Medical Cannabis under Prescription

Jim Cunningham Excerpts

Monday 20th May 2019 Commons Chamber

[Mary Glindon (North Tyneside) (Lab)]

It is an honour to follow the hon. Member for Reigate (Crispin Blunt), who is so impassioned—that was evident in his speech—and has done so much work on this issue. I think everyone would pay tribute to what he has done.

I congratulate the right hon. Member for Hemel Hempstead (Sir Mike Penning) and my hon. Friend the Member for Gower (Tonia Antoniazzi) on securing the debate and on the work they have done, alongside the End Our Pain campaign, to highlight the importance and urgency of this issue. It is heartbreaking to hear the stories of families who are trying to access medical cannabis, and especially parents whose children are so poorly. I am sure we all pay tribute to them for their persistence in standing up for their children.

[Mr Jim Cunningham (Coventry South) (Lab)]

I pay tribute to the right hon. Member for Hemel Hempstead (Sir Mike Penning). For a long time, he has been campaigning very strongly on this issue—in fact, we met some families he brought down to the House of Commons last year—as, of course, has the hon. Member for Reigate (Crispin Blunt).

If my hon. Friend the Member for North Tyneside (Mary Glindon) watched the news over the weekend, she will have seen a family who had to go to Holland and pay over £1,000 to get the medical relief that their kids need through medical cannabis. The question therefore is: why can we not do the same in this country? Why are we being so slow? A lot of kids are suffering, and some could go into a fit and die if we are not very careful. Does she not agree that the Government have to treat this with urgency?

[Mary Glindon]

I certainly would agree, and that is the case that we are all trying to make today.

I want to highlight the situation for my adult constituent, Lara Smith, who is known for courageously campaigning for the medical use of cannabis by highlighting the problems that she has faced in recent years to access the medicine Bedrocan. Lara is a wife and the mother of three children. She was a paediatric nurse and a county fencing coach before her health deteriorated because of cervical and lumber spondylosis. Over 20 years, she has had 35 different medications as well as a number of operations for her condition. Unfortunately, she has been left with permanent nerve damage, limited mobility and a constant annoying and debilitating tremor in her right hand. Her quality of life has been completely impaired, not just because of her medical condition but particularly because of the drugs that she has been prescribed over the years. This has meant that Lara was not able to be the full-time mother that she wanted to be to her daughters and son.

Fortunately, Lara’s pain management consultant in the north-east prescribed her the drug Bedrocan, and the transformation was such that she was able to come off all her other medications. Her young family said that they felt they had their mam back. The downside is that Lara can access the drug only by travelling to a Dutch pharmacy to collect it. Her arduous journey was shown just last week on “The One Show”—I hope that if people have not seen it, they may be able to on catch-up. She makes the journey every three months and has to notify full details of her prescription and travel to the Border Force. The costs of the medication and travel are expensive for her family, but it is a sacrifice that they have been making for over four years. The changes to the law that were made last November have not gone any way to making it easier for Lara to get her medication.

I raised this issue in Prime Minister’s questions, and afterwards I received a letter from the Minister for Policing and the Fire Service, who said that

“there should be no barriers to patients getting access to the appropriately prescribed medicine. The Department of Health and Social Care…has been working closely with suppliers and NHS procurement pharmacists to ensure that prescribed CBPM are available when needed.”

But that has not been the case for Lara and many other people, as we have heard tonight.

Lara’s private prescription cannot be dispensed by NHS pharmacists. Her consultant has been unsuccessful in obtaining an individual funding request, which Lara is very disappointed about. That was because the hospital trust follows the Royal College of Anaesthetists guidelines, which do not advocate the use of cannabinoids, citing a lack of evidence for effective pain relief, so all the while there has been no progress yet for Lara. Lara did approach an independent pharmacy to see whether it could get access to the drugs and bring them here to dispense them, but the licence fee would cost thousands and the cost would be borne by Lara. It is just beyond her reach.

The current state of affairs remains frustrating for Lara and all the adults and children who need these drugs. I do not know how many more trips Lara can make to Holland—not just on a financial basis, but because of her health—and I am worried about her. The process that the Government have put in place is too protracted. All I can say is that I hope the Minister will heed the words of the motion and particularly the very sensible proposals from the all-party group. This is a case of urgent need. We cannot delay any longer. Please listen, Minister, and please give some positive feedback this evening.

Health

Jim Cunningham Excerpts

Tuesday 14th May 2019 Commons Chamber

[Jonathan Ashworth]

My hon. Friend is absolutely right and, typically, anticipates the argument I am going to make.

Advances in life expectancy look as though they are going backwards for some of the poorest in our communities, particularly women. Let me take as an example our infant mortality rates, which reflect the survival rates for the very sickest of small babies. Those mortality rates have risen again, for the second year in a row.

[Mr Jim Cunningham (Coventry South) (Lab)]

Two or three weeks ago I visited a food bank, one of the biggest in the west midlands, and what amazed me was that it had to provide clothing for babies, which struck me as very profound. In other words, at least 20,000 people in Coventry are using food banks, and that tells us the consequences on people’s health. When they have to go to these centres for clothing and cots, does that not say something about austerity under this Government?

[Jonathan Ashworth]

It most certainly does. We are seeing a huge rise in the number of children living in poverty and an explosion not just in food bank use but in so-called baby banks, where parents arrive to pick up toys, nappies, and so on—even milk. It really is quite shameful.

We are also seeing an increase in the prevalence of mental health conditions among the poorest. Children and adults in the poorest areas are three times more likely to suffer mental health problems. We are also now seeing an increase in so-called “deaths of despair” for those in middle age, that is, deaths from suicide, drug and alcohol overdose, and alcohol liver disease. They are rising—[Interruption.] The Secretary of State says that that is not true, but it is in the report from the Institute for Fiscal Studies today.

