Community Pharmacies

Julian Sturdy Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Julian Sturdy (York Outer) (Con)]

Like many Members, I have been fortunate over the years to see the brilliant services provided by local pharmacies in my constituency, including in the communities of Haxby and Wigginton, Fulford and Poppleton, to name but a few. I have also witnessed the very important role that pharmacies play in delivering care in the community. We must ensure that they are properly incorporated into the delivery of primary care.

I have the utmost respect for the new Minister and I wish him well in his new role, but I fear that he has been given a hospital pass. Having said that, I understand why he wants to make reforms. I agree that we need to improve the service offered to patients, allocate resources more efficiently and ensure better integration with the wider NHS. I welcome the recently announced pharmacy integration fund, which aims to link pharmacies to primary care.

If we are truly seeking to integrate services better, however, and to reduce reliance on funding to pharmacies for simply existing and to promote high-quality care, we must further expand the role of pharmacies and the treatments that they can administer. That would help shrug off the lingering perception that pharmacies are simply drug dispensers. For example, could things such as the winter flu jab be overseen exclusively by pharmacies?

I also support the growing calls for a truly national minor ailments scheme that directs patients to pharmacies and away from GP practices where appropriate. I welcome the Minister’s announcement that NHS England hopes to have such a scheme in place by April 2018. I hope that it will be a transformative moment for community pharmacies and primary care more widely, and I look forward to scrutinising it.

I am also pleased that, through the introduction of a pharmacy access scheme, the Minister is seeking to address some of the concerns about rural communities losing their pharmacies. He has said that 40% of pharmacies are in clusters of three or more, and I agree that we should introduce a better funding system to disincentivise that practice.

That brings me to the one-mile rule. Although I understand completely the principle behind it, I remain concerned about whether it will truly ensure that

“a baseline level of patient access to NHS community pharmacy services is protected.”

In the short time that I have left, I will cite an example in my constituency. Fulford pharmacy, which is a small, independent business and is not part of a large chain, sits only 80 metres away from the one-mile rule and is, therefore, ineligible for the pharmacy access scheme. It is not in one of the 20% most deprived areas, either. As a result, I fear that the 3,000 residents of Fulford could lose access to that fantastic service, given that the next nearest pharmacy is some distance away in Fishergate. May I encourage the Minister to consider introducing flexibility or a case-by-case assessment to ensure that pharmacies that serve specific communities do not fall by the wayside?

I will reinforce that point in the last few seconds that I have left. I am told that two branches of Boots pharmacy in terminals 3 and 5 of Heathrow airport will receive pharmacy access scheme payments, as they are more than a mile apart, despite clearly not serving any specific community.

Antibiotics: Research and Development

Julian Sturdy Excerpts

Tuesday 26th April 2016 Westminster Hall

[Julian Sturdy (York Outer) (Con)]

I beg to move,

That this House has considered incentivising research and development of new antibiotics.

It is a pleasure to serve under your chairmanship for the first time in this hall, Mr Evans. I am delighted to have secured the opportunity once again to introduce a debate on the increasingly urgent issue of antibiotic resistance. I first debated this issue back in October 2014, when I discussed the wide-ranging causes of antimicrobial resistance—AMR—and our urgent need to address the problem head-on.

Today, I will focus on the most pressing elements of the issue: the need to incentivise more research and development of new antibiotics so that we have new drugs coming on stream to meet our future needs. Before I discuss the development of a new funding model for antibiotics, I will briefly explain exactly why AMR is such a pressing issue. This is far from being a problem only for the future; it came as a shock when, before my last debate, doctors in my constituency told me that patients were already experiencing the devastating effects of AMR. Across the country, we are seeing an increasing number of patients in intensive care units who have resistant infections, meaning that there is no effective treatment available. Antimicrobial-resistant infections already kill some 50,000 people every year across Europe and north America, but sadly the reality of AMR today is nothing compared with the nightmarish scenario of the future. The initial paper of Lord O’Neill’s AMR review concluded that

“a continued rise in resistance by 2050 would lead to 10 million people dying every year”.

That is more than the number of people who will die of cancer, and it is double the number of people who will die of cholera, diabetes, diarrhoea, measles, tetanus and road traffic accidents combined. Some might say that AMR is the biggest threat to mankind.

We have also been warned that the secondary health effects of AMR could result in a return to the dark ages of medicine. Our national health service and other modern health systems across the world rely heavily on antibiotics. When surgery is undertaken, for example, patients are given antibiotics to reduce the risk of infection. In a world in which antibiotics do not work, surgery will become far more dangerous. Many routine procedures, such as hip operations, will become too risky for many elderly patients, depriving them of their mobility and their active lives. Cancer treatments such as chemotherapy supress patients’ immune systems, making them more susceptible to infections. Without effective antibiotics to prevent those infections, such life-saving treatment could no longer be an option. As Jeremy Farrar, a director of the Wellcome Trust, said:

“We are sleepwalking back into a time where something as simple as a grazed knee…will start to claim lives.”

Thankfully, medical opinion is, in the vast majority of cases, that the looming global crisis can be avoided if we take action, but it must be taken sooner rather than later. It is encouraging that there have been numerous positive developments since this topic was last debated in Westminster Hall. The £20-million Fleming fund was announced in March 2015, and it will support the delivery of action plans for AMR laboratory surveillance across the world, with a particular focus on low-income countries. Just before the 2015 general election, I was delighted that the Conservative party manifesto said:

“Antibiotic resistance is a major health risk so we will continue to lead the global fight against it, taking forward the recommendations of the independent review launched by the Prime Minister”.

I promise that that will be my last reference to party politics, because this issue has the support and attention of every party in this House. AMR is such a huge issue that it transcends party politics.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

I thank the hon. Gentleman for securing this debate on an important subject. Before he completely passes on from party politics—I agree that this issue cuts across all party politics—does he agree that the nature of antibiotics, and the fact that we want to use them as little as possible when they are discovered or invented, drives against the free market system, in which new products and services are used as much as possible? For that reason, the Government and the public sector must take action, because to be effective, antibiotics should be used not as much as possible but as little as possible.

[Julian Sturdy]

I agree with the hon. Lady’s last comments. She is right that antibiotics must be used as a last resort, which is why, as I will say, the current funding model for antibiotic research is broken, and why we have to correct it.

[Maggie Throup (Erewash) (Con)]

I take the point raised by the hon. Member for Newcastle upon Tyne Central (Chi Onwurah), with which my hon. Friend the Member for York Outer (Julian Sturdy) has just agreed. This is also about having the right diagnostic tests to ensure that people who need antibiotics receive them while ensuring that they are no longer handed out like sweets.

[Julian Sturdy]

My hon. Friend is right. Later in my speech, I will discuss the model of how antibiotics are used across the country. It is chilling how antibiotics are used in different parts of the country. Testing to find out resistance to certain antibiotics is also important before any antibiotics needed are used. It is not just a matter of how we bring new antibiotics to market, which can take 15 years; it is also about how we protect our existing armoury of antibiotics to buy us time for those new antibiotics to reach the market.

The £1 billion Ross fund was announced by the Chancellor in the spending review of November 2015. Some £350 million will be spent fighting AMR by strengthening surveillance of drug resistance and laboratory capacity in developing countries, and by delivering the new global AMR innovation fund with China. In January 2016, at the World Economic Forum in Davos, 85 major pharmaceutical and biotech companies agreed to the declaration on combating antibiotic resistance, which demonstrates the industry’s willingness to take up the challenge. Earlier this month, the Chancellor addressed the issue once again by highlighting the importance of AMR at the International Monetary Fund in Washington DC. He confirmed what the industry has long been telling us: that the reimbursement models for antibiotics are broken. I entirely agree that a global overhaul is required, and I will focus on that issue today.

Lord O’Neill has also backed proposals to change the way we develop new antibiotics for the marketplace. We all look forward to the AMR review publishing its final set of recommendations in the months ahead, and the Minister might be able to give us a firmer timescale for that review. In my previous debate on antibiotic resistance, I raised the key issues at stake in the growing challenge of this continuing problem. We know that using antibiotics inappropriately increases resistance and the risk associated with routine treatments. In the last debate on the subject, I mentioned that in India, many prescriptions are purchased over the counter to treat a wide variety of unsuitable illnesses, often with no professional diagnosis. Such practices compound the problem. However, it is greatly encouraging that many countries around the world have now woken up to the impending disaster that we could face if we simply do nothing.

As a consequence, things are starting to move forward, which must be seen as positive. However, the central challenge of getting new antibiotics on stream remains. As the Chancellor said earlier this month and as we have heard, the current funding model is no longer fit for purpose. The O’Neill report makes it clear that it typically takes about 15 years for an antibiotic to go from the initial research stage to final delivery to the marketplace. For that to happen, a large amount of money is required up front to fund the project, at a stage when the company has absolutely no idea whether the drug will succeed. Astonishingly, only about 2% of products, or one in 50 proposed new antibiotics, successfully make it to the marketplace. In the vast majority of cases, large sums of money are invested with no financial return whatever.

Although to a certain extent that is true of the manufacture of all new drugs, the problem is far worse for antibiotics. Conditions such as cancer or diabetes often closely follow demographic trends, so new drugs are also used as the medication of choice for cancer or diabetes, as they are more effective than the older prescriptions. In the case of antibiotics, however, generic products can treat infections as well as new drugs for far less money, except where there is resistance. Furthermore, in the attempt to slow the development of resistance, new antibiotics are often held back and are prescribed only when everything else has failed. That is the right thing to do. The market for new antibiotics is therefore limited to a small section of patients, as new drugs are used only when existing drugs are no longer effective. They will be required as a first-line treatment only many years after their introduction, by which time their exclusive patents have often expired.

