Conception to Age 2: The First 1001 Days

Justin Madders Excerpts

Thursday 17th December 2015 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

First, I commend and congratulate the hon. Members for East Worthing and Shoreham (Tim Loughton) and for Dwyfor Meirionnydd (Liz Saville Roberts) on securing this debate. I also pay tribute to the members of the all-party group for conception to age two—the first 1001 days for developing the manifesto and raising the profile of these important issues. All the Members who have spoken today have done so with great eloquence on these issues.

Let me go through some of today’s contributions. The hon. Member for East Worthing and Shoreham, in his opening remarks, correctly said that this is about challenging the mindset and going beyond the troubled families programme, which has proved to be a success around the country. He rightly highlighted the shocking statistics on suicide among new mothers and rightly said that much of it is preventable. He gave us a volley of statistics and they all point towards this manifesto as being something on which there should be widespread agreement, and I think that agreement has been apparent from today’s contributions.

It was also a pleasure to hear from my hon. Friend the Member for Nottingham North (Mr Allen), whose work in this area I was a keen reader of before entering this place. I was glad to hear his contributions today. He rightly said that this is about investment in individuals, that a consistent approach has to be taken across changes of Government and that this is about a philosophy in the way we do things. He made an interesting point when he said that, if we proposed spending £17 billion on an early intervention programme, we may have a little difficulty in getting that past the Treasury, but that is actually the potential saving that might be realised if this is done correctly. Of course, this is about so much more than simply making savings. He said that early intervention should mean that late intervention is consigned to the dustbin of history, and we would all welcome that.

[Mr Graham Allen]

Like the hon. Member for East Worthing and Shoreham (Tim Loughton), and many others who spoke, including the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), I did not have a chance to speak about a broad policy area in this field—social investment. There is now a way of monetising and finding out how much we can save ourselves, and the many social instruments and social investments out there are growing by the day. I hope my hon. Friend will consider that in his remarks, because massive savings can be made in this area—indeed, money can be made in order to reinvest in new services.

[Justin Madders]

I am grateful for that intervention, and my hon. Friend is right to say that this can be monetised. I recall that when my local authority carried out an examination of the early intervention scheme, a figure of about £100 million was mooted. There are challenges in getting different Departments to buy into that, because they are all quite protective about their own sources of money, but if we take a holistic approach, we can see that there will be savings right across Departments. I hope that we can begin to develop that approach.

The hon. Member for Congleton (Fiona Bruce) rightly highlighted the staggering and shocking statistics about alcohol intake during and indeed before pregnancy, and rightly said that a clear message needs to be sent out about the risks. She rightly paid tribute to the work of my hon. Friend the Member for Sefton Central (Bill Esterson) with his all-party group on foetal alcohol spectrum disorder. The group took a great deal of evidence in preparation for its report, which has been released today. It is unambiguous in its recommendations about the need for clear and consistent advice to be given on the dangers of alcohol during pregnancy and the need to improve training and education across the board. He has laid down a clear challenge for the Minister in this area and I look forward to hearing what his response will be.

The hon. Member for Foyle (Mark Durkan) spoke with his usual passion and sincerity on the subject. He gave us the memorable phrase, “What happens in our early years stays with us throughout our years.” I am not sure what he meant about the goings on in Las Vegas. Perhaps he will enlighten me outside the Chamber. He rightly pointed out the academic research that is set out in the manifesto. Clearly, an evidence-based approach is welcome, because the evidence is there and it is clear.

The hon. Member for East Kilbride, Strathaven and Lesmahagow spoke with great personal experience on this area. She rightly pointed out that early experiences can affect a child’s relationships throughout their lives. We have heard from a number of Members about how difficulties in relationships can perpetuate the cycle of despair that we currently see and have been discussing today. She made a valid point about early assessment of development disorders, especially autism. At the moment, that assessment does not happen quickly enough. She also talked about this idea of a named person being the point of contact for the families, and saw it as a positive development. I am certainly aware of a number of similar initiatives that have shown the benefit of such an approach.

We have had a great many informed, respectful and consensual contributions today. I will try my best in this season of goodwill to maintain that. I am speaking here as a member of the shadow Health team. The NHS is really where my focus is. It was first conceived to be a responsive treatment-based service that supports everyone in society from the cradle to the grave. It is only in recent years that we have begun to understand how that short time in the cradle—those very first few months—can ultimately decide how long, healthy and happy a newborn baby’s life will be.

I will keep my remarks quite brief as we have been squeezed out by other business today. Let me just touch on a few areas that highlight why this period is so vital and a few areas where we should be doing a little better.

As we know, the manifesto takes its title from the period from conception to age 2 when a baby’s brain is developing at its fastest. We know that the earliest experiences have a lifelong impact on mental and emotional health. We also know that, when a baby’s development falls behind the norm during the first years of life, rather than catch up with those who have had a better start, they are actually more likely to fall even further behind in subsequent years. More than a quarter of all babies in the UK are living in complex family situations that present heightened risks to their wellbeing. The sad reality is that babies are far more likely to suffer from abuse and neglect and up to seven times more likely to die in distressing circumstances than older children. We have a duty to give every child an equal opportunity to lead a healthy and fulfilling life.

“The 1001 Critical Days” manifesto is the best chance for us to make that happen. Not only is it the right thing to do for our children, but it is the right thing for the public purse. According to the Royal College of Paediatrics and Child Health, there is increasing evidence to show that spending on early years intervention can yield a return on investment as high as 6% to 10%. My hon. Friend the Member for Nottingham North eloquently showed how that could be translated into significant savings across Government.

[Mr Allen]

I sense that my hon. Friend may be coming to the end of his remarks, so I am going to squeeze in one more intervention, if I may, and it is in respect of the next Government. There may be a change of Government in 2020. My hon. Friend has an opportunity to spend some time developing an early intervention philosophy across, as I mentioned, not only health and children’s services, but the economy and even international affairs. That preventive view, rather than attempting to cure, could be fundamental to the next Government, as it should be and increasingly is to the current Government. Will he give us an assurance that this will be in his thoughts as he develops policy in his area?

[Justin Madders]

I thank my hon. Friend for his intervention. I am certain that I will be able to take those comments on board. As I said, it is a subject in which I took an interest before I entered this place. I believe that is the right approach and I am confident that in four and a half years’ time we will have the opportunity to put it into practice. [Interruption.] Some may disagree about that. In the season of good will, a little latitude is surely permissible.

If it is done in the right way, early intervention can save money, save lives and improve the wellbeing of parents and children. The former Scottish Health and Finance Minister, Tom McCabe, summed it up perfectly when he said,

“We have heard evidence, stacked from the floor to the sky, that this is the right thing to do.”

Focusing on the first 1001 days is not just about ensuring the healthy development of future generations of children, but about making our NHS and many other public services sustainable.

I want to say a few words about perinatal mental health, as I know this is an issue that many Members feel passionately about, not least the shadow Minister for mental health. Perinatal mental health problems affect up to 20% of women at some point during pregnancy or in the year after childbirth. We heard from the right hon. Member for North Norfolk (Norman Lamb), who pointed out the impact not only on the mother, but on the child and the wider family. About half of all cases of perinatal depression and anxiety go undetected and even those that are detected fail to receive evidence-based forms of intervention. This is important because severe perinatal mental health problems are bad not only for the women affected, but for the development of the children involved, as the right hon. Gentleman highlighted.

In particular we need to ensure that all women affected have access to appropriate treatment, and that variation in access is addressed. The right hon. Gentleman referred to a map which starkly highlighted that. It is worrying that 41% of maternity units have no access to a trained mental health worker, 30% are unable to offer psychological support, and on a wider but connected issue, about a third have no overnight accommodation. It is also regrettably the case that under this Government there has been a reduction in the number of specialist in-patient mother and baby units. The Government’s pledge to spend £15 million on perinatal mental health was extremely welcome, but we need to see that pledge put into action. I would be grateful if the Minister could update the House on what he has been doing in that respect.

We will tackle the problems that parents and children might have in this period, and spot the problems early enough, only if we have joined-up multi-agency working between health services and local family support services. Children’s centres have a critical role to play in this mix in many areas. As a former member of the advisory board of the Stanlaw Abbey children’s centre in my constituency, I have seen at first hand what a welcoming and safe place it is for families to visit, as indeed are all children’s centres. In addition they have a wealth of experience and knowledge, and trained staff who have the skills to identify problems at an early stage, whether in bonding, the mother’s mental health or child development, so that that disadvantage can be tackled.

I have heard from Stanlaw Abbey the great strides made by children coming into the centre and how much progress they make, as well the support given to the parents, many of whom have re-entered education and the world of work, thanks to the help of the centre. The one challenge that continually remains, though, is how to engage with those families who do not come through the door. We know that they are out there. They will not all need support, but some will, and despite extensive efforts to reach out to these families, they simply stay outside the system for too long, missing out on the crucial support that this debate is trying to highlight.

For me children’s centres have to be the cornerstone of a successful early years policy. That is why it is so concerning that under this Government we do not appear to have any strategy for children’s centres. The Prime Minister famously promised to protect such centres, but there are 700 fewer designated children’s centres than there were in 2010.

