Oral Answers to Questions

Julian Sturdy Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Scott Mann (North Cornwall) (Con)]

1. What steps he is taking to introduce innovative technology into the NHS.

[Julian Sturdy (York Outer) (Con)]

14. What plans the Government have to improve access to innovative treatments and technologies in the NHS.

[The Secretary of State for Health and Social Care (Matt Hancock)]

We are bringing a tech revolution to the NHS to improve patient outcomes and reduce waste. Today I am delighted to announce the selection of the first batch of products under the accelerated access collaborative, as well as funding for tech test beds to ensure that more patients get faster access to the most effective innovations.

[Matt Hancock]

The tech test beds programme is about ensuring that we have units around the country that will support local collaborations between the NHS, tech companies and academia to harness new technologies right across the land, including—and no doubt—in Cornwall.

[Julian Sturdy]

The National Institute for Health and Care Excellence has so far declined to recommend the new drug Spinraza, despite its ability to transform the lives of patients such as my young constituent Matilda Jamieson, who suffers from type 3 spinal muscular atrophy. As NICE meets today to finalise the guidance, will my right hon. Friend assure me that he will work with the manufacturers, NHS England and NICE to ensure that patients such as Matilda can benefit from that drug?

Management of NHS Property

Julian Sturdy Excerpts

Wednesday 4th July 2018 Westminster Hall

[Karin Smyth]

I cannot comment on the specific company, but trying to understand accountability and how systems work is frustrating for local people. Many of us are trying to make sense of it.

The estate was an afterthought for the coalition Government and their disastrous Health and Social Care Act 2012—the Lansley Act. Their laissez-faire approach, which bordered on contempt, has saddled communities across the country with burdens and consequences ever since. The current Government recognised that in their response to the Naylor review, stating:

“The structural changes in recent years have distracted attention away from the importance of the estate as an enabler of high quality care, and the NHS has lost valuable expertise and knowledge in strategic estates planning, development and management.”

As we are developing the 10-year plan to transform our NHS into a more community-based, joined-up system, the function of the community and primary care estate as an enabler of service transformation becomes more critical. Although the Government said in response to Naylor that they want to incentivise local action, in practice there are no mechanisms to do so. My focus is therefore on the local roles of two national bodies: NHS Property Services and Community Health Partnerships.

The Lansley Act nationalised health centres, GP premises and, in my constituency, the South Bristol Community Hospital overnight. When the Government realised that no one was responsible for property managed by primary care trusts—mainly GP premises and health centres in poorer areas—they set up NHS Property Services, which became the landlord and asset manager on behalf of the Secretary of State. Community Health Partnerships took over the primary care trusts’ 20% control of local infrastructure finance trusts—LIFT companies—which were public-private partnerships for new GP premises and community-based services, such as South Bristol Community Hospital.

A key part of the LIFT incentive was that the companies made a profit and from that a dividend was returned to all shareholders, including the primary care trust. The Lansley Act passed that 20% local share to the Secretary of State. That LIFT company is still operating, as others are across the country. Bristol Infracare LIFT paid dividends totalling £823,000 last year and £2,344,000 in 2016. Community Health Partnerships received 40% of that, but 20% should have been retained in the Bristol health economy. In the last two years, that amounts to £633,400 in Bristol alone, and that is replicated across the country. I am here today with a simple message for the Secretary of State, via the Minister: I want control of this asset to be given back to the local health economy, and I want our money back.

The closer one looks at the labyrinthine structures that govern NHS properties, the more it seems that the opaque and impenetrable way in which these companies operate is not accidental. They appear to be purposefully disenfranchising and disempowering local people. Whatever the merits of the Lansley Act—I contend that there are not many—it was supposed to drive devolution, liberation and accountability.

[Julian Sturdy (York Outer) (Con)]

The hon. Lady is making a powerful argument. One of the real problems we find in York is that NHS Property Services is very distant and difficult to engage with. It needs to sit down with local communities, whether in York, Bristol or elsewhere in the country, and engage with them about the assets that need to be reinvested back in those local communities.

[Karin Smyth]

That is exactly the point I want to make, but I will go on to show how that is difficult to do and make a difference.

Patients and frontline practitioners were supposed to be front and centre of the new NHS, but that has simply not happened because, as we have heard, control is ever more centralised. It really did not have to be that way. NHS Property Services was set up as a national body, losing a wealth of local expertise and institutional knowledge in the process. With expensive London headquarters, its teams across the regions are stretched. It spent its first period of existence creating a register of assets and a new market rent system. That resulted in disputed and unpaid rents, which necessitated additional loans from the Department of Health to keep the company afloat and a complicated parcelling of subsidy via NHS England to clinical commissioning groups and GP surgeries. The early years have been an expensive disaster, with GPs and managers across the country not knowing what they were being charged for or who to call to sort out the problems. The profligacy of the system is matched only by its utter uselessness, and that is why I have been pursuing this scandal since I was first elected.

In my constituency two GP health centres and a healthy living centre are directly affected by these problems. The Knowle West healthy living centre was set up in a joint arrangement on Bristol City Council land, with public health services delivered based on the needs of a community that has some of the highest health inequalities in the country. It is no exaggeration to say that for many in the area the centre is a lifeline. However, with public health taken out of the NHS into local government, and the services now largely contracted via a third party, NHS Property Services soon came knocking on the door, bringing with it a charges bill increased by more than 200%. There was no discussion, no legal lease was in place and there was no service level agreement. Not only has the charity that runs the centre been forced to operate under the constant threat of closure, but it is unable to access the simplest forms of support. It recently asked if the windows could be cleaned, only to be told that that was not in the contract.

