Organ Donation (Deemed Consent) Bill

Geoffrey Robinson Excerpts

Committee Debate: 1st sitting: House of Commons
Wednesday 12th September 2018 Public Bill Committees

[The Chair]

Welcome to this Public Bill Committee on the Organ Donation (Deemed Consent) Bill. I will make some preliminary announcements: please switch electronic devices to silent; tea and coffee are not allowed during sittings; and a selection list for today’s sitting is available in the room, showing the order of the debates. In this case it is a single debate, so if you would like to speak, please do so in this part of the debate as there is no other option. Decisions on the amendments and clauses will take place in the order in which they appear on the amendment paper.

Clause 1

“Appropriate consent” to adult transplantation activities: England

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

I beg to move amendment 1, in clause 1, page 1, line 16, leave out “relevant” and insert “permitted”.

Amendments 1 to 3 replace references in new subsection (6A) of section 3 of the Human Tissue Act 2004 to “relevant material” with references to “permitted material” which is defined in the provision inserted by Amendment 4.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 2, in clause 1, page 1, line 19, leave out “relevant” and insert “permitted”.

See the explanatory statement for Amendment 1.

Amendment 3, in clause 1, page 1, line 20, leave out “relevant” and insert “permitted”.

See the explanatory statement for Amendment 1.

Amendment 4, in clause 1, page 2, line 10, at end insert—

“‘permitted material’ means relevant material other than relevant material of a type specified in regulations made by the Secretary of State.”

This amendment defines “permitted material”, which will be used in new subsection (6A) of section 3 of the Human Tissue Act 2004 as a result of Amendments 1 to 3. The definition has the effect that the new provision about deemed consent will not apply in relation to relevant material of a type specified in regulations made by the Secretary of State. “Relevant material” is defined in section 53 of the Human Tissue Act 2004.

Amendment 5, in clause 1, page 2, line 11, after “of” insert

“the definition of ‘excepted adult’ in”.

This amendment is consequential on Amendment 4.

Clause 1 stand part.

Amendment 6, in clause 2, page 2, line 36, at end insert—

“( ) In section 52 (orders and regulations), in subsection (3) (statutory instruments to which negative procedure does not apply), after ‘1(11),’ insert ‘3(9),’.

( ) In section 52, in subsection (4) (statutory instruments to which affirmative procedure applies), after ‘no regulations under section’ insert ‘3(9),’.

( ) In section 52, in the list in subsection (10) (requirement to consult), after ‘section 1(11)’ insert—

‘section 3(9);’”.

This amendment is consequential on Amendment 4 and produces the result that the regulation-making power conferred by the provision inserted by that amendment will be subject to the affirmative procedure in Parliament and to a requirement to consult such persons as the Secretary of State considers appropriate before the power is exercised.

Clause 2 stand part.

Clause 3 stand part.

Amendment 7, title, line 1, leave out from beginning to end of line and insert

“Make amendments of the Human Tissue Act 2004 concerning consent to activities done for the purpose of”.

This amendment replaces much of the existing long title so as to introduce reference to the making of amendments of the Human Tissue Act 2004.

[Mr Robinson]

I am pleased to be serving under your chairmanship, Mr Wilson, as I am sure the whole Committee is. I think the sensible grouping of the amendments within the clauses will allow a natural flow, and yet if anybody among the very committed members of the Committee wishes to speak they will have an opportunity too. The idea is that it should not be a long Committee. We had a very good debate on Second Reading and we had the money resolution last night. The support for the Bill at those debates made it clear that the whole House now wants to see the Bill made law and for that reason we want to make progress as fast as we can.

Amendment 1 replaces the word “relevant” with the word “permitted” in clause 1, line 16, as the Human Tissue Act 2004 creates a new term, not already defined, to ensure that deemed consent will apply only in respect of “permitted” material. It is unlikely that many members of the public appreciate the vast scope of organ and tissue transplantation. I hope that this amendment will build on the public’s trust in the system and avoid unnecessary distress to the friends and family of the deceased if the new arrangements were also to cover novel transplants. In the debate on the money resolution yesterday, we went to lengths to stress the need to keep public confidence, as people need to be clear about what is in the Bill; I have heard some rumours circulating already that were not helpful. I think amendment 1 provides a clear distinction and we will be able to define “novel transplant” elsewhere in the Bill.

Amendments 2 and 3 make consequential changes to clause 1, again replacing the word “relevant” with “permitted”. The three amendments create an important distinction between “permitted material” and “relevant material”, which enables novel forms of transplantation, such as of faces and limbs, to be exempt from deemed consent. That underlines the point about maintaining public confidence in what we are doing.

It is imperative that the amendments are made to the Bill to ensure that consent is considered to be in place only for organs and tissues that are in line with the public’s perception of donation. I am sure we all understand the need for that. The term “relevant material” is defined in section 53 of the Human Tissue Act 2004 and is applicable to other activities in the Act.

Amendment 4 provides the definition of “permitted material” that falls within the Bill. The amendment creates a power to make a statutory instrument to set out in detail which organs will be excluded from the new approach. There can be no doubt where we stand—what is included and excluded—and that is all necessary for the public’s reassurance. I am sure we all agree that this should be established by a statutory instrument subject to the affirmative procedure, which by its very nature extends to the proposed list, or any additions or changes to it, rigorous debate and a vote if necessary.

Amendment 5 is consequential on amendment 4 and provides clarification that the provision set out in section 10 of the Human Tissue Act 2004 refers only to excepted adults. It is quite clearly defined in the legislation. Amendment 6 provides that the SI set out in amendment 4, on novel transplants and innovations to be excluded from the new approach to organ donation, will be subject to the affirmative procedure.

I think that covers quite a chunk of the Bill. I invite the Minister to comment on the last part of it. It would be a very happy responsibility.

[Peter Heaton-Jones (North Devon) (Con)]

It is a pleasure to serve on this Committee. I start by paying unequivocal tribute to the hon. Member for Coventry North West for his stewardship of the Bill. There are many others who have played a significant role in getting us to this stage, and it is testimony to the fact that the Bill has received literally all-party support that the names of signatories from all seven parties represented in the Chamber appear on this private Member’s Bill. The fact that the Front-Bench teams of both Her Majesty’s Opposition and the Government support it is extremely significant. It shows the widespread support, and how important the measure is. It is truly a cross-party endeavour.

I share the hope that has been expressed that Committee stage will not take long, because there is such unanimous agreement. I will briefly share a story that I had the privilege of telling when we debated the Bill in the Chamber back in February, because it is very significant. I recognise that doing so will perhaps bring back some difficult memories for those involved, but I hope it will be inspiring. It is the story of Keira Ball.

Keira and her family were involved in an accident on 30 July last year. There was a road traffic collision on the A361, the North Devon link road in my constituency, only about five miles from my home. Sadly, despite the best efforts of the emergency services and paramedics, young Keira passed away two days after the accident. Her mother and brother were very seriously injured, leaving her father to take on his own the agonising decision that he wanted his daughter’s death to give life to other people, and therefore that young Keira’s organs should be donated. In that inspirational moment, Keira’s parents, Joe and Loanna Ball, have given hope to so many more people. They have also given life to the Bill and seen it get as far as it has. I hope it will proceed without much further ado.

Four people are alive today because of the decision taken by Keira Ball’s father after that accident. Keira donated her kidneys, heart, liver and pancreas. One of her kidneys was given to a man in his 30s, who had been on the waiting list for two and a half years. The other kidney was given to a woman in her 50s, who had been on the waiting list for nine and a half years, and a young boy received Keira’s pancreas and liver. Keira’s heart was given to a 10-year-old boy, who in many ways, has become the figurehead of the excellent campaign. I speak of course of Max Johnson, who is alive today because of the brave decision made by Keira’s father in the aftermath of that awful accident. This is, in many ways, Max’s law and Keira’s law.

Those two young people are an absolute inspiration and show why this excellent Bill, which I hope will become legislation before long, will genuinely help to save lives. For that reason, I am delighted to be serving on the Committee and to be a part of this excellent Bill’s truly cross-party support. I hope that we can move forward so that it reaches the statute book, because if there is one important job that we should be doing in this place, it is saving lives, and that is what the Bill does.

--- Later in debate ---

[Jackie Doyle-Price]

The hon. Gentleman makes a good point. One of the difficulties in making legislation such as this, where things are put very clearly on the statute book, is that we must have regard to what really happens at the bedside. It is one thing for something to be written in law, but how do relatives losing a loved one in the most atrocious circumstances deal with this? It comes back to a cultural change. The most important thing any of us can do if we want to increase organ donation is ensure that we all have those conversations with our families, so that they understand our wishes. Let us put ourselves in the position of being at the bedside of a loved one who is losing their life. We can put all the support in place—specialist nurses to talk them through the process and so on—but unless families really understand their loved one’s wishes and have had that conversation, naturally the next of kin will be reticent to give consent. One of the great virtues of the Bill and the surrounding campaigns is that we have encouraged people to have those conversations. It has been a real driver of cultural change in that sense.

The hon. Member for Strangford also shared his experience, for which I am grateful, and reiterated that no one would be compelled. Finally, my right hon. Friend the Member for Chesham and Amersham was, as always, wise in her observation that, when the facts change, people should change their minds. It is not a weakness if politicians do so from time to time. I am grateful to all Committee members for their support.

The amendments constitute a tidying-up exercise that essentially make it clear that we are talking about organ transplantation. Their effect would be to remove novel transplants—such as hand and uterine transplants—from the scope of the Bill. The medical advances that allow such transplants are amazing, but in order that the law keeps pace with those developments, we need to make those exemptions and state that we really are only talking about organs. Amendment 7 amends the long title of the Bill to better describe what the Bill will do.

Most points around the Bill have already been made, but I will touch on some of the procedural issues that will flow from it. We expect a rise in the number of organ transplants as a consequence of this legislation, because more organs will be available. We could estimate that, and it could be anything from one to 700, but even one extra life is enough for me. However, I am confident that it will be much more than that. We will also have to put in place the register and the mechanics around it and publicise the changes. Following the Bill’s passage to becoming an Act—touch wood—we are looking at an implementation period of a year before everything is completely nailed down, enshrined and operational.

There has been lots of talk about the role of families. Ultimately, families will clearly wish to have a role in the welfare of a person who lacks the capacity to make a decision after deciding to be a donor. We need a system that takes families with us on this. We are sensitive to people’s faiths and beliefs, and that will all be considered as part of the wraparound care that we will put in place. We will obviously undertake further discussions with the Welsh Government to see how far we can learn from their experiences. By the time the Bill’s passage is complete, we will essentially have the same legal structure across Wales, England and Scotland.

I have talked about novel transplants, and clearly we will have the power to alter the regulations if other kinds of transplantation become possible over time. This legal framework should therefore be future-proof and able to react to changes in medical practice.

The hon. Gentleman ably spoke to the amendments. I do not have much more to say, other than that this is an extremely valuable piece of legislation. As a Health Minister, I have been given a wonderful tool to help us to save lives. It has been an absolute pleasure to work with all Committee members and to achieve this change one way or another. I look forward to seeing the Bill on the statute book. Everybody here, who has fought so much for these measures, can be extremely proud.

[Mr Robinson]

So many generous words have been extended in my direction that I feel that some redressing of the balance is necessary. I was lucky, and I hope I chose my Bill well. Judging by the support we have had through all its stages, it seems as though there is a groundswell of approval, opinion and acclamation for it, but one thing must not be overlooked, and that is that the Bill would have been very difficult if not impossible but for the support of the Government, including the Prime Minister in person. Throughout this, she has stuck to what she said in Liverpool.

I must also say that there have been tight moments, awkward moments, but the presence of the Minister with responsibility for the Bill, who is with us today, has throughout been one of charm—a smoother who, with her grace, has been able to get us through those moments too. She said it had been a pleasure to work with the Health Committee and it has indeed, and it has been a great pleasure to work with the Minister.

We keep saying these things, but perhaps we should cut down on further compliments to each other until we get the Bill through the Lords. On that basis, we are all in this together and still working hard, because we are not there yet, and who knows what the Lords will throw at us—

[Jim Shannon]

It is the first half.

[Mr Robinson]

I think that a little restraint would be a good thing. Thank you very much indeed, Mr Wilson, as always, and the Clerks. I have received excellent briefings—models of clarity—and I advise hon. Members to take a set now, in case they are challenged by any questions in their constituency work or anything like that. The briefings deal clearly with a lot of the most difficult issues. Again, Mr Wilson, it is a pleasure to serve under you. Thank you.

Amendment 1 agreed to.

Amendments made: 2, in clause 1, page 1, line 19, leave out “relevant” and insert “permitted”.

See the explanatory statement for Amendment 1.

Amendment 3, in clause 1, page 1, line 20, leave out “relevant” and insert “permitted”.

See the explanatory statement for Amendment 1.

Amendment 4, in clause 1, page 2, line 10, at end insert—

“‘permitted material’ means relevant material other than relevant material of a type specified in regulations made by the Secretary of State.”

This amendment defines “permitted material”, which will be used in new subsection (6A) of section 3 of the Human Tissue Act 2004 as a result of Amendments 1 to 3. The definition has the effect that the new provision about deemed consent will not apply in relation to relevant material of a type specified in regulations made by the Secretary of State. “Relevant material” is defined in section 53 of the Human Tissue Act 2004.

Amendment 5, in clause 1, page 2, line 11, after “of” insert “the definition of ‘excepted adult’ in”.— (Mr Geoffrey Robinson.)

This amendment is consequential on Amendment 4.

Clause 1, as amended, ordered to stand part of the Bill.

Clause 2

Consequential amendments

Amendment made: 6, in clause 2, page 2, line 36, at end insert—

“( ) In section 52 (orders and regulations), in subsection (3) (statutory instruments to which negative procedure does not apply), after ‘1(11),’ insert ‘3(9),’.

( ) In section 52, in subsection (4) (statutory instruments to which affirmative procedure applies), after ‘no regulations under section’ insert ‘3(9),’.

( ) In section 52, in the list in subsection (10) (requirement to consult), after ‘section 1(11)’ insert ‘section 3(9);’”.— (Mr Geoffrey Robinson.)

This amendment is consequential on Amendment 4 and produces the result that the regulation-making power conferred by the provision inserted by that amendment will be subject to the affirmative procedure in Parliament and to a requirement to consult such persons as the Secretary of State considers appropriate before the power is exercised.

Clause 2, as amended, ordered to stand part of the Bill.

Clause 3 ordered to stand part of the Bill.

Title

Amendment made: 7, in title, line 1, leave out from beginning to end of line and insert—

“Make amendments of the Human Tissue Act 2004 concerning consent to activities done for the purpose of”. —(Mr Geoffrey Robinson.)

This amendment replaces much of the existing long title so as to introduce reference to the making of amendments of the Human Tissue Act 2004.

Bill, as amended, to be reported.

Organ Donation (Deemed Consent) Bill (Money)

Geoffrey Robinson Excerpts

Money resolution: House of Commons
Tuesday 11th September 2018 Commons Chamber

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

I thank the Minister for her kind words. I say right from the start that she and the Government have been an invaluable asset in getting the Bill to this stage. It has been supported throughout the House of Commons, and I was delighted with that. All the party leaders in this place have supported it. I must pay tribute to the tremendous support that I have received from the office of the Leader of the Opposition and from my right hon. Friend the Leader of the Opposition himself. All that taken together—plus the Prime Minister’s considerable personal support—means that we can now have a money resolution, which we are delighted to accept. It provides £18 million for an essential public awareness campaign, which is intended to make it clear to the public what exactly the Bill does, why we are doing it and how it will operate. If we lose public support, we have lost everything, so this money will be well spent.