Alongside that, many of the local government services that families used to rely on are taking a massive hit. The transfer to local authorities in October this year of the healthy child programme for children up to five years of age presents an important opportunity for local authorities to integrate health, education, social care and wider council-led services and to focus on improving outcomes for children from birth. But I find it difficult to square the circle of this announcement alongside the £200 million in-year cut to public health that this Government have introduced.

There is a real risk that the decision could cost more money than it saves and that the good intentions behind passing responsibility to local authorities could be stymied from the off as a result of the short-term approach to funding that the cuts represent. I would therefore be grateful if the Minister updated the House on what support he is giving to local authorities to ensure that commissioning is properly resourced when they assume this new responsibility. What steps is he taking to ensure that the cuts do not affect front-line services?

As we know, many local authorities have been forced to pare back to the statutory minimum, which is totally against the grain of what we are trying to achieve. Taken together, the failure to invest in early help services and the lack of priority the Government give to this type of provision mean that Ministers will fail to support adequately all children and families in those critical 1001 days. The cross-party agreement we have heard about today needs to be matched by cross-departmental harmony across Government.

In conclusion, the evidence is overwhelming. It is so obvious that it should have underpinned Government policy decades ago. Anyone who is a parent will recognise the intensity of feeling when observing how their child is developing. That innate desire for one’s offspring to grow up to be happy, healthy and wise should be all the encouragement we need to support this incredibly important document, not just for our children but for everyone’s children. On that note, I would like to wish everyone in the House a very merry Christmas.

ACCESS TO MEDICAL TREATMENTS (INNOVATION) BILL

Justin Madders Excerpts

Wednesday 16th December 2015 Public Bill Committees

[The Chair]

Before we begin, I have a few preliminary announcements. Please switch all electronic devices to silent. Tea and coffee are not allowed during sittings. Hon. Members may remove their jackets if they so wish.

Today’s proceedings are relatively rare; this is a private Member’s Bill. Therefore, we will proceed in what used to be the time-honoured fashion—without a sittings motion and with our business governed by my selection of amendments and groupings and the decisions of the Committee.

In general, the choreography is like that in any other public Bill Committee. The Member with the lead amendment in a group kicks off. Then I propose the formal question. Then there is a debate on the whole group. Then the Member with the lead amendment responds and tells us whether they wish to withdraw the amendment or press it to a Division. We will deal with any votes requested on grouped amendments formally when we get to the lines of the Bill that they affect. That can be a little confusing, but I will seek to guide Members as we proceed. Then we move on to the next group or clause stand part debate as required.

There is no formal finishing time for this sitting— I was not looking forward to reading out those words. I hope that 4.30-ish will see us home, but we will see. Proceedings will be concluded either by us finishing our business and reporting the Bill or by a Member who has the floor—not intervening—moving the motion that the Committee do now adjourn. That is itself a debatable question, so there can be debate on that as well. If it looks like the Committee will not be able to complete its consideration of the Bill today, I will invite the Member in charge to move a sittings motion before any Adjournment.

Clause 1

Access to innovative medical treatments

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I beg to move amendment 1, in clause 1, page 1, line 3, leave out from first “to” to “for” in line 5 and insert “provide”.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 2, in clause 1, page 1, leave out lines 8 and 9.

Amendment 3, in clause 2, page 1, leave out line 17 and insert—

“(b) all of the positive and negative results of such treatments, and”.

Amendment 4, in clause 2, page 1, line 17, at end insert—

“(c) patient experiences of such treatments.”.

--- Later in debate ---

[Justin Madders]

It is always a pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Member for Daventry on successfully progressing his Bill to Committee. I have not been in this place long, but I am aware that many private Members’ Bills fall well before this stage, so he deserves credit for clearing the hurdles placed in front of him so far. I also thank the hon. Gentleman for taking the time to meet me yesterday to discuss the Bill. I know from our conversation that he has put a huge amount of work into the Bill, and I am sure that even those who oppose it will have welcomed the opportunity that he has given to all the interested bodies to discuss it with him.

As I made clear during the debate on the money resolution, and as the shadow Secretary of State for Health, my hon. Friend the Member for Lewisham East (Heidi Alexander), set out in detail on Second Reading, Opposition Members believe that the Bill has been presented by the hon. Gentleman with the best of intentions, but we have serious reservations about some aspects of it. I will set those out in relation to our amendments 1 and 2, which we intend to press to a vote.

As I am sure the hon. Gentleman has been reminded on many occasions, the breadth of opposition to the Bill is extraordinary. It unites a huge number of professional bodies, royal colleges, charities and patients’ bodies. That opposition has been particularly strong in relation to clause 3 onwards, and we share the concerns about those clauses.

Our first two amendments relate to the introductory comments in clause 1, which sets out the purpose of the Bill. Amendment 1 would remove the words

“promote access to innovative medical treatments by… providing”

in lines 3 to 5 on page 1 and insert instead in line 5 the word “provide”. Amendment 2 would delete entirely lines 8 and 9. When combined together, and subject to what else is agreed today, those amendments would, we hope, remove entirely the provision in the Bill relating to what is described as “responsible innovation.” In our view, that provision is at best unnecessary, possibly counterproductive and at worst potentially dangerous. It is unnecessary because to date no evidence has been provided to suggest that the threat of litigation acts as an inhibitor on doctors innovating. A number of bodies have spoken on that point, as indeed have hon. Members at previous stages of the Bill.

I will give a few examples. The British Medical Association said:

“We are not aware of any evidence to suggest that the threat of litigation inhibits innovation or that confusion exists amongst doctors over the circumstances under which they can deviate from standard practice.”

The Academy of Medical Royal Colleges said that

“the Bill rests on the false assumption that it is fear of litigation that is holding back innovation by doctors. There is simply no evidence that this is the case”.

The Royal College of Surgeons said that

“there is no evidence that doctors are deterred from innovating due to the threat of legal action.”

Even Sir Robert Francis, QC, said:

“The law of negligence does not prevent responsible innovation and never has.”

As the hon. Member for Daventry will know, many have also made the same point that the current law is not an impediment to innovation, so this part of the Bill seeks to address a problem that we say simply does not exist. I am aware that some clinicians said in response to the Government consultation that that was a problem, but even the Minister conceded that very few saw it as the principal problem. If we are looking to break down barriers to innovation, a great many other factors mentioned in responses to that consultation could address the problem and are not set out in the Bill.

We also think that the Bill is counterproductive. Even were it accepted that there was a problem, the Bill could increase litigation and uncertainty among doctors. On that point, Earl Howe said in response to a similar provision in the Medical Innovation Bill that it may be that overall litigation claims increase slightly as the legislation is tested. This Bill adds an extra layer of complexity that the law does not warrant. I would be interested to know whether the Minister has any views on the potential for extra litigation arising from the Bill. As we know, the law on medical negligence has been developed over many years, and I am not persuaded that the perceived benefits of the Bill are worth upsetting the certainty and stability that the settled law has brought.

Most significantly, we consider the clause to be potentially dangerous. That is not an attempt to cast aspersions on the hon. Member for Daventry, as I know he is genuinely trying to do his best, but we all know about roads paved with good intentions. To give an example, because “innovative treatments” is not defined in the Bill, it applies to all decisions to treat that are outside the range of accepted treatments. It therefore includes treatments that would currently be considered negligent, because negligent treatments are by definition outside the range of accepted treatments. That by itself is concerning.

The Bill requires the agreement of two doctors that a treatment decision would be supported by a responsible body of medical opinion, but it does not tell us how that agreement is to be reached. Is it a chat over a pint at the golf club? On any analysis, that is in no way comparable to a court finding on the basis of expert evidence that there was a responsible body of opinion that would have supported the treatment and that the treatment was rational and reasonable in all circumstances.

“Treatment” is defined in clause 5 to include “inaction”. For example, a patient might suffer from complications after bowel surgery. The patient having a fever and abdominal pain, the surgeon decides not to return them to theatre, but to continue with treatment of antibiotics and monitoring. In fact, the patient has a bowel perforation caused by the surgery and sadly dies. Under the current law, the court would find that no responsible body of surgeons would have delayed taking the patient to surgery within 24 hours. Had the surgeon done so, the patient’s perforated bowel could have been repaired and they would have survived. The court would find that the surgeon was negligent and that the negligence caused the patient’s death. The patient’s family would in those circumstances be compensated.

If the Bill becomes law, the surgeon might have a defence where there is none currently. Suppose he had consulted a colleague and asked whether he thought a responsible body of surgeons would not take the patient back to theatre, but would adopt a “wait and see” approach. If the colleague agrees, the surgeon could say that he had weighed up all the advantages and disadvantages, that he had the agreement of the patient to wait and see, rather than to go back to theatre, that he had gone through all the right steps under the Bill and that it was just that the decision was a bad one, which in fact no reasonable body of surgeons would condone. The Bill would give him a defence in such circumstances. If he had gone through the right steps under the Bill, by definition he could not be found negligent.

I am worried that the Bill will muddy the waters on the legal route for doctors who wish to innovate. I am worried that it will reduce patient participation in clinical trials. If patients are faced with the choice of guaranteed access to treatment or participation in a trial in which there is a 50:50 chance that they will not be part of the group receiving innovative treatment, why would they choose to be part of the trial? I am worried about the potential removal of legal redress for a patient with a genuine negligence claim. I am worried that unsafe treatments could be used on dying patients. Clause 1 should be amended to remove that provision from the Bill.

