NHS Patient Data

John Glen Excerpts

Thursday 27th February 2014 Westminster Hall

[John Glen (Salisbury) (Con)]

I welcome the great opportunity to speak in this debate, Mr Amess—what a pleasure it is to serve under your chairmanship. I congratulate my hon. Friend the Member for Mid Norfolk (George Freeman) on his tireless campaigning, and on the full and sensible way in which he made his case.

Research is the most powerful weapon we have in the fight against disease. For decades, access to medical data has been integral to meaningful research—in the 1950s, it showed the link between smoking and lung cancer; in the 1960s, it proved that thalidomide was harmful to unborn children; and today, it helps our doctors identify the most effective treatments for cancer patients—but it is clearly time to move on from hastily scribbled GP records residing in dusty filing cabinets. Patient data are becoming increasingly critical to ensuring the delivery of better treatments, and they can radically improve how long-term conditions are managed and understood in the NHS and the world of medicine.

Aligned to that, we have personalised care, which is, frankly, the future of medicine. Just a few years ago, cancer was treated by giving all patients very similar, or the same, surgery and damaging radiotherapy. As an example, I understand that Cancer Research is now using some 11,000 patient records to see how their cancers respond to particular treatments. The stratified medicine programme, as it is known, goes to the genetic core of a cancer to detect the mutations that cause it and identifies the specific drugs that can stop it.

Researchers can take on those fragmented pieces of data and collate them. By identifying broad patterns, they can start to understand the most effective treatment for specific cancers at the molecular level. That has undoubtedly developed our understanding significantly. We now know that one drug is more effective than standard treatment for one branch of lung cancer and less effective for another. Unlike the trial-and-error approach of the past, the success of care in the future will depend on researchers analysing a sample and then cross-referencing it with a reliable database to identify genetic markers. A targeted treatment can then be tailored.

It is not just cancer that presents opportunities for better data use. Long-term conditions present one of the most significant challenges for the NHS, but research enables us to identify the most successful medications to manage them. The King’s Fund estimates that we spend £77 billion every year treating long-term conditions. NHS spending on diabetes, for instance, is set to rise from £9.8 billion to £16.9 billion over the next 25 years. We would be spending 17% of our current NHS budget just to manage that. If we replicated those sums of money in lots of other areas of expenditure, it would clearly be unsustainable. That highlights that we must use research to identify the most effective treatments, so we can target resources at them.

A recent Cardiff university study looked at just 10% of GP records in this country. It compared two different treatments used for type 2 diabetes over the course of 12 years and found that one of them has a mortality rate that is 58% higher than the other. Patients naturally seek reassurance that they are being given the best course of treatment. Colleagues would acknowledge that constituents who come into our surgeries are very anxious when they believe that the treatment or drugs they have received are not optimal for their use, and want to know why others are not available to them. Patients naturally seek reassurance, but the reality, if we are to reply honestly to our constituents, is that without expanding the evidence base, it will not be an easy task to maintain the narrative that most people get the best drug all the time. We have a duty to ensure that clinicians and scientists are given the right support from Government to make the ambition of personalised care a reality.

I will respond to the comments made by the hon. Member for Leeds East (Mr Mudie), who raised a number of concerns that my constituents have expressed in e-mails to me, in a few minutes.

The British Heart Foundation tells us that its researchers face considerable barriers due to a complex legal framework and the multitude of bodies involved. That is unacceptable, and it is right that we take steps to tackle unnecessary red tape and barriers to the sharing of information. However, we should also remember the implications. Just this week, we heard that researchers are exploring a test that can identify perfectly healthy patients who are at risk of fatal medical complications based on the proteins in their cells. I do not presume to understand all that, but I recognise the principle that as we have more information, we have the capability to do more, but we remain constrained by the finite budget of the NHS.

On ethics, the hon. Member for Leeds East referred to security of data and the lack of assurance. We have presented the use of data as leading to better outcomes and personalised solutions for patients. We must recognise that there are also enormous ethical implications in respect of the prioritisation of finite resources to treat new conditions and provide new therapies, which may well be just as expensive. So much more will be possible, but it is important that, in parallel with the discussion on access to data, we recognise the challenges of providing an ethical framework for prioritising those finite resources. We will never defeat human frailty altogether, but I want the medical community to reflect on the choices that need to be made to prioritise treatments. Research may find the cure for diabetes or lung cancer, but the second challenge will be to ensure that it is accessible to the population at a time of competition for resources.

Access to data must undoubtedly include safeguards, and obviously there is a lot of scepticism about the reliability of safeguards. My hon. Friend the Member for Mid Norfolk set out five actions that he feels would address some of those concerns. Legitimate questions must be asked on how we handle large amounts of data and ensure that they are used in the right way and for the right purposes. The six-month delay in the consultation is clearly the right time to explore those issues. However, it would be a great shame if we were to miss the opportunity to open up patient data for medical use.

Hon. Members should not rely on the argument, which has been in the headlines of some newspapers, that the data will be used for malign purposes. I instinctively take a positive view of the state. I think it acts in the interests of its citizens, although I am a relatively new Member of Parliament and my optimism may fray if I am still here in the years ahead. I find it deeply frustrating that, when we have the opportunity to relieve suffering and find ways of delivering personalised care for our constituents, we fall back on arguments about the loss of banking data. I listened carefully to what the hon. Member for Leeds East said, but the idea that somebody will know our individual medical histories is pretty unlikely. It would be a real shame if we did not move forward by allowing the data to be accessed more readily.

My hon. Friend the Member for Mid Norfolk is right that Parliament should be involved. It is essential that there are annual reports so we understand where things are moving and the positive outcomes. That would improve public understanding of progress. However, it is deeply wrong to prevent medical science from providing more options for health care. I acknowledge that there are security risks, but it is not beyond the wit of my former industry and the IT industry to work out the necessary protocols and safeguards.

I welcome the opportunity to contribute to the debate. It is right that we are having it, and it is right that we project the Government’s aspirations and hear concerns about them. I hope the Minister will set out in her response the safeguards that she feels are proportionate and necessary, and explain what the positive outcomes will be for our constituents, who are often frustrated by gaps in provision. The NHS is an incredibly complicated organism, and it is very difficult for a constituency MP to grasp where the problems lie. However, something positive can come from the proposal. I thank once again my hon. Friend the Member for Mid Norfolk for his deep knowledge, enthusiasm and inspiration on this subject.

Cancer Priorities

John Glen Excerpts

Thursday 13th February 2014 Commons Chamber

[John Glen (Salisbury) (Con)]

It is a pleasure to speak in this important debate. I congratulate the all-party group on its work and, especially, my hon. Friend the Member for Basildon and Billericay (Mr Baron) who, since I came to the House four years ago, has been a determined advocate on all matters relating to cancer, such as funding and NHS treatment. He has set a good example to us all of how to campaign forensically on such matters.

