Cities and Local Government Devolution Bill [Lords]

Edward Leigh Excerpts

Monday 7th December 2015 Commons Chamber

[Sir Edward Leigh (Gainsborough) (Con)]

The right hon. Gentleman is making his arguments very well and I do not want to take him to task over them, but I want to ask him a question. Presumably the Bill will again end up in the House of Lords, as the European Union Referendum Bill has done. Does he think it is the place of unelected people in the House of Lords to make a decision on this question, or should it be reserved to the House of Commons?

[Norman Lamb]

I continue to argue strongly that we should have a democratically elected second Chamber, and we sought to achieve that during the coalition Government. Sadly, Conservative Members managed to block that long-overdue reform. [Interruption.] I think the hon. Member for Nottingham North (Mr Allen) is agreeing with me from a sedentary position. But we are where we are, and because Conservative Members ensured during the last Parliament that we still have to put up with an unelected second Chamber, it will just have to do the job as best it can. It is a revising Chamber and I hope that it will again make the argument that 16 and 17-year-olds should have the right to vote. I hope that I have responded adequately to the hon. Member for Gainsborough (Sir Edward Leigh).

David Willetts made the case strongly that there had been a break in the generational contract. I believe that it is incumbent on all of us to address that serious issue and to ensure that all political parties start to show a real interest in the interests of young people. If 16 and 17-year-olds had a vote at local and national levels, there is no doubt that the parties would focus more attention on their interests.

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[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Before I call the next speaker, I gently remind the hon. Member for Bolsover (Mr Skinner) that although I did not want to interrupt him when he was in such rhetorical form in his intervention, matters concerning the health service are in the next group of amendments. The House so much looks forward to hearing what he has to say then, but that will be after we have finished debating this group of amendments, having heard Sir Edward Leigh.

[Sir Edward Leigh]

It is of course a pleasure to follow my hon. Friend the Member for North East Somerset (Mr Rees-Mogg), with whom I normally agree. I quite understand his enthusiasm for referendums, which in one sense surprises me, because a traditionalist like him would normally have opposed the concept of referendums. He would have opposed them in the past because it was felt—this point has been made many times in the House of Commons—that they were a fundamentally unparliamentary device that has often been used by Governments who are dictatorships to impose extreme changes on society.

I understand where my hon. Friend is coming from, however, because in recent years referendums have been seen as a fundamentally conservative force. Generally, the people vote against change. I understand his arguments and I understand why the Government are wary of accepting any amendment promoting a referendum, because they have looked at what has happened in the past, particularly in the north-east, where people voted against change. The Government are determined to drive change forward and fear that if there is a proposal for a referendum, people will usually vote no. This is a very interesting argument.

I want to dwell on amendment 56, which was tabled by my hon. Friend—and indeed real friend—the Member for Cleethorpes (Martin Vickers). Normally I agree with him about most things, but on this occasion his amendment concerns me, and I want to make a few points about the situation in Lincolnshire and give the Minister the opportunity to reply.

My hon. Friend represents north-east Lincolnshire, and I represent Lincolnshire. Lincolnshire is a very conservative county. It is so conservative that the Gainsborough constituency—which I am proud to represent—has had only three MPs in 90 years, and all three have been Conservative. People do not like change in Lincolnshire, and they are wary of any device such as that in amendment 56. The Government appear to have accepted the amendment, albeit with a sunset clause, and it is quite unusual for a Back Bencher to table an amendment that the Government then accept.

People in Lincolnshire—and, I suspect, other rural counties—want to proceed by consent, which seems an admirably conservative point of view. Normally, proceeding by consent means dealing with the tried and tested, and taking things forward together. Many people are scarred—this has already been referred to—by the events of the 1970s, when ancient counties were swept away. There were different enthusiasms then. They may not have been in favour of elected mayors, referendums or unitary authorities, but everything was done on the basis of Heath-ite efficiency. We now know that that drive towards Heath-ite efficiency was fundamentally wrong and unpopular, and it imposed Whitehall centrist ideas on what local people wanted. I see that my hon. Friend the Member for Beverley and Holderness (Graham Stuart) is here. As a result of 1974, we created the ludicrous county of Humberside, destroying Lincolnshire, East Yorkshire—what madness. We know that is not the right approach.

Speaking as a Conservative—not just as a party politician, but as someone who tries to understand Conservative values—I appeal to the Minister to proceed with great caution and to take people with him on this matter. Now, elected mayors are all the rage, but a few years ago so were police and crime commissioners. We had a mixed history with that—low turnouts, lack of interest, and not necessarily democratic accountability.

Lincolnshire County Council is generally well run, popular, and has been in place for 130 years. The district councils have been in place for more than 40 years. It is not for me to speak for local councillors in Lincolnshire, but since they cannot speak in this place and have only me to say these things, I hope nobody minds if I say that we do not want a solution imposed on us. What worries me about the amendment—and the Government’s ready acceptance of it—is that, as the county council and district councils recognise, in terms of unitary authorities, elected mayors and devolution, we do not want a bruising battle over many years between district and county councils about which should be abolished.

We want to proceed by consent and to get together. We are happy with the idea of central Government devolving more powers to a county such as Lincolnshire, but we recognise that we are not Manchester, Birmingham or London. We are a large, quite poor county with a low rate base and a scattered population. There is no question that we could run the NHS or anything like that; we are not in the business of devo-max. We want to leave the present structure in place with district councils and county councils, and perhaps form a new body on which those will be represented. We would then accept new powers for that body. That is how we want to proceed by consent. Given many of our discussions so far, I am worried that in our rush for change and innovation, we may ride roughshod over what local people and councillors want. Being sensible people and knowing their area, they generally want to proceed slowly, cautiously, and by consent. With that, I feel that I have made my arguments and I will let others speak. I am sure they will be far more interesting than me.

[Nigel Mills]

I am in the unfortunate position of not only having to follow my hon. Friends the Members for Gainsborough (Sir Edward Leigh) and for North East Somerset (Mr Rees-Mogg), but disagreeing with them both. I always thought that if I disagreed with my hon. Friend the Member for North East Somerset, I should sit down and think again. In this case, however, I disagree with his arguments, because I think that when electing an individual who will have significant powers, we should try to ensure that they are elected with a larger proportion of the vote than is required by first past the post.

I suspect that no one would want some kind of extremist to win a powerful mayoralty in a fluke election where there were 14 candidates and the winner ended up with 16% of the vote. I accept that that is unlikely, but it would be a horrible situation. I am sure that the people of France, having seen their election results over the weekend, are glad that they will have a run-off in their presidential election. If the Front National were to win the first round, people will get a chance to elect a non-extreme president. I disagree with my hon. Friend, because when electing an individual who will have power, I am not sure that first past the post is the right answer. We should have the system currently used for the London Mayor and police commissioners, where there is a run-off after the original vote to ensure that the person who wins commands 50% of the vote.

I also disagree with my hon. Friend that not having an elected mayor is the least worst thing. If we are to devolve significant amounts of money and power to a new body, that body must be accountable directly to the people. We need people standing and being elected on the basis of how they will use that power and money.

When people elect a leader of a district council that has a small £10 million budget and mainly does planning and refuse collection, I am not convinced that they will be thinking, “The party I am voting for will choose the leader of the council and will effectively have a veto over the new super body that covers at least two counties in my area.” That is not accountable to the people, and I think it is bad for democracy. We risk recreating the police authority model that we did not think worked, but on a much larger scale and with more powers. That would be a retrograde step for our constituents’ democratic accountability over key public services, and that is why I do not support the amendment.

On amendment 56, I am a supporter of devolution to English regions. The hon. Member for Sheffield South East (Mr Betts) made the right arguments, because areas such as Nottinghamshire and Derbyshire do not have a long-standing, coherent geography that makes people think, “That’s a natural body of government I identify with.” We must proceed carefully, and ensure that we produce Government bodies that people identify with and say, “Yes, I see a coherent natural fit. That is where I look to for decisions to be taken.”