The Government are confident that the other money linked to the programme can be found from their savings and—to give credit here, too—for the first time we have a long-term commitment to funding of £20 billion over 10 years. We should be able to find a share of the other resources we shall need—the increase in surgeons, nurses and facilities—from that and from the savings that the Act itself will bring after the first year of planning, when it comes into operation. The cost of long-term and chronic care for kidney patients is enormous. The savings are therefore real, and we take the Government’s assurance that, together with the money resolution, that will be sufficient for our present purposes.

Having thanked all those concerned and everybody in the Chamber now, I commend the money resolution to the House.

Question put and agreed to.

Organ Donation (Deemed Consent) Bill

Geoffrey Robinson Excerpts

2nd reading: House of Commons
Friday 23rd February 2018 Commons Chamber

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

It is a great pleasure to see the Minister in her place. I was very pleased that yesterday afternoon she put out an official statement of support from the Government. They will be supporting the Bill, not just on Second Reading but through all its stages. That is very welcome and I appreciate that very much.

I am also very pleased with the support—I had no doubts at any stage—of the shadow Minister who will be speaking from the Opposition Front Bench. I must also mention that early on the Prime Minister indicated to me she had a personal interest and lent the Bill her personal support. I would like to say a sincere thank you to the Prime Minister for that. Rounding off this stage of my thanks, I have to mention the Leader of the Opposition. His leadership and support, and that of his office, has been invaluable. I have seldom seen such unanimous support across the House, with the 11 Members who have sponsored the Bill representing seven political parties in this House. Carrying that unanimity and commitment to the country and reaching a consensus there would mean that the Bill can become a very effective Act.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I pay tribute to my hon. Friend for using this opportunity to bring the Bill to the House. I hope that the House gives its endorsement to the Bill today. I note that the Government have welcomed the Bill. I assure him that if the Government work with him to ensure its speedy passage, they will have the Opposition’s full support.

[Mr Robinson]

I am grateful for that and thank my hon. Friend very much indeed. His support throughout has been consistent, welcome and a great help. I am pleased to tell the House we also have the support of three previous Prime Ministers. Only Sir John Major felt that he could not support us. He said he did not know enough about it, which was sometimes his problem as Prime Minister.

As I was saying, we should try to carry the unity of the House on this issue to the country and raise public awareness about the need for the opt-out solution we are proposing. That would be a major achievement. The Government have launched a consultation on the matter. My hon. Friend the Member for Barnsley Central (Dan Jarvis), who was with me in the early meetings, urged that course upon the Government. They responded quickly and to great effect: the response has been unprecedented. I am informed, unofficially, that the number of individual responses—separate, individually written letters—is now over 11,000, which is a record for any public consultation of this kind. The consultation does not finish until 6 March. I hope that the campaign will create sufficient awareness for people to find the opportunity to participate in it online via the Government’s website.

The predominantly positive response that we have been led to understand the public consultation is producing is hardly surprising—it is very welcome, but hardly surprising. According to recent reliable polling from the British Heart Foundation, up to 90% of the public said they were in favour of donation in principle, but that only 36% get around to signing the register. I think that many people are guilty, as I was for a number of years, of finding themselves in that position. That in itself suggests how effective an opt-out register could be.

Why are we actively looking towards implementing an opt-out solution at this stage? In England, for example, the situation is disappointing. We have some of the lowest rates of consent for organ donation in western Europe. Low family rates of consent have been one of the major barriers to the donor rate increasing. In effect, that prevents one third of available organs from being used. They go straight to the grave or to the crematorium. None of us likes to think about the worst happening, and it is challenging to have conversations with family and loved ones about one’s wishes after death. However, one of the Bill’s principal aims must be to encourage open discussions among families, so that an individual’s real wishes are known to their nearest and dearest. I think it reasonable to say that in the majority of cases, given the outcome of the consultation and what we know from the polls, people would wish to donate their organs after their death.

However, there will be those who take a different view. Perhaps even one or two in the Chamber feel that way and will make their feelings known in the debate. In no way do I wish them to feel that they have been railroaded into decisions that they do not wish to take. Therefore, I emphasise to those who feel that they cannot lend their support or have doubts about the Bill at this stage that soft opt-out provisions will be built into it. Naturally, I imagine that there will be a fair amount of discussion about those in Committee. I assure hon. Members that, as the Bill’s promoter, I give them my fullest personal commitment to approach discussions about the opt-outs in the spirit of sympathetic open-mindedness.

[Theresa Villiers (Chipping Barnet) (Con)]

I am here to support the hon. Gentleman’s Bill, but I ask him to engage with the Jewish community to see whether he can allay their concerns about how it might affect observance with their religious teachings.

[Mr Robinson]

I am very pleased to have taken that intervention. I remember that one of the former Prime Ministers who supports us—Gordon Brown—wanted to introduce an opt-out system, but came up against a fairly immovable block in the then Chief Rabbi, Rabbi Sacks, who said then that at no cost could he commit the Jewish community to supporting it. That rather held matters up and the Government were then overtaken by other matters with that Bill, but yes, we will do that. I have been in touch, and we believe that the council itself has made an official statement supporting the Bill.

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate my hon. Friend on his Bill, and I know that he has put a lot of hard work into securing it. As any Member who has dealt with a Bill in the House of Commons knows, a lot of effort goes on behind the scenes. He has given important assurances on an opt-out, particularly to communities such as the Jewish community, and it is important to convey that message across. I hope we will get further support on that basis.

[Mr Robinson]

I am grateful to my hon. Friend and my honourable colleague from our shared city—we are both immigrants to it, but we hold it very dear to our heart—and his support along those lines is most welcome. I notice that my right hon. Friend the Leader of the Opposition has come in. I repeat my warm tribute to his leadership on the issue and to the tremendous help that I have received from his office in backing up the Bill. I am deeply grateful. I also took the opportunity to express a sincere thank you to the Prime Minister, who has taken a personal interest and lent her support. I know that he will welcome that, too.

[Jeremy Corbyn (Islington North) (Lab)]

I apologise for having just arrived, Mr Speaker. I thank my hon. Friend for what he said. It is wonderful that he has got this Bill introduced, and I hope that today the House can pass it and thus save an awful lot of people’s lives in future.

[Mr Robinson]

That is indeed our aim. However, I shall sound certain notes of caution about what we need to do to ensure that we get and successfully utilise that increase in organ donation. We have to watch out for certain things, and I will mention those as part of the serious approach that my right hon. Friend would expect from me and that, in due course, he would want to see his Government adopt and perhaps have to implement. I hope that that is the case, too.

We have a proud history of innovation in the field of transplantation. I think that time prevents me from going into any detail on that—indeed, I am getting the message from you, Mr Speaker, that time is of no essence, so let me mention a few things that have been achieved. In our proud history, Britain’s first living donor transplant took place on 30 October 1960 at the Royal Infirmary of Edinburgh. The operation was between identical twins, because at the time, the problems of rejection were still a long way from any sort of reliable solution. In November 1965, the first transplant in the UK from a “non-heart beating” donor was carried out, again at the Royal Infirmary of Edinburgh. In 1968, there were the first successful heart and liver transplants. There is a proud tradition, and I am sure that the whole House will join me in congratulating the NHS and all the staff concerned in this department on their magnificent work.

[Mark Tami (Alyn and Deeside) (Lab)]

I thank my hon. Friend for introducing this Bill. I think that he will move on to the point that transplant surgery is now becoming routine and people are living normal, long lives as a result. When I was growing up, a heart transplant was the No. 1 item on the news, and now they are being carried out every day.

[Mr Robinson]

Indeed, and the consequence is that to some extent we are victims of our success. We now have a growing need for organs and a growing waiting list for them, as I will mention. That problem must concern us all, and as a country, we must find a proper resolution.

[Caroline Flint (Don Valley) (Lab)]

I congratulate my hon. Friend on his campaign. There are 90,000 residents in Doncaster who are on the organ donation register, and I am proud to be one of them. However, 54 patients in Doncaster are waiting for transplants. Unfortunately, Andrew Lake, the brother of my constituent, Amie Knott, died waiting for a double lung transplant. Is it not the case that we need to secure more people who are prepared to be part of this service, so that we can save more lives?

[Mr Robinson]

The whole House will be touched by the constituency case that my right hon. Friend raises, and it will wholly agree with what she says about the need to increase the availability of organs. We believe in a system that everybody is part of unless they choose to opt out. I have made it clear that the opt-out procedure would be simple and that we would respect those who choose to do so. If we can get the Bill through, it will not make an immediate difference tomorrow, but I am sure that over a period of years, as the activity rates and our capacity to handle donations successfully increase, the availability of organs donated will also increase. That is why I am so keen to get the Bill through Second Reading today.

Since those early successes, some 50,000 people in the UK have been given a second chance and a new lease of life, thanks to organ donation. I am sure that the whole House will join me in expressing the gratitude that we all feel to the NHS for that. Even if our history is a proud one, we cannot rest on our laurels. Unaccountably, over the past few years, the steady increase in the rate for donation and transplantation has slowed. In the past four years, to be more precise, it has in effect plateaued in England.

Against that background, there has been growing concern about the fact that a certain amount of inertia is setting in. The most recent figures for the whole United Kingdom make disquieting reading. As of March 2017, 6,388 patients were registered on the active waiting list for a transplant; in the same year, 457 died while on the active waiting list. Perhaps more significantly, over the same period, 857 people died after being removed from the active waiting list because while on it they had become too ill to receive a transplant. That shows how severe the situation is.

[Liz McInnes (Heywood and Middleton) (Lab)]

I congratulate my hon. Friend on the Bill, which I support. Many of my constituents have contacted me about children who have died for want of a suitable organ donor. I wonder whether my hon. Friend will explain at some point how the Bill will benefit children who need an organ donor.

--- Later in debate ---

[Mr Robinson]

I think that that is one of the most moving aspects. We held a reception last night. Many of those present had benefited from organ donations, but in a number of cases it was their children who had benefited. I will indeed say more about that shortly.

[Tony Lloyd (Rochdale) (Lab)]

My hon. Friend is making an excellent speech, and I am, of course, here to support him. The sad reality is, however, that behind every organ donation is someone who has died. It is right and proper for there to be facilities for children to receive donated organs, but that means a very sensitive time for the donor’s parents, who have lost a child of their own. How might it be possible to deal sensitively with those families whose children have died?

[Mr Robinson]

We would encourage that across the board. Although my hon. Friend draws attention to a vital area, it is only one of those that we hope to address. As I am sure he will understand, different issues seem equally important to those who are in other categories. I do not claim that my Bill on its own is a panacea for our problems, but I am convinced that it is a vital prerequisite to the imparting of a new impetus to the increase in organ donations that we know the country urgently needs.

[Dame Cheryl Gillan (Chesham and Amersham) (Con)]

I congratulate the hon. Gentleman on the Bill, which I support. May I pursue the point made by the hon. Member for Rochdale (Tony Lloyd)? I believe that in 2016-17, after Wales had introduced presumed consent, 13 out of 33 families withdrew that consent when they were asked about it. Can the hon. Gentleman assure me that the Bill will allow room for relatives still to be consulted and to withdraw the consent? After all, it is being asked for at a very sensitive time. I want us to ensure that families are given that latitude, while trying to do everything possible to increase organ donation.

[Mr Robinson]

The right hon. Lady raises a difficult but important issue. As part of the soft opt-out, there will certainly be arrangements for families and close friends to express their opinions. It is interesting to note that in Spain, which has no register and operates what is effectively an opt-out system, there is always consultation with every family who can be reached in time in the absence of a register, and as a result of those consultations there is a tremendous rate of consent. It can, of course, work the other way as well, and the Bill will make full provision for that. It needs to be carefully worded, and I invite those with a particular interest to look at it, but the intention is to give families in that position an effective veto. I may not have fully picked up the point made by my hon. Friend the Member for Rochdale (Tony Lloyd).

[Michelle Donelan (Chippenham) (Con)]

I, too, congratulate the hon. Gentleman on the Bill, which I support. Does he agree that the point about Spain highlights the fact that the Bill is not actually the answer, but only part of the solution? After its Bill was passed, Spain took 10 years to increase the rate of donation by investing heavily in transport and infrastructure and a national organ donation system.

--- Later in debate ---

[Mr Robinson]

Yes. I shall refer to some of the circumferential investment that will be necessary to ensure that our own system is successful. Of course we would be starting from a much higher level, because our infrastructure—the nursing provision that is so vital, the body of professional surgeons and the specialist units—is much greater than it was in Spain. However, we recognise the success of the Spanish system. At its heart is the ability to reach the families and talk to them. That should happen in any event, but we believe that when it happens against the backdrop of an opt-out system, it starts from a different position and is—we hope—likely to produce a more positive result.

[Sir Roger Gale (North Thanet) (Con)]

I think it fair to say that most, if not all, Members who are present today are here because we support the Bill and want to see it on the statute book. But—and it is a “but”—the hon. Gentleman said in his response to the point made by my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan) that friends and family would be consulted. I think it important for the Bill to be very precise if the matter is not to be brought into dispute and if a wave of withdrawals is not to be generated, which is the last thing that we want. Will the hon. Gentleman ensure that that issue is very clearly addressed when the Bill goes into Committee, as we hope that it will?

[Mr Robinson]

I am grateful for the hon. Gentleman’s thoughtful and apposite intervention, and I can give him that assurance. Obviously, as the Bill’s promoter, I shall take a personal interest in ensuring that the right balance is struck. We should bear in mind that the balance will be struck in a context in which opting out is the law of the land, which I think changes the starting point of the discussions with families, but those discussions should nevertheless be handled with proper caution and respect in view of the moments of agony and the awful decision making with which families are faced.

[Jo Stevens (Cardiff Central) (Lab)]

I am here to support the Bill, but, as a Wales Member, I want to provide some reassurance. Wales already has legislation that has been working and that deals specifically with that point, and we have a higher donation rate than any other nation in the UK. I welcome the Bill, and I hope that everyone present will support it today.

[Mr Robinson]

I am very grateful for that intervention, in every sense. I was going to come on to the situation in Wales, which has been unfairly and prematurely judged to be a failure—even by as eminent an authority as the Nuffield Council on Bioethics, which yesterday opined on the basis of figures produced only one year into the scheme. However, the latest serious peer-reviewed article in The BMJ expresses a different opinion, some three or four years into the scheme. It was written in February this year, so it is up to date, and there have been a few years in which to observe the trends. According to the author, a respected journalist, Wales has more registered donors and has experienced fewer family refusals and more living donations than any other part of the UK since the introduction of an opt-out system. The article concludes that

“none of the concerns about deemed consent”

—concerns rightly expressed by Members this morning—

“have materialised”.

The signs from Wales are very good, but these are early days, and I think it behoves us to note the caution expressed by the Nuffield Council on Bioethics. We want to proceed carefully and with all the necessary infrastructure in place. One of the great aspects of our present system is that it is trusted by the public, and we cannot and will not put that trust at risk. We must ensure that the new system is introduced properly. What I have seen at first hand of NHS Blood and Transplant suggests that it is a very well organised outfit.

We do have a functioning register; we do know what we are doing; and we are building up our essential counselling nursing capability. As we build it up, some limited investments will also be needed in facilities, for any growth in demand will lead to a growth in the requirement for facilities. I say to the Minister, who is looking rather grim at the moment—[Interruption.] That’s better. I say to her that the NHS is very much in favour of this; I will quote a figure in a moment. Its thoughts as to the extent to which we can benefit in terms of increased numbers of organs and saved lives are encouraging, but it adds that its requirements for additional resources must be met. All I can say to hon. Members in that respect is that the amount of money required—the small requirement of resources in terms of software, mainly for the training of the nurses, and hardware and some facilities—is minuscule in relation to the good it can do. I think of the sheer joy we can see in those, particularly the children, who have had the benefit of a transplant.

