Induced Abortion

Diane Abbott Excerpts

Wednesday 31st October 2012 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I congratulate the hon. Member for Mid Bedfordshire (Nadine Dorries) on securing the debate. She made a point of saying at the beginning of her speech that she felt that there was a climate of fear around discussing abortion, and that some people did not feel that it was appropriate for it to be discussed in the House. I hope that she is not including me in that. I believe in the primacy of the Chamber. It seems to me vital that the Chamber is the place where we discuss issues of life and death, and war and peace. I congratulate my hon. Friends the Members for Feltham and Heston (Seema Malhotra), and for Sunderland Central (Julie Elliott), on their excellent and thoughtful speeches.

I open my remarks in a way that is unusual for me—by quoting a Conservative Front Bencher in another place. Earl Howe, the Health Minister in the House of Lords, said this month, in response to the Secretary of State’s remarks, that

“my right honourable friend is entitled to express his long-held personal view, which he did the other day...however, successive Governments have taken the view that they should rest on the evidence. There is currently no call from the main medical bodies for a review of the Act in relation to time limits, and the British Medical Association and the Royal College of Obstetricians and Gynaecologists support that view…This is a highly sensitive issue on which the Government have, as I indicated, traditionally been led by the science and the medical profession, and I think that we should bear that principle very closely in mind.”—[Official Report, House of Lords, 11 October 2012; Vol. 739, c. 1130.]

For me, at the heart of this debate is the scientific and medical evidence. I do not understand why proponents of the anti-abortion case insist on saying that the science and medicine have changed when we know that in 2007 the House of Commons Select Committee on Science and Technology held an inquiry on scientific developments and found that

“while survival rates at 24 weeks and over have improved they have not done so below that gestational point…we have seen no good evidence to suggest that foetal viability has improved significantly since the abortion time limit was last set, and seen some good evidence to suggest that it has not.”

The BMA supports that position.

[Mr MacNeil]

Will the hon. Lady give way?

[Ms Abbott]

I have to make progress. The Royal College of Obstetricians and Gynaecologists and the Faculty of Sexual and Reproductive Healthcare support that position. There is no medical and scientific case for the position that some Government Members are trying to prosecute.

Everyone is entitled to their ethical and religious views on this issue. For Labour Members, abortion has traditionally been a conscience matter, and I respect other people’s consciences on this issue. However, it is not right to denigrate doctors, scientists, nurses and other medical practitioners. It is not right to say, as some hon. Members have said, that the royal colleges are saying these things because they make their money out of abortions. It is not right to denigrate medical practitioners. It is not right to talk about women being coerced into having abortions. It ought to be possible to have a serious argument about the ethical issues without denigrating nurses, doctors and other medical practitioners who have devoted their lives to the reproductive welfare of women.

The question of Northern Ireland has come up. The issues in relation to Northern Ireland are entirely a matter for the people of Northern Ireland, but let me just say this. I congratulate Marie Stopes on opening the clinic in Belfast. I want to give my personal support to brave women, such as Dawn Purvis, who have campaigned on this issue. I give my personal support to those women in Northern Ireland who continue to believe that it cannot be right that women in one part of the British isles do not have the human rights that other women in the Union have.

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

Will the hon. Lady give way?

[Ms Abbott]

I have to make progress.

[Hon. Members]

Give way!

[Mr David Crausby (in the Chair)]

Order.

[Ms Abbott]

We have heard the concerns about high levels of abortions and repeat abortions. Let me say from the Opposition side of the Chamber that we all share those concerns. Every abortion is a tragedy. I think that we would all in this Chamber want levels of abortions to come down, but we do not fairly bring down levels of abortions by restricting women’s right to choose. As the royal colleges have pointed out, the way to bring down levels of abortions is to recognise that abortions are largely about unintended pregnancy. What is needed is better work on access to contraception and better sexual health education in schools, and, if I may say so—this is a personal view—more needs to be done to fight the objectification and sexualisation of women in society. Of course we want to bring down abortion levels and levels of unintended pregnancy, but that is done through working in schools and working with young women, through sexual health care, and by fighting, as I said, the sexualisation of women, of which we see far too much.

As I said, of course we respect people’s consciences on this issue, but we do not want, and there is no evidence that British women want, the importing of the American politicisation of abortion to this country. We have only to look across the Atlantic to see politicians trying to outbid one another in the ferocity of their opposition to women’s right to choose, to see the attacks on doctors who work in these clinics, and to see candidates for office claiming that abortion as a consequence of women being raped is not an issue because there are things about a woman’s body that kick in and prevent her from getting pregnant as a result of rape—American politicians revealing their complete ignorance of women’s reproductive health.

Sadly, that is inching into this country. There are prayer vigils outside abortion clinics. There are leaflets claiming that abortion leads to breast cancer and infertility. There is work on college campuses. British women do not want to go down the route of politicians seeking to gain a political edge by sensationalising and politicising the issue of abortion. Let us rest on the medical evidence.