It has taken me three years to get even a modicum of progress—lobbying the clinical commissioning group and Bristol City Council, talking to local media, and raising the issue at the Public Accounts Committee and actively on social media, which finally resulted in a helpful meeting with the chair of the NHS Property Services board. The issue is still not resolved, however, and we still have some way to go. It has been a battle. It is tiring for everyone concerned—frontline practitioners in particular—debilitating and, most frustrating of all, entirely avoidable.

South Bristol Community Hospital has a similar story. This facility was the focus of a 60-year campaign by local people, and it finally opened in 2012. Established by a partnership between the primary care trust, private equity and Community Health Partnerships, the local link was severed by the Lansley Act, as I said earlier. Now the board that oversees the community hospital meets far away from Bristol and with no Bristol involvement. An employee of Community Health Partnerships supposedly represents us in overseeing the management of the company that runs the hospital. Community Health Partnerships, like NHS Property Services, is an arm’s length body within the Department of Health and Social Care. The lease of the hospital is managed by a local foundation trust, University Hospitals Bristol, cobbled together in a last-minute deal with the primary care trust. Two other NHS bodies and a social enterprise are also tenants in the building. If that sounds confused, conflicted and convoluted, that is because it is.

I have been campaigning as the local Member of Parliament to get more services into the new hospital. It is a superb new building, with 96 community beds and an urgent care centre. A poll that I carried out among my constituents showed that 90% either were unaware of the services available in the building or felt that it was underused. A 2014 Care Quality Commission report found that the operating theatres were utilised only a quarter of the time, and the out-patient department only 55% of the time. We have made great progress since then, but the building is still underused as part of the health economy—on entering the building, people are faced with a whole floor with just a reception desk, and the corridors and lifts are typically empty.

The rehab unit, by contrast, is always full. The nurses, porters and other staff who keep it going all work tirelessly, but there is no escaping the sense that this facility is only rented or temporary. Everything is contractual and faceless, with rules abounding, while stroke patients spend their days and months staring at white walls because, according to the nursing staff, there are limits to what the landlord will allow—for example, there are no pictures.

The community hospital is on the southern fringe of our city, where 30% of residents do not have access to a car and the public transport links are historically among the worst in the United Kingdom. That same community has the highest rates of cancer, diabetes and asthma in Bristol, yet people are still expected to travel miles across the congested city for services that could easily be on their doorstep. I keep repeating the need for local health organisations to see sense, and my hope is that the logic is finally getting through and that we will see more facilities, such as diagnostics and perhaps even scanners, in the near future. Yet why has it taken such effort and such a long time?

South Bristol Community Hospital is perfectly placed to deliver the vision in the five year forward view and the aspiration of the 10-year plan—integrated with social care, providing a front and back door to other services to support the flow in the rest of the health system. However, progress towards those achievable goals is constantly frustrated by the fragmented ownership, the complicated money flows and the unfathomable accountability arrangements. My constituents, without fail, suffer as a result.

Time does not permit me to outline similar problems relating to the shady use of wholly owned companies, but chief among my objections to such companies is that every one of them is a lost opportunity to look at NHS estate management locally on a more joined-up basis, with some local accountability in the system. How can we promote a collaborative approach across healthcare systems when individual trusts go down their own selfish route?

The Naylor review offered some interesting recommendations to simplify the national management of the estate. The Government chose to establish a ministerial board chaired by a Minister at the national level, and it includes everyone—every NHS organisation seems to be on that board. I tried to map the board, who sits on it and how it links back to local communities, but I am afraid I gave up. Perhaps the Minister will help us with that.

Some big and controversial decisions need to be made about the estate, particularly in London, but they are being considered without any engagement with local communities. Not only does that ignore the wellspring of local knowledge that could help avoid a repeat of previous failures, but it fosters a feeling of communities being “done to”, and it makes any change hard—in most cases, impossible—to deliver. Hence, efficiencies that could be ploughed back into local health communities will not be realised.

Communities have been asked to submit estate strategies across their local health communities via the sustainability and transformation plans. They are now being asked to submit bids to a new capital programme, but how will estates run by NHS Property Services and Community Health Partnerships be factored into the mix? In addition to that complicated picture, NHS foundation trusts have their own schemes in play. Control and leverage of community and primary care estates cannot be done at the national level. That simply will not work. We cannot achieve the transformation for the next 10 years that is being talked about without local control of the architecture to deliver it.

When local leaders plan services as part of the sustainability and transformation plans, or whatever the next iteration of that is called, local people must have a say in how those services are delivered. There must be a mechanism to bring those properties, places and assets—and the people running them—back into the sphere of accountability of local health service communities.

Those are not bits of internal housekeeping; they are ways of doing business that are bad for the local health economy, bad for staff and, most importantly, bad for patients and taxpayers. Local communities across the country would like their voice back, and our local NHS would like its money back. The debate needs to do more than shine a light on a problem. I would like the Government to acknowledge that there is a problem and commit to fixing it, because anything less is a dereliction of responsibility and a huge opportunity wasted.

Bowel Cancer Screening

Julian Sturdy Excerpts

Tuesday 1st May 2018 Westminster Hall

[Nick Thomas-Symonds]

I absolutely agree. Although we all want a blanket reduction in the screening age across the United Kingdom, there are a number of risk factors for bowel cancer, one of which is family history, and we certainly need to look at having flexibility around the country so that screening can be done earlier where those risk factors are present.

The charities Bowel Cancer UK and Beating Bowel Cancer seek an optimal screening programme for men and women from 50 to 74. They rightly point out the importance of early diagnosis and the real opportunity to reduce the number of people who die from this awful disease.

