Blackpool Teaching Hospitals NHS Foundation Trust

Gordon Marsden Excerpts

Thursday 24th October 2019 Commons Chamber

[Gordon Marsden (Blackpool South) (Lab)]

This is the second Adjournment debate I have been granted in 16 months on Blackpool Teaching Hospitals NHS Foundation Trust and concerns about its governance. In the first debate, last June, I expressed profound concerns about the processes and lack of transparency leading up to the appointment of the trust’s current chair, Pearse Butler. As I said then, it was the first time in my 20-year relationship with the trust and its predecessors, as a Blackpool MP, that I felt it necessary to express such concern in an Adjournment debate. I felt I had no choice, given the catalogue of errors, evasion and lack of transparency that had accompanied the process, including failings within NHS Improvement.

Last year I said:

“I am forced to conclude that the nominations committee thought that it could get away with evading proper scrutiny and transparency—that a thin veneer of irritated politeness attempting to conceal a determined effort to override public governors unless they were rubber-stamped…would do the trick. Well, it does not do the trick”.

The Minister’s predecessor, the right hon. Member for North East Cambridgeshire (Stephen Barclay), said in his reply that the issues I raised

“are clearly a cause for concern…it is clear that the recruitment process for the new chair had a number of irregularities.”

He criticised the trust’s failure to give decent or timely advice to MPs and stakeholders or to give suggestions for people who might apply. He assured the House that he would be

“working with NHSI to ensure that the irregularities regarding this appointment do not occur in the future. The hon. Gentleman has done the House a service in highlighting the clear irregularities in respect of this appointment.”—[Official Report, 27 June 2018; Vol. 643, c. 1005-9.]

Indeed, when I met the new chair, Pearse Butler, in August 2018 for a review and a discussion of all the hugely important issues affecting our trust, which not only serves 330,000 acute patients on the Fylde coast but provides community health for nearly half a million patients into Wyre and north Lancashire, he hastened to assure me that he had taken on board the critique and would ensure new openness and transparency on these issues. I accepted the assurance at face value. I little dreamed that, just over 12 months later, I would have to return to the subject, but this time with him not as the passive beneficiary of a flawed process, but as an active agent—probably the leading agent—in another area.

I make it clear that my concerns in no way reflect on the vast majority of hard-working staff in the trust or on the challenging financial and other circumstances, especially in my Blackpool South constituency, which is the most deprived in England—overall health in Blackpool is the worst on 23 of the 32 health indicators. Their work, and many examples of good care under extreme pressure, were noted in the recent Care Quality Commission report, and I associate myself with those comments.

[Cat Smith (Lancaster and Fleetwood) (Lab)]

I congratulate my hon. Friend on securing yet another Adjournment debate on the Blackpool Teaching Hospitals NHS Foundation Trust. It is, indeed, a sorry state of affairs when we find ourselves debating the trust once again. He makes important points about the staff, who work incredibly hard. Does he share my concern that the CQC report said that the staff did not always feel respected, supported or valued, and were concerned about the culture within Blackpool Victoria Hospital?

[Gordon Marsden]

I share those concerns, and I will show how they are inextricably linked to some of the shenanigans in the confirmation of the chief executive. It is all the more reason why staff might share the concerns and sense of grievance to which I will refer.

In the autumn and winter of last year and into this spring, as the trust’s chair settled into his new position, the problems of cuts, waiting times and cancelled operations, which still leave the trust with some of the worst mortality rates and waiting times in England, continued. A snap visit by the CQC in January found patients waiting on the floor of Blackpool Victoria Hospital, because of a lack of space, and triage delays of more than three hours. As Blackpool’s The Gazette said when the report finally came out, the CQC was demanding that

“bosses must improve the standards of care and staffing…in the emergency department”.

Unfortunately, by this time, the trust had a further shadow hanging over it, with a police probe into issues of alleged poisoning in the stroke unit. That situation remains unresolved and I do not intend to talk about it further. The then chief executive, Wendy Swift, had left fairly unexpectedly in April, and the chair was at pains to tell The Gazette that her departure was

“in no way related to the trust’s performance.”

But he struck a very different tone last month when he told governors that the trust had

“needed a leader with gravitas and experience who could lead a different type of engagement with our staff.”

That person was Kevin McGee, who was appointed as the interim temporary chief executive for the six months to 31 October. Naturally, when I heard of that, in May, I spoke to the chairman, who assured me that there would be a full and proper process for appointing a permanent chief executive in due course. I said in a subsequent letter to him, on 10 June, that it would be helpful to confirm when the process would begin, with details of the period between stakeholders being advised and of the closing period, and that this had been one of the issues in respect of his appointment as chair. I heard no more until 20 June, when the trust’s secretary sent me a note, which said that the post had been advertised on 9 June and the shortlisting process would take place at the remuneration committee on 27 June. I want to emphasise that that was an even more rushed deadline that the one that the Minister’s predecessor had criticised for the chairman’s own appointment. In effect, it blocked MP stakeholders from having any ability to inform other potentially suitable applicants.

I began to be concerned, but what I did not then know was that the timeline described in the note to governors on 16 September to rubber stamp Mr McGee’s appointment as the permanent chief executive without due process had been given the following rationale:

“On 27th June, the Remuneration Committee reviewed the shortlist provided by Odgers”—

the recruiters—

“and determined that the candidates presented did not demonstrate either the experience or the leadership…required for the post…The Non-Executive Directors and myself did not believe that re-advertising the post would result in a stronger field of applicants and this had been discussed with, and agreed by, the Regional Director of NHS Improvement, after a range of discussions with experienced Chief Executives across the sector.”

How cosy! It was very cosy, and I think that to any impartial outside observer it would look like a complete stitch-up by the great and good of the region. The only communication I had received from the trust between June and 16 September was a staff bulletin from Pearse Butler, in which he had confirmed the cancellation of interviews and said

“we will now take a few weeks to consider our options”.

In the meantime, my attention had been drawn to an article published on 9 August in the Health Service Journal headed “Chief executive makes bid to lead second trust”. The journalist, Lawrence Dunhill, had interviewed Mr McGee about creating chain models and shared leadership. Mr McGee was admirably concise about what he thought—they were a jolly good thing. He told Mr Dunhill:

“Take personalities out of it, just the ability to work together in a different way”.

When asked whether he wanted to lead both trusts permanently, he said:

“If we can look at working in a different way across Lancashire then it would be a really good thing to do and I’d be really interested in doing that.”

The article stated:

“As reported last month, former Salford Royal chief executive Sir David Dalton…has been brought in to help trusts in Lancashire look at options for closer collaboration.”

Incidentally, this was the same Sir David Dalton who had been the independent assessor for the process of Pearse Butler’s own appointment as chair, which the previous Minister referred to last year.

I want to make it clear that I am not making any judgment—certainly not yet—on whether Mr McGee will be a good, bad or indifferent chief executive. He comes with some reputation, but as he has not met me since his appointment in May, I cannot say more. What is very clear is that for the second part of this exercise, having got Mr McGee as an interim chief executive of Blackpool Teaching Hospitals NHS Foundation Trust, in addition to his existing position as chief executive of East Lancashire Hospitals NHS Trust, there was a clear determination on the part of the chair at least to push through his confirmation without any attempt to reopen the selection process. We know that because of the answer to a parliamentary question that I received from the Minister on 8 October. I asked in what capacity NHS Improvement had given advice on discussing the possibility of mergers, and the reply said:

“The Chair at Blackpool Teaching Hospitals NHS Foundation Trust and the Chair at East Lancashire Hospitals NHS Trust sought the views of NHS England and NHS Improvement on the possibility of merging services and provision between the two Trusts.”

When the chairman had secured the agreement of the governors at the meeting to his proposal for Mr McGee, he finally decided to tell certainly me, and I think my parliamentary neighbour, the hon. Member for Blackpool North and Cleveleys (Paul Maynard), of his news. This consisted of a rushed phone call to me, I think out in the countryside, just before he was about to go on holiday to Japan. I made it clear to him that I was surprised that he seemed to have learned nothing from the failings of process and transparency in his own appointment, that he was now preparing to foist a merger between the two trusts, that this was a major step and that there should be utmost clarity and transparency in the process. When I asked him why he had not taken that option in respect of Mr McGee, he dodged the question about putting him automatically on the shortlist and said that it would be a great move. When I said to him that it was effectively a merger, it said that it was not, saying that it was an alignment and that no decisions had been made about any merger. We know from the answer to the parliamentary question that that was incorrect. Perhaps the House will not be surprised that in the article in The Gazette entitled “More controversy at Blackpool Victoria Hospital”, I said that the process had been

“at best ambiguous and at worst evasive”

in respect of the merger and that we needed confirmation of what was proposed. I have no doubt that the chair will continue to try to muddy the waters but, to continue the analogy, if it walks like a duck and quacks like a duck, it is a duck.

We now have clarity from the answer to a second parliamentary question that I received from the Minister that Mr McGee will receive a single salary, agreed by both remuneration committees, although the trust still refuses to tell us what it will be. I said to The Gazette that the situation “beggars belief” after last year’s debate, and I still believe it does. It appears I am not the only one. The smooth and slippery stakeholder brief that was put out by way of formal amendment for the trust talks of “strategies of collaboration” and extensive discussions with, among others, the governors at Blackpool foundation trust. I am reliably informed that that is not the case. At least one governor has said that they were called on 16 September simply to ratify McGee’s appointment and that nothing was said about the implications of a merger. I gather that others are asking for more clarification. The Gazette, which was initially fobbed off about the truth and timing of the appointment, told us the same story. It seems that a number of other non-executive directors have also been confirmed without further press or selection.

It has to be said that this is not the first time that Mr Butler has attracted controversy with governors. When he was chair of the Morecambe Bay trust and outsourced Barrow hospital’s out-patient services, the media reported governors as saying, “I do not believe you got any influence on this structure. You drove the decision and due process was not done.” Governors were not informed of what was happening until July. In this case, it was not only MPs who were not consulted, as is confirmed by the Minister’s answer to my parliamentary question, and nor was the chair of the clinical commissioning group, or the CCG itself. Sadly, in the “not good enough” CQC report on the June inspection that came out just last week, this is amply and damningly exposed.

[Mark Menzies (Fylde) (Con)]

The hon. Gentleman refers to the CQC report, which sums up what is quite frankly a failing of management and senior administration at the hospital. We have a litany of records going missing—paper records like something from the 1950s—for months on end, and patients not being informed if their records have been found. Today, one of my constituents went to the hospital for an appointment only to be told that that appointment had been cancelled, although they had never been informed. This is not about money; it is about basic admin and basic management. Quite frankly, I say to the Minister that if these people cannot sort themselves out, the time is up. We should send in a taskforce, take these people in hand and sort it out. Our constituents demand better. We are putting the money in and we need to sort these people out if they cannot sort themselves out. My patience has worn out.

