Health and Social Care

Frank Dobson Excerpts

Monday 13th May 2013 Commons Chamber

[Frank Dobson (Holborn and St Pancras) (Lab)]

I will not follow the right hon. Member for Mid Sussex (Nicholas Soames) in referring to Europe, other than to say I regret the possibility that European competition law will in future apply to the national health service, which will no doubt be exploited by major American health corporations.

I will talk exclusively about the current destruction of NHS Direct, a successful, safe and popular service, and its replacement by 111—I hesitate to call it a service— that has proved to be a shambles in many parts of the country. I must declare an interest—a sort of proprietorial one—because I was Health Secretary when we decided to set up NHS Direct in 1998. We set it up in a sensible way, and it worked from the start. We established three pilot schemes. The service was gradually rolled out across the country, learning all the time from the experiences of the earlier services that were already working. It worked well from the start, and there is no excuse for Ministers in this Government who have introduced the 111 service as a mess. They have been calling summits and announcing reviews ever since it started going wrong. That is pathetic, because they are not in the Department of summits and reviews; they are in the Department of Health.

Those Ministers were not even doing anything new. They had the opportunity to build on NHS Direct, which was a successful example. In 2002, it was described as a remarkably successful service by the Public Accounts Committee, then chaired by the hon. Member for Gainsborough (Mr Leigh), and of which the current Chancellor of the Exchequer was a very active member. Reports by the Comptroller and Auditor General and the PAC commended the service, saying it had met all its deadlines and properly addressed all the risks, and that it had a practical approach and had learned lessons as it went along. It was also commended for the fact that its computer procurement had been well managed and had been delivered to cost, and that there had been satisfactory consultation and it was clinically safe.

It was praised, too, for reducing demand on other parts of the NHS. The main reason it was reducing demand was because it was predominantly staffed by nurses, who had the professional confidence and judgment simply to offer reassurance to some who got in touch. In the current service, however, there are many call handlers, who do not have that professional knowledge and confidence, and are therefore referring people to GP services or A and E and are arranging ambulances.

I commend the views of the PAC back in 2002. It was far sighted, because it said:

“Departments should consider what wider lessons they could learn from the successful introduction of this significant and innovative service on time.”

The Chancellor’s Government have clearly decided to ignore that recommendation. The PAC also noted:

“Short lines of communication between the Project Team and those implementing the service at local level enabled lessons to be learnt quickly as the projects progressed.”

Clearly the current Government did not learn that lesson either.

The current Chancellor himself said in one of his contributions to the Committee:

“My concern is that the Permanent Secretary…is going to start saying, we are great, we have this giant switchboard for the NHS, and your service is going to lose the focus of its original function”.

That perfectly describes what has happened with the abolition of NHS Direct and its replacement by the 111 service.

The 111 service does not have short lines of communication—indeed, I doubt whether it has any at all. It has also taken on innumerable new functions, and has been expected to carry them out at less cost than NHS Direct was operating at. The only way it could reduce costs was by getting rid of nurses, because they are more expensive than call handlers. Indeed, GP representatives have told me the current service has reversed the situation: whereas there used to be more nurses than call handlers, there are now more call handlers than nurses, and in one area there are 15 call handlers and one nurse.

The computers keep going down, there are massive delays, and a lot of the call handlers are giving the wrong advice, much of which is expensive for the NHS. The Government cannot say that they were not warned about this because they were warned by Members, even Government Members, as long ago as March, not this year but last year.

In bidding to get one of these contracts, people assumed, in good faith or bad faith, that they could provide as good a service as NHS Direct at half the cost. It is now clear that they cannot. Other parts of the NHS are bailing them out to try to keep the 111 service going. As my right hon. Friend the Member for Leigh (Andy Burnham) said, the question that arises is what the Secretary of State can do about it. The people running these services have bid for fixed-price contracts. If they now need to spend more, how is the money going to get to them so that they can do so? They are left with three alternatives: they can struggle on providing this very poor, unreliable service, they can go bust and there is no service, or the money is found from somewhere else in the NHS. However, under the crackpot system that the Government introduced when they changed the law, there is no machinery for putting extra money into these services so that they can do their job properly.

--- Later in debate ---

[Paul Blomfield]

My understanding is that the majority of unions would support standardised packaging. I deeply regret the fact that the tobacco giants use some individual trade unionists as de facto lobbyists.

The Government surrendered to the tobacco giants. What message does that send to the country? This Government are prepared to see people die and, as the hon. Member for Mid Derbyshire (Pauline Latham) said, die horribly, and in their hundreds of thousands, to prop up the profits of the tobacco industry. There are no industries like the tobacco industry—the more cigarettes it sells, the more money it makes and the more people die.

Since science confirmed the link between smoking and lung cancer, the tobacco industry has opposed every single measure to reduce smoking. We all know that smoking is the largest preventable cause of cancer; it is responsible for four out of every 10 cancer deaths. According to Cancer Research UK, tobacco is responsible for 100,000 deaths in the UK every year. We have made huge strides with the measures that have already been taken against smoking, but as we have encouraged people to stop smoking, the tobacco giants have been building their market among young people. A report from Cancer Research UK in March showed that the number of children smoking had risen by 50,000 in just one year.

