Access to Primary Healthcare
Ed Davey Excerpts(2 months ago)
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Helen Morgan
Other opticians are available, but I did!
The Liberal Democrat manifesto suggested solutions to these problems, and they have been well received, as I mentioned before. We have a record number of MPs, and that is because we put this issue front and centre of our election pledge. I urge the Government to reverse the catastrophic state that the NHS has been left in by the Conservatives, to take our ideas on board and to invest in primary care as soon as possible.
Children’s Cancer Care: South-East
Ed Davey Excerpts(9 months ago)
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Ed Davey (Kingston and Surbiton) (LD)
I congratulate my hon. Friend the Member for Twickenham (Munira Wilson) on securing the debate. I should declare an interest of sorts, because my disabled son, John, has been treated at both these hospitals. A few years ago, he had a very successful operation at St George’s, and for most of the last two years he has been attending a weekly clinic at the Evelina. My wife and I are grateful to both hospitals; they are both excellent hospitals, and we regard them very highly. So the fact that I strongly believe that NHS England should choose St George’s is no reflection on the Evelina—not in the slightest.
I have approached this issue from the start by looking at the facts, talking to clinical experts and listening to both sides. I have also looked at the risks of each of the options, because that is what we really look at when we take big decisions: which is the least risky option to make sure we have the quality of services? I have looked at the facts and the evidence, and talked to clinical experts, and they suggest to me that St George’s is easily the less risky option for locating these specialist children’s cancer services—for my constituents and for people across south London, Surrey, Sussex and beyond.
I want to take everyone through some individual cancers and how risks lay for those. I will start with neurosurgery. Twenty-five per cent of children with cancer have a brain or spinal tumour, and many of those will need neurosurgery. St George’s currently delivers that; the Evelina does not. The Children’s Cancer and Leukaemia Group, which is the UK’s professional association for those involved in the treatment of children with cancers, said in response to the public consultation that if the Evelina was the option chosen, it
“would be the only Principal Treatment Centre in the UK where neurosurgery is not carried out on site”—
the only one—and that there is
“evidence that suggests that Principal Treatment Centres for childhood cancers should be co-located with neurosurgery.”
In other words, with respect to neurosurgery, the Evelina option is the most risky. The Evelina’s solution to that—to use King’s—defeats the purpose of uniting children’s cancer services.
Let us move to oncology surgery. Another 15% of children with cancer will have a neuroblastoma, renal tumour or germ cell tumour. Those children often require major surgery by a paediatric oncology surgeon to remove or reduce the tumour. That expertise is rare. There are around 20 such surgeons in the country, three of whom are at St George’s. The Evelina does not have that expertise at all and will need either to rely on surgeons from St George’s going to work at the Evelina or to build a new surgical team from scratch.
If St George’s surgeons were to travel to the Evelina to operate on children with cancer, there would remain the question of the wider, non-surgical expertise required to manage those children, including the specific anaesthetic skills. Furthermore, it would be much more challenging to manage post-operative complications. In other words, for oncology surgery, as for neurosurgery, the Evelina option is the most risky.
Let us go on to bone marrow transplants. Another 42% of children with cancer will have leukaemias, other blood cancers or lymphoma. For those children, bone marrow transplants and, increasingly, chimeric antigen receptor T-cell treatment, where a patient’s cells are modified to help fight cancer, are key treatments for any new primary treatment centres to be able to deliver. Those treatments are complex, high risk, heavily regulated and difficult to set up without experience. Indeed, the process to do that probably takes years, not months. St George’s has a bone marrow transplant programme for adults and is accredited to provide CAR-T for adults, so it is well placed to extend that offer to children. The Evelina partnership, including Guy’s and St Thomas’ Hospitals, does not currently have a bone marrow transplant programme and is not accredited to deliver CAR-T. Developing such a programme there and delivering it with the required quality, without the adult service, will cost much, much more and be much, much more challenging.
I could go on with other examples of specific cancer treatments for children, but I will end by focusing on some wider issues where, once again, it is clear that the Evelina option is just more risky. Which of the hospitals has the most experience with paediatric cancer? As my hon. Friend the Member for Twickenham said, St George’s has 25 years’ experience of caring for children with cancer. The Evelina does not have the experience of caring for children with cancer—nothing like the experience of St George’s.
On staff, where are the specialist cancer staff currently working, and what would they do if there was a change? There are 432 staff at St George’s who are involved in caring for children with cancer. They are from a wide range of specialities and professions. The vast majority of those staff and the expertise they have built up in caring for children with cancer over the years will not move to the Evelina if the primary treatment centre is moved there. Why? Because most spend only a proportion of their time caring for children with cancer and the majority of their time caring for children with other conditions. St George’s estimates that only four whole-time equivalents, out of 432 staff, would be likely to transfer under TUPE regulations. Not only would the skills be lost, therefore, but they would need to be redeveloped in another group of staff. At a time when the NHS is facing one of its most substantial staffing and skill shortages ever, is that really a risk that NHS England wants to run? That type of basic medical risk analysis points clearly to St George’s being the solution.
But let us look at the financial risk too. NHS England itself has assessed the St George’s proposal as involving lower capital costs—£13.5 million lower—representing better value for money and having a better revenue impact. By 2030-31, the St George’s option would be breaking even, whereas the Evelina option would be running a £2 million-a-year deficit. Even taking into account the charity funding envisaged for the Evelina option, it would cost the NHS £3.5 million more in capital funding than the St George’s option, and the charity funding could presumably be used elsewhere. If the PTC were moved to the Evelina, St George’s would lose the income but would not be able to lose the associated staff. The trust estimates that that would leave a £2.5 million financial gap to close in the first year. Given that NHS finances are under real strain, why take the capital and revenue risk of opting for the most expensive option?