[Philip Davies (Shipley) (Con)]

The hon. Gentleman glossed over Wales in his remarks, but Welsh Assembly Government research showed that the introduction of the opt-out has had no impact on the number of organ donors in Wales, while the organisation CARE has said it has led to a reduction, not an increase, in the number of donors. What learning has the hon. Gentleman taken from the experience in Wales, and what measures are there in his Bill to address some of the flaws there might have been in that system in Wales?

[Mr Robinson]

That is a very moderate intervention from the hon. Gentleman, for which I am grateful. He is probably looking at the recent remarks and quotes from the Nuffield Council on Bioethics, which relate back a year, if I am not mistaken, to 2016 or ’17, but we are now in 2018 and the situation has evolved. I recommend to him an article I have here in The BMJ; I will leave it out for him if he would like to read it. It gives a full account of the situation in Wales, and is very hopeful. But, as I have said, we are going to monitor this carefully, and we should be cautious, practical and realistic in our approach to the introduction of the system in the UK.

[Dame Cheryl Gillan]

May I give the hon. Gentleman some good news on Wales? The legislation in Wales was pioneering, and was much discussed when I was Secretary of State for Wales. I have been looking at the details of some of the statistics from Wales in the latest report on organ donation and transplantation activity data, and the hon. Gentleman will be pleased to note that back in 2013-14 some 1,005,213 people were opted into the organ donation register in Wales, while for the first three quarters of the years 2017-18 that number increased to 1,220,331. The fact that more people are opted into that register is very positive news from Wales.

[Mr Robinson]

It was because the figure was so low in 2013 that the Welsh Government decided to move to an opt-out system. I agree with the right hon. Lady, and disagree with those who, for some reason or another, will not look at the most recent facts and move with the situation that is developing. The situation in 2013 was bad, which the Welsh Government recognised and they then went for an opt-out system. Then there was a period of bedding-in and there appeared to be no change, but the most recent figures for 2018—as opposed to 2017 or ’16—are showing a marked improvement, and I am sure we can all rejoice at that. This is not a matter of trading economic figures across the Chamber; that is a sheer fact and one that I think we can all take great satisfaction from.

[Paul Flynn (Newport West) (Lab)]

My interest in this matter arose from a constituent—a young man—who came here and lobbied. A year later I attended his funeral because, sadly, he did not get the transplant he wanted, but he had suffered enormously in the preceding period. We have now had the opt-out in Wales, however, and, regardless of what people can do with the statistics, the fact is that people in Wales are still alive who would have died before the law was passed, and people are dying unnecessarily in England.

[Mr Robinson]

I am grateful to my hon. Friend. It was his Bill that sparked my personal interest, and I pay great tribute to the work he did in preparing that Bill, which we have adopted almost in its entirety. He will be pleased to know that we are hopeful that his Bill—from the beginning, as it were—will now find its way alongside my own on to the statute book; I know that will give him great pleasure. What he says about that individual case is certainly true. The positive news from a cautious assessment from the NHS is that, provided the opt-out system—the quintessential starting point for all these forward projections—is introduced and backed up with the necessary limited revenue and capital spending, up to 500 lives a year could be saved by deemed consent.

[Crispin Blunt (Reigate) (Con)]

I am delighted to appear as one of the supporters of the hon. Gentleman’s Bill, and am very pleased to have my name on it. I hope he will be able to look at just one thing in Committee: the issue of deemed consent involving people who lose capacity towards the end of their lives. I hope there will be more clarity in Committee to enable people who have made the decision that they want to make their organs available to do so, when just their brain is no longer of much use to anybody else and they do not have the capacity. I hope the Bill will be clear about such circumstances when people lose capacity towards the end of their lives but when the rest of the body can still be of use to others.

[Mr Robinson]

I thank the hon. Gentleman for his intervention and the fact that he agreed to be a supporter of the Bill—his name appears on the face of the Bill, he will be pleased to note. He raises an area of great concern, but it is something we will have to deal with in Committee; I am sure he will agree that it is not for Second Reading, so I will not go further into it now.

[Sandy Martin (Ipswich) (Lab)]

I thank my hon. Friend for bringing this Bill to the House, and I will of course support it. He mentions the modest investment in capital and resources needed to give effect to this when it has become law, but does he agree that by saving lives and making people healthy enough to play a full part in society, we will be increasing the ability of our country to succeed, and also—although this is obviously a secondary issue by comparison with the saving of life—we will be reducing the ridiculous amount of spend on just keeping people alive when they actually need organ donations?

[Mr Robinson]

I entirely agree with my hon. Friend and thank him for his intervention, but I would rather not go down the route of cost-benefit analysis; these are matters of life and death and are best left as such when we look at what we can do to save lives that we know can be saved.

[Hilary Benn (Leeds Central) (Lab)]

I strongly support my hon. Friend’s Bill. Alongside this measure and a number of the other things he describes, does he agree that the most important thing we can do is have that conversation with our families and loved ones, to make it absolutely clear to them that when we are gone we wish whatever bits of us are still of any use to be given to others so they might continue to live? Is that not what we really need to do to make sure that, when that difficult conversation comes to be had over a loved one who has died on a hospital bed, as many people as possible know and the family can say, “Of course”?

[Mr Robinson]

I entirely agree with my right hon. Friend. I do not know whether he was in the Chamber when I remarked on the importance of family conversations, which are absolutely vital, and also the importance of public awareness. The Government consultation has contributed enormously to public awareness. We must ourselves now set the example in terms of being registered and not opt out—I certainly have no intention of even considering that.

The other great contribution that we can make in personal terms is to hold those conversations with our own families and encourage others to do so. Public awareness will not necessarily lead to that happening, yet we know that it is at that moment when families are confronted with the awful situation that they often back off, sometimes even overriding the wishes of the deceased who happens to be a registered donor. We can do no more important work than to hold those difficult family conversations and encourage others to do so.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

My hon. Friend is making a good point about making people aware of the difference this can make. Yesterday, I found out about the British transplant games, which involve live donors and people who have received an organ transplant. This wonderful event will take place in Birmingham on 2 August. I met a woman called Pat who had been a live donor, and she said that she was going to take part in the games with the person to whom she had donated an organ. I thought that was so wonderful. Obviously, no one wants to think about the worst thing happening to their family or anyone they love, but it would be wonderful to think that anything I could give when I have gone would help someone to live a fulfilling life that could even involve taking part in a sporting event like that. We should think about the future and the real difference that this can make for so many people. I am so proud to be standing here with my hon. Friend on this day and supporting his Bill.

[Mr Robinson]

I feel inclined to say that I rest my case, but I cannot quite do that just yet. I think I am okay for time, despite all the interventions. I will, however, proceed to a conclusion now, if I may.

I have quoted some disquieting statistics, including the 500 saveable lives—or avoidable deaths because of the unavailability of an organ—a year. To put it another way, if we continue with unchanged policies, some 500 of the 6,500 people on the present waiting list will, in effect, be on a life sentence and will die in the next year if no organ becomes available. I believe that the House will agree that that is simply not good enough. We can do better as a nation. We have shown that we can do that through the creation of the NHS, which is something that no other nation achieved. Here again, we can be pioneers in making transplantation more successful, principally through an increase in organ donation.

As I have said, I do not think that my Bill is the answer to all the questions—we have discussed many of the points that need addressing in the course of this debate—but my God, I am convinced that it is a necessary start if we are to regain the momentum and the impetus that we lost by moving to an opt-out system. After all, that is why this measure has been introduced in Wales, and that is why I am putting my proposal to the House today.

My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) talked about the British transplant games. Last night’s reception, given by the Daily Mirror—very fortunately—in the Terrace Room, was very moving. I met Max’s mom, as she has come to be known—Mrs Emma Johnson—and she gave us the most up-to-date news on Max, who has become something of the face of the campaign. I make no excuse for being emotional about this, and I am sure that everyone will be delighted to know that Max is still doing well. He went back to school part time last September, and it is hoped that next year he will be back full time. The hon. Member for North Devon (Peter Heaton-Jones) represents the donor family—the Ball family, whose daughter, Keira, was killed in a terrible car crash; a most unfortunate incident—and he brought to my attention something about the Max story that I did not know. Keira gave her heart to give that young boy his life, and Max’s mom, Mrs Johnson, has said how much she is looking forward to meeting the family. She says she wonders how they will feel when they put their hand on Max’s heart and feel their daughter’s heart still beating. I had a call alerting me to the fact that the hon. Gentleman wanted to take part in the debate and to refer to this, and I said that that would be great. I am sure that he will catch your eye in due course, Mr Speaker.

There are many in this House who have been affected in one way or another. If I may, I would like to mention my hon. Friend the Member for Sunderland Central (Julie Elliott), who was also at the reception last night. Her daughter, who unfortunately could not attend, has been on daily dialysis for 12 months now while waiting for a kidney. I know that my hon. Friend will also want to catch your eye if possible, Mr Speaker.

I hope that the party opposite will take it in the best spirit when I say that I would like to thank the Daily Mirror for its magnificent campaign on this issue. It shows just what a free press, fighting courageously, can achieve for a brave cause. It is, in that sense, the best of the best. I said that to their representatives very openly last night in thanking them for the campaign, and I know that they feel that they have achieved something—perhaps more than some newspapers achieve in 24 pages of exposure. The representative of the Daily Mirror told me that my thanks were welcome, but they were nothing compared with the happiness felt at the Mirror every time there was a successful transplant as a result of the campaign, especially among the young.

I have had many letters on this subject, although it is properly not appropriate for me to read from them now, as I was intending to. I shall just say that the House has an opportunity today that, while not unique, might not occur again for several years. We have the opportunity to introduce a Bill whose enactment we could achieve by the end of this year, if it receives its Second Reading today, and whose effect could begin to be felt in the following year. I believe that the House is in the mood to rise to the occasion, and I am sure that we will seize this opportunity to pass a Bill that will come to be regarded as an Act for life.

--- Later in debate ---

[Mr Robinson]

I do not much like self-congratulation, and moments when the House gets self-congratulatory can be embarrassing, but on this occasion I am delighted to say that we have seen the House at its best. I say that because we have had a debate where not only have high standards of rational argument been deployed, but deep emotions—we all feel them—have not been kept from us. That unique combination today has enabled us to have the cross-party consensus of the size we have achieved, on a Second Reading of a Bill that is, perhaps, contentious in nature in some respects. I note that the Secretary of State for Health has just arrived and so, while plaudits are being awarded, may I just say that his support from the very beginning has given great encouragement to me and to my hon. Friend the Member for Barnsley Central (Dan Jarvis)?

This is a great moment for us. I hope that there will not be a Division, but I am sure that if there is one, we will win it. I am sure that we will be able to go out of the Chamber knowing that the Bill has passed its hurdle of Second Reading, that we are going into Committee and that with any fair wind from the Government by the end of the year we will have the Act—Max’s Act, as we should call it—on the statute book. I look forward to that moment and to saying that, at least in this Parliament, we did pass an Act for life, and I am delighted, on that note, to be able to conclude the debate.

Question put and agreed to.

Bill accordingly read a Second time; to stand committed to a Public Bill Committee (Standing Order No. 63).

Oral Answers to Questions

Geoffrey Robinson Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Dunne]

Current plans by NHS England to look at the urgent and emergency care pathways include creating 150 urgent treatment centres by the end of this year. I am happy for the hon. Gentleman to write to me about Bury and will respond in due course.

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

Is the Secretary of State aware that there is widespread support in the House for his Government’s commitment to enact the principle of deemed consent for organ donation? He knows from a previous meeting that my private Member’s Bill is due for its Second Reading early in the new year. Will he therefore agree to an early meeting now, so that we can co-ordinate the two and see how to advance his intentions? I know that my hon. Friend the Member for Barnsley Central (Dan Jarvis) will be with me again and, with the Secretary of State’s commitment to this, we look forward to an early meeting.

[Mr Hunt]

I very much enjoyed our previous meeting, which was not so very long ago. I hope the hon. Gentleman is happy that we have made good progress since that meeting, with the Prime Minister announcing that we will start a consultation, but I am always happy to see him and his colleague the hon. Member for Barnsley Central (Dan Jarvis).

Organ Donation: Opt-out System

Geoffrey Robinson Excerpts

Thursday 13th July 2017 Westminster Hall

[Dan Jarvis (Barnsley Central) (Lab)]

I beg to move,

That this House has considered the matter of the introduction of an opt-out system for organ donation in England.

It is a pleasure to serve under your chairship, Ms Buck. I want to begin by sharing with the House my reasons for tabling my debate and by telling the stories of Max Johnson and Joe Dale. Yesterday, I had the privilege of meeting Emma and Harry Johnson—Max Johnson’s mother and brother. Max is nine years old and has cardiomyopathy—a condition that enlarges the heart and can be life-threatening if left untreated. Max is kept alive by a tiny metal pump in his chest, and has been waiting for a heart transplant for six months. He is one of 6,388 people in the UK waiting for an organ donation. Last year, 457 people died while still waiting.

Joe Dale was a constituent of mine. He died last month after a sudden asthma attack, which caused devastating brain damage. He was just 16 years old. After his death, his family made the selfless decision to donate some of his organs so others might have the chance to live. Because of their decision, Joe became one of the hundreds of deceased donors who save and improve lives every year in the UK. I know that right hon. and hon. Members will want to take the opportunity to join with me in passing our condolences to Joe’s family and giving our thanks for their brave determination to help others in spite of their personal tragedy.

The stories of Joe and Max, the work of my hon. Friend the Member for Newport West (Paul Flynn) and the very important Daily Mirror campaign have re-energised my long-held belief that as a country, as politicians and as a legislature we can do more to help those in need of organ transplants.

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

I will be very brief. My hon. Friend mentioned the Daily Mirror campaign and the private Member’s Bill introduced by my hon. Friend the Member for Newport West (Paul Flynn) and other supporters, which failed due to the prorogation of Parliament and the general election. Luckily, I have position No. 6 in the ballot, and I want to inform my hon. Friend the Member for Barnsley Central (Dan Jarvis)—I compliment him most sincerely on conducting today’s debate—that I intend to reintroduce the Bill pretty much as it stands. I will be presenting it next Wednesday in the House of Commons, and I hope I can count on my hon. Friends’ support. That also applies to the hon. Member for Strangford (Jim Shannon).

[Dan Jarvis]

I join my hon. Friend in paying tribute to the Daily Mirror, which ran a very important campaign for some time, and thanking it for the work it has done. I also thank him for confirming, I think for the first time, that he intends to use his private Member’s Bill as an opportunity to introduce a legislative mechanism for the Government to change the law in England, should they wish to use it. I hope that will provide a forum where this matter can be further debated constructively in Parliament. I am very grateful to him for taking that decision, and I look forward to supporting his Bill and working with him and, I hope, the Government to make it a great success.

Four hundred and fifty seven unnecessary deaths a year is too many, and I believe it is our duty to reduce that number and save the lives of people such as Max. By changing the law to an opt-out rather than an opt-in system we in Parliament can do that.

The truth is that there is a common misconception about how organ donation works. Only a very small number of people die in a way that allows for organ donation. The vast majority of people on the organ donor register will never actually donate their organs. The figures are startling: about half a million people die every year in the UK, yet last year, out of that half a million, only 5,681 people died in circumstances that made donation possible—about 1%. Although there are hundreds of thousands of people across the country who are registered as potential donors, only a handful will ever be in a situation that allows donation to take place. The reality is that there are simply not enough registered organ donors. People in the UK—specifically in England—are dying as a result.

Accompanying those alarming facts are some more positive recent statistics, as reported in this week’s “Organ Donation and Transplantation Activity Report for 2016-17”. Last year, there was a 4% increase in the number of deceased donors to 1,413—the highest number ever in the UK. Coupled with more than 1,000 living donors, that has resulted in 4,753 life-transforming transplants this year—a 3% rise from last year. The number of patients whose lives were saved or improved by an organ transplant has increased by 3% to 4,753. All that means that more than 50,000 people are alive today thanks to a transplant.

