Medical Aesthetics Industry: Regulation

Ian C. Lucas Excerpts

Tuesday 14th May 2019 Westminster Hall

[Alberto Costa]

My hon. Friend, in his time as the relevant Minister in this area, contributed enormously to this field, and I pay tribute to the work he has done in pushing for regulation of the industry.

I am not sure how to answer my hon. Friend’s point, because regulation takes many different forms. I think we would all argue that we want a healthy, thriving, competitive beauty industry. We do not want to strangle it or place an unnecessary obstacle before the business. We seek to achieve a safe beauty industry, where our constituents can approach any beautician of their choice, safe in the knowledge that these individuals have been properly trained and are qualified and regulated. I am certainly up for having the debate on whether they should be regulated by the General Medical Council, the overarching regulator of healthcare professionals or some other regulatory body, but regulation is the key.

I would also like to highlight the distinct difference between Botox and dermal fillers. Botox is a prescription-only medicine that can be prescribed only by a regulated healthcare professional, such as somebody regulated by the GMC. However, there is a loophole. At present, the prescriber is able to delegate the administration of the injections to another person, which unfortunately creates a way for people who are perhaps not regulated at all to administer the product. On the point my hon. Friend made a moment ago, if we were to have a regulatory body that somehow was able to delegate to others, we would have to ensure that those to whom the administration of the procedure was delegated were suitably trained to administer the procedures.

It is evident that these procedures are becoming more popular, and social media has an influence: so many young people are having procedures such as dermal fillers and Botox that that is almost normalising them. Given that the procedures are so widely seen on social media, they are being viewed by young people as equivalent to, for example, having one’s hair cut, as they are just as accessible. I have heard that people will say, “I’m just going out to have my lips done,” just as we might say, “I’m just popping out to have my hair done.” The normalisation of a procedure that can result in trauma should be looked at carefully.

[Ian C. Lucas (Wrexham) (Lab)]

Freyja Medical, in my constituency, provides an excellent service, but it also pointed out to me the important role that it sees Parliament performing in highlighting the impact and consequences of some of the very poor work that is carried out on individuals. I would certainly like to join the all-party parliamentary group, and I think one of the most important things we must do is get the message out to people on how dangerous the administration of these products can be.

[Alberto Costa]

I agree entirely, and I encourage the hon. Gentleman to join both the excellent APPG of the hon. Member for Falkirk (John Mc Nally), and that set up by the hon. Members for Swansea East and for Bradford South (Judith Cummins) and me. They are complementary APPGs and we would welcome the hon. Gentleman’s interest and expertise.

I mentioned a moment ago that this debate should not centre on the conversation about medics or non-medics carrying out these procedures; I believe it is fine for properly qualified and regulated beauticians to be able to offer them. I also highlight the fact that people who receive botched fillers often end up having to go to our national health service to pick up the pieces, as my hon. Friend the Member for Ribble Valley mentioned a moment ago, so that ultimately the taxpayer has to foot the bill.

As the Keogh review concluded:

“Dermal fillers are a particular cause for concern as anyone can set themselves up as a practitioner, with no requirement for knowledge, training or previous experience.”

In February 2014, it was made illegal to offer dermal fillers without training, but the training has not been clearly defined, and some of those who may be qualified to give lip fillers may not have the necessary training to be able to dissolve them or identify when something has gone wrong. We have met or heard from beauticians who would argue that they are properly trained or qualified, but in some instances they can be trained or qualified only for one part of the procedure, and not necessarily for when things go wrong. Surely, anyone carrying out these procedures should be able to identify when things have gone wrong and remedy them immediately.

The British Association of Aesthetic Plastic Surgeons would like to see the development of clinical guidelines on the use of dermal fillers. The Royal College of Surgeons has also expressed that it would like to see dermal fillers classified as a prescription-only medicine. Serious complications of cosmetic procedures can include infection, nerve damage, blindness, blood clots and scarring. That links to what the Government have helpfully announced today, as the campaign will help to inform consumers of those risks. They are also recommending that consumers go to a regulated healthcare professional.

The medical director at NHS England, Professor Stephen Powis, has said that professionals who provide procedures such as fillers should be encouraged to join the new Joint Council for Cosmetic Practitioners. That is very sensible, as it has been set up to assist members of the public, although it is not obligatory. We also face the surrounding issue of body dysmorphia and mental health. Professor Powis has also argued that practitioners should be officially registered and trained to identify people who may be suffering from a body image or other mental health-related issue.

Social media is a powerful tool for young people to look at and to share their experiences. Platforms such as Instagram and Facebook are often used as a principal source of information when people are researching fillers and Botox. I argue that that should not be the case: education on those matters should ideally be face to face when someone is having the procedures, with a trained and regulated practitioner.

