Health Service Medical Supplies (Costs) Bill

Baroness Laing of Elderslie Excerpts

Tuesday 25th April 2017 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

I beg to move, That this House disagrees with Lords amendment 3B.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

With this it will be convenient to discuss Government amendments (a) and (b) in lieu.

[Mr Dunne]

When we last debated the Bill, I reminded the House of its importance. I do not intend to go over all that ground again, save to note the three primary purposes of the Bill: first, to give powers to align broadly our statutory scheme for the control of prices of branded medicines with our voluntary scheme, by introducing the possibility of a payment percentage for the statutory scheme, which could deliver £90 million of funding for the NHS every year; secondly, to give us stronger powers to set prices of unbranded generic medicines where companies charge unjustifiably high prices in the absence of competition; and, thirdly, to give us stronger powers to require companies in the supply chain for medicines, medical supplies and other related products to provide us with information. We intend to use that information to operate our pricing schemes, to reimburse community pharmacies for the products they dispense and to assure ourselves that the supply chain or specific products provide good value for money for the NHS and the taxpayer.

We agreed with 23 amendments made by their lordships during the passage of the Bill through the other place. Those, we accept, have made this a better Bill. We rejected just a single amendment. Despite the strength of our arguments, the other place has now made amendment 3B, which to all intents and purposes has the same effect as the original Lords amendment 3. It would introduce a duty on the Government, in exercising their functions to control costs, to take into account the need to promote and support a growing life sciences sector and to ensure that patients have access to new medicines. As I explained previously to this House, the amendment, which is no different in its effect from previously, would undermine one of the core purposes of this Bill: to enable the Government to put effective cost controls in place.

In our view, the amendment could encourage companies to bring legal challenges where the cost controls have not in themselves promoted growth in the life sciences industry. That could significantly hinder the Government’s ability to exercise their powers effectively to control costs. That would have a particularly detrimental effect if the Government were to take action to control the price of an unbranded generic medicine where it was clear that the company was exploiting the NHS—a point on which there was cross-party agreement when we debated the matter. That is because the Government might be challenged, not on the basis that the action was inappropriate, but on the basis that it did not promote the life sciences sector. Nevertheless, as I am sure all Members would agree, such action could be the right thing to do for the NHS, patients and taxpayers. The powers in the Bill that enable such action have received universal, cross-party support in both Houses.

Through debate on the issue in the other place, we have clarified that their lordships did not intend to undermine the core purposes of the Bill. Rather, the intent was to ensure a mechanism, laid out on the face of the Bill, to ensure that the Government pause to reflect on the impact of any proposed price control scheme on the life sciences industry and access to cost-effective medicines. With this clarity, the Government are now proposing amendments in lieu of Lords amendment 3B that will achieve that intent without undermining the core purpose of the Bill.

Consultation requirements prior to the implementation of any new statutory price control scheme for medicines are already set out in section 263 of the National Health Service Act 2006. Our amendment (b) in lieu would amend the 2006 Act to include particular factors that must be consulted on before proceeding with a new statutory scheme. They are:

“(a) the economic consequences for the life sciences industry in the United Kingdom;

(b) the consequences for the economy of the United Kingdom;

(c) the consequences for patients to whom any health service medicines are to be supplied and for other health service patients.”

The requirements are framed in that way to allow us not only to consider the economic consequences for the life sciences industry and for patients who may benefit from new medicines, but to balance those factors against wider considerations. I am sure the whole House can agree that while a thriving life sciences industry and access to new medicines are highly desirable, they must not come at any cost. It is the Government’s responsibility to achieve the right balance, and, indeed, to be held to account for it.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I thank the hon. Gentleman for his extremely kind words, and for his courtesy, which he always shows at the Dispatch Box and in the Chamber.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Like the hon. Member for Ellesmere Port and Neston (Justin Madders), this will be my last time speaking in the Chamber before Dissolution, and as a newbie I also want to pay tribute to the staff of the House, who made coming here much easier than we had expected it to be. I am also glad that my final speech before Dissolution is on a Bill that, despite some of our disagreements, we have worked on on a cross-party basis to produce a piece of work that we all agreed needed to be done.

I, too, welcome Government amendment (b), although I would have laid out the three paragraphs the other way around, because the whole point of the NHS, and the whole reason we are discussing this, is patient access: that is the No. 1 concern. I would have put patients first, not third. The fear of not getting access to drugs is a great issue for patients. As the hon. Gentleman mentioned, we have a significant delay that is measurable in comparison with other countries. For certain types of cancer, our performance in relation to patients with early disease is as good as anywhere, but we fall down in dealing with people with difficult or advanced disease. That is because of the delay.

I want briefly to mention the interaction of the budget impact assessment with our no longer being part of the European Medicines Agency. I am not talking about the United Kingdom losing the agency itself; I am talking about our no longer being part of the scheme. We know that there is a danger that drugs are presented for licensing in the United Kingdom at a later date than in the United States and the European Union, which are major markets. It is likely that we could also be behind Japan. I am not suggesting that we should simply hand over any amount of money, but if we were also seen as a hostile market in which there was an expected delay of three years for expensive drugs, there would be a danger that international pharma would simply say, “You know what? We’ll license everywhere else, then we’ll come back to the UK in a few years.” That could result in significant delayed access for our patients.

We need to think about how all this feeds into trials and research, and into the life sciences system. If we are not using what is considered to be the gold standard drug at the time of a new international trial, we will not be able to take part in the comparison of the gold standard with the new drug. The UK has led the EU research network, which is the biggest research network in the world. We have been a major player in that, and it is important to realise how building in this delay from NHS England could undermine that. Surely this should be part of the NICE process. It should be clear to pharma, when it comes with a drug at a price, what process it will have to go through, what evidence it will have to bring forward and how it will have to negotiate a price. I fear that there will be delays in drugs being licensed.