I will speak briefly to the other two amendments in the group. Amendment 3 replaces a paragraph that reads:

“the results of such treatments”,

and is intended to make it clear that we expect negative as well as positive results to be reported to prevent unsuccessful innovations being repeated, which would cause unnecessary suffering.

Amendment 4 would ensure that the information recorded on the database is as comprehensive as possible. In order to be a comprehensive record of the treatment, patient experiences need to be included. It may well be that the hon. Member for Daventry intends the Bill to be fairly general in its description of the database at this stage, in which case he may say that it is not necessary to have this level of prescription in the Bill. However, we believe that these are important details that should be set out now and included at this stage.

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

It is a pleasure to serve under your chairmanship, Mr Streeter. As the hon. Member for Ellesmere Port and Neston has just said, this is one of those Bills that has aroused a lot of interest. We have a number of issues to deal with in Committee and outside this room in further conversations.

I know that we are discussing specific amendments, but let me say briefly that I agree with much of what the hon. Gentleman said. Everybody accepts that the ambition of the Bill is noble: to promote innovation. Everybody in the health system accepts that innovation has been the lifeblood of medicine and of the NHS, and of this country’s leadership in medicine. The point of difference we need to focus on is the one he eloquently raised: identifying the barriers to adoption of innovation and the extent to which fear of negligence is one of them. If it is not, what is the barrier?

The hon. Gentleman made an important point about the risk of even well-intentioned attempts to clarify having an inadvertent effect of generating a festival for lawyers, to debate whether or not the Bill could potentially have any effects other than those that Parliament intended. I certainly agree with him that if that were to happen it would be unhelpful.

The point of the clause, as I understand it, is to clarify for those who fear that the existing protections on negligence create a burden of proof that is unclear in law and thus create a de facto barrier to innovation, a clear process that in no way changes the current provisions of medical negligence law. I can confirm that one of my main preoccupations has been to ensure that we in no way inadvertently or deliberately change that protection. We have had counsel look at that very carefully, and we have been advised that this would in no way change the basis of medical negligence law.

The Bill simply seeks to create a procedure that would provide clinicians with comfort that by pursuing that they are simply pursuing what is currently best practice under existing medical negligence provisions. I take the hon. Gentleman’s point that, if it creates any significant uncertainty and thus inadvertently creates confusion, it will have the opposite effect to that it was seeking, which is to clarify the process.

The hon. Gentleman touched on the importance of need, and I will return to that point later because it goes to the heart of where the Committee ought to help get the Bill. He also touched on safety. I want to address that profoundly, because my No. 1 concern as a Health Minister is patient safety. I join him in paying tribute to my hon. Friend the Member for Daventry for taking the wide interest of the House in the subject and seeking to come up with a measure that can satisfy all parties. He has done a magnificent job of moving us on.

As I have said on the record at the Dispatch Box on more than one occasion, if the Bill, despite its best intentions, undermined patient safety or significantly created the perception that patient safety had been undermined, that would be very damaging for the UK and for the NHS. As the Minster responsible for getting more medical and clinical research into the UK, I cherish this country’s hard-won reputation for setting the highest standards in research medicine. I would be concerned if the Bill specifically, deliberately or inadvertently harmed that.

The chief medical officer has said that she supports the Bill. From a safety point of view, I take a lot of comfort from that. Sir Bruce Keogh has said that he is absolutely sure that the Bill is safe in terms of patient safety, which has been our No. 1 criterion. I think that it would be fair to say that although Sir Bruce Keogh says that the Bill is safe, he does not necessarily lie awake at night longing for it to be passed. He shares some of our concerns about the avoidable but none the less quite predictable outcome of the Bill having the opposite effect to the one intended. From a safety point of view, I am absolutely sure, as a Minister, that the Bill will in no way interfere with current medical negligence practice and that it is merely an attempt to clarify the existing protections available to patients and clinicians.

--- Later in debate ---

On amendment 4, which refers to patient experiences of such treatments, when the hon. Member for Ellesmere Port and Neston and I had our conversation, I said I thought it was not required. The Bill is wide enough to cover patient experience in the databases, including information about treatments and results. Actually, the purpose of the Bill is to confer a power on the Secretary of State to consult widely on covering all such matters when he decides to act on that conferred power, so I do not think that the amendment is required at this stage. If the hon. Gentleman feels the need to press the amendment or to re-table it on Report, I will willingly work with him to get the words correct, so that he is satisfied with the wording and its purpose. For now, I ask him to withdraw his amendment.

[Justin Madders]

On amendments 3 and 4, I am happy to work with the hon. Gentleman and, if necessary, table an amendment on Report. I take what he says about this being a conferring Bill, but I think it was important for us to place on record our views about the importance of patient experience. We can have further conversations on that, and if we consider it necessary we will re-table those amendments. However, we will press amendments 1 and 2 to a vote.

I appreciate what the Minister said about the need to focus on innovation barriers. There is something in what he said about it being a cultural issue—there is no doubt about that. I do not think, however, that a piece of legislation of this nature is the right way to tackle that cultural issue. As I said in my opening comments, the Bill carries the risk of unintended consequences. We can all work together to try to tackle some of the barriers, but the Bill is not the way to do it.

Of course, the Minister has had the benefit of legal advice that I have not had on the impact on existing medical negligence law, but I am sure all members of the Committee have seen the representations from Nigel Poole QC, who is the leading authority on clinical negligence in this country. His view is that the Bill does make changes. We cannot get into a debate about who is right or wrong about that, but I focus on what the Minister said about how, even if the Bill only changes the perception of patient safety, that is important in itself. That alone is reason for us to pause and look again at the Bill, and that is why I will press amendments 1 and 2 to a vote.

[Chris Leslie]

To be absolutely clear on the effect of the amendments, as I read them, amendments 1 and 2 would delete the provisions about access to innovative treatment, but would retain the creation of the database. Have I got it right?

[Justin Madders]

Yes, my hon. Friend is absolutely correct. That is why we spent some time talking about those issues. They are really at the heart of the concerns.

[George Freeman]

Before the hon. Gentleman decides how he wants to proceed, I wanted to welcome the commitment my hon. Friend the Member for Daventry made to withdraw if we cannot reach agreement and to second my offer to sit down and work with members of the Committee and others to see whether we can get a package of amendments. I am rather less worried about other bits of the Bill from a Government point of view, but this bit is in many ways the best bit of the Bill. This is a very different Bill from the original Saatchi Bill, in that it focuses—perhaps not strongly enough for the hon. Gentleman—on getting information to clinicians on the innovative medicines that are out there. Funnily enough, it is the bit of the Bill I would most like us to keep. I reiterate that I am happy to work with members of the Committee, and to get officials to help us try to get the Bill into a better place, if that helps us to avoid an unnecessary Division.

--- Later in debate ---

[Justin Madders]

I am afraid that I do not have the confidence that we will be able to get the Bill to a place where we can agree. The widespread concern among all the royal colleges says to me that we need to start again, and that is why I will press the amendment to a vote.

Question put, That the amendment be made.

--- Later in debate ---

Database of innovative treatments

[Justin Madders]

I beg to move amendment 5, in clause 2, page 2, line 20, at end insert—

‘(b) the General Medical Council,

(c) the British Medical Association,

(d) the Association of Medical Research Charities,

(e) the Royal Colleges,

(f) the Academy of Medical Sciences,

(g) the Medical Research Council,

(h) the National Institute for Health and Care Excellence, and

(i) the Medicines and Health Products Regulatory Agency.’

[The Chair]

With this it will be convenient to discuss amendment 6, in clause 2, page 2, line 20, at end insert—

‘(6A) Regulations under subsection (1) may not be made unless the Secretary of State is satisfied that the regulations have the approval in principle of—

(a) the HSCIC,

(b) the General Medical Council,

(c) the British Medical Association,

(d) the Association of Medical Research Charities,

(e) the Royal Colleges,

(f) the Academy of Medical Sciences,

(g) the Medical Research Council,

(h) the National Institute for Health and Care Excellence, and

(i) the Medicines and Health Products Regulatory Agency.’

[Justin Madders]

I will be briefer on these amendments.

The clause deals with the creation of the database, which we consider unnecessary, because the Secretary of State already has the relevant power under section 254 of the Health and Social Care Act 2012. Even if there is a difference of opinion and the clause remains in the Bill, we want to broaden the number of bodies that the Secretary of State must consult. We think the list in the amendment is comprehensive, whereas, as the Bill stands, to make regulations under clause 2, the Secretary of State need consult only the Health and Social Care Information Centre. The explanatory notes to the Bill state:

“The detailed design of the database would be consulted upon with professional bodies and organisations”,

from which we take some comfort, but we feel that it is better to be clear in the Bill about the wider range of bodies to be consulted.

Amendment 6 would insert a proposed new subsection (6A) requiring the Secretary of State to seek approval for regulations from the bodies on the same list, in essence, as in amendment 5, but with the addition of the HSCIC. It is about having approval in principle, as well as the details and mechanics of the database.

We are not making a complicated point, but we are putting on record our wish for a broader selection of groups to be consulted.

