NHS Outsourcing and Privatisation
Jeremy Hunt Excerpts(6 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I welcome the opportunity of this debate to dispel some particularly pernicious myths.
May I say how much I enjoyed the shadow Health Secretary’s speech? If they had listened to his denunciation of privatisation and outsourcing, I think my children would have said that Alice in Wonderland has nothing on the Labour party when it comes to taking totally contradictory positions on an identical issue. My favourite thing was the stirring way in which he said, “What concerns me most is contracts handed out that are poor value for taxpayers,” after his Government left £80 billion-worth of PFI contracts for the NHS to pick up the pieces. That costs the NHS £2 billion every year—money that cannot be used for good patient care. He had lots of other gems and we will return to them during the course of this speech.
I want to start with the motion. I am afraid that it is a transparent attempt to set hares running about NHS privatisation that is not happening. He used the phrase “creeping toxic privatisation”, but the truth is that we know it is not happening and the Opposition know it is not happening. With all the pressures facing the NHS today, to scare staff and the public with fake news is breathtakingly irresponsible.
In the motion, the Opposition use the Humble Address mechanism to ask for the release of documents, knowing full well that it will fuel wild conspiracy theories if we refuse to release those documents, as we must for reasons that are nothing to do with the NHS, but to do with good governance. However, there is a flaw in their Machiavellian logic. When I asked officials for advice on what submissions we as Ministers hold on privatisation—this great swathe of secret plans that the Opposition constantly allege—this is the written advice that I got back: “Officials have, since the Humble Address was received, sought to find submissions about the privatisation of clinical or patient services within the period specified, but to this point none have been identified. Her Majesty’s Government has no plans to privatise the NHS.” That was the official advice, but don’t take it from me. The respected King’s Fund said in 2015 that
“claims of widespread privatisation are exaggerated.”
Another way in which the Labour party loves to try to scare the public is to deliberately muddle up privatisation and outsourcing, which of course are quite separate. I think the shadow Health Secretary knows that, going by some of his comments. What are the facts on outsourcing? The Prime Minister did indeed wax lyrical about the possibility of 40% of acute operations in the private sector being done under the NHS banner—not this Prime Minister, but Tony Blair in 2006. Had we followed Tony Blair’s advice, we would be spending nearly £2 billion more on outsourcing than we currently spend. The Secretary of State from that period also said quite openly, “We intend to use the private sector when it can bring expertise or resources to help improve services.” That is not me, but Alan Milburn in 2002.
And boy, did team Labour set about that outsourcing with enthusiasm: not just increasing the PFIs we have talked about and not just giving the first contract for an NHS acute hospital to the private sector in 2009—that was Andy Burnham—but increasing the amount spent on outsourcing by 50% in the last four years of that Government. [Interruption.] Fifty per cent. These are the facts. I know the hon. Member for Dewsbury (Paula Sherriff) wants to do the fake news and the scare stories, but let us just listen to the facts. Let us talk about what has been happening under this Government. In my first year as Health Secretary, the proportion going to the independent sector went up by 0.6%. In the second year it was 1.2%, in the third year it was 0.4% and last year it was 0%.
I need to correct the record. During Prime Minister’s questions, I hurriedly passed the Prime Minister a note about the increase in Wales in the use of the independent sector. She said at the Dispatch Box that in Wales it had gone up last year by 0.8%. I need to correct that, because in fact it went up by 1.2%—50% more than I thought. Wales, where Labour is in government, is racing ahead. In fact, in pounds spent, the use of the independent sector last year in Wales went up by a third. What that shows is not just that these allegations are nonsense, but that Labour knows they are nonsense. If there was any truth to them they would not be increasing outsourcing in Wales by one third at the same time as branding it as verging on the criminal in England. With the huge pressures facing the NHS and immense efforts by frontline staff to cope with flu, winter and an ageing population, can the Labour party really be trusted with the NHS when it spends its time putting out fake news?
Unlike Labour, we do not believe that the NHS should close its ears to innovation in other sectors or other countries. We want the NHS to be the best in the world and there are things to learn from others that will help patients and help the NHS. Sometimes those innovations will even come—dare I say it?—from America. But to copy global best practice from one small part of what is happening in America does not mean that we want to copy its system itself, which I think, and I think most people in this House think, is an affront to that great country, with poor outcomes, lack of coverage and high cost.
To stop ideology trumping the needs of patients, the Conservative-led Government in 2012 legislated to stop politicians choosing whether to boost the private or the public sector, formally and legally giving that decision to clinicians who run clinical commissioning groups. I will tell the House why we did that. What would happen if we followed what the shadow Chancellor advocated last year, when he said
“we will reverse Tory privatisation by renationalising the NHS”
is that 120,000 people would have to wait longer for operations on their hips, knees and for other elective surgery. The price of Labour ideology, putting ideology before patients, would be nearly 200 people waiting longer in every constituency in this House.
Julian Knight (Solihull) (Con)
The Secretary of State touches on a point that is very pertinent in my constituency. I met a former police officer who had an NHS operation on his hip. The operation went wrong, so the local NHS trust paid privately for the officer to have the operation done correctly. Does that not show that at times it can be a very good thing to involve the private sector? The key is that the NHS is free at the point of need.
Karin Smyth (Bristol South) (Lab)
I am listening carefully to the Secretary of State’s comments on ideology and the Health and Social Care Act 2012. He will remember that I, in a CCG, was implementing the 2012 Act. Is he saying that he is proud of the Act and that it has worked out as intended?
Mr Hunt
As Chinese Premier Zhou Enlai said about the French revolution, it is too early to tell.
As my hon. Friend the Member for Solihull (Julian Knight) alluded to, there is one ideology that we will not compromise on: our belief that the NHS should be free at the point of use and available to all. And why will we not compromise on this? It is because, contrary to Labour’s creation myth about the NHS, it was a Conservative Health Minister, Sir Henry Willink, who first proposed it in 1944. Here are his words from 1944 announcing the setting up of the NHS:
“Whatever your income, if you want to use the service…there’ll be no charge for treatment. The National Health Service will include”—
[Interruption.] I know this is difficult for Labour Members, but let me tell them what the Conservatives said when we were setting up the NHS:
“The National Health Service will include family doctors”
and will
“cover any medicines you may need, specialist advice, and of course hospital treatment whatever the illness”.
Nye Bevan deserves great credit for delivering that Conservative dream, but let us be clear today that no party has a monopoly on compassion, and no party has a monopoly on our NHS. There are some other myths—
Jonathan Ashworth
I really do think the Secretary of State has some brass neck. The Tory party voted against the creation of the NHS 20-odd times. That is the reality of what happened in 1948, including on Third Reading in this House. It is a Labour creation.
Mr Hunt
As the shadow Health Secretary knows perfectly well, the way that this House works is that Oppositions often vote against the Government when they disagree with elements of a Bill, but that does not mean that they disagree with the principles of the Bill. I remember the hon. Gentleman’s party voting against the Care Act 2014. That does not mean that they disagreed with the principles behind it.
Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)
The circumstances around the recent collapse of Carillion have left Liverpool with an unfinished hospital. Negotiations with a potential new contractor are under way but may require ministerial involvement because of the involvement of other Departments. Will the Secretary of State give me an absolute assurance that he will do whatever he can within his power to ensure that that new hospital is completed as soon as possible?
Mr Hunt
I can give the hon. Lady that assurance. I am most grateful to her for raising that issue and reassure her that my hon. Friend the Minister of State responsible for hospitals was at the hospital on Friday, going into detail about how we make sure that there are no delays on that issue.
Jamie Stone
I thank the Secretary of State for giving way. On the issue of freedom of access and equality of access, would he at least concede that where there are issues of distance, rurality and remoteness of location, that is a challenge—although health is devolved to the Scottish Parliament—which means that it is not quite as free for some of my constituents as it is for people who live in Glasgow, Edinburgh or London?
Mr Hunt
The hon. Gentleman makes a fair point, which would be echoed by many Government Members who represent rural constituencies. There is a balance to be struck between the benefits of specialist surgery, where greater volumes of a particular procedure are done, leading to better outcomes for patients, and the trade-off that we make with travel times. I know that that is something that the local NHS, in all parts of the UK, thinks through very carefully.
There is another myth we always get from the Labour party that I think it is very important to dispel: the narrative about the NHS being in total decline. Let us be clear about the pressures facing the NHS. We had to deal with the financial crisis of 2008, which left this country’s coffers empty. We have had to deal with the fact that over the last seven years, we have had half a million more over-75s. We had to deal with a crisis of care at Mid Staffs, which turned out to be a problem affecting many other parts of the NHS.
Yes, it is true that we are missing some important targets at the moment, but let us not forget the extraordinary things that have been achieved despite that pressure, such as for cancer. We inherited some of the lowest cancer survival rates in western Europe. In 2010, only 10% of patients got intensity-modulated radiotherapy; that figure is now 44%. We have two new proton beam therapy machines—at the Christie and University College London Hospitals—and there are 7,000 people alive today who would not be had we stayed with the cancer survival rates of 2010. Every day, 168 more people start cancer treatment than did in 2010. This is a huge step forward.
On mental health, previously we had no national talking therapy service for people with anxiety and depression; today, 1,500 more people are starting or benefiting from talking therapy services every single day, and we have huge plans to extend mental health provision to 1 million more people.
Mr Hunt
No, I do not think it acceptable at all, but I would ask the hon. Lady to bear it in mind that we have 2,000 more paramedics than we did in 2010 and that we have invested in a huge amount of capital equipment for the ambulance services. Of course we need to do more, but, when she talks about A&E, she should recognise the achievements of many hospitals, including her own. Every day across the NHS—even over this difficult winter—2,500 more people are seen within four hours than were in 2010.
Labour seems to think that quality problems in the NHS started in 2010. I should point out that because of what we have done to deal with the problems of Mid Staffs, which happened on Labour’s watch, including through the new Care Quality Commission regime, 2.1 million more patients every year benefit from good or outstanding hospitals than did five years ago. A couple of weeks ago for the first time the majority of hospitals in the NHS were good or outstanding, which is a huge step forward and a huge tribute to NHS staff. That might be just one reason the Commonwealth Fund last year said that the NHS was the best healthcare system in the world. When Labour was in office, it was not even the best in Europe.
There is another reason to oppose the motion. It has nothing to do with health policy, but is a much bigger point of principle. After more than five years in this role, the one thing I have learned is that good policy can be made only through frank and open discussion between Ministers and officials. It will not surprise the House to know that Ministers are human, we make multiple mistakes—not me of course—and it is critical that the Secretary of State in charge of the largest health system in the world can get honest, high-quality advice, but the motion would fundamentally undermine that.
This is not a party political point. Many Labour Members have benefitted from such advice, and all of us would want Ministers of any party in power to benefit from such advice, regardless of whether we support the Government, yet the motion asks us to release not just that written advice from officials, which would have an enormous chilling effect, but notes of confidential discussions between Ministers and officials. In short, as my right hon. Friend the Member for Aylesbury (Mr Lidington) said only last week, it would undermine the safe space within which Ministers and civil servants consider all the options and weigh up the best approach. Officials must be able to give advice to Ministers in confidence. The candour of all involved would be seriously affected if there were any fear of those discussions being disclosed.
No Government of any party have ever operated in an environment where advice is sought one week and made public the next. Let us look back to what Andy Burnham said in 2007 when he as a Minister was asked to release information. His words were:
“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1191.]
Far from increasing the accountability of the Executive to the legislature, releasing such information would risk weakening it, as more and more discussions would end up taking place informally with no minutes taken at all.
Alex Chalk (Cheltenham) (Con)
Does my right hon. Friend agree that it would be completely inconsistent with the Freedom of Information Act—passed, by the way, by a Labour Government—which deliberately carved out an exemption for precisely these sorts of communications? It would be very odd—in fact, completely counterproductive—to turn that on its head.
Mr Hunt
My hon. Friend speaks extremely wisely. He is right: it would fundamentally weaken the ability of the Executive—which the Freedom of Information Act tried to protect—to make considered, thoughtful and wise decisions. Ultimately, that would put at risk the credibility of our democracy itself.
I think it fair to say that, despite my many faults as Health Secretary, I have pursued transparency in the NHS with greater vigour than has been the case previously. I passionately believe that in this House we must be accountable for the outcomes of all the decisions that we make, but all of us are mortal—all of us make mistakes—so if accountability is the watchword after a decision is made, thoughtfulness must be the watchword before it is made. Any measures that affect the honesty and frankness of the advice that Ministers receive would fundamentally reduce that thoughtfulness and reduce the effectiveness of our Government for the people whom they serve.
For those reasons—as well as because of all the ridiculous myths about the millions and privatisation—I have absolutely no hesitation in asking my right hon. and hon. Friends to vigorously and thoroughly oppose the motion.
Several hon. Members rose—
Oral Answers to Questions
Jeremy Hunt Excerpts(6 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mike Gapes (Ilford South) (Lab/Co-op)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
The health and social care systems are inextricably linked, which is why we need to improve access to the social care system, and we will be setting out plans to do so in a Green Paper.
Mike Gapes
Age UK says that 1.2 million older people have unmet social care needs. Is it not time that we thought about integration in a practical way, and where we have acute hospitals with land next to them, such as King George Hospital in my constituency, we start to build sheltered accommodation or intermediate care on those sites so that people can easily be transferred into and out of the beds, freeing them up for other people who need them?
Mr Hunt
That is a wise suggestion, and it is exactly the direction of our thinking in the social care Green Paper, which will have a significant chapter on housing. Integration is not just about integrating health and social care; it is also about other services offered by local authorities. I commend, too, the hon. Gentleman’s local authority of Redbridge: it is No. 1 in the country for user satisfaction with the social care system and No. 4 for carer satisfaction.
Dr Sarah Wollaston (Totnes) (Con)
One of the most pressing issues for those who depend on social care is resolution of the back-pay issue for sleep-in shifts. Will the Secretary of State update the House with his own estimate of the liability? The independent sector puts this liability collectively at around £400 million. Will he also update us on the progress being made, because he will know that many sectors are handing back their contracts and withdrawing?
Mr Hunt
I thank my hon. Friend for raising this serious issue, and I can reassure her that a lot of work has been going on inside the Government to work out how to resolve the issue. A court case is due that may have a material impact on those numbers, but we are continuing to work very hard and fully understand the fragility of the current market situation.
Laura Smith (Crewe and Nantwich) (Lab)
In December, the health survey for England revealed that older people in more deprived areas are twice as likely as average to have unmet social care needs. Is this not yet another example of Tory cuts reducing councils’ abilities to meet the requirements of people with care needs?
Mr Hunt
I welcome the question, but let me also gently tell the hon. Lady what the actual story is with respect to cuts. Yes, the social care budget was cut after the 2008 financial recession, but she may remember that a different party was in power when that happened. Under this Prime Minister, those cuts have been reversed and the social care budget is going up by £9.4 billion in this spending review period.
Julia Lopez (Hornchurch and Upminster) (Con)
Inadequate social and primary care provision lies at the root of a great deal of pressure on hospital A&Es, so we need to plan much better for the demand for services at that level. Will the Secretary of State press the Treasury to ensure that receipts from NHS property transactions are retained by local healthcare trusts, so that they can build much larger primary care facilities than those currently planned?
Mr Hunt
My hon. Friend makes an important point: unless we make it easier for trusts to retain the receipts of property transactions, they will be likely to sit on these properties and we will not get the positive ideas such as that suggested earlier by the hon. Member for Ilford South (Mike Gapes), so we do need to find a way to make sure that local areas benefit when they do these deals.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Alzheimer’s Society estimates that at least 10,000 people with dementia have been stuck in hospital in the last year despite being ready to leave, and many of the delays were caused by a lack of care in the community for them. There can be no more disorientating thing for a person with dementia than being stuck in hospital when they do not need to be there. So with dementia awareness week approaching, is it not time for the Secretary of State to meet the social care needs of people with dementia fully by meeting the funding gap for social care in this Parliament?
Mr Hunt
Let me explain what is happening on that front. In the first five years after 2010, social care funding went down by 1.3% a year—we had a terrible financial crisis that we were trying to deal with—but since then, in the current spending review period, it is going up by 2.2% a year, which is an 8% real-terms increase over this spending review period. I completely agree with the hon. Lady that we need to do a much better job. [Interruption.] Opposition Members talk from a sedentary position about priorities; our priority has been to get this economy on its feet so that we can put more money into the NHS and social care system, and that is what will continue to happen under a Conservative Government.
Tom Tugendhat (Tonbridge and Malling) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
We want all NHS patients to be able to access appointments in the evenings and at weekends. Thanks to our programme, 40% of the population currently do so, and that will rise to 100% next October.
Tom Tugendhat
Forgive me for rushing in; I was tied up with Committee matters.
My right hon. Friend has set out a great vision for the national health service over recent years, and I very much welcome it, but does he agree that, in local areas, some of the GP provision could do with a little more work? I am particularly thinking of West Malling in my own constituency where a large element of the community is finding it harder to get access, and there is a danger that the GP surgery may leave the high street.
Mr Hunt
My hon. Friend is right to draw attention to that issue. He does have, I think, 28 more GPs in the west Kent clinical commissioning group area than in 2010, but there is a particular issue over premises. The need to invest in premises is deterring younger GPs from becoming partners, and sometimes making GP surgeries unviable. We are looking at that problem now.
Mrs Madeleine Moon (Bridgend) (Lab)
So many GP practices—no matter what salaries or what terms and conditions they offer—are reporting a reluctance by newly qualified GPs to go into GP practice. What will the Minister do about the hours of work—the time given to consult with constituents—to make it easier for people to see GP practice as a viable opportunity to serve their community?
Mr Hunt
I do very much agree with the hon. Lady, which is why we are working hard to recruit 5,000 extra GPs into general practice in England. I gently point out to her that the Royal College of General Practitioners says that, while we spend 9.2% of the NHS budget in England on general practice, it is only 7.3% in Wales.
David Tredinnick (Bosworth) (Con)
Has my right hon. Friend had time to consider the recent Professional Standards Authority report, “Untapped Resources”, of which the principal recommendation is that practitioners on PSA-accredited registers should have powers to make direct NHS referrals, which would reduce the burden on GP surgeries?
Helen Jones (Warrington North) (Lab)
The Secretary of State knows—because I keep telling him—that Warrington has fewer GPs than its population warrants. What concrete steps will he take to attract GPs to areas that are under-doctored?
Mr Hunt
Most parts of the country would say that they need more GPs, which is why we are trying to improve the capacity across the country. So, what have we done? Well, very recently we announced six new medical schools, which will have a specific focus on attracting new students into general practice. That is one of a number of measures.
Neil Gray (Airdrie and Shotts) (SNP)
Victoria Prentis (Banbury) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
Childhood obesity is one of the biggest public health challenges we face, which is why we are committed to reducing the sugar in products consumed by children by 20% over four years.
Victoria Prentis
I recently met my constituent, Professor John Wass, at an Obesity Health Alliance tea, where—the Secretary of State will be pleased to know—no cake was served. Professor Wass shares my concerns about the availability of hospital services for those with established obesity. Will my right hon. Friend set out what plans his Department has to treat those who are already obese?
Mr Hunt
We recognise the value of bariatric surgery, which is of course subject to the normal waiting time standards for those for whom it is appropriate. However, prevention is better than cure. That is why we are hoping to bring forward shortly further measures to tackle childhood obesity, which is one of our biggest concerns.
Rachael Maskell (York Central) (Lab/Co-op)
Obesity- related hospital admissions in York have more than doubled in the last three years. As part of NHS70, we in York are launching a city-wide public health initiative to ensure that we address issues around obesity, diet and exercise. Will the Secretary of State support such work and ensure that we get the funding that we need to run this initiative for the whole constituency and the city?
Mr Hunt
I am happy to give the project my wholehearted support. If we are going to tackle obesity, we need an approach that goes across all Departments of Government, including local government, and this initiative sounds excellent. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), will be looking into the funding.
Kevin Hollinrake (Thirsk and Malton) (Con)
Lambert Hospital in Thirsk was bequeathed to the town by Sara Lambert in 1890, and was closed via the back door by South Tees Hospitals NHS Foundation Trust last year. NHS Property Services is planning a sell-off to the highest bidder, despite the fair offer that is on the table from the local authority which could include provision for community use such as public health advice. Does my right hon. Friend agree that there are times when value to the public might outweigh the requirement to maximise a price?
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
This August marks two years since the world’s first childhood obesity plan was published, but the Government’s plan, at just 13 pages, left a lot to be desired. More than 5.5 million children in this country are now officially classed as overweight or obese, with 140,000 classed as morbidly obese, as the hon. Member for South West Bedfordshire (Andrew Selous) mentioned. This is now an epidemic. Will the Secretary of State confirm whether the Government’s second childhood obesity plan—due this summer, we have heard—will include meaningful policies such as restricting junk food advertising and the sale of energy drinks to children?
Mr Hunt
I agree with the hon. Lady that we need to do more, because this is a very serious issue. I think that she is being slightly unfair on our first initiative. The sugary drinks tax has been responsible for 45 million kg of sugar being removed from the market, which is enormously important for children. There is more to be done and I hope that we will be able to announce plans soon.
Tom Pursglove (Corby) (Con)
The Daily Mile initiative in schools has huge potential in reducing childhood obesity, improving academic attainment, and improving the mental wellbeing of our young people. Will my right hon. Friend look closely at that and have conversations across Government about the benefits it could bring?