The hon. Gentleman is right to suggest that some parts of north Derbyshire and north Nottinghamshire might feel better suited to the Sheffield region than to Nottinghamshire and Derbyshire. I am pretty certain that Amber Valley, which runs along the boundary between Nottinghamshire and Derbyshire and has the strapline “The Heart of Derbyshire” sees itself firmly in the Nottinghamshire and Derbyshire area, rather than somewhere else, but it is right for individual local districts to have the democratic right to say, “We represent our people, and we think that that region is the right place for us to be.” If people vote for that, that is what should happen, and there should not be a veto from a higher authority that covers a different area.

In exercising that right and making that decision, the Secretary of State should try to achieve consensus, consider the broader picture, and ensure that we do not achieve some strange, farcical democratic situation where, if the people of Bolsover choose to go with Sheffield, they suddenly have no say in holding their own police force to account because that is handled by the elected mayor for Nottinghamshire and Derbyshire. We must proceed with caution regarding what powers go to the mayors. If they are mainly economic powers and interests, and perhaps transport, perhaps elected mayors should not replace the police commissioners if we are to vary the geography, as that could be a dangerous step.

I know that people in Nottinghamshire and Derbyshire are keen to replace their police and crime commissioners, but I am not sure how one person can hold to account two different police forces. That seems a little strange, because someone could be using one mandate to hold to account two forces with very different policies. We must think carefully about such functions. We ought to think properly about the geography, not just rely on some historical, centuries-old set of local government boundaries that may not make sense in the modern world. We should step back and think about what a good system of local government would look like if we added that extra tier. I am not sure that our constituents would thank us if we had four different tiers of local government.

My constituents in Heanor or Ripley elect 21 town councillors and 45 borough councillors. They elect two councillors to the county council, which has more than 60 councillors. I am not sure that they will fancy electing a new mayor and another tier of government, and paying for all that as well. I am not sure that many of them understand exactly what functions those three council tiers have, and what a fourth one on top would do. They would probably think that all four had some role in economic development and regeneration, largely because that features significantly in most of the election literature that we see.

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[Mr Christopher Chope (Christchurch) (Con)]

I am concerned about amendment 56 and the Government’s acceptance of it, albeit subject to the proposal in amendment (a).

The reasons for my concern go back some time. Twenty years ago, before I was privileged to be a Member of Parliament, I served on the Local Government Commission, which looked at structures of local government in England, including at whether councils should switch from a two-tier structure to a unitary one. The method we adopted in those days was to invite local people and councils to submit evidence, and to hold public inquiries and hearings on the evidence. It was very much a bottom-up process. That was decided by consensus in the commission. In due course, it made recommendations to the Government, which were adopted by Parliament if changes were involved.

In Dorset, which I have the privilege of representing in Parliament, there was a lively debate about whether Poole and Bournemouth should become unitary authorities, with Dorset County Council remaining a county council and a two-tier system operating in the rest of the county. In the end, it was agreed that Poole would become a separate unitary authority, as would Bournemouth, but the remainder of the county council area would be two-tier, with Dorset County Council dealing with the main services such as education and social services, and the borough or district councils dealing with the services closest to the people.

Nothing that has happened in the 20 years since leads me to believe that people in Christchurch, East Dorset or Dorset are anything other than content with the current arrangements. When there was all this talk about the possibility of change being forced through by the Government, I was assured by my right hon. Friend the Secretary of State that nothing would happen to change things in Dorset unless it had the wholehearted consent of the councils concerned. On that basis, a half-baked proposal introduced by Poole, with support from Bournemouth, to try to set up a new unitary authority incorporating Christchurch and East Dorset, could not work. Dorset County Council understandably said that it would mean that part of its area, which enables it to provide good services and make economies of scale, would be taken away and no longer be included in Dorset county. The line, which the Secretary of State articulated to me very persuasively, was that there was no need to worry, because nothing would be imposed from the centre. It was something that would only come from the bottom up.

That is where we were until today and the inclusion of amendment 56 on the amendment paper. I assumed that the amendment did not have Government support, and I had not applied my mind to the question of opposing it. I assumed, on the basis of what I had been told, that it would be opposed by the Government. Much to my amazement, I found that a manuscript amendment had been tabled, suggesting that the Government were going to accept amendment 56, albeit on the basis that it would only be in operation until 31 March 2019, which coincides with the end of the current period for district councils. The terms of office for all the district councils that were elected last May expire at the end of March 2019.

That is the effect of the Government amendment, and they have not provided any detail about the criteria that they will use to exercise their significant power to intervene against the wishes of one or more local councils in, to take my county example, Dorset.

[Sir Edward Leigh]

I hope that the Minister is listening, because it is open to him to intervene on my hon. Friend, to make it clear that in areas such as Lincolnshire and Dorset we should only proceed towards a unitary authority by consent.

[Mr Chope]

Of course, it would be open to the Minister to do so. I understand—I have been told privately, not on the Floor of the House—that the Government are neutral on this. They do not have an agenda to try and create unitary authorities.

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[Mr Chope]

I am grateful to my hon. Friend, so far as it goes, but basically he is saying that the Government will now decide. A few months ago the process was to be bottom-up, driven by the local councils: if they wanted change, they would be able to introduce change. Now we are told that nobody will be able to dictate, neither a borough council nor the county council, but ultimately the Government will decide. This is a significant change of Government policy, announced in the form of a manuscript amendment to amendment 56.

[Sir Edward Leigh]

This is an interesting triangular discussion and it is terribly important. What I think my hon. Friend is looking for, and what I am looking for—again, the Minister can intervene on my hon. Friend—is an assurance that if either Dorset County Council or one of the district councils does not want change, that would effectively be a veto, and the same would apply to Lincolnshire and other rural areas. In other words, change would proceed only by consensus. The Minister says he wants to proceed by consensus, as I understand it, and that is extremely important. Again, he can intervene on my hon. Friend.

[Mr Chope]

I am grateful to my hon. Friend for his intervention and for his suggestion that we might be able to find a modus operandi between the two of us, who are very concerned about this, and the Minister, who I know is doing his best to give us assurances which will enable us to support amendment 56, as amended by the Government, rather than dividing the House on it. I am happy to give way once more to the Minister if he is able to give the sort of undertaking that my hon. Friend the Member for Gainsborough was suggesting he might like to give.

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[James Wharton]

We will be talking about that with the LGA and other interested parties, but we are still in the process of delivering those deals and it would be against the spirit of devolution were we to announce the format for such a forum. I recognise the hon. Gentleman’s comments, however, and the value that such a forum could bring. I am happy to put that on the record. It is our intention to have those discussions and to develop something that has broad agreement.

My hon. Friend the Member for Carlisle (John Stevenson), who cannot be with us today because of the terrible flooding that has afflicted his constituency, has tabled amendment 56, which would enable the Secretary of State to use a fast-track process for unitarisation or boundary changes in a particular area. I suspect I am going to take a few interventions on this amendment, but I wish to highlight this point: it enables a fast-track process and streamlines the use of existing powers; it does not bring in powers that do not already exist. He tabled a similar amendment on the first day of the Committee of the whole House, with a view to ensuring that no one council could effectively veto such a change, however sensible and supported such a proposal might be.

My hon. Friend wished to see a way of preventing one council from denying change that might be in the best interests of the wider area. We have heard further arguments today about the proposition, particularly from my hon. Friends the Members for Cleethorpes (Martin Vickers) and for Amber Valley (Nigel Mills). When we debated this last time, I made clear our approach: if such a governance change were to be made, there needed to be a level of consensus across the area and that we are not in the business of imposing change on any one. That remains our starting point and our intention.