[Gordon Marsden]

The hon. Gentleman speaks very powerfully about the whole process, and I agree with him exactly. Sadly, in the “not good enough” CQC report about the inspection in June, which came out just last week, ample and damning concerns are exposed. There was a continuing series of “requiring improvements” for safety, effectiveness and responsiveness; and one “good” for caring, which speaks volumes for the staff. The biggest black mark went against leadership. When asked to judge whether the trust was well led, the CQC said that it was not and that it was “inadequate”. It gave chapter and verse on the issues. I cannot read all of it out, but I will give the Minister a selection:

“There was limited understanding of the importance of culture…Staff did not feel respected, valued, supported or appreciated by some members of the board…When something went wrong, people were not always told, did not consistently receive an apology…There were levels of bullying, harassment, discrimination and the organisation was not taking adequate action to reduce this…When staff raised concerns, they were not treated with respect, or the culture, policies and procedures did not provide adequate support for them to do so…We heard from several staff groups particularly those from a BME background.”

I have spoken to the CQC since the report came out and asked it to clarify exactly when it got these comments from staff and when it investigated them. It was confirmed that it was the period between March 2018 and June 2019, three quarters of which had been under Pearse Butler’s chairmanship. I asked whether there had been any discussion about the possibility of any future merger/collaboration, and was told that there had been discussions with NHSI and that it was likely—this was in June—that Mr McGee would be able to take that through. That is further evidence, if any more were needed, of this all being sorted out by the people in the bubble between June and August. There was very little evidence that they thought there was anything wrong, but of course there is something wrong—massively wrong. Let us add to this a small number of people in that bubble, in this case spearheaded by the chief executive. Yes, these decisions will affect all our constituents.

The fact of the matter is that the implications of this merger—because that is what it is—are massive. Will the two organisations fit? How will Mr McGee handle both? Why were the governors not given the full facts? East Lancashire, which is a good trust, covers Blackburn, Accrington, Burnley, Clitheroe, Pendle, Colne and Darwen. They are all very different places in terms of geography, demographics and ethnicities. All are a very long way from some of the coastal concerns of this hospital trust. If the people of East Lancashire look to anywhere, proud inland communities though they are, they look— dare I say it?—to the Pennines or to Greater Manchester. The idea that this is going to work very easily is for the birds.

Foundation trusts were established under a quid pro quo system. They have wide powers of initiative, but in return, the public and external stakeholders have a right to be properly informed, consulted and assured that process is properly applied. In this case, that has not happened. What was needed was proper scrutiny, not winks and nods from a cosy clique within the bubble and nothing that would make the culture inadequate, as was so devastatingly laid out by the CQC. I have no doubt that some of these appointments may in themselves be good—I have met the new nursing director—but the culture over which Pearse Butler has presided over the past year has attracted these black marks.

I will conclude by saying that we really must make sure that we see a turnover from this catalogue of half-truths and evasions, and that there is a proper consultation, involving all stakeholders, about a process that is effectively a merger. Perhaps someone needs to say to the chair and some others in the trust the good words of Robbie Burns:

“Oh what a tangled web we weave,

When first we practice to deceive.”

Hormone Pregnancy Tests

Gordon Marsden Excerpts

Tuesday 23rd April 2019 Westminster Hall

[Yasmin Qureshi (Bolton South East) (Lab)]

I beg to move,

That this House has considered the Expert Working Group report on hormone pregnancy tests.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am also pleased that the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), is here to respond to this debate.

To establish the context of the debate, I will begin by acknowledging the extraordinary hard work and determination of Marie Lyon, who is here with us in Westminster Hall today. She has led the campaign on behalf of the victims of hormone pregnancy tests, and alongside her husband has travelled the length and breadth of this country, and even been to Germany, to support victims.

It has been my pleasure to work with Marie since the beginning of this campaign, alongside others including Jason Farrell, who has pursued this story for Sky News from the start; Professor Neil Vargesson of Aberdeen University; and Professor Carl Heneghan and Dr Jeffrey Aronson, both of Oxford University, whose recent work is the basis of this debate.

By way of providing more background, I remind the House that Primodos, the hormone pregnancy test drug, was taken by approximately 1.5 million women in the 1960s and 1970s to test for pregnancy. The dosage contained in those Primodos tablets was 40 times the strength of an oral contraceptive that would be prescribed today. There is considerable evidence that many women who took this drug either gave birth to babies with serious deformities, or miscarried, or had stillbirths. Those babies are now in their 40s and 50s, and they have had to live a lifetime with serious disabilities.

To this day, not one Minister or one review has been able to answer some very simple questions. First, why were no official warnings issued about this drug until eight years after the first major report that indicated possible dangers? Why were some doctors still prescribing this drug for pregnant women after official warnings were issued by the Committee on Safety of Medicines? And why were some GPs able to pull out Primodos tablets from their desk drawers and hand them to women?

I secured this debate to seek answers in respect of the Medicines and Healthcare Products Regulatory Agency-led expert working group. That was the scientific review set up on the instruction of a former Minister, the hon. Member for Mid Norfolk (George Freeman), following my Backbench Business Debate on this issue in 2015. He had clearly stated to us that this review would “thoroughly” consider all the evidence.

Such is the depth of concern about this issue that there have already been three debates on the expert working group’s review—this is the fourth. Each and every time, Members from across the House have urged Ministers to consider our concerns about the methodology, the independence of the panel members and the conclusions of the report. On each and every occasion, however, our concerns have been dismissed.

[Gordon Marsden (Blackpool South) (Lab)]

I congratulate my hon. Friend on securing this debate and on the absolutely focused way in which she has conducted this campaign, with other Members here today and with Marie Lyon. I also pay tribute to the hon. Member for Mid Norfolk (George Freeman), the former Minister: it is not easy for Ministers to override the advice of their civil servants, but he did on that occasion. That, however, makes it all the more concerning that, on 24 October last year, Lord O’Shaughnessy wrote my hon. Friend a letter that was rather confusing and defensive, and did not make any reference to enforcing a rethink by the MHRA.

We know that there are issues about how the meta tests are done, and I am sure that my hon. Friend will come on to that. However, at this stage does she still find it very concerning that Ministers have not grasped the nettle?

[Yasmin Qureshi]

I thank my hon. Friend for that intervention and I absolutely agree with him; he can probably hear in my voice some of my frustration about the fact that this issue has not been grasped by Ministers and dealt with.

In recent months, the all-party parliamentary group on hormone pregnancy tests, of which I am the chair, has written to Ministers several times to ask for meetings so that we can discuss these concerns, but each time our request has been declined. Perhaps the Minister here today could shed some light on what exactly the Government are so intent on hiding each time they refuse the request by a group of MPs for a meeting.

Let us not forget that the review was cloaked in secrecy from the very start. As an observer, Marie Lyon was forced to sign a “gagging clause”, which, if breached, could have resulted in a prison sentence. Families who gave evidence to the panel reported being treated appallingly by the MHRA. Despite the MHRA’s insistence that the expert working group was independent, two panel members had to be removed after Marie Lyon discovered conflicts of interest.

Perhaps the most shocking fact was that this review was set up with terms of reference that stated very clearly that it would seek to find a “possible association”, but the review panel and the Commission on Human Medicines chose to ignore that and instead concluded that a

“causal association could not be found between the drug and birth defects.”

Each time that Ministers have been questioned about this review, we have been told that it was

“robust, comprehensive, independent and scientific”.

If that really is the case, I hope that the Minister can provide us with answers today as to why we now have evidence, which I will set out, that clearly proves that the expert working group review was anything but robust and comprehensive.

Last November, a team of experts led by Carl Heneghan, the Professor of Evidence-Based Medicine at Oxford University, conducted a systematic review of all previous human studies. They discovered that when the data is pooled properly it shows “a clear association” with several different forms of malformation. The results were clear that there is an association that is significant. That tells us that the expert working group’s review completely failed to adopt the right approach for a systematic review. Why did it not pool all the data together and properly collate it to show an overall effect? I should also point out that Professor Heneghan’s study has been published in a peer review journal, whereas the expert working group’s review was not even scrutinised.

However, Professor Heneghan did not stop there. Marie Lyon obtained raw data used by the expert working group via a freedom of information request. It is worth noting that despite the MHRA’s claim of “transparency”, this data was not already in the public domain. The cynical among us might ask: why was that? Why hide it?

That raw data was then assessed by Professor Heneghan and his team, who carried out a meta-analysis on it, and again they found that there is an association between the drug and birth defects. Let me just repeat that point again—raw data used by the MHRA for the expert working group review was assessed by independent experts at Oxford University and it was found that Primodos causes deformities.

Can the Minister appreciate why that has led to suspicion that key elements of the research were removed from the report in order for the expert working group to reach its conclusion, and why campaigners feel that Ministers and Parliament may have been misled, given that it appears that key information was being withheld from the report in order to suggest that there is no link between Primodos and deformities?

[Gordon Marsden]

My hon. Friend is being gracious in allowing interventions. Does she not consider it confusing that the group, and indeed the MHRA, seem to be reluctant regarding meta-analysis, when only recently the National Institute for Health and Care Excellence used it to reinstate surgical mesh in the treatment of prolapse? It is widely understood to be a common method—the US Food and Drug Administration and the European Medicines Agency have adopted it. Why are we lagging behind? Perhaps the Minister would like to comment on that in her reply.

[Yasmin Qureshi]

My hon. Friend is absolutely right and I come on to explain how other bodies use meta-analysis to carry out assessment.

Does the Minister understand why we are asking why the data was not even properly assessed? When I tabled a parliamentary question to inquire whether the meta-analysis of the studies had been carried out, I was told that it had not. Can the Minister explain why not? One of the experts on the panel, Professor Stephen Evans, recently made a poor defence of meta-analysis not being used in the review, by relying heavily on a paper called, “Meta-analysis. Schemata analysis”, which was published 25 years ago. The expert working group seems not to have considered meta-analysis an appropriate way in which to assess the data. Why not? Why did it refuse to take an evidence-based approach?

Neither the Minister nor I is a scientist, but she is aware that meta-analysis is the statistical procedure that combines data from multiple studies. When treatment effect is consistent from one study to the next, as with Primodos, it is completely appropriate and evidence-based to use a meta-analysis to assess the data. Pharmaceutical companies use it to approve new drugs. The US Food and Drug Administration uses it. The European Medicines Agency uses it for the approval of drugs, and clinicians and researchers in medicine, education and the criminal justice system use it to determine whether a treatment works. The National Institute for Health and Care Excellence uses meta-analysis, and it is the cornerstone of Cochrane—previously known as the Cochrane Collaboration. The only group that discounts meta-analysis is the MHRA. Why? To say that meta-analysis was not the appropriate method is completely incompatible with an evidence-based approach.

Let me take up the matter of the independence of the expert working group. We have been told several times, by a number of Ministers, that the entire process was completely independent. It is my view that the Government are not well served by their current processes, the lack of independence and the lack of impartiality. What is in doubt is the question of whether the Government have the independent expertise required to hold Government bodies such as the MHRA to account and provide us with independent evidence with which to make informed decisions.

As the Minister is aware, in February 2018, Baroness Cumberlege began a joint non-scientific review into Primodos, sodium valproate and mesh implants, and we expect it to conclude in the next few months. Baroness Cumberlege invited the expert working group to give oral evidence to the review team, and this is how Ailsa Gebbie, the group’s chair, described herself at the beginning of an evidence session:

“I’m also the chair of the MHRA and the expert working group on hormones and women’s health that reviews all products and medicines and drugs related to women”.