I have listened to the counter-arguments brought forward by the Evelina, some experts and NHS England. A big focus of those arguments is on research into developing new treatments into the future, so let us look at that. Cellular treatments such as CAR-T are likely to be central to the future treatment of children’s cancer. St George’s is accredited and commissioned to provide CAR-T, whereas the Evelina is not. Research into using vaccines to treat cancer is at an early stage, but St George’s, University of London, co-located with St George’s, is an international leader in research into vaccines, infection studies and clinical trials, with the long-term potential for vaccine technology to be developed to support the treatment of cancer. The hon. Member for Carshalton and Wallington (Elliot Colburn) was right to point to the Institute of Cancer Research and the Royal Marsden being in close proximity to St George’s. Again, they are part of the research offer that only St George’s can provide.
To conclude, I think this is a no-brainer. I am staggered that anyone has any doubt about which is the right option. I listened to the hon. Member for Mole Valley (Sir Paul Beresford), and I take him very seriously. He is a great professional in dentistry—he offered my wife some treatment in a previous debate, and I was grateful for that. He is right that we are all looking in expectation to see what happens with tomorrow’s decision. However, having listened to the experts and spent a lot of time looking at the issue, I just do not think there is any doubt: yes, the Evelina is a fantastic children’s hospital, and my son goes there every week, but it is not an expert in cancer services or in children’s cancer services, which is the point of this decision. St George’s can offer those specialities and the expertise, and it can do it more cheaply and in a more accessible way. It is by far the less risky option. I am grateful to the Prime Minister for saying that I can meet the Health Secretary to discuss this issue, and I look forward to that. I hope that tomorrow, given the arguments set out in this debate and elsewhere, NHS England will decide for St George’s.
Sir Christopher Chope (in the Chair)
I let the right hon. Gentleman finish his speech, but I am told that there are now going to be two Divisions, which means the sitting is suspended for 25 minutes.
Support for Carers
Ed Davey Excerpts(3 years, 4 months ago)
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Ed Davey (Kingston and Surbiton) (LD)
I beg to move,
That this House has considered support for unpaid carers and Carers Week 2021.
We are a nation of carers. Millions of people every day look after one or more loved ones—a family member or a friend, or someone who is elderly, disabled or sick. I want to thank and celebrate carers and to speak up for them and the many challenges so many carers face. To be clear, when I use the word “carer”, I am not talking about professional, paid carers—amazing though they are—or child carers and the important work of parents and childminders. Instead, I am focused on the millions of people working as unpaid carers in homes across our country, many of whom would not even call themselves carers. Millions of vulnerable adults and children depend on the efforts of our country’s carers, and yet the voice of these unpaid millions is rarely heard and listened to even less.
Covid has made the job of carers even more challenging. A recent survey by Carers UK found that 81% of carers are spending more time on their caring responsibilities during the pandemic, whether due to the needs of the person they are caring for increasing, or because the local care services they used to rely on have been reduced or closed. Despite all that, carers have too often been forgotten or ignored in so many ways. Take money. Right at the start of the pandemic, when the Chancellor put up universal credit by £20 a week, he refused to do the same for carer’s allowance. He is still resisting calls by Carers UK, the Liberal Democrats and others to put that right, despite the evidence that so many carers are in real financial distress made worse thanks to covid.
Take vaccinations. When the Government initially published the list of priority groups for vaccination in December, they left unpaid carers completely off the list, even though the case for including them is obvious, with so many caring for vulnerable people. Only after campaigning by carers organisations, the Liberal Democrats and carers themselves did Ministers finally U-turn. Even then, the effort to get the message out to carers and the vaccination services was, frankly, lamentable.
There are many more examples. The Government’s 80-page health and social care White Paper left out unpaid carers altogether, as did the Queen’s Speech in May. I am glad that the Health and Care Bill does at least include a requirement to involve carers in decisions about the people they care for, but the Bill does not go anywhere near far enough. There should be an explicit duty on the NHS to identify carers and promote their health and wellbeing, yet that it is sadly missing.
Here is the nub of the problem: the Government do not seem to understand that improving care is fundamental to improving health. Yes, there is debate about reforming and investing in social care to support the NHS, but I note that even there we are still waiting for the Government to publish their social reform proposals two years after the Prime Minister told us he had them ready to go. However, the link between health and care goes far wider than the relationship between social care providers and the NHS. It is shocking that that is still not properly recognised.
The reality for every family with an elderly, sick or disabled relative is this: the health and wellbeing of their loved one is not determined primarily by the hospital or the GP. So much of improving the nation’s health comes down to the quality of care that can be provided by family and friends. Yet millions of those unpaid carers do not even register in the core thinking and planning of the Department of Health and Social Care.
That is why this debate is so important. It is a chance for us to stand up for carers and say that they must not forgotten and ignored any longer. That is carers like Gayna, who looks after her two daughters with complex disabilities. Before the pandemic, Gayna got support from social services and her local carers’ centre, as well as a much-needed break when her girls were at college or with a youth worker. However, that all came to a halt when we entered lockdown, and Gayna’s amount of time spent on caring more than doubled.
Elaine had a similar experience as she cared for her husband, Mark, who is suffering with dementia. Throughout lockdown, Elaine struggled to cope without regular visits from Mark’s care workers. She deeply missed her respite time, and worried that Mark was not getting the mental stimulation he needed from the activities that he used to do with his care workers. She felt exhausted, stressed and like she had no one to turn to for advice or support. In Elaine’s own words:
“When you’re caring alone, you just have to keep going.”
That is all taking a huge toll, especially on the mental health of carers. Back before the pandemic, the 2019 health survey for England showed that for those carers undertaking 20 hours or more of care a week, the rate of depressive symptoms was double that of the rest of the population. I shudder to think of the state of mental health of many carers now, nearly 18 months into the pandemic.
Let us not forget Britain’s 800,000 young carers. The combination of lockdown, school closures and extra caring responsibilities has taken a toll on their academic progress and their mental health. Some have not been able to return to school, because they are worried about bringing the virus home with them, and about leaving their loved ones without care.