[Sir Edward Leigh]

I know the Minister does not want to comment in detail, but, moving from the general to the particular, what would happen if Lincolnshire County Council, for example, wanted to use amendment 56 to fast-track the procedure, but one or more districts objected to a unitary authority? Do I take it that nothing in amendment 56 would make it easier for the district councils to be overridden by the county council?

[James Wharton]

The powers already exist for the Secretary of State to review and change local authority boundaries and create unitary authorities—to do many of those things that hon. Members have talked about with concern. This is a streamlining amendment that makes it more straightforward to deliver things where there is the desire; where it is important, as part of a deal; where there is consensus; and where the Secretary of State, having applied the statutory tests, is satisfied it is the right thing to do in the interests of that area. It is a welcome amendment, therefore, and I hope that hon. Members will support it.

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[Greg Clark]

I will indeed. My hon. Friend raises an important point. The whole process by which we have operated and negotiated with places has recognised that the best ideas come from local places themselves. Previous local government Bills have attempted, with unhappy consequences, to impose a Government view of how local government should be organised on reluctant local authorities. This Bill does not do that and the amendment that he mentions will not be used for that purpose either. Rather, it will bring local communities and local authorities into a discussion about what is best for their area.

[Sir Edward Leigh]

The Secretary of State, as usual, is handling difficult issues in a consensual and careful way. As I understand it, he wants to use amendment 56 to encourage a discussion. Discussions are fine, but, for the want of argument, if a county council wanted to use amendment 56 to drive for a unitary authority against the wishes of one or more district council, I take it that the county council could not use it to override the district councils.

[Greg Clark]

All of our negotiations have achieved consensus locally. That is my approach. Amendment 56 allows us to require that those conversations take place. No authority can reasonably refuse even to discuss the potential for reform. That is right. It is reasonable for neighbouring authorities to have conversations about what is the best way to proceed. As my hon. Friend the Minister said, the powers are already there.

In responding to the case that was made in Committee by my hon. Friend the Member for Carlisle (John Stevenson) and that was made again on Report, we thought that it was worth having in the Bill, as a pilot, the ability to, as it were, encourage authorities to have the conversation. Anything that is agreed needs to be agreed by the Secretary of State and by this House. My hon. Friend the Member for Gainsborough (Sir Edward Leigh) can be absolutely sure that, in exercising my authority in this area, I propose to maintain the preference for consensus that I have shown so far.

It is worth reflecting that, in the few years since we started negotiating, first with cities and then with local authorities and their businesses through the growth deals, there has been tremendous enthusiasm across the country. Members have spoken at various points during the debate about how the degree of collaboration and involvement of businesses and local authorities has been very much greater than that experienced in the past. That is absolutely the case. If we are to prosper and succeed as a nation, every part of the nation has to fire on all cylinders. This important Bill will help to drive that forward.

During the debate, many amendments have been made, resulting in the Bill’s improvement. We have accepted a need for various reports on the progress of devolution to come to this House, so they can be debated. I am grateful to my hon. Friend the Member for Altrincham and Sale West (Mr Brady) in particular, as he made a very strong case that Members should be involved in the ongoing scrutiny of agreed deals. I am only too willing to have my feet held to the fire. As the Chairman of the Select Committee, the hon. Member for Sheffield South East (Mr Betts), has observed a number of times during these proceedings, in my earlier incarnation in the Department I published a progress report of all Government Departments on whether we were living up to our commitments on devolution. I fully expect that the scrutiny of the House will be equally exacting when it comes to the receipt of the reports.

It is important that we have devolution right across the country. We started with cities, but the enthusiasm in counties and districts right across the country has been very palpable. When we issued an invitation for places to come forward, 38 places, covering almost all the country, submitted proposals. The Bill enacts some of our manifesto commitments to create a metro mayor for Greater Manchester and to create mayoral authorities for the great cities that have concluded deals with the Government.

In response to proposals, again from the bottom up and starting with Greater Manchester, we have been able to enter into discussions about the devolution of health matters, so that the two sides of the same coin that are health and social care can be better administered locally, jointly between the NHS and local government. I am pleased we have been able to make amendments on those matters.

I am pleased that we have ended the Bill’s proceedings with a degree of consensus between all parties. That was very much our intention from the outset. We started with a degree of discord on Second Reading, but I had high hopes that we would be able to persuade those on the Opposition Front Bench to move away from that. As we have scrutinised the Bill and accepted amendments from all sides of the House, including from the Back Benches, I think we have strengthened the Bill. I am grateful to those on the Opposition Front Bench for having, I think, modified their view. I hope we might even hear a degree of enthusiasm—I will be careful on that; I had better not count my chickens—from them.

This is an important moment. The Bill was in the first Queen’s Speech and one of the first to be introduced in this Session of Parliament. On Second Reading, I said it was an historic Bill that would do something our predecessors have not done and that our successors will look back on. They will see this as a piece of legislation that changed the direction of policy and built up our cities, towns and counties across the country, so that their discretion, power and ability to set their own future becomes much greater than it has been in the past.

Cities and Local Government Devolution [Lords] Bill

Edward Leigh Excerpts

Wednesday 21st October 2015 Commons Chamber

[James Wharton]

The hon. Gentleman makes an important point. We are talking about powers that are being transferred from Whitehall and Westminster and from Ministers and public bodies to combined authorities —to the areas that are making these devolution deals. It is not about powers being taken up from local councils and authorities, unless they choose to so pool them. That option is on the table, but there is nothing in this Bill that would compel it. In Greater Manchester, as part of that deal and the accountability we want to build into the process, the combined authority has a two-thirds mechanism for holding the mayor to account. That is an important part of that deal and one that gives the reassurances people in Greater Manchester—the local authority leaders who reached that deal with us—and hon. Members will want to see as we take this process forward.

[Sir Edward Leigh (Gainsborough) (Con)]

In theory devolution is fantastic, of course, and we all agree with it, but in this debate on Sunday trading will the Minister at least listen to religious people who feel the country is becoming increasingly secular and consumerist? Their concerns have to be handled very sensitively by the Government. That does not necessarily mean they cannot proceed, but those concerns have to be handled sensitively. Will he assure the Committee he will do that?

[James Wharton]

I can absolutely give my hon. Friend that assurance. The Government have consulted on, and made clear our intention to introduce as part of this Bill, Sunday trading devolution. We will have full opportunity to discuss that. This Bill is currently being discussed in Committee on the Floor of the House. There will be time for discussion and we will work with colleagues and listen to their concerns, and we will try to find a consensus, so if change is to be delivered it has the support of the House and of the broadest possible base of opinion in this country.

We accept the case for transparent and comprehensive reporting—indeed, we are advocates for it—but we are clear that the devolution statement that clause 2 requires to accompany any future Bill would be unnecessarily bureaucratic. For many Bills, such a devolution statement would be irrelevant, as the Bill would have no implications for functions that can be devolved. There is a real risk that, in practice, the production of such a statement would become a tick-box exercise, at best adding no real value and at worst becoming a distraction from driving forward real devolution, for which I think there is a broad consensus in favour among Members.

Access to Medical Treatments (Innovation) Bill

Edward Leigh Excerpts

Friday 16th October 2015 Commons Chamber

[Chris Heaton-Harris]

I shall come to that point in a moment.

When this idea was introduced during the passage of Lord Saatchi’s Bill, it was not a novel one. Several of the royal medical colleges, among others, had already called for such a database. The Academy of Royal Medical Colleges has recently stated that it believes that there should be

“an explicit requirement for the results of an innovation to be properly recorded with the outcomes made available to clinical colleagues for scrutiny and learning…The Academy believes that this is an essential requirement.

The Association of Medical Research Charities has said of data collection:

“This is a key aspect of innovation since new interventions require an evidence base to demonstrate safety and efficacy and to ensure effective uptake in practice.”