Rates of premature mortality, including deaths linked to heart disease, lung cancers, and chronic obstructive pulmonary disease, are two times higher in the most deprived areas of England compared with the most affluent. Growing up and living in poverty means people get sick quicker and die sooner. It is shameful.

Mental Capacity (Amendment) Bill [Lords]

Jim Cunningham Excerpts

Ping Pong: House of Commons
Tuesday 2nd April 2019 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to follow the hon. Member for Torbay (Kevin Foster), as I do on many occasions. I agree with what he said. First, I thank the Minister for her commitment, for our comprehensive discussions and for making herself available for each and every person who wished to have input into this process, and hopefully the changes that the Government want to see will be passed.

The Government have gone to some lengths to ensure that this Bill replaces and improves existing legislation surrounding the deprivation of liberty as a matter of pressing urgency. The current system is not fit for purpose—many people in this Chamber and outside it feel that—and this legislative change by the Government is what we want to see.

The Bill implements the Law Commission’s recommendations, introducing a new system for people who lack capacity and need to be confined for care and treatment, ensuring that the system protects vulnerable people, is person-centred and includes a strong role for carers and families. I have had a chat with the Minister about this, and the Bill will also ensure that supported people and their families are supported and included throughout the process. That is very positive.

The supported person will be afforded their rights throughout the process by an appropriate person. The appropriate person will normally be a family member. Carers and families will be given a stronger role, with an explicit duty to consult them and the supported person. As someone who cares, along with my mother and son and others, for my brother Keith, who was in a motorbike accident some 15 years ago, I know the importance of the carer’s role across the whole process.

[Mr Jim Cunningham (Coventry South) (Lab)]

The hon. Gentleman makes an important point. For far too long, families have been left out of the equation when they should have been involved. There is an argument for looking at carers’ training and their suitability, perhaps through certification, because there have been lots of cases of abuse in the past. It has gone on for years, and we have to pay particular attention to that. The Care Quality Commission should be improved; it does not have the numbers to do the job. I often follow its reports in Coventry, so I have a good idea of its needs. Does he agree that those areas could be looked at?

[Jim Shannon]

I certainly do. The Minister has responded to the concerns of the hon. Gentleman, myself and others in a spirit of generosity, and perhaps this legislative change does that.

I welcome moves taken to make the definition of deprivation of liberty as strong as possible. What the Government have done is clear. It is vital that the definition links back to the European convention on human rights and provides a sturdy basis to protect vulnerable people. That is good news.

Members have referred to the 125,000 people who are currently deprived of their liberty without the necessary protections in place. Through this legislative change—which will not be opposed; a very helpful attitude has been adopted in the House of Lords and on both sides of this House—can the Minister indicate what will be done to reduce the backlog?

The Government have been lobbied and have consulted the Local Government Association, charitable bodies and other interested people and groups. As a result, we have a vital opportunity for long-awaited reform, and the Bill needs to be passed.

Mr Deputy Speaker, I gave you my commitment that this would be a short contribution, and I intend to keep to that. I want to finish with two quick questions to the Minister. Can she explain how the role of an appropriate person will support and protect vulnerable people in the proposed new system? Secondly, will she confirm that the needs of the supported person and their families will be put first?

Oral Answers to Questions

Jim Cunningham Excerpts

Tuesday 26th March 2019 Commons Chamber

[Stephen Hammond]

I know that the Secretary of State enjoyed his visit and was very impressed by what he saw. Health Education England has led the establishment of test site partnerships across England. There were 11 test sites in the first wave and a further 24 in April 2017, and the programme is now being rolled out all over the country.

[Mr Jim Cunningham (Coventry South) (Lab)]

What discussions has the Minister had with nursing associations and the Home Secretary about the recruitment of nurses and social care workers from the European Union after we leave and about how it can be made easier?

[Stephen Hammond]

I know that my hon. Friend the Minister for Care met the Home Secretary last week and that there are ongoing discussions.

Services for People with Autism

Jim Cunningham Excerpts

Thursday 21st March 2019 Commons Chamber

[David Linden (Glasgow East) (SNP)]

Like other right hon. and hon. Members, I place on the record my sincere thanks to the right hon. Member for Chesham and Amersham (Dame Cheryl Gillan) and pay tribute to her work. We, like others, are thinking of her at this time. The hon. Member for Bexhill and Battle (Huw Merriman) did an excellent job of putting that on the record and should be very proud.

It is a pleasure to sum up the debate on behalf of the Scottish National party. It has been an excellent debate, despite the time pressure. It is incredibly annoying to sit through debates knowing that people are having to pack so much in, so I hope that we can have more of these debates. We have heard excellent contributions from the hon. Members for Bexhill and Battle, for Bristol West (Thangam Debbonaire), for North Cornwall (Scott Mann), for Liverpool, West Derby (Stephen Twigg), for Dudley South (Mike Wood), for Dulwich and West Norwood (Helen Hayes), for Berwick-upon-Tweed (Anne-Marie Trevelyan), for Cardiff West (Kevin Brennan), for Henley (John Howell), for Strangford (Jim Shannon), for Copeland (Trudy Harrison) and for Torbay (Kevin Foster). All made very powerful speeches, either about their constituency casework or their experience with family members. I was particularly moved by the hon. Member for Berwick-upon-Tweed, who spoke about her 20-year-old son and how he is thriving. We all wish him well.

On a personal level, I want to thank a constituent of mine, Aileen Orr, who lobbied me to attend this important debate. She was right to say that, as has been backed up today, there is still not enough knowledge about autism and many people can still be quite ignorant about it, which is a point on which we must all reflect. World Autism Awareness Week is a good opportunity to give this issue the focus it deserves. Particularly in a Parliament so dominated by Brexit, such debates remind us that there are other issues that people want us to focus on, and there is a lot of unity in here today.

