Accident and Emergency

Jamie Reed Excerpts

Wednesday 18th December 2013 Commons Chamber

[Mr Hunt]

I want to make some progress on this because it was the central point of the shadow Health Secretary’s speech. The reason the 48-hour target was scrapped is very simple: access was getting worse, not better, under that target. On the right hon. Gentleman’s watch, the proportion of people getting an appointment within two days fell, while 25% of people who wanted an appointment more than two days ahead could not get one. They would call wanting an appointment for the following week and be told, “You can only get an appointment by calling less than 48 hours in advance.” But do not take it from me. This morning—

[Mr Jamie Reed (Copeland) (Lab)]

Nobody takes it from you.

[Mr Hunt]

Well, the hon. Gentleman should listen to the Royal College of General Practitioners if he does not want to take it from me. This morning, its chair, Dr Maureen Baker, said that Labour’s

“proposal to bring back the 48-hour target for GPs is an ill-thought out, knee-jerk response to a long-term problem.”

Unlike Labour, we listen and act when doctors tell us that Government targets are harming patient care.

Rare Diseases

Jamie Reed Excerpts

Tuesday 17th December 2013 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

Thank you, Mr Bayley; it is a great pleasure to speak under your chairmanship again. It is a huge privilege to follow the hon. Member for Foyle (Mark Durkan), who made an incredibly telling contribution to the debate as usual. He is one of the few hon. Members—I hope that he does not mind my saying this—that it is worth staying in a debate to listen to, and he always has been. There were also tremendous contributions from my hon. Friends the Members for Poplar and Limehouse (Jim Fitzpatrick), for Plymouth, Moor View (Alison Seabeck) and for Blackley and Broughton (Graham Stringer) and an incredibly insightful and welcome contribution from the hon. Member for Wealden (Charles Hendry), who reminded us yet again of what a genuine loss he is to the Treasury Bench.

I thank the hon. Member for Strangford (Jim Shannon), who spoke in a health debate in this Chamber only a fortnight ago. I commented then that his record in contributing to health debates in this Chamber is, in my experience, unrivalled—at least, he is always here when I am here. For those past contributions, for his speech today and for securing this very important debate, I cannot commend him enough.

Figures provided by Rare Disease UK show that one in 17 people will be affected by a rare disease at some point in their life. That equates to about 3.5 million people. As we have heard, three quarters of those affected by rare diseases are children and, tragically, almost one third of those children will die before their fifth birthday. As a father of four children, I can add no words to underline the stark brutality of that statistic. My heart goes out to all the families who have faced such a shocking loss.

The term “rare diseases” refers to more than 6,000 different conditions that can affect the young or old and have an impact on physical or mental health. These can be life-threatening, debilitating diseases, but the term can also refer to manageable conditions.

The very definition of rare diseases, and how these are manifested in the statistics that I have given and that we have heard from other hon. Members, illustrate the fundamental issues that arise when we try to establish a coherent, comprehensive and useful long-term strategy through which to deal with the problems that they present. Some rare diseases will be very similar and advancements in medical sciences and research in one area can greatly benefit another, but some classes of diseases can be extremely different from others and the treatments for those can be wildly different, not sharing any empirical research base. As we have heard, economies of scale are often hard, if not impossible, to find.

That huge difference in dealing with each disease highlights a problem in trying to gear the system with the tools and resources necessary to make advances. With limited resources, any improvement in one area of research can sometimes be at the expense of another. These are difficult calculations and choices. Research and development must be rewarded. Certainty and predictability of funding for this work are essential. Some research—potentially a good deal—will yield no tangible or quick benefit at all. Supply chains, researchers and research and development environments must be identified, supported, grown and nurtured. The loudest voices will not always be the most deserving.

These are invidious choices. Can the Minister explain the Government’s priorities in this regard? How will Government ensure that the right balance is struck between all these competing pressures, and can the Minister tell us what criteria are used by Government to decide how and which areas of research are prioritised?

In 2009, before the last general election, the Labour Government set in motion a UK strategy following the adoption of a recommendation from the European Union in which member states were required to commit to better research and more resources for tackling rare disease. I think that all hon. Members on both sides of the Chamber agree that that was an important step.

It is now just a few weeks since the current Government published the UK plan for rare diseases. We welcome that plan, but I am struck by some of the apparent contradictions between what the Government say they want to do and what they are actually doing. The Minister knows full well that I respect him significantly. We will be spending a lot of time together in Committee on the Care Bill next year, and I hope that we can perhaps establish a precedent and resolve those contradictions today.

In October this year, the specialised services commissioning innovation fund was scrapped. That fund was set up, amid great fanfare, just two months earlier, with the promise that it would save lives and help patients. The fund was intended to provide finances and resources needed to expedite the synthesis of hundreds of potential new treatments for rare diseases. The Prime Minister said that it was

“becoming ever more essential to get your products tested and adopted in the NHS much more quickly”

before warning that

“the newest innovations are often the lowest hanging fruit”

when savings need to be made.

As we have heard, the commissioning innovation fund represented a £50 million investment. The BBC reported that the fund was scrapped due to “financial pressures”. John Murray, the director of the Specialised Healthcare Alliance, called the decision

“bad news for people with rare and complex conditions”.