[Sir Edward Leigh (Gainsborough) (Con)]

I am not opposed to my hon. Friend’s Bill, which he is presenting in a very effective way, but I want to ask him a question about scrutiny. Might not a bureaucratic procedure that required medical practitioners to put innovations on to a database prevent some of those innovations from being carried out in the first place because people would fear being called to account? Might that not hold people back?

[Chris Heaton-Harris]

I will continue, if my hon. Friend will allow me, because in the depths of my speech I shall come to that point and go into detail about how this will work. I am simply proposing to confer on the Secretary of State the power to establish this process, and I hope to be able to give my hon. Friend a detailed answer to his question in due course.

The Royal College of Surgeons has stated:

“The value of innovation is severely diminished if we cannot learn from it. Registration of the results of an innovative treatment, whether positive or negative, ensures that clinicians can consider the data to learn from mistakes or spread instances of good practice.”

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[Chris Heaton-Harris]

I am not particularly worried about what is going on up top, but what I would envisage is that if I wanted to get an extra bit of thatch put on I could go to my doctor, have a conversation with him and he would be able to look on the database and say, “There is nothing there. This is all pie in the sky, hokum pokum stuff and not worth going for.” The database gives people a way of checking on the success or failure of the various treatments on offer, and if innovations such as this miracle cure for baldness are not there at all, there must be questions to be asked.

Perhaps some of the treatments on offer do work, but I doubt that the quacks out there would want their supposed innovations placed under the spotlight of transparency in both practice and outcome that the database would offer. There is another much more compelling reason for having a database that records the outcomes of medical innovation, be they successes or failures. It is impossible to learn, to move forward or to spread best practice if innovation is conducted in a silo and if no one else in the health community knows what is going on.

[Sir Edward Leigh]

My hon. Friend and I are fellow Conservatives and we have battled over the years to stop more and more bureaucratic burdens being put on professionals. Our ethos is that we should trust professionals and if they have a good treatment, they will want to test it in their own time and put it on the database. What worries me is that if we have this great bureaucratic mechanism with piles and piles of untested information poured into it, although it might discourage good doctors it will not necessarily discourage quack practitioners. Does he see my point? How does he meet this Conservative objection to the Bill?

[Chris Heaton-Harris]

There are many elements to this genuine concern. My hon. Friend was the Chairman of the Public Accounts Committee and I served on that Committee for five years. We have seen plenty of IT action in the health service space that has not worked at all, but we have moved forward into a new era of big data and can now manipulate it sensibly and shrewdly. All that would be required from the medical practitioner would be a coding on the patient’s notes that would go into the system electronically. All the work would be done behind the scenes to make that visible to the rest of the registered medical practitioner community. Hopefully, it will mean a very small amount of work in exchange for a huge amount of best practice being spread across the NHS.

I have been reading a truly great book by the author Matthew Syed, which is called “Black Box Thinking”. Essentially, it makes the case for the database, for the recording of success and failure and for trying to encourage the reporting of failure so that lessons can be learned. To paraphrase, he basically says that it is rare for someone to come across “a eureka moment” without a huge amount of previous work. In fact, although most invention comes from innovation, most of it comes from innovation in tiny steps that occasionally build up to a large leap.

In a recent radio interview, the author said that healthcare needs a

“scientific mind-set that allows people to learn from their mistakes”

and to be “brutally honest about failure”. He said:

“For senior doctors, who have spent years in training and have reached the top of their profession, being open about mistakes can be almost traumatic. Society, as a whole, has a deeply contradictory attitude to failure.”

He went on:

“Preventable medical error is one of the biggest killers in the UK—when doctors make mistakes they are worried about litigation so they are not open about mistakes and they are made again and again.”

If preventable medical error was a disease, we would devote a whole medical specialty to dealing with it. Among the many causes of that disease would be fear and a culture of blame rather than learning that lead many doctors to conclude that the best option is not to be open about mistakes, which are then repeated again and again. As Matthew Syed says

“at a collective level…success can only happen when we admit our mistakes, learn from them, and create a climate where it is, in a certain sense, ‘safe’ to fail.”

So the database would do several important things. It should increase transparency in innovation, creating an even clearer trail of evidence which not only improves patient safety but encourages further innovation. It would, hopefully, encourage a culture of information sharing, spreading good ideas and also learning from less successful ones. Additionally, I want registered medical practitioners to know and feel confident that they can use the database to innovate and to discover the innovations of others, and this is partly behind clause 3.

I want to provide clarity and give confidence to doctors about how they can demonstrate that they have acted responsibly when innovating, while using the database or not. The second part of my Bill, therefore, does one thing: essentially, it brings forward what the medical community knows as the Bolam test. Currently, the Bolam test is applied only when proceedings have gone to court. However, bringing it forward to an earlier stage would allow a responsible doctor to take a series of steps to prove that they are being exactly that—responsible when providing treatment. This does not change common law. A doctor can continue to rely on the existing Bolam test before the court.

The Bill supplements the existing law; it does not replace it. The Bill will not stop a doctor being sued for clinical negligence. It simply allows a registered medical practitioner to demonstrate what their actions were and with whom they consulted. It gives a doctor that extra bit of confidence that they can prove that what they are doing is responsible and therefore not negligent. The Department of Health did a consultation on Lord Saatchi’s Medical Innovation Bill that revealed that some doctors do find the threat of litigation to be a block to innovation, although this view is not universally or widely held.

However, given that that engagement has identified that some respondents feel constrained from innovating, there is a case for addressing this through legislation. This Bill is aimed at reassuring those doctors, even if that is just an underlying fear, and to encourage the culture change I described earlier.

As Dr John Hickey told me:

“As a registered medical practitioner, a former NHS Trust Chairman and with 30 years’ experience in the field of legal medicine with the Medical Protection Society (the last five years as Chief Executive), I believe I am adequately qualified to comment on your Bill.

Over the last 30 years I have seen how doctors have increasingly practised defensive medicine both because of the fear of litigation and disciplinary action by their regulators; this defensiveness is not in patients’ best interests.

I believe that your Bill, if approved by Parliament, would assist in meeting the concerns of clinicians treating such patients . . . I believe there are adequate safeguards in your Bill, particularly with respect to consent, to prevent the potential ‘quackery’ about which some of the critics of your Bill and Lord Saatchi’s previous Bill have expressed concern.”

I hope that my Bill is given the chance to fulfil the expectations of Dr Hickey, and many others who have contacted me to express their support for it.

I know that this Bill comes in the context of perhaps a new era in treatment, where patient choice is at the heart of decision making. Following on from the Montgomery v Lanarkshire ruling by the Supreme Court earlier in the year, I think it is fair to expect that all registered medical practitioners are now consulting their patients in a full and responsible manner and involving their patients in decisions about their ongoing treatment. So following these appropriate consultations a doctor might choose to innovate in the treatment of their patient and should feel confident to do so.

This Bill is not about research or about testing on patients. It is about harnessing the trust in the common law and the already well respected, tried and tested Bolam test. The Bill just provides clear steps to evidence Bolam, but before treatment takes place. It has always struck me as bizarre that although our national health service is constantly innovating, it rarely captures the innovative practice itself, let alone the results of that innovation. Out there right now in GP practices and in hospitals registered medical practitioners are innovating to help their patients. It is beyond belief that we fail to capture these innovations and allow others to understand and learn from them and then develop them to help others. That is the intention behind my Bill and I commend it to the House.

Improving Cancer Outcomes

Edward Leigh Excerpts

Thursday 5th February 2015 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

I beg to move,

That this House has considered improving cancer outcomes.

Recent analysis from Macmillan Cancer Support shows that there are now an estimated 2.5 million people living with cancer in this country—an increase of almost half a million over the past five years. May I therefore begin by thanking the Backbench Business Committee for granting this timely debate on an issue that is becoming ever more urgent: improving cancer outcomes?