The hon. Member for Mid Bedfordshire said that the 1967 Act was a joke. I say to her that the 1967 Act was not a joke; it was a huge advance for the lives of women in this country. She talked about women marching in leafy suburbs. I have opportunities in my lifetime that my grandmother could never have dreamt of, and she was not brought up in a leafy suburb. As a result of political, social and educational advances, there are opportunities for women in my generation that our grandmothers could never have dreamt of, and the bedrock of those advances is women’s control of their own bodies and their reproductive health.

I am happy to debate this as often as Members want to bring it forward, but the debate must rest on the evidence, and we should debate the subject without denigrating our medical profession, and with respect for often very vulnerable women who have to make a difficult decision and do not welcome politicians sensationalising and politicising.

Mental Health (Approval Functions) Bill

Diane Abbott Excerpts

Tuesday 30th October 2012 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Opposition do not oppose the Bill. We are aware that much of this activity took place under a Labour Government, and we are anxious to work in the most co-operative way possible to resolve the situation. However, I would do the House a disservice if I did not set out the in-principle objections to retrospective legislation of this kind.

I should like to quote someone whom Government Members may take more seriously than some of us. In the “The Road to Serfdom”, Hayek said of the rule of law:

“Stripped of all technicalities [the rule of law] means the government in all its actions is bound by rules fixed and announced beforehand—rules which make it possible to foresee with fair certainty how the authority will use its coercive powers in given circumstances, and to plan one’s affairs on the basis of this knowledge.”

I shall set out objections to retrospective legislation, because despite the urgency of the situation and the problems that might arise if it were not introduced, we should recognise that it is a very serious matter to introduce retrospective legislation of this kind. The Opposition, as my right hon. Friend the Member for Leigh (Andy Burnham) said, were a little surprised that the Secretary of State for Health did not open the debate.

If retrospective legislation is undesirable in principle, it is particularly undesirable when it concerns the liberty of the subject. There is no precedent for retrospective legislation on such matters. We are dealing with the mentally ill and the sectioning of people under the Mental Health Act 1983. Due process is even more important in relation to issues under that Act than in relation to other matters of criminal justice, as we are dealing with vulnerable people who are not in a position to advocate for themselves. Due process is not less important in relation to Mental Health Act matters; it is more important.

I urge the House to pause for a second and see the situation from the point of view of the mentally ill, their families and their supporters. For people engaged with mental health legislation, the process may appear Kafkaesque and labyrinthine. They now know that 5,000 people—perhaps more—were sectioned, strictly speaking, illegally, which can only cause unhappiness and uncertainty. As hon. Members have said, it may even affect the condition of those people.

[Dan Byles (North Warwickshire) (Con)]

I do not disagree with anything that the hon. Lady has said, but I should like to clarify something. Is she basically saying that she supports what the Government have done, but is putting on record the fact that the measure must not be seen in any way as a precedent? This is an exceptional and unique set of circumstances. Is that effectively what she is saying?

[Ms Abbott]

I have been a Member for 25 years. I have never seen retrospective legislation of this kind. Although we support what the Government are doing, we do not want it to be seen in any way as a precedent; nor do we want it to be thought that, because the measure relates to the Mental Health Act, it is less significant than if it were a broad criminal justice concern. That is the point that I want to put on the record.

As I have said, for patients and their families, the mental health system may appear labyrinthine and Kafkaesque at the best of times. Now they find that for a long period—some of it under a Labour Government—people were being sectioned without proper due process. Ministers have said, both today and yesterday, that this is a technicality, but due process means that people should abide by the technicalities. Only in that way can we defend the liberty of the subject, and only in that way can the subject have any recourse. If we do not abide by the technicalities and if the rule of law does not apply, where do our constituents and other ordinary people turn if things go wrong?

Ministers have made a series of assertions. They have said that no patient has been wrongly detained or received care that was not clinically appropriate. They have said that no doctor was unqualified to make the decisions, and they say that urgent action is being taken to correct the situation. But I would be interested to hear from Ministers whether there has been an individual case review of these cases. How can they assert that no patient has been wrongly detained or received inappropriate care if the Government have not reviewed each case individually? How can Ministers assert that no doctor was unqualified to make the decisions if they have not reviewed each case individually?

I am not raising these issues to stop what I understand is an urgent process, but it would not be right for the House to railroad the legislation through without paying attention to the individuals and the individual cases involved. If there has been no individual case review, the question raised by other hon. Members whether the Bill will stand up to judicial review comes to the fore. Is the Minister in possession of robust, irrefutable evidence to show that none of the more than 5,000 patients detained by the approximately 2,000 not properly approved doctors was subject to clinically inappropriate detention or hospitalisation?

Will the families and carers of those individuals be advised of the situation and given an opportunity to raise any concerns that they may have? When a relative is detained under the Mental Health Act, the question whether that is appropriate can be one of the most difficult and traumatic questions that a family has to face, and to dismiss the lack of due process as a mere technicality, as Ministers have come dangerously close to doing, is not fair to those individuals and their families—our constituents.