That may explain why so many pharmaceutical companies have, sadly, exited the market over the years. Of the 20 pharmaceutical companies that were the main suppliers of new antibiotics back in the 1990s, only four remain. Furthermore, only five new classes of antibiotics have been discovered in the last 15 years. Sadly, some companies are waiting for resistance to rise before they even explore the viability of investing in a new product, which is clearly not in the best interest of patient health and wellbeing, or of the future of health care as we know it. Under the current funding model, the profitability of any new drug depends entirely on how many units are sold. As discussed, that is not suitable for the development of new antibiotics. Incentivising the increased use of antibiotics only increases resistance in patients, which can have devastating consequences.

The O’Neill review therefore proposes the creation of a more predictable marketplace that will sustain commercial investment in antibiotic research and development. A key proposal that has the full support of many pharmaceutical companies is for profitability to be de-linked from volume of sales for new antibiotics. That would guarantee developers an acceptable return on their investment when they produce a new antibiotic that fulfils an unmet clinical need. That is especially important when volume would not be sufficient to make the product commercially viable, despite its value to the NHS. A de-linked model also has the added benefit of eliminating any incentive to oversell antibiotics needlessly as cure-all miracle drugs, which, sadly, still occurs.

Before being elected as a Member of this House, as many know, I was a farmer—a farmer who produces food, not a pharma who is part of the prescription sector—so I do not pretend to know exactly what model is right for our national health service. However, it seems to me that an insurance-based approach that shares financial risk is certainly worth the Government’s consideration. Providing developers of the most important antibiotics with a fixed fee would remove the current financial uncertainty from the marketplace. It would also limit financial uncertainty for the NHS: if there were an outbreak of an infection requiring the antibiotic, the costs would be capped at an agreeable level.

I understand that AstraZeneca and the Association of the British Pharmaceutical Industry have been working closely with the Department of Health to develop such a model. We must continue to encourage innovation while doing what we can to remove the financial uncertainty of developing key new antibiotics. At the same time, it is essential that any new funding model provides the best possible value to the taxpayer. There should be no additional support in areas that are already adequately supported by the marketplace.

[Chi Onwurah]

I thank the hon. Gentleman for being generous in giving way a second time, and for making an excellent summary of the case. Although the state—the national health service—should share the risk, does that not mean that it should also share the benefits and returns? As the economist Mariana Mazzucato sets out in “The Entrepreneurial State”, where the state invests, particularly in services such as this one, there should perhaps be a return to us as well, so that the upside as well as the downside is shared.

[Julian Sturdy]

I do not disagree at all. There must be a return, in the first place, for the companies looking to develop drugs, or they will not come forward. Delivering new antibiotics must be viable. At the same time, it is absolutely right that if the Government, the NHS or, ultimately, the taxpayer invests in those drugs, they also must see the benefit and the return. When we talk about risk, we are talking about shared risk, and if we are talking about shared risk, we should be talking about shared return.

I hope to receive the Minister’s undertaking that he will continue to work closely with companies such as AstraZeneca and with the Association of the British Pharmaceutical Industry to develop a model that supports innovation and removes financial uncertainty. The industry has asked for a clear timetable of action on the development of a new funding model, as it is essential that we turn our positive words into meaningful change.

However, it is worth saying that pharmaceutical companies do not have a monopoly on innovation, and they alone cannot solve the colossal problem of AMR. Within our rich medical marketplace across the country, there are a range of other organisations that are well positioned to offer invaluable assistance in this exciting area of discovery. In fact, the O’Neill review makes it clear that the research and development of antibiotics must be opened up, offering new opportunities for small and medium-sized enterprises, academic research teams and not-for-profit entities to compete with established players in the market.

I am proud to say that one such charity is based in my constituency: Antibiotic Research UK, or ANTRUK, is the first charity in the world set up to tackle the challenge of the scarcity of new antibiotics to treat resistant bacterial infections. Some of the country’s leading scientific and clinical experts form part of this team, and they all share the same concern about the slow progress made in combating AMR, as well as a passion for taking practical steps to take up the challenge.

The charity has three key missions: first, to develop a new antibiotic therapy by the early 2020s; secondly, to educate both practitioners and the public alike about the threat of AMR; and thirdly, to provide support to patients with antibiotic-resistant infection. In less than two years, ANTRUK has raised over £400,000, and it is working towards a programme of developing antibiotic resistance breakers. This technique reverses the resistance and extends the life of existing antibiotics. ANTRUK believes that is the best hope of finding a way of breaking AMR in the short term. Basically, it is a way of buying us more time to develop new antibiotic drugs.

Charities such as ANTRUK are ideally placed to work with both the Government and large pharmaceutical companies in finding a solution to AMR. However, to maximise its effectiveness, ANTRUK needs our support. Despite being a new player in the industry, it is already demonstrating the innovative ways in which it can help to inform public policy on AMR, an issue touched on earlier in an intervention.

In co-operation with an analytic database company, ANTRUK has published a heat map of England that shows how the number of antibiotic prescriptions varies across the country. I am happy to show this map to interested Members. The results are absolutely fascinating. The research demonstrates that the number of antibiotic prescriptions being given is rising at an alarming rate in some of the most hard-pressed areas of England. The key findings are that there is a widening gap in antibiotic prescription. For example, doctors in London prescribe 20% less antibiotics than doctors in the north, and doctors in the most hard-pressed coastal towns in Lincolnshire, Norfolk and Essex are prescribing the most. In Clacton-on-Sea, the number of antibiotic prescriptions by doctors is almost double the national average. Furthermore, doctors prescribe almost 60% more antibiotics in December than they do in August. At first glance, that might not seem surprising, but many illnesses treated by antibiotics are not seasonal in nature. Is this another example of the potential misuse of antibiotics? On a positive note, it appears that the number of prescriptions peaked at 3.4 million in 2012 and has since dropped by more than 5%.

Such research is absolutely vital in the fight against AMR. It demonstrates how charities can complement the vital work of Government and the large pharmaceutical companies. Consequently, I would be most grateful to the Minister if he would agree to meet me and a delegation from ANTRUK to discuss how the Government can assist it with its mission to combat AMR. A key request is for a relatively small amount of funding from the £12 billion foreign aid budget to assist ANTRUK’s work, which could have a revolutionary impact across the world, particularly in developing countries.

I have already had one such meeting with the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for public health, along with my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), who is also my neighbour. Sadly, he could not attend today’s debate. That meeting proved to be immensely helpful, and I hope that the Minister will agree that charities, and not just the large pharmaceutical companies, have a key role to play in the fight against AMR.

Ultimately, antibiotics are often woefully undervalued, in the sense that their price often bears no resemblance to their overall value to society. Since Dame Sally Davies published her report on the threat of AMR back in 2013, there has been an unprecedented focus on the need to change how we tackle the threat of resistance. However, this concern and the widespread discussion of the topic need to be translated into action if we are to tackle the problem head-on.

Antibiotics are the fire department of our health service, and they need a better funding model. We do not pay our firefighters only when they put out a fire; nor do we think that it is a poor return on our investment when they are not in action. Instead, we ensure that we have a well-funded fire service in place at all times, to protect us in our hour of need. It is a service that we all take for granted, and exactly the same is true of our use of antibiotics.

It is probably fair to say that whoever discovers the cure for cancer will go down in history, but the pioneer who prevents a return to the dark ages of medicine through a new antibiotic discovery will probably be forgotten. Nevertheless, the clock is now ticking, and producing positive noises without taking action is simply not an option. I hope the Minister will agree to publish a clear timetable on reforming the antibiotic funding model, and I also ask him to meet me and representatives of ANTRUK, who I know have so much to offer in furthering the process of making our next great discoveries.

I hope that the Minister will work with Departments across Government to give due consideration to the idea of allowing a greater proportion of our generous foreign aid budget to be used in this vital area of study. We have the potential to be world leaders in this field. I have heard, as other Members probably have, reports that Sweden is exploring options for changing its funding model. We must not let Sweden steal a march on us.

It was British innovation that ushered in the golden era of medical discovery. Without action, we risk squandering that legacy for future generations, who may not have the benefit of antibiotics as we know them today. It is absolutely right that global action is required to solve what is ultimately a global problem, as drug-resistant bacteria do not recognise national boundaries. We have the opportunity to safeguard the future of medicine as we know it. To achieve that goal, we must both set the standard and rise to the challenge, and hopefully the rest of the world will follow us.

[Several hon. Members rose—]

--- Later in debate ---

[Julian Sturdy]

I thank the Minister for his comments. He is absolutely right to say that 2016 is a crucial year. There have been many detailed and thoughtful contributions this afternoon, especially about the devastating impact of TB and drug resistance. I want to finish by going back to the firefighter analysis, just to please the hon. Member for Poplar and Limehouse (Jim Fitzpatrick). If we have a chip pan fire, we put it out to prevent a house fire. Antibiotics put out the chip pan fire by preventing the spread of infection, but they also go on to prevent a house fire, because without them we would have widespread outbreaks of infection. Without antibiotics, we could have widespread outbreaks running right across the country, uncontrolled, like wildfires. As many hon. Members have said, a world without antibiotics is a very—

Motion lapsed (Standing Order No. 10(6)).

Community Pharmacies

Julian Sturdy Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Huw Merriman]

Much as I prefer to disagree with everything that is said on Twitter, I could not disagree with that particular scientific survey.

[Julian Sturdy (York Outer) (Con)]

My hon. Friend is making a powerful argument about rural pharmacies. A pharmacist in my constituency contacted me. He said that, if the proposed cuts go through, he will have to cut staff and the apprentices he is training, as well as reduce opening hours and stop the free services, such as the deliveries to housebound patients. The cuts would not just stop the important services that my constituents and many others get from rural pharmacies; it would also deeply impact on skills, and on skills going back into the services that we have to protect.

[Huw Merriman]

I very much agree with my hon. Friend’s point, and I can give another two reasons why pharmacists are so important. Like the post offices, our pharmacists also act as the eyes and ears for the welfare of certain vulnerable constituents. As a staple part of our village and town centres, pharmacies provide the footfall that allows our pubs, restaurants and shops to survive in an increasingly difficult environment.