There is little need for me to repeat what other hon. Members have said: cancer is a devastating disease. It is obviously right that the Government do all they can to put the best support in place and to set up appropriate frameworks to prioritise finite resources. I welcome the all-party group’s report and its recommendations on improving survival rates and supporting patients through recovery. A third of a million people are now diagnosed with cancer each year, and despite the considerable advances in research, about half those cases will sadly still be fatal.

I shall focus my remarks on end-of-life care. There is a considerable gap between what people want and what they receive. We know that 63% of all patients would prefer to die at home, while a further 29% would choose a hospice. Just 3% of patients would choose to die in hospital, yet more than 53% ended up dying there last year. Among cancer patients, nearly three quarters—73%—want to die at home, but only 29% are able to do so, which means that 36,400 cancer patients died in hospital last year although they wanted to be at home, surrounded by their loved ones. That causes great distress to family members, and many hon. Members will have met constituents who have expressed a lot of frustration about what happens at such a difficult time in their families’ lives.

The national end-of-life-care strategy has rightly called for that to change as a priority, and it has support from across the House. However, practical barriers need to be overcome to make it a reality. This is rooted in reprioritisation of resources, which, if done properly, will not mean increased costs. That is the challenge with so much that happens in the NHS. If small changes are made in certain procedures—the way that things work and research is conducted, and the way that referral processes take place—money can be saved.

There are three challenges. First, high quality 24-hour community support needs to be available. Secondly, patients need to be able to see how their services perform in helping people to die at home. Thirdly, the NHS needs to use innovative tools more effectively so that hospital professionals know what a patient has told their general practitioner. Nearly half of all primary care trusts in 2010 did not provide 24/7 community services, despite groups such as Macmillan Cancer Support and Marie Curie Cancer Care emphasising its importance and despite the clear economic case for doing so. A day of community care costs around £145, compared with £425 for a hospital bed. Improving community care is one of the most effective ways to free up much-needed bed space and prevent emergency admissions, and, of course, give a better quality of life experience for the patients involved.

In Wiltshire, we have a dedicated community nursing team, and Sarum clinical commissioning group in my constituency has chosen to focus on improving end-of-life care. It has a clear target to ensure that there is not just 24-hour community care, but specialist support and advice, which is particularly important in the context of cancer. In addition, it has chosen to set an outcomes indicator on the number of patients who are supported to die in their place of choice.

I wanted specifically to highlight this as the APPG cancer report recommends that the national indicators set by the National Institute for Health and Clinical Excellence should include it. I agree. It is important that patients can see how their local health services are respecting their wishes, or, in some cases sadly, not. It is important that where they fail to do so they can be held to account and a local dialogue can take place. This can only happen with clear and transparent data. If this measure were adopted nationally, it would mean that pressure could be exerted when patient preferences were not being respected.

Patient choice and accountability are at the heart of many of the NHS reforms in recent months and years. Those principles need to apply to end-of-life care. In some London boroughs, I understand that as many as 70% of all patients die in hospitals, yet fewer than half of Wiltshire patients end their days in the same way. It is unacceptable that one area can support 49% of cancer patients at home, while another can reach only 16% of patients. It is important that patients can readily see these numbers, and clinical commissioning groups can account for progress towards meeting their goals and targets.

In 2013, NICE recommended that death in the preferred place of care should be taken forward as an outcome indicator. I urge the Minister to make progress on this issue and ensure that the data will be available as soon as possible in a form that can be understood and digested by our constituents. But it is not just about data for patients; it is also about data for professionals. Innovation allows us to ensure that this is used more effectively, and electronic palliative care co-ordination systems are a real step forward in that area. The proportion of patients on EPaCCS who have died in their preferred place is 76%, and just 8% died in hospital. Not only is that a substantial relief for the families who have benefited, but it delivers, on average, a saving of £270,000 to a clinical commissioning group.

Salisbury district hospital, the outstanding hospital at Odstock that serves my constituency, has taken that concept further. Through greater integration with GPs in the area, emergency department doctors can now access medical records that include an end-of-life care plan. They have trialled an innovative rapid discharge pathway for patients in the last 72 hours of life, and 20 patients were successfully supported at home last year. As a result, the scheme is being rolled out across the hospital and will bring great benefit to patients in the last few days of their life.

Obviously, cancer will continue to present a significant challenge for the NHS, but I hope that the progress that has been made on palliative care can be built upon so that the NHS can support patients during an extremely difficult time. I would like to finish by once again reiterating my support for the work of the APPG and the considerable efforts being undertaken to challenge the Government, in a constructive way, to come forward with measures that will make such significant improvements in the quality of the experience for our constituents and to the functioning of the NHS.

NHS

John Glen Excerpts

Wednesday 5th February 2014 Commons Chamber

[Andy Burnham]

I will put forward a solution that the hon. Gentleman might support. I think he supported the campaign to oppose the Government’s Health and Social Care Bill, and I pay credit to him for that as we worked across party lines on that issue. It is my job to hold the Government to account where there are problems in the national health service, and if the Minister is saying to me that there are no problems in the health service right now, I am afraid I do not agree with him. Emergency services are under intense pressure. If he looks back to our time in government, as he invited me to do, he will see that the winter crisis was a regular feature at the turn of the millennium and the early years of the last decade, although it got progressively better and better and we did not see the annual winter crisis. Now it is back with a vengeance, although it is different. The winter/spring crisis has become a summer/autumn crisis too. The pressure is relentless and it needs a proper, lasting solution.

[John Glen (Salisbury) (Con)]

Would the right hon. Gentleman care to reflect on the fact that we now have 350 more A and E consultants in the NHS? Given his commitment to cut the NHS at the last election, if he is going to offer a sensible improvement, where will the money come from? How will he pay for it? That is what the people out there want to understand.

[Andy Burnham]

First, I would be grateful if the hon. Gentleman did not continue to misrepresent what I said on the NHS. I have never said, “Cut the NHS”. I stood at the last election on a commitment to protect the NHS budget in real terms. He stood on a manifesto promising real-terms increases for the NHS. I said that if there were to be increases for the NHS, they should be given to social care instead, and that would have relieved some of the pressures on A and E. Let us have the facts straight.

Secondly, the hon. Gentleman boasts about having enough A and E doctors. Perhaps he should speak to people from the College of Emergency Medicine and hear what they have to say on that subject. They talk of warning the Government of a recruitment crisis in A and E about two or three years ago. They said that they could not get through to Ministers who were obsessed with structural reorganisation. They were left feeling like John the Baptist crying in the wilderness—their words. Perhaps before the hon. Gentleman shouts the odds in the House, he should speak to the people who know about these things and who warned his Government —who failed to act.

One of the major problems with the pressure on A and E is the number of older people trapped in hospital. This is a product of demographic pressure and the ageing society. Nursing staff talk of how, when they first qualified, it was rare to see someone in their 90s on the ward. Now they are there in great numbers and that makes the task of meeting their needs much more complex. When people reach an advanced age it is simply not possible to separate out their physical, social and mental needs. Need becomes a blur of all three. Our hospitals are not geared up to provide the additional mental and social support that very frail elderly people often need.