Liz McInnes (Heywood and Middleton) (Lab)
In tackling childhood obesity, will the Health Secretary declare his support for Jamie Oliver’s AdEnough campaign and get rid of pre-watershed television advertising of junk food to our children?
Kate Green (Stretford and Urmston) (Lab)
James Morris (Halesowen and Rowley Regis) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
We are worried about the effects of social media on children and young people, which is why we have asked the chief medical officer to undertake a systematic review of all the international literature, to help us understand what further steps to take.
James Morris
I recently met a group of headteachers in Halesowen, who expressed real concern about the effects of social media on the health of their pupils. Does the Secretary of State agree that peer-to-peer support among young people in the classroom and in our communities is a vital way of benefiting young people through the positive aspects of social media and combating the negative effects on their mental health?
Helen Goodman (Bishop Auckland) (Lab)
Durham police tell me that when there is a problem on social media, particularly Facebook, it can take six months between their asking for action and the social media company tackling it. Will the Secretary of State speak to the Home Office to get the system changed and speed it up?
Kevin Foster (Torbay) (Con)
Does the Secretary of State agree that some of this is about ensuring that parents use appropriate techniques—for example, having specific screen times and engaging with their children about what they see on social media—and giving them the tools to do so?
Lucy Powell (Manchester Central) (Lab/Co-op)
Speak to any young person about what is causing child mental health issues, and the No. 1 issue is not social media, but exam and test pressure in schools, as we have found in the joint inquiry by the Health and Education Committees. Will the Secretary of State be as harsh on his colleagues in the Department for Education as he is on the social media companies when it comes to child mental health?
Mr Hunt
What we actually now have is a record number of children in good or outstanding schools—nearly 2 million more children. That is something we all want for our children, but when it comes to mental health, the NHS has very specific responsibilities, and we of course look into every possible cause.
Anna Turley (Redcar) (Lab/Co-op)
Ian Murray (Edinburgh South) (Lab)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I would like to give an update on the breast cancer screening failure. I met the Public Health England chief executive this afternoon, and I am informed that 65,000 letters were sent out last week, and the helpline has taken nearly 14,000 calls to date. Further letters are going out this week, and the first invitations to catch-up screenings will go out next week. Due to the lack of clinical consensus about the effectiveness of screening for older women, we will provide advice and support for all who missed scans and support them in making their own decision as to whether to proceed. We will also publish the terms of reference for the independent inquiry shortly, and I can assure the House that no stone will be left unturned in uncovering the truth.
Ian Murray
I am grateful to the Secretary of State for that update, but I would like to ask him about the Brexit transition agreement, which cuts the UK out of the European Medicines Agency. Can he give this House a cast-iron guarantee that that will not stop the regulation of new drugs in the UK to help patients, and will not prevent our world-class pharmaceutical companies from basing themselves here to do world-class research and development?
Robert Halfon (Harlow) (Con)
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for his update on breast cancer screening. I welcome his letter this morning with respect to patient safety in the private sector, but is not the truth that the best quality of care is provided by a public national health service? Is it not time to legislate to ensure that private hospitals improve their patient safety standards, and if he accepts that levels of safety are not acceptable in the private sector, why is the NHS still referring patients to the unsafe private sector? Should there not be a moratorium on those referrals until these issues are sorted out?
Mr Hunt
The hon. Gentleman should be very careful in making generalisations about the independent sector, just as he is about the NHS sector, because the truth is that there is too much poor care in both sectors, but both sectors also have outstanding care. I have always said that there will be no special favours for the independent sector, which we will hold to the same high standard of care, through the Care Quality Commission regime, as we do with NHS hospitals. Let me just say to him that if we stopped referring people to the independent sector, 140,000 people would wait longer for their operations, and that is not good care.
Jonathan Ashworth
We have seen the private sector fail—the NHS is sued by Virgin Care, patient transport contracts have to come back in-house, and Carillion collapses and cleaning contracts have to come back in-house—and now we learn that the hotline for women affected by the breast cancer screening failures is provided by Serco and staffed by call handlers who, far from having medical or counselling training, have had one hour’s training. Do not the women affected deserve better than that? Will the Secretary of State provide the resources for that phone line to be brought back in-house and staffed by medical professionals?
Mr Hunt
I normally have so much respect for the hon. Gentleman, but I think those women deserve a lot better than that posturing. The helpline was set up at very short notice because, obviously, the call handlers could not do all their training until I had made a statement to Parliament, which I judged was the most important thing to do first. It is not the only help that the women affected will be getting—on the basis of the advice received, they will be referred back for help at their local hospital, with Macmillan Cancer Support or through specialist clinicians at Public Health England—but we thought it was right that that number was made available as quickly as possible.
Several hon. Members rose—
Stella Creasy (Walthamstow) (Lab/Co-op)
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Dispensing practices are a lifeline in rural constituencies such as Sleaford and North Hykeham. Does my right hon. Friend agree that patients who live far from a pharmacy and attend their local dispensing practice should all have access to that dispensing service?
Alan Mak (Havant) (Con)
Healthcare delivered by app and other new technologies is increasingly popular with patients. Will my right hon. Friend undertake to ensure that the NHS fully explores the possibilities of new technologies when delivering front-line services?
John Grogan (Keighley) (Lab)
Paul Masterton (East Renfrewshire) (Con)
My constituent Susan is desperately waiting for the Government to bring forward the remedial order for single parent surrogates. The Joint Committee on Human Rights published its response to the original draft in March. Is there any update on when we will get the next version?
Jeremy Lefroy (Stafford) (Con)
Five years on from the Francis report, how does my right hon. Friend assess patient safety in the NHS?
Mr Hunt
There are still many things to tackle when it comes to patient safety, but I think the NHS has risen magnificently to the challenges in the report. There are nearly 45,000 more doctors and nurses across the system. Although there is more to be done, much credit should go to the NHS.
Lisa Nandy (Wigan) (Lab)
This week marks two and a half months since the independent inquiry into child sexual abuse recommended that compensation be paid urgently to children sent abroad by their Government and subjected to the most appalling child abuse. In that time, the Secretary of State’s Department, despite repeated requests for action, has made not a single statement. Many former child migrants have died and others are dying. How many more will have to wait, and die waiting, for justice before this Government get their act together and pay them the compensation that is owed?
Hilary Benn (Leeds Central) (Lab)
The European health insurance card enables British citizens to get medical treatment in the EU, including kidney patients who need dialysis. Without it, many of them simply could not go on holiday at all. Will the Secretary of State tell the House whether it remains the Government’s objective to keep the EHIC in place after we have left the EU, and, if so, what progress is being made to ensure that that happens?
Mr Hunt
It is absolutely our intention. We think it is beneficial for Brits and beneficial for Europeans. We are very confident that we will be able to negotiate reciprocal healthcare arrangements to protect those benefits, but our first preference would be a continuation of the current scheme.
Bim Afolami (Hitchin and Harpenden) (Con)
Will the Minister explain how and when the community pharmacy sector will gain access to the pharmacy integration fund? Millions have been promised. When will it be delivered?
Dr Sarah Wollaston (Totnes) (Con)
Thank you, Mr Speaker. Will the Secretary of State commit to publishing the progress report on sugar reduction and the next steps strategy on the reformulation programme, so that the Health Committee can examine that when Public Health England appears before us on 22 May?
Breast Cancer Screening
Jeremy Hunt Excerpts(6 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I wish to inform the House of a serious failure that has come to light in the national breast screening programme in England.
The NHS breast screening programme is overseen by Public Health England and is one of the most comprehensive in the world. It screens 2 million people every year, with women between the ages of 50 and 70 receiving a screen every three years up to their 71st birthday. However, earlier this year PHE analysis of trial data from the service found that there was a computer algorithm failure dating back to 2009. The latest estimates I have received from PHE is that, as a result, between 2009 and the start of 2018, an estimated 450,000 women aged between 68 and 71 were not invited to their final breast screening.
At this stage, it is unclear whether any delay in diagnosis will have resulted in any avoidable harm or death, and that is one of the reasons I am ordering an independent review to establish the clinical impact. Our current best estimate—which comes with caveats, as it is based on statistical modelling rather than on patient reviews, and because there is currently no clinical consensus about the benefits of screening for this age group—is that there may be between 135 and 270 women who have had their lives shortened as a result. I am advised that it is unlikely to be more than this range and may be considerably less. However, tragically, there are likely to be some people in this group who would have been alive today if the failure had not happened.
The issue came to light because an upgrade to the breast screening invitation IT system provided improved data to local services on the actual ages of the women receiving screening invitations. This highlighted that some women on the AgeX trial, set up to examine whether women up to the age of 73 could benefit from screening, were not receiving an invitation to their final screen as a 70-year-old. Further analysis of the data quantified the problem and has found a number of linked causes, including issues with the system’s IT and how age parameters are programmed into it. The investigation also found variations in how local services send out invitations to women in different parts of the country.
The existence of a potential issue was brought to the attention of the Department of Health and Social Care by Public Health England in January, although at that stage, its advice was that the risk to patients was limited. Following that, an urgent clinical evaluation took place to determine the extent of harm and the remedial measures necessary. Public Health England escalated the matter to Ministers in March, with clear clinical advice that the matter should not be made public. This was to ensure that a plan could be put in place that ensured any remedies did not overwhelm the existing screening programme and was able to offer proper support for affected patients.
I am now taking the earliest opportunity to update the House on all the remedial measures that have been put in place, which are as follows. First, urgent remedial work to stop the failure continuing has now been completed according to the chief executive of Public Health England. This was finished by 1 April and PHE is clear that the issue is not now affecting any women going forward.
Of the estimated 450,000 women who missed invitations to a scan, 309,000 are estimated to still be alive. Our intention is to contact all those living within the United Kingdom who are registered with a GP before the end of May, with the first 65,000 letters going out this week. Following independent expert clinical advice, the letters will inform all those under 72 that they will automatically be sent an invitation to a catch-up screening. Those aged 72 and over will be given access to a helpline through which they can get clinical advice to help them decide whether a screening is appropriate for their particular situation. This is because for older women, there is a significant risk that screening will pick up non-threatening cancers that may lead to unnecessary and harmful tests and treatment. However, this is an individual choice and in all cases, the wishes of the patients affected will be followed. By sending all the letters to UK residents registered with a GP by the end of May, we hope to reassure anyone who does not receive a letter this month that they are not likely to have been affected.
It is a major priority to do our very best to make sure that the additional scans do not cause any delays in the regular breast screening programme for those under 71, so NHS England has taken major steps to expand the capacity of screening services, and has today confirmed that all women affected who wish to be screened will receive an appointment within the next six months. Of course, we intend the vast majority to be much sooner than that.
We have held helpful discussions with the devolved Administrations to alert them to the issue. Scotland uses a different IT system, and while the systems in Wales and Northern Ireland are similar, neither believe they are affected. However, we are discussing with each of them the best way to reach women who have moved to another part of the UK during this period. This is obviously more complicated, but we are confident that those affected will still be contacted by the end of May.
In addition, and as soon as possible, we will make our best endeavours to contact the appropriate next of kin of those we believe missed a scan and have subsequently died of breast cancer. As well as apologising to the families affected, we would wish to offer any further advice they might find helpful, including the process by which we can establish whether the missed scan is a likely cause of death and compensation is therefore payable. We recognise that this will be incredibly distressing for some families, and we will approach the issue as sensitively as possible.
Irrespective of when the incident started, the fact is that for many years, oversight of our screening programme has not been good enough. Many families will be deeply disturbed by these revelations, not least because there will be some people who receive a letter having had a recent diagnosis of breast cancer. We must also recognise that there may be some who receive a letter having had a recent terminal diagnosis. For them and others, it is incredibly upsetting to know that you did not receive an invitation for screening at the correct time, and totally devastating to hear you may have lost or be about to lose a loved one because of administrative incompetence. So on behalf of the Government, Public Health England and the NHS, I apologise wholeheartedly and unreservedly for the suffering caused. But words alone are not enough. We also need to get to the bottom of precisely how many people were affected, why it actually happened and most importantly, how we can prevent it ever happening again.
Many in this House will also have legitimate questions that need answering: why did the algorithm failure occur in the first place, and how can we guarantee it does not happen again? Why did quality assurance processes not pick up the problem over a decade or more? Were there any warnings, written or otherwise, which should have been heeded earlier? Was the issue escalated to Ministers at the appropriate time? What are the broader patient safety lessons for screening IT systems?
I am therefore commissioning an independent review of the NHS breast screening programme to look at these and other issues, including its processes, IT systems and further changes and improvements that can be made to the system to minimise the risk of any repetition. The review will be chaired by Lynda Thomas, chief executive of Macmillan Cancer Support, and Professor Martin Gore, consultant medical oncologist and professor of cancer medicine at the Royal Mardsen, and is expected to report in six months.
The NHS has made huge progress under Governments of both sides of this House on improving cancer survival rates, which are now at their highest ever. Seven thousand people are alive today who would not have been if mortality rates had remained unchanged from 2010, but this progress makes system failures even more heartbreaking when they happen. Today, everyone in this House will be thinking of families up and down the country who are worried that they may have been affected by this failure. We cannot give all the answers today, but we can commit to take all the necessary steps to give people the information that they need as quickly as possible. Most of all, we want to be able to promise that this will not happen again, so today, the whole House will be united in our resolve to be transparent about what went wrong and to take the necessary actions to learn from the mistakes made. I commend this statement to the House.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for advance sight of his statement and for his personal courtesy in directly briefing me as well. The thoughts of the whole House are with those whose screening was missed and who sadly lost their lives from breast cancer, or who have subsequently developed cancer. Anyone who has had a loved one taken by breast cancer, or indeed any cancer, will know of the great pain and anguish of that loss. I understand that the Secretary of State has referred to estimates, but when the facts are established, will he assure us that each and every case will be looked into sensitively and in a timely manner? Our thoughts also turn to the 450,000 women who were not offered the screening that they should have had, so I welcome the Secretary of State’s commitment to contact the 309,000 women who are estimated to be still alive.
Early detection and treatment are vital to reducing breast cancer mortality rates, which was why the AgeX pilots were established in 2009 and rolled out nationally from late 2010, when the Government expanded the screening programme. Given the problems that Public Health England has identified with its randomisation algorithm for those trials, will the Secretary of State tell us whether any evaluations and assessments of those pilots had been done by the Department before the national roll-out of the programme?
I welcome the Secretary of State’s candour in questioning why this problem was not picked up—eight years is a long time for an error of this magnitude to go undetected. Did the Department receive any warnings in that time? Is there any record of how many women raised concerns that they had not received the appropriate screening? Were there any missed opportunities to correct this mistake? He said graciously that oversight of the screening programme was not good enough. How does he intend to improve that oversight? What other trials are in place across the NHS and is he satisfied with their oversight?
We welcome the establishment of the national inquiry. Will it be hosted and staffed by the Department of Health or another Department? In the interests of transparency, will the Secretary of State place in the Library the Public Health England analysis from this year that identified the problem with the algorithm? Although the parallels are not exact, where the NHS offers bowel cancer screenings for women between the ages of 60 and 74 and cervical cancer screenings for women up to 64, what assurances can he give that the systems supporting those services are running properly, and what checks are being carried out to make sure that nobody misses out on screenings for other cancers?
The Secretary of State says that NHS England will take steps to expand the capacity of screening services. Will he say a little more about that? What extra resources will be made available to help the NHS provide the extra screening now needed? He will know that the NHS faces huge workforce pressures—according to Macmillan, there are more than 400 vacancies in cancer nursing, the Royal College of Radiologists has found that 25% of NHS breast screening programme units are understaffed, and there are vacancies for radiographers too. Will he assure us that the NHS will have the staff to carry out this extra work, and may I gently suggest that, if it needs extra international cancer staff, he ensures that the Home Office does not block their visas?
More broadly, does the Secretary of State share my concerns that screening rates are falling generally? The proportion of women aged 50 to 70 taking up routine breast screening invitations fell to 71.1% last year—the lowest rate in the last decade. There is also a wide regional variation in screening rates. The number of women attending breast screening in England is as low as 55.4% in some areas, and, as the all-party group on breast cancer found, there are stark inequalities in NHS services in England, with women in the worst-affected areas more than twice as likely to die from breast cancer under the age of 75. Beyond the problems identified today, what more are the Government doing to make sure that screening rates rise again so that cancer care for patients is the best it can be?
Finally, many of our constituents over whom breast cancer has cast a shadow will feel anxious and worried tonight. Members on both sides of the House want to see cancer prevented and those who have it fully supported. Transparency and clarity are vital. Will the Secretary of State undertake to keep the House fully informed of developments to offer our constituents the peace of mind they deserve?
Mr Hunt
I thank the hon. Gentleman for his constructive tone, and I want to reassure him that each and every case will be looked at in detail. The sad truth is that we cannot establish whether not being invited to a screen might have been critical for someone without looking at their individual case notes, and in some cases, sadly, establishing a link will mean looking at the medical case notes of someone who has died.
It is important to explain that the reason for these estimates, which are much broader than we would like, is that there is no clinical consensus about the efficacy of breast screening for older women. As I understand it, that is because the incidences of cancers among older women are higher, but a higher proportion of them are not malignant or life-threatening, which makes it particularly difficult. It is also the case that breast cancer treatment has improved dramatically in recent years and so it is less important than it was to pick up breast cancer early. None the less, we believe it will have made a difference to some women, which is why it is such a serious issue.
The evaluations of the AgeX trial, which brought this to light at the start of the year, have been continued by Oxford University throughout the trial period. I am not aware of any evaluations shared with the Department that could have brought this problem to light, but obviously the inquiry will look into that. We need to find ways to improve oversight, and modern IT systems can greatly improve safety and reliability—in fact it was during the upgrading of the IT system that this problem was brought to light.
I will share with the hon. Gentleman the advice the Department received from Public Health England in January, which was the first time we were alerted to the issue, and we will certainly provide any extra resources the NHS needs to undertake additional cancer screening. One of our biggest priorities is that women between the ages of 50 and 70, when the screens are of their highest clinical value, do not find their regular screens delayed by the extra screening we do to put this problem right. He is right that one thing that has come to light is the regional variation in how the programme is operated. It was previously operated by the old primary care trusts, under the supervision of strategic health authorities, and then brought under the remit of Public Health England, but the regional variations have continued for a long time, so this problem will be worse in some parts of the country than in others. I undertake to keep the House fully informed.
Dr Sarah Wollaston (Totnes) (Con)
I thank the Secretary of State for the commitments and actions he has set out. Colleagues across the House will be thinking of the hundreds of thousands of women not called for their final screening test. They now need consistent, high-quality, evidence-based guidance so that they can make an informed choice about whether to take up the offer of screening. There is much material available setting out pictorially and clearly how they can weigh up the risks and benefits. Will he assure the House not only that a helpline will be in place but that it will be backed up with high-quality material available directly to patients and their GPs, many of whom will be directly counselling women following this news?
Mr Hunt
Yes, and I can reassure my hon. Friend that GPs will be briefed and that people will be referred for additional support to clinically trained staff at Macmillan Cancer Support and Breast Cancer Care. We have to be transparent with patients, however, about the absence of a clear clinical consensus on the efficacy of scanning for women in their 70s. The fairest thing is to explain that different people have different views and allow them to come to an individual choice, and that is what we are doing. It will of course cause considerable distress to those given that dilemma, but if anyone wants a scan, we will do that scan.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I thank the Secretary of State for my advance briefing, but, as a breast surgeon and co-chair of the all-party group on breast cancer, I gently take issue with his comment that we do not need to diagnose breast cancer early because of the changes in treatment. I would not like that message to stand: diagnosing early is still crucial.
Obviously this is horrendous for the women involved, but it will also create anxiety for women who are not aware whether they are involved and who might not have been part of the trial. Reassuring them will be a challenge. I welcome the independent review into how it happened and how it went so long without being picked up, and I am interested to know what will happen with the trial now—the loss of almost 500,000 women from it might have a major impact.
Given the normal pick-up rate of breast screening, approximately 2,500 cancers would have been picked up across England in the last round. As the Secretary of State says, this issue did not apply in Scotland, but some of the women affected might have moved and settled in Scotland, so when did he inform the Scottish Government?
The Secretary of State said that the Department knew in January. As far as I can establish, officers in Scotland were informed of a minor issue in March, were told only last week that it was actually more major, and were not told that it might affect women who now live in Scotland. There has clearly been preparation and talk about funding in England, but how many women who live in Scotland have been identified, and what efforts have been made to track them down? What preparations for funding or the expansion of services have been made for Scotland and, indeed, for the other devolved nations?
As was mentioned by the hon. Member for Leicester South (Jonathan Ashworth), radiology, and particularly breast radiology, is a huge shortage specialty. What funds will be provided to ensure that it can be delivered without messing up the normal system?
Will women who do not receive a letter in the next few weeks be able to telephone, or can the Secretary of State really guarantee that if they have not heard by the end of the month, they are clear? As a doctor, I find that a bit scary.
Mr Hunt
The hon. Lady has asked some important questions. I am sorry if what I said was not clear, but I do not think I said that there was no need to diagnose early. It is obviously incredibly important for cancer to be diagnosed as early as possible. What I said was that I had been advised that in many cases, because of advances in breast cancer treatment, it would not make a difference to the particular women affected in this case. I fully accept that in some cases it will, and of course it is very important to diagnose all cancers as early as possible.