Although I accept that the doctors concerned have acted in good faith, I hope the Minister will agree that we are dealing with a highly vulnerable group of individuals—the patients and their families—and they need to have absolute confidence in the Government’s response. We understand that introducing urgent legislation is part of offering such reassurance. It will protect vulnerable patients from a potentially exploitative situation in relation to what are commonly called ambulance-chasing lawyers, but when their relative is taken away from them, people also want to know that this is not a mere rubber-stamping process. I have heard nothing so far that would reassure me, if I were the mother or a relative of one of the people detained under a defective process, that Ministers do not regard this as a mere rubber-stamping process and that all the Bill does is alter in some technical way the nature of the rubber stamp.

My right hon. Friend the Member for Leigh made the point that we need to move forward with a very different attitude to mental health. We need to look for parity of esteem between mental health and physical health, but in this matter, in relation to the liberty of the subject, we also need to look to parity of esteem when someone’s liberty is taken away under the Mental Health Act and under broader criminal justice legislation. If people had been held in prison and there had not been due process, it would not be good enough to railroad through retrospective legislation in an afternoon in the House of Commons. There would be much more uproar.

We want to impress upon Ministers that we must take seriously the liberty of people detained under the Mental Health Act and demonstrate that we are doing so. A number of questions have been raised by hon. Members on Second Reading, and we hope that the Minister will be able to answer them. I thank right hon. and hon. Members who have taken part in the debate. As I said earlier, I hope the Government will try to involve the family and carers of those affected more closely in the process of bringing clarity. I hope that the Government will seek to remove any uncertainty and will explain to them what they can do to seek redress.

Like my right hon. Friend the Member for Leigh, I commend Ministers for their attempt to move quickly on a very difficult issue. We want to offer the Secretary of State any assistance that we can as he seeks to answer questions from patients, families, carers and the wider public, but we say to him that retrospective legislation is very serious. It cannot be dismissed as a technicality. The liberty of the subject is, so to speak, the ground zero of parliamentary democracy in this country. It cannot be dismissed as a mere technicality. Sadly, I do not believe that the debate this afternoon will be the last that we hear on the matter. It is extremely important that those of us who are in the House this afternoon tease out the answers to the questions that have been put.

Mental Health (Approval Functions) Bill

Diane Abbott Excerpts

Tuesday 30th October 2012 Commons Chamber

Question proposed, That the clause stand part of the Bill.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I want to raise two specific points. Opposition Members are concerned that the concept of “Any person” in clause 1 is too broad, because it appears to legalise approvals by anybody. Why does the clause not refer specifically to North-East, Yorkshire and the Humber, West Midlands and East Midlands?

Secondly, where is the provision for the doctors who have been approved by a trust according to what we now understand was a defective process to be re-approved by the correct process? As the clause stands, it seems—I am happy to be put right on this—that doctors approved previously by the trust will be able to continue to section patients without re-approval under the correct process.

[The Minister of State, Department of Health (Norman Lamb)]

I will first set out what the clause seeks to do and then respond to the shadow Minister’s questions.

The clause directly addresses the issue that the Bill intends to resolve. Between 2002 and 2012, four strategic health authorities delegated to mental health trusts the function of approving doctors with responsibilities under the Mental Health Act 1983. The legal advice that we have obtained is that there are good arguments, as we have already discussed, that decisions to detain made by doctors who were approved in that irregular way are nevertheless lawful. The clause removes any doubt—that is its purpose. It clearly spells out that when mental health trusts gave approval in the past they are to be treated as having had the power to do so.

The clause has the effect of eliminating any irregularity from decisions made in complete good faith, and in the best interests of the patient, by doctors fully qualified to make them. It does so in a way that is fully consistent with the legal and clinical advice that we have received on the issue, and means that patients and their families do not have to undergo the process of assessment for detention under the Act again solely for the purpose of correcting a technical error made by a strategic health authority.

The hon. Lady asked why the clause was so broad as to refer to “Any person”. I understand her concern, but the point is that we do not yet know whether there were other issues before the establishment of the SHAs. Obviously, that is part of the work that the review will undertake, but to ensure that we resolve the problem absolutely and that all those patients have clarity the decision was made for the clause to refer to “Any person” in order to avoid any risk of our uncovering another problem that might need a separate resolution. This deals with the whole problem of the approval process for the doctors who made those decisions.

The hon. Lady then asked, correctly, whether decisions will be taken properly as we progress. I can confirm that all the doctors have already been re-approved according to a proper process, so every decision that is taken from hereon in cannot be challenged. As we have said, any patient who wants to question the clinical judgement can do so and their rights remain the same as they have always been. This simply addresses the technical issue that we have been debating today.

--- Later in debate ---

[Norman Lamb]

All that is being regularised is the power to approve a doctor, not whether a doctor is clinically sound. Any patient who challenges a judgment to section them either now or in the past will retain all their rights in law. We have acted on the advice of both lawyers and clinicians to ensure that we deal with the problem that has emerged in a way that respects patients’ clinical interests and considers them with the utmost seriousness. To go through a full reauthorisation process in every case could be incredibly damaging to individuals in potentially vulnerable situations. The Bill is based on the best clinical and legal advice that we have received on how to deal with the problem.