What does independent mean if the chair describes herself in that way?

In 2015, the Commission on Human Medicines agreed to establish an expert working group to review the available data on a possible association between the hormone pregnancy test, Primodos, and adverse outcomes in pregnancy, and to make a recommendation. The commission appears to have commissioned the MHRA to do an independent review. Perhaps the independence of the MHRA can be summed up in its response to Marie Lyon, who in conversation with the agency had reminded it of its responsibility to the public interest. She was immediately corrected:

“No, the job of the MHRA is to represent Pharma”.

Of course, the agency is correct—it is substantially funded by the pharmaceutical industry and cannot be considered independent by any stretch of the imagination. Can the Minister explain why we are expected to have confidence in the independence of a review that was run by an organisation part-funded by pharma? How can we be expected to trust claims that Bayer, the manufacturer of Primodos, has no links to the MHRA? Yes, we had a review, but I am not sure we can call it independent. Will the Minister do the right thing and withdraw the expert working group report?

If the Minister needs any further evidence, perhaps I can point her to the testimony of Sandra Malcolm, a recent whistleblower. Mrs Malcolm worked for the manufacturer of Primodos, which is now owned by Bayer. While at the company in 1971, she discovered she was pregnant and spoke to colleagues:

“I was in reception one day and there were two guys there. One may have been a medical rep and he said to me ‘you want a dose of Primodos’ and the other said ‘I think it’s been taken off the market’, and the other one said ‘no, you can get it’. So with that information I went upstairs to see one of the doctors. I said ‘I’m a week overdue and can I have some Primodos?’ And he said ‘I can’t give it to you because it may not work and it may cause deformities’, so I thought that was a definite no.”

Mrs Malcolm said that after the conversation she decided not to take the drug “for obvious reasons” and that she assumed it was no longer on the market. However, many years later, when she saw a report about Primodos causing deformities, she was shocked to discover it had remained on the market for many years after problems had been listed.

Vast swathes of evidence clearly point to a cover-up by the drug company and the Government regulators at the time. It is utterly disgraceful that until this day the evidence has been ignored, as it was by the expert working group review.

--- Later in debate ---

[Emma Reynolds (Wolverhampton North East) (Lab)]

It is a great pleasure to serve under your chairmanship, Mr Hollobone. I begin by paying tribute to my hon. Friend the Member for Bolton South East (Yasmin Qureshi) for having secured this important debate, and more widely for her leadership of the all-party parliamentary group on hormone pregnancy tests and her incredible campaigning on this issue. I pay tribute to all the families who, for many years, have been campaigning tirelessly to uncover the truth about Primodos, particularly Marie Lyon, who is an incredible campaigner. She has worked hard on this issue, and I hope we can do something to make sure we get to the truth about what happened all those years ago. I also place on record my thanks to Professors Neil Vargesson and Carl Heneghan, and to Sky News reporter Jason Farrell for his determination to get to the truth. Many of his reports have been seen by families who have come forward as a result of the testimony and campaigning of others.

One of the families affected by Primodos lives in my constituency. My constituent Steven Bagley was born severely brain-damaged after his mother was given Primodos as a hormone pregnancy test in 1967. Steven needs 24-hour care, cannot communicate, and suffers from a severe form of epilepsy, which means frequent seizures that have become steadily worse with age and happen throughout the night.

I have got to know the Bagley family over the past few years: Steven’s parents Pat and Ted, and his sister Charlotte, who has been a tireless campaigner for justice for her parents and brother. She has recently moved from Southampton back to Wolverhampton to help look after Steven. His parents have lovingly looked after him for 50 years, but are now in their 80s and 70s with their own health problems, and are finding it a real struggle. What I find particularly heartbreaking about the case of my constituents, which is similar to many others, is that like other mums affected, Pat still says, “If only I hadn’t taken those pills.” However, she was doing what we all do: trusting our GP and following their advice. Like many others affected by Primodos, Pat was not given a prescription, but was given the pills directly by her doctor.

It is thanks to the tireless campaigning of families such as my constituents, and of my hon. Friend the Member for Bolton South East, that the Government asked the Commission on Human Medicines to set up an expert working group to examine the scientific evidence linking Primodos to birth defects. However, from the start, serious concerns were raised by the families, the APPG on hormone pregnancy tests, individual MPs and scientists about how that group went about its work. Those concerns have only grown as evidence of missing analysis has come to light, and questions have been asked about the methodology used.

I will raise four particular concerns about the expert working group. First, the group reinterpreted its terms of reference. It was asked to look at a possible association between the drugs and the foetal abnormalities. Despite that, it decided to look for a higher standard of proof of a causal association between Primodos and birth defects, even though it was not asked to find a causal link. It has never been clearly explained why the group chose to interpret and change the terms of reference in that way. Perhaps the Minister will reflect on that when she winds up. If not, will she take that away, consider it and come back to us?

Secondly, the report was altered before publication in several ways. Apparently the draft report, provided to Marie Lyon, stated:

“Limitations of the methodology of the time and the relative scarcity of the evidence means it is not possible to reach a definitive conclusion.”

That line was removed before the final report was published. The draft also stated that

“there is insufficient evidence to determine whether taking the medications at the doses found in Primodos tablets, for two days during the first trimester of pregnancy could have reached and had an effect on the fetus.”

However, in the final report, that was substantially changed. That uncertainty was replaced by the claim that the evidence indicated that any exposure

“was unlikely to have had an effect on the developing fetus.”

In short, the conclusion in the draft report changed from

“the evidence is insufficient to form a conclusion”,

to, in the final report,

“the evidence does not support a causal association”.

Again, there has been no satisfactory explanation for those changes. Will the Minister reflect on that in her winding-up speech or go back to the Department and convey to us why the changes were made?

Thirdly, there was no consideration of possible regulatory failures at the time Primodos was given to mothers by doctors as a hormone pregnancy test. That seems to be a huge omission. Will the Minister explain why such a vital question was excluded? It would surely help us to understand what concerns were raised or should have been raised about Primodos at the time.

[Gordon Marsden]

My hon. Friend is making an excellent speech. She is taking us necessarily into the past. What we know about the past is that how the drugs were marketed in the 1960s and 1970s would be totally unacceptable today. Does she not find it concerning that the context of how the drugs were delivered has not been looked at properly by the report? Some of the potential consequences of that, such as what women took as gospel from doctors, have not been addressed either.

[Emma Reynolds]

I agree with my hon. Friend. It is incredible that the burden of proof seems to rest on the families. That is what is being suggested in debates—not our debates, but others—but the burden of proof actually lies with the pharmaceutical company that made the products in the first place and did not do the testing required. The drugs subsequently had horrific effects on the babies who were born, yet we still have not got a Government or a Minister to accept that there is a link. We are looking for the truth to be uncovered.

I am conscious of time and your advice, Mr Hollobone, but allow me to make a fourth point about the expert working group. The credibility of the group has been further undermined in the eyes of the families and of the Members here today by its not including a meta-analysis—a pooling of all the data from previous studies. It is not clear whether such a meta-analysis was carried out and not divulged, or was just not done. Marie Lyon obtained the raw data used by the expert working group though a freedom of information request. Professor Carl Heneghan of Oxford University used the working group’s own data and found strikingly similar conclusions to his review. Both reviews showed significant associations of the use of Primodos with all congenital malformations and congenital heart defects. Both systematic reviews show that the use of Primodos in pregnancy is associated with increased risk of congenital malformations.

In conclusion, we know that Baroness Cumberlege is carrying out a wider review into independent medicines and medical devices safety. I place on the record my thanks to her and her team for listening to the testimony of Pat and Ted Bagley and their daughter Charlotte. For the first time, they feel like they have been heard and listened to sympathetically. I hope that the Cumberlege review will get to the truth of what happened, but before we do that, it would be useful for the Government and the Minister to get to the truth of why the expert working group has presented the evidence in such a way and to respond to the concerns I have expressed. The sooner we get to the truth of what happened in the ’60s and ’70s with Primodos tablets—they were taken not only by expectant mums in our country, but by others in countries around the world—the better.

--- Later in debate ---

[Sir Mike Penning]

No one in this room or anyone listening to this debate could disagree with that, unless they were a lawyer working for the drug company, the Department of Health and Social Care, or perhaps both.

Believe it or not, Mr Hollobone, 70% of me, you and anyone else in the room is the same as a zebrafish. I swim really well, but I did not realise that until this morning. We chuckle, but the point is that the effects of an experiment on zebrafish will be similar to those on a human being. There are many studies, but the link is important. Professor Neil Vargesson’s report in 2018 supported Professor Heneghan’s report. What does that mean? We all know about the disgrace of thalidomide. Through experimentation on zebrafish, it was proven that thalidomide damaged children. We do not want to experiment on humans. It appears that that is exactly what has gone on here. It is obvious that the mechanism of the action of thalidomide is the same as that shown by the Primodos tests. Everybody can read the technical stuff. There was an effect on zebrafish, who share 70% of their genes with humans. Does that mean it could have had an effect on humans? Of course it does; it is not rocket science.

[Gordon Marsden]

The right hon. Gentleman is taking us through the history. Does he not agree with me that it is extraordinary? We need to remember the chronology. The thalidomide episode took place in the 1960s and was exposed by The Sunday Times and Harold Evans in a great step forward, but the drugs continued to be supplied afterwards. Even now, 40 years later, there is, in the statement of Lord O’Shaughnessy, doubt about whether such things should still be used. We should surely say that they should not be used.

[Sir Mike Penning]

I cannot understand how a drug company, now owned by Bayer, could know what was going on and continue to supply the drug in an underhand way to GPs. As a father—as a human being—I simply do not understand it. What on earth was going on? The MHRA, which gave evidence to us, was in complete denial. We did not ask for a cause. I was lucky enough to be a Minister in seven Departments. If I had said, “This is the review that you are going to do, and these are your terms of reference,” and those terms of reference were changed by the review group without my permission, I would have smelled a rat. I would have thought something was going wrong.

We can go through all the science, which cannot be denied. I do not blame any Minister—I can feel the special advisers’ eyes on my back—but something went dramatically wrong, and it has been covered up by several Governments. That must stop now. If compensation has to be paid, fine. Most of the families simply want an apology. Why is there no apology? Because there would then be the threat of legal action. Mistakes happen. When we make mistakes, we should admit it, no matter what Government are in power. We should sort it. We did that over Hillsborough when I was a Minister in the Home Office. It was a really difficult decision to make, but we made it, and the right conclusion was reached. That should be the case in this instance.

--- Later in debate ---

[Hannah Bardell]

I absolutely agree. I share the hon. Gentleman’s despair and sadness that we are in this position so many years after the group was set up—a process into which the Government put public money and in which medical experts took part. As I have said, we are not necessarily criticising the people in the expert working group, who are medical professionals, but they have fallen victim to a process that was at best opaque and at worst corrupt, given the influence of the companies involved.

Who knows why we ended up in this mess? On the day the report was due to be published, the hon. Member for Bolton South East and I went to an event that we thought was supposed to be public—or at least open to Members of Parliament. We were stopped at the door; some of the press were allowed in, but we were not. We know that there was due to be a press conference and a public event, but they were both cancelled.