I will find out from Oxford University the dates on which it expects to report the full outcome of the AgeX trial. Obviously we all want to hear the results as soon as possible. I will also inform the hon. Lady of the exact date on which Scottish Government officials were informed. Let me reassure her that if there are any additional costs to the Scottish health system, it will of course be recompensed.
We do not think that major pressures will be created in the Scottish screening programme, and we are confident that we will be able to contact everyone in the UK who is registered with a GP—whether in Scotland, Wales, Northern Ireland or England—by the end of May. We have had very productive discussions with Scottish officials about the IT exchange that will be necessary to ensure that women living in Scotland also receive their letters by the end of May. We cannot guarantee that every single one of them will have been contacted by then—some will have moved abroad, and some will not be registered with a GP for whatever reason—but we think that we can contact the vast majority, and the helpline will be open for anyone to call if they think they may have been affected.
Mr Philip Dunne (Ludlow) (Con)
I think that Members on both sides of the House have appreciated the measured way in which my right hon. Friend has come to the House and revealed detailed commitments to helping the women who have suffered as a result of this terrible, unfortunate IT event. I also think that the measured response from the hon. Member for Leicester South (Jonathan Ashworth) properly reflected the concern that everyone shares.
My right hon. Friend referred to additional screening capacity to ensure that there is no impact on other, younger women. What undertakings can he give to any women who have been affected, and who find that they are suffering from a malignant growth in their breast, that they will be able to receive the appropriate treatment as rapidly as possible?
Mr Hunt
I thank my hon. Friend for the work that he did on cancer when he was working at the Department of Health, and for his broader work in supporting the hospital sector. He is absolutely right: additional people will come forward for treatment, so one of the other matters that we have been looking into is our treatment capacity. We certainly intend to ensure that people are treated within the normal short period if a cancer is detected, and the first step in that process is to ensure that everyone has a scan in the next six months. During that period, we will make certain that they are able to look forward to the same rapid treatment that all other people whose cancers are detected can be confident of receiving.
Dr Paul Williams (Stockton South) (Lab)
We have an ethical duty to get screening right, because we are inviting well people into our health service and offering them an intervention. May I ask the Secretary of State whether the uptake of screening by 68 to 71-year-olds during the period concerned was any lower than expected? If it was less than expected, why was that not properly analysed?
Mr Hunt
I do not know the answer to that question, but I will look into it. If we find that the uptake was lower than expected in that age group, it will be a very important clue about something that may have gone wrong, and I am sure that the review panel will want to examine it. The overall uptake rate is about 80%, but I agree with the hon. Gentleman that we should look into what the rates were in specific age cohorts.
Mrs Maria Miller (Basingstoke) (Con)
I thank the Secretary of State for his measured statement, and for all he is doing to ensure that the women affected are given the treatment and support that they need. I particularly welcome his independent review of the NHS screening programme. Will he also be looking at quality assurance programmes more widely within the NHS in relation to screening programmes? It is deeply worrying that the NHS did not identify this error for more than a decade, and there may be a need to review those programmes.
Mr Hunt
I am afraid that my right hon. Friend is absolutely right. The truth is that we do have a quality assurance programme, and it failed to pick up this problem for far too long. We need to understand why that happened. We think that a single IT mistake was made at the very start of the programme, and we understand that sometimes such mistakes are devilishly difficult to identify. None the less, as was suggested by the hon. Member for Stockton South (Dr Williams), there must have been clues that could have been picked up—or so one would think—and we need to get to the bottom of that.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
I think that anyone who listened to the statement will be devastated and appalled to learn about this fatal failure, especially given that the UK’s breast cancer survival rate is below the EU average. The Secretary of State talked about the advice line that might be available to people who had been affected, but has he given any consideration to any emotional or mental health support that should be extended to those people and their families?
Mr Hunt
We are indeed talking to the charities operating in this sector about how we can best provide all kinds of support, including mental health support, as well as clinical guidance. We often talk in the House about the challenges facing the NHS, but it is important to note that breast cancer is an area in which survival rates have been improving, and have actually been catching up with those in other European countries. The NHS deserves great credit for that, despite today’s very serious failing.
Dr Andrew Murrison (South West Wiltshire) (Con)
I commend my right hon. Friend for the way in which he brought this very bad news to the House, and the hon. Member for Leicester South (Jonathan Ashworth) for the way in which he responded to it.
As my right hon. Friend will know, breast cancer is not just about survival nowadays; it is also about quality of life after treatment. Will his contact with those who have been affected extend to those who have been treated, but who may have had to be treated in a more radical way than might have been the case had their cancers been picked up earlier?
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I thank my right hon. Friend for his statement and for the work he is doing to ensure that women who are affected are supported and treated promptly, but what is he doing to ensure that people who are due for cervical and other NHS screening programmes are being properly called, and can he tell women who are affected—and, no doubt, very worried today—what they should do now? Whom should they call, should they be waiting for a letter, and how soon can they expect a scan if they wish to have one?
Mr Hunt
According to the advice that I have received so far, there is no read-across to other screening programmes, but obviously the independent review panel will look into that as it seeks to examine all aspects of the issue. We have made the commitment today that we will invite for scans all those who either should be scanned or should consider whether they wish to have a scan, and will offer them a date before the end of October, although we hope that in the vast majority of cases it will be much sooner than that.
Ann Clwyd (Cynon Valley) (Lab)
What conversations has the Secretary of State had with the Welsh Secretary? Having long since passed the ages he mentioned, I certainly was never invited for a screening; I had to ask for one, and I eventually got the screening in England.
Mr Hunt
We have not had conversations at ministerial level, but we have had conversations at official level. The Welsh Administration do not believe this problem has affected them, even though Wales was using the same IT system we were using in England. Our concern is about people living in England who are registered with a Welsh GP or people living in Wales registered with an English GP. That is why we are having constructive discussions to share IT information and make sure everyone in England or Wales registered with a GP will get that letter.
To respond to the earlier question about what people should do now, anyone is free to call the helpline number, which will be made public today, but we are hoping to get the letters out as quickly as possible over the next four weeks, during the month of May, so that everyone can be pretty confident that they are okay if they have not received one of those letters.
Maria Caulfield (Lewes) (Con)
I welcome the Secretary of State’s announcement today that there will be an independent review; it is important that women have confidence in the screening programme. As someone who worked in breast cancer for over 10 years before being elected, I gently say to women that the screening mammogram is just one tool in the early detection of breast cancer and that if they notice a change in the interval of three years between mammograms they must seek medical advice. Also, not all mammograms pick up breast cancers, so they must not just rely on screening mammograms.
Mr Hunt
I thank my hon. Friend for her excellent advice, which gives me the opportunity to repeat that the advice for women about looking after their breasts and making sure they are alert to potential breast cancer remains unchanged. All women should take great care over this and should always come forward to see their GP or local cancer service if they have any concerns or doubts.
Lisa Nandy (Wigan) (Lab)
I thank the Secretary of State for his statement. There is no other way to describe what has happened than utterly, utterly heart-breaking, and it is hard to imagine what some of the worst affected families will be going through over the next few weeks.
I am grateful to the Secretary of State for his assurance that capacity will be expanded to ensure that women can now access screening, but unless he puts further resources into the system, other people will go to the back of the queue as a consequence. In my region of the north-west, one in five posts are currently vacant, and for far too many women in this country where they live currently determines whether they live or die. So will the Secretary of State put in the additional resources needed to make sure all women can get the screening they need when they need it?
Mr Hunt
I thank the hon. Lady for her comments. We have many other occasions to have a broader discussion about resourcing of the NHS, but I recognise what she says: in the specific situation we are in now, with the people who will need additional scans and additional treatments over and above what the NHS would have otherwise done, we will need to find additional resources to make sure others are not disadvantaged.
Mr Mark Harper (Forest of Dean) (Con)
May I add my words of support to the Secretary of State for the way he has approached this issue, and to Opposition Members for their approach too?
On the scope of the independent review, will it look at other screening programmes? It might be the case that this particular issue is not replicated, but I think people will want assurances about other screening programmes. Also, as the NHS looks to use IT as a powerful way to combat illness and disease, will the Secretary of State make sure that appropriate checks are in place so that there are proper assurances in the system and these kinds of problems do not arise in the future?
Mr Hunt
My right hon. Friend is absolutely right, and I assure him that the review being done by Lynda Thomas, one of the most senior cancer campaigners in the country, and Professor Gore, one of the most senior oncologists in the country, will look at what lessons can be learned for the entire cancer programme, and not just at the specific issue of why this particular IT problem occurred.
Diana Johnson (Kingston upon Hull North) (Lab)
The statement the Secretary of State has made today is truly shocking, and many women and their families will be very worried this afternoon. The Secretary of State said that it is estimated that 309,000 women in this group are still alive and that the first 65,000 letters are going out this week. Why are the letters not going out this afternoon to all 309,000 women? Why are we having to wait until the end of May to put at rest the minds of these women and their families?
Mr Hunt
That is a reasonable question, and I assure the hon. Lady that we are sending these letters out as quickly as we possibly can, but we felt that, even though we are not able to send them all out this afternoon—for example, because we have to reconcile with the clinical databases in Scotland, Wales and Northern Ireland for women who have moved to those areas and that is going to take place later this month—it was important to come to the House as soon as possible, without delay, to inform Members that this was happening. There will be a period of a few weeks during which people will have to wait to see if they get one of the letters, and we fully appreciate that that will cause a lot of worry to the women involved.
Sir Hugo Swire (East Devon) (Con)
This is a good time to pay tribute to all the excellent cancer support charities, counselling services, Maggie’s centres and so forth up and down the country. I am reassured that the Secretary of State has said he will be working with them, but will he commit this afternoon to contacting all these charities proactively and providing them with the resources they need to meet what will obviously be an increased demand over the coming weeks and months?
Derek Twigg (Halton) (Lab)
When did the Secretary of State or the Minister with direct responsibility for screening last ask their officials about the accuracy of the screening programme and the robustness of the checks and assurances in place to ensure it was working properly and efficiently? When, before January this year, did he last ask his officials that?
Mr Hunt
I will have to get back to the hon. Gentleman with a detailed answer to that question. Ministers were informed of this issue in March, and we are responsible, as Ministers, for the effective functioning of that system—in the way all Ministers have responsibility for their various areas—so one of the questions we need to ask is whether the right escalation procedures and checks and balances were in place so that Ministers could be informed if there was likely to be a problem.
Dame Caroline Spelman (Meriden) (Con)
My constituency has many breast cancer sufferers who were victims of the rogue surgeon Mr Paterson, so I thank my right hon. Friend for setting up an inquiry chaired by the Bishop of Norwich, in which victims feel properly listened to, and, most importantly, are being compensated. Will any of the women caught up in this current situation who might have been harmed be eligible for compensation?
Mr Hunt
I thank my right hon. Friend for suggesting the Bishop of Norwich as a good person to help in the Paterson review, and the answer to her question is yes: if, because of a failing by the NHS, harm has happened, people will be eligible for compensation, and we will do all the necessary work to establish whether that is the case.
Nic Dakin (Scunthorpe) (Lab)
Breast cancer screening makes a real difference to outcomes for breast cancer patients by diagnosing early, so I applaud the Secretary of State for saying he will look at ways of improving performance in this area across the country, but what is he going to do to try to make women who have moved out of the UK who might be affected aware of what has happened?
Mr Hunt
We will look at whether we are able to get in contact with people and will get in contact whenever we can, but there is of course a helpline through which anyone can contact us. It is also important to say that, according to the advice I have received, missing the final screening will in many cases not make a difference to a patient’s cancer or the treatment they receive, but we will do everything we can to support everyone who thinks they might have been affected.
Dr Julian Lewis (New Forest East) (Con)
While it will be for the review to investigate and report on why the fault with the algorithm was not discovered earlier, can the Secretary of State throw any more light on the circumstances in which it eventually came to be discovered? He said, for example, that it was in the course of a computer upgrade. Obviously, the circumstances that led to its discovery could be a pointer towards greater safeguards for the future.
Mr Hunt
That is a very good point. The original issue—or the original potential issue—was identified by people working on the AgeX trial for Oxford University, who then brought it to the attention of Public Health England in early January. One of the issues seems to have been the confusion about whether the scans stopped when someone turned 70 or whether they should carry on until their 71st birthday. That is why we think the original coding error happened, but obviously this is a matter for the review, and we need to learn everything from it.
Lady Hermon (North Down) (Ind)
This is a hugely upsetting and serious issue, and I commend the Secretary of State for the great compassion and sensitivity with which he has delivered this very bad news for women throughout the United Kingdom. He mentioned the fact that the Northern Ireland breast screening scheme was slightly different, but he will appreciate that he absolutely must say more to reassure women in Northern Ireland at this time because we have no Health Minister. May we please have more reassurance for women in Northern Ireland?
Alberto Costa (South Leicestershire) (Con)
I also thank the Secretary of State for his measured and sensitive tone in delivering this afternoon’s statement. He mentioned that the figures of 450,000 and 309,000 were estimates. What is not an estimate, however, is that 65,000 letters will be going out at the end of this month. Will he assure us that his team in the Department will write to Members of Parliament to indicate the number of women affected in each constituency, so that we can prepare for the inevitable contacts that constituents will make with us?
Liz McInnes (Heywood and Middleton) (Lab)
I hope that the independent review will investigate this, but is the Secretary of State aware of any instances of GPs inquiring why patients who should have had a final breast screen were not invited to have one?
Mr Hunt
That is a very good question. I am not aware of any such instances, but that is exactly what we want to look at in the review. It does seem strange that people who were expecting to be invited did not come forward, and that their not receiving an invitation did not set any hares running. That is one of the things that we need to look at.
Sir Desmond Swayne (New Forest West) (Con)
How many cancers are detected for every 10,000 screenings, and what is the clinical consensus on the effectiveness of that?
Mr Hunt
My right hon. Friend is testing my clinical knowledge here; there will be other people in the Chamber who are better able to answer that question. I am ready to be corrected by eminent experts on this, but my understanding is that, in relation to women in their 70s, for every 1,000 women there are around 12 cancers, and of those 12 cancers, around three are potentially life-threatening.
Stephen Lloyd (Eastbourne) (LD)
Let us be clear that this is an utterly desperate situation. We know that some women may well have died who might not have done had they been identified. However, I would like to pay tribute to the Secretary of State’s statement. It was transparent, it ’fessed up and it made clear what the Department of Health and Social Care will be doing to remedy the situation. I appreciate that. What will the Department do to raise awareness of breast cancer screening among women who are not currently registered with a GP?
Mr Hunt
That is an important question. We have the Be Clear on Cancer campaign, which is a national advertising campaign but, as my hon. Friend the Member for Lewes (Maria Caulfield) said, it is important for people to recognise that, if we are going to protect them from cancer, they will have to take an active and proactive role in detecting any cancers they might have. Important though the screening service might be, they cannot rely on the screening service, because their own experience of how their own body is functioning is the most important detection method of all.
Andrew Jones (Harrogate and Knaresborough) (Con)
I thank my right hon. Friend for his statement, and for the urgency and sensitivity with which he is treating this issue. Women all over the country will be very anxious at hearing this news. Will he guarantee that all women who did not get invited for their scan will now be guaranteed their screening?
Mr Hunt
We are absolutely guaranteeing that all women affected who are still alive will be invited to have a screening if they want it. Only those under 72 will automatically be sent a date and time for their screening. Those over 72 will be invited to talk to the helpline so that they can form a judgment as to whether a screening is appropriate, but anyone who wants one will get one.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
I should like to thank the Secretary of State for his comprehensive response. Can he advise me how many women who have moved to Scotland might be affected? If not, will he work double time to ensure that those who have been affected and who have moved to Scotland will get their letters timeously within the correct period?
Mr Hunt
I believe that the IT work, which is a collaboration between the Scottish NHS and the English NHS, will be completed in the week of 15 May. That is why we are confident that we will be able to get the letters out to people registered with Scottish GPs who have moved from England by the end of May, which is the same timescale as for getting the letters out to people living in England. We will then know that number, and I will of course let the hon. Lady know.
Michelle Donelan (Chippenham) (Con)
My grandmother died of breast cancer a few years ago, and my heart goes out to all women affected by this fatal IT malfunction. I welcome my right hon. Friend’s assurance that he is going to do everything he possibly can to ensure that this does not happen again. Has any consideration been given to the impact of this on GP surgeries? I expect that, during the next few days while women wait for their letters, they might make appointments with their GPs in anticipation, and in fear.
Mr Hunt
Yes, we are briefing all GP surgeries and all GPs about what the appropriate response is, because we recognise that that might happen. Of course, GPs are there for people to talk to at any time if they have concerns, and some people may choose to do that. We have also set up a specialist helpline that will be open seven days a week from 8 am to 8 pm, where people will be able to get advice straightaway by picking up the phone. We think that that will be the most practical option for most people.
Several hon. Members rose—
Jim Shannon (Strangford) (DUP)
I thank the Secretary of State for his statement and for his compassion and care. Is he aware of any discussions on the continued alignment with the European Medicines Agency’s drug licensing process to ensure that our breast cancer patients, and indeed all cancer patients, have access to the benefits of the European trials and UK citizens are able to participate in clinical trials? This is very important.
Several hon. Members rose—
Huw Merriman (Bexhill and Battle) (Con)
And I am very proud to have been.
The Secretary of State knows well and cares deeply about safety matters. As he also knows, I have spent too much of my time with the clinicians in the cancer centres of Maidstone and Tunbridge Wells. Will the review perhaps look at administrative and back-office resources and at whether they play any part in improving survival rates?
Mr Hunt
The whole House is thinking of my hon. Friend who, like many people in this country, is going through a huge amount of personal pressure as cancer strikes close to home. He is right that back-office systems are often poor when it comes to contacting patients, which is in contrast to the superb clinical care that we are usually able to offer, so we will absolutely consider that as part of the review.
Mr Speaker
I wish the hon. Gentleman well in the period ahead. I was not aware of those personal circumstances, but the whole House will wish his nearest and dearest all the best.
Simon Hoare (North Dorset) (Con)
As I understand it, Public Health England, which is of course operationally independent of Ministers, runs the screening programme, so what assurances have the chair and chief executive of that important organisation given my right hon. Friend that the actions that he has usefully set out today will be completed within the required deadlines to meet the obvious and legitimate demands of patients?
Craig Tracey (North Warwickshire) (Con)
I thank the Secretary of State for his statement. As co-chair of the all-party parliamentary group on breast cancer, I know that his Department takes breast cancer seriously, so the Secretary of State and the ministerial team will no doubt be as disappointed as I am that the statement was necessary today. However, will he set out what the women affected need to do and, importantly, what additional steps can be taken to reassure and support those women?
Mr Hunt
Anyone who has concerns as of today is welcome to call the helpline, but the women whom we know have been affected will be contacted by the end of the month. The first thing that many people will do is take action on receipt of a letter. If they are under 72, the letter will tell them that they will shortly be sent a date for a catch-up scan. If they are over 72, it will tell them how they can get advice as to whether that is appropriate for them.
Kevin Foster (Torbay) (Con)
I welcome the tone of the Secretary of State’s statement, even though its contents will be devastating for many people and families across my constituency. Will he confirm what engagement there will be with groups such as local health watches and support networks to ensure that the information that he has given is relayed to them and their users?
Henry Smith (Crawley) (Con)
As chair of the all-party parliamentary group on blood cancer, I am pleased that the Secretary of State talked about the lessons that will be learned from this breast screening error. Will he assure me that what is picked up will inform future diagnostic programmes?
Jeremy Quin (Horsham) (Con)
Tragically, it seems that the flaws were of long standing—I think the Secretary of State referred to a decade or more. Notwithstanding the length of time that has passed, will he assure the House that lessons will be learned that relate back to the procurement and design decisions that were made at the outset?
Matt Warman (Boston and Skegness) (Con)
I welcome the compassionate tone of the Opposition spokesman and the Secretary of State, and I particularly welcome the fact that he personally said sorry. Will he do all that he can to ensure that faith is restored in such technologies, because they do an awful lot of good when they work?
Mr Hunt
My hon. Friend is absolutely right. One of the most important ways of getting that change in mindset is by giving patients more control. Later this year, we will be offering all NHS patients an app through which they can access their medical record, and that should start to become a way in which people take control of their healthcare destiny, including such things as invitations to screenings for all cancers and many other public health measures.
Mary Robinson (Cheadle) (Con)
While Stockport is one of the best areas for cancer identification, there will be concern that some people may have missed a routine call for screening. Last year, my constituents in Heald Green were particularly affected when their local breast cancer screening provision was relocated to Macclesfield District Hospital, which is over an hour away. As we address the screening issue, does my right hon. Friend agree that we must ensure that breast cancer screening is local and accessible?
Anna Soubry (Broxtowe) (Con)
My friend Emma Agnew, a woman in her own right but also known as “Mrs Aggers” because she is married to the cricket commentator Jonathan Agnew, is one of a remarkable group of women who have faced breast cancer and beaten it, but it must be said that she had huge support from her husband, and our thoughts are also with my hon. Friend the Member for Bexhill and Battle (Huw Merriman). Emma had mammography last February and thought all was good, but she kept on checking her breasts. Screening is wonderful, but she checked her breasts, which was why she knew something was wrong in July. She was immediately diagnosed, she received fantastic treatment on the NHS and she is a survivor. Will the Secretary of State reiterate that we must all keep an eye out for cancer, whatever age we are?