What should be done for our nation of carers? I have already mentioned the need to raise carer’s allowance by at least £20 a week, or £1,000 a year. So far, the Prime Minister has refused time and again to do that. He must do it now. One of the next most urgent things to do is to give carers a break. The survey by Carers UK found that 64% of carers have not been able to take any breaks from their caring role during the pandemic; 74% said they feel exhausted and worn out as a result of caring during covid; and 44% said they are reaching breaking point. Local authority budgets are already stretched way past breaking point, so the Government must give councils immediate emergency funding to offer every unpaid carer the support services that they need to take a weekly break.
Ministers must also provide more cash to councils to fund the voluntary sector’s work for carers. In my constituency, we have an amazing organisation called Kingston Carers’ Network, which is dedicated to improving the lives of carers in Kingston. From support groups to advice on benefits, from special projects for young carers and young adult carers to carers’ assessments and mentoring, Kingston Carers’ Network helps more than 4,000 carers in our borough. With a professional team of 21 and a volunteer group of 72, KCN provides extraordinary value for money. With a bit more help, it could do so much more, helping the thousands of carers locally it knows it has not yet reached.
KCN has risen to the challenge of covid, providing new services. One example is the telephone befriending service it set up in March last year. It recruited and trained 23 volunteers to provide one-to-one telephone support to carers. KCN believes that that simple, extremely cheap service has helped to reduce the anxiety and stress in many adult carers and prevented serious deterioration in carers’ mental health. I hope other colleagues have similar groups in their areas and I hope that the Minister will work with local authorities so that this critical work for carers can receive far more investment.
There is much more I want to say, but I am keen to let colleagues contribute, so that the Government can hear the huge cross-party support for our carers and realise that they need to do far more. Before I finish, however, I want to declare an interest—perhaps I should have done so earlier.
I am a carer and I have been at many stages of my life. My first time was as a young carer, starting aged 12. My dad died when I was four, so when my mum became terminally ill, when I was 12, the daily care fell largely to my brother and me, and finished when she died when I was 15. Later, I cared for my wonderful Nanna, my mum’s mum, organising her care and trying to make her last few years as comfortable as I could. And now as a father, my wife Emily and I care for our gorgeous disabled son John.
I think my experience as a carer is similar to that of millions of people. Caring for a close family member or friend can be rewarding and full of love, but it is far from glamorous and can be relentless and exhausting. That is why this debate is so important. Political debate in our country needs to reflect far better the experience and needs of our nation of carers. The Government need to do far more, especially because of covid, especially to support the nation’s health and the mental health of carers, and especially because our nation depends on those carers.
Mr Philip Hollobone (in the Chair)
The debate can last until 4.45 pm. I am obliged to call the Front-Bench spokespeople no later than 12 minutes past 4. The guideline limits are 10 minutes for the SNP, 10 minutes for Her Majesty’s Opposition and 10 minutes for the Minister. Ed Davey has three minutes at the end of the debate to sum up the proceedings. Until 12 minutes past 4, there are seven extremely distinguished Back Benchers seeking to contribute, and if we impose a limit of six minutes, everybody will be able to get in. I call Wera Hobhouse.
Helen Whately
Yes, I have heard that. I have also received correspondence about the situation of somebody who may be in full-time education and seeking eligibility for the carer’s allowance. Yes, I am absolutely listening to that. I truly recognise the pressures that carers experience, whether it is juggling caring with work or with education. I have spoken myself to younger carers in that situation as well.
I want to go further on identifying carers—overcoming some potential data protection issues—and on trying to bring together our data sources, so that we have a clearer sense of who carers are and so that we will be able to contact them to offer support. During the pandemic, I found that it was not possible to write to all the carers in the country and say, “This is what is available to you.” I want us to go further on having the best data that we can.
Ed Davey
What the Minister is saying about identifying carers is absolutely critical for future Government policy on carers. It is why we talked about putting an explicit duty on the NHS in the Health and Care Bill, which is before Parliament. That would be a real step forward. Is the Minister willing to meet me and carers’ organisations to discuss the critical issue of how we can work together with the health service and local authorities, so that we can identify the carers in our communities?
Helen Whately
I am very happy to meet the right hon. Gentleman to talk about that. It is about the technicalities of data, data sitting in different places, and how we can overcome that so that we have a better and common information source. Yes, I am absolutely happy to meet him.
I will come back to some of the things that we did during the pandemic, because I want to cover the topics that have been raised in the debate. We published guidance specifically for carers to try to support them through the pandemic, including on maintaining their own health and wellbeing. We provided PPE for unpaid carers who live separately from those for whom they care, in line with the clinical advice on when it is appropriate for a carer to use PPE. Crucial to all that was drawing on the experiences and insights of carers, including young carers, during the pandemic. We held a series of roundtable discussions in order to do that. Young carers frequently fly under the radar of services and community networks that would otherwise help them.
We provided extra funding to charities, including £500,000 to the Carers Trust in order to provide support to those who experienced loneliness during the pandemic, and over £150,000 to Carers UK so that it could extend its helpline opening hours in order to provide information and support to unpaid carers. We have supported initiatives for young carers, including providing over £11 million to the Sea, Hear, Respond programme, which ran from June 2020 until March 2021, in order to support more vulnerable children and young people.
We have also worked to give extra support to young carers in education. During the national lockdown, schools and colleges remained open for the children of critical workers and vulnerable children, including young carers. I recognise that if a young carer looks after somebody who is more vulnerable to covid, they will be more worried about going to school, so I am determined to ensure that, as part of our catch-up programme for children, some of the £3 billion education recovery package can be used to support young carers who have missed out on school.