Members have spoken passionately about the lack of independence and impartiality, the gagging clause that Marie Lyon had to sign and the heavy-handed approach taken, all of which have caused serious concerns. What does it say to those in the medical community who may be invited to be part of future Government working groups that a group that was supposed to be open and transparent and get to the truth of an issue has turned out to be a cover-up? It raises serious concerns that their credibility will be called into question. That is a very dangerous situation.

As well as looking at the wider issue, we need to look at the mess that the expert group became, so that we can give confidence not only to the families and to our constituents, but to medical professionals.

[Gordon Marsden]

The hon. Lady points out precisely the contextual things that we need to learn. Does she agree that there seems to have been an element of Jekyll and Hyde in the Government’s approach over the past three years? On the positive side, I have confidence that Baroness Cumberlege—with whom I have served on another all-party group—and her team are moving in the right direction. However, everything in the statement that the then Secretary of State made in February 2018 was about the future:

“drive forward…the recommendations of the expert working group…offering the families…a full and up-to-date genetic clinical evaluation…better training and support for obstetricians”.—[Official Report, 21 February 2018; Vol. 636, c. 165-166.]

Those are all good things, but they do not address the past 40 years, offer an apology or express any sense of regret, nor do they address any of the issues raised in this debate. Would it not be a good idea for the Minister to go back to the Secretary of State and say that we need to look again at that 2018 statement, go back to that context and make the necessary decisions? People will not put up with just a broad range of recommendations —we need to get to the heart of the matter.

[Hannah Bardell]

The hon. Gentleman is absolutely correct. How many times must the families and the victims of Primodos have their hopes built up and then completely dashed? Is it not bad enough that they have gone through the trauma, the blame and having their children live with deformities and disabilities—as my hon. Friend the Member for Argyll and Bute (Brendan O’Hara) so precisely and devastatingly highlighted in the case of his constituent—without also having their hopes built up for a review that turns out to be a whitewash? That gives people no confidence at a time when, let’s be honest, confidence in politicians and the political process is not particularly good. We have an opportunity here to do something good, to do it well and to do it properly.

I have to say that my exchanges with the Medicines and Healthcare Products Regulatory Agency and with the expert working group have not been good. I wrote directly to the chair of the expert working group about people’s feelings and concerns, but the response that I received did not fill me with hope.

I am pleased that Baroness Cumberlege has taken on her new role of looking at hormone pregnancy tests, sodium valproate and medical mesh, but when she sought evidence, she did not include Scotland. I have now written to her, and that issue has been rectified, but it is important to remember all the devolved nations of the UK and ensure that they are appropriately included. We know what the academic studies have shown—the work of Carl Heneghan and Neil Vargesson has been exceptional—but there is now new evidence and we should ensure that it is included in any future plans or reviews.

What we need from the Minister is an acknowledgment of the power of the views across this Chamber and across both Houses, and of the serious impact of this issue on people’s lives. How many parents need to die without knowing what happened to their children because of a pill that they took? As the right hon. Member for Hemel Hempstead (Sir Mike Penning) said, these were women who believed that they were in the care of the NHS, that they were being given something that had been properly medically checked, and that they were not being put in danger. However, their health and the health of their unborn children were put in danger. Let us not forget that many women miscarried—there are many children who were not born because their mothers took this pill. This drug was used in Germany as an abortive and in another country as a pregnancy test. It does not take an expert to work out that that was absolutely wrong.

We have a choice, and we have an opportunity. There is a very powerful body of medical evidence that needs to be properly looked at. The Government also need to take a long, hard look in the mirror and think very carefully about why the expert working group failed so badly and why its terms of reference changed part of the way through. They need to make sure that that never happens again; that the victims of Primodos, including my constituent and all the constituents mentioned today, never have to go through any more pain and suffering; and that those victims will get truth, justice and answers to their questions. Do they need compensation? Yes, absolutely, but what they really want is an apology and an acknowledgment.

As the right hon. Member for Hemel Hempstead said, when something goes wrong, the right thing to do is put your hands up and say, “Do you know what? We got this wrong.” It is about time that that happened. I hope that now the Minister and her Government will finally do the right thing.

--- Later in debate ---

[Jackie Doyle-Price]

I come back to my opening comments: we brought forward the Cumberlege review to give an independent challenge to what is currently being done by a regulatory system. We need to look at whether that system is appropriate, given the concerns.

[Gordon Marsden]

The Minister is being very generous with her time. She is seeking to persuade us, perfectly reasonably, that she and the Government have been acting in a measured way to try to look into all these things. As I have said, we welcome Baroness Cumberlege’s report. Has the Minister at any time asked the members of the expert working group why they changed the definition that they were given?

[Jackie Doyle-Price]

I am not satisfied that that is actually what happened. When we receive drafts of reports that are circulated to committees, they often go through amendment.

Let me continue going through the chronology of events. As I said, the evidence did not support a causal association, nor did it disprove one. We will of course continue to review evidence as it arises.

Blackpool Teaching Hospitals NHS Foundation Trust: Governance

Gordon Marsden Excerpts

Wednesday 27th June 2018 Commons Chamber

[Gordon Marsden (Blackpool South) (Lab)]

At the beginning of this year, it was announced that the chair of the Blackpool Teaching Hospitals NHS Foundation Trust, Ian Johnson, would be stepping down at Easter. I had always found him approachable and helpful in my regular meetings with him to discuss the trust’s work. For the avoidance of doubt, I should say that although the trust is in the constituency of the hon. Member for Blackpool North and Cleveleys (Paul Maynard), who is sitting on the Government Front Bench, it covers not just my constituency and his, but those of the hon. Member for Fylde (Mark Menzies), the right hon. Member for Wyre and Preston North (Mr Wallace) and my hon. Friend the Member for Lancaster and Fleetwood (Cat Smith).

When it was subsequently announced that Mr Johnson had applied to become chair of the University Hospitals of Morecambe Bay Foundation Trust, I was mildly surprised, but thought nothing more of it. I was then interested, as I am sure others were—this was sent to myself and neighbouring MPs—to receive an email from the secretary of the trust encouraging us to go forward and talk about the process for Mr Johnson’s successor. I had no inkling then of the sequence of events that would lead me to seek this Adjournment debate.

What started to concern me about the circulation of this information was the extraordinarily short period of time that we were given. I did write to the secretary of the trust to ask why we had not been given earlier notice of the facts. When I found out that the advertisement had been placed in The Times, the date for the application was 16 April, which was within a very short period of time. I said that I would like more details on the shortlisting, the interviews and the interviewing panel. I said that I was sure that the trust would understand how important it was that there should be a strong transparency in the trust at such a critical point at this time. I got a slightly thin but soothing note from Michael Hearty, a governor of the trust, who announced himself as the chair of the nominations committee. He said:

“Let me first of all reassure you about the openness and transparency of the current Chair recruitment process.”

He took me through the process, and he did indeed confirm that it would be very speedy. He said that a long list of candidates had been presented to the nominations committee, but the list was not actually very long. It was a list of only eight, which makes me wonder why all the candidates were not interviewed.

There was then a very short process of presentations to stakeholders and final interviews. I wrote back to the governor and said that I thought there were still “serious questions” to be answered, particularly about the fact that there was no information about the closing date for applications. I asked him whether he would list the members of the nominations committee, and said that I was concerned that it had taken a week to provide me with merely a basic timeline regarding some of the questions that I had asked.

The second letter that I received from the governor was written in a rather smooth but slightly condescending fashion. He said:

“I am disappointed that my original response did not provide you with all the assurances that you were seeking and, as a consequence, you have found the need to ask further questions.”

As for the advertising of the process, he said that it was the first time that the trust had taken such a step, and that, in view of the progression, it thought that it would be open and transparent to let people know about it. He said:

“I am sure you will recognise its circulation as a well-intentioned act”,

although the closing date was an obvious piece of detail that could have been included in the original email.

At this point, I began to think of the old proverb that says:

“The louder he talked of his honour, the faster we counted our spoons.”

I said to the governor in response that I did not think that this was very transparent. I asked him who had appointed the nominations committee, and he told me that it was appointed by the governors. I am still at a loss to understand why the shortlisting involved such a hurry.

The other thing that bothered me was the inclusion of the chief executive of the trust, Wendy Swift, on the nominations committee. I laid out my concerns in an email to fellow MPs that I sent to them on 16 May, in which I said:

“the inclusion of the Chief Executive on that Committee, which effectively has overseen all aspects of this process, has prepared the short list of candidates and will presumably make a recommendation to Governors this Friday. I believe that to give any Chief Executive so prominent a role overseeing that process, as opposed to that person perfectly reasonably but separately giving thoughts and feedback to it, could be seen as anomalous in the context of the necessary future relationship of the new Chair to the Chief Exec.

I said that I had

“taken these steps to question what has gone on (with some reluctance and I think for the first time in my 20-years relationship with the Trust)”

because of my real concerns for the procedure, not for the individuals, because at that stage neither I nor anybody else knew who had applied or been shortlisted.

I then looked at the constitution of the trust and the manual of the council of governors. That manual made it very clear that the chief executive was not automatically one of the members of the committee. The role of the council of governors is, of course, to hold the executive to account, so the chief executive could have acted in an advisory capacity, but not as a member. The trust’s constitution said that she should be a member, so both of them could not be correct.

I wrote again to Mr Hearty on 17 May and said that the council of governors is

“responsible for establishing the Nominations Committee”.

I said that it is very clear that the chair’s appointment is its responsibility and that

“the only reference to the Chief Executive occurs in the section on Attendance at the Nominations Committee…It does not give any licence to the Chief Executive to sit as a fully-fledged member…determining all the processes, shortlisting candidates”

and so on. I asked him therefore to think very carefully as to whether this process should be “paused and recalibrated” because I believed that there was a significant danger that the clear protocols in the governors’ manual had been breached.

Well, he did not do that. In fact, an email was then sent by Sue Crouch, the lead governor, saying that although the constitution clearly indicated that the chief executive should be a member of the nominations committee, given the feedback from governors, Wendy had graciously offered to withdraw in the best interest of the process. But, of course, by that time she had taken part in three quarters of the process, and whether it was a gracious withdrawal or otherwise, I have no knowledge. That was not a very good situation.

I had become concerned about the situation with the trust and had therefore written to NHS Improvement to ask the same sorts of questions on what its role should be. I initially got back a letter from the director for the north region, Lyn Simpson, who said that NHS Improvement is not involved in the recruitment of chairs of foundation trusts, which, of course, was not what I had asked her. She said that the trust had given its assurances that this recruitment process was in line with the constitution, as well as open, transparent and governor-led, but she did not give any grounds for that advice.

I went back to Lyn Simpson, reminding her that I had had guidance from the House of Commons Library that foundation trusts are accountable to Monitor, which is now part of NHS Improvement. I had looked at the code of governance published by Monitor, which specifically referred to the appointment of chair, so I asked her to respond more fully. She did respond again, but said that there was no legal basis on which NHS Improvement could intervene in the appointment of a foundation trust chair. I did not find that very acceptable, but I did note that she said that Dr Kirkup’s recent governance report, published in February 2018, had highlighted the role that NHS Improvement plays in board appointments as “not sufficiently clear.”