This will affect us in Scotland even though NICE decisions do not apply to us. If a drug were simply not licensed here, it would be irrelevant that the Scottish Medicines Consortium chose to fund it—as it did the other week with Kadcyla—because it would still be an unlicensed medicine. We need to look at how the loss of the European Medicines Agency will work in this regard. There should not be a separate procedure after NICE that could suddenly hit pharma with another barrier to jump over. This will hit new cancer drugs, because they are expensive. It will particularly hit drugs for rare diseases, which the EMA has led on, because they are bespoke and therefore inevitably expensive. The £20 million limit would mean that if someone came up with a fabulous cure for dementia, for example, a budget impact assessment would be triggered.

Contaminated Blood

Baroness Laing of Elderslie Excerpts

Tuesday 25th April 2017 Commons Chamber

[Andy Burnham]

I will not be here, but I make a plea to the hon. Gentleman, if he is returned—do not rule out Labour in Scotland, it is on the way back. I make a plea to everybody here in the Chamber today and to the candidates who may be coming here that they must act on this information. They cannot leave this where it is. Their conscience must tell them that they have to do something about it.

When the Government ruled out an inquiry into Orgreave, despite the existence of clear evidence of serious wrongdoing by the police, they did so on the basis that “nobody died”. I am afraid that that threadbare defence will not hold here. People have died—2,000 in all—and they have been the victims of both negligence and a cover-up. In its heart of hearts, this Parliament knows that to be true, and so the question is: what are we going to do about it?

I will end with a quote from an email I received from another victim, Roger Kirman, who became infected with Hepatitis C in 1978 but only found out by accident when having a hip replacement operation in 1994—this despite having raised his family in between. His brother George died from AIDS in 1991. He wrote:

“I have been fortunate to make it as far as I have but I have a real sense of anger against successive governments for their indifference to the plight of so many. Politicians should not be surprised at the loss of confidence in Parliament when candour is not forthcoming and they are seen as interested only in preserving their own position and the status quo.”

I suspect that Roger speaks for every single family affected by this scandal.

It has been an enormous privilege to serve my constituents in the House, and it is with real sadness that I prepare to leave, but in my 16 years here I have also had my eyes opened to its shortcomings. The simple fact that since Hillsborough I have been approached by so many justice campaigns—many of them from the 1970s and 1980s—tells me that this place has not been doing its job properly. Westminster will only begin to solve the political crisis we are living through when, in the face of evidence, it learns to act fearlessly and swiftly in pursuit of the truth and gives a voice to those of our fellow citizens who through no fault of their own have been left in the wilderness.

Collectively, we have failed the victims of contaminated blood. I do not exempt myself from this, and I wish to apologise to all those affected for coming so late to this issue in my speech tonight. I also apologise to you, Madam Deputy Speaker, for the length of my comments—but in a way I do not actually: the House should be delayed tonight on this matter. Truth and justice have been delayed for people, so the House should be delayed tonight, as it hears directly what they have been through. I hope that we have given a flavour of that tonight. I say to Members here and those who might follow: it is never too late to do the right thing. [Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I do not want any clapping; “Hear, hear” will be fine.

As the right hon. Gentleman concludes his valedictory speech in the House, I am sure that the whole House will join me in wishing him well.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. We have an unusual procedural situation here. Of course there is plenty of time for our Adjournment debate, given that it started as early as this, and we are discussing a very serious matter, but Members who are now rising to speak gave no indication before the Minister spoke that they wished to do so. That does not mean that they will not be permitted to speak, but just because this happens to be the end of a Parliament, and there is time available to discuss this important issue, does not mean that I will ignore the—[Interruption.] Order. Mr Durkan! I am addressing the House. This does not mean that I will ignore the normal courtesies of this Chamber. Two people have indicated that they wish to speak. They must know that they ought to have done so before the Minister spoke. It was quite obvious when I was going to call the Minister. In these unusual circumstances, I will allow those two Members to speak very briefly now, and I do not expect further interventions.

Rationing of Surgery

Baroness Laing of Elderslie Excerpts

Tuesday 28th February 2017 Commons Chamber

[Rachael Maskell (York Central) (Lab/Co-op)]

I am grateful for the opportunity to debate the rationing of surgery. The reason this is such an urgent issue is threefold: first, it is causing detriment to the health of the people of York; secondly, it is discriminatory; and, thirdly, the policy now reaches beyond York.

I am sure the Minister will set out how, under the Health and Social Care Act 2012, matters of clinical decision making were devolved to clinical commissioning groups to make decisions about local need, but this matter is so serious that I urge him to take action, as the Secretary of State said he would. I have exhausted all routes to getting the policy reviewed, so I am now appealing, through this debate, for a complete review. NHS England has previously been clear that even time-limited bans on particular groups of patients receiving treatment is inconsistent with the NHS constitution. In the light of that, I trust it will commit to withdrawing its support for rationing now that evidence of its detriment is coming through.

The Vale of York CCG determined to delay surgery to patients who smoked or had a body mass index of more than 30. The policy came into force on 1 February 2017. It was first proposed in September last year, but then withdrawn and reintroduced in November. The reason: to delay immediate spend on surgery. However, it is a totally false economy, and although it may delay CCG spend now, in order to meet imposed spending restrictions, the Royal College of Surgeons says that it may actually increase NHS costs if patients develop complications while waiting for surgery. The college has been clear that rationing policies, such as those implemented by the Vale of York CCG, are unacceptable.

The York CCG’s ability to make rationing decisions comes direct from the 2012 Act. The duty on the Secretary of State for Health to “provide or secure” the health service was removed from section 1 of the National Health Service Act 2006, thereby removing his responsibility, and replaced by a duty to make provision for the health service. The list of services that the NHS had to provide—a principle that had been embedded in the NHS since its inception—was also removed, meaning there no longer had to be a universal list of service provision, and that each CCG could determine its own. In other words, it became a complete postcode lottery: where someone lives determines the healthcare they can access.

Nevertheless, I was encouraged by the Secretary of State’s response to a question on rationing from the Health Committee on 18 October 2016. He said:

“When we hear evidence of rationing happening, we do something about it…we are absolutely determined to give people the clinical care that they need.”