Hospices (Children and Young People)

John Glen Excerpts

Wednesday 18th December 2013 Westminster Hall

[John Glen (Salisbury) (Con)]

It is a pleasure to serve under your chairmanship for the first time, Mrs Osborne. I join other hon. Members in applauding my hon. Friend the Member for Pudsey (Stuart Andrew) for securing the debate.

I would like to make some observations and reflect on the journey that I have been on this past year in engaging with this subject, starting with a question to my right hon. Friend the Prime Minister on 5 December last year. In that question, I raised the issue of Naomi House hospice, which serves Wiltshire, Hampshire and Berkshire and does amazing work, along with all the other hospices mentioned this afternoon. Naomi House hospice also has a facility, opened in recent years, for young people in the 18-to-25 age group, reflecting the fact that, previously, young people with some of these conditions did not survive for very long, but now they have a greater life expectancy. The facility is adjacent to the Naomi House site, and they work together.

Professor Khalid Aziz, who was the chairman of Naomi House hospice for well over 20 years, observed that he received funding from three different primary care trusts, as they then were—they are now clinical commissioning groups. Wiltshire, which is my local authority area—it was the PCT at the time—had agreed a very simple tariff arrangement whereby it gave £308 per night for any child who was staying at the hospice. Naomi House had not managed to secure a similar agreement with Hampshire or Berkshire. It therefore relied on a share of the grant from the Department of Health and some other statutory local authority funding, but, as with all hospices, it fundamentally relied on raising money through fundraising activities. I think that the figure was about £4 million a year.

A little time passed and then, on 13 February, I, along with Professor Aziz, had a meeting with the Prime Minister. He understood the issue very well. He was aware of the review that is being undertaken of palliative care funding across all age groups, and we went away greatly encouraged. A few more weeks passed, and I was a little concerned that progress was not being made. I sensed that there was some reticence to separate the issues about children’s palliative care and the palliative care review that is under way. In the end, we had a meeting on 19 June with the Minister of State, Department of Health, and we set out our concern that the very simple arrangement that works so well for Wiltshire, securing a guaranteed amount of funding, should be rolled out across the children’s hospice movement as the way forward. There was general agreement, I think, among the officials at the meeting that that amount of money was the appropriate amount.

I came up and had another meeting on 29 July. That time, I met Professor Alan Craft, who is the head of children’s health, and Dr Bee Wee, the national clinical director of palliative care, and they took me through all the work that is being done to understand the profile of need, how we calibrate what the tariff would look like and what conditions would go into it. I recognise that that is a very difficult piece of work and we definitely need it to be data led, as I think the right hon. Member for Rother Valley (Mr Barron) mentioned, but we were told that this work was going to progress and basically it would happen in 2015.

I was somewhat disturbed because the system that works so well for Naomi House could easily be rolled out. It is a very straightforward arrangement whereby a CCG is engaged with a local hospice and has said, “This is a contribution to the costs.” We know that there is a significant differential between the 38% funding that adult hospices receive—38% of their costs—and the 10% to 15% that children’s hospices receive, so this was a very simple measure.

I had a meeting on 15 October with my right hon. Friend the Minister for Government Policy. Then, on 25 November, I received a letter that said that the Government would include the local commissioning example in their national tariff document. Basically, the process that the Government are going through to review the whole arrangement for palliative care funding would continue and we would wait for the outcome. In the meantime, although Wiltshire and Naomi House would be put on the table as an example, it would not be presented in a compelling way so that it could be taken up as, I think, a very reasonable interim measure.

I am somewhat disappointed by that final response after all those meetings and all that dialogue, because what is needed sometimes is yes, rigorous analysis of the facts and the issues, but also promotion of quick solutions that would work in a very helpful way—that would ease the enormous burden on fundraisers in making up the gap in funding. There is great support in our communities for children’s palliative care. I sometimes feel that because of the very emotive nature of the work done by children’s palliative care providers and the fact that it pulls at the heart strings, there is always a sense that money will be found for it. I plead with the Minister to accelerate that process if she can, because we need to address the funding gap and ease some of the considerable pressure on providers.

Oral Answers to Questions

John Glen Excerpts

Tuesday 26th November 2013 Commons Chamber

[John Glen (Salisbury) (Con)]

9. What steps his Department is taking to improve the health of veterans.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

We have made excellent progress in improving the health care of our veterans by investing £22 million to support their physical and mental health. The Government have also made available £35 million of the LIBOR bank fines to support veterans and armed forces projects.

[John Glen]

I thank the Minister for that response. Will he outline the steps being taken to ensure that there is a co-ordinated approach between those commissioning services for veterans, including Salisbury district hospital, which does so much to service the veterans in Wiltshire, so that that they get the right revenue at the right time and do not go into deficit?

[Dr Poulter]

My hon. Friend is right to highlight the importance of co-ordinating veterans services, and getting the continuity of care right between a soldier or a member of the armed forces leaving the armed forces and being looked after by the NHS. I hope he will be reassured to hear that in terms of specially commissioned services, we now have nine super-prosthetic centres available for veterans who have lost limbs, 10 specialist mental health teams looking after veterans, a 24-hour mental health support line for veterans and many other measures. We are also making IVF available to veterans who have lost genitalia as a result of combat injuries.

Oral Answers to Questions

John Glen Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Norman Lamb]

First, we should applaud the work of the many carers around the country who are doing absolutely invaluable work. It is obviously important to ensure that the policies of one Department do not have an adverse impact on the work of another, and I will be happy to look into the case that the hon. Lady has raised.

[John Glen (Salisbury) (Con)]

T10. Dr Elizabeth Stanger, a highly respected Salisbury GP, recently questioned me about the sustainability of providing multiple treatments for complex medical problems for several generations of the same family of foreign nationals. I welcome today’s announcement, and ask the Minister to reassure me that the mechanism to recover the funds will ensure that the money goes back to the clinical commissioning group so that it can provide a benefit locally.

[Mr Hunt]

I absolutely can reassure my hon. Friend about that. The point about the new, improved system for recovering charges is that we want the money to go back to the people providing the services so that they will be able to resource them better. This is not the diversionary tactic that some have accused us this morning of introducing; £500 million could have a huge impact on the NHS front line and allow his GPs to do a much better job.

Public Health England (Porton Down)

John Glen Excerpts

Wednesday 11th September 2013 Commons Chamber

[John Glen (Salisbury) (Con)]

The purpose of this debate is to seek an update from the Minister on the discussions on the future of Porton Down in my constituency. Since the debate I called in June 2010, to which my hon. Friend the Member for Guildford (Anne Milton) responded, I have had numerous interactions with Public Health England, formerly the Health Protection Agency, about the future of the Centre for Emergency Preparedness and Response, which is located at Porton.

Porton Down is a world leader in high-quality microbiological research and testing, playing a vital role in preparing, co-ordinating and manufacturing responses to health care emergencies. It is at the forefront of the UK’s research into infectious diseases, holds four international culture collections and has an international reputation as a centre of excellence.