I would also like to thank my fellow officers of the all-party group on cancer for all their hard work, and the officers of the other cancer-specific all-party groups. It speaks volumes about the importance of the issue that we have come together to secure this timely and important debate. I would like to give the all-party group on cancer a plug. The group is recognised as the wider cancer community’s voice in Parliament. It has a proud campaigning track record. It runs what is now the largest one-day conference on cancer in the UK—Britain against cancer—each December. In the Minister’s own words, it rightly holds the Government’s feet to the flames.

The timing of this debate is crucial. With only a matter of weeks of parliamentary time before the general election, and at a time when NHS England is embarking on a new cancer strategy, this is likely to be the last opportunity for this Parliament to speak up on behalf of the cancer community and feed into that strategy.

The challenge has never been greater. Macmillan Cancer Support estimates that 3 million people will be living with cancer in this country by the end of the next Parliament. By the end of next year, 1,000 people a day are expected to be diagnosed with cancer. Hospital admissions for cancer in England have increased by around 100,000 a year, compared with five years ago. The NHS has missed the target of cancer patients receiving their first treatment within 62 days of an urgent referral for three quarters.

There is also good news, though, in that we have certainly made improvements in cancer outcomes over the past few decades. The latest figures published in December show that the one-year cancer survival rates in the UK now average 68.5% to 69%—up by a full 10 percentage points since 1997. These are figures on a page, but we are talking about thousands of lives saved every single year because we are driving up cancer survival rates, particularly in the one-year figures.

However, those improvements have been gradual and incremental, and they have not been enough to catch up with our European counterparts. Research has shown that our one-year survival rates still significantly lag behind European averages. Whereas we have 68.5% to 69% in this country, the best in Europe is 81% to 82% in Sweden. That is a significant difference that accounts, very roughly, for some 10,000 lives a year. There is always a danger in making comparisons. For example, if we look at the French figures, we are making comparisons with France’s centres of excellence. None the less, the established evidence suggests that we are down by some 5,000 lives a year on European averages, and perhaps by as many as 10,000 when compared with the best in Europe.

[Sir Edward Leigh (Gainsborough) (Con)]

That is why we want an open debate about the future of the NHS. We need to recognise that the social insurance systems in France and Germany produce better outcomes for people than our own national health service.

[Mr Baron]

That is a debate for another day. I accept that dramatic improvements could be made within the existing structures of the NHS, and I want to focus on that in this debate.

The Government have estimated that from 2011 to 2015 an additional 12,000 patients will survive for more than five years after diagnosis compared with the previous five-year period. That figure tells us nothing about how we are doing relative to our European counterparts, who will no doubt also have made improvements. Are those 12,000 lives just a continuation of a fairly stable and steady trend line that has been in evidence for the past 25 to 30 years, or a kick-up, as it were, above the trend line that suggests that we are catching up with our European neighbours? I would appreciate it if the Minister provided clarity on how the figure of 12,000 additional lives saved has been calculated and what action the Government are taking to ensure that we continue to strive towards matching the best outcomes in Europe.

I am conscious that a good number of other Members will speak in the debate, so, without being exhaustive, I will focus my remarks on four key areas: earlier diagnosis and survival rates; inequalities and older people; patient experience; and, last but certainly not least, the problem that some charities are having with data access.

Earlier diagnosis has long been an issue that the all-party group has campaigned on: we describe it as cancer’s magic key. All the statistics suggest that the NHS is as good as any other health care system at treating cancers once they are detected, but poor at detecting them in the first place. That suggests that we need to raise our game as regards earlier diagnosis. Most of these 5,000 or 10,000 lives are being lost at the one-year point, and the NHS is not catching up. We therefore need to drive forward initiatives at the coalface that encourage earlier diagnosis. It is almost a national disgrace that one in five cancers are first diagnosed at A and E when those patients are, on average, twice as likely to die within a year than those diagnosed via an urgent GP referral. That shows the importance of earlier diagnosis.

With this knowledge, we have spent the past two years working with the Government and NHS England to ensure that the right accountability levers are in place to encourage earlier diagnosis. We have been successful, together with the wider cancer community—because ultimately this is about teamwork—in getting one-year and five-year cancer survival rates into the NHS outcomes framework and one-year cancer survival rates into the commissioning outcomes indicator set. That is good news. We were also delighted when Simon Stevens agreed to our recommendations on including one-year survival rates in the delivery dashboard of the clinical commissioning group assurance framework from April this year.

I have used a lot of terminology, but there is a basic logic in putting the one-year figures up in lights and breaking them down by CCG. One of the best ways, if not the best way, of driving up one-year survival rates is to better introduce initiatives that encourage earlier diagnosis at the coalface. Those could be, for example, better awareness campaigns at a local level; encouraging better screening uptake figures, some of which are pretty poor; better diagnostics at primary care; better GP referral rates; or an A and E system which, when it detects these one-in-five cancers, instead of pushing patients back down the system, refers them up, potentially saving crucial time. All or any of those could be introduced by CCGs that are trying to get their one-year figures up. Putting the one-year figures up in lights will put pressure on those CCGs to raise their game on earlier diagnosis.

Human Fertilisation and Embryology

Edward Leigh Excerpts

Tuesday 3rd February 2015 Commons Chamber

[Luciana Berger]

I am going to make some progress, because I am conscious—referring back to the intervention of the hon. Member for Wellingborough (Mr Bone)—that we have limited time and many Back Benchers wish to contribute.

It is important to note that the use of these techniques will not be rushed into lightly if Parliament does pass them today, and specialist clinicians will then have to obtain a licence from the HFEA to use the techniques. We heard last night that this will only be in centres of excellence, and the HFEA will consider applications on a case-by-case basis.

We have heard concerns in previous debates that allowing mitochondrial donation is a dangerous road to start down, and that it could potentially lead to designer babies and parents being able to select the physical characteristics of their children. But we have also heard in the public debate that these fears do not take into account the fact that these regulations are very specific and cover only mitochondrial DNA, not the nuclear DNA that determine our physical characteristics. The legislation only permits the use of these techniques in the clearly defined situation of incurable mitochondrial disorders.

The fact that these techniques apply only to the mitochondrial DNA and not to nuclear DNA should provide further reassurance to those Members concerned that this process would result in “three-parent babies.” As we have heard, mitochondrial DNA only controls mitochondrial function and energy production. Importantly, nuclear DNA, which makes us who we are and determines appearance and personality, will not be altered by the techniques that we are discussing today.

The regulations clarify that a mitochondrial donor is not to be treated as a parent, by contrast with the legal position for sperm and egg donors, who are treated as people who would, or might, be the legal parent of a child born from their donation.

There are questions around the safety of these techniques. As we have heard, this technique has received unprecedented scrutiny by the HFEA’s specially convened expert scientific review panel. However, it is possible that side effects could emerge over time and scientists have acknowledged that there would always have to be a “leap of faith” the first time the technique is used in humans.

[Sir Edward Leigh (Gainsborough) (Con)]

On the question of safety, does the hon. Lady not consider it significant that the Food and Drug Administration in the United States said that it was not clear that the scientific procedures were effective and safe? The FDA, of course, refused to allow the use of Thalidomide while we did, and the rest, as they say, is history.

[Luciana Berger]

I understand that the FDA has written to the British press in the course of the last week to contradict that position. There is a very different political situation in the US, and there is a very different set-up there in terms of the FDA compared with here and what we are discussing today.

--- Later in debate ---

[Mr David Willetts (Havant) (Con)]

I apologise to you, Mr Speaker, and to the House for missing the opening speech in the debate. Nevertheless, I was keen to speak because I think that the proposals before us today would tackle a real human need. There are parents who are currently bringing into the world children with a horrible disease and the suffering is made more acute by the fact that now, for the first time, prospective parents know that they could be doing this procedure and they therefore face the dilemma of whether or not to have children.

