the need for a new database of innovative treatments in surgery. A number of audits in surgery already exist and it is unclear what different data this additional database would cover. It would be helpful for the Government to clarify what data it envisages collecting under this Bill”.

I am sure that the Minister will cover that in his remarks later today. I believe that most patients who benefit from a particularly innovative treatment, especially if they are the first to benefit, would have no objection to their treatment being recorded anonymously.

The Royal College of Surgeons also states:

“We believe the Secretary of State already has the power to establish a non-statutory database of innovative treatments without legislation.”

Well, if that is the case, there is nothing in the Bill for it to worry about. What is clear is that if the Secretary of State does have that power, he has not used it. Indeed, I believe that there is scope to strengthen the Bill, if it proceeds to its later stages, to clarify when the establishment of the database can be expected.

The NHS’s 2011 publication “Innovation: Health and Wealth” lamented

“brilliant examples of pioneering work”

so often being “isolated examples”. As a principle of furthering innovation, therefore, surely gathering evidence in the database would be helpful to medical advancement. If treatments look like they are working, it must be right that the public and, of course, doctors know about it.

As with any new piece of legislation, we must be mindful of the cost to the public purse. That is one of the areas where I believe we still need more information at this stage. We do not yet have any real sense of what the financial implications would be, although I note that a full impact assessment is promised before the Bill goes to Committee. NHS England has forecast an annual cost increase for drugs in specialised services of 11%, rising from £2.4 billion in 2013-14 to £4.5 billion in 2019-20. I sincerely hope that the impact assessment will give some estimate of the impact that increased use of innovative treatments will have, for example on drug expenditure in the longer term.

I also believe that the impact assessment should consider what effect the Bill would have on the early access to medicines scheme, which was not in operation when the Medical Innovation Bill was first debated. The scheme allows patients to access medicines at an earlier stage in their development, following a risk-benefit assessment and subject to ongoing data collection.

A lot has been said about this Bill being potentially dangerous for patients. Yet doctors are currently prevented from carrying out reckless or dangerous treatments by the risk of proceedings being taken against them—either civil proceedings or, in the worst cases, criminal proceedings. Nothing in the Bill makes that risk any less likely. All the safeguards that are in place in law at the moment would simply remain in place.

[Chris Heaton-Harris]

I completely underline what my hon. Friend is saying. If a doctor is acting responsibly, they have nothing to fear; if they are acting irresponsibly, this Bill does not help them, and they will suffer the consequences of their actions.

[Mr Nuttall]

I am grateful that the sponsor of the Bill agrees with me on this, because it is the key point of the whole debate. Those who oppose the Bill have alleged that it will somehow put patients at risk. If that were the case, I would not be supporting it. I am supporting it because having read it carefully, and having considered all the evidence and all the views of all the professional bodies that are ranged against it, I have come to the conclusion that patients would have all the safeguards after the Bill has been passed that they do now.

The Bill has the potential to increase and improve the range of medical treatments available to my constituents.

[Philip Davies]

My hon. Friend is setting out a very good case. Does he accept, though, that the concerns of some of my constituents that I outlined are valid, and that in Committee we should look at ways in which they can be dealt with if necessary? We should not just accept the Bill in its current state; we should look to see whether we can improve it in Committee.

[Mr Nuttall]

I am grateful to my hon. Friend. The arguments are finely balanced. As he said, he has constituents who support the Bill and constituents who are against it. If the Bill receives its Second Reading, as I hope it will, the concerns of those who have reservations about it, and those who go further and are outright opposed to it, can be considered in detail in Committee and, if possible, reflected and taken into account by way of appropriate amendments at that stage or on Report.

[Chris Heaton-Harris]

I assure my hon. Friend and all other Members who have spoken, and everybody I have been in consultation with to get the Bill to this stage, that should it get through its Second Reading, I will continue to consult, to listen, to talk to and to take advice from all organisations with an interest to make sure that we take into account and deal with as many as possible of the concerns outlined by him, by other hon. Friends, and by Opposition Members.

[Mr Nuttall]

I hope that my hon. Friend’s intervention will go some way towards satisfying the concerns of those who are opposed to the Bill.

From what we have heard, there seems to be a general acceptance of the principle in the Bill that there should be greater access to medical innovation. Even looking at the views of the various medical bodies—an impressive array, as I said—the best interpretation is that some are outright opposed and others are ambiguous. Either way, they all share the view that medical innovation is a good thing. It seems to me that the devil is in the detail. I hope that my hon. Friend’s confirmation that if the Bill proceeds he will be generous in speaking to people and looking at all possible ways of dealing with their concerns will persuade the House to give it a Second Reading.

Research and innovation are crucial to the continued success of healthcare. The NHS faces increasing demands: a growing population with an increasing lifespan, which is a good thing; an increase in its own capability, fuelled by advances in knowledge, science and technology; and ever-increasing expectations from the public it serves. We should not shy away from new ideas that put the patient first and offer chances that they may not otherwise have. This Bill will increase the likelihood of life-saving solutions being found where they did not previously exist. It will mean more choice for patients—for my constituents. It will provide doctors with a mechanism to enable them to use innovative treatments giving them the best possible chance to do what they do best—help patients. I support the Bill and trust it will receive its Second Reading.