[Ms Abbott]

The Opposition have listened with great care to what the Minister has said. He has made a point of saying that his advice suggests that the Bill is the best way to deal with the situation. We argue that it is perhaps the most convenient way, but we know that the parliamentary draftsman has been under huge pressure to produce the Bill, and this would not be the first time that parliamentary draftsmen have come up with a form of words that is in some way defective. I repeat our concern about the broad nature of the clause, which states that “any person” who “has done anything” is to be “treated for all purposes”.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Perhaps I can assist in this matter. I do not believe that there is a drafting error, but the hon. Lady is absolutely right to scrutinise every word of the Bill carefully and ask questions.

Clause 1 does not mention “any doctor” because it is about the power for an SHA to delegate the authority in question, not about a doctor’s decision or clinical ability. It refers to the person who approves that power of delegation. I hope that that clarifies the matter.

[Ms Abbott]

We have listened to what the Secretary of State and the Minister have said. We remain concerned about the broad nature of the clause, but we rest our case.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clause 2 ordered to stand part of the Bill.

The Deputy Speaker resumed the Chair.

Bill reported, without amendment.

Third Reading

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

The first thing I would say to my hon. Friend about Sherwood Forest is that I know everyone in the House will join me in saying that our hearts go out to the families of the women who were misdiagnosed for breast cancer. We expect the local NHS to come up with a serious package of measures to make sure that that kind of thing cannot happen again.

My hon. Friend is right to talk about PFI. We inherited an appalling scandal. In order to tackle the PFI debts of just seven institutions, we are having to put aside £1.5 billion over the next 25 years, but we are working with all institutions to deal with this appalling debt overhang.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

We know that the Secretary of State’s views on abortion do not have a religious basis, so does he care to share with the House the scientific evidence to support his view that abortion time limits should come all the way down to 12 weeks?

[Mr Hunt]

Four years ago I voted with my conscience, as I am sure she voted with hers, but I did so as a Back-Bench Member of Parliament and we have made it clear that it is not the policy of the Government to change the abortion law. My job as Health Secretary is to implement the elected will of the House, which voted in 2008 not to reduce the abortion time limits.

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Lansley]

If I may, I will write to my hon. Friend in order to convey the precise figure. From my recollection, I believe that the bulk of the £5.8 billion efficiency savings—£2.8 billion—was in the acute sector. As most of the acute sector’s costs are pay costs, the pay freeze will have contributed a significant part of that.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Will the Secretary of State accept that some of those so-called efficiency savings are totally counter-productive? Despite Ministers’ claims to be saving money on agency staff, is not the truth that hospitals’ attempts to improve their efficiency have backfired, with jobs being cut and agency staff being hired at rates as high as £1,600 a day?

[Mr Lansley]

No, I will not accept any such thing. We are aiming to reduce agency staffing costs in the NHS under QIPP—the quality, innovation, productivity and prevention programme—by £300 million, and we have already made a reduction of more than £120 million. Since the election, in complete contrast to the situation beforehand, we have reduced the number of administrative staff in the NHS by 15,000, including a reduction of more than 6,000 managers. We have also increased the number of clinical staff by 4,000 since the election.

Adult Social Care

Diane Abbott Excerpts

Monday 16th July 2012 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

No family in the land is untouched by the challenges of social care. Families up and down the land who will watch this debate or read about it know that if social care is not an issue for them today, it may be an issue for them later. Labour Members therefore think it is important that it is spoken about not in policy wonk or accountancy terminology, but in terms of people. That is because it is an issue about people, be they the elderly, the disabled, the young disabled, about whom we heard eloquently just now, the carers within the family or the tens of thousands of men and women who work as professional care workers, about whom my hon. Friend the Member for Blaydon (Mr Anderson) talked so eloquently earlier.

Let me say from the outset that the Opposition accept that this is an issue about which we could have done more. Social care and the challenges it poses in the 21st century are unfinished business for Labour. However, it is not true to say, as some Government Members have unfortunately done, that Labour was wholly inactive on the issue of social care. We heard from my hon. Friend the Member for Leicester West (Liz Kendall) about all the steps we took and the innovations we made on issues associated with social care. To say that we were totally inactive is quite wrong and is merely party political point scoring, but it is true that we did not grasp sufficiently early the political nettle of how social care is to be paid for. That is why, from the very beginning, we offered talks and entered willingly into them, and why we remain willing to resume talks, so long as Ministers are acting in good faith.

Social care is an issue for families up and down the land. Government Members have said that people have to understand that they are going to sell off their homes, but the point about that is that homes are not mere bricks and mortar. These may be the homes that people came to as a young married couple and where they brought up their children; these are homes freighted with memory, emotion and family life. It is too easy to say that people have to be ready to sell off their homes. This is about people; it is not just about figures on a piece of paper.

Social care is also quintessentially an issue for the squeezed middle, to use the phrase of my right hon. Friend the Member for Doncaster North (Edward Miliband). The very poor will not have to meet their own costs, although there are still issues to address about standards of care, and the cost of care is not a problem for the extremely wealthy. This is an issue for the squeezed middle; it is an issue for people who, perhaps through years of struggle, have a home and assets and now see the frightening possibility—this is particularly the case for the elderly—of those assets being drained away because of a system that is not yet under control.

[Glyn Davies]

rose—

[Ms Abbott]

I am afraid that I will not be able to give way, because I want to leave sufficient time for the Minister to make her remarks.