I realise that there are important objections. My hon. Friend the Member for Congleton (Fiona Bruce) put forward the ethical objection. I fully understand the fact that our benefit from this treatment does not of itself overcome the ethical issues, which are crucial. The red line to which she referred is, I think, a red line over which we have designer babies and change the DNA that makes the character of a person. I am persuaded by the scientific evidence that the mitochondria is not part of the core DNA that does that. In the previous debates and the previous legislation, it was absolutely clear that the red line that the House was trying to set was one that stopped the changing of human nature, and we do not cross it today.

[Sir Edward Leigh]

But it can be inherited.

[Mr Willetts]

It is absolutely true that mitochondria can be inherited through the mother, but it does not change the character of the baby.

Secondly, let me consider the health and safety objection. Sometimes that objection is being used as a cover for what is really an underlying objection in principle. The scientists say, with typical caution and care, that there is no evidence that this is unsafe. It is true that nobody can have 100% certainty about that, but there have been 15 years of research and seven years of scrutiny, including by various scientific bodies and ones promoted under this Government, and so far no one has been able to come up with a concrete and powerful objection that suggests that the process is unsafe. It is right for us today to be considering moving on to the next step.

--- Later in debate ---

[Sir Edward Leigh (Gainsborough) (Con)]

Everybody who is following this debate will of course have the most profound sympathy for families who are affected by these appalling diseases, and I quite understand why so many colleagues want to vote for the regulations to lessen human suffering, but I am afraid that I will oppose the regulations. I do so on three grounds: ethics, safety and the importance of parliamentary procedure.

On the first, ethics, I think what we are considering is a new step. It will affect the germ line. Mitochondria is inherited; it is not just another organ of the body. What is proposed is a fatal and important step. As my hon. Friend the Member for Congleton (Fiona Bruce) asked, where do we stop? Given the nature of the human condition, these appalling diseases, sadly, will occur, but where do we stop? What further modifications will we make?

My second ground for opposing the regulations is safety. Under European conventions and regulations and so on, we should have full clinical trials and the scientific community should be united on aspects of safety, which it is not. Unfortunately, we will be the first state in the world to authorise the technique, and in that sense, in bioethical terms, we will be in a unique position. We should ask ourselves why no other state—not in the EU, not the US, not yet anybody—thinks that this is proved to be absolutely safe.

As for the third reason for my opposition, it has been said that this is not a final decision, and that we are just handing it over to the HFEA, but this is the final decision; it is a monumental decision. For the first time, Parliament is saying that we authorise people to affect mitochondrial DNA. That is a monumental decision. This will now happen and colleagues who vote for the regulations must appreciate that.

For those three reasons—on ethical grounds, on safety grounds and on procedural grounds—I will vote against the regulations.

Contaminated Blood

Edward Leigh Excerpts

Thursday 15th January 2015 Commons Chamber

[Sir Edward Leigh (Gainsborough) (Con)]

I echo the right hon. Member for Knowsley (Mr Howarth) in describing this as a debt of honour. That, I think, sums up what the debate is all about. We caused this. We did not cause it personally, of course, but it was caused by the state and the national health service, so we are responsible.

I congratulate all Members who have spoken—particularly, of course, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who has campaigned so effectively. I also pay tribute to my late friend Jim Dobbin. As has already been mentioned, his memorial service took place yesterday, and, in paying tribute to him, the Bishop of Southwark described him as an MP of causes. I know the House of Commons and politicians are often criticised, perhaps quite rightly, but I think this debate shows the House of Commons at its best. There are many MPs, like Jim, who do not necessarily see their political life as one of holding high office but who realise we are here to try to promote causes, particularly as, because of our constituency system, when we speak here we often do so because our constituents have approached us. In other political systems Members of national Parliaments are perhaps more remote.

One national politician who is not remote is the shadow Secretary of State, the right hon. Member for Leigh (Andy Burnham). We are all very grateful that he is here today given his other responsibilities, and I am working with him on another issue where people’s lives have been ruined through no fault of their own. We value his presence here today.

I have said that many of us are here today because of constituents, and I am here because of my constituent Gary Jones from Scotter, who has raised this issue with me several times. I want to share some of his thoughts with the House. First, however, may I make an apology: I am on the Panel of Chairs and quite soon I will have to go and chair a private Bill, so I may miss the winding-up speeches.

As I have said, I want to talk about the issues Gary Jones has raised and, in particular the Irish compensation scheme. Before doing so, however, I want to echo and emphasise what my hon. Friend the Member for Aldershot (Sir Gerald Howarth) said in an intervention as it makes the point very clearly. I have already said this once and I will say it again, and it will be said several times during this debate: let right be done.

We caused this, and we have to put it right. The state—or the establishment—is responsible. I do not know who is really responsible—probably no particular individual; no doubt everybody was trying their best—but there has been gross negligence over several decades, since perhaps as early as the 1940s when the viral risks associated with the blood products in question were known and patients were not informed. One of the greatest scandals in all this is that so many patients have been kept in the dark.

[Richard Fuller (Bedford) (Con)]

My hon. Friend said that this was an example of gross negligence by the state. In addition to what the Penrose inquiry will show that is specific to the contaminated blood issue, does he agree this is also an opportunity for us to set some guidelines and rules for those occasions when there are failures by the state health service on how it will deal with compensation so that we avoid a patchwork of problems similar to those that affected our constituents?

[Sir Edward Leigh]

I entirely agree, and I do not think this is just a question of money. If we attack the Government just in terms of money, we might not succeed in this campaign. It is also a question of learning lessons, and what the victims want above all is some sense of involvement in future schemes. We must learn lessons, and I am sure we are doing so.

The screening of blood donors was totally inadequate, allowing those with a history of jaundice to donate. Even in response to the rise of AIDS the Government failed to implement the best technology available at the time to render blood products safe. The results of this neglect have been appalling: the infection of over 5,000 haemophiliacs with hepatitis B and C, over 1,000 of whom were also infected with HIV from NHS blood products, resulting in 2,500 deaths. Although there has been compensation in many cases, it has been inadequate—indeed, they would claim it has been miserly. For instance, although there is a one-off payment available for hepatitis stage 1, there is no ongoing payment. All this is plainly unacceptable; I think everybody who has spoken agrees with that. It is also obvious that there must be a suitable scheme for compensation to the victims—not that any monetary amount can repair the damage that has been done.

The Irish scheme has perhaps not received as much attention as it should have done in this debate so far, and again I am quoting here from the arguments given to me by my constituent. It is not, as I am afraid some of my hon. and right hon. Friends on the Front Bench have suggested, that we want to link the UK compensation payment scheme to that which exists in Ireland. It is worth repeating that campaigners have never expressed a wish to place the Government’s funding of any compensation scheme in Irish hands. For myself, I do not suggest that the compensation should be exactly the same, but the Irish scheme is worth looking at in terms of compassion: it puts compassion first; it accepts liability; and it is substantial enough for the victims to gain closure. So I encourage Ministers to look further into the compensation scheme the Republic of Ireland has established and to see what lessons might be applicable to us here in the UK.

[Jenny Willott]

Does the hon. Gentleman agree that, because we are talking about quite a small number of people, fairly generous packages of compensation would be affordable? We are not looking at millions of people; we are looking at a small number of people who have suffered very seriously as a result of the NHS.

[Sir Edward Leigh]

Yes, I want to deal with that point, and I am glad that the hon. Lady has made that intervention. I can quite understand where the Government are coming from, but both my hon. Friend the Member for Aldershot and I—and others who have spoken—cannot ever be accused of wanting to waste public money. We are very aware of the pressures on Government. Again I am grateful to my constituent for some of the figures that have been given to me. He says—and I hope the Minister will reply to this point—that:

“The figures quoted in the Written Ministerial Statement are completely incorrect. The Government have refuted suggestions that they based their calculations on a typographical error in the Archer Report and claim that the costings were based on an average of £750,000 per person. The CEO of the Irish Haemophilia Society has confirmed that the average figures paid out in Ireland was ‘around €350,000’ per person.”