As Members would expect, I want to focus on the situation in Scotland. We have made good progress, but there is still a lot more work to do, as I will come on to. Last year, the Scottish Government refreshed their strategy for autism, which runs from 2018 to 2021. The review was a good opportunity to listen to people and to look at where we could improve, and I am grateful to our Mental Health Minister, Clare Haughey, who just two days ago announced a complete review of mental health legislation and autism legislation—the hon. Member for Berwick-upon-Tweed made a point about the two things being treated separately. It is good to see that recognised.

Among the themes arising from the review were the need for professionals across various areas to get more training in autism—that point has been made today—and issues of work and employment. The 16% figure that the hon. Member for Bristol West mentioned makes it clear that a lot more work needs toIt was not lined up for this debate, but on Monday I had the pleasure of visiting Aultmore Park Primary School, in my constituency, which is celebrating its 10th birthday this week. There is a language and communication resource on the school complex that works very closely with the school to make sure that the children attend from primary 1 to primary 7 and access the excellent opportunities. There was a lovely and exciting atmosphere in that school on Monday. It is such a pleasure to have it in my constituency.

On education, I know from my constituency caseload that we still have a lot more to do to support families. Like many other Members, I remain incredibly frustrated about the waiting times—in Scotland, they are often between one and two years, which is far too long—and in that regard I pay tribute to East End Carers, based in Shettleston, and the Happy Club, based in Provanhall. So often it is these voluntary charities that provide emotional and practical support for families, particularly in the period immediately after a diagnosis.

Part of the reason for the long diagnosis process is a lack of educational psychologists, which is a major issue in Scotland. There is only one university—Dundee, I think—where people can train to be educational psychologists. I encourage our Ministers north of the border to look at that.

[Mr Jim Cunningham (Coventry South) (Lab)]

Not enough is being done for schools. Teachers can study psychology. Some people teach and are also qualified psychologists. Is that not something that should be looked at?

[David Linden]

The hon. Gentleman is right to put that on the record. I am married to a primary school teacher and, although aspects of her teacher training dealt with autism, she would probably feel that she has not been given enough support. More often than not, she will be able to say, anecdotally, “This child in the class might have autism but has not had a diagnosis yet.” So he is right to put that on the record.

More often than not, a lot of housing associations do not have a proper understanding of autism. A lot of families come to me and say, “I need a house with a garden so that my child can play safely”. This chicken-and-egg situation, which I see regularly, can be quite frustrating.

I am conscious of the time—there is a heavily subscribed debate after this one—so I will round off by saying that it is of fundamental importance that autistic people and their families are understood and welcomed in their own communities and can be supported to be as independent and active as they wish to be. I thank all hon. Members who have participated in this debate. I hope that, when we debate it next year, we will be able to celebrate some progress because, if we have learned one thing today, it is that we still have a lot further to go.

NICE Appraisals: Rare Diseases Treatments

Jim Cunningham Excerpts

Thursday 21st March 2019 Commons Chamber

[Mary Glindon (North Tyneside) (Lab)]

It is an honour to follow the hon. Member for Reigate (Crispin Blunt).

I thank the Backbench Business Committee for agreeing to the debate. I also congratulate my hon. Friend the Member for Blaydon (Liz Twist), who is, as she said, my fellow member of the all-party parliamentary group for muscular dystrophy. She made a lucid and compelling case for the review of the NICE appraisal process.

I have had the honour of chairing the APPG for several years. It works closely with our secretariat, Muscular Dystrophy UK, and with patients and carers, on a number of issues that affect the lives of those with muscular dystrophy and other neuromuscular conditions. Perhaps one of the most important issues that we consider is the ability of patients to access treatments for their conditions.

For more than a year, access to the drug Spinraza, manufactured by the company Biogen, has been the focus of the APPG’s concerns about, and frustrations with, the NICE appraisal process. Spinraza is the first and only treatment for patients with spinal muscular atrophy, a rare inherited neuromuscular condition that leads to the gradual loss of the ability to walk, move, breathe and swallow. It currently affects about 2,000 adults and children in the UK. There are several types of SMA, with type 1 being the most severe, usually resulting in the death of infants before they reach their second birthday. However, clinical trials of Spinraza have had amazing results for many of the patients who have tried it. It has been so positive for children with type 1 that over two years ago Biogen opened its global expanded access programme to provide the drug free to type 1 patients.

Spinraza is currently available across 24 European countries and in the US, but for patients in this country access to the drug is being held up by lengthy delays to the NICE appraisal process.

[Mr Jim Cunningham (Coventry South) (Lab)]

Does my hon. Friend agree that the hon. Member for Reigate (Crispin Blunt) is right that there needs to be a new model, and more importantly that something must be done about the cost of drugs? We cannot carry on with the escalation of the cost of these drugs because, as the hon. Gentleman said, that affects many families in different ways.

[Mary Glindon]

That is true, and I think it will be highlighted again and again in this debate.

The delay for patients in this country is made all the more frustrating because the Scottish Medicines Consortium approved Spinraza for children with SMA type 1 last May, and it now has a new ultra-orphan pathway and has speedily reassessed Spinraza, and as a result children and adults with SMA types 2 and 3 will be able to access the drug from next month.

In England the Spinraza appraisal has already been going on for 14 months. In January last year NICE announced that the pathway for the drug would, sadly, be the single technology appraisal, used for common diseases, rather than the highly specialised technology appraisal, which has been spoken about and is used for rare conditions. On 14 August, all hopes were shattered when NICE announced that it did not recommend funding by the NHS as the clinical effectiveness of the drug was not proven and the price was too high.

NICE launched a consultation and held a committee meeting in October to review all responses. There was still no progress for patients. Then, following a previous announcement, on 1 November Biogen closed the expanded access programme for type 1 to all new infants, so although 80 children remain on the programme, any child born after that date with type 1 has no access to this life-saving drug. The process drags on, and NICE had its third committee meeting earlier this month, but as yet no information has been published.