The “Organ Donation and Transplantation Activity Report” is a good news story, but I believe we can make it an even better news story. Behind every statistic there are people, and, as Lorna Mason and Gary Masterson wrote this week in the annual transplant activity report:

“Every transplant is the result of a complex collaboration between donors and their families, a host of clinicians working in different parts of the NHS and finally in transplant recipients and their family.”

They went on to say that

“opportunities for donation continue to be missed...While we cannot quantify every missed opportunity precisely, we need to work collaboratively to make sure that these are as few as possible.”

Despite the excellent campaign run by the NHS to encourage organ donation—details of which can be found at www.organdonation.nhs.uk—the UK still has one of the lowest rates of consent in Europe for organ donation.

The “Taking Organ Transplantation to 2020” strategy, published in 2013, set the target of increasing the donation consent rate from 57% to 80% by 2020, in line with the better-performing countries in the world. That is the rate at which families who are approached by NHS Blood and Transplant actually go on to become donors afterwards. Although the consent rate has increased to 63%, it is still too far below this year’s target of 70% and the 2020 target of 80%. Now is the time for us to do something about that.

I believe that the best way for us to increase the number of lives saved through organ donation is to adopt the so-called opt-out system—sometimes known as a system of deemed consent. Under the current law in England there is an opt-in system of organ donation. In other words, people must proactively state that on their death they would like their organs to be donated to someone else. And yet surveys consistently show that there are many more people who would like their organs to be donated when they die, but they are not registered. Polling conducted by the British Medical Association supports this and has shown that 66% of people in England would donate their organs after death, but only 39% have signed the organ donor register. That means millions of people here in England are willing to donate their organs, but are not registered to do so.

I am sure we all understand that people lead busy lives and that organ donation is not something most people think about on a day-to-day basis, but the reliance of the opt-in system on our not only thinking about it but finding the time to sign up is reducing the number of organs available and the number of lives saved. That is why many other countries use a different system.

Wales has had an opt-out system since December 2015 and only last month the Scottish Government announced plans for a similar system of organ donation in Scotland. In a statement, the Scottish Health Minister said:

“Moving to an opt-out system of organ and tissue donation will be part of the long-term cultural change in attitudes to encourage people to support donation.”

That view is increasingly shared by countries around the world and by many of our European neighbours such as Austria, Belgium and Spain, which all use variations of the opt-out model. It is time that we in England joined them, modelling our system on that in Wales where they offer three clear options: first, to register someone’s wish to be a donor by opting in to the system; secondly, to register their wish not to be a donor by opting out; and thirdly, to have their consent to donation deemed by taking no action.

It was argued when the law was passed that the availability of the three options would increase the number of organs available for donation, and that that in turn would save lives. I am pleased to say that the evidence from Wales suggests that such assertions were correct and that the new law is working. Indeed, the potential pool of organ donors has almost trebled since 2014-15, and the opt-out system does not appear to have deterred individuals from proactively opting in. It is right, of course, that we strike a note of caution with that data, but the initial signs are encouraging.

I now want to address some of the concerns that people have about an opt-out system of donation. This is undoubtedly an emotive issue and there are strong feelings on both sides of the debate. I would not want to question anybody’s motives in deciding whether they wish to be a donor. It is, after all, a deeply personal matter. Under an opt-out system, people would not be required to give a reason for choosing not to be a donor, as the system is not about trying to shame people into becoming donors. Also, similar to what is happening in Wales, any new law would need to be accompanied by an active public awareness campaign: first, to ensure that people understand the new system; secondly, to encourage more people to make the positive decision to become an organ donor; and thirdly, to give people who may want to opt out the information they need to do so.

1 understand that some people have concerns that an opt-out process raises the risk that a person will have their organs taken against their will and against their families’ wishes, which in turn could cause unnecessary distress to the families of the deceased. I also understand that such concerns may be more prevalent within some ethnic and religious groups and that some members of our Muslim and Jewish communities have different interpretations of the religious legitimacy of deceased donation. I completely get that. I understand their views and have the utmost respect and sympathy for them. However, I firmly and wholeheartedly believe that not only do the benefits of an opt-out system far outweigh the risks, but that the risks can be mitigated through a public awareness campaign tailored to different ethnic and religious communities and through the use of in-hospital safeguarding measures. Any new system would have to ensure there were safeguards in place to ensure that no one’s organs were donated against their wishes; that the opt-out system applied only to those over the age of 18; and that for those under 18 it continued to be the case, as it was with my constituent Joe Dale, that the family have the final decision, because it is vital that nobody feels as though they are being coerced.

I also accept that changing the law is not the only change we need to make. It would need to be part of a wider package of measures to increase organ donation. We need to redouble our commitment to the “Taking Organ Transplantation to 2020” goal of increasing the consent rate to 80%, and to consider carefully whether the strategy needs strengthening in the light of the progress so far.

The evidence from Wales and from countries across Europe gives us the confidence to say that an opt-out system would be an important step forward. For that reason, I very much hope that we can proceed on a cross-party basis. I respect anyone who takes a different view on an issue of conscience such as this, but it is clear that the principle of deemed consent has support from Members of all parties across the House.

The Health Secretary recently told the House that an opt-out system has “a lot of merit”. Only yesterday at Prime Minister’s questions, the First Secretary of State told me that

“organ donation is clearly a hugely important part of our system, and the Department of Health is looking at the impact of those changes to see if those can give rise to further improvements in the number of available organs.”—[Official Report, 12 July 2017; Vol. 627, c. 290.]

I welcome such statements because I know that an opt-out system has merit. When the Parliamentary Under-Secretary of Health, the hon Member for Thurrock (Jackie Doyle-Price), winds up the debate, will she tell us what work is taking place in her Department and when it will report?

Before I conclude, I want to take a moment to say how much my hon. Friend the Member for Sunderland Central (Julie Elliott) wanted to be here today. About a year ago, her daughter, Rebecca, a fit young marathon-running mother of one, had blood tests that indicated kidney failure. Three weeks ago she had surgery at the Freeman Hospital in Newcastle to enable her to start dialysis. Today, she joins the 6,000 other people on a waiting list for an organ donation. The average wait for a kidney on the transplant list is two years. I know that all hon. Members will want to join me in wishing Julie, Rebecca and their entire family all the very best. Also, I want to take this opportunity to thank charities such as Kidney Care UK for their work. Because of these stories we should move forward as quickly as possible; children such as Max and mothers such as Rebecca do not have the luxury of time to wait. Anything that we can do to help them get a new organ is a step worth taking so that they can join the thousands of people in our country who have benefited from organ donation.

We have a duty of care to those in our society who need help, and that includes those who need transplants. We can and must do more to help them. We cannot save the 457 lives lost last year, but who knows how many we could save in future? As an old friend once told me, “The best time to plant a tree was 20 years ago. The second best time is now.” I very much hope that the Government will act.

Mental Health and NHS Performance

Geoffrey Robinson Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I am happy to do that. I echo my right hon. Friend’s praise for the staff at NUHT, which was particularly pressured over Christmas. They have made particular efforts to improve patient safety and quality of care over recent years. She is absolutely right, and of course I will continue to work closely with her trust and others.

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

At 9.30 am today I received an email from a constituent in Coventry who asked me to bring it to the Secretary of State’s attention; I am delighted to do so. She writes as follows:

“I am a nurse with 26 years’ experience who has always worked full time and has paid my tax and national insurance without ever having to burden the government, social services or the NHS in my lifetime but have gladly served and given 100%”

to it. She continues:

“Unfortunately, my 18 year old daughter has recently become unwell mentally and attempted suicide twice in a 3 week period…I am really sad to say—

this comes from a nurse of 23 years’ experience—

“that the care she has been given has been dreadful. I am somebody who works in the NHS so I understand the strains the service is under but I also expect that as a family who give so much to society that when it is our time of need that we can expect a service that meets our needs.”

I ask the Secretary of State whether he will kindly agree to meet Mrs Hardy and me—Sarah Hardy is the lady’s name—or arrange for her to meet somebody who can give her some sort of reassurance. She continues that she has been waiting six months without any mental health assessment or support from the NHS—six months for a daughter of 18 years of age. Will he agree to do that so that it is not just a case of more hollow words?

[Mr Hunt]

I am more than happy to meet Mrs Hardy, but ahead of that I would like to look at the particular issue of why she has had to wait for so long. The hon. Gentleman put it very eloquently, and she put it very eloquently, and we owe a huge debt to such people. What she has described with her 19-year-old daughter’s treatment is just not satisfactory: it is not good enough. That is why the Prime Minister talked this morning about the injustice of having to wait so long for treatment, and that is exactly what we are trying to put right.

Capita Contract (Coventry)

Geoffrey Robinson Excerpts

Tuesday 8th November 2016 Commons Chamber

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

I thank the Speaker for granting this debate. It is timely, because while the issue has been raised by local GP practices and their senior managers in Coventry, I am well aware, following a gracious call from the Minister’s office and given the presence of other hon. Friends, that the problem has a wider significance and that it has echoes in many other parts of England, at least. I thank Jane Moxon and others who came to see me—all very senior practice managers in Coventry. They alerted me what is evidently a growing problem throughout the country.

The Minister, who is aware of the situation emerging across the country, kindly asked whether she should address the wider issue, or concentrate on Coventry. The topic of the debate is the impact on patient care and the health service in Coventry of the privatisation of the thoroughly well-executed existing service for GPs in our area. The same thing is happening in other areas, however, and I will be very happy to give way to my hon. Friends. Sufficient time is available—not that I want to detain you unnecessarily, Madam Deputy Speaker, or the Minister or other Members, but if there is interest, I am sure that we can accommodate others, such as my hon. Friends the Members for Coventry South (Mr Cunningham) and for Coventry North East (Colleen Fletcher); all three Coventry Members are properly on parade this evening to take part in the debate.

The position was very simply summarised by the senior practice manager from Broomfield Park, Jane Moxon, when she came to see me. She acted as chair for the group, and still does. Warwick University is in the same position: students from the EU face the loss, absence or lateness of their patient records. Allesley Park hosted our meeting; Kevin Arnold is the practice manager there. They have all alerted me to the fact that GPs are simply unable to do their job without having their patients’ records to hand.

An excellent manual service was provided under the national health service, but the Government were taken in by the lure of apparent savings and the prospect of cutting 40% from a £1 billion bill, and they contracted the work out to Capita, of all people. Only last week, we saw what could happen in the absence of a properly thought-through privatisation programme. These contracts are gaily handed out to companies that do not have the skills, preparation or sheer commitment necessary to provide the service.

[Karin Smyth (Bristol South) (Lab)]

I am grateful to my hon. Friend for initiating this debate. I have been contacted by my GP practices in Bristol South about this issue. In a previous role, I worked in a commissioning group and I have employed GPs. The arrangements for doing that are very complex, requiring specialist local knowledge and a lot of experience. Does he agree that the decision to put the entire service out to a national tender was driven by a desire to make massive wholesale savings, and that the savings target completely ignored the service need locally? Does he also agree that we are in a very poor situation across the country? I hope that the Minister can address that point.

--- Later in debate ---

[Mr Robinson]

My hon. Friend speaks pointedly to the issue. She is absolutely right in every respect, and I thoroughly agree with her. I would go a little further and say that the irony is that we have ended up with a terrible service that is costing more than the previous service ever would, because the company was not properly prepared, did not have a commitment to providing the service, and was unable to do so, and because of the competing and irreconcilable claims about short-term gains in the form of profits and illusory savings for the health service.

[Kate Green (Stretford and Urmston) (Lab)]

The situation in Coventry that my hon. Friend describes is also being experienced by GP practices in my constituency. GP practice managers have told me that the system was trialled in west Yorkshire and proved unsatisfactory, yet the contract was rolled out regardless. Does my hon. Friend not agree that that is a further irony?

[Mr Robinson]

Well, we learn something every day. I did not know that, and I am grateful to my hon. Friend for bringing it to my attention. That fact was not mentioned to me in Coventry, where people felt that the new system had been sprung on them completely without trial. When I was a Minister, I was a great supporter of the idea of trialling programmes. After all, we trialled them for a purpose, which was to see whether we were ready for them and whether the contractor was able to provide them. However, that seems to have been ignored in this instance. I shall say a few words at the end of my short contribution about learning lessons. This is not the first time we have been in this position. It is not as though we have suddenly discovered that contracts are not easily transferred, and there are lessons to be learned.

[Colleen Fletcher (Coventry North East) (Lab)]

Does my hon. Friend agree that this problem does not just affect GP practices in Coventry? It has also had an adverse impact on individual residents, including people who have requested a copy of a late relative’s medical records from the primary care support service. Partly because of the service’s failure to appoint a medical adviser to deal with such requests in the Coventry area, many of those people have been forced to wait for more than twice the maximum 40 days that it should take to process such a request. It is utterly unacceptable to put anyone through that kind of delay, but it is inexcusable for it to happen to anyone who is already in an extremely vulnerable position following the death of a relative.

[Mr Robinson]

I entirely agree with my hon. Friend, who puts her finger on another aspect of the situation that reveals the true motives of private sector contractors. They are not in it to improve the service and make real savings; they are in it for short-term profit. I have nothing against the private sector making profits—I am all for it—but the irony is that the companies cannot make a profit from a proper service, so they turn to such measures as imposing a £40 charge for access to a deceased relative’s records, as my hon. Friend mentions. They do not have to impose that charge—I think it used to be left to the GP’s discretion—but they now insist on it, and people have to pay postage and delivery charges on top, which is a disgraceful pursuit of short-term gain at the expense of the people they are meant to serve.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this issue to the House. Capita holds the contract for locums for the NHS; no one questions their ability, but does the hon. Gentleman have any concerns about the scheme’s value for money? The Government should look at filling those vacancies from within the NHS, making a saving and keeping that money in the NHS for NHS services.

[Mr Robinson]

Just as I am in favour of a profitable private sector, I am in favour of savings in the NHS. We all know that we have to make savings, but let us make real savings from properly thought-through programmes. The NHS is often the best place to carry them out. We should not have badly planned impositions from the private sector, which does not know what it is going to do or how to do it.

We have to learn the lessons. It is not as if we have not had plenty of examples, as we saw in our debate last week on another private sector company that reviews benefits. That case was an absolute disgrace, but let us not get diverted on to that, because we had a good debate on it last week. Let us stay with the problem before us tonight. I look forward to hearing what the Minister has to tell us, but I must warn her that I have a few things to say yet; I have only just started. Correct me if I am wrong, Madam Deputy Speaker, but I understand that the debate can go longer than half an hour. I do not want to detain the House, but I urge any Member who wishes to contribute to do so, because we have at our disposal at least double the normal time. If I say that to the dismay and disappointment of the Minister, I am sorry, but we will not delay anybody unnecessarily.

Others have been in touch with me on this subject. I am pleased to say that the good old BBC was made aware of an issue and initiated an excellent survey of what is happening in Norfolk, Suffolk and Essex. The survey was carried out by Nikki Fox, who did a good job and presented a programme on this. She discovered that no fewer than 9,000 records had been lost. Some had been found flying loose on the ground in a car park. God knows what happened to the others—nobody knows. Some 9,000 patient records have gone missing in those three counties alone. It is very much to Mr Paul Conroy’s credit that he has written to me issuing a challenge, which I will come to later, to fulfil our public duty to reveal what has happened, which, as is usually the case, others are trying to hide. Capita says that it is unaware of the problems, yet three counties are up in arms and the BBC has conducted an exposé; it beggars belief.

No fewer than 20 practices in Coventry and Warwickshire have been surveyed, and every single one of them has said that there has been a more or less serious deterioration in services. NHS England itself has now stated that patients could be at risk. The whole purpose of tonight’s debate is to reveal that risk and to urge Capita to correct the problem.