So the total figure we are talking about here is £1.5 billion. That is very similar to the compensation paid to the victims of Equitable Life. I have campaigned on Equitable Life, as we all have, and it is pretty awful for someone to lose their life savings and there was appalling suffering, but at the end of the day they have lost their savings; they have not lost their life. So if we are prepared to pay this sort of compensation to the victims of Equitable Life, why do we baulk at similar figures for those whose whole lives have been ruined, and ultimately many of them lost?

My hon. Friend the Member for Gosport (Caroline Dinenage) put it very well:

“I recently met a delegation of people who had suffered through the Equitable Life disaster. Although I have every sympathy with their plight, today’s debate puts that matter into perspective because we are talking not about the loss of life savings, but about the loss of life itself, loss of livelihood and of the chance to grow old, and losing the chance to become a parent and see one’s children grow up.”—[Official Report, 14 October 2010; Vol. 516, c. 556-7.]

I could not put it any better, and I end on the following point. We recognise that we are at fault. We recognise that these people’s lives have been ruined. We recognise that the current compensation scheme has not fulfilled their expectations and is not fair. Let right be done.

Surrogacy

Edward Leigh Excerpts

Tuesday 14th October 2014 Westminster Hall

[Julie Hilling (Bolton West) (Lab)]

rose—

[Sir Edward Leigh (in the Chair)]

Order. I will call the hon. Lady, but she did miss most of the opening speech. I am sure she will want to apologise, although I am also sure that there is a good reason why she was late.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I congratulate the hon. Member for Erewash (Jessica Lee) on choosing this interesting and important subject for a Westminster Hall debate. She put the case eloquently, sensitively and sensibly.

It is some decades since the main rules controlling surrogacy were put in place, and it is no exaggeration to say that they are a product of their time. Although there has been welcome progress on some aspects of surrogacy—for example, provision for adoption leave and pay for intended surrogate parents was included in the Children and Families Act 2014—a more fundamental examination of our position on surrogacy is needed, so the debate is extremely timely.

Of course, it is important to say at the outset that the health and well-being of any children born as a result of surrogacy arrangements must be at the heart of our concerns. As the hon. Member for Stevenage (Stephen McPartland) rightly said, that must sit firmly alongside the need to prevent exploitation of any of those involved in surrogacy, but the welfare of children must be paramount.

Aspects of the current situation can certainly be described as troubling. The growth of the internet continues to accelerate, and it takes only a few keystrokes to bring up a search engine web page with paid advertising for commercial surrogacy services abroad. The revelation that Britain may account for as many as 1,000 surrogate births in India every year is shocking enough, but when it is contrasted with the low numbers known to be taking place in Britain, it is clear that the situation requires serious review. There is a clear need for further research to establish the size of the international trade in surrogacy and to enable the development of a deeper understanding of how it functions.

It is not just the hon. Member for Watford (Richard Harrington) and my hon. Friend the Member for Bolton West (Julie Hilling) who have experienced tricky constituency casework on this issue. Earlier this year, she and I had almost identical cases, which we discussed. The legal issues got very tricky, and that was compounded by the passport fiasco. Thankfully, my case, like hers, has been satisfactorily resolved for the parents and the child. However, the cases were tricky, which highlights just how difficult some of these surrogacy arrangements can be. While that can be compounded by factors outside the control of those involved, the arrangements in India were incredibly tricky and caused the parents a lot of heartache and trauma, as well as a lot of unex—I am trying to think of the word. I have lost my train of thought.

[Sir Edward Leigh (in the Chair)]

Unexpected.

[Andrew Gwynne]

Thank you, Sir Edward—unexpected expense. That placed the family in severe difficulties while they were in India.

Although our legislative framework might restrict exploitation in connection with surrogacy in the UK, it might simply be shipping exploitation abroad, where there are undoubted commercial opportunities to make large amounts from the exploitation of poor women. In the past few days the case has been reported of an Australian couple who are said to have abandoned one of two surrogate twin babies born in India, taking only one of them back with them. That amply demonstrates the need for international action. I hope that today’s debate will highlight the need for consideration of an international convention on surrogacy, so that we can put an end to such unethical and immoral practices.

The international dimension is important, but inevitably the question arises of how we might alter the situation in the UK to enable aspiring parents to explore the option of surrogacy in a way that protects all parties and puts children’s interests first. I suggest that we consider three things. The first is an assessment of the scale of the need for surrogacy and whether we can reduce that need through action to reduce the incidence of infertility in women. The second is an assessment of the extent of the international trade in surrogacy; on international health questions, we are much more effective if we operate in concert with other countries. The World Health Organisation appears to take little interest at present in surrogate motherhood issues, and perhaps the United Kingdom, as a member of its executive board, should take a lead in raising the issue and ensuring that it is included in the WHO programme of work. I should be interested to hear how the Minister can take that matter forward. The third thing to consider is a review of UK legislation on surrogate motherhood. Difficult issues will inevitably need to be considered, particularly the potential involvement of commercial interests in arranging surrogacy. The hon. Member for Erewash set out a possible framework, and that should be considered carefully. I am interested to hear the Minister’s response to the important points she made.

The current position is clearly unsatisfactory and in need of attention. If the population is to continue to make use of surrogate motherhood to deal with the problem of infertility, it would surely be better for the processes to take place within an ordered, regulated system here, than in a system that is not ordered, halfway round the world. It would be better for the parents, the surrogate mother and the child. The comments and suggestions made by the hon. Member for Erewash were compelling. She is right to raise the question of how to strengthen our domestic law to protect all concerned. This is a sensitive area that needs to be considered carefully, but there is a need for change at home as well as internationally, and I look to the Minister to give direction, answer questions and consider the possible solutions that Members have suggested. Thank you, Sir Edward, for filling the gaps that were left in my speech when, sadly, my train of thought left my brain.

Mitochondrial Replacement (Public Safety)

Edward Leigh Excerpts

Monday 1st September 2014 Commons Chamber

[Sir Edward Leigh (Gainsborough) (Con)]

There has been a great deal of controversy over the past few decades about genetically modified plants and crops. Through the march of applied sciences and advances in agriculture we have managed to feed billions of people, but I am sure that all Members will agree that we are dealing with entirely separate issues when we talk about genetically modified food and what we are dealing with now, which is genetically modified people. We have only in the past 100 years come to terms with the debilitating, restrictive and oppressive results of centuries of racism buttressed by pseudo-scientific notions that have since been proved entirely false. How much more of a problem will we be confronted with when humanity is divided between the modified and the unmodified?

I say to my right hon. Friend the Member for Havant (Mr Willetts) that mitochondria contain DNA. They are present in every cell in the body and just because they are not nuclear does not mean that they are any less an integral part of a human being. The mitochondria that contain DNA interact with the nucleus and many scientists therefore believe that they contribute material to the identity of an individual. Bioethicists have up until this point expressed almost universal consensus on germ-line genetic modification of our fellow humans, rejecting it as grievously immoral and completely unethical. The consensus is worth pointing out as we must know what the proponents of mitochondrial transfer are asking us to dissent from. They are asking us to dissent from opinion in every other country in the world. In this age of globalisation, we will be divorcing ourselves from the entire community of nations in terms of bioethics. Do we really want to become a rogue state in terms of bioethics?

No one can deny the debilitations and hardships that these diseases cause. No one is seeking to downplay that suffering, but this is not about a cure. This will neither heal nor cure a single human being suffering from these diseases. What is worse, when we talk about pronuclear transfer, is that that effectively requires the creation of human beings for the sole purpose of harvesting their useful parts. Is that really the sort of society in which we wish to live, in which persons—individuals—are created, their parts harvested and then destroyed, merely to provide for other human beings? There is no way that that can be considered ethical, whether in terms of purely rational deductive natural law, or by the system of Christian ethics on which we in this country have traditionally relied. I hope hon. Members on both sides of the House, and from every part of the spectrum from right to left, can unite on that point. I support the motion.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate my hon. Friend the Member for Congleton (Fiona Bruce) on securing this debate at the Backbench Business Committee and all the right hon. and hon. Members who have contributed. It has been an extremely thought-provoking debate. Inevitably, in the time available to me, which I believe is 10 minutes, I will not be able to do justice to every point, but I hope that Members know that if there is a point that I am unable to cover in my remarks, I will follow it up afterwards and attempt to respond to them.