Kevin Hollinrake (Thirsk and Malton) (Con)
I thank my right hon. Friend for his statement and for his tone. This was clearly a failure not only of IT, but of quality assurance, so will he commission a review of quality assurance right across the health service to ensure that it is as effective as it should be?
Mr Hunt
My hon. Friend may well be right that we need to do that, but what I would like to do first is to see the outcome of this review, what the lessons are and what precisely it says about the quality assurance that applied in this case, and then make a judgment about the implications for the rest of the NHS.
Fiona Bruce (Congleton) (Con)
I thank the Secretary of State for the genuine personal concern that he has shown today and for his determination to get to the bottom of the matter. Will he continue to keep the House and, more importantly, the public and any women affected informed as further information comes to light?
Chris Skidmore (Kingswood) (Con)
An additional 200,000 to 300,000 women could be seeking breast cancer screening within the next six months, which works out roughly at an additional 2,000 women a day. What reassurances can the Secretary of State give to the women who were due a screening anyway that their treatment will not be delayed as a result of the additional need?
Mr Hunt
That is an important question. One of our top priorities has been to construct a resolution to the problem that will not have an impact on the regular screening programme for women between the ages of 50 and 70, which is so important. All I can say is that a huge amount of trouble has been taken to try to ensure that we are putting additional capacity into the system to deal with the extra work.
Robert Courts (Witney) (Con)
I also welcome the compassionate tone used by hon. Members on both sides of the House today, and my thoughts are with all those affected. Will the Secretary of State reassure those in west Oxfordshire and beyond who will be concerned that this IT failure may be present in other critical systems that he will do everything possible to ensure that that is not the case?
Cancer Treatment
Jeremy Hunt Excerpts(6 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
James Brokenshire (Old Bexley and Sidcup) (Con)
I am very grateful to the Backbench Business Committee for enabling the House to debate these important issues this afternoon. It is a pleasure to follow the hon. Member for Croydon Central (Sarah Jones), who introduced the debate in such a powerful and effective way.
I do not think that anyone who watched Baroness Tessa Jowell’s speech could have been anything but moved by her powerful and poignant words. I know it moved me, having got to know, like and respect Tessa over many years for her work in Government and in the House, and for the way she is able to bring people together from across politics with a very constructive, focused and tenacious approach just to get things done.
The timing of Tessa’s speech also touched a particular chord with me, coming as it did just a week or so after my own surgery to remove a tumour from my lung. It was a brave, humbling and inspiring speech in equal measure, with her very personal description of her brain tumour and the impact it has had on her, her call to action to secure more funding for brain tumour research, and her stressing the need for more effective clinical trials and the joining up of analysis and data.
But fundamentally, what shone through in Tessa’s words was a profound message of hope—hope for the future; hope in the face of her own physical adversity—and her unstinting passion to secure positive change for the benefit of others. So many debates in this House or in the Lords, while passionate and important, can sometimes appear sterile, perhaps a little arcane, with discussions of statistics, policy or implementation of points of law. Tessa’s speech cut through all that to focus on the human condition: the life well led, what gives it meaning and purpose, and the overriding power of human kindness, compassion and love.
Tessa’s campaign has already made a difference. I warmly welcome the positive response from the Government by the Prime Minister, the Health Secretary and Members across Government to make change happen.
James Brokenshire
Perhaps I can give way to the Health Secretary on that point.
Mr Hunt
I am most grateful to my right hon. Friend. I wonder whether, on behalf of the Prime Minister and the Cabinet, I could follow the shadow Health Secretary in commending Tessa’s campaigning. Most people come to this place hoping to leave a legacy, but she has left not just one legacy, but two—her amazing achievements with London 2012 and her amazing campaigning on cancer. It is our privilege to take part in this debate and our duty to act on what she says.
James Brokenshire
I am extremely grateful to my right hon. Friend for underlining what can and will come out of this debate, which is continued momentum and a sense of purpose to bring about real change. Like the debate in the House of Lords, today’s debate should be a day not for political difference, but for how, together, we can all play our part in securing positive change to ensure that we use the best science to help beat cancer, and to offer the best support to those living with or beyond the disease.
After nearly eight years as the Member of Parliament for Old Bexley and Sidcup, this is my first opportunity to address the House from the Back Benches. While this is most certainly not a maiden speech, I hope colleagues will understand if I place some of my comments in a very local context. A few weeks ago, I was contacted by Lisa and Matt Taylor, the parents of young Olivia Taylor. In January, when Olivia was 17 months old, she was diagnosed with a large slow-growing glioma tumour, which is located at the centre of her brain. By February, Olivia had lost her sight and many other cognitive functions.
Olivia is no longer able to know whether it is night or day, impacting on sleeping patterns not just for her, but for the rest of the family. Because of its location, sadly the tumour is inoperable, and Olivia is receiving chemotherapy to keep the tumour stable and to help retain as much of her quality of life as possible. She is a very brave little girl and clearly surrounded by so much love.
As a parent, I find that a heart-breaking story, and the family face an incredible strain in meeting Olivia’s immediate needs and those that lie ahead. Despite all this, I have been struck by their hugely positive outlook in ensuring that Olivia has happy memories and that she has access to all the right support. They have launched a campaign with the hashtag #KeepOliviaSmiling to help to raise awareness of the signs and symptoms of brain tumours in children and the need for early diagnosis.
Brain tumours are the biggest cause of preventable or treatable blindness in children and the family believe that if the signs of Olivia’s tumour had been spotted sooner, her sight might have been saved. The campaign is also intended to help raise funds to support future treatment for Olivia, which might not be available in the UK. The family have highlighted to me the need for better join-up between hospitals on available treatments, accessibility to international trials and the need for greater research in childhood brain tumours, which can develop in different ways from adult tumours.
I warmly welcome the additional £45 million investment in brain tumour research, which has been committed by the Government in conjunction with Cancer Research UK. I hope that in winding up the debate the Minister will be able to commit to ensuring that part of that funding is used to advance our understanding of, and deliver new treatments specifically for, brain tumours in children. Making a difference in individual cases such as Olivia’s is precisely what today’s debate is all about. I hope that, in some way, today we too can help to keep Olivia smiling.
There is no doubt that the science and analysis of cancer are advancing rapidly. Increasing amounts of patient data are being generated, as well as much greater recognition of the ways cancer develops and the individual mutations that can cause one tumour to behave in a completely different way from another. The challenge, as we heard from the hon. Member for Croydon Central, is co-ordinating the data in a consistent way that leads to more effective treatments and therapies.
One example of that is genetic analysis to help predict a cancer’s evolutionary path. I commend Cancer Research UK for its support of the innovative and significant work to examine the genetic make-up of individual tumours. I recently gave permission for a sample of my own tumour to form part of this molecular research. I hope that in some small way that might add to our understanding of the disease.
Such work is clearly leading to much clearer analysis not just of the nature of individual cancers, but of treatments and immunotherapies that are more likely to be effective for the patient. Rather than talking generally about cancer in a particular organ, we are increasingly able to talk about the nature of a specific tumour for that individual. That is a potential game changer, but it also raises new challenges and potential restrictions that must be overcome if we are to make the necessary progress.
I believe that the UK can be a world leader in this new era of precision medicine, driving forward innovative research to deliver new treatment options, but that will take time, when time for many is a precious commodity. That is why the use of adaptive clinical trials remains important. Yes, there are existing routes for new drug treatments to be made available, such as the early access to medicines scheme, and the cancer drugs fund, but we should be prepared to be more radical.
I pay tribute to the work of the incredible people in our NHS who deliver the care and compassion that Tessa Jowell rightly highlighted. They are amazing, and having received significant NHS treatment and support over recent months, I know just how special they are. I also want to recognise the huge impact that charities such as Cancer Research UK, Macmillan Cancer Support, the Brain Tumour Charity, and the Roy Castle Lung Cancer Foundation have on the lives of thousands of people.
We need to do more as part of the broader cancer strategy, and I will return to a number of topics on another occasion, but we should be positive about what we can achieve, the difference that can be made and the outcomes that can be secured if we work together. In connection with that, some of Tessa Jowell’s own words from her speech in the House of Lords bear repeating:
“I hope that this debate will give hope to other cancer patients like me, so that we can live well together with cancer—not just dying of it—all of us, for longer.”—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]
That inspiring message is one that we should all take to heart.
NHS Winter Performance
Jeremy Hunt Excerpts(6 years, 8 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I would like to update the House on the winter pressures on the NHS following the opposition day debate held in January.
This winter we have seen worse weather than in many recent years, with sustained drops in temperature known to increase heart attacks, stroke and respiratory conditions. This has been coupled with prolonged pressure on hospitals from beds occupied by patients with norovirus and also flu, having experienced the worst flu season since 2010.
However, despite these extra pressures, thanks to the hard work of NHS staff:
over 55,000 people were seen within four hours per day in February. This is 1,000 more people per day than in the same month last year.
NHS 111 offered 150,000 extra calls each month over winter with the amount of callers receiving clinical advice increased to nearly half; and
over one and a half million more people have been vaccinated against flu compared to the same period last year, with the highest ever uptake among healthcare workers at 68.7%.
Last year’s spring Budget allocated £100 million of capital to help hospitals set up GP streaming services with 99% of NHS trusts now having this in place. In addition, at the autumn Budget, the Government provided £337 million for NHS winter funding; this funding has helped the NHS to open over 2,600 acute beds over the winter period.
In order to support emergency care across the NHS, national clinical leaders advised that non-urgent operations should be postponed in January. NHS England has published the information showing that this freed up around 1,400 beds across hospitals in England. This represents around 3% fewer planned admissions this January compared to last year.
The Government remain firmly committed to ensuring that patients are seen promptly when they need urgent and emergency care. The NHS will receive an additional £2.8 billion between 2017-18 and 2019-20. The NHS England Mandate for 2018-19 sets out the milestones for improved A&E performance during 2018-19.
[HCWS603]
Maternity Safety
Jeremy Hunt Excerpts(6 years, 8 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
I am today announcing steps towards ensuring that the majority of women will receive care from the same small team of midwives throughout their pregnancy, labour and birth by 2021, starting with 20% of women benefiting from a ‘continuity of carer’ model by March 2019.
Women who have continuity of carer are 19% less likely to miscarry, 16% less likely to lose their baby and 24% less likely to have a premature baby.
To support this, the Department of Health and Social Care is planning the largest ever increase in NHS midwives and maternity support staff, 650 new training places for midwives in 2019—a 25% increase. We will continue to work with universities and the NHS to create even more training places in subsequent years to fill the gap of 3,000 midwives.
Other key parts of the announcement include:
Professionalising the maternity support worker role by developing a nationally defined role and national competency frameworks for maternity support workers together with a voluntary accreditation register.
Working with our key partners including the Royal College of Midwives, to identify better and clearer pathways for staff to progress and to develop new training routes to become a registered midwife.
[HCWS588]
NHS Workforce
Jeremy Hunt Excerpts(6 years, 9 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
The Government are committed to the delivery of world-class public services, and ensuring that public sector workers are fairly remunerated for the vitally important work that they do.
Public sector pay restraint was necessary to tackle the deficit left by the last Government. However, in September last year we ended the 1% pay award policy for public sector workforces, recognising that some flexibility would be required in certain areas, including in return for improvements to public sector productivity. There is still of course a need for fiscal restraint—our debt is the highest it has been in 50 years, and it is not fair to pass an increasing burden of debt onto future generations.
As a result of constructive dialogue over recent months, I am today announcing that I have agreed to NHS Employers and the NHS trade unions going out to consultation on a three-year pay agreement for NHS staff employed under the “Agenda for Change” pay agreement. This agreement covers over 1 million staff employed in the NHS excluding employed doctors and very senior managers and is a good example of where public sector employers and unions can work together to agree a pay rise in return for wider reform.
The three-year deal aims to ensure that every pound of the £36 billion pay bill delivers value for and is fair to patients, staff and the taxpayer. It targets recruitment, retention and capacity issues to support staff and help them meet demand within the NHS.
The deal will help ensure the NHS can continue to recruit the skilled compassionate workforce it needs by:
Targeting the greatest pay uplifts at the lowest paid in the NHS, affecting over 100,000 FTE staff, so that the lowest starting salary increases from £15,404 this year to £18,005 in 2020-21, through reform.
Investing in higher starting salaries for staff in every pay band by reforming the pay system to remove overlapping pay points; so a newly qualified nurse will receive starting pay 12.6% (£2,779) higher in 2020-21 than this year and starting pay for a midwife on moving to band 6 will increase by 18.1% (£4,800) as a result of pay band reform.
It will support the retention of staff by:
Guaranteeing fair basic pay awards for the next three years to the 50% of staff who are at the top of pay bands—a cumulative 6.5%.
Guaranteeing fair basic pay awards and faster progression pay for the next three years to the c.50% of staff that is not yet on the top of their pay band.
Through important reforms to pay progression, the deal will help improve staff engagement and ensure that all staff have the knowledge, skills and support to make the greatest possible contribution to patient care.
It will put appraisal and personal development at the heart of pay progression—with virtually automatic incremental pay replaced by larger, less frequent pay increases subject to staff meeting the required standards for their role.
Staff will be supported to develop their skills and competencies and demonstrate that they meet the required standards before moving to the next pay point.
The system will be underpinned by a commitment from employers to fully utilise an effective appraisal process.
The deal will release capacity for provider organisations:
The partners commit to working together to improve the health and wellbeing of NHS staff so as to improve levels of attendance in the NHS with the ambition of matching the best in the public sector. NHS Digital data suggests that latest sickness absence rate for the NHS is 4.13%. For AfC staff, this is estimated at 4.5%. Estimates suggest that a 1% drop in sickness absence could save the NHS £280 million.
Finally, the deal will encourage greater consistency and modernisation of terms and conditions:
New provisions will be agreed to give staff access to consistent child bereavement leave, enhanced shared parental leave (extension of statutory), and a national framework for buying and selling annual leave.
Steps will be taken to ensure that, over time, the calculation for sickness absence pay is the same for all staff.
There will be very modest changes to the value of the higher rates of unsocial hours pay for staff in pay bands 1 to 3 over the period of the multi-year deal to ensure the difference between these staff and all other AfC staff is narrowed over time.
Overall, this pay deal is fair to staff and taxpayers and will help to improve productivity through stronger evidence-based appraisal systems and through that, better staff engagement which we know can help improve outcomes for patients.
At the Budget in November my right hon. Friend the Chancellor of the Exchequer announced that if discussions with health unions on pay structure modernisation for “Agenda for Change” staff were successful, he would protect frontline services by providing additional funding for such a settlement. I can confirm that through autumn Budget 2017, we set aside in the reserves £800 million per annum which funds the first year of the “Agenda for Change” pay deal. If the NHS trade unions accept this agreement following consultation with their members, the Government will release this funding. The Chancellor will provide for additional funding required to fulfil his commitment through the 2018 autumn Budget, and so make available the £4.2 billion over three years needed to fund the deal. This is all part of our balanced approach that keeps debt falling, while investing in our public services and keeping taxes low.
I will also be publishing a draft equality statement to meet my public sector equality duty. A final equality statement will be published when the agreement is implemented.
This agreement will be shared with the independent NHS Pay Review Body and I look forward to its report in due course.
[HCWS574]
NHS Staff Pay
Jeremy Hunt Excerpts(6 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Jonathan Ashworth (Leicester South) (Lab/Co-op)
(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on NHS pay.
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
The whole House will want to pay tribute to the hard work of NHS staff up and down the country during one of the most difficult winters in living memory. Today’s agreement on a new pay deal reflects public appreciation for just how much they have done and continue to do, but it is much more than that. The agreement that NHS trade unions have recommended to their members today is a something for something deal that brings in profound changes in productivity in exchange for significant rises in pay.
The deal will ensure better value for money from the £36 billion NHS pay bill, with some of the most important changes to working practices in a decade, including a commitment to work together to improve the health and wellbeing of NHS staff to bring sickness absence in line with the best in the public sector. We know that NHS sickness rates are around a third higher than the public sector average, and reducing sickness absence by just 1% in the NHS will save around £280 million. The deal will put appraisal and personal development at the heart of pay progression, with often automatic incremental pay replaced by larger, less frequent pay increases based on the achievement of agreed professional milestones. It includes a significantly higher boost to lower-paid staff, to boost recruitment in a period when we know the NHS needs a significant increase in staffing to deal with the pressures of an ageing population. Pay rises range from 6.5% to 29% over three years, with much higher rises targeted on those on the lowest and starting rates of pay.
As part of the deal, the lowest starting salary in the NHS will increase by more than £2,500, from £15,404 this year to £18,040 in 2020-21, and a newly qualified nurse will receive starting pay 12.6%—nearly £3,000—higher in 2020-21 than this year. But this deal is about retention as well as recruitment. It makes many other changes that NHS staff have been asking for—such as shared parental leave and the ability to buy extra or sell back annual leave—so they can better manage their work and family lives, work flexibly and balance caring commitments.
The additional funding that Chancellor announced in the Budget to cover this deal—an estimated £4.2 billion over three years—cements the Government’s commitment to protecting services for NHS patients, while recognising the work of NHS staff up and down the country. This is only possible because of the balanced approach we are taking—investing in our public services and helping families with the cost of living, while getting our debt falling. Rarely has a pay rise been so well deserved for NHS staff, who have never worked harder.
Jonathan Ashworth
The Secretary of State has finally given the lowest-paid NHS staff a pay rise. Staff, royal colleges, trade unions and the Labour party have today been vindicated in saying that a pay rise is long overdue. But when we have seen nurses, paramedics and midwives losing thousands of pounds from the value of their pay, heard stories of NHS staff turning to food banks, have 100,000 vacancies across the service, seen more nurses leaving the profession than entering and seen trusts spending billions of pounds on agency staff, this pay cap should have been scrapped years ago.
In the general election, Ministers said that scrapping the pay cap was nonsensical. When a nurse pleaded with the Prime Minister for a pay rise on national television, she was told that there was no magic money tree. Can the Secretary of State tell us how this pay rise will be paid for? Have the Prime Minister’s horticultural skills grown said magic money tree? We have heard that there will be additional money. When will trusts get the allocations, and if the money is additional, will it be paid for by extra borrowing or extra taxation? Public servants deserve reassurances that the Government will not give with one hand and take with the other.
Given the projections for inflation, can the Secretary of State guarantee that staff will not face a real-terms pay cut in any single year of the deal? We note that he has backed down on docking a day’s holiday. Will he commit to not tabling that proposal again? We also note that he will not block the transfer of hospital staff to wholly owned subsidiary companies. Will he at least guarantee that all staff employed by such companies will be covered by “Agenda for Change” terms? Can he tell us when the rest of the public sector will get a pay deal?
NHS pay has been held back for the best part of a decade. Today is a first step, but the NHS remains underfunded and understaffed. We urgently need a plan to give the NHS the funding it needs for the future.
Mr Hunt
If the hon. Gentleman wants a plan to give the NHS the funding it needs, can he explain why Labour in Wales has deprived the NHS of £1 billion of funding that it would have had if funding had increased at the same rate as in England? Far from Labour being vindicated, the House will remember that the pay restraint in the NHS for the past eight years was caused by the worst financial recession since the second world war, caused by a catastrophic loss of control of public finances.
The hon. Gentleman asks for some details. Today’s pay deal means that someone starting work in the NHS as a healthcare assistant will see their rate of pay over the next three years go up by 26%, nearly £4,000. A nurse with three years’ experience will see a 25% increase, which is more than £6,000 over three years. A band 6 paramedic with four years’ experience will see a £4,000 rise. On top of that, we are putting in a huge number of things that NHS staff will welcome, including, for example, statutory child bereavement leave and shared parental leave. Yes, we are asking for important productivity changes in return, but this is about the modernisation of NHS staff terms and conditions, which is good for them and good for taxpayers.
The hon. Gentleman asks where the money is coming from: it is additional funding from the Treasury for the NHS. It is not coming from extra borrowing. If he had been listening to the autumn statement, he would have heard that debt as a proportion of GDP is starting to fall this year for the first time. That is possible because we have taken very difficult decisions over the past eight years—they were opposed by the Labour party—that have meant 3 million more jobs and have transformed our economy out of recession into growth. None of that would have been possible if we did what his party is now advocating, which is to lose control of public finances by increasing borrowing by £350 billion. Let us just remind ourselves that countries that lose control of their finances do not put more money into their health services—they put less. In Portugal, the amount is down 17%, and in Greece, it is down 39%. The reason that we can announce today’s deal is very simple: this country is led by a Government who know that only a strong economy gives us a strong NHS.
Dr Sarah Wollaston (Totnes) (Con)
I warmly welcome today’s announcement of a well-deserved pay rise for NHS staff and, in particular, that this will be additional funding of £4.2 billion over three years, rather than it coming out of existing resources. I particularly welcome the focus on staff health and wellbeing, which was raised by the recent Health Committee inquiry into the nursing workforce. In particular, I ask the Secretary of State to go further and talk about what will be done on continuing professional development for NHS staff, because this was identified as a key factor in retention. He referred to it partially in his comments, but I wonder whether he could go further.
Mr Hunt
I thank my hon. Friend for her comments. Underneath this agreement, there is a very important new partnership between NHS employers and the unions to improve the health and wellbeing of staff through mental health provision and the implementation of the Stevenson-Farmer review, taking on board a number of points raised by the Health Committee, and through improved support for people with musculoskeletal conditions, because a lot of NHS work is very physical. However, she is absolutely right: professional development is also very important. By reforming the increments system that we have been using for many years, we will give staff the chance to see their pay go up in a way that is linked to their skills going up as well. That is something that many staff will welcome.
