Public Health Funding: Enfield

Joan Ryan Excerpts

Tuesday 16th July 2019 Westminster Hall

[Joan Ryan (Enfield North) (IGC)]

I beg to move,

That this House has considered public health spending in Enfield.

It is a pleasure to serve under your chairmanship, Mr Betts.

I requested this debate to highlight some of the harsh realities stemming from the Government’s decision to slash the public health grant to our community, and to draw attention to the fact that the ongoing uncertainty around long-term funding is prompting a crisis in public health. Our council’s ability to deliver a range of public health services aimed at preventing disease, prolonging life and promoting good health is being seriously affected.

The Government’s national health service long-term plan may have put prevention at the heart of its policy but, to quote David Finch, senior fellow at the Health Foundation:

“The sustained cuts to the public health grant clearly run counter to these aims. The public health grant is not a nice-to-have. Without urgent reinvestment, we will continue to see a direct impact on people’s long-term health”.

Last month, the Health and Social Care Committee said that cuts to public health services were a “false economy”. Cancer Research UK and more than 80 other organisations have come together to call on the Government to provide a sustainable solution for public health. Ministers must take immediate and positive action to increase investment in public health, to reduce health inequalities and to support our health and social care system.

I will take this opportunity to pay tribute to the work of the Enfield Over 50s Forum and its president, Monty Meth, who is sitting in the Public Gallery today with many of the forum’s members. Their typically dogged campaign to highlight the cuts to Enfield’s public health grant and the disparity in per-person funding between our borough and other councils in London has forced this issue to the top of our community’s agenda.

The Minister should be well aware of the forum’s work on this matter, given the number of letters that its members have written to her and her Department in recent weeks and months—although, sadly, their letters have not received a considerate ministerial response. Instead, they have received a reply from the Department’s correspondence unit that, to put it mildly, leaves a lot to be desired.

One constituent with impeccable manners, who forwarded me a copy of the letter he received, described the response as “baloney.” Another resident labelled the reply “meaningless” and “full of Whitehall gobbledygook”, and it is hard to disagree with that analysis when they are treated to phrases such as:

“The formula is designed to generate target allocation shares of a funding envelope”.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

Does my right hon. Friend agree that, because the baseline funding has been set from 2013, it takes no account of changes in the population of Enfield to do with age, poverty and other factors that might hugely affect the funding that Enfield actually deserves right now?

--- Later in debate ---

[Joan Ryan]

My hon. Friend is absolutely right; that is a key factor in this whole scenario.

On the kinds of responses that constituents are receiving, surely responses from Government Departments to citizens raising legitimate concerns on important issues should seek to clarify and not to cloud matters? I do not raise this point as an attack on civil servants, but to urge the Minister—and it is her responsibility—to provide some clear and full responses to the concerns I raise today on behalf of the Enfield Over 50s Forum and our whole community in Enfield.

Given that the population in London boroughs—including Enfield, as my hon. Friend has said—is growing twice as fast as in the rest of the country, the pressure on already strained public health resources is only set to intensify over the coming years. Enfield has some of the most poverty-stricken and deprived wards in the country, and we all know that poverty and poor health are inextricably linked.

According to a recent report by the Child Poverty Action Group, our borough is one of the 20 local authorities in the UK with the highest levels of child poverty after housing costs are taken into account. There are almost 40,000 children in poverty, or four in 10 children in the borough. Obesity rates for children in reception class are higher than the average in London and in England, and more than four in 10 year 6 children in Enfield are either overweight or obese, the eighth highest rate of all London boroughs.

However, it is not just children affected by serious public health issues in Enfield, but adults and the elderly too. Our rates of diabetes are higher than the London and England average. Cancer Research UK recently revealed that being overweight is a bigger cause of bowel, kidney, ovarian and liver cancer than smoking. More than six in 10 adults in Enfield are overweight or obese, a significantly higher rate than in London in general. Our bowel cancer screening rates for people aged 60 to 74—one of the best ways to diagnose bowel cancer earlier—are only just over 50%. That is lower than the average in England and far lower than the rate of 75% of eligible people taking part recommended by Cancer UK.

One of the most pressing issues facing our community and our country at the moment is the impact of serious violence and knife crime. I held a packed community meeting on Saturday on this issue, talking about how to keep our young people and our streets safe. Earlier this year, Enfield had the highest rate of serious youth violence in the capital. In 2018 alone, North Middlesex Hospital had to deal with the consequences of 1,457 assaults, including stabbings and gunshot wounds.