[George Freeman]

I will be brief. Following our earlier conversation about the database provisions, I emphasise that they are the part of the Bill that the Government most strongly support. The database is not envisaged as it was in the predecessor Bill—if I may call it that—as a registry for recording ad hoc innovations by clinicians, but as a fundamental database to give all clinicians access to information on innovative medicines, including off-label uses of medicines and medicines that are either unlicensed but in use, as in the early access to medicines scheme, or in clinical trials, in which a patient might be eligible to enrol. The clause gives the Secretary of State the power to make regulations conferring functions on the HSCIC, the body that develops and puts into place databases such as the one we are discussing, in connection with the establishment, maintenance and operation of the database for innovative medical treatments.

I am pleased that my hon. Friend the Member for Daventry proposed the database for recording such treatments and for getting information on them out to clinicians. The measure is important in the promotion of innovation. Crucially, the measure would give doctors the ability to search the database for innovations, so the position is very different from that under the Bill introduced in the House of Lords last year, which proposed a database as a registry on which innovative doctors could log what they had done. The database proposed in this Bill is completely different, which is why I strongly support it.

The database could result in better care and health outcomes for patients and a faster uptake of new treatments, and it could support our work to make Britain a world-leading centre for innovative medicines. The pace of progress in genomics and informatics is profoundly changing the way in which new drugs are developed, but our databases and systems information have not kept up, so that is among the things that are being considered under the accelerated access review. While the Secretary of State might already have the legal power to create a database, the Bill helpfully sets out that provision may be made to give instructions to HSCIC to create a specific database, which I would welcome. If the Bill does not, for whatever reason, reach the statute book, I would happily proceed towards establishing such a database, but it would be helpful if the provision were set out clearly in legislation.

The Government do not support amendment 5 because it is not exhaustive. Although it represents a helpful list of consultees, such a provision would need to include many more organisations. While I understand the intention behind the amendment, restricting the process would not be helpful, but I would be happy to write to members of the Committee about our approach. I undertake to write to all the relevant organisations and to ensure that they are consulted, but I am old enough and ugly enough to know that well-intentioned lists of statutory consultees can quickly become out of date. They can create weird anomalies whereby parties that really have nothing to say are statutory consultees, yet those who have a lot to say are not. I am happy to discuss what other steps we can take to ensure that those who, rightly, need to be informed about the Bill and the mechanisms it proposes are properly informed.

The Government do not support amendment 6 for the same reason—because the list is not exhaustive—but I will be happy to put in a place an alternative mechanism to ensure that those parties listed the amendment and others are properly informed. I would not want to put in law a list of consultees that we might well need to amend quite quickly. I, for one, do not want to find myself back in Committee considering a statutory instrument to amend a list of statutory consultees established by a well-intentioned proposal, so I hope that the hon. Member for Ellesmere Port and Neston will withdraw the amendment.

[Chris Heaton-Harris]

Obviously, I agree with the Minister, and I have discussed the matter with the shadow Minister. I know from my consultation on the Bill with stakeholders that we would need longer lists than those in the amendments. I hope that the hon. Member for Ellesmere Port and Neston will agree to the Minister’s generous offer and therefore withdraw the amendment.

[Justin Madders]

Our debate has shown that a well-intentioned proposal might have unintended consequences, so I accept what the Minister and the hon. Member for Daventry say about the need for comprehensive lists. I think that the lists in the amendments are pretty comprehensive, but I accept that other bodies might emerge or feel that they should be included. I am happy to work with the hon. Gentlemen to ensure that we reflect the intention behind the amendments, yet do not create additional work a few years down the line because we have to amend the legislation. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 2 ordered to stand part of the Bill.

Clauses 3 to 5 ordered to stand part of the Bill.

Clause 6

Extent, commencement and short title

Question proposed, That the clause stand part of the Bill.

[George Freeman]

On a point of order, Mr Streeter. This may be a point of order, although I stand to be corrected.

--- Later in debate ---

[George Freeman]

I would like briefly to add my thanks to you, Mr Streeter, for chairing the Committee.

We have had a constructive discussion with all parties represented on the Committee, with some front-line advice from clinicians. I thank my hon. Friend the Member for Daventry for his clear offer. I pay tribute to him for the clarity of that offer. The Government are concerned that this Bill, with the noblest of intentions, is still not in a place where it has widespread support from all parties. A Bill that elicits concerns and opposition from both industry and charities, patient groups, lawyers and the General Medical Council is a Bill whose nobility of purpose is not yet reflected in unanimity of support.

I am grateful to my hon. Friend, and I know that he is keen to get the Bill to a point where it can be distinguished from a predecessor Bill that generated a lot of heat and some opposition. I genuinely believe he is trying to get to that point, particularly on the database provisions. I urge him to keep his foot to the pedal, particularly on the negligence provisions, on which we have a bit more work to do. I repeat that if a well-intentioned Bill has the inadvertent effect of undermining patient and public trust in the world-class status of our research medicine and clinical trials, it will be self-defeating and I would find it impossible to support. However, we have a chance to avoid that.

I thank you for your excellent chairmanship of the Committee, Mr Streeter, and add my thanks to the officials sitting on both sides of you, who have guided us through this process. I hope we can get to a point where we can go back to the House on Report and say that this Committee has managed to rescue a noble cause and, with the help of my hon. Friend the Member for Daventry, put forward a proposal we can all support.

[Justin Madders]

May I start by thanking you, Mr Streeter, for your chairmanship of the Committee? I hope that this is the first of many times we will meet in such a situation. I also thank the Minister and the hon. Member for Daventry for the open way in which they took on board our concerns. I, along with my hon. Friend the Member for Torfaen, will be pleased to accept any offers to help get the Bill into a shape where it has the support of not only Members of all parties, but, most importantly, the greater medical community. The hon. Member for Daventry is a beacon of optimism in that respect, given the level of concern that remains, but we shall try. The Minister is right that we do not want to put into law something about which there is such widespread concern, but we shall see where we get to on Report.

Question put and agreed to.

Bill accordingly to be reported, without amendment.

Draft National Health Service (Licensing and Pricing) (Amendment) Regulations 2015

Justin Madders Excerpts

Monday 30th November 2015 General Committees

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The Opposition are deeply concerned about the regulations, and we hope the Government will consider their position as a matter of urgency. There are four principal reasons for our concerns, which I will outline before going into more detail about the regulations. I will welcome any responses the Minister can give.

The first area of concern is the removal of the share of supply percentage as part of the objection mechanism, which will create an imbalance. It will, for example, give a large NHS teaching hospital with a turnover of more than £1 billion the same voting weight as a private minor injuries unit with a turnover of just £150,000.

Secondly, the regulations effectively disband the tariff objection mechanism entirely, as it would be mathematically impossible to trigger the mechanism even if every NHS trust and foundation trust objected. Every NHS trust and foundation trust taken together would constitute 62% of providers, but the regulations establish a 66% threshold to trigger the objection mechanism.

Thirdly, the regulations effectively silence those on the NHS frontline in tariff setting. Setting the tariff without an effective mechanism for those delivering patient care to object could constitute a risk to patient safety and care quality.

Finally, the regulations directly contradict assurances given by Earl Howe on behalf of the Government during the passage of the Health and Social Care Act, when he said:

“I am clear that we must have a process for adjudicating on Monitor’s proposals if a sufficient number of those who will be affected by them object; otherwise, in these circumstances, either Monitor would have no way of proceeding with disputed proposals or those affected would have no other way of disputing proposals other than by judicial review.”—[Official Report, House of Lords, 6 March 2012; Vol. 735, c. 1740.]

In addition to those four major areas of concern, I have heard nothing of substance from the Minister today to suggest that anything is wrong with the objection mechanism as it stands. The Minister said the mechanism inhibits new models of care, but I am afraid he did not set out why. The Department of Health certainly did not put that forward as a justification in its consultation document. It actually said that the current system allows a

“relatively small number of large trusts”

to disrupt NHS planning, but that is simply not borne out by the facts. The last objection—indeed, the only objection—was made by 37% of all providers, which is, granted, not a majority, but which is still a reasonable amount. However, when we consider that, between them, those providers carry out about 75% of all NHS work, it is clear that this is not a fringe group seeking to disrupt things for the majority and that those involved do a significant proportion of all NHS work. That 37%—or 75%, depending on which way we want to count it—actually had a point, because the Government changed their plans as a result of the objections that were made. We therefore question whether it is embarrassment rather than effectiveness that is driving these proposals.

Let us take a moment to consider the current system and whether there really is a fundamental problem that needs to be fixed. The national tariff is the payment system for the majority of secondary care in England, and it covers £72 billion of the overall £116 billion NHS budget. It therefore affects all acute hospital, ambulance, community and mental health NHS providers and the care they can deliver.

The tariff is set annually by NHS England and the health sector regulator Monitor. To date, the objection mechanism has been a vital safeguard in the national tariff. It allows NHS providers and commissioners to formally lodge objections to the methodology used to develop the tariff.

The methodology is based on historic service costs, inflation and required efficiency savings. If 51% of commissioners or providers, either individually or based on the proportion of services they provide, object to the proposed tariff, the objection mechanism is triggered. That is not a low bar, and a significant amount of concern must exist across the sector for the mechanism to be used. It is designed not to be triggered regularly by a minority, and, indeed, it has not been. Rather, it is a patient safety alarm, reserved for use when providers and/or commissioners feel that the proposed tariff prices will not allow them to deliver safe and high-quality NHS services. It is clear from what we have heard today that, when it is used, it actually works.