David Linden (Glasgow East) (SNP)
May I associate myself with the comments made by the Secretary of State in paying tribute to our NHS staff? It is good to have not just warm words today, but substantive action. He has referred to devolved nations elsewhere in the UK, and I hope that he will acknowledge that the Scottish Government were the first Government in the UK to lift the public sector pay cap.
Although this announcement is welcome, we have committed to using any additional funds that come to Scotland through consequentials to go into the Scottish pay agreement. However, the Office for Budget Responsibility has projected that average earnings will go up by 7.7% in the next three years, while the retail prices index goes up by over 9%. Has the Secretary of State taken that into account, or are the Government ignoring the OBR on average earnings? Committing to a three-year deal could stagnate wages and lower the standard of living, and none of us in this House wants that to happen.
Mr Hunt
The majority of NHS staff will see that their pay is protected against the cost of living, but many NHS staff, including the lowest-paid, will see increases that are substantially higher than inflation rates, because, first, that is the kind of society that we believe in. Conservative Members want everyone to be given decent rates of pay, and there are many parts of the country where the cost of living is very high and this will make a very big difference. We also recognise that there will be 1 million more over-75s in 10 years’ time, so we need to expand the number of staff in the NHS and its capacity to deal with those pressures. We therefore need to attract more people into working for the NHS and social care systems.
Mr Iain Duncan Smith (Chingford and Woodford Green) (Con)
I congratulate my right hon. Friend; I know of his huge personal commitment to the NHS and how he has battled for it over the years—I have seen that personally. I unashamedly, absolutely agree that this is a very good deal, and I congratulate nurses and others on this pay rise, which they deserve and for which they have worked very hard. Is it not also right to recognise and remember that back in 2008-09, Labour’s great depression plunged the economy into the biggest and most difficult economic trench that it has faced? As a result of our stewardship and our support of the NHS through that period, unlike many other countries that cut their health spending, we secured 200,000 jobs in the NHS, and now we can start rewarding staff for their hard work.
Mr Hunt
I thank my right hon. Friend and commend him on his courage in putting through some incredibly challenging and important reforms to our welfare state, when many people said that it was nigh on impossible. He is right: the biggest and most misleading thing that we hear is the charge that in austerity Britain, the NHS budget has been cut. In fact, the countries that cut their health budgets were Portugal and Greece—countries that are following precisely the policies that are advocated by the Opposition. In this country—so-called austerity Britain—NHS spending has gone up by 9%.
Sir Vince Cable (Twickenham) (LD)
On the vexed question of how to pay for the NHS, has the Secretary of State been in any way influenced by the testimony of the recently retired permanent secretary to the Treasury, who at last acknowledged that the only way to do it was to have some form of earmarked taxation?
Rebecca Pow (Taunton Deane) (Con)
I have met many nurses from Taunton Deane to press their case for a rise in salary, and I have passed that on not just to the Department of Health and Social Care, but to the Chancellor. I welcome today’s pay rise; I think these hard-working nurses all deserve it, and we congratulate them. Does my right hon. Friend agree that today’s £4 billion commitment demonstrates that this is a listening Government who are taking investment in the health service extremely seriously?
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
We have lost over 5,000 nurses working in mental health since 2010. As a result of this announcement on pay, when does the Secretary of State expect the number of mental health nurses to return to 2010 levels?
Mr Hunt
We would have more nurses in mental health if we had not had to deal with the crisis at Mid Staffs and pronounced short staffing in our acute hospitals. Since I have been Health Secretary, we have 15,000 more nurses in the NHS and we are also finding more money to go into mental health. It is time that the hon. Lady recognised that, rather than trying to paint the opposite picture.
Mr Philip Dunne (Ludlow) (Con)
I add my voice to those congratulating the Secretary of State and his ministerial team on a tremendous achievement in discussions with the Treasury to secure this additional funding. I invite him to comment on the work that has been done by the health unions and the Royal College of Nursing, in particular, in helping to deliver this agreement and particularly to give many of the people on starting salaries a significant uplift, which he referred to earlier. This will make it easier to attract people to the vital starting roles for future generations.
Mr Hunt
I would like to pay tribute to my hon. Friend because, when he was working in my Department, he laid a lot of foundations for this deal. He chaired some very important meetings. In particular, one of the most important areas of consensus that has emerged, which he should take enormous credit for, is that we are saying today that the minimum salary for anyone working in the NHS will go up by £2,000. That is going to make a huge difference—100,000 people will benefit from that important change—and he should be very proud of that.
Bambos Charalambous (Enfield, Southgate) (Lab)
NHS trusts are spending £3 billion a year on agency staff to plug gaps in the workforce. Has the pay cap not been totally self-defeating and led to huge amounts of public money going to private staffing agencies?
Mr Hunt
What led to the mushrooming agency fee was the realisation, post Mid Staffs, that we needed a lot more nurses. Nursing staff numbers were going down until the Francis report was published, but the report created huge demand among hospitals, which realised they needed to improve patient safety by recruiting more staff. The hon. Gentleman will be pleased to know, however, that we are bringing down the agency bill, and I expect it to be significantly lower this year.
Maria Caulfield (Lewes) (Con)
It is disappointing to see the lack of welcome from Labour Members for this pay rise for NHS staff in England—one day after the announcement of five new medical schools across the country. Has the Secretary of State had discussions with the Labour Government in Wales to see if they will be replicating this pay rise for NHS staff in Wales?
Mr Hunt
First, I want to pay tribute to my hon. Friend as one of the practising nurses in the House and someone who always makes sure that the voice of nursing is heard loud and proud in this place. I very much hope that the devolved Governments will follow suit with this deal, although for every additional pound per head we have put into the NHS in England, Labour in Wales has put in only 57p.
Stella Creasy (Walthamstow) (Lab/Co-op)
Further to the question from my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous), we all know how much agency nurses cost the NHS, and the same goes for private finance initiatives. These companies are making £1 billion in profits, which is money that will not touch any of our hospital budgets, including that of my own, Whipps Cross Hospital, which has a 17% agency rate and tried to deal with its PFI debt by downgrading the pay of nurses to save money. What is the Secretary of State doing to cut the PFI bill for our hospitals and prevent them from balancing their books off the backs of hard-working staff?
Mr Hunt
The hon. Lady is right to draw attention to that problem. We have certainly stopped doing any new PFI deals of the disastrous kind that lead to the consequences she talks about. We have given some relief to a number of hospitals in that area, but I will look again at her local hospital, because it is clearly totally unacceptable if that is happening.
Will Quince (Colchester) (Con)
Colchester General Hospital has recently come out of special measures, and the staff there have worked so hard to turn our hospital around, so I welcome wholeheartedly this announcement of extra money, which means that our staff will get a well-deserved pay rise. I will always champion our hospital, however, so will my right hon. Friend commit to continuing to invest in our hospital and its people? In particular, will he look at the accident and emergency department?
Mr Hunt
I will happily do that. The hon. Gentleman has championed his hospital, which has been on a rollercoaster journey during his time in this House but which has now turned a corner. The staff have worked incredibly hard to improve safety standards for patients, but I know that, like many places, they would like more investment in their A&E, and I will certainly look at it.
Ben Lake (Ceredigion) (PC)
I, like many others, welcome the fact that NHS workers in England will finally receive a pay rise they deserve. Of course, health is devolved to the Welsh Government, so could the Secretary of State clarify how much of this additional funding is new funding and what the Barnett consequential will be for the Welsh Government?
Mr Hunt
This constitutes an investment by the Treasury of £4.2 billion, and the normal Barnett consequentials will apply, so it is perfectly possible for the Labour Government in Wales to replicate this deal if they choose to, but we know, of course, that had they replicated the increases in funding to the NHS in England, the NHS in Wales would have had an additional £1 billion spent on it over the past five years.
Dr Murrison
I warmly welcome this announcement and congratulate my right hon. Friend, the trade unions and NHS Employers on reaching this deal. One problem facing our NHS is that of people not returning to work after they have had caring responsibilities. What elements of the deal will encourage more people to consider coming back into the workforce? I am thinking, in particular, of the non-pay elements and the reform of pay structures that he has mentioned.
Mr Hunt
The most important thing about the deal is that it will discourage people who might be reaching breaking point, because of personal circumstances, from packing it all in and leaving the NHS family. There is a particular proposal to allow much greater flexibility in the buying and selling of annual leave, so that people who need to work less because of things that happen at home, and perhaps people who want to work more, find it much easier to do so. This is therefore part of a much bigger shift towards the flexible working that we know everyone wants these days.
Eleanor Smith (Wolverhampton South West) (Lab)
I absolutely appreciate the Secretary of State’s announcement on pay. As a nurse who has worked for more than 40 years, I know that it is greatly welcomed by everybody across the patch, including porters. I want to ask, however, about wholly owned subsidiary staff. I believe that some of them are not under “Agenda for Change” terms. Will they get the pay rise as well?
Mr Hunt
First, I thank the hon. Lady for welcoming the deal. I think she is the first Labour Member who has done so, and it is not insignificant that she is a nurse. A wholly owned subsidiary is a legal structure that was made possible by a change in the law introduced in 2006, under her party’s Government, and is actually an alternative to outsourcing. Employees would be far more likely to benefit from “Agenda for Change” pay rates within such a structure than if they were outsourced, which the last Labour Government tried so hard to encourage.
Mr Gary Streeter (South West Devon) (Con)
When I met Devon’s secretary of the Royal College of Nursing recently to discuss nurses’ pay, she made the obvious point that she was getting a bit fed up with politicians saying that they valued nurses while not actually adding to their pay packets. Does my right hon. Friend agree that from today not only will we be saying that we value nurses, but that that will be reflected in their pay packets? I congratulate him and the RCN on achieving such a good deal.
Ruth Smeeth (Stoke-on-Trent North) (Lab)
My healthcare economy was held together over the winter solely by the good will of NHS workers, yet they have had a 14% pay cut in real terms since 2010. This announcement is a drop in the ocean. How does the Secretary of State think that it will help retention rates?
Mr Hunt
I cannot agree that this is a drop in the ocean. If the hon. Lady does not want to hear it from me, let me point out what was said by the Unison head of health, Sara Gorton, who is also the head negotiator for the NHS unions. She said that the deal
“would go a long way towards making dedicated health staff feel more valued, lift flagging morale, and help turn the tide on employers’ staffing problems.”
That is not a drop in the ocean.
Robert Halfon (Harlow) (Con)
I strongly welcome the measures that my right hon. Friend has announced. He will have heard my question to the Prime Minister earlier, and he will acknowledge that Harlow Hospital is out of special measures and that this pay award is much deserved by staff. In the future, will he look at the particular problem we face—we are just outside London, and a lot of staff work in London, which makes it harder for Harlow Hospital to recruit—and perhaps think again about the pay scales?
Mr Hunt
I am happy to do that and to congratulate the staff at my right hon. Friend’s hospital, which he has long championed and whose pressures and needs he has highlighted assiduously. To come out of special measures is a huge achievement. I have recorded a video message, but I am happy to say in the House how proud we all are of what the staff have achieved. I also recognise the capital issues at the hospital and the fact that the building is not fit for purpose.
Tim Farron (Westmorland and Lonsdale) (LD)
The minimum amount that nurses in south Cumbria will have lost since the pay freeze is £4,306. Given that the average house price in my constituency is 10 times the value of the average nurse’s salary, Members will understand the huge impact that there has been on retention and recruitment. The rise is therefore deserved, welcome and overdue, but without a long-term plan for funding health and social care, this announcement will not be trusted, so does the Secretary of State not agree that we need a new deal to refresh Beveridge’s vision for the 21st century, and should we not be prepared to be honest with the British people and say that this will involve a modest but clear increase in taxation?
Mr Hunt
I disagree that the deal will not be believed—it is a concrete deal. NHS staff still have to vote for it, but the Government have committed to significant rises in pay. I agree, however, that we will need to find the best way of getting more money into the NHS and social care system as we face the pressures of an ageing population.
Dr Julian Lewis
Will the Secretary of State expand a little on what he briefly said about flexibility of working hours and family bereavement among NHS staff? After this urgent question, will he kindly give a short tutorial to those of us with an interest in defence on his successful techniques for extracting £5 billion from the Treasury for a Department that urgently needs it?
Mr Hunt
I would not dare to talk about an area outside my own Department’s responsibilities, even to such an eminent person as my right hon. Friend.
Flexible pay is at the heart of what we need to do differently in the NHS. This is really about two types of NHS worker. First, many people find that the shift patterns in the NHS are very unpredictable. Every six weeks their lives are turned upside down as they are given a new set of times when they have to work. People want regularity and predictability, and we do not offer that at the moment, which makes life much tougher for those who are trying to achieve a work-life balance. Secondly, we make life hard for people who want to do extra shifts at the last minute. Both those factors are important, and they will be helped by this new pay deal.
Mr Paul Sweeney (Glasgow North East) (Lab/Co-op)
We have already heard about the 14% real-terms fall in NHS staff pay since 2010. There have been eight long years of pay restraint, and this deal does not go far enough to offset that historic deficit.
The Secretary of State is having to deal with the massive problem of an ageing population and the need to increase the capacity of the NHS to deal with it. Does he agree that alienating an entire generation of junior doctors was not a productive way of achieving that?
Mr Hunt
We do not recognise the figures that the hon. Gentleman has given but, in any event, he cannot say that the deal does not go far enough without asking why that has happened. It happened because in 2008 we had the worst financial recession since the second world war, which was made an awful lot worse by the Labour Government’s loss of financial discipline. What I think is most disturbing for people in the NHS is that the hon. Gentleman’s party seems set on repeating the same mistake.
Rachel Maclean (Redditch) (Con)
I join colleagues in welcoming my right hon. Friend’s announcement. Will he join me in congratulating the nurses and doctors at the Alexandra Hospital in Redditch on their incredibly hard work in keeping people safe and well cared for throughout the winter? Following yesterday’s announcement about new medical schools and nursing apprenticeships, his announcement today represents a real, solid investment in our NHS workforce that will enable us to open the urgent care centre at the Alex for which I have been campaigning.
Mr Hunt
I certainly recognise my hon. Friend’s strong argument for an urgent care centre, and I commend the very hard work of the staff at the Alex. I know that the new leadership at the trust is making progress and turning things around, and I hope that what has happened at Harlow today will be an inspiration.
What we are doing today is significant. The extra doctors and nurses whom we are training, and a pay deal that is intended to boost recruitment in the NHS, demonstrate our recognition that we need a significant increase in capacity in the NHS and the social care system if we are to ensure that every older person gets the care that they really need, which is what the Government want.
Chris Elmore (Ogmore) (Lab)
May I press the Secretary of State a little further on Barnett consequentials? Will he confirm that there will be consequentials for each of the three years of the pay rise? Will he also welcome the Welsh Government’s introduction of a living wage in the NHS in 2014, and does he recognise that NHS and social care spending is higher in Wales than it is in England? That is a matter of fact.
Julian Knight (Solihull) (Con)
I have the great good fortune to be married to a former renal nurse, and she tells me regularly that much of retention is about work-life balance, training and interactions with management. Will the Secretary of State tell us what progress he is making in those areas?
Mr Hunt
I am happy to do so. Work-life balance is something that we need to handle a lot better. I think we have been slow to recognise that today’s NHS staff are likely to live in households in which both partners are working and that juggling life and work has therefore become much more complex than it was 30 or 40 years ago. The reform of the increments system means that there will be more focus on training and skills, which will be much more motivating for NHS staff, so I hope that my hon. Friend’s wife is pleased.
Diana Johnson (Kingston upon Hull North) (Lab)
I welcome the Government’s change of heart in awarding a pay rise to our hard-working NHS staff. May I pursue the point made by the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston)? Our Committee’s report emphasised that continuing professional development was key to the retention of nurses. It was not clear to me from what the Secretary of State said whether money would be ring-fenced—sadly, the amount has been cut—to ensure that nurses can access CPD not only in the NHS, but in social care settings.
Mr Hunt
I recognise that there have been pressures on the CPD budget, and that is because we have made increasing the number of nurse training places our main priority. We have increased that by 25%, which has meant that difficult decisions have had to be made about other parts of the budget. I can reassure the hon. Lady, however, that I think that CPD will continue to have a vital role, and we will need to return to the issue.
Huw Merriman (Bexhill and Battle) (Con)
Efficiency and productivity deserve to be rewarded, and, given the 16% increase in emergency admissions, NHS professionals have certainly earned that. In the light of this new working relationship, does the Secretary of State envisage staff and the Government working in partnership to challenge patients to be more respectful to those who work in the health service?
Mr Hunt
I thank my hon. Friend for making that point. He often raises difficult issues that need to be talked about in this place. We all know that the vast majority of patients are incredibly grateful for the care that they receive from NHS professionals, but occasionally that does not happen. Occasionally, people use services that they do not need to use, which creates pressures and denies other patients what they do need. My hon. Friend is absolutely right that as we start to expand NHS capacity, we need the public to understand their responsibilities as well.
Lady Hermon (North Down) (Ind)
I am happy to welcome the statement, but let me take a moment to remind the Secretary of State that we in Northern Ireland have not had a functioning Assembly for 14 months, and we have had no Health Minister for 14 months. How can the hard-working staff members of the NHS in Northern Ireland benefit from the new pay deal? Will the Secretary of State commit himself to speaking to the Secretary of State for Northern Ireland, whom I am delighted to see sitting on the Front Bench, to ensure that NHS staff in Northern Ireland see the benefits of the deal?
Mr Hunt
The hon. Lady speaks eloquently and my right hon. Friend the Secretary of State for Northern Ireland was listening to her comments. It is a matter of great sadness that nurses’ pay has fallen behind in Northern Ireland, not because the money was not available, but simply because the Administration were not in place to implement changes. I know that my right hon. Friend will do everything she can.
Helen Whately (Faversham and Mid Kent) (Con)
I welcome the proposed pay rise, especially the increase for the lowest paid in the NHS. Nurses at my local hospitals tell me that as well as a pay rise, what they really want is flexibility in relation to things that happen in their lives, so I particularly welcome that aspect of the proposal. Does my right hon. Friend agree that flexibility and investment in training will enable NHS employers to show their appreciation for the valuable contribution that each individual member of staff makes to the care of patients?
Mr Hunt
My hon. Friend is absolutely right and speaks with a great deal of knowledge. Let me give an example of something we are doing that is not part of this deal, but that backs up what she says. We are prioritising the use in every hospital of an effective e-rostering system that enables people to book the shifts that they want on their phones and to change them very easily through a modern IT system. That makes an enormous difference to the control that they have over the hours they work, and I think that, in combination with the new deal, that will make a big difference.
Ellie Reeves (Lewisham West and Penge) (Lab)
The NHS is now short of 100,000 staff because of the Government’s neglect of the NHS workforce. When the Government scrapped the nursing bursary, they said that that would lead to the training of more nurses, but UCAS data shows that since then the number of applications has fallen by 15,000. Will the Government now commit themselves to reintroducing the bursary?
Mr Hunt
What the hon. Lady chose not to tell the House was that since the time of the last Labour Government, we now have 5,500 more nurses and 15,000 more doctors in the NHS, and there has been a 9% rise in NHS funding. [Interruption.] I hear the shadow Secretary of State talking about vacancies from a sedentary position. I hope that he will also welcome the 25% increase in the number of doctors and nurses whom we are training precisely so that we can fill those vacancies.
Craig Tracey (North Warwickshire) (Con)
I welcome the announcement, and it was great to see the Secretary of State meeting staff at my excellent local hospital, the George Eliot, recently. What will be particularly welcomed is the hugely progressive nature of this deal, with its focus on the lowest paid. What exactly does it mean for those at the very bottom of the pay scale?
Mr Hunt
For people starting off in nursing, there will be a rise of about £2,000, which will make a very big difference, and we are increasing the minimum starting salary for anyone working in the NHS by about £2,500. This is completely in line with the Government’s policies over a whole range of areas. We have prioritised increasing the amount people can earn tax-free before paying any income tax at all. We have taken millions of people out of income tax. That is because this Government are committed to helping the lowest paid.
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
It has taken six years, but finally the Health Secretary has come to the conclusion that Labour Members reached many years ago: the pay cap is a folly. I thank Sara Gorton and the team at Unison and the GMB for campaigning on this matter for years, standing up not just for clinical staff, but for the support staff without whom our NHS simply would not function. Given that the offer in the second and third years of the pay deal is below inflation, what guarantees can the Secretary of State give that this is not a one-off deal to hide the fact that he is failing in his job, and is instead a long-term engagement to achieve proper pay in our NHS?
Nigel Huddleston (Mid Worcestershire) (Con)
I welcome the announcement and believe that it is a further obvious commitment by the Government to the NHS and NHS staff. I will continue to have a debate on whether the record spending is enough, as, personally, I would support more spending, but does the Secretary of State share my disappointment and anger that there continue to be campaigners and campaigning organisations that, for whatever reasons and motivations, spread the untruth that there have been cuts in spending in the NHS?
Mr Hunt
My hon. Friend is right. Just to reassure him, I do not think that any Health Secretary would ever say the NHS does not need additional funding. He makes an important point, and the truth is that at the 2010 election there was one party that wanted to cut funding for the NHS. It was the Labour party, and we stopped it.