I want to talk about day services, which provide essential respite for carers. It is so important that carers, particularly those who do high-intensity care, have time to see a dentist or doctor, to go shopping or to do something for themselves. Such respite is so important, and the day service or respite care is of great value to the individual who attends it. I was truly disappointed to read Carers UK’s new research report, “Breaks or breakdown”, which was published during Carers Week. It said that
“72% of carers have not had any breaks from their caring”
during the pandemic. However, many respite services and day services have not been fully operational for much of the last 16 months. I want to see the reopening of such services. That is one reason why, as part of the infection control fund, we have given nearly £1.5 billion to social care during the pandemic. One use of that fund has been to support the reopening of day services.
I know we can go further. Just last week, I spoke to local authority leaders and emphasised to them the importance of reopening day services and respite services, and I urged them to take advantage of the support that is on offer. I personally commissioned two surveys of day service provision—one last October and one in spring this year. During that period, that provision has increased; the situation in the recent report was better than last year’s, but it is not yet back to the pre-pandemic level. I will continue to work with adult directors of social services, the Ministry of Housing, Communities and Local Government and local authorities to fully understand the challenges in getting day services back to the level that they were at before.
Ed Davey
I thank every Member who has contributed. Members have made some really powerful speeches, and I think that carers in their constituencies are very grateful for the work that they do as parliamentarians.
I will single out, rather unfairly perhaps, two colleagues who have spoken, for different reasons—first, my hon. Friend the Member for Caithness, Sutherland and Easter Ross (Jamie Stone). The story about his constituent needing an extra diaper a day for his mother brought home to us all what we are talking about when we are talking about carers: the stresses, the fact that they are providing very basic care—whether it is dealing with toileting, doing washing, dressing, eating or drinking—to ensure that a loved one can have a quality of life, and how the emotional impact of that can affect people. I am grateful for his contribution, which I think brought us down to earth on what we are talking about.
I also thank the hon. Member for Sheffield Central (Paul Blomfield) for talking about the need to identify young carers. The Minister picked that up, agreeing that we need to talk about that more generally. There is an issue about helping people to identify themselves, because many people do not understand that they are carers. They see it as just looking after their wife or husband, son or daughter, or mother or father, but we need to identify them to ensure that they are getting the support that they need, whether for their own mental health, respite care or whatever it might be.
We also need to ensure, as we plan health services, social services, or whatever it may be, that we have proper information. The census, when it comes out, may refresh the figures of 2011. Many colleagues were involved in the efforts to encourage people, when they took the census, to identify themselves as carers. I would probably multiply whatever figures come from the census because I am not sure that all carers will identify themselves as such. However, if we can do that more effectively I think we can bring home to policymakers how significant the issue is. It has been massively underplayed by Government after Government, so I am grateful to the hon. Member for Sheffield Central. He mentioned young carers. I cannot see, for example, why that cannot be central to the annual school census. That is a pretty easy thing to do. I am very happy to work with him and others to try to work with the Government to bring that about.
If we value carers for the work that they do and properly identify them, I think we can come together and really improve the support that we give them, which is so essential. In so doing, we can dramatically improve the health and wellbeing of the people we are elected to serve, which is utterly crucial. May I end, Mr Hollobone, by thanking everybody—
Mr Philip Hollobone (in the Chair)
I am afraid not. The sitting stands adjourned.
Coronavirus
Ed Davey Excerpts(3 years, 8 months ago)
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Ed Davey (Kingston and Surbiton) (LD) [V]
Renewing the Coronavirus Act 2020 is about extra powers for Ministers—powers that have serious implications for people’s freedoms but are not crucial to help the fight against covid. The Liberal Democrats will of course vote against this motion tonight.
We have supported any necessary powers to keep people safe throughout this crisis. Indeed, a year ago we supported the original Coronavirus Bill, albeit with a very heavy heart. While we have sometimes had to accept that such public health actions were needed to preserve people’s liberty to survive this pandemic, we have always sounded a liberal warning.
A year ago in the debate, I said about the Bill that
“the powers must be used only when absolutely necessary during this emergency, and not for a moment longer.”—[Official Report, 23 March 2020; Vol. 674, c. 79.]
The experience of the past year shows that many of the powers that the Government still want to keep have proved totally unnecessary, including the extraordinary powers for police and immigration officers to detain innocent people potentially indefinitely. The Government themselves say that such powers have not been used once in the whole pandemic, yet they are still asking MPs to renew them for another six months. These unnecessary powers are causing enormous confusion for police and prosecutors. The Crown Prosecution Service’s review reveals that, as of the end of February, 252 people had been incorrectly charged under this Act, with not a single person correctly charged.
I do welcome the fact that Ministers at last accept that a few of the provisions should expire, especially the reduction in people’s rights to care. I warned on Second Reading last year that these were
“some of the most alarming provisions in the Bill.”—[Official Report, 23 March 2020; Vol. 674, c. 79.]
We called on the Government to remove them last September, when we showed that they were illegal under international law, so I am glad they have gone.
However, the Government still seem determined to keep most of these unnecessary draconian powers. Indeed, what is disturbing is that Ministers are now resorting to desperate false arguments to persuade MPs to vote for this motion. Ministers said that voting it down would end furlough; it will not. Yesterday, the Prime Minister said it was needed for people to carry on volunteering in the NHS; that is not true. This is fake news, and this House should not fall for it.
There are some parts of the Act that are needed, but that is not justification for renewing all these sweeping and intrusive powers for another six months, not least because there is an alternative. Liberty has published a protect everyone Bill to replace the Coronavirus Act. It contains the laws necessary to protect both public health and human rights. That is the law we should be debating, as our amendment calls for.
Conservative Ministers are asking for a blank cheque for another six months, so I really hope that Conservative Back Benchers, and indeed Labour and SNP colleagues and others across the House, will do what the Liberal Democrats are going to do, and that is not support this Bill. We will vote against this motion, and I hope Conservative Ministers go away and think again, and put liberty first.