Will the Minister tell us what those financial pressures are? I could hazard a guess, but I think that we deserve to know.

Of course, this will not be the last time that the Prime Minister says one thing and does another, but can the Minister tell us how this decision affected the interests that I mentioned earlier? Has the Department assessed how this cancellation affected the research and development supply chain, its planning, its recruitment and its work streams? If such an assessment has not been undertaken, will he commit today to doing that? More importantly, has the Department undertaken any analysis of how this chaotic mess has affected the state of the art? Have any potential treatments failed to appear as a result of the funding cut? Have any treatment delivery work programmes been interrupted as a result? It is impossible to believe that the decision has had no effect. More importantly than anything else—I know that the Minister will want to answer this question—have the funding cut and its effects had any negative effect on patients living with rare diseases?

Just one month before the cut was announced, the all-party muscular dystrophy group warned that resources earmarked for rare disease medication had been absorbed by the overall NHS budget. Will the Minister explain how the removal of significant resources that were specifically earmarked for the research and development of new treatments for rare diseases fits with the Government’s stated aims?

Let me move on to the strategy. No one would disagree that there is a need for a co-ordinated effort from all the countries in the UK when tackling the issues before us. I would be grateful if the Minister could explain, when he responds, how the new fragmented system of commissioning of services in England will be able easily to co-ordinate the commissioning of research and the commissioning of what are often expensive treatments for rare diseases and, as we have heard, orphan and ultra-orphan conditions with the NHS in Scotland, Wales and Northern Ireland. Where is the guiding mind with which to achieve economies of scale and critical mass in research, which we know is necessary for these conditions?

It is clear that NHS England has a leading role to play in ensuring that the new strategy is implemented and implemented well. The benefits of a national body taking a lead on that are plentiful, but how does that fit with the idea of creating local areas of expertise, such as the centre at Newcastle university and the centres elsewhere in the country, to steer innovation? Is the driving force behind innovation and new treatments coming from NHS England or from experts on the ground, and how will that work in practice? Of course we need to allow innovators to flourish, but we also need to co-ordinate. Where does the responsibility for that co-ordination rest?

That brings me to my final point. As in any debate on matters relating to health issues, we must always focus on the patient. If patients are not seeing improvements in their care, or they do not experience any easing of the symptoms associated with their disease, the Government —any Government—will have failed. Innovations are meaningless if the patients who rely on them see no benefits. Without the resources to back them up, strategies are little more than meaningless words. For any of us to claim success, patient access to treatments must improve. Many groups, as we have heard, are calling for a form of adaptive licensing to be implemented with regard to treatments for rare diseases. Have the Minister or any of his officials had any contact with, made representations to or received representations from the Medicines and Healthcare products Regulatory Agency with regard to adaptive drug licensing for treatments of rare diseases?

Access to treatments raises several issues from the perspectives of the patient and the manufacturer. First, bringing drugs to market is difficult and expensive. Encouraging drug companies to manufacture drugs and treatments that will benefit a relatively small number of patients is an important and challenging task. In the case of motor neurone disease, for example, no new drugs for the treatment of the disease have been approved since riluzole more than 20 years ago.

We must always ensure that drugs brought to the market are safe and effective. That means that even if the new UK strategy is effective in encouraging greater innovation in the field for developing treatments for rare diseases, those treatments will not be available to help patients for several years. That is not a problem that has arisen solely under the current Government—nothing could be further from the truth—but it is a difficult, sensitive issue. To that end, what are the Government doing to ensure that new treatments are available to improve the quality of life for patients with rare diseases as soon as possible?

From the patient’s perspective, the issue is often cost. Prescriptions for those with rare diseases can amount to a significant financial burden. The previous Government put in place a framework that would have resulted in those with long-term conditions becoming exempt from prescription charges. Can the Minister explain why the coalition Government chose to scrap that? Enabling greater access to treatment is essential, and I hope that the Minister can explain why that has not been given more prominence in the strategy.

As I have said, rare diseases affect millions of people. The impact on sufferers and their families is immense, so the cost of getting the strategy wrong is high. More importantly, no matter how difficult it is and whatever our political allegiances, we are morally obliged to get this right. When the Minister gets to his feet, I hope he can give those people some confidence and help to resolve the contradictions I have outlined. Finally, if the Government can produce a coherent, integrated and effective approach to resolve the problems that they seem to have caused, and to progress those issues in a meaningful and timely manner, they will have my support and that of my colleagues.

Dermatology Funding

Jamie Reed Excerpts

Wednesday 4th December 2013 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

As always, Mr Turner, it is a pleasure to speak under your chairmanship. I extend my sincere thanks to the hon. Member for Gainsborough (Sir Edward Leigh). I understand that dermatology is extremely close to his heart, and the personal testimony that he shared with the House today was a frank and honest account of what many of our constituents live with daily.

I can scarcely remember a health debate in this place when the hon. Member for Strangford (Jim Shannon) has not been present and made a tremendous contribution. He did so again today, as did my hon. Friend the Member for West Lancashire (Rosie Cooper) and all hon. Members. If only the House could speak with such unanimity of purpose on other issues. The chairman of the all-party group on skin, the hon. Member for Mole Valley (Sir Paul Beresford), also made a telling contribution.