Biogen maintains that the STA process is not appropriate for rare disease medicines, because the smaller patient populations in rare diseases make it inappropriate to expect treatments to achieve the same cost-effectiveness thresholds as medicines in disease areas with much larger patient populations. It has also pointed out that it is very difficult to measure the quality of life in a young paediatric population. However, that is a major determining factor in the STA process, so it is a stumbling block in approving Spinraza. The company still hopes that a managed access agreement can be reached with NICE and NHS England.

The truth is that NICE’s emphasis on cost-effectiveness stands in contrast to the focus on more flexibility and data gathering for future review, which has allowed Spinraza to be approved in Scotland and across Europe. A recent report by MAP BioPharma, “Access to orphan medicines”, highlighted that 75% of rare disease medicines recommended by NICE through an STA between 2013 and 2017 were due largely to rare cancer drugs that are covered by the cancer drugs fund, and none of the only six non-cancer orphan drugs reviewed by NICE through an STA has received a recommendation in line with full marketing authorisation.

The report makes five recommendations for the NICE STA methods review: making changes to the evidence requirements for orphan medicines; drawing from the HST methodology to consider introducing a sliding incremental cost-effectiveness ratio up to £100,000; considering adapting the evidence review group for orphan medicines; embedding formal opportunities for negotiation between companies and NHS England; and considering interim recommendations in line with the cancer drugs fund and the new Scottish ultra-orphan pathway. MAP BioPharma points out that those adaptations would help to level the playing field so that patients, clinicians and companies could be sure that all treatments for rare diseases would be considered under a fair appraisal and that access would not be held back as a result of treatments being referred for an inappropriate appraisal. I hope that those recommendations will be given due consideration by NICE, NHS England and the Department.

Meanwhile, for those awaiting a decision on Spinraza, the anxiety continues. They include families such as that of my seven-year-old constituent, Sam McKie, who has type 2 SMA. Sam loves playing wheelchair football and has played since he was three. He now plays for the Newcastle Magpies wheelchair championship team and is as good as many of the adult players. In fact, he is so good that, in November, the Newcastle United Foundation named him as its disability player of the year. Sam’s dad, Gary, wrote to me, and his words reflect the views of everyone affected by SMA. He said that

“children are facing an agonising and uncertain wait for approval whilst their condition deteriorates. Gaining early access to this drug could see Sam get stronger and gain new abilities. The SMA community would love to be able to access this drug to give our babies and children a chance, a chance they surely deserve. This drug is available now, and timely procedures are stopping our children from accessing it, this is wrong. Please help us.”

Will the Minister hear Gary’s words? Will he take action to ensure that delays do not happen in future? And will he work with Muscular Dystrophy UK and other charities towards making NICE take on board MAP’s recommendations, to help to create a new and fairer system, like that in Scotland, that will deliver for patients like Sam and, as Gary McKie says, give them the “chance they surely deserve”?

Exiting the European Union (Food and Agriculture)

Jim Cunningham Excerpts

Tuesday 19th March 2019 Commons Chamber

[Mrs Hodgson]

I absolutely agree. My hon. Friend makes a good point, and I discussed with the Government and Opposition Whips where responsibility for these SIs fell. There is so much crossover between food and health policy, and we are doing the best we can with the hand we have been dealt, but we should probably look more into this issue going forward.

[Mr Jim Cunningham (Coventry South) (Lab)]

I do not want to take my hon. Friend off the point too much, but it crossed my mind when I was listening to the Minister—I apologise to him for coming in late— that issues have been raised in the press, certainly recently, about imported food and the use of chlorine to cleanse it. Does my hon. Friend have a view about that?

[Mrs Hodgson]

Yes. The issue of chlorine-washed chicken did come up in some of the SI Committees that were held upstairs, and the Minister assured Committee members that chicken would continue to be washed in fresh water and that there would be no sneaking chlorinated chicken into our food chain. I am sure he will reaffirm that today.

The first SI today is the Materials and Articles in Contact with Food (Amendment) (EU Exit) Regulations 2019. As consumers, we are all familiar with the plastic packaging around almost every product—I suppose we are moving on to environmental policies in talking about the waste element of this, but the issue is at the forefront of consumer consciousness. Has the Minister had any conversations with his colleagues at DEFRA about the UK’s commitment to reducing plastic waste and about how this SI could help facilitate that? The authorised list of substances permitted for use in food contact plastics is generally updated several times a year. Which body will now undertake that work, and does it have sufficient resources to do so? Will the updated list be in line with that of our European neighbours?

Moving on to the genetically modified food and feed regulations, all authorised genetically modified food and feed must have a method of detection scientifically assessed and validated by the European Union laboratory, in collaboration with the European network of GMO—genetically modified organism—laboratories. What body will now scientifically assess and validate food and feed? Will the assessment process change, and will businesses have to complete a more complex process than currently? Will the UK be part of the European network of GMO laboratories after we leave the EU? If not, will the UK’s validation of GM food and feed be aligned with European network standards to ensure that GM food and feed from the EU can be placed on the UK market after Brexit and vice versa?

Can the Minister assure the House that GM food and feed will be authorised for sale only if they are judged not to present a risk to health, not to mislead consumers and not to have less nutritional value than their non-GM counterparts? Has he made any assessment of the impact that this SI may have on businesses? Has the Department contacted the food and feed industry to notify it of the changes in this SI?

Moving on to what is perhaps the most interesting of the SIs, on the regulation of novel foods, I was surprised to learn that chia seeds are classed as a novel food by the EU. I am sure I eat some of them; I have some in the cupboard—I think you sprinkle them on breakfast cereal and other things to try to get their goodness into you. Lots of other new products that I had not realised were classed as novel foods are now entering the market. I am pleased that foods that are new to the market are not automatically assumed to be safe. Novel foods must have a pre-market safety assessment before being placed on the market.