[Frank Dobson]

Let me demonstrate the absolutely vile morality—if I can combine those two words—of the tobacco industry. When it was discovered that nicotine was addictive, the industry increased the proportion of nicotine in cigarettes to make them more addictive. People like that should not be listened to; they should be shown the door.

[Paul Blomfield]

I agree with my right hon. Friend: the tobacco industry should not be listened to. However, it finds no end of ways to seek to defeat the arguments of public health lobbies against smoking, and indeed to encourage the wider use of cigarettes.

Shockingly, in the last year for which figures are available about 207,000 children aged between 11 and 15 started smoking. The vile way—to use my right hon. Friend’s word—in which the tobacco giants operate means that that is a direct result of the industry’s marketing strategies, which are as sophisticated as they are cynical. Flavoured cigarettes have been introduced, and not only menthol, but chocolate and fruit flavours. Some cigarettes are targeted at young women. Even the Daily Mail pointed out, in condemning that move, that those cigarettes seek to

“make smoking look elegant, sexy and classy”.

Alternatively, as British American Tobacco’s Hinesh Patel said, almost acknowledging the company’s strategy:

“We’ve taken a creative approach to respond to the female under-30 demand for a smaller, slimmer, less masculine cigarette…a contemporary product in a new accessible size.”

In that context, packaging is crucial. A Saatchi & Saatchi marketeer said this of British American Tobacco’s Vogue package:

“The cigarettes look like something found behind a glitzy counter at Selfridges....trying to capitalise on a woman’s desire to feel beautiful to sell their cigarettes.”

The Government public health Minister, the hon. Member for Broxtowe (Anna Soubry), is not present, but she has made her views on this subject clear. In April, she said before a House of Lords Select Committee:

“We know that the package itself plays an important part in the process of young people and their decision to buy a packet and to smoke cigarettes.”

All the experts back standardised packaging, and until a few days ago we thought the Government did, too. The public back that as well, with 63% in favour and only 16% against, according to recent polling. This Government are getting it wrong again. They are showing again that they are out of touch with people and they are on the wrong side of the argument, and I urge them to think again.

--- Later in debate ---

[Jim Shannon]

I thank the hon. Gentleman for his intervention. I perceive and am of the opinion that companies saw such measures as a loss to their profit margin, and we would like to see what happened in Australia happen here.

The former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley),was quoted in the media saying that the Government did not work with tobacco companies as they wanted them to have “no business” in the UK. Has that changed? The current Health Secretary stated that one of his key priorities is to reduce premature mortality. His call to action on premature mortality commits to a decision on whether to proceed with standard packaging. He also stated:

“Just because something is not in the Queen’s Speech doesn’t mean that the Government cannot bring it forward in law.”

Even at this late stage, may we hear a commitment to bringing forth such a measure in law? If we do, that will be good news and we will welcome it.

Some 10 million adults smoke in the UK and more than 200,000 children start smoking at a very early age. More than 100,000 people die from cancer-related smoking diseases across the UK, which is more than from the next six causes of preventable death put together. The immensity of the number of deaths from smoking cannot be underestimated. Many Members have spoken about that, and I believe the fact we are all saying the same thing is something we should underline.

We cannot remove people’s choice to smoke—that is a decision to be made by any adult—but we can, and must, ensure that everyone knows they are doing harm to themselves and those around them. Evidence that standardised packaging helps smokers quit and prevents young people from taking up the habit and facing a lifetime of addiction is clear, and we should encourage more people to stop smoking and not to become addicted.

[Frank Dobson]

Does the hon. Gentleman agree that the argument sometimes put by defenders of the tobacco industry—usually paid defenders—is that people are exercising free choice? In fact, they are not exercising free choice because they are addicts who took up the addiction when tobacco companies persuaded them to smoke when they were teenagers.

[Jim Shannon]

I thank the right hon. Gentleman for that intervention and for clearly underlining the stand we are all taking on this issue. We hope that Ministers will respond positively. I believe that plain packaging is a major step in this informational and educational journey to end smoking, and I ask the Minister to commit today to begin that journey that has been planned for so long.

Another disappointment in last week’s speech was the lack of reference to the minimum pricing of alcohol, although there has been some indication that there may be a change of heart, which we hope will be the case. Last week I was sent a copy of a study containing numerous sources, and there are certainly some shocking statistics. Its findings, among other pertinent points, demonstrate that alcohol is 45% more affordable today than it was in 1980. Men and women can currently exceed the recommended low-risk daily drinking guidelines for £1. That is hard to believe in this day and age, but it is the truth. Data from Canadian provinces suggest that a 10% increase in the average minimum price would result in about an 8% reduction in consumption, a 9% reduction in hospital admissions, and—this is the big one, Mr Deputy Speaker—a 32% reduction in deaths caused wholly by alcohol, which is even higher than the figure suggested in the Government’s impact assessment.

Alcohol Health Alliance UK stated:

“The case for introducing minimum unit pricing is clearer than ever, yet despite committing to the principle of minimum unit pricing, it appears that the Government are going to drop the measure from their alcohol strategy.”