We also have to address the issues of dementia and Alzheimer’s. They are largely dealt with as social care issues but in fact they are an increasing challenge for people as they grow older.

The Minister called social care Bevan’s orphan and I think that that is a little unfair. The world we face today is very different from the world of William Beveridge and the framers of the first national health service. People live much longer and do so with all sorts of long-term conditions, whereas changes in the role of women mean that there is no longer a vast, mute and hidden army of carers. There are also issues with dementia and Alzheimer’s.

The Opposition want to be collaborative rather than party political, but I would be failing in my responsibilities if I did not draw to the attention of Ministers the one message given to my colleagues and I as we have gone up and down the country talking to local authorities about the new public health arrangements and social care. Those in town halls, whether they are Labour or Conservative-led, have said that local authorities are under unprecedented financial pressure. Some of the things we heard from Ministers seemed to suggest a certain carelessness about or unwillingness to face up to the financial pressures that mean that local authorities are making real decisions that are affecting real people and real families. Ministers heard what local authorities are trying to do to make the money stretch. On the one hand, there are more stringent criteria, so people need to be in greater need to get social care at all, but on the other hand, they are squeezing the money and the standards. That is the only way it can happen.

If I could say only one thing to Ministers, it would be that they should listen not to the Opposition spokespeople or to Labour councillors but to their own Conservative councillors, who are trying to make them address the scale of the crisis that they face. They are very alarmed—we know that they are—that Ministers appear to be poised to place additional responsibilities on them without any ideas of how to provide funding.

I remember what the Prime Minister told this House in February 2010, speaking about social care. He said:

“What we want to know is: where is the money coming from?”—[Official Report, 10 February 2010; Vol. 505, c. 904.]

I have to say that councillors and families up and down the country, as well as Members of this House, want to know what is behind the fine words and what Ministers will do to fund the proposals outlined in their White Paper.

Precisely because I do not want to be party political, I will refrain from talking about the Conservative party’s party political broadcast on the death tax and the posters that said:

“Now Gordon wants £20,000 when you die. Don’t vote for Labour’s new death tax.”

I am not a party political person, so I shall leave that. I shall put it to one side.

We support Dilnot in principle, but we are a little concerned about the Secretary of State’s pick-and-mix approach to the recommendations. We are worried that although the White Paper reads well, it makes too many vague commitments. I would be grateful if the Minister could give me an answer on the question of loans, in particular. On that question, as she will be aware, the 1999 royal commission—sadly, we did not address the issues of funding that it raised—said that

“there would need to be an initial outlay of potentially between £1bn and £2.8bn…the scheme would be complex to establish, and to administer, probably very expensive initially and would leave the state with an uncertain liability. If Local Authorities administered it, they might be left with a complex burden of assets which would differ greatly from one part of the country to another. The Commission consider there little overall benefit to be gained from such a scheme.”

I would be grateful if the Minister could tell me —[Interruption.] It is a deferred payment scheme at the discretion of local authorities—[Interruption.] We want to know how the Government will fund the upfront costs and about the levels of interest. Members will appreciate that elderly people, in particular, are very concerned about issues of debt. On that and on a range of other issues, we are waiting for a little more detail from Ministers. They can sit on the Front Bench and make party political remarks, but that is no help to families throughout the country who are worried about how they can fund social care in the future. It is no help to local authorities, which say that in a very few years the cost of social care will have inflated so much that they will not be able to meet other needs from their budget.

There are many things in the White Paper that we welcome, not least because many of them were in the White Paper introduced by my right hon. Friend the Member for Leigh (Andy Burnham) on building a national care service. We say to Ministers that it is easy to score points. It is easy to talk about what could have been done in the past, but we need to meet the challenge of how we care for our elderly, our disabled and our young disabled. That is the challenge that the nation is facing now. The White Paper reads well, but Age Concern and all the stakeholders are asking how Ministers will fund it. We stand ready to enter talks. We stand ready to work with Ministers. All we ask from Ministers is that they act in good faith.

Cosmetic Surgery

Diane Abbott Excerpts

Thursday 5th July 2012 Westminster Hall

[Mr Stephen Dorrell (Charnwood) (Con)]

I think my hon. Friend the Minister might need some time; she will respond to views expressed by members of the Select Committee on Health, and other hon. Members who have forsaken attractions elsewhere and turned up to this debate.

The Health Committee is grateful to the Backbench Business Committee for nominating this subject for debate this afternoon. Our report on PIP breast implants aroused considerable interest among those directly affected. That is hardly surprising, because it addresses an issue of major concern for more than 40,000 women who have received breast implants that were later found to be non-compliant with standards that everyone believed they met on the day the implantation took place. That has led to considerable concern among a large number of women about the health implications of that failure of an implantation into their body, and it also raises important policy issues that the Committee has sought to address in its two reports on the subject, to which the Government have sought to respond. We now think that the issue merits wider debate.