To protect staff and patients on site and reassure the local community of their continued safety whenever they visit the hospital, North Middlesex increased its security spend by an additional £149,000 and had to hire two additional overnight security guards in its busy accident and emergency department, at a cost of £3,000 per week. North Middlesex Hospital should not have to use its already stretched budget to address a situation that is not of its making. Every penny that is spent on these interventions is money that is diverted away from essential patient care.

Both the Government and the Mayor of London want to tackle the knife crime crisis with a public health response. That is an important and welcome initiative, but if the Home Secretary is going to implement a legal duty on the police, councils and the NHS to share information and intelligence, then those bodies will need the resources to make it effective.

The public health system is already at crisis point. We require a public health budget that addresses the desperate needs of our community in the immediate and long term. But where is the support from the Government? The Prime Minister has declared that austerity is over, so where are the resources to reverse the cuts suffered by our public health services?

When the NHS long-term plan was launched the Prime Minister said:

“We also know we need to…support prevention and public health, both for the benefits they bring in themselves and to relieve pressure on NHS care.”

In 2018, the then Health Secretary, the right hon. Member for South West Surrey (Mr Hunt), told the House that

“there cannot be a transformation of the NHS without a proper emphasis on public health.”—[Official Report, 18 June 2018; Vol. 643, c. 61.]

The current Health Secretary has said that prevention is one of the three pillars of his stated priorities. He also said:

“Each year, we are spending £97 billion of public money on treating disease and only £8 billion preventing it across the UK—that’s an imbalance in urgent need of correction.”

What urgency has he shown to fix this imbalance? That statement was made more than eight months ago.

While parts of it were leaked to the press over the weekend, we still await the formal publication of the Government’s Green Paper on public health and the future of funding. Analysis by the Health Foundation shows that the public health grant is now £850 million lower in real terms than the initial allocations in 2015-16. Last month, the Health Foundation and the King’s Fund stated:

“With the Spending Review likely to be delayed, key funding decisions will be postponed and as a result, the grant will face a further real-terms cut of £50 million in 2020/21 under provisional plans…With population growth factored in, £1 billion will be needed to restore funding to 2015/16 levels.”

Enfield is one of the communities to really bear the brunt of these savage cuts. Our borough’s grant is the 9th lowest in London, at £48 per head of population, compared with the London average of £71—a gap of £23—and we are getting £2 less per person this year than last year. In total, we are receiving £440,000 less from the public health grant this year than in 2018.

In addition, Enfield is one of five London boroughs that make up the NHS’ north central London sustainability and transformation partnership, which has pledged to reduce health inequalities for its 1.5 million residents. Haringey, Camden and Islington receive £70, £99 and £104 per head respectively for public health funding. I recognise that these boroughs also have considerable public health needs, but I do not understand how the disparity in public health funding between boroughs in the same area can be so large. There is then the Royal Borough of Kensington and Chelsea, which is allocated £130 per person for public health—almost three times more per head than Enfield. Where is the evidence that Kensington and Chelsea’s public health needs are almost three times worse than Enfield’s?

It is not as if Enfield Council can step in and plug some of the gaping holes in public health funding. Up to 2018-19, the core funding the council received from the Government to provide vital services was slashed by an average of £800 per household. Ongoing Government cuts and increased demand on services mean that the council has to find another £18 million of savings this year and then £12 million more the next. Austerity is clearly not over in Enfield. The cuts will continue to bite for the foreseeable future unless the Government do something about it.

What I find so frustrating is that the extent of these cuts to our public health system, and to local government, are so short-sighted; they have immediate and long-term adverse consequences. In April, when I asked the Minister for her assessment of the correlation between the levels of public health funding allocated to Enfield and the effectiveness of the provision of public health services in our borough, the response I received was:

“We have made no specific assessment of any relationship between funding…and the effectiveness of services in Enfield.”

Really? Maybe this type of assessment is required so that her Department can gain a better understanding of the public health situation in Enfield, as well as in other communities across the country. Will the Minister resolve to look again at this issue?

Given the pressing public health issues in Enfield I have outlined today, is the Minister willing to commit, at the very least, to reinstating the £440,000 cut in public health funding suffered by our borough this year? Does the Minister accept the need to increase the level of public health funding allocated to our borough to at least the London average each year? And does the Minister agree that Enfield urgently needs its public health system to be put on a sustainable footing? More widely, I want to hear from the Minister about the future of public health funding. Can she provide any indication of when the Green Paper will be released? Can we hold out any hope that the calls from the Health Foundation and the King’s Fund to reverse the £1 billion a year cut to public health funding will be acted upon?

