Access to Medical Treatments (Innovation) Bill

Debate between Heidi Alexander and Bob Stewart

Friday 16th October 2015 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

I congratulate the hon. Member for Daventry (Chris Heaton-Harris) on securing a place in the private Members’ Bills ballot and thank him for meeting me this week.

Sometimes in this place, we need to be careful what we wish for. The process of steering a private Member’s Bill through Parliament is not only time consuming, but can become very complicated. I suspect that, after the contribution of the hon. Member for Totnes (Dr Wollaston), the hon. Gentleman may be feeling that. I should probably be honest and warn him that my contribution may add to his headache.

The very fact that we are discussing the Bill means that we are having a vital debate about the critical issue of how we can improve patients’ access to innovative and effective treatments. In putting his case for the Bill’s Second Reading, the hon. Gentleman has demonstrated that he has the right intentions, but that is probably the best thing I can say.

Many people in this House will have been in the position of seeing someone they love dying too soon. In such situations, people want hope. I understand that. They want hope that there is a treatment or drug that offers a chance of survival or of extending life that little bit longer.

If I thought that this legislation would provide genuine, well-founded hope in a safe and sound manner, I would support it, but I am not convinced that it does. In truth, I am worried that it does the opposite. I am worried that unsafe treatments could be used on dying patients. I am worried that the Bill would muddy the waters for doctors who wish to innovate about the legal route to do so, that it would reduce participation in clinical trials and that it would reduce legal redress for patients with a genuine negligence claim.

In the few weeks that I have been in this job, I have approached the Bill with an open mind. I have met a range of experts, patient groups, royal colleges and charities. It is fair to say that they are overwhelmingly opposed to the Bill. I will put some of their concerns to the promoter of the Bill and to the Minister, who I understand is actively supporting it.

The first concern that has been put to me is that the Bill attempts to remedy a problem that does not exist. I will briefly quote a few of the experts in this area. The Academy of Medical Royal Colleges has said that

“the Bill rests on the false assumption that it is fear of litigation that is holding back innovation by doctors. There is simply no evidence that this is the case”.

The British Medical Association has said:

“We are not aware of any evidence to suggest that the threat of litigation inhibits innovation or that confusion exists amongst doctors over the circumstances under which they can deviate from standard practice.”

The Royal College of Surgeons has said that

“there is no evidence that doctors are deterred from innovating due to the threat of legal action.”

The Motor Neurone Disease Association has said that

“the Bill would not remedy the problem it is aimed at, for such a problem does not exist”.

Sir Robert Francis QC, who has done so much in recent years to make sure that the NHS is focused, rightly, on patient safety, has said:

“The law of negligence does not prevent responsible innovation and never has.”

I could quote many more people, but I have probably made my point. Why do the hon. Gentleman and the Minister think that all those experts are wrong and they are right? What evidence do they have that litigation, or the fear of litigation, is preventing new treatments or hampering doctors from innovating? Even if that were an issue, does the Bill provide a robust and safe mechanism to tackle it? I am not sure that it does, but I am willing to work with the hon. Gentleman and the Minister, and anyone else who is interested, to consider how we can work on a cross-party basis to address any potential barriers to innovation.

Before setting out why I do not believe that the Bill is the right approach, I will first deal with clause 2, which provides the Secretary of State with power to establish a non-statutory database of innovative medical treatments. As the hon. Gentleman said, the clause was included as a result of concerns that were rightly raised in the other place by Lord Hunt when the previous incarnation of this Bill was debated. Lord Hunt’s amendment to that Bill would have required the Secretary of State to establish a database, but such a requirement does not exist in this Bill. As currently drafted, the Bill gives the Secretary of State “power” to establish a database, but places no obligation on them to do so.

I also question whether clause 2 is needed at all. According to the House of Commons Library, section 254 of the Health and Social Care Act 2012 gives the Secretary of State power to direct the Health and Social Care Information Centre to establish a system for the collection or analysis of information. Will the Minister confirm whether the Secretary of State already has the power to establish a non-statutory database of innovative treatments without legislation?

The Bill gives no detail about how such a database might work, but is that not crucial? A database will be effective only if it is compulsory, regulated and quality controlled. For a database to work requires participants to be just as likely to register failure as success. Will there be a requirement to remove an innovation that is not effective from the database? Will the database be quality assessed or peer reviewed? Will it be used for marketing to patients? The Bill makes no reference to those crucial points.

I am concerned about the impact of the Bill on research, and particularly on participation in clinical trials. As the Minister will know, we are a world leader in clinical research, and we must be careful not to do anything that would put that status at risk. Last December the Minister said that he hoped that the forerunner to this Bill would develop into a form that

“the vast majority of medical opinion and respectable bodies in the medical field feel able to support”.—[Official Report, 9 December 2014; Vol. 589, c. 853.]

I am not sure we have got to that point.

Let me list some of the medical research charities opposed to the Bill: Alzheimer’s Research UK, the British Heart Foundation, Cancer Research UK, the Motor Neurone Disease Association, Parkinson’s UK, the Wellcome Trust. Is the Minister comfortable supporting a Bill that those experts say could have

“significant unintended consequences for medical research”?

[Bob Stewart]

I presume that one fundamental reason why such bodies are against the Bill is that they are concerned that people who are without much hope would pin everything on something that could largely be quackery. Those poor devils will be encouraged to think that there is hope for them, when actually they should come to terms with the truth of their situation.