Rather surprisingly, there is no age restriction on cosmetic procedures, and I argue that we should have one. The Nuffield Council on Bioethics recommended that children under 18 should not be able to have these procedures unless there was an overriding medical reason for them to do so. As a comparison, the law as it stands in England is that if someone wants to use a sunbed, they must be over 18. I mentioned unregulated vets earlier; we would not consider taking a valued pet to an unregulated vet to have an injection, so why would anyone let, for example, their 16-year-old daughter have someone unregulated inject something potentially poisonous into her face? I invite the Government to consider age restrictions.

The other point I will make is about the content of many dermal fillers. There is a total lack of regulation on the content—that is, the chemical ingredients. According to the British College of Aesthetic Medicine, there are more than 60 dermal fillers available in the UK market alone. It should shock us that we often do not know the content of those fillers and what poisons they may well contain that might have a negative impact on someone’s body.

I believe that urgent regulation is required to protect consumers—our constituents. The steps that the Minister and her Department have taken today are very welcome indeed, but we must do more. I look forward to the Minister’s comments, because I am confident that she is looking into this.

Oral Answers to Questions

Ian C. Lucas Excerpts

Tuesday 13th October 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

My hon. Friend is right. A further cause of distress for the people of Wales is the fact they do not have the funding that the NHS requires in their country, just as England would not had a Labour Government been elected in 2015, because we would not have the funding that this Conservative Government have promised to ensure top care for patients.

[Ian C. Lucas (Wrexham) (Lab)]

T5. The all- party spinal cord injury group, which I chair, recently reported that very vulnerable patients are being prejudiced by delayed discharges, taking up lots of public money in hospital expenses that should be used to treat more patients. Will the Secretary of State carry out an urgent service review to address this real problem in England, Wales, Scotland and Northern Ireland?

[Alistair Burt]

Delayed discharge has been a problem across the system for many years. An awful lot of work is going on to ensure that more preventive work is done so that people do not go into hospital, and to ensure that if they do go in they leave quickly. I visited Salford Royal only a couple of months ago and saw the process it has for dealing with discharges more effectively. Learning is going on throughout the system, and more money is in the system for winter in order to cover the problem.

Care Bill [Lords]

Ian C. Lucas Excerpts

Monday 16th December 2013 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

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

Our health and care system stands for compassionate care, or it stands for nothing. That was the vision when the NHS was founded 65 years ago: that anyone and everyone, regardless of background or income, should receive the best quality health care and be treated with dignity, compassion and respect. Because we have made much progress in delivering that vision, the NHS rightly remains the single biggest reason people are proud to be British. This Government want to keep it that way, which is why we are determined to root out poor care whenever and wherever it exists. Tragically, it does exist, both in the NHS and in private provision. In recent years, we have heard of patients being left in their own excrement at Mid Staffs, of patients left unchecked on trolleys for hours on end at Tameside, and of blood on the curtains and catheters on the floor at Basildon. All are issues that could and should have been dealt with by the last Government. Tragically, those problems were swept under the carpet, with devastating consequences for families across the country.

Today it gets worse, because the same people who failed to face up to those problems as Ministers will troop into the Lobby to try to vote down the very measures that will stop them ever happening again. People watching this debate will be asking one simple question: what more will it take for Labour to learn the terrible lessons of these tragedies? How many more people will need to suffer before the Labour party, the party that is rightly proud to have founded the NHS, comes to its senses and recognises that, on its watch, targets mattered more than patients and good news mattered more than good care?

[Ian Lucas (Wrexham) (Lab)]

The right hon. Gentleman casts those allegations around widely. Will he name the Ministers against whom he is making them?

[Mr Hunt]

I will absolutely go on to name the problems and the Ministers involved, if the hon. Gentleman will just be patient.

Hon. Members should not simply take my word for this. This is what Mid Staffs campaigner Ken Lownds, a former Labour party member, says about Labour’s decision today:

“It’s shocking and deeply depressing that Labour have learnt nothing from Mid Staffs. Their decision to oppose the Care Bill is a slap in the face for the campaigners and relatives who have fought for years for these measures that deliver a safer, more transparent and more compassionate NHS. Once again they have let patients and whistleblowers down by putting their political interests ahead of patient safety.”

Spinal Cord Injuries

Ian C. Lucas Excerpts

Wednesday 4th September 2013 Westminster Hall

[Ian Lucas (Wrexham) (Lab)]

It is a real pleasure to serve under your chairmanship this afternoon, Dr McCrea. I am pleased to see that the Minister is here for this debate on the important topic of continuing health care for spinal cord injured people. The all-party group on spinal cord injury has had some difficulty engaging with Ministers over the past two years. The Health Minister with responsibility for quality, Lord Howe, and more recently the Minister for Housing, the hon. Member for Hertford and Stortford (Mr Prisk), have both refused to meet the group, which is very unfortunate.