There is a lack of clarity on the Government’s previously announced plans to phase out the public health grant to local authorities by 2021 and to instead fund public health through the proposed 75% business rates retention scheme. Cancer Research UK says that the continued uncertainty around the public health funding formula means it remains concerned about the potential negative implications of business rates on local service delivery. There is no point in Ministers extolling the virtues of a robust public health system if, in reality, all they do is weaken the prevention agenda by slashing funding for services. The success of the Government’s NHS long-term plan will be built on the foundations of improvements to public health, but these foundations will crumble, and the investment in the NHS’ long-term future will be undermined, if the Government fail to increase investment and make prevention a top priority.

Finally, I return to the work of the Enfield Over 50s Forum. Reading one of its recent newsletters, I was struck by this succinct but perfect encapsulation of why achieving fairer funding for public health in Enfield is so important:

“Improving public health is not just an over 50s issue. It concerns every single body and soul in the borough—toddlers, teenagers, every family with young children. This is one case when we are really all in this together.”

I look forward to the Minister’s response.

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

It is a pleasure to serve under your chairmanship, Mr Betts. I thank the right hon. Member for Enfield North (Joan Ryan) for raising this issue. She is a great champion for her constituency, as is the hon. Member for Enfield, Southgate (Bambos Charalambous) for his.

I reassure the right hon. Lady that the Government are fully committed to improving public health. We want to place prevention at the heart of our health and social care system, because that is the only way to make the NHS sustainable in the long term. That is challenging, as we all know. We need to tackle the root causes of poor health, not only the symptoms. The population of our country is growing. As both the right hon. Lady and the hon. Gentleman pointed out, growth in London boroughs is particularly acute and has been rapid over the six years since the formula was put in place, and we recognise the demand on the NHS, social care and other public services. My right hon. Friend the Secretary of State for Health and Social Care and the Prime Minister are aware of the great gaps in life expectancy in London boroughs and across the country. We also know that lots of diseases that people die from nowadays are preventable, which is why we want to put prevention at the heart of what we do. The Prime Minister’s ambition is to extend healthy life expectancy by five years by 2035 and to reduce the gap between the richest and the poorest. We have made great strides in many areas.

Childhood obesity is an international problem, but we are being ambitious on it, as well as on air quality and tobacco. All these measures have the potential to make a real difference to people’s health and wellbeing. We have reduced sugar in fizzy drinks by 11%, we have cut average calories per portion by 6% through the soft drinks levy, and by 2020 the NHS diabetes prevention programme will support 100,000 people at risk of diabetes across England each year. On screening, the right hon. Lady will be aware that Professor Sir Mike Richards is undertaking a screening review at the moment, so issues such as those she raises about bowel screening will be brought up. That review will report later in the year.

The Green Paper is coming up and I hope that that will take us even further. We need action across local government, central Government and the NHS. Of course, the over-50s group to which the right hon. Lady has referred is an important part of that, because only through everybody working together will we be able to tackle the determinants of health and be far more successful at improving and protecting health outcomes.

To move specifically to public health and where it sits now, we gave back to councils responsibility for public health in 2013. That was important. They recognise what is relevant for their communities and are uniquely placed to use the full range of their activity—levers such as planning, transport, housing and the local economy—to promote better health.

[Joan Ryan]

I realise that there is not a great deal of time today, but the Minister says that the funding given to Enfield Council is relevant to its needs. Is she saying that the funding that it has been given is adequate to cover the public health requirements in Enfield?

British Sign Language Users: Access to NHS Services

Joan Ryan Excerpts

Wednesday 15th May 2019 Westminster Hall

[Joan Ryan (in the Chair)]

I draw hon. Members’ attention to the fact that our proceedings are being made accessible to people who are deaf or hearing impaired. The interpreters in the Chamber are using British Sign Language, and the debate will be broadcast on Parliament TV with live subtitles and British Sign Language interpretation.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

I beg to move,

That this House has considered access to NHS services for British Sign Language users.

It is a pleasure to serve under your chairmanship this afternoon, Ms Ryan. I am pleased that we have the BSL interpreters here in the Chamber for the debate and that it will also be covered by simultaneous live BSL interpretation and subtitling on the parliamentlive.tv footage.

I have been trying to secure a debate on this important subject for several months, because for some time now I have been raising the issues with the Government and a number of other organisations. This afternoon’s debate is timely as well, taking place just days after Deaf Awareness Week, which was from 6 to 12 May. As I am sure hon. Members and the Minister are aware, Deaf Awareness Week aims to increase awareness and challenge perceptions of hearing loss and deafness, promote positive aspects of deafness, promote social inclusion and raise awareness of the huge range of organisations throughout the country that support deaf people and their family and friends. That includes the ITV SignPost team, which offers content production, access services and training from their base in Gateshead.

