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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

Mid Staffordshire NHS Foundation Trust

John Glen Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

I would also like to thank my hon. Friend for the work that he does for his local hospital in difficult circumstances directly involved in this terrible scandal. I agree with him: the corporate objective to become a foundation trust overrode everything else in the hospital, at huge expense to patient care. We must never allow that to happen again.

[John Glen (Salisbury) (Con)]

What most people want when they use the NHS is a reliable, accessible service, and to know that when something goes wrong somebody will be held to account and brought to book. Clearly, that has not happened. What can the Secretary of State say to reassure our constituents that people will be held accountable on an individual level, and that we will not see this happen again?

[Mr Hunt]

That accountability is extremely important and happens on many different levels. In particular, we have professional codes of conduct for doctors and nurses, so that in the exceptional situations where those codes are breached, we know, as members of the public, they will be held to account. Those are done at arm’s length from the Government by the General Medical Council and the Nursing and Midwifery Council, but we are talking to them about why it is that still no doctor or nurse has been struck off following what happened at Mid Staffs—I think that is completely wrong.

Liverpool Care Pathway

John Glen Excerpts

Tuesday 8th January 2013 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

I congratulate my hon. Friend the Member for Montgomeryshire (Glyn Davies) not only on securing the debate but on the calm and measured way in which he introduced it—his was exactly the constructive tone in which we should discuss this concerning issue.

Last year, an 83-year-old widower was taken into hospital feeling very unwell. His eldest daughter visited him every day. No particular illness was diagnosed, but he was certainly weak and frail. After a few days, the daughter asked a nurse in the corridor, “How is he today?” Almost casually, the nurse said, “Oh, he’s not very well at all. He has not long to live. We are putting him on the Liverpool care pathway.” There was no discussion, no explanation, no consultation—just an announcement, a statement of fact, almost in passing. The daughter was shocked. As his eldest child, she thought, “Surely there should be more formality, more dignity, more of a clear process.” What gave her particular cause for concern was that her mother had become frail just two or so years earlier—admittedly after a brain tumour operation—and had been put on a regime of limited food and fluids. It had taken her weeks to pass away, which was agonising for her and heart-rending for the members of her family, as they waited and waited for their wife and mother to die. Again, there was no discussion or consultation with the daughter, although perhaps there was with the father. He was an elderly man in his 80s, and he was now lying in bed himself, about to be put on a similar regime.

After her mother died, the daughter felt a terrible guilt. Perhaps it had taken too long for her mother to die. Perhaps the daughter should have asked more questions. Perhaps she should not have let her mother suffer so much. With no medical background, however, she was left rather sad and confused. When the nurse announced that the hospital was putting her father on the Liverpool care pathway, the daughter, knowing a little more about it by this time, immediately contacted her sister, and the next day their father was moved to a nursing home. There, his needs were attended to in a positive and caring way. There, he did not die; in fact, he got better.

Now, well over six months later, that elderly man is very much alive. He is still being cared for. He is eating well, getting up when he wants to and resting when he does not want to get up. He enjoys visits from his family, although he does not enjoy it when his favourite football team loses in the last minute or so of a match, as happened last Saturday. He is listening to tapes of Sadler’s Wells opera company singing Gilbert and Sullivan, and he is joining in with “Songs of Praise”. He is having intelligent and considered discussions about his finances and looking forward to his 85th birthday. It is not a fantastic quality of life, but it is a life, and as he told his doctor in the nursing home, “I want to live.”

Minister, Mr Weir, concerned Members, I know all that is true, because the lady who passed away so distressingly was my mother, and the elderly man I have described is my father. I, their daughter, witnessed all those events first hand. In one sense, I am not sure I need to say much else to support the points that have been made, but the application of the LCP needs to be looked into.

[John Glen (Salisbury) (Con)]

My hon. Friend is making a powerful case, and it is obviously painful for her. Does she agree that there is a distinction between accepting the notion that a life must end and accepting that there is an inevitable time frame in which that life must end? We must not make premature assumptions about that period, so it is critical that there is a clear understanding of what the Liverpool pathway means and how it can affect the timings of an event we do not know the actual trajectory of.

[Fiona Bruce]

I thank my hon. Friend for that intelligent comment, and I will talk further about that.

I want to speak now as a vice-chair of the all-party group on dying well and the all-party pro-life group. Despite my personal experiences, I believe the main intent of the Liverpool care pathway is compassionate and good. It is fundamentally aimed at what is increasingly called a good death. When correctly administered, the principles behind it are those of good palliative care, and they are fully in accordance with the view, which I hold, that all life is God-given and should be allowed to run its course, without death being hastened through unnatural intervention.

NHS Funding

John Glen Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House notes with concern the letter of 4 December 2012 from the Chair of the UK Statistics Authority, Andrew Dilnot CBE, to the Secretary of State for Health concerning public expenditure on health, further notes Mr Dilnot’s statement that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10; and calls on Ministers to reflect this position in their public statements.

Some people question whether Opposition days ever achieve anything, but not us. Last month, we brought to the House our concern about plans for regional pay in the national health service, which found an echo among Government Members. Within days, the plans of the previous Health Secretary for market-facing pay in the NHS were scuppered in the autumn statement. To some, that was just another day, another U-turn, in the life of this shambolic coalition—no big deal—but to thousands of NHS staff in the south-west facing pay cuts it was a real relief, although we are still waiting for the consortium formally to back down. We will be vigilant until it does so.

Fresh from that success, we set ourselves a more challenging task in today’s Opposition day debate to bring some much-needed honesty to the public debate on the NHS, particularly on NHS spending. Across the country, people can see the signs of an NHS in increasing distress: cataract operations are restricted; A and E departments and walk-in centres have been closed; hospitals are full to bursting, some struggling for survival; over 7,000 nursing jobs have been lost—[Interruption.] Government Members should listen to the facts before they shout out, because this is the reality and the chaos that the previous Secretary of State created on the ground. People can see that with their own eyes, but when they go home and switch on the television they see Ministers standing at the Dispatch Box making complacent boasts about “real-terms increases” that they have given the NHS and saying that everything is fine.

[John Glen (Salisbury) (Con)]

If the right hon. Gentleman wants to have integrity and demonstrate honesty in this debate, will he at the outset condemn the Labour party in Wales for the real cuts that everyone knows are being made in the Welsh health service? Will he level with the British people about that, rather than offer this empty political rhetoric that does not deal honestly with what is happening in Wales?

[Andy Burnham]

We are discussing the hon. Gentleman’s Government today, but let me deal with Wales. His Government have given the Welsh Assembly Government a real-terms £2.1 billion cut. The Welsh Assembly Government have done their best to protect health spending in that context: they have protected the NHS budget in cash terms. May I also point out to the hon. Gentleman that since 2010 there has been no real reduction in front-line staff, particularly nurses, in Wales, which is quite unlike the position under his Government? Before he appears a bit too cocky on these matters he should read up on the facts. The Welsh Assembly is doing the best that it can with the awful hand of cards that he and his Government dealt it.

There is a mismatch between ministerial rhetoric and the reality on the ground in the NHS, and it is in danger of causing confusion. If left unchallenged, it may lead to unfair claims that the problems in the NHS are all down to its staff and have nothing to do with the Government. Today we need a bit of accountability and a bit of honesty. Once and for all, we will nail the myths, spin and sheer misrepresentation of the facts that roll off the Government Benches week after week.