I will begin by stating relatively briefly how we arrived at this set of circumstances. The breast implants supplied were subject to European law and a European licence that was issued by the French regulatory authorities. I will not amuse the House by offering a French accent because, happily, the words in question are similar to their English equivalents: Poly Implant Prothèse, or PIP, is, or rather was, a French company that had a licence to deliver those products. In plain English, it was not merely a question of the company not complying with the terms of the licence. French regulatory authorities have acknowledged that fraud took place, and that falsified returns were made to the French regulators. However, not only did the breast implants supplied by PIP not comply with the regulations, but the company knew that at the time they were supplied.

The licence was issued and maintained by the French authorities, but in March 2010—the date is significant—the French regulator reported the existence of fraud within PIP, and stated that the implants that the company had supplied contained non-compliant silicon. As a result, the product was deliberately not the one that had been licensed for supply and use in human surgery.

There was then a long period—I intend to return to this issue—between March 2010 and December 2011 during which it was unclear to the Committee, as we undertook our inquiries, whether anything like a proper reaction was expressed by the French regulators or, it must be said, the regulatory system in this country. I will later return to, and dwell on some of the lessons to be learned from what happened in that time lapse between March 2010 and December 2011.

Before I consider the substance of those issues of concern to the House, I would like to complete the timeline. One might think that the announcement that there had been a fraud, and that non-compliant breast implants were being supplied, would have raised concerns and prompted somebody to do something about the matter in March 2010. As I said, however, nothing much happened until December 2011, when more or less out of the blue—at least as far as we could make out—the French regulator announced that it had decided that even though 21 months had elapsed, its concerns about the implants were now such that it recommended “precautionary removal”, as it is phrased. By Christmas 2011, the recommendation from the French regulator was that the implants should be removed forthwith—no, not forthwith; on a non-urgent basis.

Over 21 months, therefore, the regulator had gone from frankly not doing much about the issue to announcing, just before Christmas, that its concerns were such that there should be a precautionary removal of the implants. On the basis that nothing ever happens at a convenient time, that took place just as everybody was going away for Christmas, and my hon. Friend the Minister and my right hon. Friend the Secretary of State therefore had to deal with the issue during the Christmas holidays. During that period, the Government set up two inquiries. One was led by the medical director of the NHS and focused, rightly, on the priority subject, which was the risk to patients and the proper response in terms of patient care. The other inquiry was led by the Health Minister in the House of Lords, Lord Howe, who looked at the policy lessons from the point of view of the regulators.

The Committee heard evidence in February and issued its report in March. The Government responded, and we now have the question of the lessons to be learned, and the Committee’s response to the Government’s position. The Government have accepted the Committee’s recommendations in the report, with two important exceptions. I wish to talk about those exceptions, and then deal with one or two other issues raised by the Committee on which it would be useful to hear the Government’s current thinking.

The first issue concerns what happened between March 2010 and December 2011 and the lessons to be learned. In the Committee’s view, one of the most important lessons was that we were surprised, to put it extremely mildly, that implants can be put into the human body and no record kept of the fact. That seems to have implications that go way beyond the issue of breast augmentation. An implantation into the human body can take place and there is apparently no regulatory requirement on any of the professionals, service providers or providers of the devices to keep a record of that.

During the various inquiries held immediately after the Christmas recess, the Secretary of State said that the Government were minded to move back to the previous rather weak requirement for a register, but I hope that when the Government consider the subject, they will look not just at the context of breast implantation, but at a much wider question. It seems to me that if a medical device is being implanted into a patient, the burden of proof is on anyone who wants to argue that a record should not be kept. The PIP implant saga perfectly illustrates why there should be a record of which patient received which product on which day. It is so that a proper response can be organised if the product is later found not to have complied with the regulations on the day on which it was implanted, as in this case, or if the product is later found not to be desirable for any number of reasons that may not be known about on the date of implantation.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does the right hon. Gentleman agree that the idea of a register of implants—not just breast implants, but implants in general—has been raised before, but was rejected, sadly, by Minsters in a Labour Government because officials for some reason resisted the idea, and that it is important that we push forward with that common-sense idea?

[Mr Dorrell]

I agree. In fairness to officials, it was not so much the officials who were resistant in the days of the previous Government, as I understand it; the issue was that the requirement was relatively weak, and many patients were resistant. However, for reasons that I have given, it seems to me that it should be part of the regulatory structure within which medicine is practised that implantations into the human body are the subject of very secure records.

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I congratulate the Health Committee on a thorough piece of work. There has been some debate in recent days about the effectiveness of Select Committees in interrogating the facts, but the report shows how effective they can be. I also congratulate the Backbench Business Committee. I have noticed that in this Parliament we have been a lot better at addressing, in a timely fashion, issues that are of concern to our constituents, and we must thank the Committee for that.

For the more than 40,000 women concerned, this has been a period of fear, anxiety, uncertainty and distress. I have observed a tendency to address health matters in a dry, managerial manner, but there are thousands of frightened women out there who feel isolated and do not know what to believe. The Opposition accept the advice that the Government have been giving on the basis of the evidence that they have, but we are disappointed that they are not providing more help to the women affected. In addition to the general confusion, unnecessary anxiety was caused to thousands of women over Christmas and the new year. It is simply not enough for the Government to say that private providers have a moral duty to their patients; there must be, as has been said, practical action on that duty of care.