Sadly, given the subject of the debate, there appears to be no reference to Deaf Awareness Week on the websites of the Department of Health and Social Care, NHS England or indeed the Department for Work and Pensions, the Department with overall responsibility for cross-Government disability issues. I am pleased that many local NHS organisations, including the Newcastle Hospitals NHS Foundation Trust, have marked Deaf Awareness Week. The key thrust of my argument, however, is that all public bodies should be aware of and provide for the needs of deaf people, including BSL users, not just one week of the year but 52 weeks of the year. As I will highlight, on far too many occasions that is certainly not happening.

According to the British Deaf Association, the UK has about 151,000 users of British Sign Language, of whom 87,000 are deaf. That first figure does not include professional BSL users, such as interpreters and translators, unless they use it at home. As the BDA has described:

“Sign languages are fully functional and expressive languages; at the same time they differ profoundly from spoken languages. BSL is a visual-gestural language with distinctive grammar using handshapes, facial expressions, gestures and body language to convey meaning.”

Like spoken languages, sign language is not international and is not derived from the spoken language of a country. For example, the UK, Ireland and the US all have entirely separate sign languages, despite speaking the language of English in common.

In 1988, the European Parliament passed a resolution on sign languages, proposing that every member state should recognise its own national sign language as the official language of deaf people in that country, which on 18 March 2003 the British Government did. In 2009, the UK Government went on to ratify the UN convention on the rights of persons with disabilities, which states that Governments must uphold rights by

“Accepting and facilitating the use of sign languages...in official interactions…and…Recognising and promoting the use of sign languages.”

BSL, however, still does not have any legal or protected language status, despite many deaf organisations campaigning for that since the early 1980s. Back in 2014, the British Deaf Association published a detailed discussion paper and highlighted the

“policy apathy about the shocking levels of linguistic exclusion we face as individuals and as a community”,

and,

“the shocking extent to which Deaf people are denied their civil rights.”

The paper itself highlighted the good practice that takes place in Finland, New Zealand, Austria and Hungary and set out why our Equality Act 2010 was not working as intended for deaf people—an issue to which I will return. Of course, since that paper was published, the British Sign Language (Scotland) Act 2015 has been passed, requiring the Scottish Government to create a BSL national plan for Scotland to set out their strategy for promoting BSL. That was produced in 2017. The Act also required all other listed bodies such as local authorities to establish their own BSL plans.

I look forward to hearing from the Minister whether her Government have made, or intend to make, any progress towards providing BSL with legal status on a UK-wide level. I recognise, however, that she might have difficulty in doing so, given that it remains somewhat unclear just who has overarching responsibility for promoting and protecting BSL within and across Government.

Budget Resolutions

Joan Ryan Excerpts

Tuesday 30th October 2018 Commons Chamber

[Joan Ryan (Enfield North) (Lab)]

I thought I would start by picking out a few key points from the Office for Budget Responsibility report, which might have a slightly different emphasis from the points that the Chancellor would pick out. Let us start, on page 64, with household disposable income:

“Real household disposable income fell by 0.2 per cent in 2017”.

On page 65, the report says:

“We expect relatively weak growth in per capita real earnings and real disposable incomes… In 2019, real per capita disposable income growth is flat”.

On household saving and debt, on page 67, it says:

“We expect unsecured debt to rise steadily as a share of household disposable income”.

On household net lending and balance sheets, on page 70, it says:

“the ratio of household debt to income has risen steadily since the start of 2016…we expect the ratio of household debt to income to continue to rise steadily…with the ratio reaching just under 150 per cent by the start of 2024.”

On business investment and stockbuilding, on page 72, the report says:

“The latest data suggests business investment fell in both the first two quarters of this year…we expect a modest rise in business investment as a share of real GDP over the forecast period—less than would be typical at this stage of an economic cycle.”

On UK exports as a share of GDP, on page 77, it says:

“In August, the Government announced an ambition to increase the UK’s exports to 35% of GDP, but has not specified the date by which it believes that this can be achieved. The Government’s previous aspiration was to increase exports to £1 trillion by 2020—our forecast suggests that this will be missed by £320 billion. The Government is not on course to meet its current ambition in our forecast”.

On risks and uncertainties, on page 81, the report says:

“The outlook for productivity growth remains hugely uncertain.”

On page 83, it says:

“the probability of a cyclical downturn occurring sometime over our forecast horizon is…high”.

On assumptions regarding the UK’s exit from the EU, it says:

“we still have no meaningful basis for predicting a precise outcome upon which we could then condition our forecast.”

On page 91, it says:

“Real GDP Growth has been revised down in 2018”.