Perhaps Ministers will comment on that, but I sincerely hope it is not the case. Minimum pricing of alcohol is not to ensure that those on low incomes cannot have a drink, but to ensure that people of all incomes are aware how much they are drinking and conscious of the health implications of excessive or binge drinking. When it comes to minimum pricing for alcohol, we can all take note and take advantage of it.

Every year there are 1.5 million victims of alcohol-fuelled violence in the United Kingdom, and it is clear that community safety is threatened by the misuse of alcohol. Police superintendents have advised that alcohol is present in half of all crimes committed, and a 1990 study for the Home Office found that growth in beer consumption was the single most important factor in explaining the growth in crimes of violence against the person. The figures are clear. Statistics show that 37% of offenders had a current problem with alcohol; 37% had a problem with binge drinking; 47% have misused alcohol in the past; and 32% had violent behaviour related to their alcohol use. When we mix young people, who have not had time to develop their moral standards and ideals, with alcohol, we have a generation who are fuelled by the desire to live in the moment, with no thought of the consequences. Alcohol changes personalities, and young people are only learning who they are. Adding alcohol to the mix means that they will never have a good understanding of who they are. A minimum price for alcohol will lessen the number of young people who drink copious amounts of it. Hopefully, it will also mean a lessening of crimes that are aggravated or exacerbated by alcohol.

My third point is on diabetes, which is a ticking bomb in our society. We had a debate on it in Westminster Hall, when the right hon. Member for Leicester East (Keith Vaz) made the point about diabetes and obesity among children. The figures are overwhelming. The United Kingdom of Great Britain and Northern Ireland diabetes strategy ended in April, but perhaps the Minister can tonight commit to its continuation. I believe the strategy was working. Had it not had an effect, the figures would be much worse. Even given the strategy, the number of people living with types 1 and 2 diabetes has increased by 33% in Northern Ireland, 25% in England, 20% in Wales, and 18% in Scotland. The numbers are rising. A commitment to the continuation of the strategy would be helpful. The statistics are scary—3.7 million people in the UK are diagnosed with type 2 diabetes. However, we are talking not only about statistics, but about people’s lives. We need to prevent and control as well as we can.

I am aware that the health portfolio is not an easy one. Everybody needs something urgently. I understand the restrictions that apply, but does the Minister understand that the three issues that I and others have raised affect every corner of the United Kingdom of Great Britain and Northern Ireland? I believe we could have reform on those issues if the Government put their hand to the plough and disregard all but the health and safety of our population.

--- Later in debate ---

[Norman Lamb]

I was coming on to pay tribute to the hon. Lady for the work she has done. I absolutely agree with her that we need to get this right. We have the juxtaposition of two Bills, dealing with children on the one hand and adult social care on the other. Earlier I made a commitment to meet the children’s Minister; I had an opportunity to speak to him briefly when he was in the Chamber earlier. I am also meeting the hon. Lady later this week. I am committed to doing everything I can to get this right, and to ensure that young carers are not let down.

The Care Bill also highlights the importance of preventing and reducing ill health and of putting people in control of their care and support. This will involve the right to personal budgets, taken as a direct payment if the individual wants it, and putting people in charge of their care and of how the money is spent. This will put carers on a par with those for whom they care for the first time. The hon. Lady has consistently argued her case, and I am determined that we should get this provision right. The hon. Member for Rotherham (Sarah Champion) also made some powerful points on the subject.

The Bill will also end the postcode lottery in eligibility for care support. My hon. Friend the Member for Totnes (Dr Wollaston), the hon. Member for Easington and others raised concerns about the level of the eligibility. That question will obviously have to wait until the spending review, but I point out that if we were to set it at moderate need, the cost attached would be about £1.2 billion. All hon. Members need to recognise that this is difficult, given the tough situation with public finances. We also need to do longer-term work on developing a more sophisticated way of assessing need and providing support before people reach crisis point.

The Bill will refocus attention on people rather than on services. It will bring in new measures based on the Francis inquiry, ushering in a new ratings system for hospitals and care homes, so that people will be able to judge standards for themselves. The hon. Member for Walsall South (Valerie Vaz) criticised the idea of appointing a chief inspector of hospitals, but I disagree with her. It will be really important to identify where poor care exists and to expose it so that improvements can be demanded without fear or favour. The chief inspector will be able to do just that. It will also be really important to celebrate great care, so that those people in the health and care system who are doing everything right can be applauded and recognised for the work they are doing.

[Frank Dobson]

Does the Minister accept that a generalised rating for a hospital is not going to be valuable because, within one hospital, some departments might be doing a brilliant job while others are not? It would be stupid if an overall rating persuaded people not to go to a particular hospital for treatment if the specialty they required was being practised brilliantly.

[Norman Lamb]

I disagree. We brought in Jennifer Dixon of the Nuffield Trust to advise on this matter. There will be ratings for specific services within hospitals to identify areas of great care, but the single rating will give the hospital the incentive to bring up to a proper standard those areas that are falling short, and that will be a good thing.