I am not a deficit denier, and it would be hypocritical to be elected on the platform of balancing the Government books by 2020 and then to refuse to countenance savings in this area. It strikes me, however, that a better focus for efficiency is not the fees for dispensing, but the volume of drugs wasted by over-dispensing. For example, some drugs may be dispensed for a period of three months, only for the individual to change a course of treatment or stop treatment altogether. As soon as those drugs leave the pharmacy, they have to be used or destroyed. I wonder exactly how much money could be saved by dispensing for shorter periods of time.

Additionally, I find it extraordinary that pharmacists deliver NHS prescriptions free of charge to all who want that service. I understand why those who cannot collect their prescriptions should get them delivered, but to provide free delivery, effectively on the NHS, appears to be an area that is ripe for efficiency savings. I welcome the Government’s proposal for a pharmacy access scheme. That would provide more NHS funds to certain pharmacies based on factors such as location and the health needs of the population. To that end, I ask the Government to distinguish and make a special case for rural pharmacies and to focus their efficiencies on those pharmacies that are within closer proximity to each other. If difficult choices are to be made, let us ensure that our constituents can still access a pharmacy within their locality.

Bootham Park Mental Health Hospital

Julian Sturdy Excerpts

Wednesday 3rd February 2016 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

I beg to move,

That this House has considered the closure of Bootham Park mental health hospital.

It is a pleasure to serve under your chairmanship, Mr Bone. It has taken four months to secure today’s important debate about the circumstances surrounding the sudden closure of Bootham Park hospital. I am still waiting for the round table that I requested with the Minister, and for the vital independent investigation into what really happened at Bootham. Although City of York Council and NHS England are carrying out an operational review, but not a strategic review, we must remember that NHS England is not independent of what happened at Bootham.

Today, I will describe the story behind the headlines of how the system failed mental health patients in my constituency and put their lives at risk, why the issues cannot be ignored any longer, and how what happened at Bootham has national implications. Without urgent change, the problems could be replicated anywhere in the country. Two successive Care Quality Commission inspections in 2013 and 2014 highlighted risks at the 240-year-old hospital, including the line of sight around the quadrangle wards, ligature points and doors that presented suicide risks, and not enough staff. Those issues should have impressed upon all involved in the service that the setting was not safe and urgent action should have been taken, but even with the CQC report, inertia followed.

First, too many bodies were involved at Bootham Park. NHS Property Services Ltd owned the site. The commissioning was done by Vale of York clinical commissioning group. Leeds and York Partnership NHS Foundation Trust was the provider. York Teaching Hospital NHS Foundation Trust provided maintenance. English Heritage—now Historic England—had an interest in the listed buildings. Tees, Esk and Wear Valleys NHS Foundation Trust—TEWV—became the new provider from 1 October 2015. By the end, other bodies, including City of York Council’s health overview and scrutiny committee, NHS England, Monitor and the CQC, had a role in proceedings but, strangely enough, the safeguarding board did not.

The problem with the system was the unbelievable scope for too many organisations to blame one another for the lack of progress in addressing the CQC’s safety demands. I do not have the time today to run through each authority’s lack of action, but their cumulative inaction put lives at risk. There should be one authoritative body and one controlling mind, not different jurisdictions with different lines of accountability and different interests that do not relate to one another as they need to. They did before 2012. There must be a place where such matters can be settled. The Health and Social Care Act 2012 gives scope for confusion, which is admitted by those involved and evident from what happened. There are conflicting authorities, so there must be one clear and authoritative oversight of decision making in the NHS, so that everyone knows where responsibility lies. If clarity is needed, it should be quickly and easily established. This is about good governance.

Secondly, there was an issue with making things happen. Why did years pass without the CQC recommendations being implemented? How was that allowed to happen? The CQC stated the necessary improvements, but then the very bodies criticised are the ones who have to implement the repair plan. The lack of external oversight of the work meant failure and delay. External leadership must be provided, to ensure that the right solutions are expedited. Assignment to NHS Improvement would seem the obvious choice. The CQC’s enforcement policy is clearly not working, and who polices it? The CQC has powers, including when there are repeated breaches and when action has not been taken to remove risk, but they were not used. If an effective system was in place, there would be no slippage, confusion or blame, and patient safety would be at the forefront.

Thirdly, the service was to be recommissioned. There was clear dissatisfaction with the provider’s performance and an alternative provider was selected. However, a board member at the time has reported that the Leeds and York partnership trust did not invest in the required upgrades

“in case it did not win the contract”.

In other words, the contract interests of the provider outweighed patient safety, the problems were not addressed expediently, and the hospital was left in an unsafe condition.

[Julian Sturdy (York Outer) (Con)]

I thank the hon. Lady, who is my neighbour, for giving way and congratulate her on securing the debate. I agree with what she has said so far. Does she agree that the Leeds and York partnership not only failed at that point, but had failed for many months down the line? That is why we have to get to the bottom of how it behaved throughout the whole system at Bootham Park.

[Rachael Maskell]

The hon. Gentleman makes an excellent point. We need to get to the bottom of why there has been continual failure not only at Bootham, but in the general delivery of clinical services.

The board member’s revelation was shocking and demonstrated that the current system allows for interests other than that of patient safety to be put first. Leeds and York did not invest in mental health in York, which was noted by staff and patients alike, and let the service be deemed unsafe by the CQC not once but twice, and then a third time, following a third inspection, which I will come on to later. It is also clear that the other bodies involved were not able to accelerate the inactivity. It is not that nothing was happening; discussions were ongoing, and the CQC and the Department of Health knew that a plan was slowly being drawn up by the CCG-led Bootham Park hospital programme board to address the CQC report’s findings, but “slippage” was evident. However, it is clear that frustrations existed between the bodies and blame for inaction was passed from one to the other. People hid behind jurisdictions and clear leadership was lacking once again, which is why there must be external oversight.

How can we have a health system in which there is scope for other interests, lack of focus, delay, lack of enforcement and blame, and in which CQC findings are not managed as a priority? We are back to poor governance and poor frameworks, which is what this debate is really all about. Leeds and York lost the contract to provide mental health services for the Vale of York CCG to TEWV. The trust appealed the decision to Monitor last June. Leeds and York then ran a highly public and politicised campaign that showed it was not interested in improving patient safety at Bootham, only in contractual matters, as I witnessed when I met with its chair. Monitor rejected the appeal and TEWV became the new provider. However, TEWV understandably wanted to inspect the plans for the building from which it would be delivering its services. I stress that the Bootham Park hospital upgrade could only ever be a temporary step, as I outlined in my maiden speech on 2 June 2015. The only safe solution will be a new build.

The CQC made an unannounced inspection on 9 and 10 September 2015. I have been unable to ascertain if this was at their instigation or that of Leeds and York partnership, but it is clear that the 20 weeks’ notice for Bootham to be removed as a suitable location was shortened due to the Monitor appeal process requested by Leeds and York, which the CQC told me impacted on its processes. However, as soon as it was clear that Monitor had turned down the Leeds and York appeal, the CQC knew that the trust would deregister, and that TEWV would have to be registered. The CQC also knew of the safety risks at Bootham, and that repairs had not been made. The CQC therefore knew that it would not be able to register Bootham as a location for TEWV to deliver services. That prompts two questions. First, why did the CQC leave the inspection until September, which then led to a rapid closure? Secondly, why did it then wait over two weeks to announce the inspection’s outcome? A longer run-in would have given more time for transition. We must keep remembering that mental health patients were put at serious risk.

The third inspection found a worsening situation. In addition to the safety risks already identified, staffing levels were worse and unsafe, record-keeping was poor, the water was found to be at a scalding temperature, and the kitchen, lounge and activity rooms gave access to an urn, electrical wires, scissors and knitting needles. A long-standing leaky toilet was leaking urine and foul water to the ward below and there was a risk of Legionella. There were other poor maintenance issues—as the CQC’s inspectors were assessing Bootham, a piece of masonry fell from the ceiling.

The CQC reported more than two weeks later, on Friday 25 September, that Bootham Park hospital must close because of the ongoing safety risks. The need for closure by midnight on 30 September 2015 was because the CQC could not re-register the facility against the new provider as being safe, because it was not. However, if the current provider were to continue to deliver the service, other options would be available.

The Leeds and York trust chief executive said on that same day that if the Vale of York CCG at the eleventh hour did not transfer over the service at the end of the month and let Leeds and York continue to provide it, it could keep the hospital open as it would not have to re-register. He said it was important that that was achieved for months until repairs were addressed. Even as patients were being cast out of their beds and out of our city, contractual issues were being placed above patient safety. The hospital was given five days—including a weekend—to close.

The CQC fulfilled its registration remit, but that meant that the building’s registration was placed above the unsafe environment that sudden closure and relocation would place service users in. That highlights how process was the factor that closed the hospital. Patients were put at risk. There was no scope for review of the decision, no one to assess the balance of risks and transitioning arrangements and no one to agree more time despite the clinicians, patients, families and their MP all highlighting the risks.

Let me mention some of those risks: the closure of the place of safety, section 136 suite, so people in a crisis have to travel at least to Harrogate for an assessment and then on again for a bed for their own safety; the closure of acute beds, with in-patients moved as far away as Middlesbrough, creating a huge risk and insecurity; patients moved away from their support networks and families to strange environments; and the moving of 400 people engaged in out-patients’ services to new locations. I heard how one service user’s condition became so exacerbated on hearing about their move that they became seriously ill, and that is not the only story.

I have heard from a parent how their child totally withdrew—from food and from them—because he was very frightened, and they were fearful for him. I have since supported frightened service users and family members. Out-patients who were suddenly discharged were confused and one senior clinician said it would be a miracle if someone does not die.

The situation continues. We have the place of safety back and we hope that out-patients will also be back in the near future. The acute in-patients’ service will be placed in temporary accommodation from the summer, all being well. However, serious risks resulted from the decision and the deterioration of service users’ mental health occurred. Safety was put after process, with some of the most vulnerable service users placed in an unsafe situation. There was no one in the NHS under the 2012 Act who had the authority to weigh up the balance of risk and decide, when greater risk to the lives of service users could occur with the sudden move, that an alternative call could be made, such as properly planned transition. No intervention was made, not even by the Minister—in other words, no one has overarching responsibility for patient safety in the NHS. That was confirmed by all the bodies. This must change immediately.