The advantage of engagement is that it enables Ministers to understand better the needs and difficulties of individuals who have to deal with severe spinal cord injuries. Such individuals face great hardship and difficulty, and Ministers should at least be prepared to engage with them and hear what they have to say. I am sure that the Minister will do so today.

I first became aware of the difficulties faced by spinal cord injured people during my work as a practising personal injury solicitor before I came to the House about 12 years ago. I was particularly engaged with the Midlands Centre for Spinal Injury at the Robert Jones and Agnes Hunt orthopaedic hospital in Oswestry. Individuals were often admitted with severe spinal injuries from accidents, and the capacity of the—[Interruption.]

[Dr William McCrea (in the Chair)]

Order. I apologise to the hon. Gentleman, but I must suspend proceedings for a Division in the House.

--- Later in debate ---

On resuming—

[Ian Lucas]

I was just talking about the extraordinary work of the Midlands Centre for Spinal Injuries, which I witnessed some years ago and which continues. In connection with the immediate response to serious accidents where people have spinal cord injuries, a miraculous transformation can be carried out, provided that the right level of care is offered by specialists in the immediate aftermath of the accident.

The continuing effects of spinal cord injuries are important, and I want to concentrate on those today. Spinal cord injury results in a combination of the loss of motor, sensory and continence function, making it unique among long-term conditions. It is also a non-improving condition. Once rehabilitation is completed and health care needs have been identified, they are unlikely to decrease. Indeed, they are likely to increase over time, with complications brought on by ageing and as the condition continues. It is essential, therefore, that needs are well managed by a dedicated and trained team who understand spinal cord injuries. That will ensure that health complications and significant cost implications for the national health service are avoided or minimised.

How care is administered is a major concern to many people living with spinal cord injuries. It is not just the individual who is affected by the spinal cord injury; often, the family and the immediate community around that individual must cope with profound pressures. There is an increasing worry that health care provision is becoming a postcode lottery, with clinical commissioning groups interpreting the national framework differently to meet their budgets, rather than the specific needs of spinal cord injury patients.

The landmark legal case of Pamela Coughlan in 1999 set a precedent for how patients with a certain level of injury should expect to be treated. Ms Coughlan, a C5/C6 complete tetraplegic with no significant additional health needs, took her primary care trust to court when they attempted to transfer care provision responsibility from NHS continuing health care, within which health care is free, to the local authority, where charges may have applied.

[Jim Shannon (Strangford) (DUP)]

The hon. Member for Wrexham and I spoke beforehand about this issue and I wanted the information to be recorded. Perhaps the Minister will take it on board as well.

We have a specialised 15-bed unit that looks after the whole of Northern Ireland and its population of 1.7 million people. That unit has everything: trauma, orthopaedics, neurosurgery, neurology and an intensive care unit. There are dedicated teams for physio, nursing, occupational therapy, social work, psychology, dietetics, art therapy and complementary therapies. All that happens under one roof for all the people in Northern Ireland. The hon. Member for Wrexham said to me, “That is the sort of thing we need in my area.” I wanted to put that case on the record. Perhaps the Minister could look to Northern Ireland as an example of something that has been done and done well.

[Ian Lucas]

I thank the hon. Gentleman.

Going back to Ms Coughlan and the issue of continuing care, the ruling found that patients with a certain level of spinal cord injury have health care needs of a “wholly different category” than can be legitimately provided for by a local authority. These are profoundly and almost singularly serious conditions. Even spinal cord injured people with greater health needs than Ms Coughlan are finding themselves assessed as ineligible or seeing their care packages severely restricted, without any evidence of reduced need.

As local health budgets for continuing health care are being squeezed and, in many cases, reduced, many of these people are experiencing reduced care packages and unfair, and potentially unlawful, decisions on eligibility for continuing health care. There are many examples of continuing health care packages being denied or dramatically reduced after reassessments, without evidence of clinical improvement.

One individual who has been affected is John Burns. He addressed the all-party parliamentary group on spinal cord injury last year, and it is occasions like that that show the importance of all-party parliamentary groups. They allow individuals such as John to speak to Members of Parliament and explain the difficulties.

John, who is married with three teenage sons, is a C2 tetraplegic following a water sports accident while on holiday with his family in 2007. Due to the extent of his injuries, John was initially put on a ventilator and awarded NHS continuing health care. After a period in a spinal cord injuries centre, John was discharged into a care home and was successfully weaned from his ventilator. Although he remained paralysed from his neck down, his continuing health care funding was consequently withdrawn, and he was told to expect to remain in a nursing home for the rest of his life. Without the appropriate funding, John was unable to receive the care and support he needed to be with his family and return home. He described that period as being like a “prisoner,” as he was denied time with his wife and sons in his own home. That is the type of individual that we, as a community, should be aiding, rather than denying them health care.