This might be the first time I have debated with the hon. Member for Gainsborough. I was supposed to have debated religious freedom with him at the Oxford Union in 2005 when I was a young Back Bencher, but under pressure from the Whips, I was unable to attend, so we will never know whether that exchange would have been contentious. However, I am delighted to debate the issue before us today.

“Dermatology” is a wide-ranging umbrella word covering more than 2,000 conditions of varying severity, all of which have a detrimental impact on the quality of life of those who are affected. “Cancer” is also a wide-ranging word denoting many different types, including basal cell carcinoma, squamous cell carcinoma, malignant melanoma and others such as Kaposi’s sarcoma and cutaneous T-cell lymphoma. Dermatology also covers skin rashes, skin infections and acne. Acne and skin rashes may not seem to be serious medical issues and do not often cause such serious complications as other skin conditions may do, but they are far from trivial, as we have heard, and may have a huge impact on the psychological well-being of the individuals who suffer from them.

The wide-ranging nature of dermatological practice means that episodes of treatment for conditions are extremely common. Skin cancer is one of the most common cancers in the world, as we have heard, and the NHS estimates that there are around 100,000 new cases of non-melanoma skin cancer in the UK each and every year. Thankfully, through excellent research and brilliant work by professionals and charities alike, skin cancer is becoming more and more treatable, but it is not “job done” and we must continue to strive for even better patient outcomes. I am sure that all hon. Members agree.

Skin diseases represent more than one third of diseases in children. One in five children in the UK have eczema. The British Association of Dermatologists, in its recent evidence to the Select Committee on Health, stated that children with serious skin conditions have their quality of life impaired to the same extent as those with chronic illnesses such as epilepsy, renal disease and diabetes.

Acne is a very common skin disease and affects many people. It is often trivialised as a passing phase for teenagers, but that is not the case and it can continue throughout their 20s, 30s and even 40s. The scarring left by acne is permanent and may have lasting effects on the psychological well-being of those who are affected. The British Association of Dermatologists says that it may have a major impact not just on someone’s relationships, but on their employment prospects throughout their life.

In this very Chamber yesterday afternoon, hon. Members debated the side effects of a drug, Roaccutane, used to treat acne. It is very effective in clearing up acne and is often prescribed to those who suffer the condition. It can be prescribed only by a specialist dermatologist because of its associated side effects, which, it is said, can range from relatively minor issues such as dry lips and chapped skin to serious mental health problems linked to depression and suicidal thoughts, as well as physical conditions such as diabetes and kidney problems.

When a significant number of people rely on such treatment to improve their quality of life, Government of all colours must give a commitment properly to fund research and development for new treatments. Many thousands of people rely on drugs such as Roaccutane and face the many risks associated with them. We must commit to developing new and safer drugs. Will the Minister give that commitment today? Will the Government help to facilitate the development of new medicines and new treatments for these conditions?

In 2009, the previous Labour Government legislated to introduce a ban on under-18s using sunbeds. That ban was an important step in protecting people of all ages from what can be harmful tanning practices. Will the Minister, who is responsible for public health, tell us what steps she is taking to increase awareness of the risks of using sunbeds? I certainly hope that she will retain the previous Government’s focus on the issue.

Other skin complaints have an impact on many millions of people in the UK and continued work is essential for progress to be made. I again thank the hon. Member for Gainsborough for securing this debate because at a time when funding and commissioning in the NHS have been thrown into turmoil—some clinical commissioning groups will have their funding slashed in the next couple of days—it is crucial that treatments and research are properly funded.

The funding of dermatology services in the NHS has been made ever more complex by the Health and Social Care Act 2013 with some treatments now being commissioned by NHS England on a national scale and others being left to local clinical commissioning groups, resulting in a fragmentation of services and a poorer experience for patients. The British Association of Dermatologists said:

“Provision of the type of care affected people need is under resourced, fragmented and of variable quality in terms of manpower and facilities. This is exacerbated by poor teaching and training of dermatology in medical schools and general practice, and underfunding of relevant research.”

These very serious concerns have been raised by a well-respected charity with unparalleled expertise in this area. Will the Minister tell us whether they have been raised by anyone else with her Department, and what action the Government are taking to tackle them?

The resources available for dermatological purposes are majorly overstretched. It is estimated that skin conditions result in 13 million consultations each year in general practice—I think we heard that figure earlier. If we had the pro rata equivalent of dermatology consultants in Germany, France, the USA and elsewhere, we would need almost 10 times as many as we have currently. Will the Minister also tell us whether there are recruitment plans in place to ensure that this highly specialised discipline is adequately catered for throughout the national health service? Not only is access to dermatological expertise in the UK subject to a postcode lottery in terms of quality, but the resources and the necessary work force are simply not there to care for the patients who rely on those services.

We have heard many testimonies today, and not just those of hon. Members here. When hon. Members speak of their own circumstances and difficulties, we achieve a better quality of debate and tend to edge towards better policy outcomes. In the light of the testimonies we have heard today and of what our constituents, patient groups, charities and professionals tell us, it is clear that the evidence points to a specialism under severe strain. It is underfunded, understaffed, under-resourced and, as a result, under immense pressure. The profession’s staffing levels are clearly a major problem.