[Julian Sturdy (York Outer) (Con)]

I pay tribute to the hon. Gentleman for bringing forward this debate at what must be a difficult time for him. My sympathies are with him. A member of my close family—my father-in-law—is suffering from bowel cancer. Thanks to the superb support of the NHS, we hope he is on the road to recovery. That has brought home to me the importance of early diagnosis. I just want to put on the record the fact that I would support the hon. Gentleman on a cross-party basis to ensure that we bring down the screening age and improve testing wherever we can.

[Nick Thomas-Symonds]

I am sure that all hon. Members would join me in sending their very best wishes to the hon. Gentleman’s father-in-law. I would be grateful if the hon. Gentleman passed those on. I welcome the cross-party support for reducing the screening age. I referred to Bowel Cancer UK, and I should point out that I have been pleased to do a number of runs to raise money for that charity through sponsorship.

I realise that we must deal with two other things to ensure that lowering the screening age and improving the screening process across the UK is effective. First, pathology capacity must be increased, because there will obviously be vastly more samples to deal with. Secondly, we need high-quality colonoscopy capacity to deal with the increased numbers of people referred on for further investigation as more sensitive tests yield further results that need to be checked out.

Oral Answers to Questions

Julian Sturdy Excerpts

Tuesday 6th February 2018 Commons Chamber

[Caroline Dinenage]

As the hon. Gentleman was so very charming to the Secretary of State, we will of course look into the issue.

[Julian Sturdy (York Outer) (Con)]

11. What recent progress he has made on improving the performance of hospitals in special measures.

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

It is five years today since the landmark publication of the Francis report on the Mid Staffordshire Foundation NHS Trust. Since then the NHS has made a huge number of changes, not the least being that 34 trusts have gone into special measures and 19 have come out. I particularly congratulate the West Hertfordshire Hospitals NHS Trust on coming out of special measures in January and securing a “good” score for its caring: that was a fantastic achievement by its staff.

[Julian Sturdy]

Given that York’s local health service is in special measures, the additional funds in the Budget to deal with winter health pressures were very welcome. I am pleased to say that York NHS has already received a tranche of those funds, but the remainder of its share has not been released, although discussions with NHS Improvement are ongoing. Will the Secretary of State undertake to look into the situation, as a matter of urgency?

[Mr Hunt]

I will happily do so.

Cancer Treatment: Patient Travel Times

Julian Sturdy Excerpts

Wednesday 10th January 2018 Westminster Hall

[Tim Farron]

I would like to thank the hon. Gentleman’s wife for her work, but also to say that he is absolutely right. There are great models, including from the Christie in Manchester, where they already operate satellite services. Arguing for rural or any form of standalone cancer services is foolish and is not what I am asking for. I am asking for satellites of existing, established, high-quality cancer units such as the Rosemere in Preston, the Christie or others of that nature. Making sure that we meet those needs by having a satellite unit at the Westmorland General Hospital in Kendal would have a positive impact on the lives of thousands of people in south Cumbria who are living with cancer. That is what I ask the Minister to do.

Radiotherapy treatment at Westmorland General Hospital is long overdue and would mean the world to local people, who now have to make the long journey to Preston for treatment. Let us be clear: the Rosemere unit in Preston is excellent—my own mother received wonderful treatment there, and the quality of the service and care provided by NHS professionals still moves me when I look back today—but for most people in south Cumbria, it is ludicrously distant.

[Julian Sturdy (York Outer) (Con)]

I congratulate the hon. Gentleman on securing the debate. Will he also note the importance of local charities? In my constituency, we have a charity called York Against Cancer, which has raised £15 million over the past three years. That money goes towards running a local minibus from York to Leeds for patients who have to be treated at Leeds in the radiology department.

[Tim Farron]

I am very happy to acknowledge the work of local charities in my area. The Rosemere Cancer Foundation and South Lakes CancerCare do immensely good work, just like the charities in the hon. Gentleman’s constituency.

For some people living in the remotest areas of my part of the world—in south Cumbria—who are eligible for hospital-provided pick-ups, a round trip to access treatment in Preston, including waiting times, could easily surpass six hours. That is on a good day, when all standards are being met.

World Antibiotics Awareness Week

Julian Sturdy Excerpts

Thursday 16th November 2017 Westminster Hall

[Julian Sturdy (York Outer) (Con)]

I beg to move,

That this House has considered World Antibiotics Awareness Week.

It is a privilege to serve under your chairmanship, Mr Davies. Exactly one century ago, Ernest Rutherford split the atom and humanity entered the nuclear age. The groundbreaking discovery represented a momentous step forward for human progress, but at the same time it unleashed a challenge for those beyond the laboratory and academia—the avoidance of mutual assured destruction. As this debate is about World Antibiotics Awareness Week, some might wonder why I started with the splitting of the atom, but I believe that there is an equally strong argument for the aforementioned period to be referred to as the antibiotic age. It was 11 years after the splitting of the atom that Sir Alexander Fleming discovered penicillin, here in this very city of London.

No one can deny the profound impact of antibiotics on medicine, and their widespread use represents a watershed moment in our evolutionary story. However, as Fleming himself understood, shortly after making his discovery, giant leaps in scientific progress produced wholly new challenges. As antibiotics were readily available, it appeared that we had invented miracle drugs of sorts. The snag is that we now face the real and severe threat of antimicrobial resistance.

Across the globe this week, scientists and healthcare professionals are hosting a wide range of events to make antibiotic resistance a globally recognised health issue. I am delighted that we as parliamentarians are here today to represent the role that lawmakers and Governments will play in facing the challenge of antibiotic and antimicrobial resistance. The week is also intended to raise awareness of the need to preserve the power of antibiotics through appropriate use, to increase recognition that individuals, health and agricultural professionals, and Governments must play in tackling antibiotic resistance, and to encourage behavioural change and convey the message that simple actions can make a difference.