In response to the Chair of the Committee, he said:

“When we hear of occasions when we think the wrong choices have been made, when an efficiency saving is proposed that we think would negatively impact on patient care, we step in, because, challenging though it is, our responsibility to the public is to make sure that we continue to make the NHS safer and higher quality and that it offers a higher standard of care”.

Minister, it is time to step in.

Early on, the Vale of York CCG hit the headlines and became unstuck when it rationed interventions such as in vitro fertilisation treatments—a decision that was reversed—so this CCG has form. As we saw from yesterday’s health and social care debate, the NHS financial model has failed. Not only does the funding formula fall short of real need, but the NHS now has the wrong financial drivers in place, resulting in a demand- led approach to health provision and uncontrollable spend.

I could talk more on that, but the Vale of York CCG introduced a delay on surgery as a direct result of its failure to contain its spend within budget; it now has special measures bearing down on it. The CCG receives around £1,150 per patient, when demand seriously exceeds that. CCGs just down the road are receiving 50%-plus more. York has an ageing population demographic and areas of serious deprivation. I urge the Minister to look again at NHS funding, because it simply is not working and our CCG is being penalised for that.

The Vale of York CCG took the decision to ration surgery for up to a year for those overweight and up to six months for smokers. Having worked in the NHS as a clinician—I was a senior physiotherapist—I am all too aware of the risk factors created by people smoking and being overweight, not least when it comes to surgery, and I do not need the Minister, as a non-clinician, to spell them out to me today. I would see patients pre-operatively to provide advice, and would also treat them post-operatively to address the risks through respiratory therapy and mobilisation. All clinicians understand the risk factors, which is why it is so important that money is invested in public health services—something that the Government have failed to do.

A child receives, on average, 12 minutes a year of school nursing, which includes child protection work. That means that they get only a few minutes a year of advice on diet, exercise, smoking and sex education. Clearly, that is not enough, especially as PE has also been cut. Yesterday, I met local school nurses who set out how their service was being cut, and how school nurses are being downgraded and de-professionalised to make savings in York.

When the Government switched public health back to local authorities, which have had their grants slashed, public health services also suffered. The irony is that York’s council completely cut funding for smoking cessation services and for NHS health checks. It also cut the health walks programme, which was a service to help people exercise more and lose weight. Therefore, public health measures to address smoking and weight were cut first, and then patients were denied surgery because they smoked or were overweight—you could not make it up. It again shows how fragmentation creates health detriment.

GPs are now actively writing to patients to ask them whether they smoke—not that they have a smoking cessation service to refer them to. They say that it is just “for their records”. Patients who are seen by their GP and who are considered to be in need of an assessment by a specialist for surgery fill out a form. They have to declare their smoking and weight status. One would think that the surgeon would receive a letter, highlighting the risk, and then would make a clinical assessment of that risk—but no. The referral is diverted, and the patient is sent a standard letter and a leaflet, which does not reflect on their own personal circumstances, but tells them that they smoke or are overweight and therefore need to change their ways. As a penalty, they are denied surgery. The specialist never gets the opportunity to assess the patient and make clinical judgments accordingly.

I am sure that the Minister will recall the narrative, which enticed some in this House to support the Health and Social Care Act 2012. We heard that doctors will be at the heart of the NHS and that they, not bureaucrats, will be the ones making the decisions. Then there was, “No decision about me without me.” Here we have a system where clinicians are being undermined by diktats from bureaucrats; patients and clinicians have no say; and clinical evidence is left wanting.

Before I progress, let me turn to this letter that patients are sent. First, it is generic and has no personal advice about the patient’s own clinical circumstances. By the time a patient reaches the third paragraph, they are told how obesity is costing the CCG £46 million and smoking £7.2 million a year, as if that is an issue for the patient who needs surgery. The penalties are then set out. Those who are obese have to lose 10% of their weight or reduce their BMI to under 30, or wait 12 months. Those who smoke have to stop smoking for eight weeks, or wait six months. Enclosed with the letter is a leaflet entitled “Stop before your op” and a web address so that people can find out how to get support. I went through this and the convoluted website. Any public health practitioner would tell you how inappropriate and ineffective this whole system is. There is no real help available.

The Royal College of Surgeons states that denying or significantly delaying access to NHS treatment does not help patients to lose weight or stop smoking. Now those being denied surgery are paying a heavy price. I have spent much time talking to GPs and surgeons about this matter, as well as to patients. I have also talked to the CCG, which knows that the system is totally wrong, but because it is in a financial hole and NHS England has waved it through, it is just complicit. It is not standing up for patients in York.

One more point on the process: in York, patients who were referred for surgery, ahead of this policy being introduced, had their referrals sat on. The first thing that they received was their refusal letter. It is shocking that those patients’ surgery was delayed by the CCG even though their referral was made before the policy came into effect. So what is the impact on patients? Well, it is devastating. We already know that waiting times for surgery are going up, and delay in itself creates detriment. It is true that some patients are exempt—I am talking about those needing urgent care, the removal of a tumour, or trauma surgery. However, if someone requires a joint replacement because they have not mobilised well for some time due to osteoarthritis, is in pain, and, as a result of not mobilising, have put on weight, things are very different. With a new joint, they will be back on their feet. A 12-month delay in being referred will exacerbate their problems. A year of degeneration, pain and not being able to mobilise, an initial clinical assessment and then the wait for surgery will result in a surgeon presented with a more complex operation, and a physiotherapist with a patient who is less mobile and weaker, needing more input and possibly longer in rehab. Bang!—there go all the savings from rationing and more, all at a cost to the patient and a risk that the long-term clinical outcomes will be worse.

The British Orthopaedic Association said:

“There is no clinical, or value for money, justification…Good outcomes can be achieved for patients regardless of whether they smoke or are obese”.

If someone were 20 stone, they would have to drop to 18 stone before having surgery, but if they were 18 stone, they would have to drop to 16 stone 2 lbs. One person asked why surgery is safe at 18 stone in one case, but not the other. I ask the same. A patient has presented to me who was prescribed medication that had a side effect of weight gain. They were on drugs that risked weight gain, required surgery and were denied by the same GPs who gave them the drugs.