In a meeting with the Spinal Injuries Association, the then Minister of State with responsibility for care services, the right hon. Member for Sutton and Cheam (Paul Burstow), expressed concern about John’s case. Thanks to the involvement of the Spinal Injuries Association, an independent nurse was assigned to assess John’s case and immediately argued in his favour that funding should be reinstated. Yet John had to go through that process to restore the care that had been taken away from him. One can imagine the worry and distress experienced by John and his family during that period.

Despite the precedent of the Coughlan judgment, a large number of spinal cord injured individuals with health care needs demonstrably equivalent to or even greater than those of Pamela Coughlan are still denied NHS continuing health care. The culture of ineligibility continues. What action is the Minister taking to ensure that, where appropriate, spinal cord injured people have access to NHS continuing health care and that the legal ruling is adhered to? Is there a process for monitoring the level of care that individuals with severe spinal cord injuries are receiving from their immediate provider? How will the Department monitor the level of provision that is being given?

The Government must ensure that locally produced policies do not impose inappropriate and potentially unlawful care packages on a spinal cord injured person. Will the Government ensure that clinical commissioning groups adhere to the Coughlan judgment when deciding NHS continuing health care eligibility for spinal cord injured patients? Does the Minister believe that there should be a presumption of eligibility for tetraplegics when determining continuing health care? In addition to their injuries, such individuals and families should not have imposed on them the burden of worrying whether the care they received in the past will continue.

There is also concern that multidisciplinary teams assessing spinal cord injured patients for continuing health care frequently exclude health professionals with expertise in spinal cord injury when reaching their decisions. Along with the judgments that set legal precedents for NHS continuing health care, such as the Coughlan judgment, assessors and decision-making panels must carefully consider evidence from spinal cord injury clinicians and health care professionals from the NHS spinal cord injury centres. It is important that those individuals, who are so skilled in providing care, have input into the process of deciding what care the NHS is to supply in future. Will the Government take action to ensure that health professionals with expertise in spinal cord injury are included in multidisciplinary teams throughout the process?

There have been instances in which local commissioners have introduced policies that randomly restrict the amount of money available for “care at home” packages to the cost of non-complex care in a nursing home, disregarding the special care needs of spinal cord injured people and their right to family life. In an increasing number of clinical commissioning groups, local implementation policies place restrictions on the size of “care at home” packages, often based on arbitrary caps set against the equivalent cost of a placement in an establishment such as a nursing home. That has happened, for example, in the Sheffield clinical commissioning group cluster and in north-west London despite Department of Health practice guidance outlining the rights of people to choose where to live and to take risks, and despite the court’s indication that an individual’s human rights need to be balanced against cost.

The excellent spinal research charity Aspire commissioned Loughborough university to independently consider the impact on people with spinal cord injury of being discharged to nursing homes. The research found that living in a nursing home has a damaging psychological and physical impact on people with spinal cord injury. Spinal cord injury patients should not be expected to live in institutions rather than with their families. Generally, such people view care homes as a last resort.

The individual must be at the centre of the assessment process. Improving the implementation of NHS continuing health care will benefit its members, the clinical commissioning groups and the wider spinal cord injury community. Such issues affect people across the UK. They cause families and individuals profound worry, and they must be addressed urgently. The legal ruling must be adhered to, and the culture of ineligibility must end.

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship for the first time, Dr McCrea.

I congratulate the hon. Member for Wrexham (Ian Lucas) on securing this debate and on his persistence in pursuing the matter. I have noted what he said about his frustration in securing meetings with a couple of Ministers. At least we have had the chance this afternoon, albeit interrupted, to debate this important issue, and I am more than happy to talk to him if there are issues arising from this debate that he wants to pursue further.

The hon. Gentleman makes the point that how care is administered is incredibly important to the individual, and he also mentioned the profound impact that spinal injury has on the whole family and everyone involved. He talks about the emergence of a postcode lottery, but if we are honest with ourselves, the postcode lottery has always existed to some extent. The interpretation of rules has always varied somewhat across the country. Indeed, the Coughlan case was brought because of a failure to apply rules properly. I will return to that in due course, but it is essential that all areas of the country apply the rules properly, according to the guidelines, and apply the precedent that has been set.

I also pay tribute to the important work of the all-party group on spinal cord injury, which has had a major impact on issues affecting the estimated 40,000 people with spinal cord injury in the United Kingdom and Ireland alone. Every eight hours, a new person is told that they will never walk again, which is a stark reminder of the scale of spinal cord injury.

Thankfully, research is making important strides in developing new techniques to help spinal cord injury patients regain as much function and independence as possible. In 2011-12, the Medical Research Council spent £900,000 on research directly related to spinal cord injury. The Government also fund a wide range of research relating to spinal injury, and through the National Institute for Health Research, the Department of Health is funding research on spinal cord injury in biomedical research centres in Cambridge and London.