While the threat of antibiotic resistance is often considered a doomsday scenario—one might say a medical Armageddon—we must remember that that menace is all too deadly today. Currently, 700,000 people die each year from drug-resistant infections; the future threat is touted as being so severe and extreme, not because we are not living with the effects today but because of the truly appalling potential scale of the problem if we do not take co-ordinated action. If we do not act now, antimicrobial resistance will be responsible for 10 million deaths per year by 2050. That is more than the number of people worldwide who were killed by cancer in 2015. It is nearly impossible to put a number on the lives that have been saved by antibiotics; some sources put the figure at roughly 2 million, but it is entirely conceivable that we may arrive at a position where the balance tips, and antibiotics pose a greater threat than a remedy.

As I have said previously in this House, we run the risk of returning to a medical dark age, where routine operations such as hip operations cannot be carried out, and infections that are standard today become deadly. This week, the British Society for Antimicrobial Chemotherapy published a report on behalf of the all-party parliamentary group on antibiotics. The report, the briefing for which has been sent to all Members of the House, considers the AMR action plans and strategies set out by the World Health Organisation, the European Union and the UK, and asks, crucially: “Has the world lived up to the challenge?”

The overarching theme of the report is that future strategies to combat antibiotic resistance should incorporate specific, measurable, attainable, relevant and timely—SMART—targets. When the stakes are 10 million deaths each year within four decades, it is easy to become lost in the scale of response that that merits; but as is so often the case, a coherent and clear approach is our greatest weapon. I call on the Government to ensure that all steps are taken to counter AMR and explicitly to incorporate those SMART targets I listed. I believe there is much to be gained from making that standard practice and removing any doubt. I am sure that colleagues will be encouraged to read in the report that

“the UK has taken significant steps to meet the objectives of the EU Action Plan, which in turn satisfies the WHO Europe Strategic Action Plan.”

There are two aspects, however, where our country needs to up its game. First, we need to address education and public awareness, so it is entirely fitting that we meet today during World Antibiotic Awareness Week, an occasion aimed directly at bolstering an understanding of resistance and the threat it poses to humanity. We need to be forthright in promoting the “four rights” when consuming antibiotics: the right drug, the right dose, the right time and the right duration. A survey carried out across Europe in 2016 indicated that knowledge about AMR remains low, and antibiotic consumption has decreased by only 6% over the last seven years. To address that, the British Society for Antimicrobial Chemotherapy advocates the use of simple and clear language in all awareness-promoting material. There is a direct recommendation of

“monitoring the efficacy of education campaigns through online channels.”

Fleming himself was once quoted as saying that the best remedy for a common cold was a dram of whiskey.

[Patrick Grady (Glasgow North) (SNP)]

Hear, hear.

[Julian Sturdy]

I know the Scottish Members would certainly agree with that. As Fleming said,

“it’s not very scientific—but it helps.”

We now need to make the message as clear as day: antibiotics are ineffective when taken unnecessarily and doing so bolsters resistance and endangers mankind.

The second area where significant progress can be made is on the incentives for antibiotic discovery, research and development. It should be noted that the antimicrobial challenge is as much economic as it is medical. We must find an alternative to the reimbursement model, whereby profitability of bringing new antibiotics to the marketplace is linked to volume of sales. That is because we are actually seeking to limit the use of such drugs to preserve their power; to use new drugs as a point of last resort, as it were. To use an analogy, it is almost like the fire service—we need it to be there and to be effective, but we do not want to use it. However, nobody would dispute the necessity of investment and funding for that key emergency service.

To overcome this task, it is essential that measures are taken to co-ordinate a review of progress in new drugs, alongside the activation of research and development by industry for new antibiotics and related products achieved by Innovative Medicines Initiative projects. On the economics, we need to seek innovative solutions, with the pricing conditions and “pull” measures needed for the long-term sustainability of new antibiotic development, so that they are promoted. An example of that is the compact initiative of the European Federation of Pharmaceutical Industries and Associations to promote a sustainable business model and adequate conditions for the introduction of effective new antibiotics.

The O’Neill review, published last year and described last week by a columnist from The Times as

“the best argued and most accessible”

report in his lifetime, was very clear on this matter. Lord O’Neill found that much more needed to be done to close the substantial gap in research and development funding between AMR and the best-funded areas of medical science. The report being launched this week quantifies this further, and states that $40 billion is needed over 10 years, representing about 0.05% of G20 countries’ current healthcare spend. I will not claim that that sum is insignificant, but it is certainly affordable given the magnitude of the threats we face.

For improvement on a global level, the report makes it clear that co-ordinated efforts must be made in the veterinary sector, where I am pleased that tangible progress has been made in the UK. Figures from the Countryside Alliance show that sales of livestock antibiotics across the sector have fallen by an average of 27%—their lowest levels since records began—which is a good start, because a failure to address AMR in livestock has fundamental implications for the treatment of human diseases. For that reason, mirrored co-operation between Government Departments is essential.

While I am delighted that we are joined by my hon. Friend the Under-Secretary of State for Health, this matter also encompasses the Department for Environment, Food and Rural Affairs, the Department for International Development and the Department for Exiting the European Union. We need a clear commitment from the Government that that co-operation is there and that an interdepartmental strategy is on the agenda. Beyond that, we require what Antibiotic Research UK describes as a “grand alliance” to come together, comprising the Government, the pharmaceutical industry, collective medical research charities and academics.