The geographical scope of the existing regulations is being maintained so that food that had a history of consumption in member states of the EU, and that could therefore be marketed in the EU without needing to be authorised, will not become novel and require authorisation to be sold in the UK when we leave. However, when we do leave the EU and new foods are added to the EU’s novel food list, will the UK mirror the same list and authorisation, or will it conduct its own review and authorisation? If the UK conducts its own review, which body will do it? Will the EU’s assessment be taken into account when we conduct a UK-only assessment? Public safety is paramount in all of this, as the Minister and I have discussed many times, so it is important that any reviewing body has the funding and resources to conduct a review. Can the Minister confirm that that is indeed the case?

Will a list of novel foods be available in the UK? Consumers are becoming more and more conscious about what is in the foods they eat, and rightly so. Any list must therefore detail all the information taken into account during the assessment so that consumers can make their own decisions. Packaging must also be clearly labelled with information about novel foods to ensure consumers are aware that their food is safe. It is of course highly important that any food entering the UK market for the first time is safe for human consumption. Leaving the EU should not mean a reduction in our food health standards.

Finally, the anomaly among these SIs, if we did not think that novel food was an anomaly, is the animal feed regulations—I suppose the Minister and I are discussing them because we are the Health Minister and the shadow Health Minister. This SI focuses on animal health and welfare, while taking into account the impact that that can have on human health—that is probably why it has fallen to the Minister and myself to debate it.

The SI says that all rules will remain the same as at present and that there will be a smooth transition for businesses, the feed sector and consumers. The elements of the instrument addressing deficiencies in the Animal Feed (Composition, Marketing and Use) (England) Regulations 2015 apply only in England. What discussions has the Minister had with his counterparts in the devolved Administrations? Is he confident that any regulations on animal feed will be similar, if not the same?

Any animal feed on the market, or used, anywhere in the UK must be safe. The conditions set out for labelling, packaging, sampling, analysis and hygiene must also meet a high standard to protect animal health and wellbeing. Animal feed must also be tested to ensure that it is not harmful to humans in the food chain.

Finally, any changes as a result of this SI must be effectively communicated to the agencies affected in a timely manner. With what could be as few as 10 days to go until Brexit day, will the Minister please confirm that he has had conversations with such agencies to notify them of any changes? The regulations must also be able to be amended easily in the event of emerging threats or changes in safety standards.

In closing, I would like to put on record once again that I am disappointed and concerned that it has come to this just 10 days—if nothing changes—before we are due to leave the EU and that we are still tying up loose ends in such legislation, which is so important to our food safety. We cannot let food safety standards slip as a result of Brexit. They are crucial to human and animal health, safety and welfare. That is why, although I am concerned about the way the Government are rushing through important legislation such as this, I none the less support these SIs. The UK’s food safety standards are paramount to our health and something we must not compromise on. With those remarks, I look forward to the Minister’s response. As ever, I hope he is able to answer some of my questions.

Leaving the EU: Health and Social Care

Jim Cunningham Excerpts

Tuesday 19th March 2019 Westminster Hall

[Brendan O'Hara (Argyll and Bute) (SNP)]

I beg to move,

That this House has considered the effect of leaving the European Union on the UK’s health and social care sector.

It is a pleasure to serve under your chairmanship, Mr Bone. I thank the Backbench Business Committee for agreeing to the debate, and all hon. Members who have come along to take part in it. I put on the record my sincere thanks to Robert McGeachy of Camphill Scotland, to Craig Wilson and Gareth Jones from the Scottish Council for Voluntary Organisations, and to Andrew Strong of Alliance Scotland, for all their help and support in preparing for the debate.

The debate’s origins are in my private Member’s Bill, which I tabled in November 2018. It sought from the UK Government provision for an independent evaluation of the effects on the health and social care sector of the United Kingdom’s withdrawal from the European Union. Like many others, my Bill will almost certainly fall this Friday, without ever seeing the light of day or being debated. I was always prepared for the likelihood that the Bill would fall because of a lack of time, so that does not surprise me. What did surprise me, however, was my Bill’s impact on the organisations that deliver vital health and social care to so many vulnerable and needy people day-in, day-out right across the United Kingdom.

Currently, no fewer than 102 different third sector organisations, trade unions and charities have publicly supported the measures in the Bill. Not a single one of those organisations believes that Brexit will be good for the health of the people of these nations. Moreover, they all support the idea that an independent evaluation of the effects of Brexit on the health and social care sector should be carried out, and that it should examine the sustainability of public funding, the challenges faced by the workforce, and the efficiencies and effectiveness of the sector.

I will not test everyone’s patience by naming all 102 organisations that have lent their support, but I can assure hon. Members that they cover every part of the United Kingdom. They include the Western Isles Carers, Users and Supporters Network, which is based in Stornoway, the Northern Ireland Council for Voluntary Action, Disability Wales, and the London-based Mentor UK, which does great work with young people on alcohol and drug misuse. Those organisations share my concerns, and I want to put on the record my sincere thanks to each and every one of them for contacting and supporting me.

In the light of the extremely high levels of concern among those delivering services at the sharp end, I did not want this hugely important issue simply to disappear from the radar on Friday, when my private Member’s Bill will almost certainly fall because of a lack of time. I felt that I owed something, not just to those organisations, but to the most vulnerable in our society: those with disabilities; children and young people; older people; unpaid carers; those living with long-term health conditions; and those who rely on the vital contributions made by the highly valued EU citizens who provide for our health and social care needs right across these islands. Their voices are not being heard, or their views properly considered. I felt that I owed it to those people to ensure that the very serious issues that the health and social care sector will face post Brexit are examined and discussed in this place so that, 18 months from now, no one can claim not to have known what the sector or the service users were saying.