There is an increasing range of guidance available to provide advice on the causes, treatment and management of spinal cord injuries. Stakeholders such as the Spinal Injuries Association and Aspire provide information and support services for patients and their families following spinal injury, and we should pay tribute to the work of those organisations. In February 2008, the Royal College of Physicians published a guideline for GPs and other health professionals involved in the management of adults with spinal cord injury in the acute hospital setting. I am confident that that range of guidance will be useful for educating people and, critically, professionals on spinal injuries and how to manage them.

More work is taking place to develop guidance for the treatment of those with spinal injuries. The Department has asked the National Institute for Health and Care Excellence to produce guidance on the assessment and imaging of patients at high risk of spinal injury. NICE is developing five pieces of guidance relating to trauma, with expected publication dates in June and October 2015. Each piece of guidance will focus on a different aspect of trauma care. The guidance on spinal injury assessment will form one part of the wider work and is expected to be published in May 2015.

The hon. Gentleman appropriately raised NHS continuing health care for individuals with spinal cord injuries. NHS continuing health care is a package of health and social care that is arranged and funded solely by the NHS for individuals outside the hospital setting who have complex, ongoing health care needs. It is important to say that eligibility for NHS continuing health care is dependent not on an individual’s condition or diagnosis—it is important to maintain this point—but on the individual’s specific care needs. That must be appropriate, so that what is assessed is what the individual needs.

The assessment for NHS continuing health care is complex and involves a multidisciplinary team co-ordinated by the relevant clinical commissioning group looking at an individual’s needs across 12 care domains and assessing how those needs interact. The process determines whether individuals have what is called a primary health need. If they do so, they will be entitled to continuing health care.

The hon. Gentleman specifically referred to concerns about specialist involvement in continuing health care assessments. The national framework, which underpins the assessment and decision making for NHS continuing health care, makes it clear that someone with specialist knowledge is involved in the process, with other highly skilled professionals, such as doctors, nurses, social care staff and therapists. If that is not happening in an area, that is a failure to follow the national framework and should be challenged. I am interested to hear about cases in which that is not happening, because corners cannot be cut—things should be done properly. He made an important point.

The family or representative may also be involved, to ensure that a holistic picture of the individual’s needs is properly identified. After all, the family probably knows best about what the impact really is.

Individuals receiving NHS continuing health care will have their case reviewed three months after the initial decision and annually thereafter. It is important to remember that the focus of the review is not only whether the individual remains eligible, but whether their needs are being properly met and the package of care remains appropriate. Let me be clear, however, that an individual must be kept fully informed about the process and any proposed change to the care arrangement.

The hon. Gentleman expressed concerns about refusals of NHS continuing health care or the package being drawn too narrowly, suggesting that the Coughlan judgment was not being followed and that cases more serious than the Coughlan one were being refused—I think I have put that correctly, from what he said. I again make the point that if any areas are failing to follow the national framework, that must be challenged. I appreciate that families may not always understand or know how to go about challenging, or what they are entitled to, but we all have responsibility to disseminate that message and to encourage people to challenge decisions that cannot be justified.

[Ian Lucas]

The Minister is being very constructive in his response. Is there any process for monitoring the decisions? Organisations such as the Spinal Injuries Association can bring individual cases forward, but there needs to be some sort of system to ensure that the rules, which I am grateful that the Minister is stressing today, are being enforced as a matter of course.

[Norman Lamb]

The hon. Gentleman makes a fair point. I was about to say that I will ask NHS England to provide me with an assessment of how the work of CCGs complies with the guidelines. The very fact of that request for information will help focus minds and ensure that things are being done properly.

I am aware that there are some concerns about how autonomic dysreflexia is reflected in NHS continuing health care assessments. It is unique to spinal cord injuries and should always be treated as a medical emergency. The needs of individuals experiencing autonomic dysreflexia are to manage both the risk of episodes occurring and the risks involved if and when such episodes occur. Such risks, and therefore the needs, vary from one individual to another. It would be relevant to establish whether the individual has signs and symptoms of an advancing episode or whether the episodes are random and unpredictable.

It has been suggested that more people with spinal injuries are being placed in nursing home settings, rather than being offered a care package in their own home. The national framework is clear that NHS continuing health care packages should be as far as possible personalised—designed to meet that individual’s needs—and that the individual’s wishes should be taken into account. It is our hope that personal health budgets—a concept developed under the previous Labour Government, but strongly pursued under this Government—will give people more personal control over their care.

We recognise that it is more efficient for people with long-term conditions such as spinal cord injuries to have control over their own budget for health and social care, because they are less likely to duplicate services or to choose ones that are not right for them. Beyond being efficient, however, it is simply what we should be doing: we should be putting the individuals in charge and allowing them to determine their priorities. On that basis, CCGs are already able to offer personal health budgets to people on a voluntary basis, if they consider that it is cost-effective and will improve the individual’s quality of life.