[Heidi Alexander]

I think that is broadly the point, but it also goes back to what the hon. Member for Totnes said about the impact on participation in clinical research trials. It seems entirely possible to me that a doctor might choose to prescribe an innovative treatment, or a patient decide to take an innovative treatment, rather than enter a clinical trial. If a patient is faced with the choice of guaranteed access to a treatment or participation in a trial in which there is a 50-50 chance that they will not be part of the group receiving the innovative treatment, why would they choose to be part of the trial? I would be grateful for the Minister’s comments on that. Does he not accept that the arrangements for clinical trials, including as they do monitoring and ongoing data collection, provide a much better mechanism for evaluating new treatments and advancing medical progress than a situation that could become more pervasive as a result of the Bill?

If the concerns I have set out so far are not enough, let me now turn to my main concern about the Bill, which, if passed, could undermine a patient’s ability to hold doctors to account when things go wrong.

Criminal Justice and Courts Bill

Debate between Heidi Alexander and Bob Stewart

Tuesday 17th June 2014 Commons Chamber

[Heidi Alexander]

It is a pleasure to follow the hon. and learned Member for Harborough (Sir Edward Garnier). I share some of his concerns, but not all of them, and I have arrived at a slightly different conclusion. He is right to say that there is a degree of uncertainty, but one of the things we need to consider when deciding how to vote on the new clause is the message it sends not just to those who may be caught up in knife crime, but to the victims of knife crime and their families.

Like the hon. Member for Enfield North (Nick de Bois), I represent a London constituency and I know how our communities are scarred by the use of knives. Many of my constituents live with loss as a result of knife crime. The House needs to demonstrate how seriously we take the issue with regard to not just sentencing, but, as the hon. Member for Cambridge (Dr Huppert) said, all Government action to address the problem. That means preventive work as well as work at the other end of the process.

I have been a Member of Parliament for the past four years, and I have been struck when the Prime Minister has stood at the Dispatch Box on a Wednesday to talk about the fallen soldiers who have given their lives in conflicts. During those four years, I have met the families of a number of young men who have lost their lives thanks to knife crime. I do not necessarily make a comparison between the circumstances involved, but I think it is important for me to read out the names of the young men in my constituency who have been killed as a result of knives. In March 2012, Kwame Ofosu-Asare was stabbed to death in Brixton. In August 2012, Nathaniel Brown was stabbed to death in Downham. In September 2012, Kevin Ssali was stabbed as he got off a bus in my constituency. Those are the names just of my constituents; sadly, many other young people in London have lost their lives as a result of knives.

[Bob Stewart (Beckenham) (Con)]

I want to support and amplify what the hon. Lady is saying. The families of people who have lost sons serving in uniform abroad at least have the great satisfaction of knowing that their boy—or their girl—has died in the service of their country, but the families of someone knifed on the streets of Lewisham or any other London borough have no such satisfaction or support for their grief. I totally support her intention in making such an analogy.

Hospital Services (South London)

Debate between Heidi Alexander and Bob Stewart

Tuesday 22nd January 2013 Westminster Hall

[Bob Stewart (Beckenham) (Con)]

I thank the hon. Lady for giving way, and I will make a short intervention, Dr McCrea, so that I do not get a finger-wagging from you. Frankly, GPs should be in support of these changes; support from GPs is one of the conditions that is a requirement for such changes. If they are not in support of these changes in Lewisham, that is a big problem.

[Heidi Alexander]

The hon. Gentleman is, of course, referring to the four tests for service reconfigurations that his own Government have said must be met if changes are to be made. GPs in Lewisham are opposed to these changes, and they have been very vocal in making their case.

--- Later in debate ---

[Heidi Alexander]

My right hon. Friend has consistently made that point in the House, and I totally agree.

It is a fact that maternity services in south London are under enormous pressure. In the 20 months between April 2011 and November 2012 providers of maternity services across south-east London suspended services on 37 occasions. Women in labour were therefore turned away from hospitals and told that they would have to go elsewhere. Of those 37 suspensions, 26 were necessary because of lack of beds. King’s College hospital also tried to suspend services on a further six occasions, but was unable to do so as no other unit had capacity to accept the women it was trying to transfer.

[Bob Stewart]

As the father of six children, I can tell the House from experience that nothing is more upsetting for a lady who is about to give birth than being shipped around when she tries to get into hospital. That is deeply upsetting to someone at such a fraught time in their life.

[Heidi Alexander]

The hon. Gentleman makes his point incredibly well.

Just a few weeks ago, both King’s and Woolwich were sending women to Lewisham to give birth. Women should be able to give birth at their local hospital and should not have to go to one hospital for the antenatal appointments only to have to go somewhere else to give birth. With high numbers of teenage pregnancies and a higher than average proportion of older mums in places such as Lewisham that is doubly important. The proposal for a midwife-led birthing unit at Lewisham is not a genuine option for any woman who wants to give birth safe in the knowledge that she would have back-up obstetric support if it were needed. I am told that that would not be an option for first-time mums. If I were to have a baby in two years’ time, I would not be able to go to Lewisham. The report tries to convince me that I would have greater choice, but that is just a joke.

One of my main concerns about the proposals for maternity services relates to where, and to what extent, capacity will be enhanced at other hospitals to deal with the mums who would otherwise have gone to Lewisham. The proposals before the Secretary of State assume a relatively even redistribution of women from Lewisham to King’s, the Queen Elizabeth hospital Woolwich and the Princess Royal university hospital in Farnborough. However, historically, when Lewisham women have not given birth at Lewisham, their main hospitals of choice have clearly been King’s and St Thomas’s. If more women go to those hospitals, projected births there could exceed 8,000 a year. Those would be really big maternity departments, potentially requiring a double rota of staff and consultants to deal with them. The cost of a double rota in maternity units at King’s and St Thomas’s is not accounted for in the plans before the Secretary of State.