In 2014-15, the mechanism was triggered for the first time, with 75% of providers, calculated by share of supply, objecting. Their reasons were substantial, and the decision to object was taken reluctantly. As the Minister said, the objection is to be used in exceptional circumstances only, so it is worth looking at the circumstances of that objection to understand why it was exceptional.

The basis for the objection was an unrealistic efficiency requirement for the fifth year in a row, making it impossible for providers to cover their costs, as well as changes to the way specialised services were paid for, significantly reducing essential funding for the care of some of the most vulnerable patients, such as those suffering from cancer. That would have introduced a marginal rate for specialised services, whereby providers would have been paid just 50% of the tariff price for services that exceeded their own projections of patient demand. Such projections are not a perfect science, in particular as conditions that require specialised treatment proliferate as our population grows and ages. It simply would not be safe or sustainable for providers to agree to carry out some of the most complex and cutting-edge treatment in the NHS at half the agreed cost. The proposals also sought the continuation of a punitive lower rate for emergency admissions, which effectively penalises hospitals for admitting patients in accident and emergency despite such demand increasing.

The objection allowed NHS England and Monitor to go back to the drawing board and return with a solution: they moved £500 million over to providers from the commissioning side, increased the marginal rate for specialised services to 70% and allowed providers the option of remaining on the previous year’s tariff. NHS Providers, the association of NHS trusts and foundation trusts, highlights that the commission now forecasts a budget surplus of £500 million this year and providers project a deficit of £2 billion to £2.5 billion. The mechanism was triggered responsibly and produced a better overall outcome for the NHS. Will the Minister therefore explain the rationale for changing the law to make the important elements of the tariff objection process effectively redundant, when this year’s experience shows that the process enabled a better outcome for the NHS and patients alike?

I will turn to the regulations, which, in a nutshell, we consider to be unbalanced, risky and rushed. They simultaneously remove the providers’ ability to object on a weighted or share of supply basis, and raise the threshold for triggering the objection mechanism to 66%. That has two effects. First, it gives every licence provider the same say over the tariff. Non-NHS providers who deliver just 4% of NHS tariff services will, in the future, have as much influence over how the NHS tariff develops as NHS trusts and foundation trusts even though they provide just a fraction of those services. What is the Minister’s rationale for not distinguishing between the NHS public providers for whom the national tariff is a matter of fundamental importance and non-NHS providers for whom it is of peripheral relevance?

Secondly, the regulations increase the trigger threshold from 51% to 66%. That, along with the ability of providers to vote for share of supply being removed, will mean that even if all NHS trusts and foundation trusts object to a proposed tariff, they would account for only 62% of all providers. That is the 62% of providers who deliver 96% of all services under the NHS, so 96% of all NHS services could effectively be denied a voice and a transparent mechanism of opposition.

By removing the weighted vote from NHS trusts and foundation trusts, I do not think it is possible to suggest that the intent behind these regulations can be anything other than to remove the objection mechanism in all but name. I therefore ask the Minister why the Government who introduced the 2012 Act recognised that it was fair to give providers the right to object to the tariff and a greater voice to those providing the most tariff services, but this Government take a different view?

That the NHS is under an unprecedented period of financial pressure is beyond dispute, even with the additional funds announced in the comprehensive spending review for NHS England’s budget next year. We know that 80% of all providers are currently in deficit, with a provider sector deficit of about £2.2 billion by the end of the year looking likely. It is therefore not the time to seek to stop providers from being able to raise concerns about unviable tariff prices. The stakes we are dealing with are too high and the risks to patient care and safety are real.

As I set out earlier, if the objection mechanism had not been triggered last year, the providers’ finances would be in an even more parlous state than they are now. In the light of those risks, it is vital that we understand in full the potential impact of the regulations. It seems irresponsible that the regulations have been laid so rapidly, without an impact assessment having been prepared.

The Lords Secondary Legislation Scrutiny Committee noted that the consultation on these regulations, which relate to a highly complex area of NHS policy, ran for just 29 days, from 13 August to 11 September. The Department suggested to that Committee that such a short window of time during a summer holiday period was appropriate because it had forewarned informed bodies. However, that is not an appropriate basis on which to conduct proper, meaningful and transparent consultation and I hope that the Minister will acknowledge that.

The consultation is all the more extraordinary because not only was it done at a time of year when people are not traditionally about, but the Department has completely ignored its responses. The 221 commissioners and providers that were able to respond in the consultation timeframe delivered a pretty unambiguous verdict: 82% of respondents stated that the objection threshold should not be raised from 51%, and just shy of two thirds—65%—disagreed that the weighted vote of providers should be removed. Another point that came out of the consultation, as the Minister highlighted, was that it is too soon to evaluate properly the effectiveness of the current system. Will he explain in his closing comments why he has shown complete disregard for the views of the bodies responsible for planning and delivering NHS services? What level of response would be needed for a different reaction— 85%? Ninety per cent.?

If passed, the regulations will effectively make the statutory consultation process the sole means for providers and commissioners to raise concerns about any risk associated with the proposed tariff. Given the clear evidence that the Government have not been effective in their consultation on the matter, does the Minister agree that providers and commissioners have every right to be concerned that their views will not be heard through a consultation process alone in the future?

The Department has set a damaging precedent with the consultation on the regulations, and strong assurances must be offered on how the tariff consultation process will respect and respond to concerns expressed by those working at the NHS coalface. There was clearly a rationale for introducing the tariff objection system in the first place, and I struggle to see what has changed in the past few years to warrant this change, other than the system being seen to do what it was set up to.

Our fundamental concern is that the regulations appear to remove the ability of those providing services on the NHS frontline to raise an early warning signal that proposals will not be sustainable. We know that efficiency savings proposed in the five-year forward view are at best challenging, at worst impossible, and there will be a temptation to pile more and more of those savings through this system. Without an effective mechanism in place to force a pause in such proposals, there is a real risk to the safety and quality of patient care and the sustainability of local health economies. In the words of the House of Lords Secondary Legislation Scrutiny Committee:

“The opposing views of the Department and the major Providers are a significant cause for concern and raise the question whether these Regulations may imperfectly achieve their policy objective.”

For that reason and the others I have set out, the Opposition strongly believe that the regulations are unbalanced, risky, rushed and should not be passed.

--- Later in debate ---

[Ben Gummer]

That is not entirely the gloss I would give to my comments.

There is no veto to all providers, because we are talking about 66% of providers in total meeting the objection threshold. This means that one particular bloc in the healthcare system as a whole that uses the tariff—it is not just used by NHS providers—will not be able to block the proposed tariff. Currently a smaller proportion of NHS providers—it is not even the full number—can block the tariff. It is not a scientific process, but in trying to balance the interests of commissioners and a healthy provider sector, which incidentally we will fund considerably more in years to come, we feel it is not right to give an objection threshold of 51%, and that we need to show a more significant number. That is why 66% of all providers would have to meet the objection threshold.

I would not like to speak for Earl Howe, who I know spent many hours explaining this matter and going through it in detail during the passage of the 2012 Act, but I think it was understood at the time—this was why the Bill developed as it did during its gestation—that, as with any health economy, the regulations would need to be finessed as issues emerged. To be blunt, we are at a time when NHS spending has gone up over the past few years, although it has been under significant pressure, as the hon. Member for Ellesmere Port and Neston said, because of changing demographics, and the way in which the tariff system and the changes made in the 2012 Act have enabled the tariff and the whole health economy to operate has allowed us to manage funds in an efficient manner.

I am conscious that others may want to speak, so I want to cover some of the other issues that the hon. Gentleman raised. He mentioned patient safety. I hope that I can place the issue in the larger context of all our reforms around the Care Quality Commission, introducing a simple grading system that gives complete transparency, and our additional funding to the commission over the past five years. By everyone’s estimation, the commission has improved its performance significantly, although we all want to it to improve still further.

We believe that patient safety is ensured by a raft of measures, not just by increasing NHS funding, but by increasing transparency on outcomes, by better regulation and inspection, and by giving a voice to NHS workers—giving them freedom to speak out through the whistleblowing champions that we have introduced and the efforts we are making to bring in a learning culture in the NHS. We are making those efforts in order to develop an NHS that learns from mistakes, can point out and shout about failures in patient safety, and can improve patient care in an iterative process.

That cannot, and can never be, about just pumping money in at one end and expecting to get improved care out at the other. We know that increased resources are one component, but to characterise tariff as a patient safety alarm is itself a little alarmist. It is one part of a health economy. As I explained, it is set by clinicians and economists, and the whole architecture that the Government have tried to reinforce and in parts introduce is there to underpin patient safety in the round. This is merely one component of that.

The hon. Gentleman raised specialised services. He could also have raised the issue of emergency admittances. Both those things are being looked at in the current tariff proposals. I understand the concerns that he raised, and I know that officials and Monitor will have heard them.

I must finally address the consultation process itself. I am not sure that the hon. Gentleman’s characterisation is fair on this. The consultation lasted a month. I do not think we can count a Spanish summer as happening in the NHS in the way he might suggest, as if everyone had vanished and was unable to respond. We received a significant number of responses. Given the fact that there are roughly 147 NHS acute trusts and a significantly larger number of commissioners—we are not talking about thousands, however—receiving 221 responses is good. They were full responses and I was completely open about their nature and the fact that, frankly, they were split, if not 50:50, about as close to 50:50 as a public consultation gets, on the quality of the Government’s proposals. The Lords sits in the summer months in a way that the House of Commons does not when we are back in our constituencies, but the 20-day scrutiny period is significant, and their lordships will have looked over it with due care and attention.