Coronavirus Act 2020 (Review of Temporary Provisions)
Ed Davey Excerpts(4 years, 2 months ago)
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Matt Hancock
Yes. The powers in the Act have allowed us not only to ensure that people get the care that they need and that that care is targeted where necessary, but to allow people to get better and faster access to care when they are in hospital and have to leave, by ensuring that a care package is there. In their totality, the measures on care in the Act have without doubt helped us both to protect the NHS and to support social care, and crucially to support the patients who need that care. We will therefore of course take them forward, because of that positive overall effect.
Ed Davey (Kingston and Surbiton) (LD)
Has the Secretary of State seen the evidence that many disabled people and people who need care have not received the care that they need? If he listens to the organisations that represent disabled people, he will hear that they are extremely worried about schedule 12 in particular and the easements on the duties of local authorities to assess and meet care needs. Is he telling the House that the Government are not renewing that schedule—yes or no?
Matt Hancock
Yes, we are renewing that schedule, because it is very important for ensuring that we prioritise care for those who need it most. The concerns that the right hon. Gentleman raises now were raised during the passage of the Act, when we had a good discussion on the subject. I believe that the way the Act has worked has, overall, improved access to care for people both in hospital and in our social care system, which has, of course, been an area of great scrutiny throughout the pandemic.
Ed Davey (Kingston and Surbiton) (LD)
I refer the House to my entry in the Register of Members’ Financial Interests; I am a patron of the Disability Law Service.
This pandemic is taking an enormous toll on people across our country. The pandemic is hitting everybody. That is why Liberal Democrats have worked constructively with Ministers, backing every measure to keep people safe, from lockdowns to face coverings. In March, when the Coronavirus Bill was rushed through, we were willing to take Ministers at their word that the Bill was essential, despite reservations about its impact on people’s wellbeing, freedoms and rights, but with the benefit of six months’ experience of the Act, we must today oppose its renewal.
As I raised on Second Reading in March and with the Prime Minister two weeks ago, this legislation undermines the rights to care of disabled people, the rights to care of some of society’s most vulnerable people and the rights to care of children with special needs and disabilities. That is wrong, and it breaks international law. We know that the Conservative party does not care about breaking international law. The fact that the Act breaches our legal obligations under the United Nations convention on the rights of persons with disabilities may not matter to Conservative Members, but it should. How a country treats its most vulnerable people in an emergency is one of the most critical tests of its character.
I am pleased, but not surprised, that polling shows the true character of the British people. Two thirds of the public believe that the Act’s social care reductions are unacceptable. Liberal Democrats agree, as do more than 150 organisations campaigning for the rights of disabled people that have called for those sections of the Act to be withdrawn. It is no good Ministers saying that these powers have rarely been used. The experience of disabled people during the pandemic should shame this Government. Inclusion London published a report, “Abandoned, forgotten and ignored—the impact of Covid-19 on Disabled people”. It has horrifying reports from disabled people across the country about cuts to their care packages, food shopping not done, personal washing not done and vital care at home not done. Speaking as the father of a disabled child, huge numbers of parents of disabled children have been hit. A survey by the Disabled Children’s Partnership showed that for 76% of families with disabled children, vital care and support previously relied on had been stopped altogether. This House should speak up for those families, for those carers, for disabled people and vote against this measure tonight.
Independent Medicines and Medical Devices Safety Review
Ed Davey Excerpts(4 years, 5 months ago)
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Ms Dorries
My right hon. Friend makes an impassioned and compassionate contribution, and he should be recognised for his long-term campaigning and his advocacy of the people he mentions who have suffered as a result of what has happened. I cannot comment on the individual points he has raised, particularly on Primodos, because there is legal action pending, but I hear everything he said and others will hear his comments too.
Sir Edward Davey (Kingston and Surbiton) (LD)
I thank Baroness Cumberlege profusely for her review’s welcome conclusions on Primodos, and I praise the Sky journalists who have worked on this, and Marie Lyon and all the other campaigners. However, can I tell the Minister that I see this just as the beginning of the end, because we have not yet got justice for the women involved or their adult children? We want to see the conclusions implemented as soon as possible, and we want to see compensation for the women and their adult children. But I also want to see criminal charges brought against the real perpetrators of this scandal for the cover-up, the suppression of the evidence of harm, and the marketing and sale of a drug that Schering and Bayer knew was dangerous and would result in miscarriages and birth defects. I am grateful for the way that the Minister has produced her statement today. Will she ensure that her Department, the Department for Work and Pensions and the rest of Government know that we will not stop campaigning until full justice is given to these women and their adult children?
Ms Dorries
I commend the right hon. Gentleman for his compassion and for his commitment to campaigning on this. I just have to repeat what I said in my previous answer. I have every—every—sympathy with every parent, mother and family who have been affected, but due to pending legal action I cannot make a statement.
Oral Answers to Questions
Ed Davey Excerpts(4 years, 7 months ago)
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Edward Argar
The Government did act in looking at all previous modelling and all previous exercises. That is why the UK was well prepared. Let me take the example of ventilators, which she mentioned. The UK has massively increased the number of ventilators available to our NHS, meaning that at no point thus far in this pandemic has there been a shortage of ventilators. I reiterate, returning to the original question, that participating in those four initial joint procurement schemes with the EU would not have allowed us to do anything we have not already been able to do for ourselves.
Sir Edward Davey (Kingston and Surbiton) (LD)
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
I would first like to place on record my thanks to everyone on the frontline, be they in a hospital or in social care, as well as those in less obvious places such as my community nurses, pharmacists and others who are working ceaselessly on the frontline. We are working round the clock to ensure that everyone across the NHS and care sector has the personal protective equipment that they need. To date, we have delivered more than 1.11 billion items of PPE. We are ensuring that PPE is delivered as quickly as possible to those on the frontline. We have delivered to over 58,000 health and care organisations, and we are working closely with industry, social care providers, the NHS, NHS Supply Chain and the Army to ensure that all our NHS and care staff can get the protection they need.