Now, the Chancellor, of course, would and did choose to cherry-pick a different set of headlines yesterday, but I think this is a more balanced picture than that presented by him.

I can assure the Chancellor of two things in relation to this Budget. First, the people of Enfield are sick and tired of austerity. Secondly, we have no confidence that the Government’s programme of austerity is coming to an end. The Government’s £1 billion cut to the Metropolitan police budget since 2010 has resulted in 230 police officers and police community support officers being removed from the streets of Enfield. Over the same period, violent crime has surged locally by 85%. Where was the Chancellor’s announcement to reverse those cuts, put more bobbies on the beat and help create safer neighbourhoods?

How can the Government have the cheek to say austerity is over, when they are still planning cuts of £1.3 billion to councils next year? By 2020, the Government will have slashed funding to Enfield Council by 60% in just a decade.

There is a better example in this Budget of the Government’s misguided priorities. The Chancellor announced more funding for potholes than for our schools. Pothole funding is welcome, but surely education should be a higher priority. Does the future of our children not matter? This is a slap in the face for many schools in my constituency, which are having serious problems paying for basic items such as pens and paper, let alone retaining and recruiting teachers.

Austerity is not coming to an end, and nor, as the Chancellor asserted, is the “economy working for everyone”. This year, we have seen household debt rise to its highest level on record. Over-indebtedness in Enfield is higher than the London and national averages, and we have more than 14,000 residents in real financial difficulty. One in three workers living locally does not earn a living wage, and the average worker is £800 a year worse off than they were a decade ago.

The Government’s abject failure to address the housing crisis means local families are struggling to cope with soaring rents and a lack of affordable homes, with our borough having the highest eviction rate and the second highest level of homelessness acceptances in the capital.

The last Labour Government lifted 1 million children out of poverty, but child poverty rates under the Conservatives are getting worse, not better. Some 34,000 children in Enfield are now living below the poverty line. This is a shameful record for the Government, and a record that could deteriorate still further as a result of their disastrous universal credit roll-out.

[Karin Smyth]

My right hon. Friend is making an excellent speech. Does she agree that the failure to say anything considerable in the Budget about early years support and education and Sure Start centres yesterday represented a glaring omission, and addressing those issues would have helped families in constituencies such as Bristol South and Enfield North?

[Joan Ryan]

My friend is absolutely right. In fact, in Enfield, we now see a real problem, as we do in many other parts of the country, with children not being ready for school at the age of five. This has a significant impact on their achievement throughout their school careers and on their future.

North Enfield Foodbank has said that food bank usage continues to increase, with Enfield having the fourth highest rate of food bank usage in London last year. The main reason for that increase is delays in the payment of benefits and changes to them.

The Chancellor said that the Government were

“delivering on the British people’s priorities, supporting our public services”—[Official Report, 29 October 2018; Vol. 648, c. 668.]

There is no public service or institution more important in our country than the national health service. Huge pressure has been placed on doctors’ surgeries. Well over half the residents who replied to my GP services survey said they had difficulty getting an appointment to see a doctor, and we know that, going forward, Enfield is short of 84 GPs to serve our growing population.

The Government’s chronic underfunding of our national health service since 2010 means that North Middlesex Hospital, like so many other hospitals across the country, is operating with a substantial financial deficit. NHS England is trying to deal with a deepening staff crisis, while hospitals are trying to recruit doctors and nurses. This is an impossible situation. We cannot square this circle. On public health, which warranted no mention whatever, we in Enfield are facing another £1 million cut by 2020, and everybody knows the link between poverty and health.

The Government have failed to address eight years of devastating cuts to our communities, and they are failing to deliver on the priorities of the British people. Austerity is not coming to an end. Yesterday’s Budget proves it. There is no hope here that I can take to the people of Enfield from this Conservative Government. I will not be supporting this Budget.

Cancer Treatment

Joan Ryan Excerpts

Thursday 19th April 2018 Commons Chamber

[Joan Ryan (Enfield North) (Lab)]

May I join my hon. Friend in paying tribute to the courage and bravery of our friend, Baroness Tessa Jowell, and particularly her significant decision to make her medical data available? Does my hon. Friend agree that, given the low level of participation in clinical trials, if we are to achieve much better results for patients, the Government and all of us must do much more to encourage participation in these trials in all of our local areas and in our national politics?