To reduce further the overall use of antibiotics in the veterinary sector, guidelines have been developed for prudent use. The EU road map also proposed the creation of an animal health legal framework, based on the principle that prevention is better than the cure. Take the example of colistin. In 2015, evidence emerged of colistin resistance with the potential for transfer and spread between bacterial species. In order to preserve colistin for human medicine and limit the spread of resistant genes, the European Medicines Agency imposed strict limitations on its use and recommended the withdrawal of marketing authorisations for all oral colistin in veterinary medical products. Professor Galloway, from the Royal College of Physicians and Surgeons of Glasgow, is calling for a full review of the use of antibiotics used in both animal husbandry and human clinical practices, and I believe the Government should actively consider that suggestion.

In the UK, some sectors have conclusively beaten the target set by the veterinary medicinal products directive. Such industries represent very clearly what we are aiming for with the SMART targets I referred to at the beginning of my speech. In many cases, progress has been made through voluntary schemes. I request that the Government look directly into specific sectors in order to investigate best practice and what we can learn from it.

However, we must go further as a global leader and recognise that this is an international challenge. Almost 80% of antibiotics used in the USA are not taken by people but used within the livestock sector, which I find astonishing. In India, people consume an average of 11 antibiotic tablets per year. Only today, data has been released showing that antibiotic resistance is growing in Europe. Progress that Britain makes will be quite simply irrelevant in the absence of a confident international stewardship programme.

The British Government must act as an example in their commitment to tackling resistance head-on globally and, while I recognise it is not in the specific gift of my hon. Friend the Under-Secretary of State for Health to dictate his published ministerial responsibilities, I believe it is timely explicitly to add antimicrobial resistance to those responsibilities. That symbolic act would send a clear message that Britain is committed to remaining at the forefront of the fight against antibiotic resistance.

[Dr David Drew (Stroud) (Lab/Co-op)]

I share the hon. Gentleman’s concern about the problems with antibiotics, which we see with farm animals. However, there is also now a problem over supply, due to the increased concentration of the pharmaceutical industry—there are new mergers coming along as we talk. Does he think that that is worthy of proper investigation? Those companies can turn the supply on, but they can also turn it off, which can also be life threatening.

[Julian Sturdy]

The hon. Gentleman makes a fair point. As I said, we have to encourage new antibiotic discovery. In our current system, the big pharmaceutical companies have been reluctant to come forward and put that money in, because the financial model just does not work.

However, encouragingly, we are now seeing smaller companies and spin-outs—from science departments within medical departments within universities—looking specifically at antibiotic discovery. There is something to be said about that, and again we have to look closely at it, because it could be used to our advantage. I encourage the Government to look at that, I encourage all Members who have a university in their patch to talk to them and I encourage those who have any of these small companies to visit and talk to them. It is incumbent on us all as parliamentarians to go out there and promote what is happening on our doorstep.

There is no doubt about it: the big pharmaceutical companies are finding it very difficult to promote new antibiotics. It takes 15 years for a new antibiotic to come to the marketplace from the start of the process of discovery. Companies have to make a huge investment. If that investment leads to a drug that is not actually used, because we are using it as a point of last resort, the financial model as it currently sits just does not stack up. That is something we have to address.

The discovery and development of antibiotics should not be seen as a curse. However, we must recognise that responsible steps now need to be taken to ensure that they persist and that we keep resistance firmly locked down. The antibiotic age can remain a golden one, and our collaborative actions can prevent a fall into what has been described by many as a medical abyss without antibiotics.

In the antibiotic age, we are all on the same side. This is not about politics or what the UK can do; it is about global action. That cannot translate into a lack of zeal and an absence of the will to win. I very much look forward to hearing what the Minister has to say. The UK Government have made great steps forward. The O’Neill report was a great start, but we have to continue that, and we have to be world leaders in this. We have a great opportunity to do that, if not for our generation, for future generations.

--- Later in debate ---

[Julian Sturdy]

I thank all hon. Members for their contributions and the Minister for his response. From speaking to him previously and from what he has said today, I know he understands the task ahead not only for us in the UK but globally. It is important to remember and to pay tribute to the work that has already been done, which was ably led by David Cameron and the O’Neill review—one of the most important reviews that was set out by the then Prime Minister.

We have a job to do in this House. I have attended packed Westminster Hall debates on issues such as cycling and bee health—I am not decrying those important issues; I do not want my inbox full of emails on that tonight—but if we are not getting hon. Members from all sides of the House in for a debate on something as important as antibiotic resistance that affects us all, all our constituents, our country and the globe, that is quite worrying. If all hon. Members take that away from this debate, that will be encouraging.

We are an immensely fortunate generation to have been born and to have grown up in the world of the antibiotic age. I look at this issue for the sake of future generations. I have an interest in that because I have young children, and I think the Minister has children of a similar age. When the next generation hit their 30s and 40s and begin to start families of their own, there is a real possibility that their children will be born into a world without antibiotics—a post-antibiotic age. That is quite terrifying. It is essential that the required steps are taken for that next generation.

If we get that right, no medals will be handed out. No statues will be erected in the streets. If the Minister becomes the Minister with responsibility for antibiotic resistance and succeeds in his pledges, he will not be immortalised in a statue in the centre of London. The world will continue as it is, and many will not even know the threat that faced them. If we stand by and do nothing, however, history will be extremely unkind to our generation. It is essential that we act. The UK is making great steps forward, but there is so much more to do and it has to be done on a global stage.

Question put and agreed to.

Resolved,

That this House has considered World Antibiotics Awareness Week.

Pandemrix Vaccine: Compensation

Julian Sturdy Excerpts

Wednesday 8th March 2017 Westminster Hall

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

I beg to move,

That this House has considered compensation and the Pandemrix vaccine.

