EU Working Time Directive (NHS)

Ian Paisley Excerpts

Thursday 26th April 2012 Westminster Hall

[Ian Paisley (North Antrim) (DUP)]

Thank you, Mr Brady, for giving me the opportunity to speak unexpectedly early in the debate; I really appreciate it. The European working time directive is a complete disaster. Those are the words not of some amateur politician, someone on the street, a journalist or a headline maker, but of the president of the Royal College of Physicians, Sir Richard Thompson. He has described the European working time directive as “a complete disaster” for both patient care and the quality of training. He said:

“We are not providing the service or the training that we require. I cannot overemphasise the damage to service provision and to training.”

The directive is a complete disaster in terms of providing a service to the people who need it the most—the vulnerable and the sick. It is a complete disaster to the physicians who are the lifeblood of the NHS; and a complete disaster to the future of our hospital structure.

In September 2010, the European working time directive impacted on hospital rotas. The Royal College of Physicians criticised “the reliance on locums” in rural hospitals in particular. It said that

“a service opt-out or modification should continue to be pressed for.”

The Causeway hospital in my constituency faces losing its accident and emergency department, which is the only such facility in one of the most rural parts of Northern Ireland. The area has one of the largest inflows of tourists at certain times of the year. Why is the department going to close? It is going to close not because it is useless or there is no demand, but because of its over-reliance on locums, which is a direct result of the European working time directive. It is a complete disaster for our rural hospitals. It is a complete disaster in terms of sickness leave among doctors. The report of the Royal College of Physicians, which was published in April 2010, shows that sickness leave has soared since the European working time directive was introduced. It says:

“The apparent rise in sickness rates of junior doctors since the introduction of the European Working Time Directive highlights the additional stresses that are being put upon trainees by new rotas.”

Let us not mince our words: this is a complete disaster. Let us be honest and say it as it is. As far as the NHS is concerned, the European working time directive has failed and we need to get a better plan or structure in place that coincides with the needs of patients and with the ability of our physicians to deliver the best care service in the world. The sooner that we call this as it is the better.

[Mr Nuttall]

The hon. Gentleman is making a powerful case. Does he agree that the effects of the working time directive on our respective constituents is one reason why an increasing number of people are reaching the conclusion that we would be better off out of the European Union?

[Ian Paisley]

The hon. Gentleman pre-empts me. He is a mind reader. He seems to be able to find something that perhaps we are all agreed on. If the directive is a complete disaster; if it is starving our patients of good care and our junior doctors and senior physicians of being able to deliver what they are brilliant at delivering, we should address the problem at its root. The root cause is that we have a poison in the body politic of this kingdom. We are being regulated by people who do not live in this kingdom, do not care about this kingdom, are not part of this kingdom or do not have the needs of this kingdom at their heart, and we should stand up and recognise that. The over-regulatory practice that is being put upon us by Brussels is destroying this country. The sooner that we realise that, the better, and the sooner that the Government realise that and recognise that they should address the root cause of the problem, the better for us all.

[Chris Heaton-Harris]

The hon. Gentleman should just come off the fence. I have to declare that I was a member of the European Parliament for 10 years and served alongside his father. On two occasions, I attended an employment committee meeting in Brussels and saw Labour Ministers pleading with representatives to not allow the various connotations of the directive to flow through. Back in 2004, when the Commission opened up its first rethinking of this process, Labour Ministers came to the Parliament to plead with their MEPs not to vote to insist that this went ahead and to plead with the rest of the Parliament to allow Britain to do the right thing for its own people.

[Ian Paisley]

The hon. Gentleman gives us a valuable insight, or an inside track, into what the horse trading is really like in Brussels. This is not about the needs of the constituency or of the people, but about horse trading. It is about what we can achieve here to solve something in Brussels, Lithuania or Greece that is completely unrelated to the health needs of this nation. That horse-trading mentality is failing this nation. The insight that the hon. Gentleman provides is useful, and I am glad that he has come out from the shadows of Europe and, like me, is standing here in this Parliament. I know the happy times that he spent with my father when he was in Europe.