Vicky Foxcroft (Lewisham, Deptford) (Lab)
When my sister broke her neck only weeks ago, I saw at first hand the pressures that NHS staff are under. They start shifts early and finish shifts late, and there are not the right staffing levels on wards. Those staff were amazing, however. The NHS is now short of 100,000 staff because of this Government’s neglect of the NHS workforce. Will the Government apologise to all NHS workers for undervaluing them for so long?
Mr Hunt
The hon. Lady needs to look at the facts before making those kinds of claims. Let us look at what has happened in the last five years—the period during which I have been Health Secretary. The numbers of qualified clinical staff have not gone down, but have gone up by 43,000. We are doing everything we can to increase the capacity of the NHS, and the hon. Lady should be welcoming that.
Michael Tomlinson (Mid Dorset and North Poole) (Con)
I warmly welcome the Secretary of State’s statement. I met representatives from the Royal College of Nursing in my constituency recently, and I am sure that they, too, will welcome this statement. Does this not show that, contrary to the assertion so often made by Labour, it is this Government and Secretary of State who are committed to long-term investment in our NHS?
Mr Hunt
I am grateful to my hon. Friend for saying that. The truth is that there is probably one thing that those on both sides of the House agree on: the long-term future of the NHS depends on long-term funding for the NHS. Sadly, there is one thing that only Conservative Members understand: to do that, we need a strong economy.
Tom Brake (Carshalton and Wallington) (LD)
I welcome the statement. Has the Secretary of State had time to assess the impact on retention and recruitment of EU citizens who work in the NHS? If he is feeling generous, may I remind him that St Helier Hospital is in need of £400 million?
Mr Hunt
I am aware of the estate issues at St Helier Hospital. I have seen them myself and know that that building is, in many areas, not fit for purpose. On EU citizens, the picture is mixed. We have seen a small decline in the number of EU nurses, but overall the number of EU citizens working in the NHS has gone up by 3,200 since the referendum. That has happened because the Government and NHS staff have made a huge effort to reassure them of just how valued they are and that we want them to stay.
Oral Answers to Questions
Jeremy Hunt Excerpts(6 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Alan Mak (Havant) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
The UK has a fantastic life sciences industry. As a result of the sector deal announced in December, a further £210 million is being invested in research and £162 million in medical manufacturing.
Mr Hunt
I am looking forward to reading my hon. Friend’s report into this topic in May. We are a bit of a curate’s egg in this country. We have five of the world’s top 10 medical research universities and more than double the number of Nobel prizes of France, so we do incredibly well on the research side, but some of our hospitals are still running on paper, which is totally inappropriate. That is why we are determined to implement the Wachter review.
Dr Paul Williams (Stockton South) (Lab)
Co-operation in medical research, science and innovation with our European partners must not be hindered by a bad Brexit deal. What steps is the Secretary of State taking to ensure that UK patients are not left behind during the negotiations?
Mr Hunt
Let me reassure the hon. Gentleman—as a doctor, he is very conscious of such issues—that the absolute need to ensure that we have an uninterrupted supply of the most critical drugs is forefront in our minds. We are confident that we will be able to achieve that, but we also want great collaboration with European universities, which is why we have said that we would be happy to be an associate member of the European Medicines Agency.
Vicky Ford (Chelmsford) (Con)
Part of the life sciences strategy is about ensuring that we have the skills for the future. May I thank the Secretary of State for the fantastic news about the five new medical schools opening in the country, including in Chelmsford?
Sir Vince Cable (Twickenham) (LD)
The Secretary of State will be aware that one of the factors stifling innovation is the difficulty of rapid-growth companies in crossing the so-called valley of death. Since the establishment in the coalition Government years of the business growth fund, the biosciences fund and the British Business Bank, how far is the sector from crossing the valley of death?
Mr Hunt
I hope that we are crossing the valley into eternal life because we have a fantastic life sciences industry that is worth £61 billion and employs 250,000 people. The right hon. Gentleman is right—he was involved in this when he was Business Secretary—that part of that is about having close links with the key people who make decisions about where to invest their resources.
Jim Shannon (Strangford) (DUP)
With companies such as UltraLinq raving about Belfast’s ability to provide technology support and skills from local universities, will the Secretary of State confirm what steps he is taking to invest departmental moneys in universities to set up life sciences skill centres in co-operation with the Department for Education?
Mr Hunt
I reassure the hon. Gentleman that we are conscious of the importance of a good outcome to the Brexit talks for universities, including Queen’s University Belfast, for precisely the reason raised by the hon. Member for Stockton South (Dr Williams) earlier. There are excellent research links with universities all over the world, but it is particularly important that we carry on working with European universities.
Mr Mark Francois (Rayleigh and Wickford) (Con)
Richard Graham (Gloucester) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
By 2020, investment in general practice will have risen by £2.4 billion, which is 14% in real terms, including an additional £680 million in infrastructure and premises in the last two years.
Richard Graham
The Health Secretary knows how hard staff have worked at the Gloucestershire Royal Hospital to ensure that this year—in fact, in January—it was rated 15th out of 137 hospitals for its A&E performance, despite the intensities of the winter. He knows from his recent visit that all staff, and their co-operation with health services, as well as within the A&E, have led to this, but will he also recognise and do all he can to let Public Health England know how important it is that new capital expenditure is available in order to increase beds and to serve the demographics of an ageing population?
Mr Hunt
I was pleased and privileged to see the brilliant work that staff are doing in Gloucester when I went on that visit. Deborah Lee and her team deserve enormous credit for getting a 10% improvement in performance year on year to February. A capital bid has been put in by my hon. Friend’s sustainability and transformation partnership. It is a promising bid and I hope to be able to give him news on that soon. If it is successful, it will be in no small part thanks to lobbying by him and our colleague, my hon. Friend the Member for Cheltenham (Alex Chalk).
Helen Jones (Warrington North) (Lab)
Research shows that access to GPs is now more difficult than it was five years ago, and in Warrington, we still have fewer GPs than the population would merit, putting more pressure on A&E. What is the Secretary of State doing to attract more GPs to areas such as this and to reduce the burdens on those already in the profession, so that they do not take early retirement, as many are planning to do?
Mr Hunt
The hon. Lady is absolutely right about how important is to increase the number of GPs. The most significant thing is what we announced this morning, which is five new medical colleges that are in parts of the country where it is particularly hard to recruit doctors. Our intention is that half the medical school graduates should be moving into general practice because it is so important.
Sir Roger Gale (North Thanet) (Con)
Thanet enjoys an ageing population and I am pleased to be a part of it. We will be delighted to know that one of the five new medical schools designated by the Secretary of State today is going to be based in east Kent: the bid from the University of Kent and Canterbury Christ Church University was successful. It will not have escaped my right hon. Friend’s notice that the Christ Church campus is in close proximity to an A&E hospital— the Queen Elizabeth The Queen Mother Hospital—and we hope very much to see all the benefits very soon. Thank you.
Mr Speaker
May I just say to the hon. Gentleman that if memory serves me correctly, he was born on 20 August 1943, and therefore, he is really not very old at all?
Mr Hunt
I congratulate my hon. Friend on being born five years before the NHS was founded—a very short while ago. Kent is an area that, although it is the garden of England, has some profound challenges in its health economy. One of those challenges is attracting doctors to work in Kent and other more geographically remote areas, so I am very hopeful that this big new announcement for the University of Kent will be a big help.
Wes Streeting (Ilford North) (Lab)
The GP-patient ratio in my constituency is unacceptably high, meaning that many people cannot get a GP appointment when they need it and they are turning up at the A&E—not only creating additional pressure but costing more in the process. What is the Secretary of State going to do to make sure that outer-London boroughs such as mine get the GP support that they need, because frankly, the assurances that he has already given are not manifesting themselves on the ground in terms of practical results for patients?
Mr Hunt
I appreciate that there are pressures in the hon. Gentleman’s constituency. I think most hon. Members would say that there are pressures in their constituency when it comes to general practice, so what have we done so far? Let me put it that way. This year, 3,157 medical school graduates will go on to specialise in general practice, which is the highest ever, but we still have to do more to improve the retention of GPs who are approaching retirement.
Rebecca Pow (Taunton Deane) (Con)
Forgive me, Mr Speaker, if first of all, I congratulate you on a marvellous event this morning, celebrating 10 years on from your acclaimed report on young children’s speech and language and calling for a national strategy on that, which directly links into education and health. It was an excellent event, thank you. But of course, on to Taunton Deane. Tomorrow, I shall be very proud in this Chamber to be presenting my petition, which over 6,000 good people from Taunton Deane have signed, calling for a new surgical centre at Musgrove Park Hospital. They are not querying the quality of the healthcare given, but they are querying the facilities. I wonder whether my right hon. Friend would agree that this is a very deserving case for a new centre and for funding.
Mr Hunt
If these cases were decided on the persistence and strength of the lobbying of local Members, for sure my hon. Friend’s would be at the very top of the list. I have been to the hospital and heard about the issues from staff—it was a very good visit. She has campaigned persistently on this and I very much hope that we can give her good news because I am aware of how urgent the need is.
Mr Speaker
Not only was the hon. Lady present in Speaker’s House this morning, but her sister and distinguished speech and language therapist Rosalind Pow was present as well, so we had two doses of Pow in the course of a breakfast meeting. It was an unforgettable experience for all concerned.
Tim Farron (Westmorland and Lonsdale) (LD)
I cannot compete with that, Mr Speaker. Back in November, I wrote to the Secretary of State about the increased service charges on GP practices. Ambleside surgery in my constituency, which serves an increasingly ageing population, faces a huge increase of £25,000—more than double—and the staff there fear they cannot keep the surgery going long term with that kind of increase. A ministerial written response in November did not mention Ambleside once, so will the Secretary of State commit now to intervening directly to guarantee that Ambleside will not have to pay this unjustified additional £25,000 a year?
Mr Hunt
I will re-look at the issue and the response that the hon. Gentleman was given. The issue is that there is unevenness and unfairness in the rates charged to GPs whose surgeries belong to NHS Property Services. We are trying to make this fair across the country, but we also want to make sure that no GP surgeries close.
Dr Philippa Whitford (Central Ayrshire) (SNP)
With an ageing population, I, too, welcome the aim of integrating health and social care and developing population-based planning, as we have done in Scotland with health and social care partnerships, but the outsourcing of health service contracts to private providers in NHS England has led to more fragmentation rather than integration. Will the Secretary of State agree that we need to repeal section 75 of the Health and Social Care Act 2012 so that local commissioners can develop patient-centred services and not fear litigation if they do not put them out to tender?
Mr Hunt
We want to encourage the NHS to move towards more integrated services, and part of that is about contractual structures, but part of it is about funding, and I gently point out to the hon. Lady that 8% of the NHS budget in England goes to general practice and only 6.6% in Scotland, which is why there is an even bigger problem with GP surgeries closing in Scotland.
Dr Whitford
The many and varied new integrated care structures developing in NHS England have no statutory basis, yet in the future will control the entire health budget for a population. Does the Secretary of State accept that with another major NHS reorganisation we need debate and legislation in this place to get the structure and governance right?
Mr Hunt
In my first few years as Health Secretary, the message I heard loud and clear from the NHS was that it did not want a huge structural reorganisation, so we are very cautious about changing statutory structures. We want to encourage integration, but in time, if the NHS says it would like the statutory structure changed, we will of course listen.
Eleanor Smith (Wolverhampton South West) (Lab)
Huw Merriman (Bexhill and Battle) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
This afternoon I will make a speech setting out the principles with which we will approach the social care Green Paper, including a focus on the highest standards of care, integration of the health and social care system and developing a long-term sustainable funding solution.
Huw Merriman
Given that the arithmetic of this place is so tight, it is clear that there will need to be some form of cross-party consensus for any meaningful reform. Given that the Opposition appear to favour a wealth tax and our party has mooted the idea of individuals paying more for their own care, surely cross-party consensus is within reach; what is the Secretary of State’s view on that?
Mr Hunt
My hon. Friend always speaks very thoughtfully on this matter, and it is important, because social care issues will continue for decades ahead unless we find a solution and both parties will have to deal with this issue in government. In truth, both parties have made things worse by politicking in the past, whether by discussion about a death tax in 2009 or a dementia tax in 2017.
Derek Twigg (Halton) (Lab)
I have received a document from my local authority sent out by Cheshire and Merseyside NHS which tells it that it should be looking at there being a minimum of one choice of place for people coming out of hospital into a care home, and if that cannot be met it should be looking at transitional placements. So it will have to ask people who are frail and elderly to go into transitional placements, and that will cost more money. How are people going to be able to cope with this? At the end of the day, the problem is simply this: there is not enough money; there is not enough money to pay for good quality staff; and there are not enough places. The Government should be ashamed of themselves.
Mr Hunt
It is the hon. Gentleman’s party that should be ashamed of itself for leaving us with the financial crisis 10 years ago that has created such huge pressure in both the health and social care systems. Yes, in 2010 there were some cuts in the social care system, but that has changed now and over this Parliament the budget is going up, with £9.4 billion of additional resources, which is an 8.6% increase in real terms. We need to go further, however, which is why we have a Green Paper.
Damian Green (Ashford) (Con)
May I add my thanks to those of my hon. Friends for the fact that one of the new medical schools will be placed in east Kent, which is an extremely welcome development for the health economy? On social care, the Secretary of State will be aware that the funding issue is one of the big long-term questions that need to be answered. Can he assure the House that the Green Paper will not only address that, however, but will place equal emphasis on the need for rising quality in social care across the board, because in the short run that is what many families feel most anxious about?
Mr Hunt
I thank my right hon. Friend for doing some incredibly important work when he was responsible for this area; he laid some really important foundations. My right hon. Friend is absolutely right: earlier my hon. Friend the Minister for Care talked about the fact that 81% of adult social care providers are good or outstanding, but that means that one in five is not, which means too many people are not getting adequate social care provision. We must put quality at the heart of this, and of course that does link to funding.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
I hope the Secretary of State saw last night’s “Panorama”, which highlighted the link between the low pay of careworkers and the gender pay gap. We all know about the amazing work careworkers do, particularly in difficult circumstances such as when there is severe weather or where there are 15-minute appointments, so what is the Secretary of State going to do to ensure they are properly rewarded?
Mr Hunt
I am pleased that the hon. Lady mentioned that, because today is world social worker day. It is a day on which to celebrate the brilliant work done by people working in the social care system, often at low rates of pay. We should also celebrate the fact that, thanks to the national living wage, 900,000 workers have benefited, including through a raise of up to £2,000 a year in the take-home pay for the lowest paid workers.
Tracy Brabin (Batley and Spen) (Lab/Co-op)
Chris Law (Dundee West) (SNP)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
All policy teams in my Department have conducted assessments of the implications of Brexit and continue to plan for all scenarios.
Chris Law
Well, I hope to hear some good news then. In my constituency, Dundee University and Ninewells Hospital are recognised centres of biomedical and clinical research, working closely with other European colleagues and institutions. That work is threatened if the UK is outside the European research network and excluded from data-sharing and the new clinical trial system. How does the Secretary of State plan specifically to protect the academic and clinical research excellence of Scottish and UK institutions post-Brexit?
Mr Hunt
We have made it clear that we want to integrate very closely with European structures when it comes to medicines research. I would gently say to the hon. Gentleman that great universities such as Dundee also collaborate with universities all over the world, and I think that this is a good opportunity for us to ensure that we strengthen our research networks internationally as well as using the tried and tested ones that we have with the EU.
David Tredinnick (Bosworth) (Con)
Does my right hon. Friend agree that leaving the EU will be a good opportunity to build links with other countries’ medical systems, particularly those of the Chinese, who have, for instance, integrated Chinese medicine and western medicine to reduce the demand for antibiotics?
Nigel Mills (Amber Valley) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
Following the Government’s commitment to expand medical school places by 25%—one of the biggest expansions in the history of the NHS—I am pleased to announce to the House the results of the competition to set up five new medical schools. They were chosen following a rigorous and independent bidding process, which prioritised attracting doctors to harder-to-recruit areas and increasing the number of GPs and psychiatrists. Many congratulations to the winners, which are: the University of Sunderland; Edge Hill University in Lancashire; Anglia Ruskin University in Chelmsford; the University of Lincoln working in collaboration with Nottingham University; and Canterbury Christ Church University.
Andrew Lewer
With the death of Professor Stephen Hawking in all of our thoughts, can the Minister tell us what steps his Department will take to support research to develop a cure for motor neurone disease?
Mr Hunt
Professor Hawking was an inspiration not just because of his scientific thinking, but because, to many people with motor neurone disease, he was an absolute exemplar: he was given two years to live at the age of 21 and ended up living until he was 76. This disease is a big area of priority for us. In the last year for which we have full-year figures, £52 million was invested into it, and we are currently recruiting for 24 clinical trials.
Several hon. Members rose—
Jonathan Ashworth (Leicester South) (Lab/Co-op)
Thank you for your instructions, Mr Speaker. We have heard today more warnings that the winter crisis will stretch beyond Easter. We have seen the worst winter crisis for years. The Secretary of State will blame the flu and the weather, but patients are blaming years of underfunding, blaming years of social care cuts, and blaming years of cuts to acute beds, so will he now apologise for telling us that the NHS was better prepared than ever before this winter?
Mr Hunt
The NHS did prepare extremely thoroughly for this winter, but the hon. Gentleman is right to talk about funding because of course it matters. He will be interested in these figures, which are for the last five-year period for which we can get all the numbers: in Wales, funding for the NHS went up 7.2%; in Scotland, it went up 11.5%; and in England, it went up 17.3%.
Jonathan Ashworth
This Government are moving into their eighth year, not their fifth year, and yet, after eight years, life expectancy is going backwards in the poorest parts of the country and infant mortality is rising. New research shows that, in the first 49 days of 2018, an additional person died every seven minutes. That is shameful. Is it not time that we had a full national inquiry into widening health inequalities? In the 70th year of the NHS, will this Government now bring an end to the underfunding, cuts, austerity and privatisation of our health services?
Mr Hunt
Really, the hon. Gentleman can do better than that. The truth is that the NHS has had its most difficult winter in living memory, which is why last year, in preparation, we invested £1 billion in the social care system; invested £100 million in A&E capital; and gave the flu jab to 1 million more people. He still has not explained why, for every additional pound that we have put in per patient in the NHS in England, the Labour Government in Wales put in only 57p; that is underfunding.
Mr Ranil Jayawardena (North East Hamp- shire) (Con)
Ruth George (High Peak) (Lab)
Mr Hunt
That is totally unacceptable, which is why we announced a £300 million expansion of CAMHS in the autumn. CAMHS funding went up by 20% last year. We are specifically trying to end precisely the situation that the hon. Lady mentioned, whereby people are told that they are not yet ill enough to get treatment. We have to put a stop to that.
Sir Henry Bellingham (North West Norfolk) (Con)
Mr Philip Hollobone (Kettering) (Con)
Mr Hunt
I was very inspired by how hard the staff there are working. My hon. Friend always champions them in this House, but it was a great privilege to see that for myself. There is new leadership coming into that hospital, and I am confident that that leadership will put in place some simple changes that will enable the hospital to get out of special measures, hopefully quickly.
Ronnie Cowan (Inverclyde) (SNP)
Dr Paul Williams (Stockton South) (Lab)
Mr Hunt
As the hon. Gentleman will know, these figures cover England and Wales. He will also know that they do not take account of changes in population or changes in demography, so we use the age-standardised mortality rate, which, according to Public Health England, has remained broadly stable over recent years.
Bim Afolami (Hitchin and Harpenden) (Con)
Does my right hon. Friend the Secretary of State recognise the strong business case for the merger between Luton and Dunstable University Hospital and Bedford Hospital in terms of delivering value for money for our local health economy?
Helen Whately (Faversham and Mid Kent) (Con)
May I welcome today’s announcement on a new medical school for Kent? In an area that struggles to attract doctors, this will make a huge difference: it is genuinely a game changer. Will my right hon. Friend congratulate the University of Kent and Canterbury Christ Church University on their successful bid?
Alex Chalk (Cheltenham) (Con)
Cheltenham General is a wonderful hospital, but it needs investment in theatres and wards. May I take this opportunity to commend the application for over £30 million of capital funding, which would make a huge difference to my constituents?
Stephen Lloyd (Eastbourne) (LD)
Bowel cancer remains a major killer in the UK. The National Institute for Health and Care Excellence recognises the new FIT—faecal immunochemical test—to be a far more effective bowel screening process, but there remains a lack of clarity about when it is going to be rolled out nationally. Will the Minister provide that clarity today so that people can be saved down the line?
Sir Edward Leigh (Gainsborough) (Con)
You wanted short, Mr Speaker. I thank the Secretary of State for our new medical school at Lincoln.
Judith Cummins (Bradford South) (Lab)
My local paper, the Bradford Telegraph and Argus, has recently launched its “Stop the Rot” campaign, as children in Bradford have some of the worst dental health outcomes of anywhere in the country. Does the Minister agree that prevention is key to improving children’s dental health? Can he tell us what steps the Government are taking to ensure that prevention is a key element of any new dental contract?
Medicines and Medical Devices Safety Review
Jeremy Hunt Excerpts(6 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
With permission, Mr Speaker, I would like to make a statement setting out the action the Government are taking to address public concerns regarding the safety of medicines and medical devices used by the NHS.