[Mr Reed]

I thank my right hon. Friend for that well-timed intervention. We absolutely need to boost participation in clinical trials. Only 6.4% of adults with this particular form of cancer take part in those trials, whereas over 61% of people with leukaemia participate, so there is a clear need for a major increase in the numbers participating in these trials if we are to get the data we need to learn. I join my right hon. Friend, too, in congratulating Baroness Jowell on her historic decision to become the first patient to consent to share her data fully and openly, in order to speed up the discovery of new cures and ways to help other people; she is an example to so many people in so many ways, but here again we need to learn from Tessa’s example, because that is how we will help to find a cure for this terrible form of cancer.

I say to Ministers, who will be responsible for regulation as well as funding, that it is important that regulation is not drawn so tightly that it does not allow for innovation and for new treatments to be developed. We must be open to doing things in different ways and to learning from failure as well as success; we cannot regulate against failure, but we can always learn from it so that we can improve.

We must increase the funding going into the kind of research that will find a cure for this form of cancer and put it on a par with other, perhaps more high-profile, forms of cancer that have attracted levels of funding that are making a bigger difference. In that respect, I put my name on record in welcoming and congratulating the Government on the increase in funding of £45 million —I believe that is the figure—announced since the very moving debate, which many of us attended in the House of Lords, led by Tessa Jowell.

Tessa has been a fighter all her life and now she is in the fight of her life, but how typical it is that she has turned it into a fight to allow others to live well, live better and live longer. Every one of us in this Chamber, and many others beyond, are proud to stand with Tessa today. I would like to say this to her, if I may: Tessa, you have all our love and all our respect. Please keep going and keep being the inspiration to all of us that you have always been.

--- Later in debate ---

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I cannot compete with some of the wonderful speeches that have been made today. My research would be perfunctory by comparison with some of the things that Members of the House have told us. I will leave this debate knowing so much more about brain cancer than I did when I arrived.

My purpose in speaking is simply to say to Tessa: we are with you. You know, Mr Speaker, that politics is a rough old trade, and sometimes you fall out with people—people you think the most of. I just wanted to be here to say to Tessa that whatever the arguments or disagreements, it counts for nothing by comparison with my admiration and my determination to do anything I can to support her in her campaign.

[Joan Ryan]

Let me grab this opportunity to say something, because I am sure that Tessa can see that she has got these three women here—me, my right hon. Friend the Member for Don Valley (Caroline Flint), and my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh). We entered this House in 1997 and joined Tessa Jowell on the Government Benches, and we served with her through three terms of the Labour Government. She gave us such fantastic support. I just wanted to leave a rounded picture of Tessa in this very serious debate. I bet she is really a little bit embarrassed at all the praise, but she deserves it. She is such a strong supporter of women coming into this place and getting them through the process to get here. She also has a very ready but very kind wit that we witnessed much of when she was at the Dispatch Box.

[Siobhain McDonagh]

I thank my right hon. Friend—my very best right hon. Friend in this House—and Members can see so many reasons why that is.

Sometimes we fall out, and perhaps we fall out harder on our own side than we do with parties on the other side. Tessa is extraordinary in her example, as are so many people, particularly in the NHS. At 7 o’clock tonight, I will be holding a reception in the Jubilee Room of the House of Commons for the winter heroes from Epsom and St Helier University Hospitals NHS Trust to say thanks to them. If anybody wishes to join us, there will be a glass of wine and a packet of crisps for them. Thanks to the NHS, thank you to Tessa, and thanks to everybody for their brilliant speeches today.

Medicines and Medical Devices Safety Review

Joan Ryan Excerpts

Wednesday 21st February 2018 Commons Chamber

[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.

Oral Answers to Questions

Joan Ryan Excerpts

Tuesday 6th February 2018 Commons Chamber

[Steve Brine]

I am keen to visit my hon. Friend in Sutton, so let us fix a date as soon as we can. Cancer survival rates are at an all-time high, but I like the idea of a one-stop shop, and the hub that he talks about could be very exciting.

[Joan Ryan (Enfield North) (Lab)]

T3. The delivery of sustainability and transformation plans is too dependent on the NHS estates strategy, as discussed in the Naylor review, and there is great concern that our NHS assets will be sold off quickly, cheaply and without transparency to make up for Government underfunding. Will the Minister agree to pause the process to accommodate the urgent need for parliamentary scrutiny?

[Stephen Barclay]

The King’s Fund has said that STPs offer the best hope for the NHS and its partners to sustain and transform the delivery of healthcare, so the King’s Fund endorses this recommendation. As the right hon. Lady will know, we announced an additional £325 million of capital funding in the spring Budget to invest in local areas, and in the autumn Budget we committed an additional £10 billion package of capital investment over this Parliament.