[Kate Hollern (Blackburn) (Lab)]

I thank my hon. Friend for securing this debate. I have been approached by several GPs in Blackburn who feel that the service they are providing to the public is going under. They can no longer cope with the burden placed on them. Would it be in order to ask the Minister whether she can urgently step in? GPs are under a lot of pressure right now, and this added burden is a false economy and could put patients at risk.

[Mr Robinson]

I entirely agree with that. We see the problems extended across the border, and indeed they are not peculiar to any one part of the United Kingdom. By their very nature, they are systemic and infect, for want of a better phrase, the whole country, and I am pleased to welcome the Member from the Scottish National party to—

[Kate Hollern]

No, I am from the Labour party.

[Mr Robinson]

I am so sorry, dear. I shall not live that one down in a hurry, but I thought I had detected a Scottish accent. I welcome my hon. Friend to the debate. She is the only one who did not tell me she would be participating tonight, Madam Deputy Speaker. I do apologise, but I cannot correct Hansard and I am afraid to say that the error will stand. I am sure she will forgive me, even if others may enjoy the mistake I have made.

There is no doubt that we are facing a major threat with this situation, and we hope we can stop it before we get to a major incident or catastrophe of some kind. That is the point of tonight’s debate. There is no doubt that this threat exists in Coventry, and we want to see what the Minister has to tell us about it. It is also clear from the interventions, which I have been pleased to take and to respond to, that this problem is widespread in England as a whole. As we have heard, in Bristol and in Manchester, and in the constituencies of those others who have made interventions, the problem is growing, not waning. Given the situation, we have to take steps.

Although we have risen to the challenge put out by Mr Paul Conroy, it is not enough for any Member just to speak up and expose this situation. That is a public duty we have as Members of this House, and the BBC has a duty as the national broadcaster to speak about these problems. We have all had experience of this. Not only have I had my business experience, but I have had experience of problems of this kind while in ministerial office and from others. Everybody in the country knows—it is no secret—that these privatisations, unless they are carefully controlled and well thought out, go wrong, so why do we keep doing them? This particular one involves Capita—it is in the hot seat tonight. It should know what this is about by now, as it has been through several of these and got them all wrong—Capita seems to learn nothing either. Ministers change, and it may be that the Minister knows about it but then gets moved. That is the nature of our appointments system, and I would not want to change anything there, but the civil servants who run these Departments should start to understand these things.

Contract management has many attractions to Ministers and to Government, who contract the problem out and lose direct responsibility for things. Everybody then heaves a sigh of relief and closes the file as if the thing is nothing more to do with them, but that is an illusion, because it comes back to bite them harder than it would have done had they kept the problem under their direct responsibility. It is an illusion to think that we can contract out. The responsibility for a contract remains with the person issuing that contract, and where it is for a major national public service, that contract must be taken seriously. What I did learn in the private sector is that the best companies spent more time preparing the bids for a contract, the assessments of the validity of the contracts and the validation process for a contract than they ever spent in negotiating the thing, which civil servants and Ministers often like to think they are good at. They say, “We had a hard-nosed negotiation on that one. We got them down from Y to X and we saved all this. It is great. We really screwed the private sector, didn’t we?” That is all a total illusion.

The most important thing when we do a contract of this complexity and of this kind is to get to the basis of the issues: to see who is really competent to take it on; who can make the savings that are being claimed in the real world; and who can do the other elements of the contract that have to come into play in a difficult situation competently. It is a question of competence.

[Kate Green]

My hon. Friend brings his extensive business experience to the debate about value for money when issuing private contracts. Does he agree that whatever the cost savings that may apparently be achieved under this contract, the cost to GPs and to practice managers of coping with the chaos, chasing records and trying to contact the help desk but failing to get through has been substantial? Does he also agree that those GP practices deserve compensation for the additional costs they have incurred?

[Mr Robinson]

I entirely agree with every single word my hon. Friend says. I would add, by way of a warning, that it is not a question of trying to punish the private sector by making it pay for this. Capita has to put the necessary resources into trying to correct the problem, and that must be its first priority. Something must give in the drive for profit, the drive to cut the costs of the services and the drive to improve the services. Those are irreconcilable objectives to start with, and in rectifying them the first thing that has to go is the drive for profit. Capita must realise that when it comes to put this right, it has to put the resources behind that. Compensation for GPs is important—I do not disagree with my hon. Friend for a minute on that—but I put it secondary to the provision of resources to get the contract right. I am sure that she would agree.

One other aspect of this shows an unacceptable, unpleasant and displeasing aspect of the privatisation process. It appears—I do not know this first hand—that Capita has turned to CitySprint to deliver these things. The effect of that is that we are employing drivers with no contracts, no sickness benefits and no breaks. This continual turning of the screw downwards is leading to a low-wage, low-productivity, low-output and impoverished economy. The workforce is suffering from that and it seems to be characteristic in many areas. For the public service to be involved in that process and almost to accelerate it, tightening that screw, is unacceptable.

This is another aspect of the commitment to negotiation and to the evaluation and validation process. The Government must learn to consider the quality of the service being provided and the quality of the means by which they intend to provide that service. CitySprint does not measure up to the standards we would expect from a good public sector contractor or employer.

To return to the main theme of tonight’s debate, what do we learn from this? The Government—principally the civil service, but Ministers, too—must learn to evaluate and validate the process of contracting out services. They cannot be driven by short-term savings, which are invariably illusory, but must consider the quality of the underlying contract. That is an art that must be learned, but I think it can be.

[Karin Smyth]

My hon. Friend is being generous with his time. I do not know whether he is aware that the Public Accounts Committee recently held an evidence session on the contract awarded to UnitingCare in Cambridgeshire. Many of the issues he has rightly outlined about the scoping of such contracts and expertise within the NHS were highlighted, particularly as regards whether the expertise was there to do the sort of detailed and specialist work he mentions. Should that expertise be built back into the NHS, so that it can conduct those contracts in the spirit of good public service as opposed to yet more taxpayers’ money being spent on expensive external consultants?

[Mr Robinson]

We are ranging wide of the debate, but again I have to say that I entirely agree with my hon. Friend, and I saw something about that Public Accounts Committee hearing. That is absolutely right; the problem is getting these lessons learned by the Government. I do not know what it is; it is as if there is an institutional or cultural inhibition leading to resistance to doing the technical job properly. People can be brought in to do it, but—I think that this was my hon. Friend’s point—there is a wealth of knowledge and expertise about the health service in the NHS that needs to be released and employed. Being able to do that is the art of management.

That is my plea. Yes, we want to bash Capita tonight, but more than bashing Capita and hitting out at incompetence and inexperience in the civil service, the real point of tonight is to tell Capita it is in disgrace and needs to get this right. It is obviously a nationwide—an England-wide—problem and it is not just restricted to Coventry. Capita’s overriding No. 1 objective is to put it right. That is our message tonight: “Get your finger out, put it right. Put the resources into putting this whole problem right and do not go for the short-term solution.”

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I congratulate the hon. Member for Coventry North West (Mr Robinson) on securing a very important debate. As the hon. Member for Stretford and Urmston (Kate Green) said, his business acumen was clearly on display. The importance of this debate is clear from the presence of a clean sweep of Coventry Members, but I know that the issue is important to colleagues across the House, so I am pleased to respond to the debate this evening.

I will start with Coventry, as it is in the title of the debate. Coventry is at the forefront of providing extended access to GP services seven days a week through the GP access fund, and it is doing excellent work to ensure that frail or elderly patients can avoid unnecessarily long hospital stays, using integrated neighbourhood teams to make sure that patients have the right primary and community care in place. As has been made clear by the speeches and interventions that we have just heard, excellent primary care such as this relies on effective and efficient support services. The hon. Member for Coventry North West is therefore right to be concerned that the service provided by Capita under the primary care support services contract in Coventry and elsewhere has so far fallen well short of the standards that we expect, and GPs have borne the brunt of these failings, as we have heard today.

It is true, as the hon. Member for Bristol South (Karin Smyth) said, that NHS England needs to make efficiencies. I was pleased to hear that the hon. Member for Coventry North West supports that in principle, and I am happy to confirm that all the savings that are made through this contract are ploughed straight back into frontline NHS services.

It was always clear that Capita’s services needed to be at least as good as those that they replaced. Quality was always part of the tender process. The contract was let via a competitive tendering process, which was subject to scrutiny not only by the Department of Health but by the Treasury, and the bids were assessed for quality, not just cost. Capita put forward the most credible of any of the bids accepted on the short list, and at the time both the Department and NHS England had every confidence that the programme would be a success. However, it is evident that Capita was inadequately prepared for delivering this complex transition.

[Mr Robinson]

First, does the Minister agree that part of the process preceding the award of the contract should have been to assess whether Capita was ready for it? That is precisely the point that I was trying to make and that my hon. Friends referred to in the debate. Secondly, how can the Minister talk of savings? How can any savings have been made when 9,000 patients records have been missing for more than two months, without which they cannot attend doctors surgeries? It is illusory to speak of savings. There are none, unless the Minister would care to tell us where they are and how they came about. I would be pleased to hear that.

[Nicola Blackwood]

The hon. Gentleman’s point about scrutinising whether Capita was competent as part of the tendering process is purely common sense and obviously that should have been done as part of the process. If he will allow me, I will come to the other points in the course of my speech. I would like to concentrate on how we resolve the problem that we find. We need to make sure that GPs and their patients receive the service to which they are entitled.

We want to restore acceptable services, and the contract contains sufficient financial incentives to ensure that Capita shares that goal, which is an important part of the contract and process. Let us be clear that the problems encountered with medical record transfers and overdue payments are entirely unacceptable. The Department shares that view. Both Capita and NHS England are co-operating fully with the Information Commissioner’s Office to address the implications for information governance, and I accept the need for urgent action to address the impact that this is having on patients and practitioners. That is why I have been holding regular meetings with Capita’s chief executive for integrated services, Joe Hemming, its new managing director for primary care support, Simon England, and NHS England’s national director for transformation and corporate operations, Karen Wheeler, and I will continue to hold such meetings.

Both NHS England and Capita openly acknowledge that the service has not so far been good enough. NHS England has demanded and received rectification plans from Capita for the six most affected service lines and has embedded a team of seven experts within Capita to support it as it resolves these issues.

As the hon. Member for Coventry North West said, it is also about having the right resources in the right place at the right time. Capita has informed me that it is adding around 500 more full-time equivalent staff to the service, at its cost, and that it is improving the training provided to ensure that new staff understand the importance of the service to both patients and practitioners.

I know that these problems have caused great inconvenience and distress, but with reference to risk—the hon. Member for Bristol South raised this point—NHS England has assured me that it is not aware of any direct cases of patient harm that can be attributed to service issues. However, NHS England is working closely with regional and local medical directors, so that we can be assured of patient safety. In particular, Dr Raj Patel, medical director of NHS England Greater Manchester, has joined the embedded team to ensure that clinical risks and concerns are appropriately addressed.

The priority now is to deal with any backlogs, particularly with medical record requests, and to ensure that services are stabilised with the capacity to deal properly with new requests. There has been progress on that, which is encouraging. The backlog of medical record requests has reduced from 17,262 to 3,465 in the past two weeks. Capita assures me that it has an effective triage system in operation for new requests and is confident that the situation will not recur. However, I will be monitoring the situation closely.

Child and Adolescent Mental Health Services

Geoffrey Robinson Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

I am grateful to be called to speak in this debate after the hon. and learned Member for North East Hertfordshire (Sir Oliver Heald), who has ministerial experience in this sphere. I do not, but I have some experience in other spheres of finding money for it and I know how difficult that can be. I therefore congratulate the hon. Member for Totnes (Dr Wollaston), Chair of the Select Committee, on her report. We in Coventry find it very timely, and we look forward in due course to the Minister’s taskforce and its report, leading, we hope, to what the hon. Lady very precisely referred to in terms of improvements to services—better services for children and adults on the ground, which is where it matters. She also said she found having to grapple with out-of-date figures—it is rather surprising that we should have them—frustrating. I therefore thought I would take part in the debate in order to bring up one or two up-to-date figures on a particular aspect of young persons’ and adolescents’ mental health that is becoming more and more prevalent, and disconcertingly and alarmingly so in Coventry: self-harm.

We have seen a terrible and frightening increase in self-harm over the past five years. The first figures we had were back in 2010 and the figures for 2014 have just come out. They show an alarming increase from 50 referrals in 2010 to over 300 in 2014. That is a terrifying rate of increase. It has been going pretty steadily at over 20% year in, year out, and, as my hon. Friend the Member for Stoke-on-Trent South (Robert Flello) pointed out so tellingly, it points to the impact deprivation and poverty can have on children, as there is a fairly well-established causal link between pockets and areas of deprivation and poverty and the tendency among adolescents to self-harm and referrals.

Those referrals come on top of what we already know is a crisis in A and E. They are only exacerbating that, and leading to youngsters with terrible mental health problems being turned away—doors closed in their face. It is a situation that in Coventry has led to a clear and recognisable crisis, and to an emergency meeting of the scrutiny board to examine exactly what the situation is, to report on it, and to see what measures can be taken to deal with it.

It is often all too easy to blame lack of resources and the Government, but, as the Chair of the Select Committee said, there clearly is a lack of resources. Towards the end of my brief remarks, I will discuss the fact that mental health services have always been the Cinderella services of the health service. I think that is fairly well accepted both outside and within the NHS. If we are to embark on yet another reorganisation and integration of health services as a whole, I hope that the underfunding and the lack of past attention that has affected and led to the present situation in mental health services will not be overlooked. It is not as though all the services can be integrated equally or proportionately, but if certain services are not to be further damaged, they will need to receive particular recognition and get preferential priority in the integration—I do not like the word “reorganisation”—which all the parties agree needs to be done carefully. This should not be rushed. We do not want another reorganisation forced on the health service. It should be done sensibly and gradually, and with sensitivity to the individual needs of the services that are being integrated.

[Mr Jim Cunningham]

Does my hon. Friend agree that the Caludon health centre at the University hospital Coventry does a very good job in very difficult circumstances? Yesterday, I met some young people from Coventry college who told me about the pressures that they were under. They are worried about exams and about whether they will be able to get a job after their exams, because the number of young people out of work in the west midlands is extremely high. Does my hon. Friend agree that we need to consider all the pressures that young people face these days?

[Mr Robinson]

Yes, I do indeed. The pressure in the education system to achieve results at any cost simply adds to the problem, as do the deprivation and poverty to which other Members have referred. All those factors have resulted in a situation in which incidents of self-harm are increasing at the rate of 20% a year. Referrals in Coventry are going up, and that constitutes a crisis, given that our accident and emergency services are already overcrowded and hard pressed.

Let me explain what that crisis means in regard to the number of weeks involved. Normally, effective substantive intervention would be expected within 18 weeks, but in Coventry the average wait for a substantive intervention has been 44 weeks. That is in a sector in which early intervention is clearly the most effective route to the successful management and eventual elimination of a mental health condition. That simply is not good enough, and I put that to the Minister for consideration by his taskforce.

We have asked the local council what can be done. As my hon. Friend the Member for Coventry South (Mr Cunningham) has said, budgets have been heavily cut. According to current Government plans to reduce public expenditure to 1930s levels—from which I know the Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb) has dissociated himself—Coventry would experience a further 50% cut over the next five years. There would be nothing left. Fortunately, however, that is unlikely to happen, as I am sure that there will be changes of one kind or another to those plans, or to those making the plans, in the very near future.

It is impossible for the councils to find more funds, because they are under tremendous pressure, but there has already been a £50 million cut in the budget for CAMHS. It has been cut from £766 million. I think that that relates to the £800 million figure quoted by my hon. Friend for Eastleigh—

[Grahame M. Morris]

Easington.

[Mr Robinson]

Easington. I beg my hon. Friend’s pardon. The CAMHS budget has been cut to £716 million, which is a cut of £50 million. That is an enormous cut.