Other nations do not gild the lily as we do. We are pretty special at gilding the lily. We can really implement regulations like no one else. Why do the Government do it? Every other European nation seems to interpret the European working time directive in whatever way they want and get away with it. I am amazed that Ireland—the other bit—has been able to interpret the directive its way and get away with it. Surely, if it can say that training is not part of being a doctor, we too can find the flexibility—a word used by the hon. Member for Bristol North West (Charlotte Leslie)—necessary to make this work for us. Let us use the F-word; let us be flexible and get this right for our patients, our hospitals and our services.

In Lithuania, there is poor EWTD compliance because of the recession, so it can get away with it. Greece, too, has got away with not implementing the European working time directive because of its poor economic financial state. Surely, we can get away with implementing the European directive our way, and in a way that is flexible for our people and for our country. Apparently, Portugal is fully EWTD-compliant. However, many doctors and surgeons there now work more than their contracts say that they should. Surely, if the rest of Europe can find a way to be flexible to suit the needs of their people, it is not beyond the kith of men or beyond our wonderful Health Minister who is here today and our wonderful Department of Health to come up with a way to make the directive flexible for our people, for our nation, for our kingdom and—most importantly—for the needs of our patients, and to allow our doctors to deliver the service that they need to deliver?

I believe that we have a complete erosion of fundamental realities when we look at how the EWTD is being implemented to the destruction of the delivery of service and patient care. I hope that the Minister and the Department are listening to a voice that is coming across from all this kingdom, which says that the directive needs to be changed and changed fast.

--- Later in debate ---

[Chris Skidmore]

Sixty hours would be a start—65 is what most people seem to be calling for. It is about getting a balance. We do not want to go back to the 80, 90 or 100-hour working week, but nor do we want to face the consequences of the 48 or 56-hour working week. There is a balance to be struck, and I would be very interested to hear what the Minister thinks can be done. This debate is obviously an interesting one because it can go down a European direction, which I know a Health Minister cannot say very much about today. However I would be interested to hear what he has to say about the NHS in his capacity as a Health Minister.

[Ian Paisley]

There is also the issue of bean counting. We must be very careful, because this debate is about delivering something to the patient and ensuring that the team around the patient, including the doctors, co-ordinate their work to meet the needs of the patient. If we get into very strict bean counting—whether we are talking about 48 hours, 60 hours or whatever—and do not recognise that this is about a patient-centred service, we will keep having more and more of these problems that we have discussed. That is the critical issue, and why we need the flexibility.

[Chris Skidmore]

I entirely agree with the hon. Gentleman. Patient-led care is where we must get to. That is why we are all here; that is what the Health and Social Care Act 2012 will deliver. I am sure that we will all be working further to ensure that the patient is placed at the heart of the NHS.

Cigarette Packaging

Ian Paisley Excerpts

Tuesday 17th April 2012 Commons Chamber

[Mr Robinson]

I am grateful to my hon. Friend for bringing up that point. It was the staggering figures about the illicit tobacco trade in Coventry that first prompted me to consider that there could be adverse, unintended consequences to the measure that I am proposing with the good intention of reducing smoking.

Let me give the House the figures for the illicit trade in Coventry. My constituency is one of the three that make up the city of Coventry. In 2011, an Empty Pack survey was carried out. Its evidence was pretty reliable; I do not think that it has been seriously disputed. I am pleased to see the Minister nodding in agreement. It found that the illicit trade had increased from 14.5% of total sales to 30.3%, meaning that one in three cigarettes were being sold on the illicit market. That is well above the national average. The figure for the west midlands was only 17.2%, and the national average was 15%. Those are both high figures, but the problem is clearly approaching epidemic proportions in Coventry. I therefore remain concerned that we should do everything we can to prevent the problem from spreading further and that we should do so through the introduction of plain packaging.

When we consider all the covert measures that have been tried out by the Government, with the industry reluctantly co-operating, we realise that the present system cannot be very effective if the figures are as high as they are. If the figure is already 30%, it is hard to see how our countermeasures are being effective against the illicit trade in tobacco. We therefore have to take another approach.

That idea led me to read about what is happening in the north of England. There is a strong argument by the industry that the problems that have been mentioned could indeed happen. There is a plausible presumption that they might. In the north, people have realised that the present measures are ineffective, and they have set up the north of England tackling illicit tobacco for better health programme. It has brought together key agencies such as Her Majesty’s Revenue and Customs, the UK Border Agency, the police, local authority trading standards departments and the NHS to take part in a comprehensive action plan covering all those areas of government. It illustrates linked-up government working together at local and regional level. At the conclusion of this debate, I shall be writing to Coventry city council to recommend that it initiates and co-ordinates such an attack on what is clearly a big problem in Coventry and the west midlands.