Public Health England’s site at Porton Down is therefore unique. It possesses two distinct world class capabilities: first, the translational research facility, which partners with academia, international agencies and companies seeking specialist expertise in turning research concepts into tangible products; and, secondly, the production, development and manufacturing capability, which represents about a third of current operations. It is important to emphasise that, although the facilities are separate, their co-location means they work closely together and ensures that there is a cohesive resource to support the Government in the event of a national microbiological emergency.

Immediately adjacent to Public Health England’s facilities at Porton are the Defence Science and Technology Laboratory’s new multi-million pound headquarters. Some DSTL functions are complementary and contribute to the overall emergency response capability. Indeed, originally, the PHE and DSTL sites worked under the same banner. They continue to work closely together. DSTL chose recently to relocate its headquarters to Porton Down as a result of its own estate consolidation, which was a vote of confidence, and a demonstration of the value that the Ministry of Defence attaches to being close to the CEPR.

As was acknowledged in the debate three years ago, the laboratory facilities are in need of modernisation, both because of wear and tear and in order to reflect the increased demands placed on Porton owing to the expanded responsibilities of Public Health England. It was to address those problems that Project Chrysalis was created in 2008 under my predecessor. The project was designed to investigate the cost of refurbishment and subsequently to explore the possibility of moving some of Porton’s facilities to a new site in Harlow, where they would be consolidated with other laboratory sites in the Public Health England portfolio.

In theory, this would create a single science hub for Public Health England. In practice, the complexity of a move has generated as many questions as it answers. The geographical distance between the various PHE sites has never been raised as an issue before. This is because there are few functional dependencies between the different agencies, so I still maintain that the assumed advantage of geographical proximity will not, by itself, validate the business case for a move. However, there is a natural synergy between the research conducted at DSTL and CEPR. A single hub proposal also potentially loses the advantage of a site surrounded by Ministry of Defence land, which minimises the risks of working with animals and the most dangerous diseases in the world.

I was therefore relieved when, in August 2012, the decision was made to delay the conclusions of Project Chrysalis because the Treasury believed that considerably more work needed to be done on the outline business case to demonstrate value for money. At this point, Public Health England also commissioned a review by Professor George Griffin to look at whether the concept of a single science hub was worthy of further investigation. He concluded that it was, and in April this year Public Health England began a further review into how the business case fits with its vision for the future of its facilities overall. Running in parallel with this review, I understand that the Cabinet Office has recently instigated a separate examination of the future of the development and production facilities at Porton. It is these two reviews that have prompted me to seek this second debate today.

Although I fully accept that it is not for me to dictate the outcome of any studies examining the options for Porton Down, it is imperative that decisions are made on the basis of the evidence and have the broadest possible terms of reference. My concern is two strategic projects are now under way, both of which have implications for the wider scientific infrastructure of the UK, and we must get those decisions right.

The first piece of work, now termed the single science hub, is essentially examining the business case for a consolidated PHE facility in Harlow. Public Health England, as an arm’s length body of the Department of Health, has a specific core mission to secure and improve the health of the population. From that perspective, it is understandable that the wider commercial activities around translational research may not be deemed integral to PHE’s core purposes. However, from a UK plc point of view, they are critical for the growth of the life sciences industry in the UK. Some of the projects being carried out by this team include the largest pre-clinical TB vaccine evaluation in Europe, and supporting the US human health services with vaccine development. I have no wish to see the UK’s expertise dispersed across the globe in future due to the fact that it conceivably exists within PHE but has ended up under the umbrella of a Government Department with a narrower mission, where the skills could be seen as no longer entirely fitting.

The crux of the issue is that Porton’s complexity means all its combined capabilities do not sit comfortably with one Government Department or agency. The work of translational research scientists is perhaps more in keeping with the Department for Business, Innovation and Skills agenda to drive growth in the life sciences industry, while other work, in partnership with DSTL, is of interest to the Ministry of Defence. Existing departmental delineations of responsibility must not inhibit the right decisions about the future of translational research being made.

The second piece of work under way is confined to the potential of the production and development facilities alone. It might be suggested that Public Health England could remove the need for investment in refurbished facilities by entering into partnership arrangements or other commercial propositions, but that could entail the UK losing its sovereign capability to produce vaccines in a biological emergency. Key public functions must be safeguarded, including the only anthrax vaccine licence in Europe, as well as the emergency response training undertaken across the public and private sectors. I recognise the financial options for the production and development facilities, but their relationship with translational research scientists is an operating reality of what currently goes on at Porton and is of wider value to the UK economy. They do not just generate new products for market; they also maximise the potential receipts from the development of new ideas.

Exploring the future of production and development separately means that there is a risk that this valuable translational research capability could be lost to the UK, because its role is not about short-term commercial receipts, but about generating value for UK plc through high-level research that requires a degree of investment and flexible, innovative collaboration with other bodies and scientists abroad. The partnership between translational scientists and co-located production and development colleagues must therefore be fully analysed. Any recommendations for the future must neither damage the wealth creation potential of scientists at Porton nor put at risk the public health protection capabilities that currently reside there. Critically, the ongoing discussions must consult fully the expert staff on the ground, to get an accurate reflection of their roles, whom they interact with internationally and the ideas they have to catalyse Porton’s development.

I fully understand the logic that leads some to believe that it makes sense in principle to aim for a single science hub—as I note the project has stealthily been renamed—to create a single site of expertise for PHE. It is a neat concept on paper, but as I have stressed for the past three years, Porton Down is a unique strategic asset for the UK, and there is little sense in duplicating capability that exists elsewhere across government in a time of austerity. The need for new containment level 4 facilities at Porton could be reduced if DSTL’s similar facilities next door could be shared—something that I know DSTL is willing to consider.

My suggestion this evening, as I described in a slightly different way three years ago, is to look at a new model of ownership, based on the principle that stronger partnerships are possible between the public and private sectors without compromising important public health requirements. Porton has become a globally recognised brand that generates £18 million of royalty revenues every year through its high-quality research licences and products. It generates five times more external income than it receives in core funding from PHE and remains a pioneering example of the best public sector expertise generating growth for UK plc. The Government should therefore consider ways to capitalise on this.

I urge the Minister to examine the potential of a public-private partnership, which would give scientists at Porton the ability to leverage new facilities through their royalty income stream, as they themselves have suggested. Such a role would also enable Porton to operate more strategically, providing a cost-effective way to protect the UK’s microbiological emergency response capabilities. In peacetime, it would operate as a national translational research facility, with a key role in delivering the Government’s life sciences strategy. This overall vision represents a commercialisation of the facility’s scientific potential, while protecting its public role in emergencies.

As the Department of Health’s antimicrobial resistance strategy set out yesterday,

“the relevant Research Councils, industry and third sector should work together to establish a range of new mechanisms to facilitate greater collaborative working”.