I have had a patient who is active and works full time, but is over the weight threshold. She needs surgery to enable her to conceive. She is not young. Surgery is needed now, as recommended by her GP. However, it was denied and could result in her never having a family. A patient with hypothyroidism, a chronic condition that leads to weight gain, needs surgery for gastrointestinal abnormalities but, despite their condition, will be restricted. One patient was a very fit body builder, but was refused surgery because of their high BMI. The case for delay has not been evidenced.

From talking to epidemiologists and reading academic papers on the issue, we know that there is a strong correlation between smoking and obesity, and social and economic deprivation. As the British Medical Association said, this could also be seen as rationing on the basis of poverty. Those with mental health challenges have a higher propensity to smoke, and those with chronic conditions are more likely also to have elements of depression and possible weight gain. Many people find it difficult to lose weight or give up smoking. Minister, you know the figures. This policy is totally discriminatory.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I am quite sure that the hon. Lady did not mean to address the Chair, but means to ask the Minister whether he knows the figures.

[Rachael Maskell]

Indeed that is the case.

This policy is totally discriminatory and is having further detriment for those with co-morbidities. It is creating problems, not solving them. All surgery carries a risk, and it is for clinicians to assess that risk. As the Royal College of Surgeons says,

“It risks preventing a patient from seeing a consultant who can advise them on the best form of treatment, which may not be surgery. Surgery may be needed to help someone lose weight.”

That point was also made by a patient who was able to mobilise after a joint replacement. This is why clinical decision making is needed. Patients have to be part of this too.

Public health programmes need restoring so that patients can properly engage with people to help to optimise their health. The passive approach of the CCG is setting patients up to fail. David Haslam, chair of the National Institute for Health and Care Excellence, said that rationing of surgery concerned him. He says that the NICE osteoarthritis guidelines make absolutely clear that decisions should be based on discussions between patients, clinicians and surgeons, and that issues such as smoking, obesity and so on should not be barriers to referral. These are the experts.

The Vale of York CCG has gone down this route, and others are now following, with 34% of CCGs looking to ration on the basis of obesity or smoking. Harrogate and Rural District CCG and East Riding of Yorkshire CCG target smokers and those who are overweight with a six-month delay. Wyre Forest, Redditch and Bromsgrove, and South Worcestershire CCGs ration on the basis of pain impact. South Cheshire CCG requires a BMI of less than 35—not 30—as does Coventry and Rugby CCG. The policy is spreading. Although York is the worse example of rationing, every clinician knows that it is wrong and contravenes their professional duty of care.

I am blowing the whistle on this today because the policy is directly discriminatory, clinically contraindicated and financially perverse. I would be the first in this House to advocate health optimisation programmes supporting smoking cessation or providing help to improve diet, exercise, wellbeing and lifestyles, but to leave someone in pain or without a child brings our NHS into disrepute.

This evening, I have made a clear case for why the rationing of surgery must end. As the Secretary of State said to the Health Committee, it is time to step in.

Health and Social Care

Baroness Laing of Elderslie Excerpts

Monday 27th February 2017 Commons Chamber

[Dr Wollaston]

My hon. Friend is absolutely right. It is important that the evidence is available not just to us, but to the local communities. There should also be a sense that consultations are a genuine process. As I have said, it is about the co-design of new services. Time and again, we have reports from the NHS that demonstrate that co-producing new services results in a much better service in the long run, so I thank her for her point.

We are talking about the cuts not only to the trusts, but to the clinical commissioning groups. What we are seeing now is that CCGs are being asked to hold back £800 million of their budgets to offset deficits in trusts. Again, this is about patient care that is being cut back. Alongside that, we have seen cuts to Public Health England and to Health Education England. The idea that we have an NHS that is on a sustainable footing is, I am afraid, simply not the case. I ask Ministers to be realistic about the current position, and I ask our Chancellor, in his forthcoming Budget, to address this matter by urgently giving a lifeline to social care, because that will benefit not just social care, but the NHS. In addition to announcing that lifeline, which I hope he can do by bringing forward the better care fund with new money rather than a transfer from the NHS, I hope that he will promise a genuine review of sustainable future funding covering both health and social care. I call on Members from across the House to agree that, rather than our having the usual confrontational debates, we should see this as a generational challenge that will face whichever party is in power over the coming years. We should all work together, for the benefit of our constituents, to produce a sustainable future for the NHS and social care.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I call the Chair of the Public Accounts Committee, Meg Hillier.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. It will be obvious to the House that a great many people wish to speak this evening. Of course, we have plenty of time, but it is limited. If hon. Members take a self-denying ordinance and speak for no more than nine minutes, everyone who has indicated that they would like to speak will have an opportunity to do so. I hope not to have to apply a formal time limit, because nine minutes is actually a very long time: if you cannot say it in nine minutes, you have to go away and practise. I know that no practice is needed by Anne Marie Morris.

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[Mr Betts]

I just want us to have a process that gets us to a similar position. Even if local authorities remain part of the funding solution, we cannot assume that the increase in business rates and council tax will keep pace with the level of demand.

I know that you have encouraged us to keep to a time limit, Madam Deputy Speaker.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I ought to say that, as the hon. Gentleman is the Chairman of a Select Committee, I do not apply the time limit as strictly to him.

[Mr Betts]

I have gone two minutes over time, so I had better not stray too far. Of course, health and social care need to work closely together. It is going to be very interesting to see how Manchester develops. It is not, however, a panacea; it is not going to solve all the problems.

I agree with the Chair of the Health Committee: the sustainability and transformation plans are an interesting way forward, but unfortunately they are seen as a way of making cuts. They will need some pump-priming to make them effective. They have not been done properly, with full co-operation, in every local authority area. If they are done properly and consider how we can better plan and pull together health and social care for the future, I think they will make an important contribution. Ultimately, however, we have to acknowledge that the process is going to take time and that it will need up-front funding to make it work.