On Friday, I will host campaigners, clinicians and safety experts from across the world as part of the world patient safety, science and technology summit, which is being held for the first time outside the United States here in London. As part of that, we will release a landmark report on the extent of medication errors in modern healthcare systems, as well as the NHS’s plan to tackle them. Alongside those in the report, there are three areas of potential medication error that I wish to update the House on today where serious concerns have been raised by patients and their families.
The first is Primodos, a hormone-based pregnancy test, which is claimed to have led to miscarriages and birth defects during the 1960s and ’70s and was prescribed to more than 1.5 million women before it was withdrawn from use in 1978, partly due to more modern pregnancy tests becoming available. The second is sodium valproate, an effective anti-epilepsy drug, which has been definitively linked to autism and learning disabilities in children when taken during pregnancy. Campaigners have suggested up to 20,000 children may be affected. The third is vaginal mesh implants, often used in surgical interventions to address complications after childbirth, which have been linked to crippling, life-changing side effects.
Of course our first thoughts are with the individuals and families whose lives have been turned upside down by these issues. Many people have endured, and continue to endure, severe complications and tremendous pain, distress and ill health, alongside a strong sense that their concerns have not reached a satisfactory resolution. I pay particular tribute to those who have responded to such experiences not just with understandable anger, but with resolute determination to campaign for change on behalf of others. Many of them have met Ministers and Members to share their concerns, and I thank everyone who has written or spoken to me personally to raise these concerns on behalf of their constituents.
We must acknowledge that the response to these issues from those in positions of authority has not always been good enough. Sometimes the reaction has felt too focused on defending the status quo, rather than addressing the needs of patients, and as a result patients and their families have spent too long feeling that they were not being listened to, making the agony of a complex medical situation even worse, so today, in addition to practical steps for each of the three cases, I am setting out plans to establish a fairer, quicker and more compassionate way to address issues when they arise, bringing different voices to the table from the start and giving individuals and their families a clear path to answers and resolution.
Immediate action is being taken in each of the three cases. On Primodos. I have asked my ministerial colleague Lord O’Shaughnessy to drive forward, and where possible accelerate, the recommendations of the expert working group, further strengthening our systems for monitoring the safety of medicines in pregnancy. That will include offering the families of the Association for Children Damaged by Hormone Pregnancy Tests a full and up-to-date genetic clinical evaluation; better information for pregnant women and their families; better training and support for obstetricians; better evidence around dosing recommendations; making electronic yellow card reporting available directly to clinicians at the point of care; and stronger and more joined-up messages on safety.
The issue of valproate extends beyond the UK. The outcome of the EU review, expected in March, will strengthen our regulatory position. In preparation, we have tasked system leaders with delivering a rapid, co-ordinated response. Directly responding to calls from patients, we are introducing a new warning symbol on valproate packaging; updating National Institute for Health and Care Excellence guidance on valproate; pushing for valproate to be contraindicated for women of childbearing potential not using effective contraception; strengthening alerts across all GP systems and community pharmacy systems; and, for those women for whom valproate is an effective treatment, offering stronger and more tailored advice on risks and contraception.
On vaginal mesh. I asked the chief medical officer for advice in the light of calls for a full ban. She has been clear that clinical experts here and abroad agree that, when used appropriately, many women gain benefit from this intervention, hence a full ban is not the right answer in the light of the current evidence available. However, this is not to minimise the suffering many women have experienced, which is why today I can announce that we will be publishing a retrospective audit to investigate the links between patient-level data to explore outcomes, and investing £1.1 million to develop a comprehensive database for vaginal mesh to improve clinical practice and identify issues.
Those actions will improve the way the regulators and the NHS deal with issues related to vaginal mesh and valproate, as well as improve monitoring of the safety of medicines in pregnancy, but the fact that it has taken so long to surface these issues raises much bigger questions. It is an essential principle of patient safety that the regulatory environment gives sufficient voice to legitimate concerns reported by patients, families and campaigners, works alongside them and responds in a rapid, open and compassionate way to resolve issues when these are raised. My view is that that did not happen in the way I would expect in these three cases.
To do better in the future, we need to ensure that patient voices are bought to the table as systematically and consistently as other voices in the system, so today I have asked Baroness Julia Cumberlege to conduct a review into what happened in each of these three cases, including whether the processes pursued to date have been sufficient and satisfactory, and to make recommendations on what should happen in future. She will assess, first, the robustness and speed the of processes followed by the relevant authorities and clinical bodies to ensure that appropriate processes were followed when safety concerns were raised; secondly, whether the regulators and NHS bodies did enough to engage with those affected to ensure their concerns were escalated and acted upon; thirdly, whether there has been sufficient co-ordination between relevant bodies and the groups raising concerns; and fourthly, whether we need an independent system to decide what further action may be required either in these cases or in the future. This is because one of the judgments to be made is whether, when there has been widespread harm, there needs to be a fuller, or even statutory, public inquiry. Baroness Cumberlege will make recommendations on the right process to make sure that justice is done and to maintain public confidence that such decisions have been taken fairly.
Although I am deliberately leaving the terms of this model open for Baroness Cumberlege, I have asked that she consider how we strike the right balance on the criteria or threshold for a “legitimate concern”; how best to support patients where there might not be a scientific or legitimate concern, but they still have suffered harm; how we can be more open to the insights that close attention to patient experience can bring, including whether a patients’ champion could help to act as a point of contact for people or families raising legitimate concerns, ensuring that these are heard and responded to; and how any new entity interacts with existing bodies including NHS Resolution, the Healthcare Safety Investigation Branch and the ombudsman. Recognising that this is an issue that many hon. Members have been concerned about, I have asked Baroness Cumberlege to meet relevant all-party parliamentary groups and campaign groups early in the review process.
We are rightly proud of the NHS and all it has achieved and will achieve in the future. Much of this has been built on the strong connections between scientific discovery and medical progress, but innovation requires safeguards, including a culture of learning to protect against the unintended consequences of new technologies and treatments, and a clear focus on the experience and treatment of patients and their families affected by these consequences. From Mid Staffs to Morecambe Bay to Southern Health, patients and their families have had to spend too much time and energy trying to access, lobby and influence NHS leaders and Ministers to get a hearing for their concerns. The stress and frustration of campaigning, sometimes in the face of closed ranks and a defensive system, has added insult to injury for too many families. We need to establish a fairer and quicker way to resolve such concerns when they arise in the future.
It must be said that our regulatory system is, in many ways, world-leading, but it too needs to adapt to a changing environment and to draw intelligently on multiple sources of feedback to protect the safety of patients. Today’s announcement will build a system that listens, hears and acts with speed, compassion and proportionality, strengthening the commitment to patient safety, which is at the heart of this Government’s and this House’s priorities for our health and care system. I commend this statement to the House.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for the advance copy of his statement. I welcome the tone of his remarks and generally welcome his commitment to a review of medical device safety, although I note that the 2017 Labour manifesto called for an inquiry into medical devices and product licensing and regulation. Today’s announcement is an acknowledgement that there are major problems, going back decades, to do with safety and lack of proper scrutiny and research.
In debate and Committee, Members in all parts of the House have offered moving testimonies about the devastating impact of mesh, Primodos and sodium valproate on the lives of thousands of women and children in our constituencies. I wish to put on the record my thanks and tribute to all the campaigners and the MPs from across the House, but especially those who have worked so hard with the all-party groups, including my hon. Friends the Members for Pontypridd (Owen Smith) and for Bolton South East (Yasmin Qureshi), and the right hon. Member for North Norfolk (Norman Lamb), who have all spent many years campaigning for justice on these issues.
We have heard how mesh implants have left women in permanent pain, unable to walk, unable to work. This is an ongoing public health scandal, and we hope the Government will do much more to support those who are affected. Mesh has been suspended in Scotland and banned in other countries around the world. I understand that mesh has been paused for use in cases of prolapse. Will the Secretary of State consider fully suspending mesh use while the review is carried out?
On Primodos, the Secretary of State indicated that the Department will drive forward and “accelerate” the recommendations of the expert working group, but does he accept that that report was met with concern on both sides of the House? Indeed, campaigners branded it a whitewash.
I am grateful to the Secretary of State for including sodium valproate. My constituent, Emma Friedmann, took sodium valproate during and after her pregnancy, leaving her son, Andrew, with severe autism along with hearing and sight problems. Andrew, who is now 18, needs round-the-clock, full-time care. Emma, like thousands of others affected, was never fully informed of the risks of taking sodium valproate during pregnancy. Last year, a charity survey found that almost one fifth of women who are taking the drug still do not know the risks that the medicine can pose during pregnancy. I welcome the Government’s efforts to raise awareness of the dangers of sodium valproate, but will the Secretary of State tell us whether the review will look at the guidelines for clinicians who prescribe it to women of childbearing age?
We offer the review our support, but note that it falls short of the calls for a full public inquiry, which campaigners have been demanding. Will the Secretary of State give the House an absolute reassurance that the review will gain access to medicine regulation files held in the National Archives, access to any valuable evidence cited in unsuccessful legal actions and access to documents and information held by pharmaceutical companies and that all such material will be made public?
Does the Secretary of State agree that those affected must have trust and confidence in the review? Who will the noble baroness report to, and who will provide the secretariat to the review? I say this with no discourtesy to the Department or the Medicines and Healthcare Products Regulatory Agency, but does he agree that the review must be independent to avoid any sense of conflict of interest that has hampered previous inquiries? I understand the steer that he has given to the noble baroness on setting the terms of reference, but I press him to ensure that victims agree with the terms of reference to maintain trust and confidence in the review.
Is the Secretary of State now ruling out a full public inquiry, or is he saying to victims that they should wait for the review’s outcome? When can we expect it to report back to the House? More broadly, can he reassure us that the inquiry will have three separate strands that will look in depth at each issue to ensure that nothing gets watered down and lost?
In the broader context of Brexit, when profound uncertainty remains about medical and device regulation as we leave the European Medicines Agency, does the Secretary of State agree that the review must inform future regulatory mechanisms and take into account how we best co-operate with other national and international regulators post Brexit? What assurances can he offer the House that the medicines and devices that women use today—especially pregnant women—will not become the tragic and desperate scandals of the future?
On the treatment of the victims involved, the Secretary of State will know that many women have been denied access to legal aid to pursue compensation claims. Does he agree that women and children deserve full compensation and support? Is that not the Government’s responsibility? Will they establish a compensation fund, and what consideration has he given to compelling the pharmaceutical industry to support a compensation fund for those affected?
Finally, mesh, sodium valproate and Primodos have devastated the lives of hundreds of thousands of women and children. Is it not time that they were given a full apology? Surely, that is the very least they deserve.
Mr Hunt
I thank the hon. Gentleman for his considered response and for its tone. Like him, I thank all the all-party groups who have worked incredibly hard to raise this incredibly difficult issue. Let me go through the points that he raised; he asked detailed questions, which I want to give a proper answer to.
When it comes to mesh, no EU country has banned its use. In my understanding, Australia and New Zealand have not introduced a full ban. We have taken very clear advice. We obviously have a responsibility to all patients, and the medical advice from the chief medical officer is clear that some women benefit from mesh, if it is appropriately used, so we are following that advice. However, the review will look at all the processes around mesh. We will publish NICE guidelines on persistent pain and ventral meshes—it is also important to say that meshes are used in men as well as women—and we absolutely have to get this right.
I fully accept the point that the hon. Gentleman made on the concerns of many patients and families about the findings of the expert working group. He will know that this is a very difficult, hotly contested area. We are not proposing to revisit the science, but we are giving Baroness Cumberlege full freedom to look at what the expert working group did and to come to her own views. We are not excluding her from looking at what happened, even though we think that it is important to accept throughout that we have to follow the science at every stage to get this absolutely right. We will be going forward with some important recommendations of the expert working group regardless, such as the yellow-card system.
One thing that is clear is that when people, whether clinicians or patients, have an immediate concern about a medicine, there is no easy way to raise that quickly. If women are raising these concerns all over the country, we need to find that out very quickly at the centre, so that we can take action more quickly than happened in this case. We will also be offering genetic testing to families who have suffered, or who think that they have suffered, as a result of Primodos.
On valproate, we will issue guidelines to clinicians. We also want to make sure that there is greater awareness among patients. We are changing the NICE guidelines and the labelling. When it comes to valproate, we want to push for this to be a contra-indication for women of childbearing age who are not taking effective contraception, because it is so important to get this right.
The hon. Gentleman made very important points about the public inquiry. We are asking Baroness Cumberlege to give us her considered view on the appropriate way forward in this case, and that, of course, has implications for the issue of compensation. What I would say is that we have a problem in our system, in that there is no proper process for deciding what next steps are appropriate. Is it an investigation by the Department of Health and Social Care and NHS England, or do we need a full statutory public inquiry? We particularly want her to look at whether we should have an independent process to evaluate what happened. In my time, and in the hon. Gentleman’s time, we have been approached by a lot of people who want public inquiries, but it should not simply be about the strength of lobbying. There needs to be a process, because there may be people who do not have a loud voice, who are equally worthy of a public inquiry, but who do not get considered in our system at that moment. That would not be right.
Baroness Cumberlege will report to Ministers, not to the MHRA, and there will be full consultation with the families affected by the three issues over the terms of reference. That is absolutely the right thing to do.
The hon. Gentleman made a final very important point about how we regain the trust of families deeply scarred by these issues. We can do it in two ways: first, by being open and transparent in everything we do in this process so that they can see we want to get to the bottom of it as much as they do; and secondly by recognising the fundamental issue that in the past when we have assessed these clinical medical safety issues the voice of patients has not been as strong as it should have been. We have to put that right, and I know that everyone in the NHS, as in the House, is committed to doing so.
Dr Sarah Wollaston (Totnes) (Con)
I welcome the Secretary of State’s statement and his ongoing focus on patient safety, which has added so much to the patient experience. I also welcome the fact that he is clearly representing the voice of patients when learning lessons. Many of those who, courageously, have come forward, including many of my own constituents, have been harmed in the private sector. Will he confirm that all patients, wherever they were treated, will be included within the review and that there will be a focus on clinical governance, not only in the NHS but in the private sector?
Mr Hunt
I can absolutely give that assurance. We are considering how to strengthen oversight, because a tragedy is a tragedy wherever it happens, and we should be demanding the highest standards of care throughout our healthcare system. We are particularly considering the issue of data sharing, because often clinicians operate in both the NHS and the private sector, and we want to make sure that we do not have two datasets but that we share data in a way that makes patients safer.
Martyn Day (Linlithgow and East Falkirk) (SNP)
I thank the Secretary of State for advance sight of his statement, although I am sure that some of the women affected by these medicines or medical devices will be sceptical and might wonder whether the Government have not just announced a review of reviews, especially given the outrage among patients and the wider public over the review process and its outcomes in the past.
Medicines safety and licensing are reserved matters, and although we welcome the fact that the Government are not just doing nothing, it is disappointing that the review will not really consider the scientific evidence on Primodos, valproate and surgical mesh. Given the recent shambles over the Primodos expert working group, everyone needs confidence that this will not turn into a Government whitewash. How can patients be assured of the chair’s independence? Who will take a final decision on who advises the chair? Will those affected and those who took part in the initial reviews be able to participate? I am sure the Secretary of State is aware that Professor Alison Britton is already leading an independent review in Scotland of vaginal mesh. Will he and his officials seek to take advice and soundings from her findings and expertise in this process? Finally, having as much information and background as possible on women’s experiences is extremely important in getting justice and improving patient safety, so does the Secretary of State think that setting up a mechanism within his Department to collate extensive qualitative research for patients would be useful?
Mr Hunt
With respect to the hon. Gentleman, he is being a little uncharitable in describing this as a “review of reviews”. We have announced immediate action in each of these three cases—it will happen right away and will be of huge significance in the use of valproate, help for families who think they have suffered as a result of Primodos and the use of mesh. A lot of things are happening right away. These are complex issues, however, and if we are to step back and look at the systemic failures we think have happened, it is important that we ask what changes are needed. That is why we need someone of Baroness Cumberlege’s experience: she has a huge track record of campaigning on women’s issues; she was a Minister at the Department of Health for five years; and she did the “Better Births” review for NHS England in 2015. She is hugely experienced and passionate about patient safety and making sure that the patient voice is heard.
George Freeman (Mid Norfolk) (Con)
I welcome the review and the announcement of Baroness Cumberlege as its lead. I am sure the whole House will agree that she is, as the Secretary of State said, highly qualified and trusted. I pay tribute to the many hundreds of thousands of women who have suffered in silence and campaigned so effectively. As the Minister who surprised a few in announcing the Primodos working group, setting up the sodium valproate taskforce, with my right hon. Friend, and brokering the deal on the Saatchi Bill, I have seen the passion and the silent suffering with which so many women have had to live. He is absolutely right that for too long the medical establishment has tended to link arms and act very protectively when challenged, and we need to make sure that the patient voice is put right at the heart of this.
Will the Secretary of State agree with two points? First, does he agree that it is important that this does not become some legal witch hunt, but starts as a review of the evidence, the science and the clinical data in order to avoid future patient suffering? If it is couched in terms of legal liability, everyone will draw in and resist the sharing of evidence that is so key. Secondly, will he look at training? On mesh, the MHRA has licensed the device, but my understanding is that the problem is often with the training of clinicians in its installing. We need an intelligent healthcare system that uses everyday data to support patient safety.
Mr Hunt
I would like to put on the record my thanks to my hon. Friend for the work he did as a Minister in my Department that led to the setting up of the expert working group, which I think has taken this issue forward and which he championed. His experience of the life sciences industry was incredibly helpful. I take on board both his points. It is absolutely right that this needs to focus on patient safety and how we put in place processes that help people suffering now and avoid it happening in the future. His point about training is a very good one.
Mr Ben Bradshaw (Exeter) (Lab)
I welcome the Secretary of State’s statement, although would have been nice for the victims to have heard a little more about the legal aid and compensation issue. He was absolutely right to describe our regulatory framework as world leading. It is, of course, European and precautionary based. Will he dissociate himself from the Foreign Secretary’s comments last week in which he included medicines regulation in the list of those areas for which he favoured full regulatory divergence?
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I welcome the review of the yellow card process. The first responsibility of the doctor is always to do no harm, and every doctor, when making any prescribing decision, always balances the potential improvement in patient care with the known risks. Sometimes, as more drugs are given to more people, rarer side effects will come through, and the improvements in the yellow card system will mean that those are identified earlier.
My other point is about Roaccutane. It is a drug given to treat acne but is known to be exceptionally toxic in pregnancy. I remember from my time working in dermatology that to get a prescription women had to attend monthly and have a negative pregnancy test before the next prescription was issued. I wonder whether that approach could be more widespread in the prescription of some of these drugs, which do provide some benefit but are known to be harmful.
Mr Hunt
My hon. Friend’s question demonstrates how useful it is to have people with medical experience in the House. To be honest, I am slightly overwhelmed by the detail in her question, but her broad point is absolutely right. The difficulty with the issues today is how much they affect women, particularly pregnant women. Through the review, we want to establish whether we are doing less well than we should on women’s health issues. Given that Baroness Cumberlege has done more campaigning on women’s health issues than pretty much anyone else in either House, I think she is the right person to take the review forward. My hon. Friend is absolutely right about strengthening the protections for pregnant women.
Yasmin Qureshi (Bolton South East) (Lab)
As the chair of the all-party group on oral hormone pregnancy tests, I am disappointed with the wording of today’s announcement. What happened with Primodos was a scandal similar to the Hillsborough, contaminated blood and sexual abuse scandals. Victims of Primodos and their families have waited 40 years for an answer to this grave historical injustice. It was a deliberate criminal cover-up by the statutory authorities of the day. The scientific evidence now shows a link between Primodos and deformities that was known to the drugs companies and our regulatory bodies 40 years ago. Will the Secretary of State ensure that the review—we want a full public inquiry—looks at the regulatory failures that took place 40 years ago? There was a systematic and deliberate cover-up, including the destruction of documents, by our health bodies as well as the drugs manufacturers. Primodos is, therefore, perhaps different from some of the other cases. We demand a proper inquiry and proper compensation and that the victims be put at the heart of the inquiry. They were completely ignored by the expert working group—that document was not worth the paper it was published on.
Mr Hunt
The hon. Lady and I may not agree on every part of my statement, but I thank her for her campaigning on this issue, and for the voice that she has given to thousands of women who believe that they have suffered badly as a result of Primodos. The things for which she has asked were not ruled out in the statement; in fact, what I have announced will create a process during which someone will look very carefully at the issue.
The hon. Lady has made some very serious allegations, and it is absolutely her right to do so as a Member of this House, but they differ from the conclusions reached by the expert working group. It is precisely because of that disagreement that we have asked Baroness Cumberlege to look carefully at the issue and form her own view of the right way forward. However, I assure the hon. Lady that regulatory failures are at the front of our minds, and we are absolutely determined to ensure that victims’ voices are heard.
Fiona Bruce (Congleton) (Con)
I thank the Secretary of State for the compassionate tone that he has struck today, and for taking account of the years for which many campaigners, such as Janet Williams and Emma Murphy, have tried to make their voices heard, on valproate in particular. If, following the review, various medicines or medical devices are found to be unsafe—or, indeed, to have been taken unsafely—will there be legal consequences for the regulators who should have acted differently?
Mr Hunt
The simple answer to that question is yes: there are legal consequences for regulators who have failed. In that instance, it would be the responsibility of the Government, or of the drugs companies who failed in their responsibility to inform patients of the dangers of taking drugs. The priority is to establish the facts. Some of those are clear now, but some are not, and that is why I think that the review will help us.