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

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

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

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

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

[Julian Sturdy (York Outer) (Con)]

I congratulate the hon. Lady on securing this important debate. My constituent Ben Foy suffers from narcolepsy and cataplexy caused by the Pandemrix vaccine. I raised his case in the House in 2014, 2015 and 2016, and I now do so in 2017. The Department for Work and Pensions accepts the causal link between my constituent’s illness and the Pandemrix vaccine that he received, on NHS advice, in 2010. Does she agree that the Government have a moral obligation to quickly resolve the issue of payments to those who have been so badly affected by Pandemrix, not drag the process out with unsuccessful appeal after unsuccessful appeal, which is what seems to be happening at the moment?

[Tracy Brabin]

I will come on to that point, but I totally and utterly agree. As the hon. Gentleman will know, the Government’s foot-dragging is causing unacceptable and upsetting suffering and distress for the families involved.

Although I acknowledge the difficult balancing act involved in weighing the risk of a pandemic against the risk of fast-tracking a vaccine’s licensing, that does not excuse the fact that some patients were not made aware of the facts, nor does it excuse the Government from subsequently attempting to avoid responsibility for the damage caused. Making the vaccine available at the time of the pandemic clearly came with a degree of risk. GSK was given an indemnity from any liability by the UK Government. My constituent has made it clear to me that she was not informed that the vaccine had not been fully tested or that GSK had obtained an indemnity. Therefore, as the result of advice given to his mother by the NHS, my young constituent Sam received the vaccine on 27 April 2010. He was four and a half years old.

Four months later, concerns were raised in Finland and Sweden about the association between the vaccine and narcolepsy. Following that, a study by the UK Health Protection Agency and others, which was funded by the Department of Health and the HPA, found that around one in every 52,000 to 52,750 Pandemrix jabs led to narcolepsy. The results of that study were published in The BMJ in 2013 and were consistent with the findings of the aforementioned Finnish and Swedish studies. Pandemrix stopped being given to children in the UK in 2011, but that was too late for Sam and dozens of children like him.

Sam has been affected by 14 severe or chronic neurological issues, including narcolepsy and cataplexy. He suffers from night terrors in which he can see and smell dead people. He suffers from a damaged heat regulation system, automatic behaviour, micro-sleeps, temper issues, joint and muscle pain, anxiety and depression. Sam is now 11 years old and has faced unimaginable strain. In addition to being prohibited from enjoying a normal childhood, he lives in a world in which most people know little about his condition and misunderstand his symptoms. Shockingly, on one occasion while Sam was passed out in the street as a result of his condition, a dog walker allowed her dog to urinate on him. No 11-year-old should be expected to face the indignity and pressures that children such as Sam live with as a result of the Pandemrix vaccine.

Tragically, Sam has tried to commit suicide several times. We know from a coroner’s report that one 23-year-old woman took her own life after telling her family that living with narcolepsy after receiving Pandemrix had become unbearable. This is all too desperately sad.

The link between Pandemrix and narcolepsy has had a profound effect on families. My young constituent’s parents have found themselves under immense pressure, and in October 2016 his mum Di had no choice but to call a liquidator into her engineering business. It was impossible for her to work and ensure that her son’s complex care needs were met. Life is unacceptably hard for Di and Sam. They are very grateful to Narcolepsy UK, which receives no assistance from the Government but has been a source of huge support for them.

The Vaccine Damage Payments Act 1979 was intended to help to ease the burden on individuals for whom a specified vaccine had caused severe and permanent disability.

O’Neill Review

Julian Sturdy Excerpts

Tuesday 7th March 2017 Westminster Hall

[Kevin Hollinrake]

My right hon. Friend is right that bacteria can move from animals into humans, and the O’Neill review was clear that we need to take action in agriculture as well as our health services.

The national risk register states that we will be unable to treat some 200,000 people with existing drugs and

“around 80,000 of these people might die.”

That is a Government report.

[Julian Sturdy (York Outer) (Con)]

My hon. Friend is making a powerful argument. Is it not true that it takes about 15 years for a new antibiotic to get to the marketplace? Given the position that he has just laid out—deaths and resistance are happening already—that is quite frightening.

[Kevin Hollinrake]

My hon. Friend makes a very good point. We need to take action now because of the delays in producing new drugs.

Pharmacies and Integrated Healthcare: England

Julian Sturdy Excerpts

Wednesday 11th January 2017 Westminster Hall

[Mrs Anne Main (St Albans) (Con)]

I beg to move,

That this House has considered pharmacies and integrated healthcare in England.

It is a delight to serve under your chairmanship, Mr Bailey. In the light of the extreme pressures on our health services, particularly in the winter months—much has been made of this recently in the media, although it is not dissimilar to many other years—with our over- burdened frontline services, clogged up A&E departments and congested GP services, I believe it is vital that we explore new models of delivering patient care, particularly an integrated model of patient care.

In 2016, there was an average of 2,500 more attendances at major A&Es a day compared with 2015, which is a 6% increase. People aged 80-plus have the highest rates of A&E attendance. As a country, compared with only a few decades ago, we are now fortunate enough to benefit from innovative drug treatments, greater survival rates from complex surgery, better nutrition and better education; but, as a population, many of our residents are living longer. For example, in my constituency of St Albans, the average life expectancy for a pensioner is over 89 years—it is nearly 89 and a half years. However, for far too many of our constituents, the latter part of their lives brings a prolonged period of frail health, with dementia and diabetes on the rise and an increased incidence of ill health linked to lifestyle choices such as lack of exercise, alcohol, obesity and smoking. That period at the end of our lives is often not characterised as a period of good health.

We need to come up with a seamless, flexible model that makes the best use of precious resources and benefits patients. It is therefore timely to explore in this debate the role that local pharmacies play in local health services and the potential role that they might play to ease the strain on more congested frontline services. I also want to make the Government aware of the continuing importance of pharmacies in communities and their potential to do so much more.