We also have to acknowledge that there are big differences between health and social care. There are not many differences in culture, but the funding arrangements are different. Health is provided free at the point of use, whereas social care is not and probably will not after any changes are made. There is also a fundamental difference between the two on accountability: social care is accountable to directly elected local councillors, whereas health is ultimately accountable to the Secretary of State. If Members want to see the problems that creates, they should read the evidence that the former Health Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), gave to the Communities and Local Government Committee about his understanding of accountability in the Manchester system. It shows that the Government have not worked it out in such a way that they could flick a switch tomorrow and get it all operating smoothly. We have a lot of work to do. The Select Committee will consider all the evidence we have received and will produce reports on a range of issues.

Public Administration and Constitutional Affairs Committee

Baroness Laing of Elderslie Excerpts

Thursday 2nd February 2017 Commons Chamber

[Mr Jenkin]

I am most grateful to the Minister for his question and for the fact that he has personally appeared at the Dispatch Box today with his opposite number from Her Majesty’s Official Opposition. I know that his presence here underlines the commitment of the Secretary of State to this programme of change.

I very much welcome the shared programme of work to which my hon. Friend refers, but, in taking evidence for this particular report, we found that there was some dislocation between the various bodies involved in it. We conclude that it is only Ministers, and probably only the Secretary of State, who can draw this together to ensure that there is a coherent strategy and a plan, which is what we emphasise in this report.

Finally, my hon. Friend refers to legislation in passing, but I hope that valiant efforts are being made in that regard. Perhaps something can be included in Her Majesty’s Loyal Address later this year. I must point out that it is not just about statutorily underpinning the independence of HSIB, but the safe space to which he refers and on which he thanks the Committee for its contribution. The safe space has to be legislated for. Without legislation, there is no safe space. The AAIB, the Marine Accident Investigation Branch of the Department for Transport and equivalent bodies could not possibly function unless they can provide people with protection, so that those people can come and talk openly and off the record about what has happened. That has transformed the safety culture in other areas, and it is the transformation that we need in the health service. I leave with the Minister the word “legislation” echoing in his ears, and I very much look forward to making further progress with him on these matters.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The House is grateful to the Chair of the Public Administration and Constitutional Affairs Committee for bringing his report before the House this afternoon and for taking questions.

Provision of Cervical Screening

Baroness Laing of Elderslie Excerpts

Friday 27th January 2017 Commons Chamber

[Paula Sherriff]

I absolutely agree. I definitely expect the Minister, at least, to partake in such activity.

I thank Jo’s Cervical Cancer Trust for the work that it does all year round towards the eradication of this disease. It has been my pleasure to work with it, through the auspices of the all-party group, on issues to do with access to cervical screening, and I look forward to doing so again in the future.

I am glad that the Minister is sitting down, as I would also like to break with my habit in this House by giving a word of praise for current Government policy. As almost all cervical cancers are caused by persistent human papillomavirus—HPV—I welcome the Government’s commitment to the HPV vaccination programme, even though I feel that its effect could be amplified with compulsory sex and relationships education in our schools.

Successive Governments have developed a successful cervical screening programme and, to their credit, this Government have maintained it. It is responsible for saving an estimated 5,000 lives a year. That is to be applauded, but it should not be taken for granted. Recent years have seen a drop in cervical screening coverage, and this risks an increase in the incidence of cervical cancer and the danger of further unnecessary deaths when we have been very close to making a breakthrough. We need to be vigilant if we are to maintain the progress we have already made and make up further ground in tackling the disease.

Even with the progress that we have made on screening, some 3,000 people a year are diagnosed with cervical cancer, and an astonishing 890 a year people die of it. The figures for 2015-16 show that the coverage in England sits at 72.7% of eligible women, which is the lowest for 19 years. This is in spite of the so-called Jade Goody effect, when the TV star’s death from cervical cancer in 2009 resulted in 400,000 more women getting screened. Sadly, that effect has now been completely reversed. The numbers of screenings have been falling year on year, and they now stand at 3% lower than they were in 2011. Screening coverage rates across all age groups are falling.

I cannot stress strongly enough how significant and worrying these statistics are. They mean that more than a quarter of women in this country are leaving themselves open to a cancer that can be prevented, but that can easily be fatal if left undetected. As we all know, the general rule of cancer is that early diagnosis leads to a better prognosis, and cervical cancer is no different. The later the diagnosis, the poorer the health outcomes, and the more invasive and personally costly the treatment options. It benefits everyone involved if cervical cancer can be prevented, or detected and treated early.

Let me address one of the groups with the least coverage: young women. Women are invited for smear tests from the age of 25, but new research by Jo’s Cervical Cancer Trust has shown that more than a quarter of women in the 25 to 29 age bracket are too embarrassed to attend one. Shockingly, the same research also suggested that 70% of young women did not believe that smear tests could reduce a woman’s risk of cervical cancer. Let me be clear: they absolutely can. We know that 75% of cervical cancers can be prevented from developing through regular smear testing, yet more than 220,000 of the 25 to 29-year-olds invited for a test in England in the past year did not attend.

The research found several other causes for concern, including the fact that 24% of young women were unable to recognise a single symptom of cervical cancer, and that only just over half of them recognised that bleeding outside of periods was a symptom. That is the most common symptom of cervical cancer. Additionally, fewer than half knew that smear tests look for pre-cancerous cells, and almost a quarter incorrectly thought that the test was for ovarian cancer.

This problem is not unique to the younger generation. The 25 to 29 age group remains the group with the lowest coverage, but the 45 to 49 age group has seen the fastest decrease in coverage in recent years. Women over 50 display a similar tendency to put off or ignore smear testing, with a third having delayed or not attended their test. A shocking one in 10 have delayed for more than five years. This is particularly disconcerting because women aged 50 to 64 are the most likely to receive an advanced stage diagnosis, with half of those being stage 2 or later. As I mentioned earlier, this means more invasive treatment and risks poorer outcomes.