I welcome this opportunity to discuss mitochondrial donation and to reflect on the scientific and policy journey that has brought us to this point. As many Members have said, children are being born with and are dying from devastating conditions that are caused by mitochondrial disease. Scientists and clinicians have developed a treatment to tackle it but, rightly, Parliament will need to approve new regulations for it to be used.

As Members have said, this is not a new subject for Parliament to be debating. In 2008, Parliament agreed amendments to the Human Fertilisation and Embryology Act in anticipation of these groundbreaking developments. That provided a power to introduce regulations that would allow mitochondrial donations. It is that next stage that is the focus of our deliberations.

I will explain the thorough and open approach that has been used to assess the safety and efficacy of the proposed donation techniques, and to gauge the public’s views. This has not been a rushed process and I do not agree that Parliament is being asked to vote blind, as some have said—far from it, as others who have been in this House for longer than I have testified. We have asked the HFEA to convene a panel of experts three times since 2011 to review the scientific evidence on the safety and efficacy of the proposed donation techniques. All three reviews have indicated that the donation techniques—maternal spindle transfer and pronuclear transfer—would be effective, and all three reviews have found no evidence to indicate that either technique would be unsafe. To quote the chair of the expert panel, Professor Andy Greenfield, whom I have met to discuss the reports:

“In three years’ study the expert panel has seen no evidence which suggests that these new mitochondrial replacement therapies are unsafe.”

However, I appreciate that some Members have expressed concerns. Some are opposed in principle and some have practical concerns about whether we have looked at all the important details.

The decision on whether a new treatment can be described as safe is never absolute, as Members have said. Doctors and scientists rarely, if ever, make an unqualified statement that a procedure is safe. Instead, they proceed by hypothesis, evidence and risk analysis. Indeed, no medical procedure is without risk, from a cataract removal to a triple heart bypass.

There have been calls today for more research into mitochondrial donation, but research cannot be expected to answer every question. All that we can ask is that it adds to our knowledge and highlights areas that need to be looked into further and monitored more closely. We are currently considering the most recent report of the expert panel, the assurances that have been given on the safety and efficacy of the techniques involved and the recommendation of further experiments to confirm earlier findings.

The draft regulations to allow mitochondrial donation, on which we consulted, would also bring into place important safeguards, as others have said, through the HFEA’s strict licensing procedures. For a licence to be issued to a provider of mitochondrial donation, they would first have to demonstrate that they could carry out the procedure safely and effectively.

[Sir Edward Leigh]

Will my hon. Friend give way?

[Jane Ellison]

I will take only one intervention, if the House will allow me.

[Sir Edward Leigh]

It has been said in the debate that we are not creating three or four-parent families, but given that the cells of a second mother will be used, will a child have a legal right to know the identity of the three or four people who contributed to their creation?

[Jane Ellison]

That was one area of detail covered in the draft regulations and the responses to the consultation on it, and I will write to my hon. Friend with a detailed response. A wider point is that we should surely not reduce the notion of parenthood to genes. Many Members who have spoken in the debate, particularly my hon. Friend the Member for Congleton, who moved the motion, have often spoken in other contexts about parenthood being more about loving, nurturing and so on. It cannot be reduced simply to the donation of genes—I worry that that, in itself, would be a slippery slope.

Mitochondrial donation is supported by both the chief medical officer, Professor Dame Sally Davies, and many clinicians and IVF experts, including, I am pleased to say, Professor Lord Winston, who has been quoted a number of times in the debate. Among other comments, he has made it clear that he supports the draft regulations and would vote for them.

This is undoubtedly a really difficult area in which to gauge public opinion, because it is complex and technical and a lot of people know nothing about it. Some Members who have seen e-mails going around the House asking them to attend this debate have told me that they did not know what it was about. That means that the exercise of engaging the public needs to be carried out in a thoughtful and comprehensive way. That was exactly what the Government did—we tested the public acceptability of introducing these techniques through a comprehensive dialogue process commissioned by the HFEA and led by external experts. It included events such as workshops and focus groups, and it showed that when the process of mitochondrial donation was fully explained to them, the majority of people supported its use provided that it was carefully regulated. The Department of Health’s consultation was on the draft regulations, and those who commented on them broadly supported them. I urge people to be mindful of the way to go about testing public opinion on the matter. We have to ensure that it is done on the basis of facts.

Oral Answers to Questions

Edward Leigh Excerpts

Tuesday 15th July 2014 Commons Chamber

[Jane Ellison]

Unsurprisingly, that is another example of the hon. Gentleman putting politics before patients. We have had a slew of information put out to people in his area and surrounding areas, much of which did not highlight the new facilities that are being introduced. I would love to hear the hon. Gentleman talk up the new facilities coming into that area. Charing Cross hospital will be redeveloped as a 21st century health care facility, in line with my right hon. Friend’s decision based on the independent reconfiguration panel’s advice. Charing Cross and Ealing will have a local A and E with 24/7 access to full diagnostic support, consultant advice and specialist care—and it would be really refreshing if the hon. Gentleman, rather than following his usual line, could tell some of his constituents the good news about health care in his part of London.

[Sir Edward Leigh (Gainsborough) (Con)]

5. What steps he plans to take to improve standards in general practice.

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

We are working hard to improve standards of care in general practice. We have brought back named GPs for those aged 75 and over, introduced a new inspection regime and are doing everything we can to recruit more GPs to improve capacity.

[Sir Edward Leigh]

When will both political parties be honest about the massive looming black hole in health funding, with an ageing population demanding ever better care? We cannot afford to pay for it out of general taxation, so are we going to be honest and have an open debate about moving to the French system of social insurance in which people are charged and repaid if they do not have the means, giving them an infinitely better health service?

[Mr Hunt]

I do not agree with my hon. Friend; let me explain why. The first and important point is that independent studies, such as that which was done last month by the Commonwealth Fund, have ranked the NHS top out of 11 major health economies, including the French example. Money is, of course, tight throughout the NHS, but we have been able to find efficiency savings of £20 billion over the last five years, and we will continue to find them. What I would not support, however, is any system of charging that would make it harder to access NHS services, particularly for older people whom we need to access more services more quickly if the NHS is to be sustainable.

Oral Answers to Questions

Edward Leigh Excerpts

Tuesday 10th June 2014 Commons Chamber

[Norman Lamb]

My hon. and learned Friend has raised an extremely important point. It is essential that the maximum possible use be made of investment. I know that the Secretary of State will look into this issue when he has received the letter, but we must ensure that all such facilities are properly used.

[Sir Edward Leigh (Gainsborough) (Con)]

14. What steps he plans to take to improve the provision of health services in the east midlands.

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

Decisions about local services should be made as close to patients as possible, by those who are best placed to work with patients and the public to understand their needs. Clinical commissioning groups commission the majority of health services, working with health and care professionals to design services for local populations.

[Sir Edward Leigh]

In large rural areas like Lincolnshire, the air ambulance can make the difference between life and death, particularly for car crashes where roads are blocked. What plans does the Minister have to strengthen the services of the East Midlands air ambulance service?

[Norman Lamb]

I will be very happy to discuss the issue with my hon. Friend, if he would like to do so. I pay tribute to the extraordinary work the air ambulance services undertake across our country. I have witnessed that in my own community and I would be very happy to talk further about what more can be done to strengthen the work they do.