I understand the hon. Gentleman’s concerns about the nature of the changes, and it is understandable that he wishes to raise them. In part, they are the objections of some providers, and I am glad that he has brought them to the Committee’s attention, but I hope that, after this discussion, he understands that the regulations are part of a larger balance between different parts of the NHS to ensure that the additional money that we are putting into the NHS—the NHS budget will exceed half a trillion pounds over the course of this Parliament—goes towards reforming the system, new models of care and the primary, social, community and mental healthcare that all our constituents want improved on the ground. This tariff reform will help the process by ensuring that a bloc of providers cannot obstruct that change without significant enough numbers.

[Justin Madders]

I am grateful to the Minister for his gracious comments at the start of his speech. Does he accept that, under the regulations, if all NHS providers objected, they still would not reach the objection threshold? Can he explain why NHS providers are being put on an equal footing with non-NHS providers?

[Ben Gummer]

I hope the hon. Gentleman understands that the tariff, because it is a set price across the entire sector, has to treat every provider with equality. We cannot have a tariff of one price that accounts for one provider differently from another. All providers operate under the same tariff system, which means that no single bloc in the NHS or the healthcare system can obstruct tariff reform.

In summary, I hope that the Committee understands why these changes are necessary. They have been consulted upon in full, which is why I continue to commend these regulations to the House.

Question put,

World Prematurity Day

Justin Madders Excerpts

Tuesday 24th November 2015 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is an honour to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Daventry (Chris Heaton-Harris) on securing the debate and on how he introduced the subject, which, as he rightly said, does not receive enough attention in the House or in the media. Hon. Members from all parties have made excellent and sometimes very moving contributions to this debate; I am pleased to have the opportunity to respond on behalf of the Opposition.

World Prematurity Day on 17 November gives us the opportunity to raise awareness of premature birth and concerns involving pre-term babies and their families. The landscape is ever changing; advances in medicine mean that many more babies survive than ever before, and many survive at very young ages that even a few years ago would have seemed impossible. We should warmly welcome those advances, while acknowledging the extra demands that they bring. We should also use this debate as an opportunity to take stock of the progress that we have made in improving outcomes for premature babies and, more importantly, to focus on the challenges that we face and what more we can do to ensure that progress continues.

This issue is extremely significant, and I am pleased to see it receiving attention and a good turnout by Members. As the hon. Member for Daventry said in his opening remarks, an estimated 15 million babies around the world are born prematurely each year, and pre-term birth problems remain the leading cause of death among children under five, responsible for nearly 1 million deaths in 2013 alone. The World Health Organisation estimates that if everyone had access to the same kinds of intervention that we in the developed world enjoy, three quarters of those babies could be saved. This country has a proud cross-party tradition of supporting international development, and I hope that world prematurity day will provide a catalyst for us to redouble our efforts to support programmes to improve outcomes worldwide.

Turning to matters closer to home, in 2013 more than 50,000 babies were born prematurely in England and Wales, meaning that tens of thousands of families faced one of the most terrifying and physically and emotionally exhausting experiences imaginable. I recently spoke to one of my constituents about the issue, and I wanted to share her story with the House, as I am sure that it will be familiar to many who have, sadly, faced the same issues. She told me:

“My twins were born nine weeks prematurely, and seeing your tiny poorly babies hooked up to machines and wires, having to watch while your baby’s heart has stopped and seeing them helped back to life, praying the machine will pick up a rhythm again, isn’t something that I would wish on my worst enemy.”

I am sure that some Members will recognise the intensity of that statement. She goes on to say:

“All we want is for all premature babies to be looked after and given the best chance possible, with the best medical care available to help them to survive”.

Who can disagree with that? I am pleased to say that my constituent’s twins are now four years old, fit and healthy and attending a local primary school, which by coincidence I visited last Friday.

We have made significant progress on increasing the number of premature children who go on to live full lives. Mortality rates have improved year on year, falling by 15.5% between 2006 and 2012. Thousands of people are alive now who would simply not have survived in previous decades. That is the impact of the progress that we have made in recent times, and particularly of advances in treating the most premature babies. We should be rightly proud of that.

However, there is no room for complacency. I am sure that hon. Members share my concern about the recent report by the charity Bliss, which has already been highlighted, particularly by the hon. Member for Daventry. The report, “Hanging in the balance”, argues that neonatal services are “stretched to breaking point” and states that two thirds of neonatal intensive care units do not have enough doctors and nurses, with 2,140 more nurses needed to fill the gap. It also identifies a shortage in junior doctors, a situation that could worsen if the Government do not reverse their current antagonistic stance toward the profession.

The Bliss report goes on to state that more than 850 babies were transferred between hospitals last year because there was not enough space or staff at the units where they were. More than 100 of those babies were ventilated. Such transfers are unnecessary and risky. Frankly, at such a time, the family has quite enough stress already, so I hope that we can work to reduce the number of transfers needed in future.

A report by the Royal College of Midwives states that more than 40% of wards became so busy last year that they were forced to close their doors. The average unit closed its doors on five occasions, with some closing more than 20 times. That situation cannot be allowed to continue. One key issue is training. Trusts currently face the Catch-22 situation of having insufficient qualified staff to cover for nurses on training, while the lack of training contributes to the shortage of qualified staff.

It is clear that a co-ordinated approach is required from the Government, the NHS and local managers to tackle the issue. We welcome the announcement by the Secretary of State on 13 November of extra investment in high-tech digital equipment and training, but we question just how far £4 million will go, particularly when we consider that the shortfall in nurses has almost doubled in the last five years, while during the same period the proportion of nurses with specialist qualifications has fallen by 19%. I would welcome any comments from the Minister about when we can expect that investment to come on stream, and what impact he expects it to have on the number of staff available in our overstretched neonatal units.

However, the biggest issue is without doubt a lack of adequate funding for neonatal services across the board. We welcome the work being done by NHS England and its partners to review the payment model for neonatal services and the priority being given to this area in next year’s NHS plans. I hope that the Minister will be able to reassure us that that will result in the increases in funding that are required to provide the right level of care for premature babies. I also hope that he can reassure us that we will be able to provide that care in the right place, with the number of transfers being minimised as far as possible.

As I set out earlier, there has been a huge amount of progress in reducing the rates of stillbirths and infant deaths. Sadly, however, we know that there is further work to do. The national confidential inquiry, which was led by the University of Leicester, found that more than 60% of stillbirths might have been avoided with better care. As the hon. Member for Daventry said, Britain is currently ranked 33rd out of 35 countries in the developed world for stillbirth rates. As the hon. Member for Colchester (Will Quince) said, that is a national scandal, and there is an urgent need for improvement. He also quite rightly pointed out the massive regional variations that exist. Those variations should be avoidable, and they inform us that best practice should be disseminated further so that improvements can be made across the board.

We welcome the Secretary of State’s declaration of his ambition to reduce the rate of stillbirths and neonatal and maternal deaths in England by 50% by 2030. However, as the hon. Member for Strangford (Jim Shannon) pointed out, the rate of stillbirths has remained stable for the last 10 years and 2030 is clearly a long way off, so we hope that some of the issues can be tackled in the much shorter term. I would welcome any comments from the Minister about what progress is expected within the next five years.

I will return to the experience of my constituent for a moment. In addition to telling me about the obvious pain that she experienced during the time that her babies were in hospital, she went on to express to me something that appears, sadly, to be common among mothers of premature children—a sense of guilt for not being able to carry their children until full term. My hon. Friend the Member for Torfaen (Nick Thomas-Symonds) quite rightly raised the issue of parental health, as did the hon. Member for Banbury (Victoria Prentis), and we have heard that up to 40% of mothers of premature babies are affected by postnatal depression soon after birth. So it is not just the premature babies who need the care; it is the parents as well. That is why it is so concerning that a third of neonatal units have no overnight accommodation, 41% have no access to a trained mental health worker and 30% are unable to offer psychological support.

My hon. Friend the Member for Croydon North (Mr Reed) highlighted the challenges set out in the campaign The Smallest Things, including the financial, emotional and developmental challenges that premature births create, and the impact that those challenges can have on the mental health of parents. Interestingly, he also touched on the need for greater flexibility in maternity and paternity leave. Although we have legislation on such leave, it is a fact that working mothers still face considerable workplace discrimination, and from what my hon. Friend said it seems that those problems are exacerbated when a mother is dealing with a premature birth. I hope we will see some recognition of that issue by the Minister.

I also hope that the Minister can confirm to us what steps he will take to expand access to mental health services in neonatal units. We should also point out that services have been stretched, so a significant allocation of resources is required if progress is to continue to be made.

We will continue to hold the Government to account to ensure that the vision of England as one of the safest places in the world to have a baby becomes a reality, and while the Government continue to make progress they will have our support.