By far the biggest risk factor in developing cervical cancer is not attending cervical screenings, but Jo’s Cervical Cancer Trust has found that attendance declines with age. The charity’s long-term modelling has shown that if screening coverage continues to fall at its current rate, incidences of cervical cancer will have increased by 16% among 60 to 64-year-olds, and by a shocking 85% among 70 to 74-year-olds, by 2040. If screening coverage falls by another 5%, the mortality rate among 60 to 64-year-olds will double.

Age is not the only determining factor of one’s likelihood of being screened. One area of particular concern is that only 78% of black and minority ethnic women knew what a cervical screening test was compared with 91% of white women. This fell to 70% when looking at Asian women alone. Worryingly, only 53% of BAME women thought that screening was a necessary health test. This needs to be addressed, both nationally and within those communities.

The anxieties that all women were found to have about being screened, including embarrassment, worries about taking their clothes off in front of a stranger or discomfort with their body in general, are all heightened in particular ethnic communities with certain cultural norms. I have heard examples of mothers in certain minority ethnic households intercepting NHS screening invitation letters, leading to distress among younger women, who may experience cultural pressure that they should have maintained their virginity. If such factors put young BAME women off getting screened, that exposes them to significant risk of the disease. Particular focus should be paid to ensuring that mothers in those communities appreciate the dangers of cervical cancer, and that such cultural norms are not worth risking their daughters’ lives over.

We must ensure that coverage does not continue to fall. Indeed, it must be raised to an acceptable level, but the current outlook is mixed. A new report by Jo’s Cervical Cancer Trust for this year’s Cervical Cancer Prevention Week found that local provision is confused. While there is some evidence of best practice among local authorities and clinical commissioning groups, almost half of local authorities and almost two thirds of CCGs in England have not taken steps to increase cervical screening attendance in the past two years. The report also found regional disparities. In Yorkshire and Humber, 65% of CCGs had taken steps to increase screening, compared with just 18% of CCGs in the west midlands and the north-east. Similarly, 78% of local authorities in the north-west have taken action compared with just 33% in the east midlands. Perhaps most shockingly of all, in London, where coverage lags behind the rest of the country at just two thirds of women, 20 out of 32 local authorities reported no activity at all towards increasing screening coverage. That has all the appearance of a postcode lottery. We risk coverage continuing to fall in some areas of England while other areas make progress. Nobody wants a situation in which someone’s likelihood of developing cervical cancer is determined in no small part by the area in which they live. The Government should play their part to ensure that improvement happens across the board.

What can be done? We must seek to make access to cervical cancer screening as easy as possible. Screening takes five minutes and can save a life. Great strides have been made in recent years in making another simple test—blood pressure—available at every opportunity, which has been remarkably successful. There is every reason to expect that we could do the same for cervical cancer screening. However, I fear that the Government have taken a step in the wrong direction in recent years. Cuts to sexual health funding have led to a significant reduction in the provision of cervical screening through sexual health services. Jo’s Cervical Cancer Trust found that screening is available to all women through sexual health services in less than a third of areas, which again points to a postcode lottery. That seems like a grave misstep when over a third of women in the 25 to 29 age group expressed a wish to access screening through such services, while one in five women over the age of 50 wanted more flexibly timed access to screening. My GP practice offers cervical screening only every Tuesday morning, making access difficult and deterring many women from going for an appointment. I hope that the Government will look again at how much their cuts to local government funding have affected sexual health services, particularly the accessibility of cervical screening.

We must also move with the times. In addition to the cultural issues about invitation letters that I mentioned earlier, the use of letters is now old fashioned. While I appreciate that many NHS services across the country now use text message reminders, we should ensure that reminders to come in for screening are, to the greatest possible extent, accessible in the format of the patient’s choice, be that text message or email. Digital accessibility is necessary in the modern world. We must also be cautious about the wording of the reminders. It has been brought to my attention that the current NHS literature sent out with reminders reads:

“It is your choice whether to have a cervical screening test or not. This leaflet aims to help you decide.”

I fail to see how that in any way contributes to the aim of urging as many women as possible to attend cervical cancer screening. We already know that far too many women across all age groups and ethnicities are already content to put it off for a potentially dangerous length of time. I implore the NHS to reconsider the wording of the leaflets and to include a greater degree of urgency, because the phrasing will undoubtedly have an effect.

You will note, Madam Deputy Speaker, that I might not have been my usual challenging self this afternoon. Because of the gravity of the issue at hand, I happily recognise where the Government are on the right path. The inclusion of a commitment to increase cervical cancer screening in the 2015 cancer strategy is particularly welcome, as is the Government’s commitment to HPV primary screening, the implementation of which could prevent at least 400 cases of cervical cancer a year.

I will finish by asking several questions of the Government. Will the Minister commit to a national campaign to prioritise an increase in cervical screening attendance? How will the Government encourage co-operation between the different levels of the health service to ensure that we see cervical screening rates rising once again? Will the IT systems for HPV primary screening be up and running as planned, or will we experience unnecessary delays that could result in avoidable diagnoses? Will the Minister look at the quality and outcomes framework incentives for general practitioners to make sure that GP practices are really incentivised to improve cervical screening coverage? Finally, how do the Government intend to address problems with the accessibility of cervical cancer screening among particularly hard-to-reach groups, such as BAME women?

It is not unthinkable that we could see the effective eradication of cervical cancer if we take the necessary action. Although I applaud the Government’s existing programmes and their commitment to tackling cervical cancer, I hope that the Minister will take note of the research from Jo’s Cervical Cancer Trust—perhaps he will even work with it to identify where there are still gaps in provision—and take that action now.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Just before I call the Minister, I say to the hon. Lady that Jade Goody lived in my constituency. When she died, I wrote to her mother to say that her daughter’s death had not been in vain because it had drawn attention to the situation and had warned generations of women of the action that they must take to protect themselves and give themselves a chance.

I am shocked that the hon. Lady has drawn to the attention of the House this afternoon the fact that that has not been the case. I sincerely hope that her bringing this debate to the House this afternoon and the Minister’s attention to the points she has made—I am sure he is about to address them now—will reverse that situation.