Porton is one of the best-placed sites in the country to develop

“coalitions between academia and biopharmaceutical companies”

and has a proven track record of doing so. Without doubt, the scientists at Porton Down are world class. A unique relationship exists in the Wessex Life Sciences Cluster, which includes PHE and DSTL’s capabilities, alongside Salisbury district hospital, Wessex Genetics and the university of Southampton. This makes it ideally located to work with others and to take products from concept to market, as the Department of Health strategy sets out. The strategy goes on to state that the Department of Health wants to

“stimulate the development of new antibiotics, rapid diagnostics and novel therapies”

by

“ensuring excellent science is developed and has a clear route for translation”.

That is precisely what Porton does, and this emphasises why the translational facilities must be supported in the best possible way.

Perhaps the strongest indicator of Porton’s potential for a PPP is the proposed regional growth fund investment of £8 million in a new science park. This will provide much-needed space for emerging bioscience enterprises in an industry that generated £1 billion for the UK last year. Crucially, it will also create opportunities for spin-out companies based on products conceived at Porton, which have previously moved away from the site due to lack of space.

I do not have a rigid view of what the future should look like, but it is important that Porton’s fate is not decided on the basis of any short-term capital receipts through the incentive of removing refurbishment liabilities or an overriding desire to consolidate Public Health England’s estate. It is clear that there is no silver bullet solution involving relocation to Harlow or the straightforward commercialisation of the production and development facilities. It is critical that any decisions should be in the best interests of the preservation of public health in this country as well as of the proven commercial potential of translational research scientists, even if that necessitates a realignment of organisational boundaries within the agencies of Government.

Tobacco Products (Plain Packaging)

John Glen Excerpts

Tuesday 3rd September 2013 Westminster Hall

[John Glen (Salisbury) (Con)]

Would my hon. Friend not wish to make a distinction between moderate consumption of alcohol and fatty foods, which is perfectly tolerable, and moderate consumption of cigarettes, which have an appalling effect, no matter how many are consumed? There is a real distinction.

[Mark Field]

No doubt the health lobby would quickly suggest that alcohol and fatty foods were equally intolerable, even at the lowest level.

Let me make it clear at the outset: I accept fully that tobacco is addictive, but it is a legal drug for adults. I am the father of two young children—a son of five and a daughter of two—and I would not want them to take up tobacco, not least because my late father also died of lung cancer. In passing, it is worth making the observation that our coalition partners and the Opposition would allow 16 and 17-year-olds to vote, but not to purchase cigarettes. The age restriction for tobacco, of course, has risen from 16 in recent years.

I accept that tobacco smoking is subject to commensurate regulations and restrictions. No one should sensibly want to see children take up smoking or should encourage them to take up the habit. I believe that we should do all we can to discourage, to educate and ultimately to prevent those under the legal age from taking up smoking. However, I also believe passionately in the concept of freedom of choice. The decision of whether or not to smoke should remain that of an informed adult, without gratuitous interference from the state.

One should not forget that tobacco is already one of the most highly regulated products in the world. The introduction of plain packaging would almost certainly amount to a regulation too far, and the so-called “denormalisation” of tobacco is not a sufficiently valid policy decision to justify such action. Any decision by the coalition Government must be unequivocally evidence-based. To contemplate taking such a significant measure for a legal product, the evidence base must be rock solid and reliable, with a guarantee that it will have the outcome intended.

I must confess that I am very pleased that the Department did not place a bid in this year’s Queen’s Speech, and that the Government, with a very libertarian junior Minister as we know, have sensibly delayed making a decision until it is clear what impact plain packaging has in Australia, where a plain-packaging law has been introduced. In my view, it makes sense to see how that experiment works first, before following their lead.

Any decision must be categorically made on the basis not of who shouts loudest or which side of the debate is able to muster the largest number of automated e-mail responses. The enforced introduction of plain packaging would infringe fundamental legal rights that are routinely afforded to international business. It would erode some important British intellectual property and brand equity, and it would create a dangerous precedent for the future of commercial free speech in areas such as alcohol and, indeed, within the food industry.

There is so much more that I would like to say, Mr Hollobone. It has been an interesting debate. I accept that my contribution is on a different path from those of many other Members here, but it is a voice that perhaps needs to be heard in this debate, which we will no doubt have in the months and years to come.

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[Fiona Bruce (Congleton) (Con)]

I congratulate my hon. Friend the Member for Harrow East (Bob Blackman) not only on an excellent speech—which I fully support—but on his work on the all-party group on smoking and health, of which I am a member.

My motivation in supporting the debate today comes entirely from wanting to ensure that we protect children and save lives. I echo everyone who has said, “Let’s do as much as we can to prevent young people from starting to smoke,” because the later they start the less likely they will become addicted and the fewer lives we will see debilitated. It is not just about saving lives; it is about the quality of life that many will suffer. How many people who have taken up smoking desperately want to stop? The best way to stop smoking is not to start in the first place.

[John Glen]

Does my hon. Friend share the grave concern that a disproportionate number of people from the poorest communities are taking up smoking in ever increasing numbers?

[Fiona Bruce]

I absolutely do, and I also share the view that young people are attracted to designer brands. They are attracted not just to the product but to the packaging. I have two young sons—one is 17 and one is 20—and I was amazed to discover that not only do young people want to buy designer clothing but there is a trade on eBay for the tags and packaging. People collect the labels.

We have known for a long time that young people are attracted to labels. In 1995 a survey of youth in America told us that young people associated the following words with designer packaging: popular, cool and good-looking. With cigarettes in plain packaging, they associated the words boring, geeky and cheap. In 2012, another survey found that young people felt that if they smoked stylish packs they would be “better and more popular”. The evidence is there. We do not need to delay.

It is a tragedy that each year 200,000 people start to smoke when we could take action. I do not believe that the fact there have already been successful measures is an argument for not taking further action—quite the opposite. According to one statistic I have seen, the display ban on large shops has contributed towards 100,000 fewer young people taking up smoking each year. If that is correct, let us build on the success. Let us do more, and see more and more young people discouraged from taking up smoking.

If I saw a young child drowning in a canal or about to run in front of a car, I would do all that I could to stop them and to save that life. Is that not what we are in a position to do in this House? The public do not want to see young people’s lives and futures damaged by smoking. More than 190 health organisations support standardised packaging. People in this House support it. Let us have a debate and a vote, and take action to protect the health and lives of future generations.

Mental Health

John Glen Excerpts

Thursday 16th May 2013 Commons Chamber

[Mrs Moon]

My hon. Friend is correct. Craiglockhart hospital and the work of Dr Rivers are a prime example of the excellent treatment that was given to some officers. Many people continued to cope with post-traumatic stress disorder, which we now recognise. It was not identified as a condition at the time, although it is detailed in some post-war journals. We have, however, moved forward.