The reason I am so vexed is that four months have passed and nothing has been done about the system. Lives remain at risk, were such events to happen elsewhere. My constituents ask me, and I ask myself: is it because we are in the north? Is it because it is mental health? Or is it because the Government are too proud to admit that their Act has created that risk, as before 2012 there was someone who made such decisions?

I know that the circumstances at Bootham Park are exceptional and I trust that this will not happen again, but it could. The lives of my constituents were put at risk, and harm to their health occurred. The system failed them. That is why I and my constituents are focused on the need for a fully independent strategic investigation. Through my work and the health overview and scrutiny committee’s processes and now their operational local review, issues have come to the surface, but an independent review must occur. Lessons must be learnt of the failures in the way that health bodies relate to one another, and the problems that there are with governance. My constituents deserve to have answers.

Serious risks to patients were created in the NHS, and that cannot be ignored. No one died, but do we always have to wait until it is too late for someone before problems are taken seriously and situations are investigated? Agreement to an independent investigation is overdue.

In closing, I want to thank the service users and their families and carers for their continual pressure to get answers as to what happened to their services. They have been extraordinary in these very difficult times and deserve a confirmation that their concerns about the system will be addressed. I again invite the Minister to meet them. I also want to praise the outstanding efforts of all the staff involved in trying to support this unnecessary crisis, and in particular Martin Barkley for providing the leadership as the chief executive of TEWV. After 40 years of working in mental health, Martin is standing down, but I trust that his legacy will be a new, state-of-the-art mental health facility on the Bootham site for York by 2019.

Minister, four months is too long to wait to meet, too long to wait to undertake an independent review of the situation, and too long for my constituents to get the answers they deserve. Lives were put at risk and harm occurred. I trust that we can move the situation forward today.

--- Later in debate ---

[Alistair Burt]

Let me be clear. I spoke to the hon. Lady at an early stage and first I advised that a debate would not be a bad idea to bring issues out. I was concerned that there might be delays with the trust in terms of what may happen with the new premises, but at the time of the incident there was no point in having a meeting about what would happen next. Since then I have genuinely not been aware of a request for a meeting. I am very happy to have such a meeting, but at the time it seemed sensible that we would wait until there was a point in having a meeting. We have met and passed each other pretty regularly in the meantime and, had there been a delay that had caused grave concern, it would have taken a matter of a second to say, “How about that letter —are we going to meet?” but I have not had that conversation.

May I thank my hon. Friend the Member for York Outer (Julian Sturdy) for his interest? We have spoken on this subject from time to time.

Those issues, however, are incidental. The hon. Lady’s interest has been sincere and consistent, and she highlights a pretty unhappy story in which there are circumstances that cause me genuine concern. I will first say a little about what we know about the circumstances and then what we can do next.

Bootham Park hospital could provide care to about 25 to 30 in-patients and about 400 out-patients. The Vale of York CCG had previously announced its intention to commission a new, state-of-the-art facility and is working with NHS Property Services Ltd and NHS England to press for funding. I understand that the intention is to provide a new hospital in York to replace Bootham Park by 2019. At this stage, I have heard no suggestion that that will not be the case.

[Julian Sturdy]

On that point, will the Minister highlight what discussions he has had with the new trust, TEWV, about the new hospital, and whether the timelines are still on track?

[Alistair Burt]

I have not had those discussions at this stage, because my understanding is that the timelines are on track. I suggested to the hon. Member for York Central that if there were concerns about foot-dragging, I was very willing to have that conversation with other colleagues in the room, to ensure that the original stated timetable was stuck to. I was interested in whether there was any opportunity to bring that forward, but my understanding is that that is not the case. I will come to what happens next in a moment.

Until recently, as the hon. Lady said, the hospital was operated by Leeds and York Partnership NHS Foundation Trust. In October 2015, the Vale of York clinical commissioning group ended the relationship with that trust and asked Tees, Esk and Wear Valley NHS Trust—TEWV—to take over the provision of services.

Bootham Park is a very old building, at 200 years old, and is probably one of the oldest buildings in use for patients in the NHS. It is also a grade I listed property, which has not necessarily made things any easier over time. The hon. Lady said in her maiden speech:

“Bootham is not fit for purpose and the CQC concurs.”—[Official Report, 2 June 2015; Vol. 596, c. 512.]

She was entirely right. As such an old building, Bootham Park had a number of problems that modern buildings designed for healthcare services normally avoid, one of which was ligature points—in other words, fixtures or fittings that someone could use to hang themselves from. As the hon. Lady knows, that was sadly not a theoretical problem at Bootham Park, since a lady was found hanging in her room at the hospital in March 2014.

The inquest heard that in December 2013, CQC inspectors had already identified the ligature point that that lady later used, along with a number of others, and asked that it be removed. The CQC’s report, published in 2014, clearly said that there were a significant number of ligature risks on the ward, but that work was unfortunately not done by the trust. The coroner noted at the inquest that he would have expected management to see that the work was done.

The Leeds and York Partnership NHS Foundation Trust fully accepted that it should have done the necessary work. However, when the CQC returned to inspect the hospital in January 2015, it again identified risks to patients from the building infrastructure and a continuing need to improve the patient environment. Refurbishment had been taking place both before and after the January 2015 inspection. Work carried out since February 2014, at a total cost of £1.76 million, included a number of improvements. Among those was an attempt to remove all the ligature points, as well as an overhaul of the water hygiene system and other repairs.

The CQC inspected the hospital again in early September 2015. At that point, it once more recorded a number of familiar problems, although it acknowledged the effort the trust had made to deal with them. The CQC found insufficient staffing numbers; areas with potential ligature points that could have been remedied without major works; poor hygiene and infection control; poor risk assessments, care plans and record-keeping; an unsafe environment due to ineffective maintenance; areas deemed unsafe or found unlocked; and poor lines of sight on ward 6. Furthermore, part of the ceiling had collapsed in the main corridor of the hospital. The debris was cleared away but the area was not cordoned off, which meant people were still at risk of harm.

The building’s listed status meant that it was not possible to remove all potential ligature points. The quadrangle-shaped wards meant there could never be a constant line of sight for nurses to observe patients. Despite the money already spent, the systems for sanitation and heating were outdated. The CQC felt that despite repeated identification of problems at inspections, not enough had been done—the hon. Lady was quite right to point that out—or perhaps could be done to provide services safely at the hospital. Patients remained at risk. The CQC therefore took the decision, as the regulator, to close the hospital with effect from October 2015. The CQC and the Vale of York CCG both agreed, as the hon. Lady said, that the current estate was not fit for purpose.

The timing of the closure was unfortunate. Mental health and learning disability services in the Vale of York were due to transfer from the Leeds and York Partnership NHS Foundation Trust to TEWV on 1 October 2015. That meant the new provider was taking over as the facility was being closed down for safety reasons. However, when the CQC, as the responsible regulator, comes to the conclusion that a building is so unsafe for patient services that they cannot continue and that it cannot be made safe, the local NHS has no choice in the matter.

The hon. Lady spoke about the number of different organisations involved. I understand her frustration, and I am interested in looking at how that has happened. Different bodies have different responsibilities. Bodies’ not having separate responsibilities for regulation, supply, commissioning and so on runs other risks. She is quite right, however, that having such separation and so many different parties involved means we run risks. If people are ducking and diving to evade responsibility—I will come to that in a second—that is a risk too. There is no easy way to do this, but I am quite clear that bodies have specific responsibilities that they should live up to; I do not think that that is necessarily wrong, provided they all know what they are doing. This situation was particularly difficult.

Nearly two years had passed since the CQC identified serious safety issues at the hospital, which seems more than adequate notice of the problems. The CQC said that it could not allow the service to continue indefinitely or allow a new application to open services at the hospital until the risks to patient safety had been addressed. Ensuring continuity of services for patients immediately became a priority. By midnight on 30 September, eight patients had been transferred to facilities in Middlesbrough, two went to another facility in York and 15 were discharged home. Arrangements were made for some 400 out-patients to continue to receive services at other locations in York. That was a considerable undertaking for the local NHS and achieved under great pressure. It was, of course, not what patients needed or wanted. The change and speculation about what would happen was inherently unsettling.

The NHS had to get matters back to an even keel as soon as possible, and that is what has been happening since. As the hon. Lady said, there has been a recovery of the section 136 services at the hospital. The NHS now has an interim solution in the adaptation of Peppermill Court. The in-patient service for older men with dementia, formerly provided at Peppermill Court, will now be provided at Selby. TEWV started work this week on the development of Peppermill Court as an adult in-patient unit and intends the refurbished 24-bed in-patient unit to be completed by the summer. Out-patient clinics continue to be held at a number of locations in York, and TEWV hopes to move all out-patient appointments back to Bootham Park hospital later this month.

That is where we are, with one further caveat: the business of trying to find out what has happened and why. My understanding is that an external review has been taking place, involving a number of different bodies that have had responsibility and are now looking at this. It seems almost impossible for the review to be concluded without its findings being made public, which would be a good opportunity for people to examine exactly what has been done. I want to see that review’s findings. I want to see the questions that the hon. Lady has raised today answered, and I want a good, clear line of sight as to what has happened, how it happened and, as far as lessons learned are concerned, how to ensure that this could not happen again in the rest of the system, as she says.

Based on what the review says, I will have further thoughts about the questions the hon. Lady has asked. Until we see the review’s findings, we will not know how complete it is or the answers to all the questions. Let us see the review’s findings first. If it is plain that the review is inadequate and leaves things unsatisfactorily handled and dealt with, with questions still arising, we will need to have a conversation at that stage. It might be appropriate, after the review has concluded, to have a round table and use it as an opportunity to have that conversation. However, until I have seen the review’s findings, I cannot decide whether there is anything further to be done at this stage. I want to ensure that the questions are answered, and that there are ramifications across the system. We also want to make progress with the new hospital. Let us see what comes out of the review, and then we will meet again.