[Jim Shannon (Strangford) (DUP)]

Quite clearly, if procedure has not been followed, as the hon. Gentleman has outlined, surely at some stage he has to refer this case to the Local Government and Social Care Ombudsman. That must be a way of getting action given that this procedure has not been followed.

[Gordon Marsden]

It might be, but I am hoping that the Minister might be able to make some comments on these issues today, because NHS Improvement has to fulfil its duties under legislation, and I do not believe that it has done that very well.

I received another letter expressing pleasure that the trust had responded positively with the concerns on the point that I had raised, but that was really a question of shutting the door after the horse had bolted, for the reasons that I have explained. I then wrote again, asking for a response from Mr Hearty. I did not get that, but I did get a reply from Sue Crouch, who told me about the meeting to confirm the candidate who was going to be presented. That candidate turned out to be Mr Pearse Butler, who coincidentally had just stepped down as chair of the Morecambe Bay NHS Foundation Trust, to which the former chair of the Blackpool trust was about to go. I finally got to see the minutes of the process, and I was told that the discussion panels had worked well but that there had been a difference of opinion about the candidates.

I was also then told by a number of people that the proceedings at the confirmation were rather irregular. According to governors, not only did Michael Hearty ignore the request from three governors for a secret vote, but he said that abstentions would count as a yes vote, which struck me as a rather strange position. For obvious reasons, and because the trust has larded around a lot of “confidentials” and “highly confidentials” on various things, I am not going to name the governors who have spoken to me, although they are perfectly prepared to talk to people about it. I will just quote what one governor said:

“A few governors, including the Chief executive were involved in the recruitment process. The rest of the Governors were asked to attend presentations and panels as part of the recruitment process. I requested, on a number of occasions, the criteria and weighting for the presentations and the panels, including set questions. These were not sent. At the presentations, pieces of paper were presented on which we could make unstructured comments. These were supposed to be weighted, however there was no…criteria to do so…Candidate were questioned at each panel. No questions were pre set in advance…We were asked to choose a candidate based on the activities. There was disagreement from a number of people…about the preferred candidate for Chair…At the council of governors meeting called to ratify the appointment there was discussion about the process and the selection. A paper ballot was refused and a show of hands insisted on.”

I have a further comment from someone who will again remain nameless, but was a senior manager at Blackpool Vic and in other organisations in the past. He wrote to me to say that the council of governors had always been viewed as an inconvenient necessity rather than a valued part of the trust governance arrangement. I found that very disturbing and concerning.

One might have thought at that stage that the trust, and certainly the nominations committee, would have paused for thought, given all these criticisms from the governors, but we have had the same process for the appointment of a new non-executive director, not the clinical director. Again, there were two panels of candidates, who again included the chief executive, Wendy Swift. I understand that the chair-designate was present on this occasion as well. Let us call the two candidates X and Y. Panel 1 had preferred candidate X by four votes to two, and panel 2 had gone for the same candidate unanimously, but the nominations committee had recommended candidate Y. It is not surprising, therefore, that many trust governors have so far not gone back to ratify this appointment in any shape or form.

Those are some of the issues that have come out of this, and I want to make one or two observations in conclusion. The chair of any health trust is crucial, particularly in the difficult circumstances in which the Blackpool trust finds itself: still requiring improvement, according to the Care Quality Commission, and hit hard by the strains of morbidity and the impacts of transience and demography, which put extra pressure on. We therefore need the process for the appointment of a chair or non-executive director to be as transparent and reaching-out as possible, not a cosy old pals act reinforced by groupthink. That is what has sometimes come up through the bureaucracy.

I am forced to conclude that the nominations committee thought that it could get away with evading proper scrutiny and transparency—that a thin veneer of irritated politeness attempting to conceal a determined effort to override public governors unless they were rubber-stamped, and indeed delaying so as to block out others such as myself from discussing these things, would do the trick. Well, it does not do the trick, and it is frankly an insult to all the hard-working staff who have worked their socks off in the past few months in recent crises at Blackpool Victoria Hospital.

The use of the words “confidential” and “highly confidential” by the lead governor, Sue Crouch, could be seen as an attempt to intimidate or gag governors who had legitimate concerns about the process. I am very concerned about that. As I say, I have circulated this letter to all my neighbouring MPs. My hon. Friend the Member for Lancaster and Fleetwood (Cat Smith) is unable to be here today, but she asked specifically for me to indicate that she shares my concern about the governance of the hospital. I understand that the hon. Member for Fylde (Mark Menzies), who is also away from Parliament, has said that he has a number of issues with the governance.

I ask the Minister to reflect on whether we need some form of inquiry into the process that went on at the Blackpool trust. I can assure him that some of the governors who have shared the concerns that I have are prepared to give evidence on that. We need some clarity as to the role of NHS Improvement, because it is supposed to be a backstop to addressing both stakeholder and individual concerns, but in this instance it seemed all too ready to accept the version of events from the people who had convened all this and the way they wanted it to go.

The principle that governors should not feel pressured or fettered is very important. If the Government want to encourage democratic involvement in the NHS—a real people’s NHS in its 70th year—there is a lot more to do to support and enable people to secure those rights of representation. Members of Parliament who raise legitimate issues of transparency should be able to get proper answers.

I have no idea whether Mr Pearse Butler, who was announced as the new chair on 18 May, will be a good, bad or indifferent chair of the trust, but I am clear that the process by which he was appointed was deeply flawed and not transparent.

Surgical Mesh

Gordon Marsden Excerpts

Thursday 19th April 2018 Commons Chamber

[Gordon Marsden (Blackpool South) (Lab)]

I, too, have constituents who have been affected by this, and one of them has written to me to say:

“I had this operation carried out—it was only effective for a few months and had failed, leaving me with constant discomfort…The operation itself was a long one and I have so far managed to put up with this discomfort as I really don’t want further surgery.”

Does the hon. Lady—and indeed the Minister—have any thoughts on how many people might be going under the radar because they are in a similar situation to my constituent?

[Carol Monaghan]

I thank the hon. Gentleman for his intervention. That concern has been raised time and again in the all-party group. We believe that many of the women affected are not being captured in the figures, and it is important that we should carry out an audit to find out what is going on. That audit should include GP visits and visits to consultants. They should all be part of it.

Mesh implants have been described as the “gold standard” treatment for incontinence and as a “minor procedure” that would change lives. Sadly, the procedure did change many lives, and crucially, the device manufacturers who have marketed mesh so aggressively are making a profit on it. For the women affected, the manufacturers’ profits have come at a heavy price. My hon. Friend the Member for Argyll and Bute (Brendan O’Hara) has been working closely with a constituent, Nancy from Dunoon, who was left suicidal after having mesh implants several years ago. Four months ago, Nancy underwent an operation to have the mesh removed, and I am sure the whole House will join me in wishing her a full and speedy recovery. She has said that

“if they’d discovered this kind of serious fault in a car, they’d have recalled them all and stopped making them. So why didn’t they do that with mesh?”

It is important that we now have a complete suspension of mesh implants. Also, a number of Members have mentioned that physiotherapy should be offered as standard for new mothers, to give them other methods of dealing with slight incontinence and to help them to restore their core after birth. Many mesh survivors are now calling for a sunshine payment Act, as there is in America, that lists all industry funding, sponsorship or grants received by GPs and surgeons. This would show any conflicts of interest, and it would help with all medical issues, not just mesh. Finally, I would like to pay tribute to the campaigners from Sling the Mesh and from Scottish Mesh Survivors for all their work in bringing this issue to the attention of the wider public and to the attention of us here in this place.

--- Later in debate ---

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

I, too, pay tribute to the APPG and to the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy). I also pay tribute to the women who have campaigned. If they had not campaigned, the issue would not be at this point today.

As a surgeon for more than 30 years, I have to start by pointing out that there is no such thing as risk-free surgery. There will never be an operation about which it could be said there is not a 1% complication rate. When I looked at complications and talked about risks, I used to write them down on the consent form so that I went through every single one with patients. We talk about the complications that are minor and common, and we warn patients, “This will probably happen, but it’s minor.” The complications that are life threatening or quality of life threatening, even if they are rare, should be up there in block capitals so that women know.

We, as surgeons, have a duty to minimise risk and to inform the patient so that, as has been discussed, decent and informed consent can be given. The problem of this saga is that a lot of the surgeons were not informed. If a surgeon is doing 30, 20 or 15 mesh implants a year and they become aware of a problem only in two or three years’ time, it does not register in their brain as being common. We also know that many of these cases really presented only years later, so that feedback loop—“Oh my God, we have a problem!”—was not there. That is why so much of this is to do with regulation, reporting and, inevitably, the yellow card.

[Gordon Marsden]

Obviously, the hon. Lady has enormous personal experience of surgery and of this area. Does she agree that one of the other possible problems for some surgeons, although I hope not many, is that in this country we have historically been very bad at explaining risk-benefit analysis to patients? If people are being offered an operation for a condition that is not necessarily life threatening, the judgment in a risk-benefit analysis is very different from that for something far more serious.

[Dr Whitford]

I thank the hon. Gentleman for his intervention. In fact, there are studies showing how difficult it is even to explain risk, let alone risk-benefit, to patients. Certainly in the cancer field, in which I spent so much time, patients will go through really appalling treatments even if there is only a relatively small chance of cure. As a clinician, it is difficult to explain a lot of this.

Sufficient information has not been given to the medics, and therefore clearly not to the patients. We have heard this described as a “minor, straightforward procedure”.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I add my thanks and congratulations to the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this debate. She approached this issue with her characteristic passion and forthrightness and gave me a number of challenges—again. I am pleased that she acknowledged that, since we last debated this, there has been progress. It is in that spirit that we need to continue this dialogue not just to address the issues, but to make sure that we do the right thing by those women who have been harmed by the use of vaginal mesh.

Ultimately, the tragedy of this case is that women have put their trust in the medical establishment to look after them and to make them well, and they have come out with the most debilitating, life-changing injuries. In many cases, these were very young women. It is very clear from the clinical guidance on these products that they should not be used as a first intervention, and should be used only in very extreme cases. We are to be very concerned about the extent to which this has been adopted.

It is great that the evidence shows that the use of this product is less than it was. Clearly, as the hon. Member for Pontypridd (Owen Smith) pointed out, there was a spike in the use of the product, and that use was not always appropriate. That highlights the need for proper understanding of the risk of any medicine or product, and underlines the need for very mature and sensible conversations between medical professionals and their patients so that people understand the risks of treatments, as opposed to understanding just the benefits. Most of all, it illustrates the need for informed consent on the part of the patient. I have been horrified in this debate to hear how many women did not understand the treatment that they were getting. That is clearly unacceptable.

In that spirit, I want to continue this dialogue. As the hon. Member for Central Ayrshire (Dr Whitford) pointed out, women are often sent away and told that, “It’s women’s problems.” Women are often patted on the head by members of the medical establishment. None of us women in this place is a shrinking violet, but we have also fallen victim to that behaviour, which is just not acceptable. We need to do more to change the culture of our health service and the way in which medical professionals interact with women. If we do not, the outcome is exactly the experience to which those ladies who are sitting in the Public Gallery can attest. I am very grateful to them for sharing their experiences. Sharing our very intimate and distressing personal details is not the most comfortable thing in the world, but the work they have all done in sharing their experiences has raised awareness and put the issue on the agenda. It has also made us more vigilant about protecting our own health when we are faced with problems. I thank them all.