[Sir Paul Beresford]

The biggest problem is education. It takes a very long time to give someone expertise, particularly in this area with around 2,000 diseases or variations of them. Will the hon. Gentleman think carefully and recognise that any unfilled consultant place goes right back to a lack of education under his Government?

[Mr Reed]

I am grateful for that intervention. I make the point repeatedly every time hospital doctor statistics are mentioned by Ministers. I absolutely recognise the hon. Gentleman’s point and welcome his making it: he is absolutely right to say that education is surely at the core of the problem.

Staffing levels in the profession are clearly a major problem. Will the Minister give an assurance today that those who need the services of a specialist dermatologist will have access to them? If not imminently, when? Should the Government bring forward effective proposals, I give the Minister the assurance that they will have the Opposition’s support. Where the Minister cannot answer my concerns, I would appreciate a written reply.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 26th November 2013 Commons Chamber

[Mr Hunt]

As ever, my hon. Friend speaks very wisely about this subject. In his review of A and E services, which was published a couple of weeks ago, Professor Keogh said that paramedics could deal with 50% of 999 calls on the spot, without taking people to hospital. I think that there is a big role for ambulance services that are prepared to upskill. It is also important for us to ensure that they have the necessary information. One of the main changes that we intend to make next year will ensure that they have access to the GP records of the people whom they pick up, so that they can give those people the care that they need in their own homes.

[Mr Jamie Reed (Copeland) (Lab)]

The president of the College of Emergency Medicine has said that the Government’s reorganisation has made A and E recruitment worse; the chief executive of the NHS Confederation has said that A and E pressures have been compounded by three years of structural reforms; yesterday, we learnt that the number of nurses choosing to leave their profession had jumped by more than one quarter under this Government; and the Health Secretary himself admits he is worried by the fall in nurse numbers on this Prime Minister’s watch. I hope he listens carefully so that he can answer precisely: will he today give the House a guarantee that every A and E in the country will have enough nurses this winter?

[Mr Hunt]

Will the hon. Gentleman think about what he has said? He said he was against a reorganisation that got rid of 8,000 managers and put 6,600 doctors on to the front line. That is why we are doing nearly a million more operations every year and why waiting times for longer waits are shorter than they were under Labour. We are recruiting more doctors because we are putting money into the front line.

Pharmacies and the NHS

Jamie Reed Excerpts

Wednesday 20th November 2013 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

I thank the hon. Member for Ipswich (Ben Gummer) for bringing this debate to the whole of Parliament today—we often forget that Westminster Hall is Parliament. Issues of the utmost importance have been raised regarding pharmacies and the pharmaceutical industry, and shocking allegations have been made. The House of Commons has a duty to learn the facts and to act accordingly, whether by expanding the role of the pharmaceutical industry and pharmacies or by remedying any wrongdoing in existing price structures.

The hon. Gentleman is right to extol the virtues of community pharmacies for many reasons and I will touch on them in due course. He is right to open up an extremely broad debate, and we have touched on its potential breadth. We need to explore the scandal of what The Daily Telegraph called the drug price racket. I can understand a patient missing an appointment which regrettably wastes the time of clinicians and costs the NHS money. I can understand the worried well occupying GPs’ time when they have no real need to do so. I can understand patients not taking a full course of antibiotics or keeping the medicine cabinet at home filled with prescribed drugs for which they have no real need. All those behaviours cost the NHS money, but individuals will not be aware of the costs they are incurring for the NHS, nor do they intend to divert scarce resources. There is no deliberate disregard for the NHS, for other patients, or for the taxpayer in these instances, but clearly more work needs to be done to reduce these costs.

Let us consider one of the central allegations before us today—the drug price racket. Some private interests—pharmaceutical companies and pharmacies—are knowingly and deliberately committing fraud. We live in a world that is very different from the pre-crisis world that existed before the global economic crash. We live in an era that is set to be defined by austerity, and public finances are still in a parlous state. In society at large, not just in Parliament and across the political spectrum, but at the school gate, in the high street, and in the boardroom, it is understood that public money is valuable and scarce, and that it should be spent wisely and prudently.

Drug price fraud is happening in our most valued public service at a time of economic crisis, and it has occurred by design and not accident. Those responsible are not simply undertaking a grotesque financial deceit of patients and taxpayers, but are probably depriving the NHS of resources that could and should be used for patient care. To take the point to its logical conclusion, these parties have fraudulently diverted from the NHS resources that could have saved lives.

A few years ago, the Prime Minister referred to lobbying as

“the next big scandal waiting to happen”.