Sir Edward Davey [V]
I thank the Minister for that answer, but given how care homes have become a tragic focus in this pandemic, with so many staff and residents losing their lives, when will she be able to guarantee that every care home will have all the PPE they need? And why is the Clipper system, which is meant to supply PPE to the care sector, now one month late?
Jo Churchill
Every NHS and social care worker must have the protective equipment that they need. Clipper has been rolled out, and it is important that it is able to deliver the products that are ordered online. This is now being rolled out to more than 1,500 general practices and care home providers, and as it is piloted and stood up to more and more individual organisations, that will help that stream of work to ensure that people have the personal protective equipment they need. That is on top of the national supply disruption response—NSDR—line that people can ring in case of emergency, and this is also backed up by the wholesale distributors, where only last week 52 million more items were placed into that line as well.
Covid-19 Update
Ed Davey Excerpts(4 years, 8 months ago)
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Sir Edward Davey (Kingston and Surbiton) (LD)
It is good to see the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries), back in her place—I am not sure whether the Secretary of State still needs to have 2 metres distance.
May I press the Secretary of State on personal protective equipment? I hear what he says, and it is good that the military are being involved in the distribution, but is there enough PPE available for all healthcare workers and social care workers? If not, what is happening with manufacturing and the procurement from around the world, because we are told there is some available from around the world?
Matt Hancock
Yes, we have a huge quantity that we hold ready for an eventuality such as this. That was, in fact, enhanced in our no-deal preparations, but of course we are also using that up, so we are buying to make sure that those stocks are replenished.
Coronavirus Bill
Ed Davey ExcerptsMonday 23rd March 2020
(4 years, 8 months ago)
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Matt Hancock
I entirely agree. This exchange is an example of the cross-party approach we are all taking. I am very grateful to the hon. Member for the work he has done, together with the Paymaster General, to bring this point to light.
I am also grateful for the work the hon. Member and many others have done with faith groups of all religions who want to gather. Understandably, it is upsetting not to be able to do that, but it is right that they cease large gatherings—or, indeed, any gatherings—where there is social contact that can spread the disease. It is happening around the world. It is a difficult thing for some, and I pay tribute to the faith organisations and faith leaders across all faiths who have made the right decision. I urge all faith leaders to see what has been done by those who have taken the right steps and to follow them.
I wish to thank the hon. Member for Leicester South (Jonathan Ashworth) for his constructive approach to the passage of this legislation and his constructive tone in respect of this whole crisis. I reassure him that I listen to what he says very carefully. Even when he does not agree, he has done so in a calm, sensible and evidence-based way. I think the House can see from the Bill that we have taken on many of his suggestions, and they will go into law. Along with the Labour Administration in Wales, the SNP Government in Scotland and the multi-party Administration in Northern Ireland, we have taken on ideas from all parties.
The measures in the Bill fall into five categories: because we rely on the NHS and social care staff now more than ever, the first set of measures will help us to increase the available health and social care workforce; secondly, there are measures to ease the burden on frontline staff, both in the NHS and beyond; thirdly, there are measures to contain and slow the spread of the virus so that we can enforce social distancing; fourthly, there are measures on managing those whom the disease has taken from us with dignity and respect; and fifthly, there are measures on supporting people to get through this crisis. I shall briefly take each of them turn.
The first part of the Bill is about boosting our healthcare workforce at a time when it comes under maximum pressure, both through increased demand and because of household isolation and the fact that large parts of the workforce may fall sick. The Bill allows for the emergency registration of health and social care professionals, including nurses, midwives, paramedics and social workers. I can update the House with numbers: 7,563 clinicians, including Members of this House, have so far answered our call to return to work, and I pay tribute to every single one of them. These are difficult times and they have risen to the call of the nation’s needs. We know that many more will join them.
Our thanks also go to the social workers who play such a vital role in protecting the most vulnerable in this country. The Bill protects the income and the employment status of those who volunteer in the health and social care system. Volunteers will play a critical role in relieving the pressure on frontline clinicians and social care staff. Again, I offer our thanks.
Sir Edward Davey (Kingston and Surbiton) (LD)
Is the Secretary of State aware that many people in the refugee community in the UK are qualified healthcare professionals? I have spoken to the refugee charity RefuAid, which says it has 514 qualified healthcare professionals on its books. These are people who are willing to work and fully qualified in their own country, but there are bureaucratic barriers to their coming forward. Will he please look into this matter with great urgency so that such people can help us out?
Matt Hancock
Yes. If the right hon. Gentleman emails me with the details, we will get right on to it. He refers to bureaucratic barriers; we of course have to make sure that people are able to do the work that is necessary, but we have already shown in the Bill that we are willing not only to bring people back into service but to put into service those who are towards the end of their training, to make sure that we get as many people as possible in full service. I absolutely want to pick up on the right hon. Gentleman’s proposal and take it up with the General Medical Council or the relevant regulator to see whether we can find a way through for the period of this crisis.
Sir Edward Davey (Kingston and Surbiton) (LD)
I would like to begin by thanking everyone who is working hard to keep our country and our world as safe as possible from this dangerous pandemic. Above all, I want to thank the staff of our NHS and our social care sector. We are seeing people face personal risks, and we will forever be grateful for what they are doing.
In normal times, I and my party would be opposing many of the measures in the Bill with every breath in our bodies. The implications for civil liberties and human rights are profound and alarming, but our society now faces the unprecedented threat of coronavirus, which leaves some of the most vulnerable in our society at serious risk. It seems clear that at least some of the new powers being sought by the Government are necessary to deal with the threat. Nevertheless, our position is that the powers must be used only when absolutely necessary during this emergency, and not for a moment longer.
Like others, I welcome the Government’s change of heart on the two-year renewal. The six months now proposed is, self-evidently, a significant improvement. Nevertheless, we remain unclear why it is six months rather than three months. There may be good reasons, but it is important that the Government set out why they chose six months. After all, the Prime Minister said just the other day that the peak of the epidemic would be just 12 weeks away, so it is not unreasonable to ask why six months is needed.