We have also brought in legislation that will allow CCGs to offer direct cash payments as a way of managing personal health budgets. However, to make personal health budgets more of a reality for people, we have put measures in place to ensure that CCGs go further than offering them only on a voluntary basis. As of April 2014, those receiving NHS continuing health care will have the right to ask for a personal health budget, including a direct payment. Using a personalised care planning process, personal health budgets help people choose how to meet their health needs in ways that work for them.

I have just set out how the process for NHS continuing health care is intended to work. Let us not pretend, however, that it works perfectly in every case—it clearly does not. I am delighted that the Spinal Injuries Association continues to have a strong presence on the NHS national continuing health care stakeholder group. It is important that its voice and that of the people it represents are heard.

Eligibility for NHS continuing health care depends on a needs-based assessment. Therefore, some individuals will not be eligible, but they must still receive the appropriate level of care and support. Disjointed care is a source of complete frustration for patients and staff alike. To stay relevant to changing needs, different parts of the NHS and other organisations such as social services have to work more effectively together to drive joined-up care.

The first NHS mandate sets out a requirement to provide

“care which feels more joined-up to the users of services”,

and which

“ensures people experience smooth transitions between care settings and organisations”.

That is vital, and there is a total focus in Government on integrating and joining up care around the needs of the individual patient. On that basis, we have asked NHS England to make huge efforts to focus on delivering integrated care and support to improve outcomes for patients and for people who use those services.

I thank the hon. Gentleman for securing the debate. The issues that we have discussed this afternoon are important, because of their impact on people who have sustained a spinal injury which in itself is completely life changing. We must ensure that the care and support systems work to meet their needs and to enable the best possible quality of life and outcomes for those individuals.

Question put and agreed to.

Social Care Funding

Ian C. Lucas Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

These proposals cover the care costs, but we will be making an allowance for accommodation and food of £1,000 a month at 2017-18 prices. The reason for doing that is that a person would face those costs whether or not they were in a residential care home, and we think it would be wrong to create a system where that person was better off financially being in a residential care home than living at home.

[Ian Lucas (Wrexham) (Lab)]

Beveridge committed to “the cradle to the grave” as the principle in health care. It is clear today that the Government have given up on the public sector contributing to the pre-£75,000 figure. Has he any idea or has he inquired how much the cost of provision would be for a family to obtain cover for that first £75,000?

[Mr Hunt]

I think the hon. Gentleman needs to study these proposals with a great deal more care. If he had listened to them, he would know that we are extending dramatically the help available to people who have to pay up to £75,000, by increasing the threshold from £23,000 to £123,000 at 2017-18 prices.

Winterbourne View

Ian C. Lucas Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

I am happy to discuss the matter further with the hon. Lady. It is clear, though, that when a care home provider seeks to recruit a member of staff to work with people in a care home setting, they have to—[Interruption.] They are obliged in law to carry out criminal records checks on people who work within that setting. I repeat, however, that I am happy to discuss the matter with the hon. Lady and to look again at the issues.

[Ian Lucas (Wrexham) (Lab)]

As the Minister has made clear—his commitment is coming through—the care provider is key. As he moves forward, will he look at whether there is any disparity between private and public sector provision? In cases that I am aware of, there has been a qualitative difference: vulnerable individuals are not being looked after as well as they ought to be by some private sector providers.

[Norman Lamb]

We probably all know from our constituencies of fantastic private sector care providers that provide a fantastic quality of care to older or younger adults with disabilities and so on, so we must be careful not to condemn the whole sector. My clear view is that wherever there are low standards of care it is unacceptable. But let us remember Mid Staffordshire hospital, where hundreds of people lost their lives unnecessarily owing to poor standards of care. It can happen in both public and private sectors. We must find it intolerable in both.

Oral Answers to Questions

Ian C. Lucas Excerpts

Tuesday 27th March 2012 Commons Chamber

[Paul Burstow]

The Bill will not lead to fragmentation. It actually supports greater integration of health, social care and public health and, at a local level, it allows health and wellbeing boards to become the means by which to co-ordinate all the agencies that have a part to play when it comes to tackling TB, not least in ensuring that the advice of public health officials benefits not just the NHS but wider public services that also have a role to play in raising awareness of the disease and ensuring that it is properly tackled.

[Ian Lucas (Wrexham) (Lab)]

4. What discussions he has had with Ministers in the Welsh Government on the treatment by the NHS of patients with defective breast implants.

[The Secretary of State for Health (Mr Andrew Lansley)]

My officials have kept colleagues in the Welsh Government closely informed about the advice of Sir Bruce Keogh’s expert group and about our plans for the NHS treatment of patients with PIP breast implants.

[Ian Lucas]

The Secretary of State has said that private providers have a moral duty to replace faulty implants for free. Will he tell the House how many private providers have carried out that moral duty?