Every one of us knows that there is already a crisis in social care across the United Kingdom, with a seemingly relentless pressure on funding. Our population is ageing and has increasingly complex care needs, and we face major challenges in the retention and recruitment of the workforce required to meet those needs. One would have thought that, in the immediate aftermath of the EU referendum in June 2016, the Government would at the very least have made a top priority of safeguarding the health and care of their citizens. Guaranteeing a secure supply of the vital medicines that are manufactured in the EU, or that have to be transited through it, would have been a good starting point, particularly as the Department of Health and Social Care’s own estimate states that two thirds of the medicines that we use in the UK come from or via the European Union.

One would have thought that securing access to the essential pool of labour that we require now, and will increasingly need in future, would have been at the top of the to-do list, or thereabouts. Yet in March 2019, just 10 days from possibly crashing out chaotically, we are still discussing the dangers that the weakest and most vulnerable in our society will face as a result of Brexit, and particularly the type of Brexit that the UK Government have chosen to pursue. It is one in which their ideologically driven, self-imposed red lines will deliberately sever the essential link between the health and social care sector and the pool of labour on which it depends. Exactly two years ago, Professor Ian Cumming, the chief executive of Health Education England, said:

“Our biggest risk in the short term, as a result of Brexit, may be in the non-professionally qualified workforce across health and social care”.

Without exception, every single organisation that offered me support for this debate or prepared a briefing ahead of it highlighted the enormous damage that Brexit, and particularly the end of freedom of movement, would do to their ability to deliver care and undertake essential medical research—every single one. They include Cancer Research, CLIC Sargent, the Local Government Association, the Northern Ireland Council for Voluntary Action, researchers from the University of Birmingham, Macmillan Cancer Support, the British Medical Association and Age UK, to name but a few. They have all said that the health and social care sector values and wants to retain its EU staff, and wants nothing to stop it recruiting more of those hugely valued and important staff members in future.

[Mr Jim Cunningham (Coventry South) (Lab)]

It is timely that the hon. Gentleman is bringing this issue to the forefront once again. On healthcare, one of the things that certainly worries my constituents and me is the potential for the national health service to be open to predators post Brexit. As I am sure he knows, on one hand, the care side of the NHS is vastly underfunded, while on the other hand, people cannot afford care to look after their families, including elderly parents and others. Research and development in medicine and collaboration with Europe are also important, and two universities in Coventry that engage in a lot of that have voiced concerns to me about it. Does he agree with those concerns?

[Brendan O'Hara]

The hon. Gentleman is absolutely right. The fear in the sector and among care users is palpable. A recent article in The Lancet, which backs up his points, states:

“All forms of Brexit involve negative consequences for the UK’s leadership and governance of health, in both Europe and globally”.

For me, that sums up the hon. Gentleman’s point exactly. I hope that he agrees.

We cannot get ourselves into a situation in which there is a barrier between the health and social care sector and that pool of labour. Age UK recently said that

“our care workforce is in no position to withstand the loss of good…care workers, wherever they come from.”

The King’s Fund said:

“Widespread and growing nursing shortages now risk becoming a national emergency and are symptomatic of a long-term failure in workforce planning, which has been exacerbated by the impact of Brexit and short-sighted immigration policies.”

The message from the sector to the Government is therefore clear and unambiguous: we simply cannot afford to cut ourselves off from the labour markets on which we have become so reliant and on which we will depend more and more in future. One look at the frontline of the health and social care sector and its delivery, and it is easy to see how heavily it depends on workers from outside the United Kingdom. Without access to those workers, the UK home market will be required to fill the gaps, but people are not queuing up to fill the vacancies that exist now, so do the Government believe that somehow post Brexit people will suddenly become available for work in the care sector?

Integrated Care Regulations

Jim Cunningham Excerpts

Monday 18th March 2019 Commons Chamber

[Jonathan Ashworth]

The changes in the regulations have aroused considerable concern in the country, and proper parliamentary time should have been made available for a proper debate on them; they should not have been made through secondary legislation.

The Opposition oppose the regulations and will seek to test the House’s opinion on them. We oppose the changes not because we are against integration. We have long called for greater integration of services to offer seamless care to patients, because the demands on the NHS are of a different nature from those of 71 years ago, when a Labour Government created the NHS with a tripartite structure. In those days, life expectancy was so much shorter, and infectious disease was the overwhelming medical challenge. In 2019, we are worlds away from the days when 30,000 hospital beds were set aside for the treatment of tuberculosis, or when wards were filled with row after row of iron lungs to treat those suffering from polio. Today, we are all living longer, with a variety of complex conditions, from diabetes to cardiovascular disease and chronic obstructive pulmonary disease—conditions that increase the risk of a poorer quality of life and mean a greater risk of premature death. Indeed, around 14.2 million people in England—nearly a quarter of all adults—have two or more conditions. More than half of hospital admissions and out-patient visits, and three quarters of primary care prescriptions, are for people living with two or more conditions.

The issue is not just ageing and frailty; poverty takes its toll. People in the most deprived areas of England can expect to have two or more health conditions at 61 years—10 years earlier than people in the least deprived areas. Health inequalities are widening, while advances in life expectancy are stalling. An ageing population, the increase in long-term conditions, and the increasing number of people with multiple health conditions means that we need to integrate services. Sometimes in these debates, when we talk of long-term conditions, we suggest that we are talking about a homo- geneous group, but it is quite the opposite. We could be talking of a 61-year-old man with renal failure and high blood pressure, or a 101-year-old woman with profound deafness and blindness. The way that such conditions affect quality of life, and the extent to which they are amenable to medical intervention, is likely to vary.

If health services are not better co-ordinated and not integrated, there is a greater risk to patient care through the poor co-ordination of medical care and increased time spent managing illness. The need to manage multiple medications may lead to poorer medication adherence, adverse drug events, and the aggravation of one condition by the symptoms or treatment of another. It can also mean damaging self-management regimes in which there are competing priorities, and a bewildering landscape for patients, who are often of an advanced age, with cognitive impairment and limited health literacy, so we support integration.