On the hon. Lady’s request for a meeting, I have just been handed a note—we had an email from her office on 15 January. We are now going through the invitation process but have not responded.

Swine Flu Vaccination: Compensation

Julian Sturdy Excerpts

Tuesday 12th January 2016 Westminster Hall

[Stephen Twigg]

The hon. Gentleman’s intervention is timely, because he raises the issue to which I now turn. Lucas Carleton is a young boy who lives in my constituency in Liverpool. On 17 January 2011, he was vaccinated with Pandemrix. He was seven years old at the time and was in good health. His mother, Pauline, asked her GP to vaccinate Lucas because a family friend had recently been very ill with swine flu and, perfectly understandably, she believed it was a responsible step to get her son vaccinated. A week or two after Lucas received the vaccination, he began to experience excessive daytime sleepiness, which is a common characteristic of narcolepsy. He also started falling when he laughed or got excited, made strange facial expressions and experienced a loss of control of his tongue. That is known as cataplexy and is a common symptom of narcolepsy. After two to three weeks, Pauline sought medical help from a GP and Lucas was taken to hospital on a number of occasions. In August 2011, he was diagnosed with narcolepsy.

Narcolepsy is an incurable neurological disorder that until 1999 was classified as a psychiatric condition. Its main symptoms involve excessive daytime sleeping, hallucinations, sleep paralysis, temperature control problems and cataplexy. Cataplexy is a side symptom of narcolepsy that causes involuntary muscle relaxation brought on, for example, by laughing or anger. Narcolepsy begins in the hypothalamus, the part of our brain that controls our autonomic nervous system, which involves processes such as breathing and the regulation of the heart. Narcolepsy occurs when the brain cells that produce neurotoxins in the hypothalamus are destroyed, either through a trauma or through the body’s immune system mistaking those cells as foreign bodies.

The Department for Work and Pensions has accepted that the Pandemrix vaccine is capable of causing narcolepsy in children. It has also accepted that, in many cases, Pandemrix did in fact cause narcolepsy in children. However, it disputes that narcolepsy amounts to a severe disability. That is an issue on which the DWP has been defeated in court, but I understand that it is appealing against the decision. Herein lies the issue: the 1979 Act recognises that there can be adverse reactions to vaccines that can cause severe and irreversible damage to patients. Since the Act was passed, around 900 people have been awarded compensation, which is a very small number when compared with the 650,000 children vaccinated every year. Compensation can range from £120,000 into the millions.

The pandemic swine flu vaccine was part of the 1979 Act from September 2009 until it was removed by the Vaccine Damage Payments (Specified Disease) (Revocation and Savings) Order 2010. That is preventing Lucas from claiming compensation, as he had the vaccine administered outside that period, in January 2011. If the pandemic swine flu compensation period was simply extended to April 2011, Lucas and others who had adverse reactions could claim compensation for the reaction to the vaccine.

[Julian Sturdy (York Outer) (Con)]

The hon. Gentleman is making a powerful argument, and I congratulate him on securing the debate. My constituent Ben Foy sadly suffers exactly the same symptoms as Lucas, and the DWP has acknowledged that there is a link between Ben’s swine flu vaccination and the development of narcolepsy and cataplexy. The Department appears to acknowledge that he is disabled as a result, as Ben is in receipt of disability living allowance, but it is saying that his case is not severe enough and there are no grounds for that disability compensation. As can be imagined, the family feel that that is a complete insult. Does the hon. Gentleman have any thoughts on that?

[Stephen Twigg]

I am grateful to the hon. Gentleman for making that point. While the focus of my remarks has been on the compensation period, there is clearly a related issue with the attitude of the DWP on the severity of disability. I concur with the important point that he raised on behalf of his constituent. A number of other families in other constituencies around the country are also affected, and I welcome the colleagues from all parties who are in the Chamber for this debate.

It is worth reiterating the point that the hon. Gentleman just made: the Government have accepted that there is a causal link between the vaccine and narcolepsy. Since 2014, the Department of Health has had responsibility for the 1979 Act, which is a welcome change. Bringing the Department of Health into the process should ensure that responsibility for the legislation is controlled by health professionals, rather than benefits officials. That shift of responsibility can be a good thing for constituents like mine who have outstanding compensation claims. I am asking the Department for Health to extend the compensation scheme to make it possible for all citizens who have life-changing conditions as a result of vaccines to claim compensation. That is not only important for the individual families suffering as a consequence of adverse reactions; it is crucial to ensuring public confidence in the vaccination system.

Mental Health

Julian Sturdy Excerpts

Wednesday 9th December 2015 Commons Chamber

[Julian Sturdy (York Outer) (Con)]

I will focus my brief contribution on the mental health services in York and in my constituency.

The Minister is aware that Bootham Park hospital, a mental healthcare facility in York, closed on 30 September, after the Care Quality Commission declared the 18th-century grade 1 listed building unfit for purpose. In fact, it stated that patients were at “significant risk of harm” at the hospital.

The facility had been part of the Leeds and York Partnership NHS Trust, and concerns had been raised about it since 2013, when the CQC inspection declared that the hospital did not meet the required safety standards.

Although improvements were made at a cost of £1.7 million, the CQC visited again and expressed its continued concerns about the safety of some of the wards. As a consequence, significant improvements were called for in January, and the money was made available. However, when the inspectors returned nine months later, in September, no improvements had been delivered. No one denies that there were problems with the facility due to its structure and age. I visited the hospital and saw for myself the problems that were raised by the CQC.

The trust had nine months to rectify those well-known and well-documented problems, yet it did nothing, which led to this important facility being closed, with staff and patients being given just five days’ notice, which is unprecedented and which caused an immense amount of stress and anxiety for patients, families and the hard-working staff.

Things were further complicated when the Vale of York clinical commissioning group chose to transfer York’s mental health services from the Leeds and York NHS Trust to the Tees, Esk and Wear Valley NHS Trust. That was due to allegations that a disproportionate amount of funding was being allocated to Leeds, with York missing out. Was that because Leeds had been prioritised over York? Well, Leeds and York NHS Trust has many questions to answer, and I wish to know who will bring it to account over a situation that never should have arisen. There were plenty of opportunities to solve the problem and the trust had enough warnings. Sadly, action was not taken and the facility was closed.

Finally, in this very brief contribution, let me say that, in the long term, we hope to see a new purpose-built facility in York. From my meeting with the Minister, I know that he feels the same way, and I am confident that he will deliver it, but I want to hear him say it today. We also must deliver parity of esteem across the board, because, at the moment, York is not getting that parity of esteem.

Cystic Fibrosis

Julian Sturdy Excerpts

Tuesday 8th December 2015 Westminster Hall

[Mrs Gillan]

The hon. Gentleman is absolutely right. I pay tribute to the other colleagues in the House who took part in that petition. That truly cross-party effort aimed to draw attention to the drugs that are not readily and fully available to our constituents. I was grateful that it was a cross-party delegation, because such things are much stronger when they take place in an atmosphere of good co-operation across the board rather than a political atmosphere. We saw parliamentarians at their best, so I thank the hon. Gentleman for attending that lobby at No. 10 Downing Street, which was inspired partly by Muscular Dystrophy UK and partly by the families it supports.

The issue for me is the drug that the hon. Member for Dudley North referred to. Translarna is its trademark name; it is called ataluren. It is produced by a company called PTC Therapeutics, which calls it its “lead product candidate” for these disorders. I know that the Minister is familiar with PTC Therapeutics, and I hope that in his winding-up speech he will refer to any contact he has had with the company. One of the issues surrounding the efficacy and licensing of the drug is the cost, so I hope the Minister will update us on that situation.

PTC Therapeutics states that the drug is a

“novel, orally administered small-molecule compound for the treatment of patients with genetic disorders due to a nonsense mutation. Ataluren is in clinical development for the treatment of Duchenne muscular dystrophy caused by a nonsense mutation…and cystic fibrosis caused by a nonsense mutation…Ataluren was granted conditional marketing authorization in the European Union under the trade name Translarna”.

I believe that it is already available in France, Germany, Italy and Spain. It is the first treatment approved for the underlying cause of Duchenne muscular dystrophy, which is a complicated condition.

Nonsense mutations are implicated in a variety of genetic disorders. They create a premature stop signal in the translation of the genetic code contained in the mRNA. That prevents the production of full-length, functional proteins. The company says that

“ataluren interacts with the ribosome, which is the component of the cell that decodes the mRNA molecule and manufactures proteins, to enable the ribosome to read through premature nonsense stop signals on mRNA and allow the cell to produce a full-length, functional protein. As a result…ataluren has the potential to be an important therapy for muscular dystrophy, cystic fibrosis and other genetic disorders for which a nonsense mutation is the cause of the disease.”

The importance of access to Translarna cannot be overstated. Boys such as my constituent Archie Hill have been waiting since August 2014 for a decision on whether Translarna will be approved in England. As I said, it is the first licensed drug to tackle an underlying genetic cause of Duchenne’s. It would help to keep Archie and these other boys walking for longer and potentially delay the onset of the devastating symptoms affecting the heart and lungs that I referred to earlier.

NICE’s appraisal of the drug is ongoing, but the families have not yet been made aware of when guidance will be issued, leaving them facing an anxious wait over the Christmas period. Over the time I have known Archie and his family, I have seen his mobility decrease; it is depressing to see such an active, energetic, lively, intelligent young man, who has his life before him, being denied a drug that could well keep him active for longer and improve his quality of life.

[Julian Sturdy (York Outer) (Con)]

My right hon. Friend is making a powerful argument. She is right to say that we must improve access to new medicines, which can transform the lives of people such as her constituent Archie. Does she agree that new medicines may also reduce hospital admissions, which would have a huge impact on the NHS?