[Mr Lansley]

I will write to the hon. Gentleman with the latest figures and place a copy of the letter in the Library. Overall, however, I am aware of 5,232 referrals to private providers, as a result of which 2,704 scans have been conducted. Consequently, the decision to explant breast implants has been taken in 298 cases. Some 75 such operations have been completed.

Health and Social Care Bill (Programme) (No. 2)

Ian C. Lucas Excerpts

Tuesday 21st June 2011 Commons Chamber

[Mr Burns]

The hon. Lady, from a sedentary position, rather like a Greek chorus that ill-befits her, asks when. The answer is that we expect to table the amendments by 23 June, which, if it helps her, is in two days’ time. That is despite the fact that many previous Bills—[Interruption.] The hon. Member for Islington South and Finsbury (Emily Thornberry) should listen to this because it has some direct relevance that she will not like. We are doing this despite the fact that many previous Bills were not recommitted under the previous Government despite their having undergone significant change. For example, the Local Government and Public Involvement in Health Bill in 2007 had 54 new clauses and three new schedules added by Government amendment, but rather than returning it to Committee the previous Government added them on Report. The Planning Bill of 2007-08 had 29 new clauses and three new schedules added by Government amendment; again, rather than return that Bill to Committee, the previous Government added the clauses on Report. Indeed, a Bill has not been recommitted for eight years since the Planning and Compulsory Purchase Bill in 2003.

No fair-minded person can claim that we are not subjecting the Bill to the closest possible scrutiny. Our recommitting the Bill will give hon. Members additional time to examine parts of the Bill that the Government propose to change. Of course, hon. Members will have further opportunity to scrutinise the entire Bill on Report in the Commons and the Bill will receive full scrutiny in another place. We do not believe that it is necessary for the entire Bill to be recommitted—[Hon. Members: “Why not?”] If hon. Members will listen they will find out why not. We do not believe that it is necessary for the entire Bill to be recommitted in order for proper scrutiny to take place. Indeed, we feel very strongly that that would unnecessarily delay the progress of the Bill to the ultimate detriment of patients. It is now time to give greater clarity and direction to staff and patients. As Professor Steve Field said in the Future Forum report:

“It is time for the pause to end.”

Professor Field is not alone in the opinion that now is the time to move forward and to enable proper and thorough scrutiny of those parts of the Bill that will change but without delaying the Bill’s passage beyond what is absolutely necessary. The Academy of Medical Royal Colleges said in its response to the Future Forum report:

“We hope the Government will now accept the Future Forum’s recommendations in full and move swiftly to make the changes to the Bill and the proposals that are required”.

The King’s Fund has also emphasised the need to avoid unnecessary delay. It said:

“The ‘pause’ has served the NHS, its staff and patients well”—

[Ian Lucas (Wrexham) (Lab)]

On a point of order, Mr Deputy Speaker. I tabled a named day question to the Minister, of which he is aware, in which he made it very clear that the changes to the Bill that he says relate to the recommendations of the Future Forum were in fact—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Please resume your seat. That is not a matter for the Chair; it is an extension of the debate. Yet again I reiterate that we are now 13 minutes into a one-hour debate and we have yet to hear from the shadow Minister and a number of Back Benchers who wish to participate, so, please, could we restrain bogus points of order—that is No. 1 —and could we also have more quiet?

--- Later in debate ---

[John Healey]

My hon. Friend has a point. What is wrong is a partial recommittal of the Bill, because the Bill requires full scrutiny of the full provisions with the changes that the Government propose to make, once we have had a chance to see them.

The Health Minister and Government Members urge us to go faster. Everything this Government have done with their NHS reorganisation has been rushed and reckless, and the motion signals that they are set to repeat the mistake by railroading the Bill through at breakneck speed and denying this elected House its proper role in scrutinising the legislation. Labour tabled a motion a month ago for the full Bill to be reconsidered in Committee, for more time to look at the detail of the amendments and for proper scrutiny and debate in Committee.

[Ian Lucas]

Is it not important to take into account the written answer that I received to the named day question—a very good question—that I put to the Minister? He gave me a very good answer: far from recommittal being a consequence of the NHS Future Forum, the Government were consulting on these very amendments to the Bill prior to the announcement that they made on the consequences of the Future Forum. Is not the entire process a sham?

[John Healey]

My hon. Friend is right. We know that the Prime Minister is a PR man. We know that he was forced to call the pause and that, when he did, he was looking for a PR solution. The answer that my hon. Friend flushed out of the Government stands that up clearly.