Hormone Pregnancy Tests

Joan Ryan Excerpts

Thursday 14th December 2017 Commons Chamber

[Joan Ryan (Enfield North) (Lab)]

I congratulate the right hon. Member for Hemel Hempstead (Sir Mike Penning) on securing this debate. Like many Members, I represent families who strongly believe that their lives were forever changed because of the drug Primodos.

Today I speak on behalf of my constituents Chris Gooch and her daughter Emma Gooch. They have given me permission to share their story about how hard life has been over the past four decades, their criticisms of the expert working group’s report, and why they will continue to fight for justice, and they are with us here today.

In June 1970, Chris Gooch was prescribed Primodos by her GP to find out whether or not she was pregnant. Like any of us, Chris trusted the words of her GP and had no idea that the drug might be unsafe, or that it had been linked to deformities. It was only when Chris’s daughter, Emma, was born seven months later on 28 January 1971, that she was found to have limb deformities in her hands and feet, with both sets of fingers foreshortened and her toes webbed and foreshortened. Her mum, Chris, told me about how Emma has struggled to live with those deformities for her entire life. She said:

“There are many things that Emma would have liked to have done, like playing the piano or guitar, but she has been unable to do so because of limited mobility in her hands. This also came to impact her education and at secondary school she became school-phobic and was physically sick every morning before going to school. Emma has always suffered from severe back problems and has to live in intense pain all the time. She has sought treatment and scans confirmed that she has spinal deterioration, for which she was offered a spinal fusion. This only had a limited chance of success and risked making her condition worse. Emma refused this and is trying to come to terms with her long-term prognosis. She can’t work full time, has to pay for all her medications and has even been refused a blue badge, despite having to use a stick to walk and having no proper fingers or toes. Emma will be 47 next month and can now only manage to work for three days a week and even this she finds extremely draining. She is worried about her ability to keep working in the future, and the implications this has for her financially and socially.”

When I met Emma, she told me:

“Myself and many others have to live with the devastating results of our mothers being given hormone pregnancy tests like Primodos. Whilst the effects on me were much less severe than on some victims, I was born with very specific deformities which I have only ever seen shared by fellow Primodos victims, so in my mind this can be the only possible cause.”

[Tom Tugendhat (Tonbridge and Malling) (Con)]

The right hon. Lady is speaking very powerfully. Does she agree that there are many who are not as severely affected as her constituent, about whom she speaks so courageously, but who are similarly affected and nevertheless feel great pain? I speak of people I have the privilege to represent.

[Joan Ryan]

I absolutely agree. Members across the Chamber today have given examples, but there are many victims with different levels of disability, illness and deformity as a result of this drug.

When I asked Chris and Emma what they thought about the expert working group’s report and how the inquiry process had been handled over the past three years, their criticisms could not have been clearer. Chris told me:

“I feel angry that they treated us like idiots. We have been treated appallingly. The Expert Working Group produced a report in October and then, following a meeting with our Chair, Marie Lyon, they removed some material and re-issued it a month later. They said it was to make it more readable. They found no causal link, which they weren’t even requested to look for. They only gave us a day’s notice to organise a visit to hear the report’s findings and I am sure that is because they hoped no one would turn up to hear them. Now nearly 50 years on, our children, the ones who are still alive, are still suffering. I am angry that for Emma, and for many other members of the Association for Children Damaged by Hormone Pregnancy Tests, life is a constant struggle and we still haven’t really been heard.”

Emma herself told me that she

“cannot help but feel angry that for decades we have waited for an independent and unbiased enquiry, but the Expert Working Group’s obviously flawed report feels like an attempt to discredit us and instead protect the powerful companies and authorities that were at fault.”

Since I was first made aware of the issues surrounding the drug Primodos, I have been reminded of the thalidomide and contaminated blood scandals. I am reminded of the fact that it took decades of tireless campaigning before the truth and natural justice were reached. The inquiry has been accused of failing to consider all the evidence fairly, failing to have the trust and confidence of the victims for whom it was set up, and failing to be transparent and open in its due process. The inquiry failed to consider any evidence regarding systematic regulatory failures of Government bodies at the time. Campaigners have widely dismissed the inquiry as “seriously flawed”. I therefore join the cross-party calls for a public inquiry into the use of Primodos and its connection to deformities and other birth defects. I shall end by once again quoting the words of my constituent Emma Gooch, as I believe that her determination will be shared by Members on both sides of the House. She said:

“Sadly it is too late for some, but the victims and parents still deserve justice and we will continue to fight for it.”

Pandemrix Vaccine: Compensation

Joan Ryan Excerpts

Wednesday 8th March 2017 Westminster Hall

[Joan Ryan (in the Chair)]

Before the next debate begins, I am pleased to say that, on International Women’s Day, we have a woman Member opening her first Westminster Hall debate and a woman Minister to respond, and of course I am in the Chair. On this day, I thought that was worth remarking on. I call Tracy Brabin to move the motion.