New Cancer Strategy

Justin Madders Excerpts

Thursday 19th November 2015 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I congratulate the hon. Member for Basildon and Billericay (Mr Baron) on securing this incredibly important debate along with the hon. Members for Bury St Edmunds (Jo Churchill) and for Bosworth (David Tredinnick). I welcome the considered way in which he set out the issues in his opening speech. He raised a series of important questions for the Minister on earlier diagnosis, the measurement of the performance of CCGs, patient experience metrics and the cancer drugs fund. Those are all important issues that are set out in the strategy. I echo his tribute to the various all-party parliamentary groups on cancer. They do an extremely good job of highlighting these issues in Parliament and we all welcome the contribution they make.

I thank my hon. Friend the Member for Alyn and Deeside (Mark Tami) for raising the important issue of blood cancer. His family experience highlights the lack of support, particularly for children, during the period beyond cancer. The strategy tries to begin to address that issue. I also thank my hon. Friend the Member for Scunthorpe (Nic Dakin) for his speech, as well as for his work as chair of the all-party group on pancreatic cancer. He quite rightly pointed out the very poor survival rates for pancreatic cancer and the difficulty of getting referrals for diagnosis from GPs.

I echo the comments made by the hon. Member for Castle Point (Rebecca Harris). She raised important issues regarding the repurposing of drugs, particularly for the treatment of brain tumours. The hon. Member for Foyle (Mark Durkan) also made valid points about how the various groups should not be seen as rivals. Indeed, they should be united behind this one strategy, the full force of which has been expressed today.

I also echo the comments made by the hon. Member for Bury St Edmunds. She pointed out that, with more than 200 different types of cancer, an overriding strategy is needed. She reminded us of the shocking statistic that about 20% of diagnoses take place in accident and emergency, which really highlights the challenge we face in making correct diagnoses. She also highlighted the policy gap in relation to off-patent drugs, which we recently discussed in the Chamber.

All Members speak on this matter from experience, which is sometimes of a very personal nature. It is the personal experience of many of those who have contributed to the strategy that we are debating that makes the document so powerful. We know that one in five people who are diagnosed with cancer feel they are treated as a set of symptoms, rather than recognised as a person. We clearly need to change that. The very moving speeches today help us to remember that behind every statistic there is a person with a family and friends.

The Opposition welcome the recommendations of the independent cancer taskforce, many of which build on proposals that the Labour party set out before the election. We hope that the strategy will be implemented in full. It has the potential to deliver improved outcomes for patients, while also delivering better value to the taxpayer. However, as several hon. Members have said, we will realise such benefits only if the recommendations are delivered in full, with front-loaded investment. I hope that the Minister will confirm that the funding required to deliver the strategy will be included in the comprehensive spending review next week. He may be under instructions not to pre-empt the Chancellor’s big day, in which case we hope that the mood of the House can be conveyed to the right hon. Gentleman.

There have been some positive developments on cancer drugs and screening in recent years, but our progress on cancer care has stalled to some extent. The target to treat at least 85% of cancer patients within 62 days of being urgently referred by their GP for suspected cancer has been missed in successive quarters across England for almost two years. Of the 21,629 patients who waited more than 62 days in 2014-15, 42% waited between two weeks and one month after the target date and about a quarter waited for even longer. As Cancer Research UK has pointed out, this is not just a missed target; patients are being failed when they have to wait too long for treatment.

Another concern is that, despite progress in improving some cancer survival rates over the past decade, we still lag behind the best-performing countries. As several hon. Members have mentioned, it has been estimated that up to 10,000 deaths each year in England can be attributed to lower survival rates compared with those in the best-performing countries. As hon. Members have repeatedly pointed out, diagnosis of cancer at a later stage is generally agreed to be the single most important reason for the lower survival rates in England, so it is vital that we do better not only on early diagnosis, but on prevention and awareness.

With a total of 95 recommendations, the strategy will need consistent political and financial support if it is to be implemented in full. We welcome the possibility of a national cancer advisory board, which, as the report states, would allow a mirror to be held up to the NHS on progress in implementing the strategy. No doubt the precise make-up of such a body would be a matter of detail, but we are keen to ensure that there is an independent chair, as has been mentioned, and that patients’ voices are heard on that body.

With so many individual recommendations in the report, it is impossible to do them all justice in the time available. For those unable to read the entire report, I suggest that the principles set out on page 16 are a very helpful overview of the core aims of the strategy. I do not propose to go through all 95 recommendations—we certainly do not have time to do so—but I want to talk about one or two areas.

I want to speak about the quality of life after treatment and about end-of-life care. One of the most compelling and difficult debates in which I have been involved during my short time in the House was that on the Assisted Dying (No. 2) Bill. One message that came through loud and clear in the debate was that there are massive differences in the quality of palliative care available. Evidence consistently shows that far more people diagnosed with a terminal illness would prefer to die in their own home than currently get the chance. That is not an easy conversation to have, but we must get better at it.

I was pleased that the report acknowledges the clear link between cancer and poor mental health. Around 10% of patients with cancer will develop serious depression, and around half of all patients have some unmet need six months after treatment has concluded. Proposals to improve detection of mental health issues and to integrate better the various treatments are to be welcomed, and will hopefully lead to better patient outcomes.

However, the strategy goes well beyond that and, as we have heard, it recognises that support for patients post-treatment in terms of lifestyle, finances and work must be hugely improved. Secondary cancer is also a huge problem, and we must ensure that care after cancer is just as good as treatment of it. I am glad that the Secretary of State has committed to the development of a quality of life metric. Improvements to the system must ensure that how well people are living is just as important as how long they live for.

Too many people are left to fend for themselves in a complicated, bureaucratic maze, while having to cope with unmet physical, emotional and financial needs—my hon. Friend the Member for Alyn and Deeside set out starkly some of the challenges that individual patients have to deal with. Nobody should have to go without help after suffering the hardship of cancer treatment, and we hope it will be possible to ensure that everybody with cancer has access to a recovery package by 2020.

In the short term, steps can be taken to make life easier. Macmillan Cancer Support has calculated that the financial impact of a cancer diagnosis makes someone on average £575 a month worse off. That is why proposals in the Welfare Reform and Work Bill to take away £30 a week in unemployment support allowance from those with cancer who are placed in the work-related activity group seem at odds with what is set out in the strategy. We need joined-up thinking not just across the health service, but across the Government and the whole of society. The report estimates that by 2030 the number of people in work who will be affected by cancer is set to increase by 1 million, and although there is statutory protection under the Equality Act 2010, in reality someone is 1.4 times more likely to be unemployed if they have cancer.

The greater role that wider society can play is set out clearly in the report, which calls for

“a radical upgrade in prevention and public health.”

If we are to make this strategy work, we must consider forming a new tobacco control strategy, and a national obesity strategy that goes beyond the responsibility deal, which is largely limited to reducing the prevalence of obesity in children. The strategy is right to include an ambition to reduce the prevalence of overall adult smoking to less than 13% by 2020. It is not difficult to imagine that current measures will do much to make that happen, and I am pleased that the report includes a recommendation that the NHS should work with the Government to deliver and implement a new tobacco control strategy within the next 12 months.

This is a matter of equality. We all know about the diverse life expectancy figures in different parts of the country, and about how a difference of just a few miles can mean huge gaps in life expectancy. There would be around 20,000 fewer deaths per year across all cancers if socioeconomically deprived groups had the same incidence rates as the least deprived. Smoking plays a large part in that, and more than half of the inequity in overall life expectancy between different social classes can be at least partially attributed to higher smoking rates among the less well-off.

My hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) deserves praise for her marathon effort to ban smoking in cars with children, and such measures will further deter smoking and encourage people to give up. However, even before that strategy has found its feet, it has been undermined by another huge cut to the public health grant for local councils, which will almost certainly mean that smoking cessation services are slashed.

If we are to take the Government seriously on public health, and if this strategy is to work, it must be supported fully. In-year cuts to public health funds go wholly against the strategy, and are contrary to any strategy that seeks a sustainable health service moving forward. As many experts have said, these cuts will end up costing more than they save. They are a political choice, and we should send a strong message to the Chancellor that they should not go ahead.

The introduction of the cancer drugs fund has been a positive development, and it delivered important benefits to patients over the course of the last Parliament, which we welcome. However, 19 treatments were cut from the cancer drugs fund at the beginning of the year, and another 18 went this month. Charities estimate that more than 5,500 patients a year will now be denied access to these life-extending treatments. Will the Minister tell the House whether he supports the removal of those treatments, and, crucially, what support will now be given to the thousands of patients who will miss out on the drugs in the future? I appreciate that this is not an easy situation, but it seems particularly cruel to give people hope and then to take it away.

I want to mention the need for renewed focus on treatments other than drugs. Before the election, Labour promised to create a new cancer treatment fund to look at all treatments available. Surgery and radiotherapy are responsible for nine in 10 cases where cancer is cured. The taskforce concluded that in a number of areas access to treatments such as radiotherapy are not at the level they should be. About half of all radiotherapy machines are reaching the end of their useful lives. We need to upgrade them so we can deliver safer care. We should also enable the more widespread use of modern radiotherapy techniques. Some 38% of cancer patients in England currently have radiotherapy as part of their treatment, but evidence from abroad suggests that this should be closer to 50%. We need to understand why there is this difference and to work towards correcting it.

I have touched on only a few parts of the strategy, and I hope there is recognition that there are wider challenges beyond the strategy itself. Where the Government are clearly working towards the aims of the cancer strategy, they will have our support. I would therefore like to ask the Minister what steps the Department will be taking to ensure that comprehensive implementation plans are laid out for the strategy as a whole by 31 March 2016.