[Mrs Gillan]

I thank my hon. Friend for that intervention. He is absolutely right. There is no doubt that increasing the length of time that these young people can be kept active and mobile will inevitably reduce the amount of time that they spend requiring treatment in other health settings.

I also want to describe the emotional journey. Seeing anybody suffering with a muscle-wasting condition is terribly draining, because they fade before one’s eyes. That is why the drug is so important, particularly for young people suffering from Duchenne’s. I turn now to my constituent’s mother, Louisa Hill, for a quotation. She said:

“Decision makers need to understand the impact on children of even a small change. It gives them more time to run and play football with their friends. It’s really buying precious time. Archie will have to deal with very difficult mental and physical challenges as his condition progresses. Translarna is buying time for Archie just to be a kid.”

If you are not touched by that statement from a mother, I do not know what you would be touched by.

Translarna is not the only potential therapy that could benefit Archie. For example, others, such as utrophin upregulation, which involves injecting a protein called utrophin into the muscles to compensate for the loss of dystrophin in boys and young men with Duchenne’s, are in a later stage of clinical trial. It is vital that the process of moving such drugs from the laboratory to the clinic is expedited, including ensuring that appraisal processes are as swift as possible; that secure funding is available to help meet the costs of new drugs; and that NHS England and NICE have effective mechanisms to negotiate an appropriate price with drug companies.

On 14 October, I had the temerity to question the Prime Minister on Translarna at PMQs. He referred to the cancer drugs fund and its role in reducing the costs of drugs for rare types of cancer. A similar model would help for rare disease drugs for conditions such as Duchenne muscular dystrophy. The Prime Minister said:

“The cancer drugs fund has helped to reduce the costs that the companies charge. We need to see that in other areas, too.”—[Official Report, 14 October 2015; Vol. 600, c. 313.]

The Government’s accelerated access review provides an important route through which such issues could be addressed. I hope that the Minister will have his feet held to the fire by the Prime Minister’s answer.

Research into treatments for Duchenne’s is at a promising stage, with a range of potential therapies in late stage clinical trials. As I said, Translarna is already licensed in Europe, but the UK muscle centres where trials are conducted are reporting that given the growth in clinical trials they lack the resources, such as staffing levels and equipment, to keep pace. As a result, centres report that they are turning away new trials—not because of bad science, but because of a lack of capacity. [Interruption.] I see the Minister shaking his head. He knows that the situation is serious and I hope he will comment on it.

That lack of capacity risks causing a bottleneck in drug development and gives boys such as Archie Hill less chance to enrol on a trial that could allow them access to a new therapy. A clinical trial capacity audit, conducted by Muscular Dystrophy UK as part of the “Newcastle Plan” of joint working with UK Duchenne charities to address clinical trial capacity, corroborated the reports and also found that:

“Work on clinical trials is not counting towards specialist training at many centres for medical doctors, physiotherapists and nurses”

which is affecting trainee participation. In addition, it was found that a

“lack of acknowledgment of research in clinical job planning means that already overstretched clinical staff are having to carry out research activities in their own time. This is consequently severely limiting centres’ abilities to take part in research.”

It also found that the process of setting up a clinical trial can be excessively bureaucratic. Perhaps the Minister, with his experience in this area, will be able to comment on that.

I am disappointed that Archie Hill and the other boys suffering from Duchenne’s do not have access to Translarna. The process has seemed to take an incredible length of time, and I hope that the Minister will be able to do something about it. Like the hon. Member for Dudley North, I have a series of questions that I want to put to the Minister, which may help him when he sums up.

First, will the Minister commit to meet representatives of Muscular Dystrophy UK? I would be grateful for that, and it would be helpful for him to discuss the accelerated access review, particularly in the context of the emerging treatments for Duchenne’s. Secondly, I do not suppose that he can say this, but when can families such as Archie’s expect to be notified of NICE’s guidance on access to Translarna on the NHS? It is the obvious question and one that I hope he can answer.

Thirdly, will the Minister ask the chief executive of the National Institute for Health Research’s clinical research network how his organisation plans to work with specialist muscle centres to address concerns over the lack of clinical trial capacity, particularly for Duchenne’s? The hon. Member for Dudley North referred to the latest thinking in Scotland and Northern Ireland, such as introducing a ring-fenced fund for rare diseases. I hope that that might be a recommendation of the accelerated access review.

I do hope that the Minister will be able to give us some optimism. Boys such as Archie Hill are an inspiration to us all. For one so young, he is very mature in his attitude towards not only his Duchenne muscular dystrophy, but other children suffering from rare diseases. He has great capacity for humanity and for tireless campaigning. This will be the second Christmas since I met him that he will be waiting for an outcome on Translarna. Will the Minister talk to PTC Therapeutics, to NICE and to anyone else to whom he can reach out, to ensure that this year the Christmas present for Archie Hill and other boys in England is to have access to ataluren or Translarna?

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

It is a pleasure to serve under your chairmanship, Sir Edward. I congratulate the hon. Member for Dudley North (Ian Austin) and other hon. Members from across the House who have spoken. This timely debate has been incredibly powerful—not that there has been much disagreement in it. It has been an opportunity to raise important issues that I am dealing with, and I am grateful to colleagues for acknowledging that.

The debate is particularly timely because I am convenor of a major summit today on accelerated access for faster cures. There is a precision medicine summit in London and the Association of Medical Research Charities has just held its annual conference, at which I exhorted members to come to my table with ideas about how to accelerate novel treatments and give the charities more of a voice. A powerful and helpful debate is going on.

I pay tribute to the work of the Cystic Fibrosis Trust, which is among a number of charities that lead the debate on innovative treatments and medicines. Its leader Ed Owen in particular plays an important role in that; but so do Carly, Lorraine, Michael, Kelly and the other people who have been mentioned. Many of the charities do extraordinary work to articulate the experience of patients who suffer from disease and bring it to the policy table in a powerful way. It is a change in policy making that I am keen to accelerate.

The debate goes to the heart of the challenge and opportunity that precision medicines represent for our system and the landscape of assessment, testing, approvals and reimbursement, as well as the growing role of charities and the patient voice. Those things are passions of mine and I want to discuss why, in the next few months and the years ahead, there will be dramatic progress.

The Government and I wholeheartedly support the cystic fibrosis campaign’s central aim of ensuring that as many people with CF as possible will have access to personalised medicines by 2020. That sets an inspiring and clear goal and I relish the attempt to deliver it. I want to make some remarks about the condition, about what NHS England and the NHS in Scotland and Northern Ireland are doing about treatment today, about the rare diseases and precision medicine landscape, and about the reforms that I am pushing to try to deal with the issues that have been raised.

I have had a career in biomedical research, so it is an extraordinary privilege to have been given my role by the Prime Minister, who has personal experience of the tragic consequences of genetic disorders affecting children. I am delighted to share with the House the fact that my passion to lead in this field, and unleash the power of the NHS and our research expertise in a new landscape for accelerated access, is exceeded only by the Prime Minister’s.

As hon. Members know, cystic fibrosis is the most common life-limiting inherited condition in the UK. It affects about 10,500 people in England—and more, of course, in Scotland, Northern Ireland and Wales—more than half of whom are adults. Cystic fibrosis is one of the UK’s commonest life-threatening inherited diseases. It is caused by a single defective gene. As a result, the internal organs and especially the lungs and digestive system become clogged. That results in chronic infections, inflammation in the lungs and difficulty digesting food.

The number of adults living with CF is gradually increasing over time, because of improvements in diagnosis from newborn screening and new treatments. The condition affects everyone differently—that is an important point—but for many it involves a rigorous daily treatment regime including physiotherapy, oral, nebulised and occasionally intravenous antibiotics, and taking enzyme tablets with food. For those who are very ill with cystic fibrosis and who have very poor lung function, daily life can be a struggle as basic tasks can leave them breathless. Some patients use a wheelchair to get around, and use oxygen to help them breathe.

For patients and their families, managing the condition is extremely challenging. That is made worse by the absence of an effective treatment or cure—or, as several colleagues have explained today, by the tantalising presence of a possible treatment or cure that cannot yet be administered to them or their suffering loved ones. I pay tribute to patients who grapple with the disease day in, day out, and who have done so for years, for their patience as we try to bring new solutions to the table. Current treatments generally target the complications rather than the cause of the condition. Treatments can be broadly classified as nutritional support, relief of airway obstruction, treatment of airway infection and, ultimately, lung transplantation.

What are the Government doing? I want first to talk about what the NHS is doing in England and in Scotland and the other devolved areas, and then to say something about what we are doing more strategically to tackle the new landscape.

Since April 2013 NHS England has been responsible for securing high-quality outcomes for patients with cystic fibrosis as part of its remit to deliver specialised services. Its service specifications for cystic fibrosis—one for adults and one for children—set out what providers must have in place to offer high-quality care and support equity of access to services for patients with cystic fibrosis, wherever they live. The NHS England cystic fibrosis clinical reference group has developed a number of clinical policies for the treatment of patients with cystic fibrosis and it reviews outcomes with the Cystic Fibrosis Trust and with patients and charities.

As we have heard, Scotland, leading within the United Kingdom—and it is not the first time—has launched a dedicated fund worth £40 million this year to give patients greater access to new medicines, as the Scottish Health Secretary, Alex Neil, has announced today. The £40 million new medicines fund expands and replaces the rare conditions medicines fund established in March 2013, giving health boards access to greater resources. In 2013-14 the rare conditions medicines fund supported the cost of 45 different medicines, benefiting more than 200 patients, including ivacaftor for cystic fibrosis as well as other treatments for related rare diseases.

NHS England is investing significant resources into the provision of new medications that work directly on the genes causing cystic fibrosis. Since 2013, it has routinely commissioned ivacaftor or Kalydeco for the treatment of cystic fibrosis in those with a certain gene mutation affecting only 5% of the CF population. Earlier in 2015, that indication was extended to an additional eight mutations for patients aged six years and above. NHS England is considering a policy proposition for extending the use of ivacaftor for the same gene mutations to children aged two to five years. It will consider the evidence base and be included with other therapies requiring investment as part of NHS England’s prioritisation process for specialised services for 2016-17.