[Tracy Brabin (Batley and Spen) (Lab)]

I beg to move,

That this House has considered compensation and the Pandemrix vaccine.

It is a pleasure to serve under your chairmanship, Ms Ryan, on the occasion of my first Westminster Hall debate. I thank my hon. Friend the Member for Liverpool, West Derby (Stephen Twigg) for his extensive work on this issue on behalf of his constituent Lucas Carleton. I also thank Mr Speaker for allowing this debate to take place. It is vital that Parliament considers this matter and public awareness is raised.

I will set out the effect that Pandemrix has had on several predominantly child patients and their families and discuss the need for the Government to acknowledge and express regret for what has happened to those patients and provide them with support. I will explain the challenges of accessing the necessary medication for affected people, and I will conclude by making recommendations to the Government.

Before I set out the issue at hand, I wish to be clear that, overwhelmingly, vaccines save lives. Thanks to vaccines, we have seen the eradication and near-eradication of diseases such as smallpox and polio, and I have no intention of discouraging parents from ensuring that their children receive tried and tested vaccinations. Quite the opposite—I want the Government to rebuild and maintain trust in our world-class inoculation programme. However, on occasion, certain vaccines have been shown to have damaged patients, sometimes with life-altering consequences. All precautions should be taken to prevent that from happening, and pharmaceutical companies and the Governments that give those companies indemnity should take immediate and full responsibility when that is shown to have happened and, having accepted responsibility, do all they can to support affected people.

I worked to secure this debate because I believe that Parliament and the Government must listen to and support individuals and families who have been affected by narcolepsy and cataplexy as a result of the Pandemrix vaccine. I became aware of this issue when my constituent Di Forbes came to one of my regular advice surgeries. Di has travelled to Parliament to watch these proceedings, and I hope that she will be able to travel home to Batley and Spen having received some assurances from the Government. Di explained to me the damage that the Pandemrix vaccine has caused her son Sam and the unacceptable battle that she has faced while seeking financial support to secure his long-term care and the appropriate medication for his condition.

By way of background, the Pandemrix vaccine was developed by GlaxoSmithKline and given to 6 million people during the global H1N1—swine flu—pandemic in 2009 and 2010. Owing to the nature of that pandemic, the European Commission, on the advice of the European Medicines Agency, fast-tracked the vaccine’s licensing. The UK Government then undertook a vaccination programme, based on advice from the Joint Committee on Vaccination and Immunisation. In short, Pandemrix was licensed for use in the EU, including the UK, without the usual clinical trials having been completed.

Oral Answers to Questions

Joan Ryan Excerpts

Tuesday 7th February 2017 Commons Chamber

[David Mowat]

The Government are committed to GPs offering appointments seven days a week, 8 am until 8 pm, by 2020. By 2018, we will have rolled that out in London. Part of this is about GPs working smarter in integrated hubs of between 30,000 and 40,000 patients, thus enabling them to spread out and to offer services such as pharmacy, physio and social care.

[Joan Ryan (Enfield North) (Lab)]

In a survey of Enfield North residents that I conducted, 58% agreed that it is difficult to get a GP appointment. The Royal College of General Practitioners has calculated that Enfield needs 84 more GPs by 2020, but between 2010 and 2014, we lost 12 practices and had only one opened. If the 5,000 GPs appear by 2020, what will the Minister do to ensure that Enfield gets those it needs?

[David Mowat]

As I said earlier, we will have 5,000 further doctors working in general practice by 2020. A chunk of those will be available for every part of the country, and Enfield is included in that. I do accept that the GP system is under stress and that we need more GPs, and the points that the right hon. Lady makes are right.

Social Care Funding

Joan Ryan Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

The hon. Lady paraphrases what I said rather inaccurately. I said that money would help with any system, but the issues are about quality, leadership and best practice as well. All those things are within the ambit of my job, and that is what I am pursuing.

[Joan Ryan (Enfield North) (Lab)]

Everything we have heard today from the Minister seems fundamentally to deny that the council tax precept is no solution to the problem and in fact exacerbates it. Is he aware that Ray James of the Association of Directors of Social Services has said:

“The Council Tax precept will raise least money in areas of greatest need which risks heightening inequality”?

If that is what experts in the field are saying, why does the Minister think he knows better?

[David Mowat]

I often discuss this and other issues with Ray James. It is true that the precept on its own would result in an uneven distribution of revenue, which is why the additional moneys coming from the better care fund will be allocated using a formula that corrects that.