[Ian Paisley (North Antrim) (DUP)]

It concerns me greatly that the hon. Gentleman appears to be advancing an argument that is based on a wing and a prayer, and a proposition that he hopes will get rid of counterfeiting. Is he not concerned that the counterfeiting of cigarettes across the United Kingdom amounts to a multi-billion trade—worth £3 billion at the last count—by criminals? They are not just any criminals; they are among the nastiest, most contemptible criminals in the world. The proposal that the hon. Gentleman is advancing is not going to stop them, and the idea that plain packaging will do away with the problem is not being advanced here tonight.

[Mr Robinson]

I am grateful for that intervention. I do not think by any measure that I could be thought to be suggesting that plain packaging is going to be a magic wand to deal with counterfeiting in itself. It is not, so I agree that it will not be enough in itself. The point I am making—it seems obvious to me—is that the extent to which measures are failing at the moment clearly shows that prevalence is increasing and will increase further unless we get effective action by Government agencies. This is where the Minister has a key role to play in the Department. I shall try to prompt local government in Coventry and the west midlands to get active in this respect, but the Minister has an overriding responsibility to deal with the problem for the whole country, as it is indeed a major problem.

--- Later in debate ---

[Anne Milton]

I will certainly look into the matter, and I apologise if the hon. Gentleman has not received a timely response. I would hope that we would always give him such a response, and I will make sure that he gets one. He mentions jobs, but we have also to consider the human costs of smoking-related disease. If breadwinners in families die prematurely, that has an implication for families. This is not just about jobs.

Any decisions to take further policy action on tobacco packaging will, as I say, be taken only after full consideration of the consultation responses and of any other relevant information or evidence, which is emerging all the time. In addition, we will explore any implications relating to the sale of illicit tobacco, a matter that has been raised. I point out that existing packs are very easy to forge; covert markings are already used to distinguish illicit cigarettes and this proposal will make absolutely no difference to the situation.

Our tobacco control plan explicitly complements Her Majesty’s Revenue and Customs and the UK Border Agency’s strategy to tackle the illicit trade in tobacco products, which was published in April 2011. There is absolutely no room for complacency, but thanks to the hard work of HMRC, local councils, the NHS and civil society, good progress is being made in reducing the amount of illegal tobacco products finding their way on to the market. According to the latest information collected by HMRC, fewer people are using illicit tobacco. Illicit sales of cigarettes were down to 10% in 2010 from 21% in 2000—that is a marked reduction. The figure for hand-rolling tobacco remains high, at 47%, but it has reduced from 61%. So the trend is in the right direction. I particularly wish to compliment the north of England tackling illicit tobacco for better health programme—some of these programmes have ghastly names, do they not? None the less, it is an example of how organisations can work together to tackle the supply of and demand for illicit tobacco. In coming to a view on the impact of standardised packaging, the availability of illicit tobacco will obviously be important, but we do want to see good, hard evidence on this.

[Ian Paisley]

rose—

[Anne Milton]

I shall give way briefly.

[Ian Paisley]

I thank the Minister for being very generous with her time. Has she given any thought to the view that if the Government are ultimately successful and stop people smoking, the Treasury will lose £11.1 billion in resources? How will that gap be filled?

[Anne Milton]

I will happily cross that bridge when we get to it; of course the Treasury would lose revenue, but as Minister with responsibility for public health, my aim is to improve the public’s health. Premature deaths would be prevented, and there is a huge human cost, let alone the financial cost to families, of people dying early.

Under the terms of the World Health Organisation’s framework convention on tobacco control, to which the UK is a signatory, we will be asking all respondents to consultations on tobacco control measures, including the consultation on tobacco packaging, to disclose whether they have any direct or indirect links to the tobacco industry. Responses from the tobacco industry, or from those with links to the industry, will always be carefully considered alongside other views received.

I hope Members will make their constituents aware of the consultation. The hon. Member for Paisley and Renfrewshire North (Jim Sheridan) raised the issue of jobs, and we must take that into account. We must also make sure that this consultation is real and meaningful and that the public know that we value their input.