Several colleagues raised the matter of Orkambi. Some drugs for cystic fibrosis will be considered by NICE through its technology appraisal process, including Orkambi, which, as many will know, is lumacaftor in combination with ivacaftor. NICE is currently developing technology appraisal guidance on the use of Orkambi for the treatment of patients with cystic fibrosis. It currently expects to issue final guidance in July 2016. NHS England will commission drugs where there is a positive NICE technology appraisal, and I will say something about the changes that we envisage in the landscape in that respect.

NHS England operates a horizon-scanning process to identify new treatments and the cystic fibrosis clinical reference group advises on the development of services for patients and keeps relevant published literature under review. Where NICE is not considering a therapy, NHS England can consider the evidence base and may propose commissioning treatments through its policy development process. I shall say something shortly about changes that we are considering in the way NHS specialist commissioning might embrace the new freedoms in the accelerated access review to accelerate the commissioning of rare disease treatments.

In fact, ivacaftor is something of a mild success story. NHS England commissioned it earlier than might otherwise have been expected, having agreed, in discussion with the company that makes it, a flexible pricing model. We want to see more of that sort of innovation.

I am grateful to the hon. Member for Denton and Reddish (Andrew Gwynne) for giving me some time to answer the various questions asked, which I will try to do in some detail. First, I want to set the scene in terms of why this debate is happening and why this landscape is under such pressure. The truth is that breakthroughs in genomics and informatics—our ability to understand patients’ genetic predisposition to different diseases and to respond to different drugs, as well as the availability of large-scale data sets, including individualised patient treatment histories and anonymised cohort studies—are transforming the traditional pathway for drug R and D, which normally takes years. It now takes roughly 15 years and $2 billion to bring the average drug to patients.

Genomics and informatics, particularly for some of the rare genetic diseases, allow us to take time, cost and risk out of the development pathway in a profound way. That is driving opportunity and challenge in our system; the Prime Minister created this post and put me in it to ensure we respond to that challenge with ambition.

[Julian Sturdy]

My hon. Friend the Minister is absolutely right to say that the medical landscape is changing hugely at the moment, but does he feel that the wider implications of new medicines are being fully explored by NHS England and NICE? We have heard about the huge consequences of cystic fibrosis for not only the sufferer but their wider family and the NHS. Does he feel that those wider consequences are being fully explored?

[George Freeman]

My hon. Friend raises an important point. Over the past few decades, the NHS across the UK has played an inspiring role in leading a lot of the breakthroughs in new treatments, but we have become latterly a slower adopter of the very treatments we often helped to discover. That is partly because the pressure of an ageing society and the rising cost for the health system today of just treating existing conditions are extremely challenging. In some areas, that has made innovations appear a cost to the system, when in fact good innovations may come with a cost spike on day one but generally lead to downstream savings in years 2, 3 and 4.

My hon. Friend puts his finger on a profound challenge at the heart of this landscape: in order really to assess the impact of innovative treatments, we need a much better handle on the existing costs, many of which are hidden, that come with a diagnosis. For that reason, I am spearheading work in the Department of Health to drive through a system of per-patient costing, so that we can begin to get a much clearer handle on what a CF diagnosis means on day one for both the patient and the health economy. That will allow NICE and NHS England to develop much more intelligent systems for assessing whether an innovation really represents good value.

Genomics and informatics are changing the landscape; for that reason the Prime Minister has created my post and we have launched a series of initiatives. On genomics, we have launched a groundbreaking £300 million initiative to sequence the genomes from 100,000 NHS patients of cancer and rare diseases. We have also launched 11 genomic medicine centres across the NHS, so that genomics is fundamentally embedded in our health system. On informatics, we have released huge amounts of cohort data to drive research, and we just announced in the comprehensive spending review a major £3.5 billion programme to invest in NHS digital infrastructure to support that.

We have launched precision medicine and cell therapy catapult centres with the Medical Research Council and industry partners to lead in both understanding causal mechanisms of rare diseases and developing and accelerating new treatments. We continue to fund the excellent National Institute for Health Research, for which it is my privilege to be responsible, to the tune of £1 billion a year, and we committed this year in the CSR to fund it throughout this Parliament, at a cost of £5 billion. We have funded the £700 million Francis Crick Institute, and roughly £2 billion of the drugs budget is allocated to new medicines and new treatments in this Parliament.

There is a major commitment, in terms of science and funding, to trying to tackle this issue, but crucially we need policy reforms to ensure that breakthroughs in science can be harnessed for much quicker benefits for patients. That is what the accelerated access review and a number of other initiatives, such as the test bed programme and the vanguards I am running with NHS England, are about—trying to ensure we can change the pathways for getting innovation into our health system for much quicker patient benefit.

I want to say something about the accelerated access review and the specialist commissioning reforms that NHS England is putting in place. I know all Members here take an interest in this subject, so I hope they will be aware that I have launched the independent AAR to ask and answer one big question: what can we better do to harness the extraordinary infrastructure here in the UK in terms of our deep science research base, our NHS-NIHR research base and our NHS daily treatment platform?

The NHS is the fifth biggest organisation in the world, making millions of diagnoses and carrying out millions of treatments every day. Its original founding mission was to be a research organisation, but unless we better capture the data on those interventions, we are still practising, in many cases, blind medicine; we are not harnessing that intelligence enough to inform treatment.

I have asked that the AAR tackles three big questions. First, what can we do to allow the innovators—the developers of new drugs and innovations—quicker access to patients, to reach the all-important moment of proving an innovation works in patients? Secondly, what can we do to harness our leadership in genomics and informatics in order to create a more intelligent system for NICE and NHS England, with more flexibilities, so that they can assess, adopt, approve and reimburse innovations using real-time data about real patients? That will allow us to develop a more flexible set of pathways and adaptive tools with which to embrace this revolution.

When a drug comes to us with a genomic biomarker and we know that it will work for a certain sub-cohort of patients, that profoundly changes the risk dynamic of a traditional pharmaceutical clinical trials programme and should allow us to accelerate adoption for particular patient groups.

Cities and Local Government Devolution Bill [Lords]

Julian Sturdy Excerpts

Monday 7th December 2015 Commons Chamber

[Mr Betts]

I shall speak specifically to Government amendment 27. The proposals for combined authorities are welcome. They are essentially about local authorities coming together where they wish to combine their approach, their workings and their functions to deliver better services and, hopefully, greater economic growth for the residents in their areas. The idea was pioneered in Manchester. The one fundamental difference between Manchester and some of the other areas that we are considering is that Manchester has had a number of authorities that have worked together over a period of time and these happen to be the authorities that were part of the old Greater Manchester metropolitan area. There were 10 districts that formed that old Greater Manchester metropolitan county, so they have always had a sense of being together and working together over a number of years. They are also unitary authorities that all have the ability to make their own decisions about whether they come together, how they do so and what they do to form the combined authority. It is a relatively simple and easy arrangement in constitutional terms.

The difficulty for some other areas is that the constitutional arrangements are slightly different. Obviously, I am now going to refer to my own area. Sheffield contains the four districts which used to form the old South Yorkshire metropolitan county, and which have worked together to varying degrees, and with varying degrees of success, since the counties were abolished. They came together to form what is now the Sheffield combined authority.

To an extent, the same applies to Leeds, which contains five districts that used to be the West Yorkshire metropolitan county, and which have been working together as a combined authority. There are, however, some differences, which have been recognised at various times by parties on both sides of the House. Sheffield contains not merely the four districts of south Yorkshire, but five other districts which form part of either Derbyshire county or Nottinghamshire county: Derbyshire Dales, Chesterfield, North East Derbyshire, Bolsover and Bassetlaw. They are not part of the old South Yorkshire county, but they are very much part of the local economy of the Sheffield city region—the travel-to-work area.

That has been recognised in a number of ways, and I remember when it was first recognised. I went to the first meeting between the leaders of those nine councils, which took place at Meadowhall shopping centre, and which had been called by David Miliband when he was number two in his Department. I am not sure which Department it was, but it was probably the Office of the Deputy Prime Minister. I expected a reaction from the districts outside south Yorkshire—I expected them to think that Sheffield Big Brother was going to take them over—but the leader of Bolsover district council said, “Actually, it is quite good that we are involved in this.” He said, “I know that not everyone who lives in Bolsover will have a job in Bolsover, and that many people have to travel to work in Sheffield. What happens in Sheffield matters to us, and how people transport themselves from Bolsover to Sheffield matters to us. It is right that we are sitting round the table having discussions and being involved in the decision-making process.” Those were wise words, which have stood the test of time.

The coalition Government adopted a similar approach. When they formed the local enterprise partnerships, they recognised that the historical regional boundaries were not always appropriate. I know that the previous Secretary of State had a thing about regions: people almost had to cross themselves, or put money in the Department’s swear box, if they mentioned them. He was not always right in damning the regional spatial strategies and blaming them for every evil on the planet, but I think he had a point nevertheless, in that the old regions did not necessarily represent local economies and the way in which areas worked in day-to-day life.

The districts of south Yorkshire were in the Yorkshire and Humber region, but the districts in Derbyshire and Nottinghamshire were in the old East Midlands region, and that often did not work because the two regional development authorities did not always speak to each other. That was a fundamental problem for the Sheffield regional economy, which the last Government recognised when it created the LEPs and allowed them to create themselves across the old regional boundaries to reflect the travel-to-work areas and the local sub-regional city region economies.

We now face a challenge. So far, the districts in that position in North Nottinghamshire and North Derbyshire have, to an extent, been able to have it both ways. They can continue as districts, as part of the two counties, but they can also be non-constituent parts of the combined authority in Sheffield. Ultimately, however, the districts will have to make some sort of choice.