Although there may be some specific points on which we differ, it is clear that we all share a determination to address the issues that have been raised. Clearly, a number of women have experienced extreme suffering, and it is important that the NHS does its best to make life better for those women and gives them the treatment that they need. I say to Members that if there is any evidence that women are not getting the treatment that they should be getting following a complex mesh procedure, please raise that with me and bring it to my attention and I will take action accordingly.

[Gordon Marsden]

I am very grateful to the Minister for giving way. She is acknowledging the depth of disquiet, suffering and pain, but she will also be aware from my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy), and indeed from my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), who spoke from the Front Bench, that there have been persistent calls for NICE to speed up the process. I ask the Minister a very specific question: what conversations has she had with her officials and NICE as to why they cannot bring this forward? Is it a question of a lack of appropriate aggregate evidence; is it a question of their own internal priorities; or is it a question of resources?

[Jackie Doyle-Price]

It is actually an issue of rigorous process. We need to make sure that NICE guidance has clinical integrity. The guidance to which the hon. Gentleman refers comes at the end of a longer process of other guidance that is going through the system. None the less, that intelligence is shared throughout—it is an entirely consultative process. The issues that we need to settle are all part of the public debate. Essentially, the publication of the NICE guidance comes at the end of that. The important thing is that everyone knows the issues and that we are very clear about the context in which this is an appropriate treatment. The guidance is very clear: this treatment should not be offered as a routine first intervention.

Medicines and Medical Devices Safety Review

Gordon Marsden Excerpts

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

The simple answer to that question is yes: there are legal consequences for regulators who have failed. In that instance, it would be the responsibility of the Government, or of the drugs companies who failed in their responsibility to inform patients of the dangers of taking drugs. The priority is to establish the facts. Some of those are clear now, but some are not, and that is why I think that the review will help us.

[Gordon Marsden (Blackpool South) (Lab)]

Constituents of mine have been affected by both sodium valproate and Primodos. The Secretary of State has already heard the dismay expressed by my hon. Friend the Member for Bolton South East (Yasmin Qureshi) at the outcome of the review by the expert working group, but may I ask him another specific question? What he has announced today will not give a great amount of satisfaction to people, and confidence that his Department will take notice of Baroness Cumberlege’s review will be reduced by a written response that I received yesterday which stated that the Department had no plans to fund any independent scientific research on hormone pregnancy tests. We know that Dr Vargesson produced a report last week. Will the Secretary of State ensure that Baroness Cumberlege looks very carefully at this particular issue?

[Mr Hunt]

I can give the hon. Gentleman an absolute assurance that she will do so. In the case of valproate it is very clear what the next steps should be, because there is no dispute over the science. When there is controversy over the science—and I appreciate how distressing that is for the families involved—the first thing we must do is establish the truth of the situation, and that is why we have given Baroness Cumberlege a free hand to look at the whole issue.

Land Registry

Gordon Marsden Excerpts

Thursday 30th June 2016 Commons Chamber

[Bill Esterson]

My hon. Friend is right. Of course, we have seen a steady direction of travel towards foreign ownership of British interests for a great many years. It is surprising that we have anything of any substance left in this country that is not foreign owned, given the way the Government proceed. He puts his finger on an important aspect of the debate and another good reason why the proposal should be turned down.

My hon. Friend the Member for Swansea East (Carolyn Harris) mentioned the timing. The way in which the Government time their announcements is normally a good indication of how conscious they are that they are on thin ice. The proposal to relax Sunday trading laws is one such example, because they slipped out that unpopular policy at the last possible moment—the night before it was debated and after legislation had gone through the Lords, where the relevant Bill started its life.

[Mr Gordon Marsden (Blackpool South) (Lab)]

It did not do them much good.

[Bill Esterson]

As my hon. Friend reminds me, the approach did not do the Government much good on that occasion. I suspect, following today’s debate, it is not going to do them much good this time either.

They chose to release the proposal on the Land Registry on the afternoon of the last day of Parliament before the Easter recess. Were you a cynical man, Mr Deputy Speaker, you might think that that was done deliberately to avoid attention, but of course you are not cynical, so there is no way you would think that.

The Government are fully aware that the public do not want this and that the proposal will not stand up to scrutiny. This is not the first time they have tried to railroad through Land Registry privatisation. The public response that they received last time could not have been more overwhelmingly negative: 91% of those asked in 2014 said that privatisation would not provide a more efficient service, while just 5% thought that it would. Survation’s more recent polling—not that we should necessarily believe everything we read in polls—delivered the same message, with opposition outstripping support among the public by more than 4:1. The online petition that was signed by 300,000 people was handed to BIS just the other week. Those 300,000 people made it clear within a month of the opening of the consultation that they, like many others, were against the privatisation.

If the Government think that they can mask an economically incoherent proposal with a “public sector bad, private sector good” mantra, nobody is going to be fooled. Do they honestly think that a private operator would create a more profitable Land Registry and therefore support broader economic growth? In public hands, it is generating £100 million-plus for the Treasury each year, so that simply does not stack up as an argument. The New Economics Foundation has pointed out that state assets—not just the Land Registry, but Ordnance Survey, NATS and Channel 4—are all examples of publicly owned services that are delivering lean, efficient and profitable business models. If the Government have any interest in long-term growth and stability, they should hold on to those assets, not sell them off. Securing this annual revenue is the economically responsible and more stable approach at a time when we lack the certainty on which the economy and business depend.

Do the Government honestly believe that a private operator would create a more efficient Land Registry? The Open Data Institute says that moving the body out of public hands would build barriers in our data infrastructure, reduce efficiency not just in the Land Registry but across Departments and other public services, and have clear consequences for public confidence. Do the Government honestly believe that a private operator would support a more transparent Land Registry? If it was privatised, it would cease to be subject to the Freedom of Information Act. It beggars belief that the Government can seriously suggest that, in the wake of the release of the Panama papers, it would be reasonable to pursue policies that make it easier to conceal landownership for non-doms?

If the privatisation happens, the Land Registry will go to private interests that are not subject to the same checks and balances, such as freedom of information provisions, as any remaining public sector body. As my hon. Friend the Member for City of Chester (Christian Matheson) said, we are not just talking about any private interests. Judging from the interested parties so far, these are interests that are already tied up overseas, including in tax havens. Given that we are dealing with trillions of pounds of property that underpins our whole housing sector, this can only be downright dangerous.

Privatisation would deny homeowners, mortgage lenders and buyers an independent national register of title deeds. It would be destabilising. The consultation asks how, not whether, privatisation should go ahead. We should enable the Land Registry to continue innovating, and delivering savings and revenue to the Government. It is already a success, so why does the consultation not consider the option of encouraging further improvement, development and success in our public sector, both to improve service and to generate further revenue, if that is what is driving what the Government want?

As I understand it, the Minister for Small Business, Industry and Enterprise has told constituents that this is a ridiculous idea driven by Treasury capital receipts. I agree. Labour will fight this privatisation, and I hope that the Government will once again perform a U-turn in the face of widespread pressure from professionals and the public alike.

Social Care and Military Compensation

Gordon Marsden Excerpts

Wednesday 25th March 2015 Commons Chamber

[Mr Gordon Marsden (Blackpool South) (Lab)]

As has now been confirmed several times, this is the last occasion to raise such issues in this Session, and I wish to speak about the unfair treatment of some veterans owing to the disparity in the way that different armed forces compensation schemes are treated when social care costs are calculated. I pay tribute to Poppyscotland and the Royal British Legion, which highlighted that issue with their Insult to Injury campaign. In the past, I have been pleased to work closely with the Royal British Legion, both nationally and locally in Blackpool, and together we delivered a petition with 3,000 signatures calling for stronger punishment for those who vandalise war memorials. I was also pleased to support the Blackpool armed forces covenant and veterans charter in 2011. I wish to touch on that veterans charter and covenant, praying in aid the arguments I will present tonight.

As chair of the all-party group on veterans, which deals with a number of issues, including welfare, I was fortunate to initiate a meeting in Parliament with the Forces in Mind Trust. Its latest report is about support for veterans’ families, and we will hear tonight about veterans who are losing the means to support their families when compensation payments are removed. Fundraising year-on-year by the Royal British Legion and other ex-service organisations, including Poppyscotland, provides extra support for veterans. Locally and nationally, our veterans should not be left by the state in financial circumstances that are unfair. The state must do its bit, particularly when there are unequal Government regulations.

Tonight I will focus on the disparity between the way that the two different compensation schemes operate. Those injured before April 2005 received compensation for particular injuries through the war pension scheme, which provides regular payments based on the severity of injury. Those injured from April 2005 onwards receive support for any disablement through the armed forces compensation scheme—AFCS. That comes in two parts: a lump sum and, in a similar fashion to the war pension, a regular payment for the most severely disabled veterans and ex-servicemen. Those two schemes seek to compensate for the pain and challenge of particular injuries that some veterans receive when serving bravely in our armed forces, but when it comes to how they are processed through the social care system, they are treated very differently.

As of 2012, any veteran supported by the newer AFCS scheme has all that income disregarded while they are means-tested for social care. Although their other forms of income are rightly considered so that they make the same contribution as any civilian to their social care, they will still have left over the income they receive to compensate for the injuries they received in the military. Those on the older war pension scheme, which could cover awards from the second world war up to 2005, receive far less support. Only £10 of their war pension is automatically disregarded, and the rest can be clawed back by local authorities into paying for their standard social care. The full value of the war pension—which of course reflects the level of disablement suffered by that veteran—is on average £80 a week and can be as much as several hundred pounds a week for the most severely injured.

Does the Minister agree that it does not show enormous respect to veterans on the war pension scheme, who have fought in conflicts from the second world war to Korea, the Falklands and in some cases as recently as Afghanistan, if we suggest that the pain of those disabling injuries is worth only £10 a week? What compounds that regrettable diminishment of the veterans’ sacrifice is the apparent injustice and inconsistency in the way the two schemes are treated in social care and the way different arms of Government look at the problem.

Almost all local authorities use their discretion fully to exempt the income from both compensation schemes when council tax or housing benefit is calculated, and central Government have recognised that both types of compensation should be left untouched when the new universal credit is calculated for recipients who have served in the forces. Yet protecting that income for council tax and housing benefit will be in vain if the great majority of it is then lost to pay for social care. As I have said, Government guidelines only disregard £10 of the war pension, and in present circumstances local authorities have not been able to go much further, with only 12% of councils using discretionary funding fully to exempt those on the older scheme. That is completely inconsistent with the way that civilian personal injury compensation is treated in social care means-testing. When saved in a trust fund, that income is fully disregarded by local authorities as they calculate care costs. What is left appears to be a social care system that, however worthy its objectives, fails to meet two criteria of the armed forces covenant that Members from both sides of the House were proud to support.