Christmas was a troubling time. On 23 December, the Secretary of State said:

“we have no evidence of a link to cancer. We have no evidence of toxicity, we have no evidence of substantial difference in terms of ruptures of these implants compared to others”—

a statement that was proved wrong—

“So we don’t have a safety concern that would be the basis for the routine removal of these implants.”

By 31 December, he had announced that the NHS medical director, Professor Bruce Keogh, would carry out an urgent review of the situation.

The problem is that months later, the websites of some of the private providers still had the Health Secretary’s original, somewhat consoling, statement. The shift of emphasis during that period caused uncertainty and allowed private clinics to rest on the earlier statement, rather than acknowledge the fact that an urgent review had been called for. We found that many women were unable to access their records, and that some had to pay up to £50 to access them. In the case of what was intrusive surgery, it is unacceptable that women could not access their records as a matter of routine. The uncertainty was unnecessary and women are still unhappy about it.

Women who have PIP implants are still concerned about the Government response. As the Minister will be aware, many of them are calling for a public inquiry, and I must do them the justice of putting that demand to her. Among their concerns is that the Government have received advice that there is no problem with the implants and that they are not a threat to health. Among the things that women want is an investigation of common reported symptoms in patient reports, and an assessment of medical records, which has already been referred to. They want the Medicines and Healthcare products Regulatory Agency to release details of the toxicology testing done on the implants. Everyone present will be aware that they also want clinics that have fitted PIP implants either to offer free removal and replacement, or to face sanctions, such as losing their licence.

The women’s biggest concern, however, remains the health aspect, after the trauma of unexpectedly having to remove the implants. Let us bear in mind that this is not like chiropody; this is invasive surgery. Women’s breasts and reproductive organs are a particularly sensitive matter of concern for them. Ministers have spoken about the issue as if women who purchase cosmetic surgery were purchasing cans of beans off the shelf and should, therefore, observe the rule of caveat emptor—let the buyer beware. The fact is that any sort of invasive surgery is not like purchasing beans off a shelf. The issue of duty of care by individual practitioners and by clinics—and even by Government Ministers when they talk about the issue—should be at the forefront of our debate.

These women have faced this trauma, and many of them still feel that they have nowhere to turn with the symptoms that they continue to experience, even after the implants have been removed. The official Government line remains that there is no evidence of harm, but women are anxious that that should not be a once-and-for-all conclusion on the physical and medical consequences of the implants, and that the ongoing research and information should be kept under review. In such situations, we all know that it can take many years to find out what the real health issues are.

The women are calling for the publication of exact rupture rates, and for the cosmetic clinics to have sufficient information about PIP breast implants. Above all, they are calling—this has been echoed by both Government and Opposition Members—for a register of medical implants, an issue that was first raised by Labour MPs in the 1990s. Members of all parties have raised the issue, and the time to address it came long ago. We cannot possibly help to rectify problems if we do not even know who all the women, men and children who had the implants are. That is a basic requirement, and I hope that the Minister will say that the Government intend to move speedily towards addressing that.

Apparently, 68 chemical compounds have been found in implants so far. The women are concerned about the evidence showing that the substance has the capacity to migrate across organs. They are concerned that, if it can migrate across membranes, there could even be implications for chemicals crossing to the placenta. It is not good enough for Ministers to say, in the summer of 2012, that there is no evidence of harm while not keeping what is happening under review.

Women want to know why the UK is one of the only countries not recommending routine removal. They want to know, as my right hon. Friend the Member for Rotherham (Mr MacShane) has said, why it took 25 months for an unannounced inspection of a PIP factory. Why did the MHRA not test the products for sale in the UK? The women want to know about the 68 chemical compounds. They have noted the Health Committee’s view that Sir Kent Woods’s statement that there was “no evidence of harm” was misleading, and they want to know why Ministers have not retracted it.

On the role of private clinics, we know that some of the leading cosmetic surgery clinics are ignoring the Government’s appeal. We know that one such clinic, Transform, which used PIP implants on more than 4,000 patients, has said that women will have to pay £2,800 for their removal. We know that the chairman of the Harley Medical Group, which has 13,900 patients with PIP implants, has said that he will pay for the cost of the new implants, but only if the NHS pays the bigger bill for surgery. This is not a satisfactory state of affairs. It reduces the purchase of invasive surgery—even if it is invasive cosmetic surgery—to the status of a mere purchase of some grocery product from a supermarket. The women think that the Government have not been empathetic to their situation or fulfilled their duty of care, let alone ensured that the private clinics fulfil theirs.

There is a strong feeling among our constituents that the clients of those private clinics have been let down. If I may say so, that shows the importance of regulation in relation to large-scale private sector involvement in health care. It should not be the case that women get a better duty of care from health service providers than from private sector providers, but that is their experience, whether it applies to getting their records or to being charged for the removal of the implants.

In view of the reluctance of some private health-care providers to foot the bill to replace the implants, what action will the Secretary of State take to help women who are unable or cannot afford to access their records? Has the Secretary of State considered regulation, or some kind of levy, so that private companies, now and in the future, can cover the cost of removing defective devices? Will the Government’s recommendations be kept under review?