We now know that he was wrong. Shamefully, in recent months and again today, we may have unearthed the next big scandal that the Prime Minister warned of. My hon. Friend the Member for Islington South and Finsbury (Emily Thornberry), the shadow Attorney-General, wrote to the Serious Fraud Office about the drug price racket in July:

“You will be aware that the Telegraph has brought to light extremely serious allegations that pharmaceutical companies in collusion with chemists have been rigging the market in prescription drugs that are generally not covered by NHS price regulations…If the allegations are substantiated it will mean that the NHS has been systematically overcharged hundreds of millions of pounds. This would represent a colossal fraud on the taxpayer. An offence of that magnitude would surely warrant the attention of the Serious Fraud Office and not just an internal inquiry of the counter-fraud department of the NHS. I would be grateful if you could let me know what steps, if any, the SFO intends to take on what appears to be prima facie evidence of conspiracy to defraud.”

David Green, CB QC, of the Serious Fraud Office responded on July 19 and concluded:

“The SFO are working closely with NHS Protect and the allegations that have been made are the subject of careful consideration. If, having considered the available information, evidence of fraud is identified, further consideration will be given as to which agency is the most appropriate to investigate these matters.”

My hon. Friend has received no other communications from the Serious Fraud Office in the intervening period, and I have today written to Mr Green asking what progress the SFO has made with its considerations. I have also written to the Chairs of the Select Committee on Health and of the Public Accounts Committee to alert them to these issues with a view to their undertaking their own inquiries.

The Daily Telegraph should be congratulated on its investigative journalism. There is absolute consent on that. It has provided a great service to the public and the NHS. We should be cognisant of the awful parallel that it rightly exposed: the parliamentary expenses scandal. That was another truly remarkable service entirely within the public interest. It is an apt comparison. The abuse of public money represented by the parliamentary expenses scandal resulted in the jailing of Members of Parliament and of peers. Shocking as that was to the public and seismic as it was to the political establishment, the fraud and false accounting pales into insignificance in monetary terms compared with the sheer scale of the embezzlement that is now being alleged in the drug price racket.

I repeat that this is not just a get-rich-quick caper, but the knowing and deliberate abuse of public money that should have been used to save lives. That is the scale of the allegations. We need the pharmaceutical industry, and we need pharmacies and pharmacists. We need the pharmaceutical industry to help to deliver our national life sciences strategy. We need it to help to underpin academia so that we can continue to break new ground in medicine research and to develop new treatments, new drugs and new medicines. We need to recognise and reward the public good that that represents.

We need to expand the role of community pharmacies if we are better to deliver a more integrated, efficient and effective health care system. We need to make better use of the 1.6 million interactions that will take place today between the population in England alone and pharmacies. The average person visits the pharmacist 14 times a year—more than once a month—and we need to capture better and utilise those interactions for improved individual and public health. Of that, there is absolutely no doubt.

However, for us to do any of that, we need to be able to trust the motives and actions of all the groups involved. Let me say to the pharmacists and pharmaceutical companies that are doing no wrong—clearly, that is the overwhelming majority—that I regret the distress that this issue will inevitably cause them, but it is essential for all of us involved with the sector to leave no stone unturned in establishing the facts, if we are to be able to maintain the faith and trust of the public. I know that the Minister, for whom I have genuine respect, will be as appalled by the revelations as anybody else, and I hope that he will be able to answer the questions that I put to him today. If not, I would appreciate a written reply.

The Daily Telegraph describes the Government announcement of drug-pricing caps in 2011 as “a ‘hallelujah’ moment” that has led to significant fraud. Does the Minister consider that that is the case, and will he investigate why it is that those disposed to committing fraud are using the announcement as the basis on which they are able to defraud the NHS? On 20 July, the Secretary of State for Health told The Daily Telegraph that he had ordered an investigation into the allegations. Will the Minister tell us where those investigations are up to? What has been investigated? What is the scope of the investigation? When will the investigation be completed? The Minister will note that Serco has been made to repay £24 million to the Treasury for financial wrongdoing in the course of delivering public services. Will the Minister support repayments to the NHS if price fraud allegations are proven?

Finally, we all want to develop the role of community pharmacies. We all want to help our pharmaceutical industry to thrive and innovate, and we all have a duty to spend public money effectively, properly and honestly. I look forward to the Minister’s reply.

--- Later in debate ---

[Dr Poulter]

On how drugs are accessed, one of the problems—this was why the cancer drugs fund was set up—was that some people, as the hon. Gentleman rightly outlined, had been receiving drugs in other countries for many years, but we in this country were a little slower to respond to some of those innovations. But of course we need to ensure that, whatever fund we set up for providing medications, those medications are shown to be effective and there is an evidence base for them. However we do things, there will always be new treatments on the horizon that we would like to get through to people more quickly, and we need to ensure that those treatments are always evidence-based. I think that we can be pleased that the cancer drugs fund has made a significant difference by providing treatments in a more effective and much quicker manner, but if the hon. Gentleman would like to discus the matter further, I would be very happy to see him and talk it through in more detail.

I think that it would be useful for me, picking up on the points raised early in the debate, to outline the processes involved in opening a pharmacy. Anyone can open a pharmacy anywhere, subject to the premises being registered with the General Pharmaceutical Council, when the owner’s service model includes the sale or supply of pharmacy medicines or prescription-only medicines against prescriptions from that pharmacy. However, there are extra criteria for providing NHS pharmaceutical services. Anyone wanting to provide NHS pharmaceutical services is required to apply to the NHS to be included on a pharmaceutical list.