We are to have an elected mayor in the Sheffield city region. We have had discussions and arguments about that, but it is going to happen. Should the people of Chesterfield, Worksop or any other parts of those districts be able to vote for the mayor in Sheffield, who will be in charge of transport in that area, or should they not be able to vote for the mayor, who will then cover only part of the travel-to-work area with his or her transport responsibilities? That strikes me as illogical, because it will not bring about a combined authority that really covers the city region and the travel-to-work area.

Is it possible that the people of Chesterfield will not have a vote for the mayor because Chesterfield will not become part of the Sheffield city region combined authority—although, under the proposals, the mayor will be involved in discussions and decision making about economic development matters that affect Chesterfield, even if it is only a non-constituent part of the combined authority? I do not think it reasonable for an individual who has not been not elected by the people of Chesterfield to have a say in what happens there.

What the amendment does is ensure that the districts of North Derbyshire and North Nottinghamshire will be able to make their own decision about the long-term position—about where they think they fit and where their future lies—without the county councils’ having a veto. Like my hon. Friend the Member for Nottingham North (Mr Allen), I hope that that will done by means of consensus and discussion. No one wants Chesterfield to feel that it is no longer part of Derbyshire county or Bassetlaw to feel that it is not part of Nottinghamshire county, for many other purposes.

[Julian Sturdy (York Outer) (Con)]

The hon. Gentleman is advancing a powerful argument. He is absolutely right about consensus. He is also right about the fact that businesses do not recognise local authority boundaries. Surely, when we talk about devolution, we must talk about it on the basis of economic rather than political areas, but there is a danger of our being sucked into those political areas.

[Mr Betts]

I entirely agree. In the end, of course, a district council as a whole will have to go to an area, but, as the hon. Gentleman says, the focus should be on what works for the economy in terms of job creation, growth and the development of skills, and on ensuring that the necessary transport links exist.

I hope that the Minister will clarify one important point. There may ultimately be a decision for the Secretary of State or the Minister to make on these matters. The districts in North Derbyshire and North Nottinghamshire, or some of them, may well decide to become part of the Sheffield city region—I hope that they will, because I think that it makes economic sense—but it is nevertheless possible that Derbyshire and Nottinghamshire will form another combined authority, an N2D2, and that there will then be a conflict between the two decisions.

I understand from the amendment that it will be up to the Secretary of State to decide which combined authority the districts should join, because they cannot join two; the people in those areas cannot have a vote for two elected mayors in different combined authorities. I hope when he decides that he will indicate that his key criterion will be what is right for the local economy—that point was made by the hon. Member for York Outer (Julian Sturdy)—and right for developing skills, for economic growth, and for the development of a proper transport strategy for those areas.

--- Later in debate ---

[James Wharton]

I think the assurance I can give the hon. Gentleman is that what is done will proceed by consensus. We will look to talk to local areas about the different deals they want. The temptation in debates on Bills such as this is to look at the individual deals in individual areas. The Bill will enable us to have maximum flexibility to respond to local demand and local desire for devolution to deliver deals that will stand the test of time. I am unable to talk in detail in this particular forum, given the amendments and new clauses we are discussing, on what is proposed specifically in individual areas or the hon. Gentleman’s concerns, but I would be very happy to meet him to discuss any particular issues he wants to raise. I can assure him that the intention is to find consensus and build on it to deliver the devolution agenda.

[Julian Sturdy]

We need to ensure we get the safeguards and assurances on amendment 27, so that however well-meaning it is—I do not doubt what the Minister is trying to achieve—it will not have knock-on consequences for county councils in areas where we are trying to deliver devolution deals based on economic, rather than political, grounds.

[James Wharton]

My hon. Friend has discussed with me outside this Chamber some of the issues of interest to him in his area, for which he is an effective advocate. I can absolutely assure him that the intention is to find consensus and the right solutions for each area. We need flexibility in the Bill to deliver that. Where there are real concerns, far from being ignored they will very much be heard and acted on. I know some of the issues he raises in relation to his area. I am happy, as always, to meet him and his colleagues to discuss them as things progress, but there is no desire to do anything to areas—indeed, quite the opposite. This is about areas asking for things that we can then deliver. The Bill will give us the flexibility to deliver them.

--- Later in debate ---

[Greg Clark]

All of our negotiations have achieved consensus locally. That is my approach. Amendment 56 allows us to require that those conversations take place. No authority can reasonably refuse even to discuss the potential for reform. That is right. It is reasonable for neighbouring authorities to have conversations about what is the best way to proceed. As my hon. Friend the Minister said, the powers are already there.

In responding to the case that was made in Committee by my hon. Friend the Member for Carlisle (John Stevenson) and that was made again on Report, we thought that it was worth having in the Bill, as a pilot, the ability to, as it were, encourage authorities to have the conversation. Anything that is agreed needs to be agreed by the Secretary of State and by this House. My hon. Friend the Member for Gainsborough (Sir Edward Leigh) can be absolutely sure that, in exercising my authority in this area, I propose to maintain the preference for consensus that I have shown so far.

It is worth reflecting that, in the few years since we started negotiating, first with cities and then with local authorities and their businesses through the growth deals, there has been tremendous enthusiasm across the country. Members have spoken at various points during the debate about how the degree of collaboration and involvement of businesses and local authorities has been very much greater than that experienced in the past. That is absolutely the case. If we are to prosper and succeed as a nation, every part of the nation has to fire on all cylinders. This important Bill will help to drive that forward.

During the debate, many amendments have been made, resulting in the Bill’s improvement. We have accepted a need for various reports on the progress of devolution to come to this House, so they can be debated. I am grateful to my hon. Friend the Member for Altrincham and Sale West (Mr Brady) in particular, as he made a very strong case that Members should be involved in the ongoing scrutiny of agreed deals. I am only too willing to have my feet held to the fire. As the Chairman of the Select Committee, the hon. Member for Sheffield South East (Mr Betts), has observed a number of times during these proceedings, in my earlier incarnation in the Department I published a progress report of all Government Departments on whether we were living up to our commitments on devolution. I fully expect that the scrutiny of the House will be equally exacting when it comes to the receipt of the reports.

It is important that we have devolution right across the country. We started with cities, but the enthusiasm in counties and districts right across the country has been very palpable. When we issued an invitation for places to come forward, 38 places, covering almost all the country, submitted proposals. The Bill enacts some of our manifesto commitments to create a metro mayor for Greater Manchester and to create mayoral authorities for the great cities that have concluded deals with the Government.

In response to proposals, again from the bottom up and starting with Greater Manchester, we have been able to enter into discussions about the devolution of health matters, so that the two sides of the same coin that are health and social care can be better administered locally, jointly between the NHS and local government. I am pleased we have been able to make amendments on those matters.

I am pleased that we have ended the Bill’s proceedings with a degree of consensus between all parties. That was very much our intention from the outset. We started with a degree of discord on Second Reading, but I had high hopes that we would be able to persuade those on the Opposition Front Bench to move away from that. As we have scrutinised the Bill and accepted amendments from all sides of the House, including from the Back Benches, I think we have strengthened the Bill. I am grateful to those on the Opposition Front Bench for having, I think, modified their view. I hope we might even hear a degree of enthusiasm—I will be careful on that; I had better not count my chickens—from them.

This is an important moment. The Bill was in the first Queen’s Speech and one of the first to be introduced in this Session of Parliament. On Second Reading, I said it was an historic Bill that would do something our predecessors have not done and that our successors will look back on. They will see this as a piece of legislation that changed the direction of policy and built up our cities, towns and counties across the country, so that their discretion, power and ability to set their own future becomes much greater than it has been in the past.

[Julian Sturdy]

Like many on the Government Benches, I praise my right hon. Friend for all his work bringing the Bill to the House, but does he accept that some areas might need more time to come to the right devolution deal, rather than rushing a bad deal? Will he assure those areas that they will not be penalised for taking their time over what might be, for certain areas, quite a difficult decision to get the right conclusion?

[Greg Clark]

I can certainly give that assurance to my hon. Friend, who has played an active role in talking to his local authorities and businesses to build a consensus. It is clear that different places will proceed at different paces, as they have done already, but I and my hon. Friends are completely committed to inviting every part of the country to put forward and negotiate a deal that is right for them. We invite all parts of the country to propose that which would make the biggest difference to local areas. To paraphrase Disraeli, the Bill exists to show areas their riches to themselves. We can, with the Bill, unleash the growth, the jobs, the homes and the futures that everyone across the country has a right to hope for, and because of that, I commend it to the House.

Oral Answers to Questions

Julian Sturdy Excerpts

Tuesday 17th November 2015 Commons Chamber

[Mr Hunt]

I do think it is a serious problem. People find it hard to live near to the hospital at which they work, particularly where housing is very expensive. This is an issue that we are looking at closely.

[Julian Sturdy (York Outer) (Con)]

T8. Can the Secretary of State assure me that the NHS funding review that is currently under way will deliver a fairer formula for my constituents and many others across York and North Yorkshire by putting age and rurality—some of the biggest drivers of health costs—at the heart of this long overdue review?

[The Minister for Community and Social Care (Alistair Burt)]

Clinical commissioning group formulae are based on advice provided by the Advisory Committee on Resource Allocation. I can assure my hon. Friend that an adjustment per head is made for morbidity over and above age and gender, but as to whether or not one area is fairer than another, I am afraid that that is always a matter for local decision and discretion.

Oral Answers to Questions

Julian Sturdy Excerpts

Tuesday 7th July 2015 Commons Chamber

[Julian Sturdy (York Outer) (Con)]

T10. The disparity in health funding allocations due to the imbalance in the system which favours deprivation over age has yet again been highlighted, this time by the British Medical Association’s annual meeting a couple of weeks ago. Having met the Secretary of State in the last Parliament, I know he is looking to address that. Will he update me and the House on this issue?

[Alistair Burt]

Yes, age and rurality come up quite regularly in discussions about funding for the contract. It can plainly be seen that there might be an increase in costs for rural areas, but it has been difficult for those involved in contract negotiations to pin it down to specific evidence. I assure my hon. Friend, however, that both age and rurality issues will remain very important for those deciding on the future contract and he can be sure that they will be taken into account.