To return to my original point, the military is often at the cutting edge—it needs to be—of looking at mental health problems. Post-traumatic stress disorder has risen up the mental health agenda in the armed forces, mainly because of statistics from the United States. The US Department of Veterans Affairs estimates that post-traumatic stress disorder affects 11% of veterans of the war in Afghanistan and 20% of Iraq war veterans. By contrast, the figure for the UK—these statistics are taken from a 2010 edition of The Lancet—is 4%, while 19.7% reported more common mental health disorders and 13% reported alcohol abuse.

I want to consider the issue of alcohol abuse in the armed forces and its impact on mental health problems. The Ministry of Defence has spent a lot of time providing services, raising awareness and developing programmes such as TRiM—trauma risk management—which I will look at later, and there is far greater understanding of mental health problems among the military. Much of that is thanks to the excellent work of and collaboration between the MOD and King’s college London. I draw Members’ attention to “King’s Centre for Military Health Research: A fifteen year report”, which was published in 2010 and sets out the stunning work that has been carried out. It talks about the roll-out of TRiM. The unit has helped to raise the awareness of most common mental health problems among military personnel, including depression, alcohol misuse and post-traumatic stress disorder, although that is not the most prevalent. The unit found that pre-deployment screening was not effective in picking up problems and that mental health problems did not necessarily apply only to those whose problems had been indentified before they were deployed. Who will be affected by deployment cannot be predicted.

[John Glen (Salisbury) (Con)]

In the hon. Lady’s investigations into this critical area, has she discerned any difference between the ways in which reservists and regulars are treated with respect to screening and treatment? If she has, does she think that that needs to be addressed?

[Mrs Moon]

I thank the hon. Gentleman for his intervention. When he was on the Defence Committee, he took a particular interest in this area. As I will explain later, reservists are particularly vulnerable. That is more of a problem in the US because they are deployed for longer and have less support once they are home. However, it is a major issue that we must address in the UK as we increase the percentage of reservists in our armed forces.

The work at King’s college London highlights the importance of adhering to the Harmony guidelines and the negative impact of changing tour lengths during tours. The Secretary of State for Defence announced in a statement yesterday that we are extending the tour length for two brigades that will be deployed over the next two years. That has implications and we must ensure that King’s college London is involved in tracking the changes that it brings.

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[Mr Jones]

It is a statement of fact that people with mental illness will self-medicate, and alcohol is the most easily available drug. I am surprised by what my hon. Friend describes. If services are taking that approach to people, that is wrong. Her point is also linked to the bigger debate about access to alcohol.

Let me return to the issue of stigma, which my hon. Friend the Member for Dudley North (Ian Austin) raised. He quite rightly said that we do not talk about it, but we are making some progress. I thank Mind, Time to Change, Rethink and the Royal College of Psychiatrists for doing a great job of raising the issue and tackling the stigma. We should remember that it is not just the individuals with mental illness who suffer, but family members too. Earlier my hon. Friend the Member for Ashfield (Gloria De Piero) mentioned her own family. A lot of families suffer in silence because they think there is no one to turn to. In many cases, they think they have failed in some way or wonder where they can get help. It is not uncommon—I have come across a lot of these cases—for carers to end up suffering from mental illness themselves because of the daily pressures on them.

The hon. Member for Broxbourne raised the issue of schizophrenia. I pay tribute to the Schizophrenia Commission, which reported towards the end of last year. It looked not only at services for schizophrenia, but at the stigma attached to. Again, the popular image in the media is that someone suffering from schizophrenia is potentially the mad axeman or woman next door who will come and kick the door in, when nothing could be further from the truth. When we describe people’s conditions, there is an onus on us all to describe them properly, because there are people suffering from schizophrenia who, with proper treatment and support, can function quite normally.

I also pay tribute to the hon. Member for Croydon Central (Gavin Barwell), who introduced the Mental Health (Discrimination) (No. 2) Act 2013—a good use of a private Member’s Bill. Like my friend the hon. Member for Broxbourne, I also pay tribute to Lord Stevenson, not only for championing the Bill through the other place, but for the work he does with his new charity. Did that legislation help in itself? Yes, it did, because it sent a clear signal that we were starting to take discrimination more seriously. Will it change things overnight? No, I do not think it will, but the more we talk about the stigma, the better people can address it.

I have been criticised—we see this occasionally in some newspapers—by people who say, “Well, it’s okay for famous film stars or even MPs to say they’ve suffered from mental illness,” as though it is somehow an easy thing to do, but I can tell Members now that it is not. I would like us to reach a position where people generally are talking about mental illness, so that if people are suffering in a workplace, they can open up to their colleagues. I should point out—not just to people in this Chamber, but to those in the wider audience—that most people who are suffering from a mental illness would be very surprised by the reaction if they told people. However, it is a big step, and I know personally that it is a very difficult one to take.

One of the best examples of that was from a Channel 4 programme that I appeared on after I spoke last year—I pay tribute to Channel 4 for its work to raise awareness of the stigma around mental illness. The programme had the great title of “Mad Confessions” and was presented by a very mad individual called Ruby Wax. By chance, it happened to include one of my constituents, Derek Muir, who suffered from depression. The programme started with him talking about his depression—he had been off work for a number of months and lives in Edmondsley in my constituency. At the end of the programme they got all his colleagues together in a room and he told them. It was the first they had known about it, but the reaction was very positive and supportive. That is the point we need to get to. Sometimes it is a big step for people suffering from mental illness or depression to admit what is seen as a frailty—although it is not. The strength is in opening up and asking for help.

One area that we need to do more work in is getting mental health policies in the workplace right. I pay tribute to BT and Dr Paul Litchfield for their policies, which have buy-in not just at the level of personnel managers, but from the board downwards. They are not only talking about getting people to talk to one another and open up about mental illness, but trying to be supportive of people with mental illness. When I was at a seminar with Paul last year, somebody asked him, “Why has BT done this? Is it just to tick the social responsibility box?” He said no. Indeed, the board was quite clear: the policy makes economic sense for BT. The message we need to get across to more and more employers is: “Why write off people who are valuable to your business, just because they happen to suffer from a mental illness?” BT is to be congratulated, and I certainly congratulate the board and Paul on their work in this area.

[John Glen]

The hon. Gentleman is making a typically brilliant speech on this subject. Will he also focus on what we could change in regard to education in our schools? For many, laying the foundations of understanding at an earlier stage, prior to the workplace, would be very effective in creating better outcomes and helping all those young people who have to witness mental health problems among adults.

[Mr Jones]

The hon. Gentleman makes a very good point: schools are important in this regard, and it is important to get young people to talk about the issue. I have a fantastic charity in my constituency called If U Care Share, run by Shirley Smith. It was created following the tragic circumstances in which Shirley’s 19-year-old son hanged himself. Her organisation goes into schools, youth groups and football clubs—Shirley is working with the Football Association and others—to get people talking about their emotions. We need to get more of that kind of work going.