Many Members will have lost someone close to them as a result of cancer. We owe it to everyone affected by this terrible disease to implement and support in full the recommendations set out in the strategy, so we can take further steps towards finally beating cancer.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 17th November 2015 Commons Chamber

[Mr Hunt]

My right hon. Friend championed the cause of patients when he was a Health Minister, and we must continue to do the right thing for patients, which is also the right thing for doctors. It is wholly inexplicable that the BMA should try to gag the GMC and stop it issuing guidance to doctors about their professional responsibilities. Whatever the disagreements over the contract, the most important thing is to keep patients safe.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I am sure that both sides of the House genuinely appreciate the excellent work done by all staff in our NHS, which at a time of unprecedented strain relies more than ever on the goodwill of its employees to keep going. We have to support and value our staff, not criticise them and provoke them when there is disagreement. Calling junior doctors militant is not the way to end a dispute, and we have heard more of the same rhetoric this morning. Industrial action is always a last resort when negotiations have failed. Does the Secretary of State accept any responsibility for that failure?

[Mr Hunt]

I accept total responsibility for doing the right thing to save patients’ lives. I have to say that I think that any holder of this office would be doing wholly the wrong thing if they were to try to brush under the carpet six academic studies that we have had in the last five years that say we have higher mortality rates at weekends than we should expect. This Government are on the side of patients and we will do something about that.

NHS (Charitable Trusts Etc.) Bill

Justin Madders Excerpts

Friday 6th November 2015 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I congratulate the hon. Member for Aldridge-Brownhills (Wendy Morton) on introducing this Bill, which contains a number of welcome measures. I will keep my remarks brief and had hoped that others would do the same, as this is one of a number of important items to be debated today, and Labour Members, at least, are keen to ensure that they receive the attention they deserve.

Before I come to the measures in the Bill, I want to reflect briefly on the remarkable role that charities play in our NHS. They fundraise for innovation, research, additional facilities, services and equipment that have saved lives and have changed lives. Their efforts allow hospitals to offer kindness, time and an incredible level of care at some of the most difficult times that patients and their families face. Every Member of this House will have had their own experiences of the remarkable work that NHS charities do. If this Bill enables these charities to grow and develop their activities to operate even more effectively, then it is certainly worthy of our support.

In the previous Parliament, the Government committed to move towards a model of greater independence for NHS charities, and this Bill removes the remaining barriers that stand in the way, most notably the dual regulation that is unique to NHS charities. It allows charities to demonstrate fully their independence from Government—a theme picked up by several Members. It also creates a very sensible mechanism to enable Great Ormond Street Hospital Children’s Charity to exercise greater autonomy while continuing to benefit from the generosity of J. M. Barrie. It is very fitting that, on this occasion, Wendy has come to the rescue of Peter Pan—although I think we have heard enough about Peter Pan today. This is a straightforward and sensible Bill that Labour Members are keen to support.

Off-patent Drugs Bill

Justin Madders Excerpts

Friday 6th November 2015 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I congratulate my hon. Friend the Member for Torfaen (Nick Thomas-Symonds) on bringing this Bill before the House and the eloquent way in which he introduced it today. He has been in this place for only six months, but today and on other occasions he has spoken with assurance and authority that already mark him out as an accomplished parliamentarian.

As we know, this Bill builds upon the work of the former Member for Cardiff North, whose Bill was defeated almost exactly a year ago to the day, but it also very helpfully speaks to some of the concerns raised by the Government on that occasion. I am pleased to speak in support of the Bill, but in the interests of progress I will keep my remarks as brief as I can.

The adoption of this Bill could allow us to deal simply and effectively with a serious lacuna in the licencing system and a clear failure in the market. It would ensure that people who are at risk of or have been diagnosed with conditions such as multiple sclerosis, Parkinson’s disease, breast cancer, leukaemia and prostate cancer may have access to treatments that they would otherwise be denied. Although I note that the Government opposed the Bill last time, I hope they acknowledge the steps taken by my hon. Friend to address their concerns about the previous Bill and will offer their support to ensure that this Bill is moved on as swiftly as possible.

When the previous Bill fell on Second Reading, a non-legislative solution was presented by the Minister at the time as the alternative to the Government supporting the Bill. However, in the 12 months since then little progress appears to have been made, despite clear promises both on Second Reading and in subsequent ministerial answers to parliamentary questions. In the meantime, the problems persist and the market failure is still there for all to see.

One such example is zoledronic acid, a repurposed drug, which has been shown to reduce the risk of breast cancer spreading to the bone in post-menopausal women by 28% and the risk of death by 18%. Definitive published evidence to this effect has been available since July, yet the treatment has not yet been made routinely available, despite the fact that it costs just 5p per day per patient and could save 1,000 lives every year. Everyone should have equal access to this treatment, but this will not happen unless it is licensed.

The problem is clear for everyone to see and it can be addressed if this Bill is enacted, so it is imperative that we allow it to progress today. Many Members have spoken in favour, and in particular the contributions from the hon. Member for Bury St Edmunds (Jo Churchill) and the hon. Member for Central Ayrshire (Dr Whitford) contained great personal knowledge and experience of the benefits of this Bill. So let us listen to those Members, let us listen to the medical royal colleges, the clinicians, the commissioners, the charities and our many constituents who have contacted us about the Bill, and let us support it today.

Access to Medical Treatments (Innovation) Bill (Money)

Justin Madders Excerpts

Tuesday 3rd November 2015 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I will not detain the House for long, as my hon. Friend the shadow Health Secretary set out in detail our concerns about the Bill on Second Reading. I will say in summary that the Opposition believe the Bill to be at best unnecessary, and at worst a danger to patients.

The Bill is strongly opposed by a number of medical royal colleges, including the Royal College of Surgeons, the Royal College of Pathologists and the Royal College of Paediatrics and Child Health. There is strong opposition from several medical research charities, including Cancer Research UK, Alzheimer’s Research UK and the British Heart Foundation. There is also strong opposition from bodies such as the Wellcome Trust, the Patients Association and Action against Medical Accidents.

Given the range and depth of concern, I do not understand how the Minister can be so comfortable in supporting the Bill, even though he contends that he is not supporting it. I ask him to reconsider the Government’s position. We will see very shortly whether the point made by the hon. Member for Totnes (Dr Wollaston) is correct, and whether the Government are as neutral on the Bill as they state.

[George Freeman]

The hon. Gentleman will be familiar with the procedures of the House, but I just want to confirm that once the House has given a private Member’s Bill a Second Reading, the convention is that the Government, even when they robustly oppose it, always table a money resolution so that the Committee need not concern itself with that matter. Doing so is not a signal of Government support; it is absolutely in line with the convention of the House with all private Members’ Bills, whether we oppose or support them.

[Justin Madders]

I am grateful to the Minister for his clarification. As I say, we shall see very shortly whether that is the case.

I understand that the part of the Bill to which the money resolution primarily relates will give the Secretary of State the power to set up a database. As the shadow Secretary of State set out on Second Reading, we consider that unnecessary because, under section 254 of the Health and Social Care Act 2012, the Secretary of State and NHS England have the power to direct the Health and Social Care Information Centre to establish and operate a system for the collection or analysis of information. I note that, in a recent letter to the shadow Health Secretary, the Minister said:

“Under section 254 of the Health and Social Care Act the Secretary of State has the power to direct the Health and Social Care Information Centre to establish and operate a system for the collection or analysis of information of a description specified in the direction.”

I understand that the Minister’s argument is that he thinks it is appropriate to give the Secretary of State an express power, but I am not convinced by that and neither are many in the medical profession, including the Royal College of Surgeons.

We believe that the Bill attempts to address a problem, namely the fear of litigation, that simply does not exist and for which the profession has provided no evidence. There is a risk that it will undermine the methodical and reasoned approach to research that already exists. In the context of the £30 billion challenge that the NHS faces and the financial problems that are taxing us all, we note that the Bill may prove to be a step in the wrong direction. We will vote against the money resolution for the Bill, and we will no doubt see what the Government make of it when they have considered their research on the costs.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 13th October 2015 Commons Chamber

[Ben Gummer]

The hon. Lady knows that the Immigration Advisory Committee is independent and it makes its recommendations on that basis. There are trusts—I have visited some myself—that had previously relied on agency and migrant labour that have now managed to change the way they are hiring staff so that they can better source sustainable staffing from the domestic staffing pool.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

In December 2009, Lord Lansley, as the then shadow Health Secretary, described the amount spent by the NHS on agency staff as “unforgiveable”. Since he made that statement, agency spending has spiralled out of control, rising by 83% in the past three years. Ministers are in denial about the root causes of that increase. The cuts to nursing training places have created a shortage of nurses and forced hospitals to spend vast amounts on expensive agency staff. Will the Minister now come clean and admit that it was the Government’s mismanagement that caused this financial crisis?

[Ben Gummer]

The hon. Gentleman should know that the unforgiveable thing was the dereliction of care by a Department of Health under a previous regime. It contributed to short staffing—a significant part of the scandal at Mid Staffs—that we needed to put right in short order. That required an emergency response and agency labour to be employed. We are now putting staffing on a sustainable basis; we were left with short staffing in 2010.