[Jim Shannon (Strangford) (DUP)]

It is appropriate that the last Adjournment debate of this Parliament concerns our veterans and our soldiers, and I congratulate the hon. Gentleman on securing it. Many Members have a particular interest in the armed forces. In the years that I have been a Member of Parliament, we have had the chance to speak on behalf of our veterans. I know many veterans who suffer from post-traumatic stress disorder and their number, after Iraq and Afghanistan, has increased significantly in the past few years. Does the hon. Gentleman agree that the onus is on the Ministry of Defence, the Department of Health and local government to work together to address this issue? The Minister represents the Department of Health. Other Departments, which are not represented here tonight, need to work alongside her.

[Mr Marsden]

I agree with the hon. Gentleman, who is assiduous in covering veterans’ issues in this House. I pay tribute to the military from Northern Ireland for the sacrifices they have suffered over the years. He is absolutely right. We are pleased that the Minister is here tonight, but the issue can only be solved out of Government silos.

The covenant enshrines the principles of no disadvantage and special treatment. These, in turn, dictate that a person should experience no disadvantage as a result of military service and that it is appropriate in some cases for special treatment to be applied to those who are serving or have served. We have already seen that as a result of failing to disregard the war pension, Ministers are not providing any special treatment for veterans. More fundamentally, however, they end up failing the rule of no disadvantage, too, as the injuries incurred purely as a result of action in the armed forces receive little compensation when income such as the war pension is diverted into providing standard civilian social care.

I am pleased, therefore, that my colleagues in the Labour Front Bench team have pledged, under a future Labour Government, to review the compensation schemes to see where they might be improved. In particular, the focus should be to take a laser-like focus to existing and new rules that affect veterans through the prism of the armed forces covenant. We want to ensure that the principles of no disadvantage and special treatment are met by all arms of government.

All Members have, at one time or another, drawn attention to the strong feelings of many veterans and others about insufficient engagement with the concerns raised in relation to social care and military compensation. I welcome the reports from the Government, the Royal British Legion and Poppyscotland that talks are ongoing about how the two schemes might be aligned, but we need to see results. After all, every year, as more elderly veterans pass away, the group of people who could benefit from a change in the rules diminishes by 5%. Half that group are aged 70 or over. We are running out of time to offer these people the chance to navigate social care in far greater comfort, with access to the full deserts of their military compensation. With a change in the rules, we can put this right, but it needs real Government commitment. I have to say, however, that when we look at the Government’s stated objections so far, they seem to give the impression of delaying progress rather than accelerating it.

Ministers have claimed that some of those on the old war pension scheme also receive top-ups to their pension, which are designed to help to pay for care costs. Only 6% of war pensioners actually receive such care top-ups. More to the point, it is surely not beyond the wit of the Government to devise guidelines that will include those care top-ups in the payment for social care, but not include that part of their income that relates to the pain suffered through injuries received in the field of conflict. This is a position that the Royal British Legion accepts would be perfectly reasonable.

Ministers have also suggested that military compensation could be placed in a trust fund to protect it from social care means-testing. However, given how war pension works, only a small amount is provided as a lump sum. For the most severely injured veterans, most compensation is provided through regular payments that cannot be placed in a trust. It has also been suggested that the war pensions scheme was established before the modern understanding of personal injury compensation, yet it is clearly understood that way, as is evident, as much as anywhere, from the words of the veterans Minister, who said:

“The War Pensions Scheme provides no fault compensation to Service personnel disabled as a result of their service in HM Forces.”

In the discussion of all these disregards, different schemes and allowances, the human effects of these rules and their perceived injustices can too often be forgotten. In my area, the Royal British Legion estimates that 600 veterans in the pre-2005 group could see their war pension eaten up by care costs, and Members across the country will have service constituents who have told emotive tales of the effects of losing their compensation.

Keith Clarke, who is 43 years old, was left paraplegic while attempting to put out a fire on his submarine. He receives a large war pension for the most severe injuries, but £100 is lost every week to meet the cost of his care worker, who visits daily to help him dress and look after his two children, one of whom is also disabled. His only other benefit comes from statutory benefits. He told The Daily Telegraph:

“I feel angry and frustrated. It’s…an injustice to be treated as a second-class citizen.”

Fred Cannon, who fought on the Gold beach at Normandy on D-day when he was 19 years old, was the only survivor of the company to come home, but a severe bullet wound left him with one leg shorter than the other. Now in his 90s, like too many others, he is left with only £10 a week compensation. Then there is the 50-year-old Lancashire veteran who was diagnosed with osteoporosis from his time in the Army. He said:

“Unless the system changes, I’m concerned that I will lose a lot of my pension, which isn’t fair. People who receive AFCS don’t pay for their social care—and rightly so—but why should we pay just because we were injured before April 2005? It doesn’t make sense.”

Of the two principles of the armed forces covenant, it is ultimately not special treatment that veterans want; all they want is not to be put at a disadvantage: to have the injuries they suffered in the armed forces compensated for in their own right and then to make a contribution from their other income towards social care, just as any civilian would rightly do. They want fair treatment for all and a system that does not discriminate on the basis of an arbitrary date; they want to be treated the same in the different means tests that central and local government operate; and they want to be treated in the same way as civilians who receive compensation for personal injury.

Whatever the historical context of the creation of the war pension scheme or the complexities of its operation today, it is surely possible to design a system that will meet the requirements of the proper 21st century fairness that the veterans are asking for. The time has come to go beyond discussions and look for concrete solutions to the disparity between the two different military compensation schemes, rather than focusing on the obstacles to a more just system. I am pleased to note that Labour would review the fairness of military compensation in the light of the armed forces covenant, and I call on Ministers to show a similar political will and commitment.

Many Members will have the date of 7 May on their minds tonight, but many other people will have a possibly more important date—the next day—on their minds. That will be the 70th anniversary of VE-day. I feel honoured that both my late parents served in that conflict, and I am mindful of the debt we owe to those of that generation who remain with us. At this time, we must surely refocus our energies to ensure that we provide all the support that the brave men and women who have served in conflicts spanning the last 70 years deserve, particularly as they make their way through challenging periods of their lives in the social care system.

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

I am grateful to the hon. Member for Blackpool South (Mr Marsden) for bringing this important issue before the House. It provides me with an opportunity to clarify our current position. I hope the hon. Gentleman will allow me first to place the issue in the broader context, particularly the context of reforms in social care.

To make some sense of that broader context, at the turn of this century there were 25 times as many people aged 85 and over than there were at the turn of the last century. Although this is something to be celebrated, it also means there are more people needing care and support, and three quarters of us can expect to need long-term care.

Care and support is an issue that has, I think, been ignored for far too long, and I am proud to say that this Government have taken steps to put that right. The Care Act 2014 is a bold and historic piece of legislation that for the first time places adult care and support law in a single clear statute. The Act puts people at the heart of the system by enshrining the principle of individual well-being at its core. It will ensure that people themselves will be able to shape their care and support, focusing on what they want to achieve and the outcomes that matter to them, and it will support them to maintain their well-being and independence for longer.

The Care Act focuses on acting early to prevent people from reaching crisis points, and will ensure that everyone can access information and advice to help them understand the new system and what it means for them. This means services for the broader community—not just those with assessed needs—further supporting our aim to help people to stay independent for as long as possible. When we do need care, the Act provides for a single threshold for eligibility to care and support in England, ensuring transparency and consistency, irrespective of where we live. I am pleased that this historic legislation will come into force exactly one week from today.

We do not intend to stop there. How we pay for health care and support is just as important as the care we receive. Most people do not realise that care and support has never been free, unlike health, and we have always been asked to contribute what we can afford. Those who have the greatest needs and the longest care journeys risk losing nearly everything simply to meet that cost.

For all the other areas of life where we face such risks, we are protected by the welfare state or we can protect ourselves through insurance. When it comes to care, however, successive Governments have taken a different view. We are often left alone at the point when we are most vulnerable. That is clearly not good enough, and I am proud that we will be introducing the biggest reforms of how we pay for care in over 65 years. We do so through the cap on care costs, which will put an end to the risk of catastrophic costs, and we will provide greater financial help for those who need it most.

The detailed proposals of how the new system will work are currently out for consultation. With just under a week still to go, I am pleased that we have already had over 700 responses and have engaged with over 1,000 people through a series of events helping to ensure that we take account of a wide range of views. The new cap system will play a critical role in helping people to plan and prepare for the risk of needing care and support, and create the right conditions for the financial sector to create new products that could cover these costs.

When it comes to those who have served their country and have made a great sacrifice in the line of duty, this Government have given a very clear commitment to support members of the armed forces community, both serving personnel and veterans. The hon. Member for Blackpool South has illustrated exactly why that is the right thing to do. We have enshrined that commitment in legislation through the armed forces covenant.

As the hon. Gentleman outlined, for those who have been injured in the line of duty there are currently two different schemes that provide compensation, based on when the injury occurred. For those who were injured before the 6 April 2005, there is the war pension scheme; for those injured afterwards, there is the armed forces compensation scheme. While both schemes have the same goals—to offer financial support to those injured in the line of duty—they are ultimately both a product of their time and the social context in which they were developed. Under both schemes, personal injury compensation lump sums are disregarded when deciding how much someone can pay for care, provided the payments are placed in a trust—I noted the hon. Gentleman’s concerns about regular payments—but other sorts of payments may be taken into account.

The war pension scheme was created after the first world war in response to the large numbers whose lives had been irrevocably changed as a result of their service to their country. In 1918, however, there was no welfare state, no NHS and no benefits system. Most people did not have access to private pensions, meaning that for those needing care but without family or friends to support them, the outlook was often bleak. The scheme therefore provided for that. It provides a basic war disablement pension and a variety of supplementary allowances that would be equivalent to the modern benefits system, and it reflects the fact that people needed to pay for both health and care costs.

By contrast, the armed forces compensation scheme introduced in 2005 reflects the fact that we have an advanced welfare state. It therefore looks to the NHS and the benefits system to provide support, just as it would to anyone, ensuring the principle of “no disadvantage” enshrined in the armed forces covenant.

The scheme introduced a modern, fair and simple system that provides a strong basis for the future, but this is a difficult and complex issue. I note the hon. Gentleman’s frustration—as he said, there has been much discussion—but, as I have said, the issue is complex. Depending on the extent of their injuries, veterans can receive a number of different allowances under the war pension scheme, such as constant attendance allowance, an unemployability supplement, comforts allowance, age allowance, treatment allowance, mobility supplement, and medical expenses.

The Royal British Legion broadly accepts that the treatment of war pension scheme payments is complex. I am grateful to it for highlighting its concerns, and for continuing to working with departmental officials to help us to understand the issue better. It is vital for us to understand it fully before considering what is to be done next. We must understand how the two schemes work, and the implications of considering any changes, to ensure that there are no unintended consequences, and we must also understand any cost implications of change. I note what the hon. Gentleman said about the commitment of his party colleagues to reviewing the scheme, but that commitment to a review suggests that they too are cautious, and feel the same need to understand the possible implications.

[Mr Marsden]

I do not wish to intrude on the Minister’s time, and I agree that the process is complex. I recall Churchill’s observation that it was not the end or even the beginning of the end, but it might be the end of the beginning. Will the Minister tell us how far down the line we might be expected to be at this point, and what stage the Government think has been reached?