The workplace is important. Although he is not in the Chair at the moment, I want to pay tribute to Mr Speaker, as well as to the House of Commons Commission. Following our last debate on this issue, they earmarked some funding for our own mental health in this place. Dr Ira Madan, the head of the unit across the road that MPs and staff can access, has told me that that was valuable in that it allowed her to assist Members with mental illness, and that there had been an uptake of the services since the money was made available. I would recommend that anyone who wants to go and have a chat with her should do so, as she is a very good and open individual. We must give credit to Mr Speaker and the Commission for that funding, because that was not an easy decision to make, especially as he was getting criticism from certain newspapers for giving special treatment to MPs. It is not special treatment; it is a vital service. Unfortunately, it is still not open to many MPs because of the stigma that surrounds mental illness.

Health and Social Care

John Glen Excerpts

Monday 13th May 2013 Commons Chamber

[Andy Burnham]

As ever, my hon. Friend says it more eloquently than I can. The Government are playing politics rather than addressing the national interest. People will see that, but at least the Government have revealed their hand. We will work hard over the next two years to show who is really to blame and expose this Government’s failures on social care, the NHS and public health. Let me take each in turn.

At face value, the social care measures that the coalition is proposing sound like progress towards a fairer and simpler system. Indeed, the Care Bill builds on many of the recommendations of the Law Commission’s review of adult social care legislation, which was initiated by the last Government and included in the White Paper I published before the last election. National standards for eligibility could help to bring consistency to the care system, and stronger legal rights for carers are long overdue, as is improved access to information and advice. However, the question in the minds of many today, particularly councillors watching this debate, will be: how on earth will we be expected to pay for all that? That is when we realise again that there is a huge gap between the rhetoric we hear from the Dispatch Box and the reality on the ground across England. More than £1.3 billion has been cut from local council budgets for older people’s social care since this Government came to power.

Just last week, the Association of Directors of Adult Social Services said that Government cuts to care and councils would mean a further raid of £800 million from care budgets in the next year. The Care and Support Alliance has said that the system is in deep crisis and that without

“appropriate funding for the social care system…the aspirations set out in the Care Bill will not be reached.”

The Care Bill does nothing for people who face a desperate daily struggle to get the support they need right now, with many paying spiralling charges for their care. That is the effect of this Government’s drive to cut councils to the bone. They are foisting huge care charges on the most vulnerable people in our society. These are the coalition’s dementia taxes.

[John Glen (Salisbury) (Con)]

Does the right hon. Gentleman not understand that the people of this country would have more confidence in what he says at the Dispatch Box had he not said in the last general election campaign that it would be irresponsible to safeguard the NHS budget, which is what this Government undertook to do?

[Andy Burnham]

I will come directly to that quotation in a moment, because the hon. Gentleman will remember that at the last election he stood on a manifesto promising real-terms increases for the NHS. I hope that when he speaks later—or if he wants to get up right now—he will tell me whether they have been delivered.

[John Glen]

I am grateful for the opportunity to acknowledge the great difference between England and Wales, where Labour is in power and where we are seeing real cuts in NHS spending.

[Andy Burnham]

Government Members are just embarrassing themselves. When they cannot answer a question, they try to raise another one or go on about Europe. It is just not good enough. The answer is—though the hon. Gentleman cannot admit it—that Andrew Dilnot said this Government had cut the NHS. It is there in black and white. That is what they have done, and they stood on a manifesto promising the opposite. I secured a budget to protect the NHS at the last election. I said that I could not give real-terms increases because that would be irresponsible; and as it turns out, nor can the hon. Gentleman. His party was writing cheques that it simply could not cash, and that is a fact.

The Care Bill does nothing for those hit by the coalition’s dementia taxes right now. Since this Government came to power, the average care user has paid £655 a year more for home care than when they came into office. Overall, that is around £6,800 a year. Dial-a-ride transport services have doubled in price over the same period, from an average of £1.92 to £4.12. Meals on wheels now cost an extra £235 a year, while people in Conservative areas pay more for each service on average than friends and family in Labour-controlled areas—on average, £15 a week or £780 a year more for home care. That is the record of this Government.

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[Mrs Madeleine Moon (Bridgend) (Lab)]

There are approximately 6 million carers in the UK, 2.2 million of whom provide more than 20 hours of care a week. Between them, they provide more than £119 billion- worth of care each year. They are listening to this evening’s debate. They want to know whether what is in the Queen’s Speech are empty words and further promises, or whether their lives will improve and changes will be made.

A lot of people have spoken of the work undertaken by my right hon. Friend the Member for Cynon Valley (Ann Clwyd) in the complaints review. I have sent copies of the letters I wrote when I made a complaint about the absolutely appalling treatment of my mother in an English hospital over a number of visits. I worked hard to make the complaint stick and ensure that my voice as her carer was heard, but even I, as a Member of Parliament, was worn down in the end.

I have sat in this debate and listened to Government Members criticise the Welsh health service. I have a very sick husband. He uses the Welsh health service, and I am grateful for the quality of care that he receives from it every day of the week. I know that my GP service is excellent and I know that if I need care from my local hospital for him, it is there, so I want to hear no more nonsense about the Welsh health service.

[John Glen]

Will the hon. Lady give way?

[Mrs Moon]

No, I will not; I am in the midst of my speech.

In Bridgend, there are 18,000 people providing care for relatives or friends. Some 5,500 of them provide unpaid care for more than 50 hours a week—care that is compassionate and dedicated; care of a quality that we would love to hear is being provided in our hospitals. I asked a group of carers recently what it meant to be a carer. One of them said, “It’s like trying to live two people’s lives and cramming them into one person’s life.” The other said, “You’re an expert in bodily fluids. Urine, faeces, blood and vomit are the daily recipe.” Is it any wonder that the Royal College of General Practitioners recommended last week that all carers should be screened for depression? It recognises that carers are particularly susceptible to depression and that there is a need for greater support.

Carers UK has reported that almost a third of those caring for 35 hours a week or more receive no practical support, while 84% of carers surveyed said that caring had a negative impact on health. That is up from 74% in 2011-12, so the problem is getting worse. Four in 10 —42%—of those caring for someone discharged from hospital in the last year felt that the person they were caring for was not ready to come out of hospital and that they did not have the right support at home. I worked in discharge care in a number of hospitals in Wales. Safe discharge was a major platform on which we worked. The things that are a problem remain the same. There is a lack of specialist equipment readily available for carers to assist with discharge—I am talking about beds that prevent bed sores, hoists, commodes, adapted bathrooms, swallowing assessments, speech and language therapy, occupational therapists and physios. It is not just nursing we need to focus on; it is all those important services.