[Adam Afriyie (Windsor) (Con)]

The hon. Gentleman is making a powerful case, particularly on resourcing. Clearly, we would all like to see more resources going into adolescent mental health challenges, but does he share my view that if we get this right, with proper standards, proper implementation and early intervention, there could be a net saving to the Exchequer overall?

[Mr Robinson]

I absolutely agree with the hon. Gentleman. I think the whole House would agree with his intervention, which was short and to the point. As in so many situations, prevention is better than cure. It is also a lot cheaper. We all know that, and there is a case for it in this context, but it will require investment up front. That is where the Government do not get it, because they usually take a short-sighted view of these matters.

I wish to make two points in closing. First, if local councils do not have the resources at the moment, we cannot look to them to provide these services and so they are likely to get overlooked. Lastly, will the Minister confirm something about the leak—I am sure he will have read about this in the press—from his taskforce, which speaks of the perverse incentives that have arisen, particularly in relation to mental health, from the Government’s reorganisation? Have they exacerbated the problem? As a result, is the real cost of that reorganisation to the mental heath services not £50 million, but possibly a much higher figure?

In any event, we all know from our constituency experience that we have had losses. Last night, I saw in a television programme that we have lost hundreds of doctors and thousands of nurses, and the prospect in the next few years is an accelerating trend on both. So the Labour party’s commitment for 20,000 new nurses and 8,000 new doctors is a bold one, but it is manageable. It is also absolutely necessary if we are to deal with any of our current problems. That is the message I would like to leave the House with. We need early intervention; a commitment to increase the number of doctors and nurses; parity of treatment—and even ahead of that— in the integration of mental health services; and the restoration of the CAMHS budget as soon as possible.

--- Later in debate ---

[Norman Lamb]

I totally agree. When I embarked on the mission to introduce waiting time standards in mental health, I was very clear throughout that they must apply equally in children’s services, as in any other service. One of the first two standards we are introducing from April this year is a two-week standard to start treatment for early intervention in psychosis, where there is a wealth of evidence that quick intervention can lead to good results.

My hon. Friend the Member for Brigg and Goole (Andrew Percy) talked about the absolute importance of youngsters learning about mental health at school. It ought to be part of the curriculum, and we would benefit a lot if that was the case. He also made the important point that although lots of areas of the country have seen really ridiculous disinvestment in mental health and children’s mental health, other enlightened areas have not done that. There is no necessity for it to happen; it depends on what the local priorities are. In his area they have done the right thing and made the necessary investment.

The hon. Member for Easington (Grahame M. Morris) talked about the horror of suicide. The husband of my hon. Friend the Member for Totnes is a psychiatrist in Devon. He has been a brilliant advocate of the case for a zero-suicide ambition. Every organisation within the NHS ought to be setting the same ambition that has been set in Devon.

The Government have prioritised improving mental health as part of our commitment to achieving parity of esteem, or, as I would prefer to call it, equality. I have been frank that the current system for supporting children and young people’s mental health is simply not good enough, but let us be clear that this is not a new problem. Previous reviews into CAMHS have identified similar issues to those that the Committee highlights, such as a lack of beds, complex commissioning and referral arrangements, poor practice around transition from children to adult services, and instances of children being treated far from home or on adult wards. These issues are deep-seated and hard to resolve. Lord Crisp was recently quoted in the Health Service Journal, when asked about parity of esteem:

“If something has developed over 40 or 50 years you don’t solve it in five minutes.”

I know a youngster who in the past decade was horribly let down by mental health services at that time. This is not something that has just emerged over the course of this Parliament. I fully recognise that too many areas of the country have disinvested in young people’s mental health. I firmly believe that the situation can and must improve. The Government have taken steps to do this.

It is worth saying that, as I have done this job, I have seen some really impressive services. There is a brilliant NHS team in Accrington providing the best possible service to young people. I visited South London and Maudsley, where there is a fantastic eating disorder service based on the quickest intervention, with specialist support for youngsters very quickly reducing massively in-patient admissions. That is the sort of service we need to see across the country. There is a brilliant in-patient facility in Colchester, where there is a great school in the mental health service so that youngsters do not lose out on their education while they are receiving support. There are some brilliant third sector organisations. MAC-UK is a wonderful organisation that takes therapy out on to the streets to support youngsters who get involved in gangs, rather than expecting youngsters in those circumstances to visit traditional services. MAP—the Mancroft Advice Project—in Norwich is a brilliant service supporting youngsters in a non-stigmatising way.

Since 2010, we have raised the profile of children and young people’s mental health to unprecedented levels. We have produced the mental health and suicide prevention strategies, set out the top 25 priorities to help to achieve parity of esteem in the “Closing the gap” document last year, and we have worked, through Time to Change, to reduce the stigma attached to mental health issues. The 2014-15 mandate to NHS England sets it a clear objective to deliver equality and parity of esteem, and in 2014 we published our five-year vision for mental health. At its heart was a radical change: an ambition to set access and waiting time standards for mental health—just as they exist for physical health—including children and young people’s mental health, for all services by 2020. That is a landmark step in rebalancing our health and care system and achieving equality.

[Mr Robinson]

It is good to hear that the Government are setting those targets. Will the Minister have a look at the situation in Coventry and explain to me why it has happened? Can he also confirm that the targets he has set will be achievable, despite the £50 million cut that has been made?

[Norman Lamb]

I am very happy to look at Coventry if the hon. Gentleman wants to send me a note about that.

I make the case that there needs to be more investment in mental health, and my party has argued for £500 million of additional investment a year in mental health in the next Parliament. Investing £54 million for the children and young people’s IAPT—improving access to psychological therapies—programme has started to transform existing services, and it now covers 68% of the nought to 19-year-old population, which exceeds the original target of 60% by 2015. NHS England continues to plan for nationwide roll-out, as set out in the mandate, which should be achieved by 2018.

As part of the autumn statement, the Deputy Prime Minister and I announced £150 million of investment over the next five years to deal with eating disorders. This will help to ensure that any young person can get the help they need, no matter where they live, and will allow the development of waiting time standards for eating disorders from 2016. This is a condition that can kill, so it is so important that we get early access. We have invested £3 million in MindEd, a digital resource to help people who work with young people and children. It is an online platform designed to give them the help that they need in the work that they do.

The prevalence survey is being undertaken—we have secured the money for it—and we plan for it to be ready by 2017. The aim is for it to cover children and young people from two years to 19 years, which is a wider range than in the original survey. That should be widely welcomed.

As for the taskforce, although there has been much progress, the Government have been open about the scale of the challenge and acknowledged that there is still much to do. As the Committee is aware, I set up the taskforce last summer. It is chaired jointly by the Department and NHS England and brings together a whole load of experts from outside Whitehall and listens to the voice of young people as well. This is a massive opportunity fundamentally to modernise the way children and young people’s health services operate, embracing the role of the voluntary sector and the potential for online support for youngsters, and sorting out this ridiculous, fragmented commissioning. The problem has been there for a long time, but things need to be made much simpler, so that we can have coherent services that are easily understandable for children and their families. If we can grasp this opportunity, we can make a massive difference for young people.

Let me say a word about crisis care. In a way, this is the area where the gap between physical and mental health is greatest. The Torbay case that my hon. Friend the Member for Totnes mentioned was a shock to the system, although we have already seen considerable reductions in the number of young people going into police stations. We are on course to see a reduction of about 30% this year, but it needs to be much greater than that. In my view, we need to legislate to end the practice completely. It is surely completely unacceptable that young people under the age of 18 end up in police cells rather than in a hospital. That practice simply has to come to an end.

I applaud everyone who has participated in this debate on a really important subject. I think we have an opportunity massively to improve things.

Contaminated Blood

Geoffrey Robinson Excerpts

Thursday 15th January 2015 Commons Chamber

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

Like other Members, it is appropriate that I should pay tribute to the right hon. Member for North East Bedfordshire (Alistair Burt) and the hon. Member for Colne Valley (Jason McCartney), who secured today’s debate, and, most of all, to my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), who has been responsible for getting the all-party group report out earlier this month. While we support and congratulate each other, we have to remember that the real victims in all this are those who have been infected and suffered this terrible disaster and tragedy, which has now been with us for more than 30 years. It is unique in one way, in that it is, alone in the health field, the fault of successive Governments. In no sense is this a party political debate, and the tone of today’s debate is a great credit to the Members who have taken part. It shows the growing awareness throughout the House and, I hope the civil service, too, of the seriousness of what took place all those years ago and the extent of our maladministration—let me put no finer point on it—in the handling of it since then.

The wide geographical spread of constituencies represented today is a testimony to the impact that this issue has had throughout the country. It has been pleasing to see two new Labour Members, my hon. Friends the Members for Wythenshawe and Sale East (Mike Kane) and for Heywood and Middleton (Liz McInnes), who have clearly taken on the role of successor MPs in the campaigning sense to their predecessors. My hon. Friend the Member for Wythenshawe and Sale East has already spoken to great effect, and he follows in the footsteps of Lord Morris and Paul Goggins, both of whom campaigned with us very effectively. Sadly, however, we have not really been successful yet. One point I wish to make to the new Members in the House is that they should not think we are starting all over again, because we are really at the end of this campaign now and they will, I hope, see the—I was going to say fruits, but there are none to reap here—thing brought to some sort of satisfactory conclusion, after all this time.

[Liz McInnes (Heywood and Middleton) (Lab)]

I thank my hon. Friend for his kind comments and I wish to pay tribute to the tireless work of the late Jim Dobbin on this campaign. Let me add that I have been contacted by two constituents who praised the work that Jim had done and asked me specifically to attend this debate. They do not want their names to be made public, but they wanted me to be here and to take in what was said, and I will be meeting my constituents afterwards.

[Mr Robinson]

I am grateful for that intervention. I was about to discuss Jim Dobbin, so my hon. Friend fortunately anticipates me. Jim was a good friend of mine for many years, and we had his memorial service yesterday, as she will know. He, alongside Peter Archer, Alf Morris and Paul Goggins, as well as others from the Government side of the House, was one of a series of outstanding campaigners that we have had on this issue. The fact that it is an all-party campaign enables us to get together to seek some resolution. This has been going on for an awfully long time and it has been very unsatisfactory, under all Governments. I must emphasise that all Governments are equally to blame, Labour and Tory Governments going back even to before Margaret Thatcher—I mention a name that will immediately resonate on both sides of the House.

As has been said, some of those who have been terribly affected have not wanted their names to be mentioned. Among those affected has been one of my constituents, Mr Joseph Peaty, whom I visited in his home only a few weeks ago. I believe he is here watching today’s debate and I would like to read to the House two brief extracts from his most recent letter to me. I am pleased to say that he is now the chairman of the Tainted Blood group, one of the campaigning groups that have been very effective on this matter. He wrote to me just reviewing the 30 years he has been infected. The House will be interested to know that he is now 49 years old and was first infected when he was 16. He has lived all his life in my Coventry constituency. He wrote to me recently—I got the letter only yesterday—to say the following:

“I miss being able to contribute to a productive career...Perhaps because of my age when I was first affected, my hopes and expectations, that were much like anyone else’s (education, home, partner, children, career, travel, ‘make a difference to the world’) were taken from me. I am now just a shadow of the potential I once held, struggling to exist let alone live a purposeful, fulfilling life, worrying what the next viral complication will be.”

In his case there is a shadow overhanging him, after all these tragedies, and after the terrible suffering, pain and treatments that have had to be gone through; he faces the prospect, having been infected by both Hepatitis C and HIV and undergone all the treatments, that he could now have to deal with some transmutation into CJD—mad cow disease. We just do not know. It is as bad as that.

The tone of Joseph Peaty’s letter is much better than these extracts perhaps reveal. There is nothing self-pitying about Joseph Peaty. He is in every sense a man of immense dignity and tremendous forbearance in the face of suffering that was inflicted on him by the very organisation that was meant to be treating his ill health. He writes:

“By supporting the haemophilia community in the pursuit of justice and financial recompense, I have learnt far more about the background to the introduction of pooled blood products than we were ever told prior to their administration. As a result I find the evidence overwhelming that the governments of the day knew of the infection risks, did not take adequate steps to mitigate onward transmission, failed to prevent non-consensual testing on patients, failed to inform patients of the risk, and put costs ahead of patient safety. The government were responsible for ensuring the safety of their citizens and failed disastrously in this primary duty.”

That is a terrible indictment, but it is true; it is factual, undeniable and incontestable in every respect. Joseph is referring to the entirety of his adult career since he was 16 years old. He lived in Coventry and that is the sum total of what he can point to in his life.

I do not wish to strike a discordant note when I mildly disagree with the right hon. Member for North East Bedfordshire—I congratulate him on securing the debate and on the way in which he introduced it—about the need for more reports. We do not need the Penrose report as we have already had the Archer report. All sorts of investigations have proved beyond doubt that this is the Government’s responsibility, that the extent of the tragedy is tremendous and that the provision we have made so far has been inadequate. That is the end of the story. What we now need is a resolution.

We are pleased that the Secretary of State attended the debate. Obviously, he is no longer in his place as he has other matters to which he needs to attend. I am also delighted to see my right hon. Friend the shadow Secretary of State in his place. We are all aware that the Prime Minister, in a moment of generosity, said that he would try to resolve this matter by the end of the year. I fear that he will not be able to do so—we know the pressures that Governments work under—and that is a great pity. The one useful thing that the coalition Government could do is to settle issues such as this. Indeed, when I raised the matter with the Deputy Prime Minister when he was deputising for the Prime Minister at Question Time, he said that he would take on the matter personally. I thought that we would at last have a more productive encounter between the two in the name of the sufferers in this tragedy. I hope that such a meeting can take place. If it cannot, the next Administration, whatever form they take—who knows what that will be—should take on the matter and settle it early. There will never be a good time. The only time is the earlier the better.

--- Later in debate ---

[Dr Julian Lewis (New Forest East) (Con)]

Mr Deputy Speaker, having come late to the debate because of a clash with a meeting of a parliamentary Committee on which I serve, I am grateful for the indulgence of the Chair in allowing me to make a brief contribution.

I wish to focus on three points. The first is that people are still, even now, long after the event, being discovered to have been infected with contaminated blood; the second is that momentum for a settlement is in danger of being lost; and the third is that the best treatment is not always available for those who have been infected.

I was struck by what the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke) and others said about the debate being a chance to give a voice to individual constituents. I was also struck by the question asked on 10 December of the Deputy Prime Minister, who was standing in for the Prime Minister, by the hon. Member for Coventry North West (Mr Robinson), because he said in that question what he repeated today—that the scandal had reflected badly on successive Governments, possibly going back as far as that of Harold Wilson, if not further. In the context of momentum being lost, he said that the Prime Minister had undertaken in June to look at and rectify the situation. In fact, according to my constituent, Mrs Lesley Hughes, who only a week before he asked his question had got in touch with me about this very issue, the Prime Minister had apparently told one of his own constituents who was affected by this that he hoped to have a resolution within six months. This would have meant the end of the last calendar year.

I said that my first point was that people are still being discovered who were infected long ago, and that is Lesley Hughes’s situation. In 1970, she and her future husband were involved in a very serious road traffic accident in London, and she had to receive no fewer than 44 pints of blood. For many years she knew nothing about the fact that she had been infected, although over those years she had many visits to GPs and hospitals with numerous symptoms of illness, and considerable pain and suffering. Only last year was it finally discovered that she had been infected with hepatitis C by NHS contaminated blood. Her main concern in writing to me initially was that, given that the Prime Minister had said that he hoped to wrap the issue up himself, she was really anxious that we should not get to the general election—which is, after all, scheduled to be about five months after the deadline that the Prime Minister had set himself—without reaching a resolution.