Before September 2012, there were control of entry requirements. The NHS (Pharmaceutical Services) Regulations 2005 determined whether a pharmaceutical contractor could provide NHS pharmaceutical services. In England, no new contractor could be entered on to a PCT pharmaceutical list unless it was “necessary or expedient” to secure the adequate provision of pharmaceutical services locally. That was the control of entry test. If a new service provider was judged neither necessary nor expedient, the NHS, or the PCT in question, had to refuse the application. There were rights of appeal to the family health services appeal unit, which is run by the NHS Litigation Authority. That was available if there was a concern.

Part of the reason for the strict criteria relates to the pricing mechanism and how pharmacists are paid, which I will come to later. Obviously, the local health economy is an issue, and pharmacists are not paid just for the number of prescriptions that they provide; they are also given a baseline fee. When we have a publicly funded health service and we need to ensure that need and demand are aligned, it is important that we look at this in the round. I sympathise very strongly with the points about the need to de-bureaucratise the NHS where possible—those were good points well made—but we also have to recognise that this is not just about arbitrary mapping; it is about aligning need and demand for a service within the pricing framework in place. That is not just about the number of prescriptions that are provided; it is a much more complex mechanism. I will come to those points later.

[Mr Jamie Reed]

I am grateful to the Minister for giving way; he is being typically generous. On pharmacy numbers, does he think that we have too few or too many, or is the number about right?

[Dr Poulter]

The hon. Gentleman will be aware that under the previous Government, the Office of Fair Trading did a review and recommended total deregulation of the pharmacy industry. That was in 2003. The previous Government put in place a strong package of reforms to recognise that we need some degree of what my hon. Friend the Member for Ipswich would call market forces but I would probably refer to more as patient choice. We need to support patient choice as much as we can, but within the context in which we have a publicly funded service that needs to be regulated. It is a health care service; it is treating and looking after patients. We need not only to secure good value for the taxpayer, as part of how we fund that service, but to ensure that there is independent regulation and some regulation by Government as well. That is about ensuring that we have the highest-quality services available.

Given that I am running short of time, I will write to my hon. Friend or I would be happy to meet him—whichever he prefers—to talk through the specifics of the context of mapping out a local needs assessment, which is now carried out by health and wellbeing boards. That is a pharmaceutical needs assessment. I am happy to talk through with him in detail how that interrelates with the pricing mechanism and how we need to ensure that the two are kept in balance in the context of the conversation that the hon. Member for Copeland and I have just had.

It is worth highlighting the fact that pharmacists and pharmacies play an increasingly important role in our NHS. Many pharmacies now provide additional services. They are contracted to do so outside those pricing frameworks. That is done locally by clinical commissioning groups. Health and wellbeing boards or local authorities can also contract pharmacists to provide services. As my hon. Friend will be aware, responsibility for public health—40% of that budget—has now passed to local authorities. Given that public health responsibility, there is a strong role for local authorities in commissioning local health care services if they feel that that would be in the interests of the local population.

Under the Health and Social Care Act 2012, other providers of health care services, outside the traditional framework of GP and community services and secondary care, were given more of an opportunity to put themselves forward and offer to provide valuable services. This is a real opportunity for pharmacists to bring forward to CCGs what they do and to make the case that they can provide many services in a way that will be focused on primary prevention and that will save the local health economy money but also deliver better care. The track record of pharmacies and pharmacists is very good in delivering community care—whether looking after people with diabetes or providing simple services for other patient groups. Under the 2012 Act, there is now a much greater opportunity for pharmacists to come forward and put in offers, within an integrated health service, and make the case about how they can provide services. They may be able to do that in a much better way, as they are often embedded in their communities, than some of the traditional mechanisms in the NHS.

I hope that my hon. Friend will be reassured by the fact that the legislation that we have put in place as a Government has given pharmacists a much greater opportunity to contribute to their local health economy, not just in economic terms and in terms of the economic benefits that that will bring for pharmacists, but by delivering the very good care that we know they can deliver.

We have had a wide-ranging debate. I think that we can be sure that there is in place a robust pricing mechanism, which on the whole works very well and secures good value for the taxpayer and for local patients, but there are issues about certain items that pharmacists can prescribe, and we do need to look into them. There is a role for NHS Protect in doing that. We value the innovation that pharmacists provide locally in delivering better—higher-quality—patient-centred care, and the 2012 Act has put us in a better place to support local pharmacists in delivering the kind of patient care that we all want to see in our local communities.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Mr Hunt]

Obviously, the suggestions my hon. Friend makes are extremely serious. If she lets me have a copy of all the things she is directly concerned about, I will look into it with the greatest priority.

[Mr Jamie Reed (Copeland) (Lab)]

With regard to openness and transparency, the Secretary of State’s failure to extend the Freedom of Information Act to private providers delivering NHS services is fostering a culture of secrecy. As he forces clinical commissioning groups to tender more services to the private sector, and if he truly believes in openness and the independence of health regulators, will he follow the clear advice from Monitor and extend FOI legislation to private providers, or is he content to allow them to continue to withhold information from patients?