To return to the motion before the House and the question whether the Bill requires, as we argue, recommittal in full, parliamentary precedent demands this, proper parliamentary scrutiny demands this and, above all, our responsibility to NHS patients to try to get the legislation right demands this. The parliamentary precedent is clear, as my hon. Friend the Member for Cardiff West (Kevin Brennan) said. The House of Commons Library tells me that the last time a Bill was recommitted in part was 60 years ago. In response to a point of order, the Health Minister cited the Planning and Compulsory Purchase Bill of 2003 as a precedent. The Labour Government recommitted that Bill in full and gave Committee members the whole of the summer recess to examine the detailed amendments before the Committee sat again. Why are the Government not acting as they should and as Labour acted in government with that Bill?

The NHS, the legislation and the changes to the changes announced last week are all complex, and the House cannot do its proper job unless the Government’s changes to one clause can be considered alongside the consequences for other parts of the Bill and for the health service. How can the promised changes to Monitor’s role be considered without looking at all 29 clauses dealing with its licensing powers? The House cannot do its proper job unless all the areas that the Government say they will change are recommitted.

Why are the clauses on the failure and designation regime for hospitals, which the Government say they will change, not covered in the recommittal motion? The House cannot do its proper job, and organisations cannot give proper evidence to the Bill Committee, unless all the amendments are tabled in good time, so why will there be only two full working days between the tabling of amendments and the Committee sitting? The House cannot do its proper job unless the Bill Committee has sufficient time for scrutiny.

The 64 clauses in the recommittal motion took 45 hours of debate in Committee last time. The Government are now cutting that time in half. The Minister said that he expects 160 amendments in Committee. That allows less than 10 minutes for each amendment that the Government table, and that is before the Opposition table our own amendments and before taking into account the six schedules that are being recommitted.

Health and Social Care Bill

Ian C. Lucas Excerpts

Monday 31st January 2011 Commons Chamber

[Mr Lansley]

With his knowledge of European matters, the right hon. Gentleman knows that we are in the later stages of the collective approval through the European Union of the European cross-border health directive, which allows precisely that and makes it clear that the same criteria are applied to patients seeking health care in other countries as would apply were they to seek it through the NHS in this country.

[Ian Lucas (Wrexham) (Lab)]

Will the Secretary of State give way?

[Margaret Hodge (Barking) (Lab)]

Will the Secretary of State give way?

--- Later in debate ---

[Mr Lansley]

Thank you, Mr Speaker. I can give my hon. Friend the Member for Ealing Central and Acton (Angie Bray) precisely that reassurance. I was with NHS London at the beginning of last week, and it is clear that GP commissioning groups are coming together with providers to develop those kinds of commissioning plans, going beyond trauma and stroke care, which has already happened in London, to look, for example, at the integration of diabetes care between primary care and hospital services.

Under the Bill, patients will come first and will be involved in every decision about when, where, by whom, and even how, they are treated—“there must be no decision about me, without me.” The 2002 Wanless report called for patient engagement, but that did not happen. Now it will. Because patients cannot be empowered without transparent information, an information revolution will give them more detailed information than ever before, showing them and their doctors the consultants who deliver the best care, giving them control over their own care records and enabling everyone to access the care they need at the right place and at the right time. Patients and their doctors and nurses will be able to see clearly which health care provider offers the best outcomes and to make their decisions accordingly.

[Ian Lucas]

The right hon. Gentleman is being generous in giving way. If those proposals are so important and necessary, why were they not included in the Conservative party manifesto at the general election?

[Mr Lansley]

They were, as I will explain in a minute.

--- Later in debate ---

[Mr Lansley]

I agree with my hon. Friend. In effect, that gives the lie to what the hon. Member for Wrexham (Ian Lucas) suggested. The coalition agreement states:

“We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf.”

Our manifesto stated that we would strengthen the power of GPs,

“putting them in charge of commissioning local health services.”

[Ian Lucas]

Will the right hon. Gentleman give way?

[Mr Lansley]

I am sorry, but 57 Members wish to speak, as you have rightly told us, Mr Speaker. I will give way as often as I can, but more than one intervention from each Member is excessive. [Interruption.] I have just quoted from the coalition agreement and our manifesto, so hon. Members have heard both.

Through the outcomes framework, which we published in December, we will stop the top-down, politically motivated targets that have led to real quality being sidelined. We will ensure that we focus on the outcomes that really matter and back them up for the first time with quality standards that are designed to drive up outcomes in all areas of care. Those standards have not been dreamt up in Whitehall, but are being developed by health professionals themselves. Similarly, doctors and other health professionals will not be told by us how to deliver those standards. The standards will indicate clearly what is expected, but it will be up to clinicians to decide how to achieve them. At every step, clinical leadership—that of doctors, nurses and other health professionals—will be right at the forefront. It will be an NHS organised from the bottom up, not from the top down.

The shift in power away from politicians and bureaucrats will be dramatic. The legislation none the less builds on what has gone before. It is not a revolution, but as the shadow Secretary of State said just a fortnight ago:

“The general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes—and are common ground between patients, health professions and political parties.”