[Mr Robinson]

I am not sure that the exact undertaking that the Prime Minister gave is recorded anywhere, but it is recorded in exactly those terms by my constituent, Joseph Peaty, as well. Does the hon. Gentleman agree, though, that the impression was left that the Prime Minister would do his very best to get a settlement by the end of the year? We are past that deadline now. Does he agree that, irrespective of the reports being compiled, we do now have the means necessary to settle the issue, and that is what the Prime Minister should try to do?

[Dr Lewis]

That is exactly my view, and for that reason I wrote to the Secretary of State for Health, drawing attention to the matter. I received a reply dated 12 January from the Minister who will reply to this debate. Of course she was sympathetic in the terms that she used, but the important part of her letter was the conclusion, which was that

“this issue is being looked at very seriously, and…an announcement will be made to affected individuals and MPs once work has been concluded.”

My simple question to the Minister is, when will that work be concluded, and will she and the Prime Minister undertake to get this work concluded, on behalf of my constituent and many others, before this Parliament comes to an end? Otherwise, we are back to square one—a cycle which I am sure has been repeated over and over again.

Finally, I said that I would mention the other point about how the best treatment is not always available. I understand from Lesley, whom I have not met yet but whom I believe to be present with her husband today, and whom I hope to meet after the debate, that there are problems with the fact that many people suffering from infection are offered the older interferon and ribavirin-based treatment, and that not everybody can tolerate that, particularly as it takes a long time to clear the system, and particularly if they are people who are at a later stage of their life.

If the Minister cannot answer today, will she perhaps write to me later about the situation of patients in that position? Kinder and more effective treatments are available, but are not always sanctioned for reasons of cost either by NICE or by individual health trusts. I wish to give others the opportunity to speak, but once again I thank my constituent for her bravery in allowing me to tell her story and attribute it to her, and I thank the House for its indulgence in allowing me to contribute to the debate at such a late stage.

--- Later in debate ---

[Andy Burnham (Leigh) (Lab)]

We have heard a series of fine speeches today—as has been said, Parliament truly at its best—but none more powerful and affecting than that of the right hon. Member for North East Bedfordshire (Alistair Burt) in leading the debate. Many of the things he said will have affected people greatly, but the words that remain with me now are those that he quoted from a letter he had received: “Every day is like a day on death row for a crime I did not commit.” If that does not convey the sense of injustice we are dealing with, nothing else will, because it really is that appalling.

When historians come to look back at the 2010-15 Parliament, it will be seen to be characterised by a welcome drive to correct historical injustice. First, we saw the apology in relation to the events of Bloody Sunday. We have seen a range of ongoing inquiries related to historical child abuse. There was the action on the injustice that I know too well from my own personal background—the death of 96 innocent people at Hillsborough. The right hon. Gentleman was absolutely right to pay tribute to my hon. Friend the Member for Liverpool, Walton (Steve Rotheram), who put those names on the record. But we cannot put on record the names of the people in this case who have suffered such devastation—not just the people who have died but those whose lives have been ruined as a result of this scandal, and it is a scandal.

What opened up those other injustices has not been the Government voluntarily moving to correct those wrongs, but Parliament. The resolution to those other injustices began here. It is beholden on each and every one of us here today to remember that and to use the power that we have from the office that we hold to work together across the Floor of this House to find a resolution for the thousands of people whose lives have been ruined by this scandal. If we hold to the cross-party spirit that delivered the beginnings of justice in those other campaigns, then we will do so in this case too. The right hon. Gentleman described it as the 15th worst peacetime disaster—like Hillsborough, entirely man-made. To add to that, Lord Winston has described it as

“the worst treatment disaster in the history of the NHS.”

We must resolve today, even if we cannot do it in the time that remains in this Parliament, to make sure that this injustice and this scandal is resolved early in the next Parliament, and that the people who have suffered finally have truth and justice.

I want to explain why I am standing at this Dispatch Box today. Like many others who have spoken, I have constituents who have been victims, including somebody who does not want to be named who speaks of having lived for more than 30 years seeking justice and support, and who contracted HIV and hepatitis C through contaminated blood in the 1970s and ’80s; and my constituent Simon Carter, whose father died and left the family facing a whole range of financial problems—people whose lives have been for ever altered and devastated by the scandal.

There is another reason I am here today. It goes back to a time towards the end of the previous Parliament, when somebody who has been mentioned by Members in all parts of the House, my good, late friend Paul Goggins, asked me to meet him and his constituents Fred and Eleanor Bates and Peter Mossman—now the constituents of my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) whom he mentioned so movingly—in my constituency office in Leigh, and I did. I had no real understanding of what they had been through, and were going through, until I sat down with them, at Paul’s request, and listened to what they said. That campaign mattered hugely to Paul, whom I miss every day. I will continue to work in his memory to get justice not just for his former constituents but for everybody who has been mentioned in the debate. I want to signal the seriousness with which I will address this issue by speaking in this debate today.

As people have said, it is not that nothing has been done. Plenty has been done. There have been well-meaning attempts in all parts of the House down the years to put in place mechanisms to try to lessen the hardship and address the problems that people face in their daily lives. However, as many hon. Members have said, that has left a patchwork of support that is complex and bureaucratic—that, in the end, is about handing out bits and pieces, with people having to go cap in hand, not even given the dignity they should now have in having the problems that they were given rectified in a proper manner.

As a result of that meeting with Paul and his then constituents in my office in 2010, I reopened the issue at the end of the previous Parliament. Many Members have mentioned the Archer report. A resolution was put in place after that report, but it was not good enough, and that was recognised in all parts of the House. Paul asked me to look again at the issue, and I did.

I want to bring a new perspective to this debate—that of a former Minister who tried to do something; indeed, a former Secretary of State, because that is what I was at the time. I do not say this to blame any individual in the Department of Health, but more in terms of speaking as I found as I tried to lift the shutters that had been pulled down on an issue that the Department wanted to go away. The hon. Member for South Norfolk (Mr Bacon), who is no longer in his place, said that Governments of both parties have failed, and that is absolutely right— they have; there is no debate about that. But I do not detect the failure being caused by Members of Parliament or, indeed, Ministers; I have met many who want to resolve this in the right way. I have to say that in my experience the resistance is found in the civil service within Government. That is often the case in examples such as this; I found the same with Hillsborough too. It is very hard to move that machine to face up to historical injustice.

[Mr Robinson]

My right hon. Friend is making a very important point. Nobody wants to point the finger of blame, but he has gone to the heart of a problem in Government. He speaks with great authority as a previous Secretary of State. He says that it is hard to get officials to do what a Minister wants, and that is certainly true, but is it not also the case, and therefore a failure of successive Governments, in the plural, and Ministers, in the plural, that officials advise and Ministers decide? That is part of the failure so far.

[Andy Burnham]

I believe that it is. The hon. Member for Bedford (Richard Fuller) made this point. Perhaps there is a resistance that comes from not wanting to point the finger or to show the culpability of people who perhaps did not do their jobs as well as they might, but that is unacceptable. That is not something that anybody elected to serve in this place should accept. On a personal level, I know how hard it is when faced with such resistance. The way to help a Minister in that position is by giving them the sort of support that has been expressed throughout this Chamber today. That is what gives a Minister the power to have the courage to make a change.

The result of my efforts led to a review of the Skipton Fund, and I give credit to the current Government for continuing that work. It led to a small improvement, which has been mentioned, but, by God, it was hard enough to get that, so I do not underestimate how difficult it will be to move things forward.

Part of the problem is that the people dealing with the issue inside Government are insulated from the people we sit alongside in our constituencies and whose stories we listen to. Could there be a more heart-breaking story than that told by my hon. Friend the Member for Ogmore (Huw Irranca-Davies) about the damage that this scandal has caused down the years? People need to hear and listen to what is being said, to understand why it is immoral to allow the situation to persist and go uncorrected.

I will not go through all the problems raised by colleagues about the inadequacy of the current process of applying for support, but I will pay tribute to the all-party group on haemophilia and contaminated blood, which, under the leadership of my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), produced an outstanding report yesterday. I believe it will further reinforce the case for truth and justice.

I wish to draw the House’s attention to another development, which has not been mentioned today, namely the filing of a legal case by three unnamed victims. They have written to the Health Secretary, asking him to come forward with a settlement before full legal proceedings take place. Of course, it should not have to come to that, but, as colleagues have said, people are still waiting and they have waited long enough. We hope the Health Secretary will listen to that request and take action as soon as he can.

If the Minister, working with the Secretary of State, is able to find a solution, she will have the support of Labour Front Benchers and, I am sure, Members throughout the House. We will offer our good offices to ensure that a settlement can be reached. There needs to be a proper and fair resolution. None of us can predict what the make-up of the House or, indeed, the Government will be after the coming election, but I personally commit to working towards that full and final settlement for which people have waited long enough. I hope that Members on both sides of the House will make a similar commitment. As Paul Goggins said in the Westminster Hall debate mentioned by the right hon. Member for North East Bedfordshire,

“no debate about the issue should omit the need for a proper acknowledgement of what took place and why, and a profound and sincere apology for the suffering created by the disaster.”—[Official Report, 29 October 2013; Vol. 569, c. 201WH.]

The full and final settlement should have four components. First, there must be a national apology for the suffering down the years. Secondly, to echo what my hon. Friend the Member for Hammersmith (Mr Slaughter) has said, there must be an inquiry. Whether it should be a public inquiry or not is a matter to be debated, but, having been involved in the campaign for justice for the 96 victims of the Hillsborough disaster, I know that other forms of inquiry can reach the truth and unlock a campaign for justice. There may be other ways to do it, but people need disclosure: they need to understand how this was allowed to happen. In my view, all papers held by the Department of Health should be released so that people can begin to see the full truth of what went wrong. I do not believe there is any reason at all to prevent that from happening.

The third element is, of course, a proper settlement for all those who have suffered—not just those who are still suffering, but families who suffered greatly as a result of the disruption caused to their lives. Fourthly, as my hon. Friend the Member for Kingston upon Hull North has said, we must give the best treatment possible to those who are still suffering.

The all-party group’s report quoted somebody infected with hepatitis C:

“You can’t give us back our health. But you can give us back our dignity. This tortured road has been too long for many of us. But for the rest of us, please let this be the final road to closure.”

Everybody present needs to listen to those words and act on them. Sadly, many of those affected have died and are not able to listen to our proceedings, but they, those who remain and the families they have left behind deserve the dignity of a full and lasting settlement.

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

I welcome the tone with which the shadow Secretary of State responded to the debate on behalf of the Opposition. I also congratulate my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) on securing this debate and on his hard work and commitment—as a Minister, I am well aware of it—over the past year. The same is true of so many colleagues who have worked on behalf of those infected with NHS-supplied blood or blood products before 1991.

I thank all hon. Members who have contributed to the debate, which has been conducted in a constructive and thoughtful way, and, of course, distinguished former colleagues who championed their constituents so ably in the past. As we have heard, many of those constituents have been profoundly affected by this issue. I attended the last debate on it when I was a Back Bencher, and today I have heard once again about the impact these infections have had on the lives of individuals and families.

I will focus mainly on the current situation rather than the past, not because the past does not matter, but because it has been ably covered and because I want to add to the knowledge of the situation as it is now and give an indication of the way forward. I hope Members will understand that. If there are any issues that I do not address, I will, of course, write to Members, and if their concerns involve other Departments, I will seek to get a response from them.

There have been calls for a further inquiry and review. That subject has come up before, with calls to look at the historic circumstances of these events. There are various ways in which that could be done and I acknowledge the suggestion made by the shadow Secretary of State. I stress that the Government wish to be as transparent as possible about these events, but I remind the House that they have already been repeatedly examined in a number of different ways, including in court on a number of occasions, and the Department of Health has already published on its website all the relevant documents held for the period up to 1986. I acknowledge that there might be more to do, some of which relates to Lord Penrose’s work.

The Penrose inquiry has loomed over this debate. Let me give the House a sense of my frustration. When I came into office, I was advised that the original date of publication would be June 2014. Let me also give the House a sense of the seriousness with which I took the preparation for that report. I met Scottish Health Ministers last spring to discuss it and other issues. Obviously, work is taking place in Scotland and the publication of the final report has been delayed. The inquiry now expects to announce a publication date this month. There has been no formal confirmation, although a date has been offered during the course of the debate. I understand that Lord Penrose will examine any particular adverse consequences for infected patients and their families, and identify lessons and implications for the future. That is why we feel we need to wait to see the report.

As the events under discussion took place before devolution, the final report of the inquiry will clearly be of interest to the Government and we await its recommendations. I am extremely frustrated by the continued delay and accept that it will have an impact on the scope of our response in this Parliament.

As has been touched on, the Government, like their predecessors, provide ex-gratia financial and other support through the system of payment schemes that is in place.

[Mr Robinson]

The Minister has touched on the nub of the issue, namely the Penrose report and the delayed decision. Does she agree that we do not really need that? The broad aspect of the financial settlement that ought to be made is well known to the Government. It is a matter of getting a decision now.

[Jane Ellison]

I will come on to why I do not entirely agree with the hon. Gentleman, but my concern is essentially that after families have endured so much, I would hate to tell them the way forward only for that to be unpicked and revisited in the light of any recommendations by Penrose. I am afraid that I do not agree with him, because it is important to consider the report.

General Practices (Coventry)

Geoffrey Robinson Excerpts

Thursday 30th October 2014 Commons Chamber

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

This debate might not be as lively as the debate on post offices in May, when we also had the pleasure and privilege to have you presiding over us, Madam Deputy Speaker. Nevertheless, we have an important topic to debate and I am pleased that the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) is ready to respond, because we have one or two questions for him. I thank Mr Speaker for granting the debate. My hon. Friend the Member for Coventry South (Mr Cunningham) would like to take part and he has my willing acquiescence. I do not intend to detain the Minister or the House for long this evening, but I wish to put to him a point that was made to me in a precise and graphic way by the local medical committee for Coventry—it is also for Rugby, but in this debate I am principally speaking as the Member of Parliament for Coventry North West.

The situation has been described as a “crisis”. A letter, almost a cri de coeur, went out from the local medical committee on behalf of GPs, issued in the name of the chairman of Coventry local medical committee, Dr Peter Whidborne. He said that,

“due to increasing workload, and decreasing resources, general practice has now reached crisis point.”

That is what triggered my interest in this matter and my concern as the local MP, and it was reinforced by many anecdotal and personal encounters with residents in my constituency—I am sure my hon. Friend will confirm the same thing for Coventry South—who said that they cannot get appointments with GPs. Patients are finding the situation increasingly frustrating, and an assiduous campaign has been waged by certain elements of the popular press against the 2004 GPs contract and all the weaknesses that we know it contained, yet there is also the reality of the pressures under which GPs operate.

The public’s general impression is that the previous Government granted GPs all too easy a deal but that GPs have not responded in kind, and that despite the general improvement in their terms and conditions, rather than improving services they have in fact responded with a decrease in the level of service provided. Many would agree that there has been such a decrease, but they would disagree that that is due entirely, or even mainly, to the 2004 contract changes. In fact, it is a reflection of the general unease throughout the whole health care service. Such unease is reflected in, among other things, reliable figures produced by the Deloitte Centre for Health Solutions, which I will refer to in a moment. On access to GPs, as with other areas of the health service such as A and E departments in the acute hospitals or services for elderly people who suffer from a chronic condition, people are finding it increasingly difficult to get the level of care required, and the resources needed to provide it, because of the stretching of health service provision at a time when resources are relatively stagnant.

Let me cite some figures that I think graphically illustrate the situation we are facing. In Coventry, the number of people emigrating from other countries is increasing and the number of GPs is decreasing—the figure from the Deloitte study is something like a 2.5% decrease in the total number of GPs over the last five years, at a time of increasing demands on them in terms of visits and patients to be seen. Let us remember that 90% of all patients are first seen in a primary practice by GPs before they access any other services offered by the NHS, including the general hospital, and that figure is increasing every year. For the first time in the NHS’s history, however, the number of GPs is shrinking. We must deal with that basic fact at a time when numbers should be increasing.