The issue has caused a great deal of personal concern, fear and anxiety to tens of thousands of women. The uncertainty in the run-up to Christmas was unnecessary and we are anxious that the Government do not just take a once-and-for-all view of the health consequences of the implants. We are also concerned that broader issues exist in relation to the regulation of not just cosmetic surgery, but cosmetic procedures such as botox. Ministers need to consider those issues.

We live in an extraordinarily body-conscious era. Recent figures show that unprecedented numbers of girls under 16 are having breast reduction surgery, and that unprecedented numbers of teenage girls are having breast enlargement surgery. That is not because there is suddenly a whole new range of associated medical problems, but because of the pressure on women of all ages with regard to their body and their appearance, and, frankly, because of the exploitative and predatory activities of some people in the cosmetic surgery industry. I hope to return to those broader issues on the Floor of the House.

In closing, I say to the Minister that there are tens of thousands of women, some of whom are in the Public Gallery today, who do not feel that they had the clear advice they should have had in the run-up to Christmas; who do not feel that they have had the support they should have had; and who do not feel that the Government are taking their position sufficiently seriously. I hope that she will have answers to some of the questions asked by my hon. Friend and me this afternoon.

--- Later in debate ---

[Anne Milton]

That may be a subject for a Backbench Business Committee debate on co-payments and what the NHS is and is not responsible for. The difficulty is—

[Ms Abbott]

Because the Minister mentioned Nye Bevan, I feel obliged to intervene to say that there is no more vigilant defender of an NHS true to Nye Bevan’s principles than me. However, when women will be faced with two separate invasive operations, we ought to make an exception to the rule.

[Anne Milton]

I thank the shadow Minister for her intervention. I accept the strength of feeling on the issue in this debate. The clinching argument is that if the NHS were to offer what is in effect subsidised breast augmentation for non-clinical purposes—I stress the use of the word “clinical”; it is not that cosmetic surgery is unavailable on the NHS, but that it is available if there is a clinical need for it—

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 12th June 2012 Commons Chamber

[Anne Milton]

We will introduce an alcohol check within the NHS checks for adults from April 2013. My hon. Friend is right to highlight the substantial impact that identification and brief interventions in the GP’s surgery and elsewhere can have.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Labour Members share the hon. Lady’s concern about the human, economic and public order cost of alcohol abuse. We understand that the question of a minimum price per unit, to which the Secretary of State is a belated convert, has gone out to consultation, but does the Minister recognise the need to align our minimum price with that in Scotland, because otherwise there will be problems with cross-border smuggling?

[Anne Milton]

I can assure the hon. Lady that we will be talking with the devolved Administrations, and indeed all other agencies, and welcome any input on this. It is good to hear her welcome our strategy, and I am sure she will agree that the only way we can reduce alcohol harm is by working across Government.

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 27th March 2012 Commons Chamber

[Paul Burstow]

My hon. Friend makes an important point about one aspect of the better control of TB and its spread. The Home Office has been running a pilot programme for some years. It continues to evaluate the effectiveness of that programme with a view to establishing whether it is more widely applicable. We know that this disease has moved from the general population to specific high-risk groups, which is why the targeted approach I mentioned in my initial answer is the key to controlling it.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Minister has heard that TB is a particular problem in London—there was an 8% rise last year—and he will be aware that the current difficulties concern delays in detection and referral and the variability of commissioning and service provision. Given that the Health and Social Care Bill will necessarily lead to further fragmentation, separating health protection and public health from commissioning, how will he ensure that the Bill does not make a bad situation, in respect of TB in London, worse?

[Paul Burstow]

The Bill will not lead to fragmentation. It actually supports greater integration of health, social care and public health and, at a local level, it allows health and wellbeing boards to become the means by which to co-ordinate all the agencies that have a part to play when it comes to tackling TB, not least in ensuring that the advice of public health officials benefits not just the NHS but wider public services that also have a role to play in raising awareness of the disease and ensuring that it is properly tackled.

Health and Social Care Bill

Diane Abbott Excerpts

Tuesday 20th March 2012 Commons Chamber

[Liz Kendall]

The point is that the rest of the Bill absolutely trumps that. That is the concern of others—[Interruption.] Conservative Members groan, but people who work in the system say that the Bill—[Interruption.] The hon. Member for Winchester (Steve Brine)has not stumped me. He said that one phrase in a Bill is supposedly going to outweigh the rest of the implications in the Bill, which the Faculty of Public Health says will increase the postcode lottery and widen inequalities, without providing value for money or improving the quality of services. Conservative Members should listen to the concerns of the people who work in the system.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does my hon. Friend agree with me—

[Mr Simon Burns]

No.

[Ms Abbott]

She will, you know. Does she agree that it is apparent over the years that it is one thing to see an intention built into a Bill, but quite another to see it implemented on the ground? It is the contention of Opposition Members that, worthwhile as the statements in the Bill are, in the context of this particular car crash of a Bill, some of those intentions around public health will be dead on arrival.

[Liz Kendall]

I thank my hon. Friend for her, as always, powerful and eloquent description of the realities of the Bill.