NHS and Social Care Funding

Baroness Laing of Elderslie Excerpts

Wednesday 11th January 2017 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Before I call the next speaker, it will be obvious to colleagues that a great many Members wish to speak this afternoon and that although the debate has advanced a long way in time, it has not advanced very far in the number of Members called. We therefore now have to have a time limit of 10 minutes. [Interruption.] I can see that there is some surprise about that; it is 10 minutes for the moment, but anyone who can do any arithmetic will be aware that it will have to be reduced later, so I suggest that Members start working on their speeches now.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The House was right to assume that 10 minutes per person is unsustainable. After the next speaker, I shall reduce the time limit to seven minutes. The House will be glad to know, however, that the time limit remains 10 minutes for Sir Simon Burns.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I am afraid that this is rather unfair on those who have waited all day and have not yet spoken, but some Members have taken much more than seven minutes, and I must now reduce the time limit to five minutes.

--- Later in debate ---

[Simon Hoare (North Dorset) (Con)]

My hon. Friend is absolutely right about the need for a grown-up debate about integration and about learning from best practice. Does she share my concern that as Labour Members fan the flames of their artificial indignation, all they are doing is proving yet again that they are either unwilling, ill-equipped or ideologically—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Thank you. Jo Churchill.

[Jo Churchill]

I agree in that since we last debated this with the Opposition on 23 November, apart from asking for £700 million to be brought forward, they have put forward very little in the way of tangible plans. We are talking about everybody here, and just slinging bows and arrows across the Chamber will not get us to the solution we need.

If this is about money, why do some areas do better than others? It is actually about the allocation of resources and good leadership. I have received three letters about good healthcare. A resident in my constituency saw the GP on 28 October, the consultant on 8 November, and had their operation on the 29th. That was at my district general hospital that used the private facility locally to enhance the patient experience.

We need a long-term solution. I am pleased that the Prime Minister has spoken about tackling the difficulties of mental health. The right hon. Member for North Norfolk (Norman Lamb) has championed that and shares a mental health trust with me. I am pleased to see that another 49,000 people are being treated for cancer—that is something that I came to this place to champion—and another 822,000 people are receiving specialist cancer treatment. We have seen huge increases in demand, and we need to admit that we cannot just carry on. There have been advances in drugs, but we need to take into account comorbidities and an ageing population.

We need to understand what is wrong, and we will do that by having better data throughout the system. The Richmond Group wrote in support of my private Member’s Bill that information held in healthcare records has a huge potential to provide better care and improve health service delivery within the service. Paramedics have asked me for better access to data so that, when they find someone on the floor, they will know what meds they are on and what the most beneficial treatment would be. GPs want their information to flow through the system to help social care and the hospital sector. Pharmacies need to be able to read and write, and those working in social care need to be able to look at someone’s pathway. Patient outcomes should be the thing that we are all talking about, but we have to make decisions. At the centre of all this, we need to support those colleagues who are working above and beyond at this time. We need to behave in a grown-up, responsible way, just as they are, in caring for our NHS.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am pleased to follow the hon. Member for Worsley and Eccles South (Barbara Keeley) and to be able to close this debate. I thank all 34 hon. Members for their contributions, some of whom—mostly those on the Government Benches—managed to rise above party politics and make some constructive comments.

I join my right hon. Friend the Secretary of State in thanking the 2.7 million staff working in our NHS and social care system. As the Prime Minister said earlier, we recognise that they have never worked harder to keep patients safe, with A&Es across the country seeing a record number of patients within four hours in one day last month.

Regrettably, after five and a half hours of debate and criticism from Labour Members, we have heard little, if anything, about how to provide solutions to the challenges that our A&Es face.

Once again, the Opposition have touted more funding as their only answer to solve public sector challenges. In fact, they have pledged to raise corporation tax eight times, promising an unspecified amount from an unspecified source. That will not help our NHS and it will not fool the public. There is much to do to protect the system and ensure a sustainable future, but it is this Government who have plans in place to get through this extremely challenging period and sustain the NHS for the future.

The shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), spoke for about three quarters of an hour without making a single suggestion about how to solve the problems that face the NHS—not one. He should have stayed to listen—he may have done and I apologise if I did not pay enough attention to his presence in the Chamber.

The former Health Minister, the right hon. Member for Doncaster Central (Dame Rosie Winterton), asked specifically for community pharmacists to be paid for providing minor ailments services. I am pleased to be able to tell her that that is precisely what we are doing. The Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), was discussing that only this morning in Westminster Hall, and I regret to say that not a single Labour Member was present to hear what he had to say. [Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Surely the House wants to hear the Minister after this long debate—with courtesy.

[Mr Dunne]

We have heard a number of comments from Opposition Members—I am pleased to say that they were outnumbered in this Opposition day debate by Government Members—rehearsing some tired phrases to mislead the public over alleged increasing independent provision in the health service and also misrepresenting what my right hon. Friend the Secretary of State was saying in his remarks about A&E targets. Having said that, I wish to pay tribute to the hon. Member for Chesterfield (Toby Perkins), who is in his place, and the hon. Member for Workington (Sue Hayman), both of whom showed considerable personal courage in explaining the circumstances surrounding the death of each of their fathers, and they did so in an entirely honourable and sensible way, and I am grateful to them for sharing that experience.

I congratulate my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) on managing to get her son into hospital to have his appendix treated on Boxing day. As she said, that showed that that service was working well.

The Opposition sought to take the moral high ground in this debate. The hon. Member for Dewsbury (Paula Sherriff) challenged Government Members on whether they had visited hospitals over the Christmas period other than on an official visit. Her position was completely punctured by my hon. Friend the Member for Lewes (Maria Caulfield) who pointed out that she was doing a night shift between Christmas and new year in her role as a nurse—she was not on an official visit.

There have been some impressive contributions. I thank the Chair of the Select Committee on Health, my hon. Friend the Member for Totnes (Dr Wollaston), who was supportive of a more nuanced target for A&E, and for her calm and generally constructive comments, and my right hon. Friend the Member for Chelmsford (Sir Simon Burns) for his support for the success regime in Essex and for pointing out that it is not closing any of the three A&E departments in the hospitals there. I also thank my hon. Friend the Member for Crawley (Henry Smith), who made a very thoughtful speech and welcomed the opening of an assessment unit in Crawley to help to relieve pressure on the A&Es nearby. Finally, I thank my right hon. Friend the Member for Forest of Dean (Mr Harper) for another thoughtful contribution from the Back Benches.