We also need to look at the availability of treatment and medication that make a difference to people’s lives. I want to talk briefly about a condition that really shocks me and the carers of those who have it: aHUS, or atypical hemolytic uremic syndrome. I am the co-chair of the all-party kidney group. A few weeks ago I chaired a meeting of people with aHUS. There is a drug available for the condition that is called—excuse me, Madam Deputy Speaker, but it is a dreadful drug to pronounce—eculizumab. It sounds like some sort of African tribe, but that is what it is called. Taking eculizumab can virtually cure someone with aHUS. They get their life back. We are talking about a very small number of people who have the condition—less than 170. The typical form is triggered by a bacterial infection such as E. coli; the atypical form is genetic. We heard tragic evidence from families in which perhaps three or four generations of children and adults carried the genetic trigger. More importantly, the only treatment other than taking eculizumab is to have dialysis on a virtually daily basis. We heard from carers who have to place the extremely painful and long needles needed for dialysis into their children’s arms. Those children cannot have a kidney transplant because the transplant would almost certainly have the same condition. Even if they had a transplant, they would continue to need dialysis.

I am appalled to learn that the Government have agreed that those who are taking the drug on a trial basis may continue to take it, while those who have already been diagnosed but refused access to the drug on a trial basis will not be allowed access to it. Newly diagnosed patients will, however, have access to it. That is nonsense. We could save a large amount of money, and we could save those patients the trauma of daily dialysis. The drug was recommended for use by the Advisory Group for National Specialised Services and it has now been submitted to the National Institute for Health and Clinical Excellence for further appraisal. Sufferers of the condition might therefore have to wait until 2014 to get access to it, which is totally unacceptable.

Madam Deputy Speaker, I am sorry that I shall not be able to stay for the winding-up speeches, but I hope that the Minister will consider whether it might be possible for access to this drug to be extended to all sufferers of aHUS, so that they and their carers can once more have a decent quality of life, and so that the NHS can save money.

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[John Glen (Salisbury) (Con)]

I welcome the Queen’s Speech, particularly where it promotes the interests of people in our society who work hard, want to get on and recognise that in the long term their well-being is likely to be sustained when they rely more on themselves than on the state.

I want to focus most of my remarks on the Care Bill and on the absence of the plain packaging legislation. Before I do so, I make the observation that the integrity of the Government and their ultimate success will be reliant not so much on what they say on Europe, but on what they deliver on welfare reform and the state of the economy. Thankfully, there was no significant new legislation on welfare reform in the Queen’s Speech, because it is now about the delivery of what we have already brought before Parliament. I am delighted that the Government are listening carefully and working deliberately and carefully through the process of pilots before bringing in fully the welfare reform.

One aspect of that reform, referred to in the Queen’s Speech, is access to benefits for immigrants. It is right that the Government are considering limiting access to housing benefit and health care for people who have not earned the right to it. It is not enough to keep ignoring that uncomfortable truth because we are frightened of being too right wing, too nasty or too unpleasant. The routine experience of people up and down this country is that on the front line, at the point of delivery and at the point of receiving public services, they are too often displaced by people who, apparently, should not have the right to access those services. I am pleased that the Government will address that in legislation.

On the health aspects that are the focus of today’s debate, it is right that the Government have finally introduced the Care Bill, as every constituency MP has been concerned about this issue for many years. In some of our earlier exchanges today, we have, as usual, debated who cut what when. I know that before 2010—or before 2007—there were prolonged periods when this country had significant surpluses of moneys and, despite considerable evidence indicating that reform of the care system was required, nothing was done. I am therefore pleased that the coalition Government have found a way forward.

Some specific details on how the arrangements will work—the interaction with the local authorities, and the timing and practicalities of the cap roll-out—need to be delivered. That requires a spirit of collaboration and constructive engagement, and an examination of the complexity of multiple agencies of government working together to deliver care in circumstances that cannot always be defined by legislation. Too often in these debates we use examples from our constituency case load, which are often emotive and provoke an emotional response, but our responsibility as Members of Parliament is surely to absorb and take on those challenging individual cases, and to work through the different processes of government to see that better outcomes accrue and occur. We must also reflect honestly on the systems that led to those failures, and distinguish between the systems that may have failed and cases where—sadly, unfortunately—human error and individual failures led to dissatisfied constituents.

We must be honest about issues with the NHS, because we need behavioural change and a different appetite among the electorate for public health measures. We also need to take a constructive view about what is affordable with pensions. Therefore, I welcome the single-tier pension, which simplifies a lot of the complexity that has developed in our system.

I am deeply disappointed that the Government have failed to include legislation on plain packaging of cigarettes explicitly in the Queen’s Speech. I completely agree with the speech made by the hon. Member for Barnsley Central (Dan Jarvis). When we have 10 million smokers, when two thirds of those who start smoking do so before the age of 18 and when 200,000 young people start to smoke every year, it is not enough to rely on arguments about the complexity of illegal trafficking.

[Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op)]

The hon. Gentleman is making an important and valid point and we have heard a number of his colleagues making similar points; I suggest that they table an amendment on the issue. If they do so, they might find that a lot of Labour Members support them, and who knows what might happen?

[John Glen]

I am grateful to the hon. Gentleman for that intervention, but I think we have had quite enough amendments this week.

Nevertheless, the point remains that we cannot rely on a debate about the issues of the illegal production of illicit cigarettes or in the packaging industry; those issues need to be tackled head-on. The core point is this: why does the tobacco industry spend so much money on elaborate packaging? It does so because such packaging works and because it encourages young people to take up the habit of smoking.

In this Chamber, the hon. Member for Shipley (Philip Davies) would usually sit next to me. Fortunately he is not here today, because if he were I am sure he would have intervened. He would have said it should be about freedom to choose. I am sorry, but I do not believe that 16-year-olds faced with massive peer pressure in certain communities genuinely have freedom to choose. It is not enough to say that the Government gain lots of tax revenues. For those individuals and their families, the health implications of smoking are dire. The situation is disappointing and I hope that a private Member’s Bill or another mechanism will be found to address the issue before the end of this Parliament.

[James Duddridge]

I am persuaded to a degree by my hon. Friend’s argument, and if plain packaging were the solution to eliminate the problem, I would be inclined to vote for it. However, I cannot help but think that there will be something else around the corner, such as a ban on smoking in films or a ban on role models being seen to smoke, and ultimately an absolute ban on smoking. That might well be the right answer, but I am not quite sure where the debate is going.

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[John Glen]

The reality is that smoking is almost unique in its proven health implications: the fact that it is so addictive and the fact that, particularly for young people, the implications for their future health are dire. We cannot just use the “freedom” arguments or ask “Where will the debate go?” to hide from that reality. We have a responsibility to do something about it.

I want to use my remaining speaking time to focus on the issue of rhetoric versus reality and the gap between the two, because I recognise that the election results a couple of weeks ago threw up big issues for my party about how we handle that. That takes me back to what I said at the outset. Most people want a Government who are concerned about the economic well-being of this country, about generating growth, about delivering fairly provided quality public services that not only look after the most vulnerable properly but give incentives to those people who can create wealth and jobs to do so, and about allowing the economy to prosper.

I think it would be wrong to get into a trade-off of rhetoric on the Europe issue, because all the proposed solutions are a long way off. The reality for this Government is that it will be a slow, hard and difficult process, but it is one that is well set out in this Queen’s Speech, with practical, sensible measures that are likely to win support over the course of the remainder of this Parliament.