I welcome having had a chance to discuss this matter, and I hope this will not be the last opportunity to do so. I look forward to hearing the views of all Members.

Question put and agreed to.

Ovarian Cancer

Ian Paisley Excerpts

Wednesday 12th October 2011 Westminster Hall

[Stuart Andrew]

The hon. Gentleman makes an important point. I will talk about early diagnosis, which is crucial, as is awareness—making people aware of the symptoms. That is crucial in the campaign to fight this terrible disease.

I return to the letter that I was quoting from, which is relevant to the point that the hon. Gentleman made:

“I really hope the message regarding this disease can increase, as I wouldn’t want anyone else to suffer as my mother did. If she had gone to her GP straight away when she presented with symptoms and the GP acted straight away, then she may still be with her family, who miss her so much.”

That is a powerful testament to the problem that the disease causes.

According to figures from the National Cancer Intelligence Network, only pancreatic cancer involves a higher proportion of people diagnosed with the late stage of the disease. but with ovarian cancer, unlike pancreatic cancer, we know what the symptoms are. That was not always the case. The hon. Gentleman referred to it as the silent killer, which is often how it is referred to, but in most cases the symptoms go unrecognised for some time by the women or their GPs. It is alarming that Target Ovarian Cancer has found that one third of women waited six months or more after visiting their GP for a correct diagnosis. That is staggering.

The National Institute for Health and Clinical Excellence has published guidance on the recognition and initial management of ovarian cancer, and listed symptoms such as persistent bloating or increased abdominal size, abdominal or pelvic pain, difficulty eating and feeling full quickly, and the need to urinate more frequently. If women experience such symptoms frequently, particularly more than 12 times a month, they should undergo tests.

[Ian Paisley (North Antrim) (DUP)]

Under NICE guidelines, the first thing that should be done is a CA 125 test. Is the hon. Gentleman concerned that there are apparently restrictions on a GP’s ability to obtain that test for their patients, and importantly that there have been attempts block those tests from being carried through to pathology laboratories? The CA 125 test is the one thing that can spot the disease and increase the possibility of early diagnosis and greater chances of success.

[Stuart Andrew]

I am grateful for that intervention, which proves the need for the debate. I hope that we can take forward many of the issues raised today to try to tackle the disease. The hon. Gentleman’s point is incredibly valid and important.

NICE’s information is a step forward because it offers women, and importantly GPs, the chance to distinguish between ovarian cancer and more common but less serious conditions such as irritable bowel syndrome, which is the most common misdiagnosis. The ovarian cancer awareness measure, which is an accredited tool used by Target Ovarian Cancer in its pathfinder study, showed that only 4% of women felt confident of spotting the symptoms of the disease, and just 9% were aware that persistent bloating is the most common symptom of ovarian cancer. Compare that with 76% of women who recognise that a lump is the most common symptom of breast cancer.

--- Later in debate ---

[Ian Paisley (North Antrim) (DUP)]

I, too, congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this important debate, which I hope will be a springboard for increasing awareness and for encouraging the Department to pick up the gauntlet set before it today.

In the next 12 months, between 11 and 15 women in my constituency will die because of ovarian cancer. That is not a high or low figure; it is the average across the United Kingdom. We must wake up to the reality and that figure must be checked. We must embark seriously on a national campaign that will achieve better survival results, as has happened with major cancers such as breast and lung cancer.

I want to put four important and sobering statistics before the House. Most of the women who are diagnosed—75%—have late-stage disease, when survival rates are very poor. That is a very high figure. Also, 30% of women are diagnosed following admission to their local accident and emergency ward, not by their GP. Women with ovarian cancer are five times more likely to die within a month of diagnosis than women with breast cancer, and the UK’s late diagnosis is thought to be the key driver for those survival rates. Only 4% of women are confident that they can spot the symptoms of ovarian cancer.

I have two questions for the Minister. First, why, as the hon. Member for Winchester (Mr Brine) said, is there not yet any Department of Health-led activity to improve awareness of symptoms? That is the key to addressing the issue. Secondly, I take the view that what is not measured is not done, so why is there no national measurement for ovarian cancer?