[Mr Hunt]

When it comes to transparency about care, there should be an absolute level playing field between private providers and NHS providers. To answer the hon. Gentleman’s question on regulators, what this Government are going to do, Mr Speaker, is ensure that the Care Quality Commission has statutory independence so that no Government can ever try to interfere with the processes of reporting poor care.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 16th July 2013 Commons Chamber

[Dr Poulter]

I thank my hon. Friend for that question and his diligent local campaigning on the issue. He is absolutely right that the Marsh review highlighted a failure of leadership at the trust and in the trust board as well as a disconnect between the front-line staff, who work effectively and well, and that leadership. We now have a new team at the top and we must give it time to respond to the Marsh report and put in place the right measures. I believe that efficiencies can be made at a back office and regional level, but there is a good case for ensuring that more localised data are presented about ambulance response times countywide.

[Mr Jamie Reed (Copeland) (Lab)]

The East of England ambulance service is failing to meet the needs of patients on the Secretary of State’s watch. The hon. Member for Waveney (Peter Aldous) has said:

“This did not used to happen.”—[Official Report, 25 June 2013; Vol. 565, c. 19WH.]

The hon. Member for Witham (Priti Patel) has said:

“Lives are put at risk.”—[Official Report, 25 June 2013; Vol. 565, c. 2WH.]

Does the Minister agree with those Members, and does he believe that clinical outcomes for patients in the east of England have been affected by the collapsing service over which he has presided?

[Dr Poulter]

The hon. Gentleman would do well to heed the Marsh review before asking his questions, because it highlights a fundamental, systemic failure of leadership at the ambulance trust which dates back to the last Government’s time in office. As we know, the number of NHS managers in the east of England rose by 86.4% under the last Government, but there was a lack of connection between the managers of the trust and front-line staff. Government Members are promoting clinical leadership, and trusting clinicians and front-line paramedics to deliver a much better ambulance service. I suggest that the hon. Gentleman should prepare his questions more thoroughly in future, and should read the Marsh review before he asks them.

Health Services (North-West)

Jamie Reed Excerpts

Thursday 11th July 2013 Commons Chamber

[Mr Hunt]

With regard to pressures on A and E, we are working very hard with A and Es across the country to make sure that they learn the lessons from what happened last winter and are properly prepared for this winter. Those discussions will include the A and E departments that serve his constituents. He will know that any decisions about service changes or reconfigurations are a matter for the local NHS; they come to me only if they are referred to me following a formal proposal by a local health overview and scrutiny committee, and that has not happened in this case.

[Mr Jamie Reed (Copeland) (Lab)]

Like other Members across the House—I speak particularly on behalf of my hon. Friend the Member for Barrow and Furness (John Woodcock)—I condemn the poltroonish way in which this statement has been handled. Will the Secretary of State concede that instability is corroding health services right across Cumbria? Will he guarantee that when North Cumbria University Hospitals Trust is acquired by Northumbria Trust this decision will not be yet again reconsidered?

[Mr Hunt]

Today is a sitting Thursday and we have followed parliamentary procedures. I am doing everything I can to help the hon. Member for Stretford and Urmston (Kate Green) to have as much engagement as she needs given that she was not able to be here at the start of the process. With regard to stability, the hon. Gentleman cannot have it both ways. If he wants stability and wants decisions to be taken decisively, then he has to support the Government when they take difficult decisions like today’s and not be opportunistic, in the way that the shadow Secretary of State was.

East of England Ambulance Service

Jamie Reed Excerpts

Tuesday 25th June 2013 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to speak under your chairmanship again, Mr Howarth. I intend to be fairly brief, to allow the Minister to answer many of the questions that have been put to her by colleagues. I extend my thanks to the hon. Member for Witham (Priti Patel) for securing this debate, which is timely and important, as today’s attendance illustrates.

Along with other Members, the hon. Lady is right to praise the commitment and dedication of front-line staff. Their vocational example illustrates the best of everything that there is to say about the NHS. I am sure that all Members are aware of cases that have arisen through poor ambulance service performance. Members have spoken today, sometimes in shocking detail, about examples of people who deserve better care from this ambulance service, and the debate is needed because of those cases. Indeed, in opening the debate, the hon. Lady said that, right now, lives are being put at risk.

The East of England Ambulance Service NHS Trust covers more than 7,500 square miles and deals with more than half a million emergency calls a year. That undoubtedly presents challenges, but there can be no excuse for less-than-excellent service. As the hon. Member for North West Norfolk (Mr Bellingham) said, second best is not good enough, and I absolutely endorse that.

Dr Anthony Marsh’s governance review, which was published earlier this month, is deeply worrying. He commented that the trust’s board and senior management team have developed a sense of helplessness. That is exceptionally disturbing, and it needs to be rectified. He has said that internal and external communications need to improve without delay, but furthermore, performance needs to improve.

Comparing December 2011 with December 2012, the average handover time—the time between an ambulance arriving at a hospital and the hospital taking responsibility for the patient—increased by more than three minutes to more than 20 minutes a patient. The number of patients waiting more than 30 minutes increased by 75%, from around 2,000 to more than 3,500. Even more worryingly, the wait for patients does not start there; the number of ambulances responding to the most serious call-outs within eight minutes was fewer than 70%.