I have seen integration working on the ground. Just last week, I was in Bolton, where I visited the Winifred Kettle centre to see the model of integrated multi-agency work bring together mental health professionals, pharmacy, physio, occupational therapy and social workers. In Bury, I heard about how the local council’s chief executive doubles up as the chief executive of the clinical commissioning group. In Luton and Dunstable I saw with my own eyes that the hospital trust has various social care workers in its discharge unit, helping to avoid the indignity of huge numbers of elderly patients being trapped in hospital, ready for discharge but delayed for days on end, as happens too often. In Wolverhampton, a fascinating example is being developed: the hospital trust is taking on and employing GPs directly. In Wolverhampton, they call it vertical integration, although some might wish to go as far as to suggest that it is the nationalisation of general practice, something that not even Nye Bevan was able to achieve.

A Labour Government would move away from a competitive landscape of autonomous providers to one of area-based care delivered through integration, collaboration, partnership and planning. We will restore a universal, publicly provided and administered national health service. Locally, we envisage something akin to health and care boards, with a duty to provide health not only for those on a CCG list but for all residents. Nationally, the Secretary of State’s duty to provide care will be reinstated. We are consulting on these matters with patients, staff and wider stakeholders.

[Mr Jim Cunningham (Coventry South) (Lab)]

Very quickly, does my hon. Friend not agree that the big problem with integration, if we support it, is the lack of funding, and the lack of proper training in the various disciplines? Only a couple of years ago, there was a cut in the funding for pharmaceuticals.

[Jonathan Ashworth]

My hon. Friend makes a very important point. Integration is not about saving money. For integration to work properly, it needs to be fully funded, and, of course, the NHS has been through the biggest financial squeeze in its history. We do not oppose integration. Indeed, that is why the previous Labour Government introduced a section 75 partnership arrangement, and why we were so vociferous in our opposition to the Andrew Lansley Health and Social Care Act 2012, which went completely counter to international evidence and exacerbated local fragmentation of health structures. It is a delicious irony that Ministers, all of whom were dragooned through the Lobby to support the Lansley Act, despite expert after expert warning them what a mistake it would be to press ahead with it, are now trying to propose regulatory changes, so that we can essentially work around that Act. The reason why we cannot support the regulations today is that the most damaging part of that Act is still on the statute book.

Health and Care Professions Council: Registration Fees

Jim Cunningham Excerpts

Thursday 14th March 2019 Westminster Hall

[Mr Jim Cunningham (Coventry South) (Lab)]

I beg to move,

That this House has considered registration fees at the Health and Care Professions Council.

You and I have known each other a long time, Mr McCabe, but I think that this is the first time I have led a debate under your chairmanship. I hope you will show a bit of leniency, particularly to some of my hon. Friends. I thank Mr Speaker and the Chairman of Ways and Means for making provision for the debate. In actual fact, we were granted the debate at short notice; I think somebody else pulled out. Hon. Members will have to excuse me—I have a heavy cold, to say the least. I hope they can all hear me.

The debate follows on from early-day motion 2069, which I tabled last month and which condemned the Health and Care Professions Council’s unfair rise in registration fees. To date, that early-day motion has been signed by a truly cross-party group of 118 MPs, which shows the real concern across the House; it is very hard to get such a number. I hope that the debate leads to a rethink from the HCPC and the Government.

The HCPC exists to regulate health and care professionals. It sets standards, investigates complaints and keeps a register of workers in 16 different professions. Members might be interested to know what those professions are: arts therapist; biomedical scientist; chiropodist and podiatrist; clinical scientist; dietician; hearing aid dispenser; occupational therapist; operating department practitioner; orthoptist; paramedic; physiotherapist; practitioner psychologist; prosthetist and orthotist—I do not know what those are-radiographer; social worker, in England; and speech and language therapist. That covers quite a wide range, to say the least. Notably, social workers in England are still covered, despite plans to change that from 2019. Altogether, the HCPC regulates more than 360,000 professionals, 90,000 of whom are social workers.

To register, professionals have to pay an annual registration fee, which is currently £90. In autumn last year, the HCPC announced plans to raise its registration fees from £90 to £106 per year—an 18% rise. That follows a 5% rise in 2014 and a further 12.5% rise in 2015, so with the new rise fees will have risen by 40% since 2014. The HCPC argues that the rise is necessary in order to secure its financial health, giving five main reasons for the fee increase.

First, it plans to increase efforts to prevent problems before they occur. Secondly, it wants to use innovation and technology to modernise and improve services. Thirdly, it needs to address a caseload that is growing in number and complexity. Fourthly, it needs to address the impact of inflation since its last fee increase. Finally, it needs to pre-empt the transfer of social workers to a new regulatory body. While the HCPC has faced higher expenditure since 2015, these reasons cannot possibly support an 18% rise. Expenditure increased by £2.8 million in 2017-18, but £400,000 went on redundancy packages for management staff and £1.2 million went on refurbishing the HCPC head office.

The HCPC put its plans for a fee increase to its members over the winter. Responses to the consultation were damning, with 90% of respondents opposing the increase. Despite the findings of the consultation, the HCPC decided last month to impose the 18% increase. It has defended the rise by saying that its fees are lower than those of any other health and care regulator. However, other regulators are not comparable. Some cover very few members, reducing their economies of scale.

[Mike Hill (Hartlepool) (Lab)]

My hon. Friend is making an excellent speech. Of course, this issue affects not only the HCPC’s but other registrants, such as nurses, who have to register with the National Midwifery Council. Does he agree that, along with other things, such as car parking charges, low pay and no automatic incremental progression in a lot of health-related occupations—particularly for nurses—these kind of registration fee increases are just another tax on healthcare workers’ wages?