Gordon Marsden (Blackpool South) (Lab)
Constituents of mine have been affected by both sodium valproate and Primodos. The Secretary of State has already heard the dismay expressed by my hon. Friend the Member for Bolton South East (Yasmin Qureshi) at the outcome of the review by the expert working group, but may I ask him another specific question? What he has announced today will not give a great amount of satisfaction to people, and confidence that his Department will take notice of Baroness Cumberlege’s review will be reduced by a written response that I received yesterday which stated that the Department had no plans to fund any independent scientific research on hormone pregnancy tests. We know that Dr Vargesson produced a report last week. Will the Secretary of State ensure that Baroness Cumberlege looks very carefully at this particular issue?
Mr Hunt
I can give the hon. Gentleman an absolute assurance that she will do so. In the case of valproate it is very clear what the next steps should be, because there is no dispute over the science. When there is controversy over the science—and I appreciate how distressing that is for the families involved—the first thing we must do is establish the truth of the situation, and that is why we have given Baroness Cumberlege a free hand to look at the whole issue.
Helen Whately (Faversham and Mid Kent) (Con)
I welcome the statement, which is consistent with my right hon. Friend’s track record of driving the NHS to stop causing harm to patients. May I ask him to continue to focus on encouraging, requiring and supporting all healthcare professionals to make the shift from a defensive to a learning mindset, so that they listen and learn not just from NHS experience, but from patients as well?
Mr Hunt
My hon. Friend, who has huge experience in healthcare, is right to say that at the heart of dealing with these very complex issues is the need for us to be careful not to inadvertently encourage a culture of defensive medicine. If doctors feel unable to be open about mistakes that may have happened because they are worried about legal consequences, we will not benefit from the learning that is so incredibly important, and one of the purposes of the review is to ensure that we support that open learning culture.
Sir Edward Davey (Kingston and Surbiton) (LD)
On behalf of my constituents whose families have suffered from the effects of Primodos, I thank the Secretary of State for taking a step in the right direction. He has announced that there will be another review with another remit. Can he reassure the House that one of the reviews will be able to investigate the cover-up over Primodos that we know has taken place for decades, and that if a crime has been committed, it will be dealt with?
Mr Hunt
I totally respect the right hon. Gentleman for airing his constituents’ concerns, but, as he will know from my answers to earlier questions, the difficulty in the case of Primodos—and this is incredibly distressing for the families involved—is that scientists do not agree about the issue, and as a result we do, unfortunately, find ourselves having to review what has happened. The review conducted by the expert working group was our first attempt. We are now giving Baroness Cumberlege a free hand to consider that and any other evidence that has come to light, and to draw her own conclusions.
Huw Merriman (Bexhill and Battle) (Con)
Just an hour ago I met my constituent Carol Short and Emma Friedmann, a constituent of the hon. Member for Leicester South (Jonathan Ashworth), to discuss the next stage of the valproate campaign, but because of the statement, that meeting was adjourned. I am happy that they are now in the Chamber, and I am sure that they are pleased to hear about the review.
Is it possible to ensure that GPs are giving out the excellent advice that the Medicines and Healthcare products Regulatory Agency has put together? I am sorry to say that it seems that far too many are not, and there appear to be no regulatory sanctions to ensure that they do.
Mr Speaker
Order. I mean no discourtesy to the hon. Gentleman, but I hope that the people whom he mentioned are in fact in the Gallery rather than in the Chamber. That would be greatly reassuring to us, and quite possibly to them.
Mr Hunt
I can give my hon. Friend the assurance for which he has asked. We have announced today that we are improving the system of alerting both general practices and community pharmacies to ensure that the right advice is given and the right safeguards are in place, so that people who are pregnant or might become pregnant do not take a medicine that is very powerful and very effective in the right circumstances, but incredibly dangerous in the wrong ones.
Maria Eagle (Garston and Halewood) (Lab)
I welcome the Secretary of State’s intention to look further at these very concerning issues, but I fear that his putting them all in one place means that he may not be giving sufficient attention to the Primodos issue, which is a scandal of very many years’ standing. I do not think that the recent report of the expert working group is the basis on which Baroness Cumberlege or anyone else should look further at the matter, because it was a complete whitewash, and the Secretary of State needs to acknowledge that. I think that if he were to do so, the people affected by Primodos over the last 40 years or more would feel much more confident that the process that he has described today might enable them to secure some resolution.
Mr Hunt
I understand why the hon. Lady has asked her question in the way that she has, but we set up the expert working group after a lot of very careful thought because we honestly wanted an answer. We are faced with circumstances in which scientists disagree, and in those circumstances it would not be right for me, as Secretary of State, to announce a different scientific view. I think that the right thing to do is to allow someone the time and space in which to look at the issues that the hon. Lady has raised, and that is what Baroness Cumberlege will do.
Andrew Selous (South West Bedfordshire) (Con)
I have a constituent whose quality of life has been completely ruined by a surgical mesh implant. What reassurance can we have that the Cumberlege review will ensure that the voice of the patient is listened to much more quickly in future, so that when things go wrong, we limit the number of patients who suffer the type of harm that we have heard about this morning?
Mr Hunt
That is the right question to ask. I suggested in the statement that we might need a patients’ champion whose job would be to collect the experiences and views of patients who think that they may have suffered as a result of medicine or medical devices. However, we want Baroness Cumberlege to look at the issue in much more detail. The central point is that if we are to avoid the agonies experienced by my hon. Friend’s constituents, the patient’s voice needs to be as strong as the clinician’s in discussions about the efficacy of medicines or medical devices. That clearly has not been happening to date, but I think that we are moving away from the paternalist system that has operated in the past, and the review will constitute a further step in that direction.
Diana Johnson (Kingston upon Hull North) (Lab)
The Secretary of State will know the phrase
“the patronising disposition of unaccountable power”,
which applied in the Hillsborough families’ fight to get justice, and applies, it seems to me, in what has happened to the groups affected by today’s statement. Will the Secretary of State explain why Baroness Cumberlege’s report will not come straight to Parliament, so it can make a decision about how patients can get justice quicker than has happened in many cases such as the ones we are discussing today?
Mr Hunt
Those words about the patronising disposition of unaccountable power came from Bishop James Jones, who has made an extraordinary contribution as a voice for people whose voices have been ignored for too long. The House will have every opportunity to debate Baroness Cumberlege’s report. The Government will decide their actions and we will put them to the House, which will have every opportunity to listen, make suggestions for improvements, and to become involved at every stage of the process as we take this forward.
Simon Hoare (North Dorset) (Con)
With their incredibly moving stories, my constituents Karen, a victim of vaginal mesh, and Angie, with Primodos, will have listened intently to what my right hon. Friend has said. May I underscore a point made by colleagues on both sides of the House? There are two key issues apart from the Cumberlege review. First, we must ensure that our medics, from med school up, realise that they are not gods, because that is how many patients feel when they have to deal with them and their concerns are too easily dismissed. That needs to change from the bottom up. Secondly, my right hon. Friend made the point that this is an issue not just for the NHS but for private health care too. It involves patients living in all quarters of the United Kingdom. How will this learning, and the learning of the review, spread, while respecting the devolved Assemblies, in those regions where the health service is not under the control of my right hon. Friend?
Mr Hunt
Those are both important points. I will make one comment about the second one. The spreading of best practice is central. We must ensure that we do not just have a system where we have new NICE guidelines, but that we have confidence that it is being implemented across 30,000 GPs in 250 NHS trusts and so on, and I know Baroness Cumberlege will be thinking about that.
Hannah Bardell (Livingston) (SNP)
For my constituents Wilma Ord and her daughter, Kirsteen, the wait for action on this issue and to get truth and justice has been almost unbearable. While I welcome the Secretary of State’s candour and tone, the actions outlined today are not enough, and I fear that the baroness, as welcome as she will be to this process, will be doing her job with one hand tied behind her back. The Secretary of State said in his statement that we are not revisiting the science, but then said that we needed to be led by science. Unless I misheard him, there is a contradiction. Will he confirm that the victims affected by all these issues will be at the heart of this, as will the science, because there is an important new study by Neil Vargesson that must be considered in this process in relation to Primodos?
Mr Hunt
I do not accept that there is a contradiction. We have to be open to the science and we have to be led by the science at every stage, and if there is new scientific evidence, we must absolutely take that on board. We must also always be led by patients in what we do, and that is exactly what I am announcing.
Sir Mike Penning (Hemel Hempstead) (Con)
It was a pleasure to lead the debate in the House when we secured time from the Backbench Business Committee to discuss this. I really appreciate the tone adopted by the Secretary of State, and by the Prime Minister when I asked her earlier if there was good news. May I also pay tribute to the Minister, my hon. Friend the Member for Winchester (Steve Brine), who is sitting next to my right hon. Friend the Secretary of State, for the work that he did, because I gave him really quite a hard time during the debate?
However, there will be huge disappointment among the Primodos campaign team. The idea of being led by the science from the expert working group is fascinating, because it refused to allow some science to come forward as it had not been peer-reviewed, but then accepted a load of other evidence from the drug companies. On this review going back to the Department of Health and Social Care, it is implicated in this, in that these drugs were given out by GPs in surgeries without prescription, so that will give no confidence at all. I therefore think that the Baroness will have both hands tied behind her back when doing her work.
Mr Hunt
I commend my right hon. Friend’s campaigning, but I am afraid I have to disagree with him. This is an important step forward; we are absolutely going to be led by the science—we have to be led by the science—and we are giving Baroness Cumberlege full rein to look at what the expert working group did, and to challenge it if she thinks fit.
Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)
The expert working group that the Government set up on Primodos changed its own terms of reference. It refused to look at all the scientific evidence and it did not have the confidence of the families affected. How will the Secretary of State’s proposals be any different?
Mr Hunt
This is something for Baroness Cumberlege to consider, but the broader point is right. We have for too long in each of these three cases, and in others as well, had processes that have not had the confidence of patients. That is why we are proposing today not just specific measures on each of the three issues, but a broader look at the regulatory structure to make sure that patients’ voices are louder and we avoid precisely what the hon. Lady said.
Mark Pawsey (Rugby) (Con)
I welcome today’s announcement, which I am sure will also be welcomed by my constituent who had surgical mesh implanted in 2008 during a hysterectomy, and, significantly, without her knowledge or consent, which has led her to suffer severe distress and significant pain. When she raised that with her doctors, she was told it was all in her mind and she was imagining it, and she believes that she is still not being taken seriously 10 years later. Does the Secretary of State share my hope that the very existence of the review will encourage a more sympathetic response to people such as my constituent from the medical profession?
Mr Hunt
I very much hope so, and the crucial point that has come out from the contributions of Members in all parts of the House is that the processes we have had in place to date have not had the confidence of the families affected. That applies to a whole range of issues, and I believe medicine is changing fundamentally: people who are passionate about medical innovation and life sciences know that we need to have a very close partnership with patients in order to make proper advances. But we have not always got this right, and that is what I hope Baroness Cumberlege’s review will help us to do.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
I welcome the audit on vaginal mesh and the promised register, but there are a couple of things I want to raise. One is support for victims. My constituent Angie was referred from Hull to Manchester to see somebody, and has now been told she will have to wait months before anybody can properly analyse what has happened to her, so can more resource be given to help the victims of vaginal mesh? Also, will the Secretary of State look into the licensing process on how these things get into the market and are put out there for use by surgeons? Finally, we should not just look at training, because it is not just about the training for how we put these things in; I believe that the product itself is faulty.
Mr Hunt
We will certainly look at all those things, and the hon. Lady is absolutely right to draw attention to them. Licensing is one thing, but it is also important to ensure that proper information is available to clinicians and patients, because it appears from these cases that there are a number of drugs and devices that are safe but only in certain circumstances, and that knowledge might not have been properly disseminated. The database that the hon. Lady mentioned will help us to get that right.
Derek Thomas (St Ives) (Con)
I pay tribute to constituents of mine who have had surgical mesh implants—their campaign has been quite extraordinary and I am humbled by their work. The truth is that there is little prospect of any improvement in their condition. I welcome the statement and I recognise the issue around the ban and why that might not be possible, but will the Secretary of State assure this House and my constituents in west Cornwall that surgical mesh will be used only when there is absolutely no alternative?
Mr Hunt
This is a complex procedure that can go wrong, so it would only ever be used if it was absolutely the right thing for patients. We have looked at this very carefully. Other countries have introduced restrictions on the use of mesh, but we have concluded that that would be disadvantageous to women in certain circumstances. However, that means that we have to take much more care in when it is used so that we avoid those truly horrific complications.
Joan Ryan (Enfield North) (Lab)
Those whose lives have been forever changed by the drug Primodos will be very disappointed today, despite there being a step in the right direction. Asking Lord O’Shaughnessy to drive forward the recommendations of the expert working group will not bring any confidence. That expert working group changed its terms of reference: it was asked to examine whether a possible association exists between Primodos and birth defects and it did not do that; it looked at a causal association. That is the crux of the problem, and that is what makes that working group’s findings unacceptable, aside from the fact that the scientific evidence not included existed before it even started its investigation. Unless these factors are taken into account in a wide-ranging independent inquiry, I doubt those victims will ever get the satisfaction and justice they deserve.
Mr Hunt
I hear what the right hon. Lady is saying. The reason it was important to ask whether there was a causal link was that it has an implication for the compensation to which people might be entitled, but I would like to reassure her that Baroness Cumberlege will have the freedom to look at all the issues that she has raised.
Bob Blackman (Harrow East) (Con)
The pharmaceutical companies have consistently refused to accept a causal link between sodium valproate and autism. My right hon. Friend has now set out measures to warn people about this in the future, but that does not compensate the victims. What attempts is he going to make to ensure that victims are fully compensated for the dreadful impacts on the lives of their children?
Mr Hunt
In this country, the compensation system works through the courts. There are times when the NHS is liable and there are times when the drugs companies are liable. I hope that Baroness Cumberlege’s work will take us closer to understanding where the liability actually lies, so that we can give relief to the families who have suffered for too long.
Mr Ivan Lewis (Bury South) (Ind)
Will the Secretary of State join me in paying tribute to my constituents, Emma Murphy and her colleague Janet Williams, for their courageous campaigning to highlight the risks presented by sodium valproate? As he and other hon. Members have acknowledged, victims are incredibly suspicious of the health establishment, and for very good reason. I ask him sincerely whether he is concerned by the fact that Baroness Cumberlege is the director of a company that specialises in advising pharmaceutical companies on how they can most effectively lobby Parliament. What will that do for victims who are already incredibly suspicious of us in this House and of the NHS establishment?
Mr Hunt
I understand the respectful tone in which the hon. Gentleman has asked this question. I do not think that anyone has a better track record than Baroness Cumberlege on campaigning for women’s health issues. In her career, she has shown an absolute willingness to take on the medical and scientific establishments when she thinks that that is the right thing to do, and she does so with a great deal of knowledge and a huge amount of passion, so I have every confidence that she will do a good job.
Paul Masterton (East Renfrewshire) (Con)
I welcome the statement today. The Secretary of State will be aware that we had a mesh review in Scotland, but unfortunately it quickly lost the confidence of patient groups, who branded it a whitewash after chapters were deleted and evidence was a re-presented. Can he assure me that patient groups will not be treated as an inconvenience, and that the real-life personal experiences of these women who have been crippled by mesh implants will be taken fully into account and taken seriously?
Mr Hunt
I wish I could say to my hon. Friend that those people’s terrible suffering has been taken as seriously as it should have been, but the truth is that we have a system that has not treated patients’ concerns with the seriousness that it should have done. That is why we want to make the important changes that we are announcing today.
Alex Cunningham (Stockton North) (Lab)
Forty-four years ago, my constituent Lesley Holmes took two Primodos tablets that had been handed to her by her trusted GP, to check whether she was pregnant. She was, but the consequences for her son have been devastating. With the expert working group’s report having been stripped of its credibility, Lesley is still seeking answers and recognition of her family’s plight. The Secretary of State appears to agree that we need to recognise that fact and provide the answers, but how long is this going to take? How is he going to ensure that the outcome is actually credible this time?
Mr Hunt
All I can say is that we completely understand those concerns and the despair that many people feel about this issue, but it is difficult to resolve it quickly when there is disagreement among the scientists. What we are trying to do today is to create a process to resolve that disagreement, and that is what I very much hope will happen.
Michelle Donelan (Chippenham) (Con)
I welcome the announcement of this much needed safety review. All UK citizens should be confident that the most rigorous safety standards are in place. Can my right hon. Friend confirm that the review will not have an impact on initiatives such as the accelerated access review and the cancer drug fund, which have fast-tracked access to much needed drugs and treatments?
Mr Hunt
I can confirm that, although it is also important to say that if we discover changes in procedures that will improve the safety of medicine use or medical device use, the people who put those new drugs on the market would want to benefit from any changes in regulatory processes, but what we would not want to do is reduce the speed.
Emma Little Pengelly (Belfast South) (DUP)
I welcome the Secretary of State’s statement. I have met and been contacted by many women in my constituency who continue to suffer excruciating pain and serious detrimental outcomes as a result of surgical mesh implants. I welcome these initiatives, but I suggest that there would be huge value in some of them, such as the database, being established at a UK-wide level. What discussions have he and his Department had, or do they intend to have, with the devolved regions to ensure that this could take place at a UK-wide level?
Mr Hunt
Our approach on safety issues is that we are happy to do anything on a UK-wide basis if that is what the devolved Administrations want, because we do not see any benefit in not sharing data. If the willingness is there among the other Administrations, we would be happy to play ball.
Bill Grant (Ayr, Carrick and Cumnock) (Con)
I welcome my right hon. Friend’s announcement of a review of these three important medical matters and his securing the much respected Baroness Cumberlege to lead it. I should like to focus on Primodos, which has affected around 1.5 million women throughout the United Kingdom. It has been a terrible long journey for those individuals and their families. They have simply been pursuing truth and justice, but to date they have received neither. I have heard much about the use of data and science in the review, but will my right hon. Friend ask the Baroness to introduce humanity into the review as well, and to take into account the peer-reviewed research carried out by Aberdeen University that is now available? I certainly hope that this review will be a stepping stone to a full public inquiry for Primodos victims. Maybe then, and only then, will they receive the truth and justice that they and their families so richly deserve.
Neil Gray (Airdrie and Shotts) (SNP)
The Secretary of State was right to say that patients’ views have been neglected, and that they need to be central to this review. My constituents who have been impacted by Primodos lost faith in the working group’s review, not least because of that concern. How far will this review go? Will it, for instance, look into the fact that there might be a diminished amount of evidence available because the medical records of women who took Primodos were destroyed, including those of my constituents?
Mr Philip Hollobone (Kettering) (Con)
This is the first chance I have had to thank the Secretary of State for visiting Kettering General Hospital last week, and I do so now. It is a laudable and oft-stated ambition that the NHS should be the world’s safest healthcare system. Are we there yet? If not, when will we be?
Mr Hunt
International experts from the Commonwealth Fund in New York say that we are the safest healthcare system in the world, but that gives me pause for thought because there is still so much avoidable harm and death in our system right now. If we are the safest, that says that healthcare everywhere needs to improve.
Margaret Greenwood (Wirral West) (Lab)
Campaigners on Primodos will be hugely disappointed by the Secretary of State’s statement and his failure to recognise the concerns they have raised about the expert working group. That aside, how many patients does he envisage being involved in the review, and how does he believe that they will be best accessed to ensure that those people who are quiet actually have their voices heard?
Mr Hunt
That is the entire purpose of the review. Obviously, Baroness Cumberlege will want to involve patients in the process right from the start, and I will talk to her about that. I will also write to the hon. Lady to spell out in detail the way in which the Baroness intends to involve patients in the process.
Kevin Foster (Torbay) (Con)
I thank the Secretary of State for his statement, which will be of comfort to vaginal mesh implants victims in my constituency. It is right that the review will be wide-ranging, but will he confirm whether those who have been barred from receiving compensation owing to the statute of limitations under the Consumer Protections Act 1987 will be included?
Tony Lloyd (Rochdale) (Lab)
The Secretary of State will be aware that many of the women who took Primodos would not necessarily have known at the time that that was what they were taking or what the consequences were, and it is only later that they may have realised what took place. How will they be brought into the review? If there is to be compensation at some point, what will the test be? It would be unfair for them to have to prove that they were victims of the drug.
Mr Hunt
I wish it was easy to give the hon. Gentleman a straightforward answer, but the truth is that there is much scientific disagreement about whether there is a causal link, which makes it difficult to give clear answers to his constituents and, indeed, to mine. I hope that the review will shed some clarity on the situation, because that is what many people want.
Liz McInnes (Heywood and Middleton) (Lab)
What advice has the Secretary of State sought from the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists and the Royal College of Pathologists? What involvement will those bodies have in the review?
Jim Shannon (Strangford) (DUP)
I thank the Secretary of State for his statement. As he indicated, our products are world leading, and China and the UK have come to an understanding on medical device regulation, which is great news. However, does the Secretary of State have any information about further such understandings to ensure that we can export our medical innovations throughout the world safely and with as little red tape as possible?
Mr Hunt
It is fair and important to say that our regulatory system is admired the world over because we do safety extremely well and take it extremely seriously, but that does not mean that we cannot improve it. The lesson of today is that patients’ voices have not been strong in that process, and that is what we need to change.