Those numbers are shocking enough, but the figure that helps to demonstrate the worst type of patient experience is that, in December 2012, at least one patient waited in the back of an ambulance for more than six-and-a-half hours, and the hon. Member for Harlow (Robert Halfon) raised an even worse example. It is worrying how only a few numbers can paint such a vivid picture of a service that is clearly not working as it should for the patients who rely on it, and, as has been pointed out repeatedly, who pay for it as well.

I am heartened to learn that the trust recognises that its service has not been acceptable, and I welcome the turnaround plan that was released in late April. I ask the Minister to outline any discussions that she, or the Secretary of State for Health, has had with the trust that informed the plan and its implementation. Will she explain why, when the data that I have just given, as others have freely done today, are so easily accessible, nothing has been done previously to improve performance in the trust? I also ask her to provide the details of all efforts made by the Department to help the trust improve performance, when those began and what the results have been. We are seeing all aspects of emergency care services—whether ambulance trusts or accident and emergency departments—being driven into chaos too often of late. We have just endured the worst winter performance in A and E for years, and the warnings are that next winter’s will be even worse.

It cannot be a coincidence that during December 2012—the month to which my previous figures relate—hospitals in the east of England region missed their A and E target more often than not, and almost one in 10 patients had to wait for more than four hours in A and E before receiving treatment. Pressures in one part of the service can manifest in other places—as has often been said, A and E is the bellwether of NHS performance—and there is clearly a link between poor performance in ambulance services and the pressure so clearly apparent in A and E units around the country. When a patient needs emergency care, they are being made to wait at home, then wait in an ambulance, and then wait in a waiting room. When the Minister responds, I hope that she will offer some explanation for that poor performance. I hope that she will also outline any discussions that she has had with other ambulance trusts to ensure that those failings are not repeated elsewhere in the country.

Moving on to the personnel aspect of Dr Marsh’s report, he raised concerns about the rate of sickness absence in the trust. Alarm bells should be ringing that the level is so much higher than in other trusts. Did the Department of Health become aware of that, and if so, when did it become aware and what was done about it? In April, at the time of Dr Marsh’s governance review, the acting chief, Andrew Morgan, announced plans to recruit 350 staff. He denied a staffing crisis, but admitted that the leadership was not good enough. I think that that is an understatement, given that it was widely reported in May that the trust was offering financial incentives to staff to retire early or to leave the service. The trust spent almost £100,000 on those incentives, and it is now offering staff a £500 bonus if they refer a friend to join the trust. If it needs staff, it should not be offering incentives for staff to leave. What kind of recruitment programme is that, and how does that illustrate protection of the public purse? It is an incredibly worrying demonstration of the lack of communication and oversight within the trust. The position appears to be entirely incoherent.

Dr Marsh’s report put a great deal of emphasis on the existence of a real disconnect within the organisation. As he rightly outlined,

“It is the responsibility of the Board…to ensure the Governance arrangements and the plans for the Trust are appropriate and robust enough to keep risk as low as practicably possible”,

which includes ensuring that

“all patients receive the best treatment in a timely fashion.”

It is crucial that members of the board take responsibility for that and for patient care in a wider context. Has the Minister met the board recently to find a solution to the current organisational and personnel issues that are referred to in Dr Marsh’s report?

I have outlined the poor performance of the trust from only a few key indicators from data that are widely available. The Department needs to be robust in helping to address those issues, and I hope that the Minister gives the assurances that patients need and deserve. In her response, I hope that she tells the Chamber when she expects the problems with this ambulance trust to be resolved; what the Department is doing to assist the trust with its recovery; what additional expenditure, if any, that will require; and whether hospitals that are reliant on the trust can expect any additional support, financial or otherwise, owing to the avoidable operational pressures that the ambulance trust has placed upon them. Can she guarantee that the performance of the trust has not seriously affected clinical outcomes for patients in the local area? Based on today’s evidence, I would find that hard to accept. Can she give an assurance that, once the trust is operating acceptably, the Department will not allow this to happen again? Finally, when will patients in the east of England get the ambulance service that they deserve?

Care Quality Commission (Morecambe Bay Hospitals)

Jamie Reed Excerpts

Wednesday 19th June 2013 Commons Chamber

[Mr Hunt]

My hon. Friend has campaigned with great assiduity and distinction on this issue. The report about the culture of cover-ups and secrecy was the Francis report, and my job now is to do what is necessary to bring forward the change so that we move on and have a culture of openness and transparency. That means, yes, openness and transparency in this place and among Government Departments and regulators, but it also means creating a culture for front-line staff where they feel that they can raise concerns. We do not do that as well as we should, and it is even more important.

[Mr Jamie Reed (Copeland) (Lab)]

I share a great deal of the sentiments that the Secretary of State has expressed. He said at the Dispatch Box that the involvement of lay inspectors in the CQC was a problem, yet the Keogh review, which I comprehensively support, is involving significant numbers of lay inspectors. Does the Secretary of State agree with that approach? Is it the right or the wrong way forward?

[Mr Hunt]

As I understand it, the terms of reference, the way it is conducted and the timetable for the review happening at the moment are being set independently, but we should give every support to the people doing that review to make sure that they have access to the clinical expertise they need.