[Mr Cunningham]

In considering that, we have to remember that a lot of those workers’ salaries—for want of a better term—have in some instances been frozen since 2010, while in some instances they may have increased by 1% or 2%. With inflation at about 2% over that period, that is roughly an 18% cut in wages. Add the increased fee, and those workers are carrying a heavy burden that they should not have to carry. Adequate funding should be provided, rather than finding it by using hidden taxation methods. We all know that nurses and so forth in some of our hospitals have to pay car park charges. Given all those hidden costs, these workers are quite frankly bearing the brunt of the recession.

[John Howell (Henley) (Con)]

A lot of these organisations have always said that they want to keep their independence and do not want to be funded by other sources; they are pretty keen on making sure that that continues. Is the real issue not the amount of regulation that they have to deal with? That must be one reason why the funding level has increased.

[Mr Cunningham]

Organisations always argue that they want to be self-sufficient, but that should not come at the expense of the people whom they actually regulate. I am not an expert on the regulations that some of these bodies govern, but we should be very careful when thinking about changing regulations or reducing their amount. We would need to test that.

Altogether, the HCPC has not given a strong reason for this huge increase, leaving affected workers frustrated and angry. In addition, the Government’s response to the fee change has been very disappointing: in answer to written questions, they have just repeated the HCPC’s weak defence of the fee rise. Ministers have argued that the registration fees remain the lowest of any health regulator, but that does not change the fact that the rise is disproportionate and unfair. The Government should be concerned over the threats to staff levels in the affected professions, but Ministers say they have made no assessment of the impact on staffing of this rise. That is a complete dereliction of duty, with staff openly talking of leaving due to the rise.

It is an irresponsible move by the Government to hide behind the HCPC’s independence. They must take steps to prevent fee rises from being the norm for the HCPC, and for all regulators, and help to build bridges between healthcare professionals and the HCPC, as trust is breaking down. HCPC members are understandably angry, believing that it is exploiting a stranglehold over their jobs. The rise amounts to nothing less than a tax on practising, and it has had little scrutiny or debate. I would like the HCPC to reverse the decision to increase registration fees by 18%. The Government and the HCPC must change the way fees are decided on, to prevent such a huge change happening in the future. The HCPC must operate in a fairer and more transparent way, and the Government must play a role in ensuring that that happens. It is time that the Government and the HCPC stopped taking advantage of those who take care of us all.

In response to the rise in fees, Unison conducted a survey of affected members and found that 99% of respondents did not back it. Importantly, it found that 76% did not see the current £90 fee as good value for money. Members feel that the HCPC offers no real benefit except for allowing them to practise. They are also critical of the justification given by the HCPC for the fee rise.

First, it must be pointed out that the 18% rise completely outstrips inflation. If the HCPC was genuinely concerned to cover inflation, it could implement smaller, year-on-year rises. I doubt whether the staff could afford those, frankly, but it is one way to look at it. Secondly, it is unfair for members of other professions to cover the costs of transferring social workers to a new regulator. The HCPC faces upheaval because of the change, but it is wrong for other professionals to pay the price.

Thirdly, the case for needing more funding after the transfer of social worker regulation is dubious. Social workers make up a quarter of members, which is a substantial number of registration fees. We all know what a difficult job they do. Often they are put in a situation where they cannot win, and they bear the brunt of some of the ills of society, to say the least of it. However, they also account for more than half of all fitness to practise cases. That is the HCPC’s largest area of expenditure. Despite a loss of income, the HCPC will face a sharper fall in costs at the same time. That fundamentally undermines the case for an 18% rise, and proves that it is unnecessary.

Unison also highlighted several changes that the HCPC should implement to reduce spending. First, it must take steps to make its complaints process more efficient. The Professional Standards Authority for Health and Social Care found in 2018 that the HCPC’s investigation committee refers cases too readily to the fitness to practise panel and that more than 20% of complaints are found at final hearings to be “not well founded”. Overall, members are funding a system that handles complaints against 0.64% of registrants and sanctions just 0.09%. No wonder so many members are left feeling that they gain nothing from their registration.

The fee rise comes on top of many years of wage freezes and below-inflation wage rises. Although £106 might not sound much to the Government or to some higher-earners in the health sector, the rise will be a real hit to part-time workers and those on lower wages. Professionals are left doubting their trust in the HCPC after being ignored in the consultation. The HCPC is facing growing unrest and resentment among its members. Many are now moving to non-regulated posts, and part-time working will become a lot less attractive, inevitably causing a fall in the number of workers in the sector.

--- Later in debate ---

[Mr Jim Cunningham]

I thank all Members who took part in the debate: my hon. Friends the Members for Heywood and Middleton (Liz McInnes), for York Central (Rachael Maskell) and for Blaydon (Liz Twist), the hon. Members for Strangford (Jim Shannon) and for Argyll and Bute (Brendan O'Hara), my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders), and of course the Minister.

I welcome the undertakings that the Minister gave. I realise that some of the national health service issues that were raised are above his pay grade; the wages and conditions of employees are really an issue for the Secretary of State, so I would not expect any undertakings from the Minister about them.

I very much appreciated the contributions made by Front Benchers and Back Benchers alike, and I hope that listening to them enlightened the Minister. It certainly enlightened me, because I have never been involved in the national health service or anything like it; I have been involved more in the engineering side of life and in industry. It is always useful to hear from hon. Members about their experience. More importantly, I also thank the trade union for the invaluable background information that it provided. Some colleagues are probably aware of the situations that it has highlighted, but others may not be.

The Minister gave an undertaking to my hon. Friend the Member for Stroud (Dr Drew) that he would talk to the Professional Standards Authority; if he sent me a copy of that communication, I would be very interested. I come from an industrial trade union background. We were always taught, “Just because you get a knock-back, it doesn’t mean you should give in. Pick yourself up, dust yourself down and keep campaigning until you get justice.” Once again, I thank everybody who participated in the debate.

Question put and agreed to.

Resolved,

That this House has considered registration fees at the Health and Care Professions Council.