In an ever-changing world, we have a duty continuously to challenge the old models of health delivery systems. In October, the Government proposed to reallocate money to NHS frontline services. We all accept that the NHS is labouring under huge financial pressures, so any areas in which precious resources are dissipated due to inefficiencies or duplications ought to be considered. It is important to integrate community pharmacies into the NHS urgent care system and GP services. We need to promote a pharmacy-first culture for minor ailments to take pressure off frontline services.

Community pharmacies currently see some 1.6 million people a day in the UK. It is worth noting that the recent standard patient experience report for the East of England Ambulance Service NHS Trust in 2016 showed that 0% of respondents in my county of Hertfordshire had contacted a walk-in service, an out-of-hours GP service or a pharmacy service before contacting the ambulance service. I think we can agree that a lot more can be done to take the pressure off emergency frontline services.

Pharmacies are the most accessible health services in most communities: they are found on high streets, in supermarkets and in shopping centres. In St Albans, we have some great independent local pharmacists who want to get more involved and we even have the headquarters of the National Pharmacy Association, which supports independent pharmacies and helps them grow their businesses. We need to look at the current pharmacy model. In St Albans, patients can choose from five dispensing pharmacies within a half-mile area of the high street. Some pharmacies are just over the road from each other, and some have only yards between them. Given the Government’s financial support of £25,000 for those dispensing 2,500 prescriptions per annum, which comes directly out of our NHS budget, it is easy to see why we need to look at the model of provision and ask how we can get a better bang for the NHS buck.

I accept the Government’s assertion that a balance must be struck to ensure that pharmacies remain accessible but are not excessive in number and, importantly, that we have a range of offering. All the local pharmacies on the high street in St Albans are closed on Sunday, whereas the big supermarket pharmacies are open, in line with their shopping experience. It is worth noting that Sunday is the busiest day for most A&E services. However, a recent survey showed that 50% of people prefer, for a variety of reasons, not to use a pharmacy in a supermarket, particularly the retired, the elderly and other frequent pharmacy users. We therefore need to examine the model of opening hours, as well as location and the type of provision on offer. Given that many supermarkets are located outside the town centre, their pharmacies are not accessible to everyone, particularly the most vulnerable in society. Diversity and accessibility of provision are key to integrating pharmacy and health services.

Let us explore what pharmacies could do. Pharmacies should be capable of providing general health services. They could increasingly work beyond the traditional role and offer services to promote sexual health, increase physical wellbeing and give advice on flu immunisations and drug-harm prevention, for example. However, if we expect pharmacies to do more, we need the funding formula to reflect the quality of service they provide. That is what the pharmacies want. Local pharmacists in St Albans believe that they should be the first point of contact for advice on medicines, minor illnesses, healthy living and wellbeing. To facilitate that, the Quadrant pharmacy in St Albans has undertaken a major refit, with a brand new consulting room, and invested heavily in technology, including an expensive automated robot for dispensing medicine.

I visited the Quadrant—I am sure that many hon. Members made similar visits after the Government’s pronouncements in October—in November last year to discuss the opportunities and challenges facing small independent pharmacies. The pharmacy is a friendly, attractive place to pop into and is well regarded by local people. It has the potential to do so much more, but that extra service does not come without a cost. If people spend time talking to their local pharmacist, the pharmacy gains nothing if they then walk out of the door and go off to see their GP. It is important that we recognise the role pharmacies are being asked to play in giving advice, holding consultations and, potentially, dispensing services. There must be some reflection of the cost involved in the staff time that it takes to do those things.

Rachel Solanki, the director of the Quadrant pharmacy, told me:

“General Practice will need to continue to be the gate keeper of referral to secondary care.”

However, she helpfully suggested

“a whole raft of services and support for self-limiting and long-term conditions”,

such as dealing with uncomplicated urinary tract infections in women, impetigo and bacterial skin infections; managing non-complex patients with high blood pressure; performing healthy heart and cholesterol checks; and supporting patients diagnosed with diabetes. The list was quite exhaustive. She proposed that pharmacies could and should act as wellbeing hubs for the communities they serve. She went on to say:

“The community pharmacist, a highly-skilled and trained individual, is the most accessible healthcare professional and is available without an appointment. If a mechanism could be found to incentivise and remunerate, we are confident the mutual agendas would be achieved.”

That is her view, and that of many other local pharmacists. There is a mutual agenda for providing good healthcare for patients that could be achieved if pharmacies were brought into play.

The Government’s proposals in October last year were a step in the right direction, but we need more detail. I want to ask the Minister a series of questions, and hopefully he will be able to answer some of them. How can the Government make smaller and local pharmacies more attractive and accessible for everyone? How can the Government encourage GPs to offload services such as flu jabs on to pharmacies? In saying “offload”, I recognise that where there is a cost to the pharmacy and the GP is in receipt of payment for that flu jab service, that needs to be considered, but I would like to hear the Minister’s views on that. How can the Government promote the pharmacy as an alternative local health provider that can be trusted and deliver a quality service? This is not just about having a shop that you take your prescription to and maybe pick up a few aspirin; it is about the pharmacy being a health provider. How can the Government increase pharmacy capacity to provide a broader range of health services and ensure the correct remuneration for the service provided?

Responding to an oral question on 2 March 2016, the then Health Minister, Lord Prior, stated:

“The big driving force going through healthcare and community pharmacy today is one of integration, which means that community pharmacies must in future work more closely with their local hospitals and GPs.”—[Official Report, House of Lords, 2 March 2016; Vol. 769, c. 817.]