[Jane Ellison]

I will come to that, and will try to give the hon. Gentleman a bit of reassurance about the advanced and ongoing work that is taking place.

Social care is a priority for the Government, and, in the context of difficult spending decisions, we have taken steps to protect care and support services. For example, we have allocated extra funds for those services during the current Parliament. We have created a better care fund, which, next month, will introduce a £5.3 billion pooled budget for health and care that will provide much needed funding for care and support, and will break new ground in driving closer integration of services.

Although spending on care and support is ultimately a decision for local government, we must be mindful of the overall fiscal position. I think that Members on both sides of the House agree on that. We must ensure that if we change the charging rules nationally, the cost will be met. To that end, my officials are continuing to work with their counterparts at the Ministry of Defence—I hope that that gives the hon. Gentleman some sense of momentum, and deals with his concern about “silo” working—and with the Royal British Legion, with a view to considering the issue during the spending review that will take place after the election.

I hope that the hon. Gentleman—and, indeed, all hon. Members—will welcome the historic reforms that will come into force in just one week’s time. They are very significant in the context of the broader issue of care. This Government have been the first to prioritise care and support. I hope that Members in all parts of the House will feel able to welcome the clear plans that I have set out for the future. As for the specific issue that the hon. Gentleman has raised, I hope he recognises that this is ongoing work which is taken very seriously. His securing of what has turned out to be the last Adjournment debate of this Parliament has underlined the importance of the issue that he has raised. I think that, throughout the purdah period and beyond, the debate will give added momentum to the work that is being done.

Given that this has been the last Adjournment debate of the current Parliament, Madam Deputy Speaker—and you and I have shared a number Adjournment debates—let me take this opportunity to thank you and, through you, Mr Speaker and the other Deputy Speakers. I also thank all the staff of the House, and, in particular, those who have sat through some of our late-night health debates, of which there have been many. However, I especially thank the Chair, and all those who have supported the Chair during these important Adjournment debates, which give us a chance—as tonight’s debate has—to explore important issues in some detail, outside the heated atmosphere that the Chamber attracts on other occasions. I also thank Members in all parts of the House, some of whom are very regular attenders at these debates, for their attendance tonight, and for the interest that they have taken in these important matters.

Contaminated Blood

Gordon Marsden Excerpts

Thursday 15th January 2015 Commons Chamber

[Alistair Burt]

My hon. Friend puts it very well. He is yet another example of an MP who does not have a constituency interest but has recognised the responsibility that we all share, and the state shares, for what has happened.

Only this morning we saw in one of the newspapers that local authorities had spent £5 billion on consultants. As I say, at any one time a Government will have no money or can find money.

[Mr Gordon Marsden (Blackpool South) (Lab)]

I apologise for not having been here at the beginning of the right hon. Gentleman’s speech. I want to touch on his point about payments. My constituency has four times the national mortality rate from hepatitis C—of course, not all of it acquired from contaminated blood—and a number of constituents who are living with the condition have written to me about it over the years. The latest comments have been about getting a conclusion to this process as fast as possible. One of them says:

“Existing mechanisms should be disbanded and replaced as quickly as possible with a new improved arrangement for processing payments.”

Is that not a short-term consideration to go with the longer-term ones?

[Alistair Burt]

I personally think that it is. That process will be informed by what the all-party group has spoken of, and its members will speak today. I thank the hon. Gentleman for his intervention.

As I said to my hon. Friend the Member for Stratford-on-Avon, I am not sure that I fully share the conclusions of the all-party group’s report with regard to the MacFarlane Trust. There is a great deal of detail in the report. As I was not responsible for compiling it, I can be lavish in my praise of the effort that went into it. A lot of hard work was done by a lot of people connected with the offices of the hon. Member for Kingston upon Hull North and my hon. Friend the Member for Colne Valley, and I am grateful for that. On the basis of information contained in the report and other information that we have, I do not believe that the MacFarlane Trust is saveable or capable of reform. I and others have seen a copy of a letter to the Secretary of State from two former trustees that is quite damning of its leadership, and one from some 68 beneficiaries that is equally uncompromising.

It would be unfair to go into more detail now. It may be that the trust has an impossible role. However, there should be no doubt that a body set up to support beneficiaries and those who have been victims of what happened is anything other than on their side—not an arm of Government, nor seen to be, and prepared to take on the Government to argue for the funds it needs without fearing a conflict of interest. The Department of Health has contributed to the situation by structuring too cosy a relationship, possibly in its own interests, and that has to stop.

Augmentative and Alternative Communication Services

Gordon Marsden Excerpts

Thursday 6th June 2013 Commons Chamber

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

It is a pleasure to speak in this debate on this very important issue. I mean no disrespect to you, Mr Deputy Speaker, but it is a shame that Mr Speaker is not in the Chair, because he has been a great champion of speech, language and communication needs down the years. It is worth quoting his key comment from the Bercow report:

“'Communication is crucial. Recognising that is right in terms of equity for those in need and right in the national interest as we all wish to cut the costs of failure”.

Nowhere is that clearer than with augmentative and assistive communication. As that is rather a mouthful, I shall refer to it as AAC.

AAC is a series of aids, some complex and some not so complex, that assist those with neurological conditions that make it hard for them to express themselves. I was delighted when I received a commitment from the Prime Minister during Prime Minister’s questions in March that, as a result of the new commissioning landscape in the NHS, it would be available to more children and adults. I welcome that, and my aim is to ensure that it can actually happen.

I have a personal interest in this subject; it is not something I acquired when I was elected. I attended Hebden Green special school at the age of just three or four, and many of my fellow pupils would have benefited from these complex aids. It gives me real pleasure that one of my pupils, Alexis Egerton, recently gained a PhD thanks to utilising a complex powered aid—an example of how AAC can change people’s lives.

I am grateful to the Minister for the time he was able to spend yesterday meeting me and representatives from Communication Matters and the ACE Centre. I apologise for detaining him further today with a variation on the same theme. It is worth focusing on how the users of the aids feel about how the system currently works. Toby Hewson is an AAC user. He said:

“I cannot express adequately how frustrating it is for people with disabilities to have to battle with the system in the way we are forced to do...like a game of pass-the-parcel, people like me are sidelined and marginalised until we are exhausted.”

That is just an indication of the frustration so many people, and their families, feel about a system that has not yet worked properly for them.

I would be misleading the House and unfair to the Government if I did not make it clear that a great deal of progress has been made, not least through the Bercow report, the work of communication champion Jean Gross and the decision to ensure that most of the commissioning will occur at a national level. I hope that the Minister can act like a statin in the arteries of NHS England to allow what is good to occur, and for policy to be implemented in the way that I am sure everybody in the Department of Health wants it to be implemented.

However, I would also be misleading the House if I did not express some of the concerns about how policy is being implemented. The issue can be as fundamental as the funding mechanism deployed. I am sure that we would all agree that NHS England has to start from somewhere in deciding how much money it will allocate to this type of provision. I am reminded of the farmer leaning over a fence who is asked by a walker, “How do I get to Blackpool?” He replies, “Well, I wouldn’t start from here.” I would not start from where NHS England is starting, because it intends to use historical budgets, which might sound perfectly sensible—perfectly obvious perhaps—but if all that involves is ringing up a local hospital manager and asking how much he spends on AAC, when he might not even know what AAC is, I do not think it a particularly satisfactory starting point.

It is more frustrating still given the work done on levels of need by the communication champion—available to NHS England—and further reports since from the University of Manchester. We know the level of provision and unmet need: 0.014% of the population currently use a powered aid, but total need is 0.05%. I am sure that the Minister can do the maths. It is about 3.5 times what is currently being funded. I am not making the predictable everyday point that more must be spent—far from it—but I want NHS England to begin from a sensible starting point when making its decisions.

[Mr Gordon Marsden (Blackpool South) (Lab)]

I am grateful to the hon. Gentleman, my constituency neighbour, for giving way. I warmly commend his work to bring this matter to public attention. He and I have constituents at Highfurlong school and other special schools in Blackpool where these issues are very important. I have had correspondence from two constituents involved with the school. I know that Governments are not always keen on ring-fenced budgets. Does he agree, however, that NHS England should take account of the technology to come, rather than relying on past practice?

[Paul Maynard]

Indeed. We disagree on many things, but on that issue the hon. Gentleman and I can agree. In Highfurlong, we have an excellent provider of specialist communication provision, so I hope he shares my concern at the proposals, which look to be coming from the local council, that could result in Highfurlong being shut. It causes me great concern, as it does many parents in his constituency and mine, so I hope he will join me in ensuring that Highfurlong is not threatened in the way it might be.

The funding decisions being made have consequences for the proposed hub-and-spoke model. I would welcome a commitment from the Minister that clinical commissioning groups should not interpret the existence of specialist hubs as a justification for winding down their investment in local spokes. That, to me, is crucial, if only because of the issue of complexity. The hon. Member for Blackpool South (Mr Marsden) alluded to that.

Contaminated Blood and Blood Products

Gordon Marsden Excerpts

Thursday 14th October 2010 Commons Chamber

[Jenny Willott]

The fact that we have a deadline of Christmas for the report is very helpful. That is not too far away, and a concrete date has been specified. I hope that the Minister will ensure that we get the response by that time, and that if given the chance later, she will speak further on that subject.

The time that this process is taking is clearly a major issue. Given that it has taken more than 20 years even to hold an inquiry, the least the victims deserve is for the recommendations to be considered seriously, even those that would be expensive to implement. Lord Archer made a number of sensible and important recommendations, and although many have been implemented, a number still need to be acted on. Some would be expensive to implement, but others would not. Improved compensation is clearly the most controversial, and I appreciate that in the current financial climate the Government will find it hard to deal with, but, as was pointed out by my hon. Friend the Member for West Aberdeenshire and Kincardine (Sir Robert Smith), other issues, too, have not been considered properly so far. For instance, patients with hepatitis C are treated differently from, and worse than, those with HIV. That simply is not fair. The widows of those who died before August 2003 receive nothing, and that is not fair either. Those who are infected cannot obtain insurance, which has massive implications for their lives.

[Mr Gordon Marsden (Blackpool South) (Lab)]

The hon. Lady has been very generous in giving way. I do not wish to be partisan, but do not some elements of the statement give us pause? It refers to access to insurance. “Access” is a very vague word. It is not just a question of access; as constituents have pointed out to me, it is a question of provision as well. Does the hon. Lady agree that the Government need to be much clearer about that in the terms of reference?

[Jenny Willott]

I hope that they are clear about it both in the terms of reference and in the final review and announcement. Although the issue is not particularly glamorous, and is fairly complicated and difficult for people to understand, it has massive implications for day-to-day life, and it really does need to be dealt with sooner rather than later.

The victims of the tragedy were infected more than 20 years ago. This has gone on for a very long time. Year by year we are losing those victims: people such as Haydn are, tragically, passing away each year. We cannot let this drag on any longer. Being a politician is about standing up and representing people who cannot represent themselves. Haydn can no longer represent himself, and many other people who are affected by this are no longer able to speak for themselves. It is our job to stand up and do the right thing, and I hope very much that we can do that today.