Moreover, we need to look carefully at the review process. When it comes, it should enable amendments to this law, and the other place needs to be allowed to vote on it too. Let me give one reason why a more frequent renewal process should be considered. It relates to the Bill’s provisions on social care. The Bill temporarily suspends the duties on local authorities to meet people’s care needs—from older people to adults and children with disabilities. I am yet to be convinced that those provisions are needed at all. They are some of the most alarming provisions in the Bill. At a time when the most vulnerable in our society need more care, not less, why on earth are people’s rights being reduced? At the very least, such a reduction in rights for the elderly, disabled and mentally ill must be subject to early review and renewal.
The right hon. Member for South West Surrey (Jeremy Hunt) was right to raise the issue of personal protective equipment and testing. NHS staff who have contacted me are angry and alarmed at the lack of PPE. They do not understand why the distribution system has taken so long and is still failing to provide PPE for so many people. The testing experience in this country compares appallingly with other countries.
There are other problems with the Bill. Due to the time, I will mention just one: the Bill’s failure to enable the Government to extend the Brexit transition period. I know that is politically sensitive and contentious. I know we need to bring our country together after Brexit tore us apart, so I do not seek to reopen the Brexit question, despite what my heart tells me. I raise the Brexit transition period as a practical and real issue. Our economy faces its biggest challenge since the second world war—disruption to business on a scale even greater than would have been caused by the worst-case scenario of a no-deal Brexit. Surely, the Government should think again and allow themselves to extend the Brexit transition period.
We on the Liberal Democrat Benches will support the Bill tonight, but with a very heavy heart. We hope the Government will come back and allow the House to ensure that we can protect our country against this coronavirus threat but not ditch our civil liberties and human rights.
Hormone Pregnancy Tests
Ed Davey Excerpts(5 years, 7 months ago)
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Sir Edward Davey (Kingston and Surbiton) (LD)
I agree with all colleagues who have spoken. My friend, the right hon. Member for Hemel Hempstead (Sir Mike Penning), is right about a cover-up. He could have gone further; there is a danger that it is a criminal cover-up. I say that to the Minister in all gravity, because if she and her colleagues do not get on top of this issue, it will end up in the courts. The Government and the medical establishment will be defeated, and a lot of money will have to be paid. It will be a national scandal. It is one already, but it is not as well known as it ought to be. It will be on the front pages. I say to the Minister that it is time to act.
When I last spoke on this subject, on 14 December 2017, I used material from the Berlin archives, thanks to the amazing Marie Lyon and the Sky journalist Jason Farrell. I showed that lawyers and the scientific advisers from Schering knew about this in the 1960s. Minutes from meetings in ’68 and ’69 showed that they knew that there were problems, and that they would be found guilty in a court of law. I used long-standing evidence that the people involved knew there was a problem.
Today, I will focus on the science—first, on the association between HPTs and deformity, and secondly, on the issue of causal links. The 2017 expert working group report said that there was not an association. It is interesting, however, that when members of the EWG gave evidence to the review, they had a different story. The Minister needs to think about why that is. Professor Stephen Evans, for example, in evidence on 28 January 2019, at 28 minutes and 46 seconds into the video, said that
“Dr Olszynko-Gryn says this: ‘More optionally the authors’—this is Heneghan…‘the authors might consider reflecting on the extent to which the association they identify implies a causal association. An association between the use of HPTs and birth defects has long been recognised and was rarely in dispute.’ Well, we don’t dispute that; there is an association.”
He did not say that in 2017. Ailsa Gebbie from the EWG, at the same oral hearing, said:
“But everybody admits there is a possible association, and that’s why the report was carried out in the first place.”
I think it is more than a possible association.
Let us go to the meta-analysis that has been quoted, which is where lots of studies are brought together to see whether together they tell a consistent story. I am not a scientist or a mathematician, but I have spoken to academics who really understand this. They say that when the studies are brought together, their homogeneity, and the consistency of the findings, is extraordinarily striking. They all show an association.
The EWG wants to dismiss that. Professor Evans does not want to accept that methodology. As we heard from the hon. Member for Blackpool South (Gordon Marsden), Professor Evans is going against the Food and Drug Administration—the US authorities—the European Medicines Agency, the National Institute for Health and Care Excellence and clinical researchers in this area across the world, who accept meta-analysis for this type of risk analysis. The Minister needs to ask her officials why the EWG refuses to accept the analysis, because it is strong, overwhelming and proves the case, I personally think, in legal terms, beyond reasonable doubt. The Minister must leave the Chamber knowing that there is an association, because that is what the science shows.
We have heard about the desire for a causal link to be shown. I urge the Minister to ask her experts and officials what is needed to prove a direct causal link. That test is very rarely met. If a recognised poison that is known to be lethal is given to someone, they will die; that is a binary issue. However, most other pharmaceuticals and drugs are not like that. The balance of probabilities is the test that is normally used. All the evidence that we have shows that, on the balance of probabilities, there is no doubt that there is a link.
It is sometimes difficult to show causalities. It has been suggested to me that I mention the Fairchild case, to show how difficult it is to establish causation. The Fairchild exception is a relaxation of normal tests for causation. A mesothelioma victim can prove that a particular exposure to asbestos caused the mesothelioma by proving that the exposure was such as to create a material increase in risk of the victim contracting the disease.
Has a material risk been proven? According to the meta-analysis, there is a 40% increase in risk of all malformations from taking HPTs. There is an 89% increase in risk of congenital heart malformations—more than a doubling. I say that because a doubling of a risk is material in court. There is nearly three times the risk of nervous system malformation. There is a 224% increase in risk of musculoskeletal malformation, and a 747% risk of vertical defects. That is what the evidence shows. I bring that to the Minister’s attention. She must know that. She should go back to the Department and challenge her officials, because they are getting this wrong and letting people down.