I am pleased that the Labour party has pledged—this is not a party political point—to increase the number of GPs by 8,000, and to raise the money for that and for wider £2.5 billion spending on the health service through a mansion tax and a tax on tobacco companies. I am sure that in so far as such measures have success—I have some experience of that with the windfall tax that some Members may remember—the latter idea will find widespread support throughout the House. If at the end of the day the mansion tax does not prove successful for whatever reason, the Government will have to look elsewhere, but the need for additional resources can no longer be denied.

Shortly before coming to the Chamber for the debate, I heard on the news that the Secretary of State has said that the reconfiguration involves not only integration of care for the elderly and social care with the mainstream health care services. That is important, but it also involves dealing with the divisions between the acute hospitals, which take the bulk of the spend, and GPs. The reconfiguration must mean that more is done by GPs when services can be sensibly provided by them, and that less is done in hospitals. I believe I am correct that that idea was first mooted by Lord Darzi in around 2008-09. The word used at the time was “polyclinics”, which require a lot of investment. In the interview on television news, the Secretary of State said words to the effect that we need more GPs and 15,000 more community workers in GP practice to make it a success, both of which clearly require more money.

Somehow or other, the Government must face up to the fact that, when it comes to claims for money, services to patients in Coventry and cities throughout the country must be increased. Otherwise, we will have more closures of local management committees and GP practices. Some 518 UK practices have closed in the past five years. Others have expanded, but in Coventry alone, eight major practices have closed. We have shrinkage of capacity and an increase in demand. By the definition of those two statements, we have a crisis, which is the subject of our debate.

Will the Minister tell us how far the Government have got with the pilot scheme under the clinical commissioning group in north Lancashire? The pilot intends to find out how the additional resources—£1 million has been put up—can be fed in without taking away from other parts of the health service, which it is important to emphasise. How is that working out?

That point came to my attention with the letter and prompted me to apply for the debate. The situation was highlighted in an early-day motion back in June. I did not sign it at the time but have rectified that. It was tabled by a Member who speaks for the Liberal party and seconded by two distinguished Labour Members, a former Chairman of the Select Committee on Health and my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson), a previous Labour Secretary of State for Health—he was Secretary of State in one of the earlier Labour Administrations. An amendment that I would be interested in supporting was tabled by a Government Member. He said that money was available for that pilot study. I would like to hear how it is making services more effective and providing more resources effectively for the delivery of GP services.

There is a conundrum. Why are GP practices not as attractive as they ought to be to new entrants? Fewer of those qualifying in the medical profession want to go into general practice, hence we have a net decline in the total numbers at the very time when, for all the reasons I have given, we should be increasing those numbers. Why is it so difficult? When one gets into a practice, and before becoming a partner, one gets more than £50,000 a year. Beyond that, when people become partners, they get approaching £100,000 and sometimes more, even in the initial stages. The average pay for GPs in Coventry is more than £100,000 a year.

[Mr Jim Cunningham (Coventry South) (Lab)]

Some months ago, I visited one or two different general practices in Coventry. The disparity in medical technology was startling. I have raised that in the House before, but I hope the Minister will touch on the reasons why we get such disparities.

[Mr Robinson]

I am very grateful to my hon. Friend for his intervention.

Some 10,000 GPs—I am sure these figures are well researched by Deloitte—have expressed an intention to retire in the next five years. That is 2,000 a year, and Labour is promising to increase the number of GPs by 8,000. We will therefore need considerably more than that just to remain where we are now. What are the projections for doctor qualifications and the division between secondary and primary care? Are we catering for enough or will we have a continuing crisis with people blaming the previous contract, as they do in the press all the time, when in fact there are simply not enough doctors or resources to go around?

I do not want to say that all doctors are perfect. They are no more perfect than the rest of the human race. The simple fact is that they are under strain. I could cite many instances, but I would like to mention one in particular. Dr Jamie Mcpherson, the secretary of the local medical committee in Coventry, is a very fine and dedicated GP whom I have known for years—he was one of the first people to come and see me when I was first elected—through the troubled years when Lady Thatcher’s Governments were first introducing tremendous cost pressures. When there was the idea that GPs would be budget holders of practices, he came to see me and said, “We don’t want that. We are aware we have to improve, but we want to be doctors serving the community.” That was his view. There is always a tension between the pressure to make GPs into budget holders who look at costs and the need for them to be committed to what they are really there for: serving the community as doctors.

I said I would give plenty of time for my hon. Friend the Member for Coventry South to speak and I intend to do so. Before I sit down, however, I would like to raise a few more points. What are the Government’s plans to ensure that there are more GPs, not five years out but in the next year or two? Can we expect any net increase in resources and in the number of GPs? Do we have any plans to have 15,000 extra community care health workers? It seems to me that we have an undue concentration on the reorganisation of the secondary sector. We have always had, in this House and outside, a top-down preoccupation with the secondary sector, the acute hospital, as if we solve everything by a concentration on it.

When I received the letter from the Coventry GPs, I realised that an increasing problem relates to the place that GPs occupy within the health community. What progress is being made in north Lancashire? What are the Government’s plans in the next year or two—they must have them, because they budget over three years—for the number of GPs, increasing resources and the establishment of new buildings?

I would like to mention another point that has been brought to my attention. There has been some investment in new buildings for GP practices. Has that investment been made with a view to them becoming polyclinics and taking on more of the “routine” jobs, if we can call them that? They are still very specialist and require trained nurses, which is why Labour has plans for 20,000 more nurses—not all, perhaps, for GP surgeries—and 8,000 more doctors. They are very skilled jobs, even though they are more routine. How much of the investment in new buildings for GPs has been devoted to the provision of a wider range of care? I ask that because it is clear that the capital cost of investing in providing new premises for practices is one of the stumbling blocks to getting new entrants into GP practices.

The other point I want to draw attention to when it comes to the Government’s plans, in addition to whether there is a problem with the practices and the capital costs of buildings, relates to women GPs. Nearly half of all GPs are now women—I think it is roughly 50%—and they need to be able to work part time. We therefore need a flexible contract. Is it flexible and is flexibility encouraged? They have a tremendous and increasing role to play.

Those are the questions I wanted to put to the Minister. We are very pleased to see him in his place and I am very pleased that we are having this debate.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Thank you, Madam Deputy Speaker, and I thank the hon. Member for Coventry South (Mr Cunningham) for his kind regards in that respect.

I congratulate the hon. Member for Coventry North West (Mr Robinson) on securing this debate. Like his hon. Friend, he raised a number of important broader points about the future of general practice and the work force—I hope to provide some reassurance in that regard—and some important local issues, which I also intend to address.

I commend both hon. Members for their interest in local health care matters as they affect their constituents, and I pay tribute to the dedication and professionalism of all the GPs and other staff working in primary care in Coventry and surrounding areas. The House will agree, I am sure, that good quality patient care is expected, regardless of which part of the country we live in. GPs are the bedrock of our NHS, with an estimated 340 million consultations taking place in general practice every year. We want to ensure that we always give GPs the right support so that they can deliver the best possible care for patients.

I am aware that the Coventry and Rugby local medical committee of the British Medical Association issued an open letter on 26 September, giving its views on national and local issues in general practice.

Let me turn first to one of the important points raised in the debate, which was that there has quite rightly often been a focus on the NHS as viewed through the prism of secondary care, yet the majority of engagements with patients is in primary care and in the community. We need to recognise the role of pharmacy, too, as many people’s first point of contact will be with the pharmacist and, in the NHS, with their GP or another element of primary and community health care. It is therefore important to challenge that traditional prism through which the NHS tends to be regarded. We know that it is not just about hospitals; it is about primary care, too, and about ensuring that we invest to support GPs and deliver other high-quality community health care services.

[Mr Robinson]

We are greatly reassured by the Minister and agree with what he said. Will he confirm the figure—I was quite surprised to discover it—that at least 90% of all initial contacts with the NHS are through primary services? As he rightly says, it is mainly GPs, but chemists and others, too. Is the 90% figure correct?

[Dr Poulter]

I believe that that estimate is correct, although it is impossible to give a totally accurate figure, because some of the consultations, particularly with a pharmacist, might be informal rather than registered as an official consultation. For many people, it is important to get advice from their local pharmacist about how better to manage their medication regime or just to seek simple advice about what to take for an upset stomach. Those informal consultations are not usually registered in the same way as GP consultations, even though they happen every single minute of every day in our health service. Those points of contact are in the community, not in secondary care. This is how most people will come into contact with the health service, although in this place we sometimes talk about the NHS through the prism of secondary care. It is a legitimate challenge for all us of to recognise the importance of primary and community care and to continue to invest in and support those people who deliver that when we design health care services in the years ahead.

As a doctor myself, I particularly recognise the work of GPs and the vital role that they play. Shortly after the local medical committee issued its letter, as highlighted in the remarks of the hon. Member for Coventry North West, the Government were pleased to see that NHS employers, on behalf of NHS England and the BMA, reached agreement on changes to the GP contract. The BMA made the point that these changes will provide much needed breathing space for general practice and greater stability for patients. However, we accept there is much more that we need to do in the longer term to support general practice, such as recruiting more GPs to help tackle GP burn-out. I shall say more about that later.

We are of course pleased to have reached agreement with the BMA, and I think it is useful to set out a few points about what we have done nationally and what we want to do in the coming years, as this will help to address some of the concerns raised by the hon. Gentleman.

First, it is worth highlighting some of the investment in general practice that has taken place. We recognise the need for a reversal of the shift that the hon. Gentleman described so articulately—the shift that has taken place, over decades of investment, away from community care and towards hospital care. I hope the hon. Gentleman will be reassured by the latest figures, which show that the total investment in general practice increased in cash terms by 2.92% between 2012-13 and 2013-14, from £7,863.8 million to £8,093.4 million. I shall write to him to confirm those figures, but I think we should all welcome the reversal of the traditional shift in favour of secondary care, towards general practice and other primary care. The hon. Gentleman may be aware that NHS England published its “Five Year Forward View” last week. In that report, it committed itself to more investment in primary care over the next five years, including investment in infrastructure.

I know that the hon. Gentleman is rightly concerned about GP numbers. Although the headcount figure in this year’s annual work force census shows a very small decrease of 29, the full-time equivalent figure has increased by 423, or 1.2%, which represents a real increase in capacity in the system. There are now 36,294 full-time equivalent GPs working in the NHS, including registrars and retainers. That is an increase of 423 since 2012, and an increase of more than 1,000 since 2010. There are 329 full-time equivalent GPs working in the Coventry and Rugby clinical commissioning group area, compared with 305 in 2010, so numbers are beginning to increase locally. I hope that that, too, is reassuring.

I understand that the NHS England Arden, Herefordshire and Worcestershire area team is working with the deanery, examining work force development issues and, specifically, ways of improving the process for GPs who want to return to general practice after a career break. The hon. Gentleman made the important point that the work force now includes many women GPs. That is one of the great strengths of the profession, but we must bear in mind the need to enable women who take career breaks in order to start a family to return to general practice. I know that a great deal of work is being done in that regard, not just locally but nationally, involving the Royal College of General Practitioners and the General Medical Practice.

We accept that the work force must grow to meet rising demand from an ageing population. That is why our mandate to Health Education England requires 50% of trainee doctors, after graduation—3,250, on the basis of current forecasts—to enter GP training programmes by 2016; the current figure is about 40%. That will enable further increases to be made in the GP work force: we expect an increase of about 5,000 by 2020. Although numbers are rising, we know that GPs need more resources.

[Mr Robinson]

My hon. Friend and I are very reassured by what the Minister has said. As for the numbers—which, of course, we always have to plan for—does the increase of 5,000 by 2020 mean an increase in the total number of doctors, or an increase in the number of GPs? Will that be enough, given that 10,000 doctors will retire from general practice alone in the next five years? Does the 5,000 figure relate to the position after those GPs have retired? How does the calculation work?

[Dr Poulter]

The figures that I gave are based on what we assume will be the attrition rate over the next five years. The total number of doctors has increased by, I believe, about 7,000 over the last four years, but the 2020 figure relates specifically to GPs.

The hon. Gentleman has made a good point. The same consideration has historically applied to health visitors. When a large proportion of that work force has been close to retirement over a five or 10-year period, it has meant the loss of a great deal of experience, but that is not the only issue: there is also the need to plan for those retirements in advance. The figures that we worked out with Health Education England take account of attrition rates.

Part of that is about ensuring that half those medical students become GPs on graduation; currently, only 40% do so. That is where the extra increase in capacity will come from. That will also address the fundamental issue that we have been discussing today—namely, that we need more people working in the community and in primary care. We need to move the prism of the discussion about what good health care looks like away from it being just about delivering good health care in hospitals.

The work being undertaken by Health Education England will improve the applications and fill-rate for GP training. The work includes: a review of the GP recruitment process; development of a returner and refresher scheme; development of a pre-GP year to give prospective GP applicants exposure to the specialty; and careers advice for foundation doctors and medical students. That careers advice is important. When I was at medical school, everyone in my year wanted to be a hospital doctor. I entered a hospital specialty. It is therefore important that, from day one at medical school, students are encouraged and supported to recognise the tremendous opportunities that a career in general practice could offer.

Part of the challenge is to set the aspirations of medical students appropriately and to recognise that the work of a general practitioner is as important as—if not sometimes more important than—the work of a hospital specialist. We need to encourage greater recognition of that fact in medical schools, given that we want to deliver more care in the community. I believe that it is Lancaster medical school that has done a very good job of placing a greater emphasis on prospective GPs doing more community-based and primary care placements during medical school training. That has encouraged more students to enter general practice afterwards. I think I am right in saying that it is Lancaster medical school, but I will write to the hon. Member for Coventry North West after the debate to outline exactly where that kind of initiative has been effective. When looking at how we should train our future work force, it is vital to ensure that more medical students focus on a career in general practice from an early stage of their development if we are to encourage more of them to choose that route. We know that that has worked in the past.

I shall not detain the House by describing the work that Health Education England is doing nationally. Instead, I want to respond to the hon. Gentleman’s questions by talking about what we are doing now to support GPs through technology to enable them to provide a better service to patients. This applies not only to the service available during the current opening hours but to how we might facilitate community and primary care services on a more seven-days-a-week basis.

Last autumn, the Prime Minister announced a challenge fund of £50 million to support innovative GP practices in improving services and access for their patients. As well as offering seven-days-a-week access and evening opening hours, pioneer GP groups will test a variety of forward-thinking services to suit modern lifestyles, including Skype, e-mail and phone consultations. We need to recognise that this is about engaging with people on their own terms. Someone who is working might want to engage with their GP in a different way from someone who is retired, for example. The challenge fund will help to address those questions.

The challenge fund is now supporting more than 1,000 practices covering every region. The pilots will draw best and innovative practice from GPs on the ground to determine what is needed and works locally. We recently announced a second wave of access pilots, with further funding of £100 million for 2015-16. Yesterday, NHS England published details of how to apply to become a wave 2 pilot site, including the application criteria, process and time scales. I hope that practices in Coventry will take advantage of that fund and make applications to support local patients.

The £3.8 billion Better Care Fund combines existing funding in a single health and care pot, promoting integrated care and joint working between health and care services. It aims to ease pressure on services by encouraging greater prevention and by supporting people to stay independent for as long as possible. I have been informed that, in 2015-16, the Coventry clinical commissioning group will receive £9 million to improve services in the local area. Demand continues to grow nationally, and Coventry is no exception to that trend. However, I am told that significant work has been done over the past few years to increase access and to support local initiatives. Significant investment has been made in premises to improve better access to services and an improved patient experience. Four practices co-located to the City of Coventry health centre in 2012 and three practices moved to the new centre at Clay lane in 2013. The hon. Gentlemen raised some issues about practice closures—