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does my hon. Friend agree that greater awareness and early detection were the key to the significant progress made with other cancers? Many charities became involved with departmental officials to ensure that those things became the driver, which led to reductions in numbers. That is the key for ovarian cancer as well.

[Ian Paisley]

I thank my hon. Friend for making that point incredibly well. We have all come to realise that there is a lack of awareness because of lobby groups, patients in our constituencies and the families who come to see us saying, “Why did we not know? If we had known, we would have done something else and gone to the GP earlier.”

As I have said, a gauntlet has been thrown down to the Department. Let us have better national measurement of outcomes established and followed up—year in, year out—so that the disease, which has been described as a silent killer, can be properly tackled and we can achieve the same successes as we have with breast, lung and bowel cancer survival rates.

Oral Answers to Questions

Ian Paisley Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

I am grateful to my hon. Friend for that question. Over many months, we have been in discussions with colleagues at the Local Government Association, and the Association of Directors of Adult Social Services recently produced new guidance on maintaining continuity and quality of care for individuals in homes that may be in difficulties. That is the appropriate way for us to proceed. We continue to work with them to ensure that all the necessary arrangements are in place. However, I remain focused, as all Members in this House should be, on ensuring that the company has the best possible opportunity to get itself on a stable footing so that it can continue to provide the care that people want.

[Ian Paisley (North Antrim) (DUP)]

The Minister will be aware that 25 care homes in Northern Ireland operate under the Southern Cross banner. What is he going to do to ensure that there is a consistent approach across the entirety of the United Kingdom? Will he have discussions with the Health Minister in Northern Ireland and other concerned parties to ensure that patients and residents in those homes are treated equitably and fairly?

[Paul Burstow]

The hon. Gentleman makes a fair point that relates to the earlier question where I indicated that we are in constant contact with the devolved Administrations and will continue to have that dialogue—if necessary, at ministerial level.

Swine Flu

Ian Paisley Excerpts

Monday 10th January 2011 Commons Chamber

[Mr Lansley]

I share the hon. Gentleman’s deep regret. H1N1, unlike many previous flu strains, does not particularly impact on the elderly; it impacts on younger people and on younger adults in particular. That is the principal reason why we are seeing a relatively larger number of people occupying critical care beds. The NHS response has been to accelerate the provision of critical care capacity and of ECMO beds in particular.

[Ian Paisley (North Antrim) (DUP)]

The Secretary of State will be aware that tragically there have been 14 flu-related deaths in Northern Ireland during this winter. Given that that figure is proportionately higher than in other parts of the United Kingdom, what discussions has he had or does he intend to have with his counterpart in Northern Ireland to assess why the proportion is so much higher and whether there is a black spot with regard to that disease?

[Mr Lansley]

The figure of 50 deaths to which I have referred is the total number of deaths verified by the Health Protection Agency. There have been more deaths than that, but they have not been verified to have been caused by flu. I cannot comment on the relationship between the number that I quoted for the United Kingdom as a whole and that for Northern Ireland, because we are not dealing with comparable figures. My colleagues in the devolved Administrations and I will continue to keep in touch. It is important for us not to be simplistic about this. There are differences in vaccine take-up between Administrations—they are not major, but they exist. There are differences in the prevalence of swine flu, and the prevalence of flu in Northern Ireland is very high compared with England—it is even a great deal higher than that in Scotland. Happily, the number of deaths is only ever a very small proportion of the people who contract flu. To that extent, it is difficult to draw from the number of deaths conclusions about the nature of the response to flu overall, not least because the prevalence is overwhelmingly among people who are not in the at-risk groups, who, I hope, were vaccinated.

Oral Answers to Questions

Ian Paisley Excerpts

Tuesday 7th September 2010 Commons Chamber

[Mr Lansley]

As I said in response to a previous question, one of the four criteria that I set out on 21 May was that reconfigurations must have the support of local general practitioners as the future commissioners of services. To that extent, a reconfiguration that did not have the support of local general practices would not be able to meet that test.

[Ian Paisley (North Antrim) (DUP)]

What discussions, if any, has the Secretary of State had with the Minister for Health, Social Services and Public Safety in Northern Ireland about making Avastin and other specialist cancer drugs available on the same terms and conditions under which they are available to people who suffer from cancer here on the mainland? Will those drugs be made available in Northern Ireland under the same terms and conditions?