Paula Sherriff (Dewsbury) (Lab)
It is a pleasure to serve under your chairmanship, Mr Hollobone. Like other hon. Members, I sincerely thank my hon. Friend the Member for Bolton South East (Yasmin Qureshi) for securing this debate. I also thank Marie Lyon, chair of the Association for Children Damaged by Hormone Pregnancy Tests. Without those two strong, brave women and their pursuit of justice, truth and answers, we would probably not be having this debate. I think we can all agree that the personal stories that we have heard today are very powerful indeed, and that these people and their families deserve definitive answers to their questions, especially after so many years.
Although I am pleased that the Government have committed to the ongoing review, I hope that on this occasion all available data will be analysed and all research will be taken into account, so that the review’s conclusion can satisfy those who have campaigned so vociferously for so many years. It is alarming to read the report from experts at Oxford University, led by Carl Heneghan, Professor of Evidence-Based Medicine. The report appears to identify huge gaps in the expert working group’s 2017 study.
To find that huge areas of research were left untouched is nothing short of an insult to the campaigners who have devoted their lives to seeking justice. Some reports suggest that key elements of research were removed on purpose to support the conclusion and mislead Government and Parliament. If so, we as parliamentarians must do our utmost to right those wrongs; I hope that today the Minister will pledge to do just that. Indeed, the Prime Minister herself said in January that she would
“listen very carefully to any recommendations that come out of the review”.—[Official Report, 16 January 2019; Vol. 652, c. 1160.]
The results of animal testing from a 1979 study released by the pharmaceutical manufacturer Schering, now owned by Bayer, found strong links between the drugs and malformations, as well as the death of embryos, and yet the expert working group in 2017 declared that those results provided insufficient evidence. The expert working group examined human studies, and the majority similarly favoured an association between Primodos and deformity, but still the working group felt that the evidence was not strong enough. Was the evidence not properly assessed, or was it simply omitted? Either way, that conclusion has undoubtedly prolonged the agony of those who have lived for 50 years without answers.
There has been much talk about whether meta-analysis should have been used by the expert working group in 2017. When Professor Heneghan carried out a random-effects meta-analysis, the results were opposite to that of the expert working group report and found that there was an association between the drug and the malformations, which was consistent with his own study.
Sir Edward Davey
I think I am right in saying that when the raw data that the expert working group had used was rerun by Professor Heneghan, it showed that if the expert working group had done that, it would have reached similar conclusions. That makes the group’s conclusions even more worrying.
Paula Sherriff
The right hon. Gentleman makes a very important point, which gives further credibility to the view that the review by the expert working group was completely insufficient.
One thing that I have been utterly appalled about during my research on this subject is the inhumane and patronising way in which women were treated and spoken about during the period that Primodos and other hormone pregnancy tests were available, and subsequently, when a possible link between the drugs, early abortions and birth defects was identified. As the chair and founder of the APPG on women’s health, I am often asked why I feel it necessary to have a group that looks exclusively at women’s health. This is a prime example of the inequality that women have faced over the years when they have sought help on major health issues.
One senior medical officer from the Committee on Safety of Medicines said in 1969:
“It is somewhat difficult to summon up enough enthusiasm to place a high priority on this, when so much other and possibly more important work is pressing.”
In 1968, Dr N.M.B. Dean, of the Royal College of General Practitioners, stated:
“With regard to the rather high incidence of abortions in the Primodos group, I think it must be borne in mind that women going to their doctor for this type of test often hope that they are not pregnant and it is not impossible that these women took other steps to terminate their pregnancies”.
Jackie Doyle-Price
I hear what my right hon. Friend says. There has to be some element of cause, otherwise there is no scientific basis for a judgment. I will have to agree to disagree with him on that point.
Sir Edward Davey
I have to intervene on the Minister on that point. In many cases, drugs are looked at on the probability of risk, not on causality. Causality is a much stronger test. In science, it is very difficult to prove. If her officials are telling her that about a causal link, they are wrong. I urge her to get separate independent advice on that.
Jackie Doyle-Price
The drugs are no longer available because of association, due precisely to that balance of risk. The issue that we are looking at now is to what extent that was understood at the time, and to what extent there is a liability. That is what the group is ready to look at.
Sir Edward Davey
The Minister is being very generous with her time. I refer her to the evidence that was in the Berlin archives, which goes back to 1968 and 1969, and to the meta-analysis, which proves that on the balance of probabilities there is no doubt. That became known not this year, but years ago.
Jackie Doyle-Price
I am answering on behalf of the working group. That is an independent process and I will try to do my best. The right hon. Gentleman raises the issue of the meta-analysis and the suggestion that Parliament has been misled about why that was not done. The expert working group discussed the merits of doing a meta-analysis at its fifth meeting. In its view, the studies were very different, not sufficiently robust and suffered from extensive limitations. The group concluded that conducting a meta-analysis was not the most appropriate way to analyse this type of study. Instead, the group developed a set of quality criteria and presented its assessment of each study in a series of plots. To reconfirm, the data was not considered sufficiently robust for meta-analysis to be used. One of the real problems we have is that we are talking about data that, as we have mentioned, is 50 years old and not sufficiently robust.
There have been some suggestions that the expert working group has been less than transparent. In line with the Government’s commitment to publish the report of the review and all the evidence considered by the group, all documents have been available for public scrutiny since November 2017. We have been very grateful for the involvement of Marie Lyon throughout that process.
There has been some criticism of the lack of an external peer review of the expert working group report. The Government’s independent scientific advisory body on the safety of medicines, the Commission on Human Medicines, acts as the peer reviewer for all expert working groups. It reviewed the draft report on two occasions before it was published. I know that Baroness Cumberlege will be looking at whether there has been sufficient peer review of that report, and I look forward to receiving her recommendations. As with any issue, new evidence can emerge in the meantime. I reassure the House that the Government have made a commitment to review any important new evidence, and we have honoured that commitment.