That is the point of today’s debate. The Government have pursued several polices that are intended to lead to better integration of community pharmacies, including the introduction of a pharmacy integration fund as part of the 2016-17 community pharmacy settlement.

Last month, Richard Murray of the King’s Fund published a paper looking into the role of community pharmacies in the NHS. In December 2016, the Minister described that review as

“an essential road map that sets out how we are going to move the community pharmacy network away from a remuneration model based just on dispensing and on to services as well.”—[Official Report, 20 December 2016; Vol. 618, c. 1301.]

When can we expect a response to that incisive review?

The NHS “Five Year Forward View”, which was published in 2014, recognised that GPs are “under severe strain”, and many of us will have met GPs locally who have restated that view to us. It also states that steps will be taken to:

“Build the public’s understanding that pharmacies and on-line resources can help them deal with coughs, colds and other minor ailments without the need for a GP appointment or A&E visit.”

I urge the Government to listen to pharmacists when considering how to take that integration forward, as we do not want to lose what is good in the system, especially where it works well for our local patients. For example, I know that the Government are piloting an urgent medicine supply service. Rachel Solanki, the director of the Quadrant pharmacy, tells me that in Hertfordshire there is a local scheme that is so well regarded that it has now been rolled out again. Her concern is that the proposed national service does not necessarily promote a pharmacy-first culture. The Minister may wish to clarify that that is not the case, but that was the view she expressed to me. She was worried that there might be a perverse incentive to encourage patients to phone NHS 111 in order to get a referral to the pharmacy service.

In an email Rachel wrote to me recently, her view was that the change could have the unintended consequence

“of actually increasing NHS 111 calls for emergency medicines when they should be directed to community pharmacies first. Our local service offers both the facility to help the patients get their medicine but, more importantly; also offers incentivisation of the community pharmacy to promote ordering medicines in a timely way to reduce medicines waste, and hopefully therefore preventing a further incident of need.”

She thinks it unlikely that the proposed 111 service will operate both the services that we have locally and the new model, and she worries about losing the existing local scheme. Will the Minister reassure me by saying whether schemes such as the one operating in my county of Hertfordshire could still operate in tandem, or will they be mutually exclusive?

[Julian Sturdy (York Outer) (Con)]

My hon. Friend is making a very powerful speech. Does she agree that although we must encourage clinical commissioning groups to work closely with community pharmacies—she has highlighted some good examples of that—the practice is patchy across the country? There is reluctance in some areas for clinical commissioning groups to engage with their local pharmacies. We have had that problem in York, where the CCG has been very reluctant to talk to local pharmacies. Local MPs, across parties, have written to it and finally got it to engage but it has been very slow, and we have to speed that up. We have great examples in some parts of the country, but poor examples in others.

Accelerated Access Review

Julian Sturdy Excerpts

Tuesday 13th December 2016 Westminster Hall

[Ian Austin]

My right hon. Friend is completely right; he raises a point I will make shortly. It is good that he is here to support people with cystic fibrosis in his constituency, and to bring his knowledge and experience of the national health service to bear in the debate.

The Cystic Fibrosis Trust’s proposal would provide foundations for a managed access scheme for the drug. That was in line with the interim findings of the accelerated access review, which recommended the merits of such an approach and referred to the UK cystic fibrosis registry as an exemplar. I will say more about the accelerated access review in a few moments.

As expected, seven months later NICE referred to a lack of long-term data in rejecting Orkambi for use in the NHS. That was despite Orkambi’s being proven to halve hospitalisations and NICE’s recognising it as a

“valuable new therapy for managing cystic fibrosis”

with significant clinical benefits, as well as

“wider benefits to society for people with cystic fibrosis and carers of people with cystic fibrosis.”

[Julian Sturdy (York Outer) (Con)]

I congratulate the hon. Gentleman on securing this important debate. He correctly points out that this is not just about the way in which Orkambi improves quality of life, which I know is extremely important, but about cutting hospital admissions. That has to be taken into account when we look at the wider cost implications of the drug. What we need is time for the drug to be given the chance to prove its worth.

[Ian Austin]

The hon. Gentleman is completely right to say that Orkambi could reduce hospital admissions, and could shorten the amount of time people spend in hospital when they have been admitted.

In its statement, NICE referred directly to the trust’s proposal as a potential solution to the shortage of long-term data. With the NICE process exhausted and seven months wasted, we hoped that the way would be clear for direct negotiations between the drug manufacturer Vertex and NHS England, which would allow for a speedy resolution to the situation. However, Department of Health officials then demanded that the drug be put through a rapid review process, which, at 16 weeks, is anything but.That process is based on exactly the same criteria that had just seen Orkambi denied to those who need it. Vertex has declined to enter the process, because of the certainty that it will come to nothing.

New data published in October at the North American cystic fibrosis conference, which my right hon. Friend the Member for Leigh (Andy Burnham) mentioned, are based on 96 weeks of trials and show that Orkambi slows the decline in lung health by up to 42%. That is comparable with the 47% slow in decline caused by the transformational treatment Kalydeco, which is widely available in the UK for a less common mutation of cystic fibrosis. Those data were unavailable to NICE but clearly illustrate that drugs such as Orkambi need the chance to prove their worth in the long term. That also underlines the fact that we now have a situation where people with cystic fibrosis face discrimination by genotype, because they are being denied the same level of treatment that people with a different genetic mutation of cystic fibrosis receive.

Twelve months after licensing, negotiations are at a standstill. I understand that Vertex is keen to offer a substantial discount, but for commercial reasons would need to do so confidentially. It would like to take up the trust’s offer of monitoring the effectiveness of Orkambi for a trial period. That could build on the American data and allow NHS England to conduct final negotiations based on an accurate reflection of the drug’s effectiveness.