Of course, the Conservative party and the Government recognise that our NHS faces the immediate pressures of the colder weather and the wider pressures of an ageing and growing population. There were nearly 9 million more visits last year to our A&Es compared with 2002-03—the year before the four-hour commitment was made. That is more than 2 million A&E attendances every month, and our emergency departments are now seeing, within the four-hour target, 2,500 more people every single day compared with 2010.

--- Later in debate ---

[Margaret Greenwood]

On a point of order, Madam Deputy Speaker—[Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. If Members wish to have conversations, they should go somewhere else. The hon. Lady is making a point of order.

[Margaret Greenwood]

The Minister told the House that there were no Labour Back Benchers in this morning’s debate on community pharmacies. In fact, he has inadvertently misled the House in that regard, because I was in Westminster Hall and I spoke in the debate, as was my hon. Friend the Member for Sefton Central (Bill Esterson), who also spoke in the debate. I just wanted to put the record straight.

[Madam Deputy Speaker]

I understand the hon. Lady’s point of order. It is not a matter for the Chair, but I understand why she wished to make the point.

[Mr Dunne]

rose—

[Madam Deputy Speaker]

It looks as though the Minister would like to say something further to that point of order.

[Mr Dunne]

Further to that point of order, Madam Deputy Speaker. To give the House complete clarity, I understand that two Labour Back Benchers were present and made minor interventions in the Westminster Hall debate, but there were no speeches or substantive contributions by those Labour Members.

[Madam Deputy Speaker]

I am sure that the House is grateful to the Minister for clarifying what he said in his speech, and to the hon. Lady for clarifying the position. The matter is now closed.

Health Service Medical Supplies (Costs) Bill

Baroness Laing of Elderslie Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 6th December 2016 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

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

[Madam Deputy Speaker (Mrs Eleanor Laing)]

With this it will be convenient to consider:

Amendment 8, in clause 1, page 1, line 14, at end insert—

“(2A) In exercising functions in relation to the controls on the costs of health service medicines, the Secretary of State must ensure that any payments made by manufacturers or suppliers to whom the scheme relates calculated by reference to sales or estimated sales of medicines are utilised solely for the purpose of reimbursing the NHS for expenditure on medicines and medical supplies.”

This amendment would confirm that the Secretary of State has a duty to reinvest rebates in improving access to new and innovative medicines and treatments.

Amendment 9, in clause 5, page 4, line 5, at end insert—

“(7) Before making regulations under Clause 5 the Secretary of State must conduct a consultation on the potential effect of this clause on the maintenance of quality of those medical supplies, and seek representations from manufacturers, suppliers and distributors of medical supplies as part of the consultation.”

Government amendments 1 to 6.

Amendment 10, in clause 6, page 7, line 11, at end insert—

“(1A) Information provided by virtue of section 264A must be disclosed by the Secretary of State to persons listed in subsection (1)(a) to (i) at that person’s request.”

Government amendment 7.

[Justin Madders]

I rise to speak to new clause 1, which stands in my name; to amendment 8, which is in the name of my hon. Friend the Member for Burnley (Julie Cooper); and to the other amendments in the group. The Opposition do not oppose the Bill. Our proposals are a constructive attempt to help the Government to achieve their stated aims, and to close the growing gap between the UK’s record on developing new drugs and the ability of NHS patients to access them.

New clause 1 would put a duty on the Secretary of State to commission a review within six months of the Act coming into force, focusing on its impact on the pricing and availability of drugs and medical supplies; on research and development; and on the NHS’s legal duty to promote innovation. The pharmaceutical industry in this country employs more than 70,000 people, in predominantly high-skilled and well-paid jobs—just the sort of jobs Members on both sides of the House would want to encourage and see more of.

This country’s record in the pharmaceutical sector has been one of our great success stories, but we cannot take that success for granted, particularly because investment decisions are often taken by parent companies in other parts of the world. There is considerable unease in the sector about the relatively low take-up of new and innovative medicines by the NHS compared with that in comparable nations, and about the ongoing uncertainty surrounding the future of the European Medicines Agency. A number of major companies have based themselves here because of the EMA, and the worry is that they might wish to follow it if it relocates following Brexit.

The impact assessment for the Bill states, as we might expect, that there will be an impact on the revenue of the pharmaceutical sector, and that it could lead to a reduction in investment in research and development and consequent losses for the UK economy estimated at £l million per annum.

While we fully agree with what the Government seek to achieve with the Bill, we are mindful of the storm clouds on the horizon. We therefore believe that prudence requires that such a review takes place within a reasonable timeframe to ensure there are no unintended consequences and that we can remain confident that the pharmaceutical sector in this country will continue to be at the forefront. We face competition not only in Europe but from emerging nations such as Brazil and China. We also need to ensure that the NHS does not trail in the take-up of the new drugs. Worryingly, the Office of Health Economics studied 14 high-income countries and found that the UK ranked ninth out of those14 across all medicines studied.

Successive studies have demonstrated relatively low take-up of new medicines in the UK compared with other countries. That is bad for patients and bad for our pharmaceutical industry. The Bill therefore needs to achieve a balance. We need to ensure the best possible patient access to medication at the fairest price, but we also need to encourage the pharmaceutical industry to invest in research and development.

National Health Service Funding

Baroness Laing of Elderslie Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Relevant documents: Letter from the Chair and members of the Health Committee to the Chancellor of the Exchequer, dated 26 October 2016, and the Chancellor’s response, dated 8 November 2016.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I advise the House that Mr Speaker has selected the amendment in the name of the Prime Minister.

Social Care

Baroness Laing of Elderslie Excerpts

Wednesday 16th November 2016 Commons Chamber

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I inform the House that Mr Speaker has selected the amendment in the name of the Prime Minister.