East Midlands Ambulance Service

Debate between Justin Madders and Geraint Davies

Wednesday 21st February 2018 Westminster Hall

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

Thank you for calling me to speak, Mr Davies. Perhaps the hon. Member for Mansfield (Ben Bradley) had a call from his lawyers.

[Geraint Davies (in the Chair)]

He has called an ambulance, I should think.

--- Later in debate ---

[Justin Madders]

I congratulate my hon. Friend the Member for High Peak (Ruth George) on securing this debate. She has again shown that she is a strong advocate for issues in her constituency. She described the ambulance service as the glue that binds the NHS together; I would go further and say that all the staff are that glue who bind the service together.

My hon. Friend reeled off a whole range of statistics about performance in EMAS. The ones that stuck out for me were the nine-hour wait for an ambulance and the queuing times at hospitals, which were also mentioned by a number of other hon. Members. She talked about the risk-averse approach of 111; although clearly no one wants that to go too far the other way, I know that more clinicians are now working for 111. I will be interested to hear whether the Minister feels the balance between clinicians and non-clinical staff in that service is now right.

We heard from a number of Members, but unfortunately I will not have enough time to go through all the contributions. In a very thoughtful and relevant speech, the hon. Member for Sleaford and North Hykeham (Dr Johnson) made some interesting points about whether staff are utilised as effectively as we might like.

My hon. Friend the Member for Bassetlaw (John Mann) made some interesting points about geography—he should look at some of the sustainability and transformation plans too, to see whether the geography there makes any sense—and privatisation, which probably got a fairer hearing from Members on our side of the Chamber than those on the Government Benches, but that is something we need to examine closely.

We also heard from my hon. Friend the Member for Lincoln (Karen Lee), who spoke movingly and passionately from her personal and professional experience. We heard about people with chest pains waiting two and a half hours for an ambulance—we can only begin to imagine how stressful that must be.

As a number of hon. Members said, geography is clearly a big issue. As we also heard, the trust is one of the most poorly performing in the country. The sparsity of population is clearly driving that problem. The staff are not to blame. Last year the Care Quality Commission report expressed serious concerns but also commented on

“caring, professional staff delivering compassionate, patient focussed care in circumstances that were challenging due to the continued demand on the service.”

It is important to remember that across the whole of the NHS, providers struggle to meet the demands.

The financial squeeze has been pointed out on more than one occasion, not only in this debate but by many politicians, patients and staff, and by the assistant coroner for Nottinghamshire, Heidi Connor, in her comments in the regulation 28 reports to prevent future deaths, all of which have been sent to the Department of Health and Social Care, NHS England and NHS Improvement. As Members know, the reports are made when a coroner believes that action should and can be taken to prevent future deaths. In May 2016, in the second of two reports expressing concern, she said:

“The issue in this case…was essentially a matter of resource. In essence, I found that there is only so much an ambulance service can do where they simply do not have an ambulance to send. Demand is clearly greater than the resources they have most of the time”.

We have heard that echoed by Members.

We know that there will be occasions when demand peaks, but Heidi Connor makes it clear that that is not an exceptional spike in demand but a situation that exists most of the time. She goes on to say:

“I consider that there is a risk of future deaths...unless an urgent review of resources is undertaken”.

Will the Minister confirm what specific steps were taken by the Department in response to the regulation 28 reports issued on 11 and 26 May 2016?

Those statements are not the only ones we have heard about the resource situation. After the 2017 CQC report, the chief executive of the service said:

“EMAS was not commissioned to meet the national performance targets during 2016/17, and therefore was not resourced to do so”.

As my hon. Friend the Member for High Peak said, there can be no doubt that finance is the root cause of the issues we are hearing about today. We are in the longest and most sustained financial squeeze in the history of the NHS, and that is having real consequences. The fact that EMAS receives the second lowest urgent and emergency income per head of population in the country is a challenge, in particular given the sparsity of the population and the geographical challenges, as we have heard.

Despite the pressing need to invest more in frontline services, I am concerned that EMAS is having to service debts that have increased from £35,000 to £376,000 in the past year as a result of a loan taken out from the Department of Health in 2015-16. How can the service deliver the improvements we all want when it has to divert money to repay debts, just to keep things on the road?

It is true that EMAS’s performance is below average; it is also true that trusts have deteriorated significantly in their performance since 2010. The same is true of all targets in every part of the NHS. This Government have failed to hit any of their NHS ambulance targets since May 2015. The truth is that underfunding of the NHS has pushed ambulance services to the brink and left record numbers of patients everywhere suffering in discomfort and in terrifying circumstances, as we have heard today.

New performance standards are an opportunity to build a system that has the support of paramedics and patients alike. I conclude by asking the Minister to give an assurance that the new series of standards are based on the best clinical evidence and not just designed to obtain what is achievable with the money that the Department has allocated.

[Geraint Davies (in the Chair)]

Minister, we will end at a quarter to, so you will have time to allow a couple of interventions should you wish.

Medicines Regulation

Debate between Justin Madders and Geraint Davies

Tuesday 21st November 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate my hon. Friend the Member for Bishop Auckland (Helen Goodman) on securing this extremely important debate. It is sad there are not more Members here, but—as always—there are competing interests. She has been assiduous in asserting the rights of Parliament to scrutinise the terms of our exit from the European Union, and today’s debate is no exception to that.

In common with the vast majority of Members—whatever our views on the European Union—my hon. Friend spoke with a genuine desire to ensure that our departure happens on the best possible terms. I am sure we can all see that one priority is to ensure that our economy is able to thrive and that patients are able to access all the medical treatments that they need, as every hon. Member has said. Most of them also mentioned the decision to relocate the European Medicines Agency from London to Amsterdam. I do not know whether the debate was timed with that in mind, but it is certainly apposite.

When my hon. Friend began her speech, she said there had been no explanation, no policy statement, no impact assessment and no opportunity to debate the many issues we have discussed today. Of course, she has a considerable constituency interest in this subject area, but, as we have heard from most Members, the issue affects every single person in this country. The importance of it cannot be downplayed.

My hon. Friend said that regulation is one of the major costs to the industry. I share her frustration that we do not have a clear steer from the Government on what the future of that vital component of the industry will be. As she said, investment decisions are being made now and we are already beginning to lose out. I totally agree with her that the Minister should make it clear that we are putting patients and public safety first.

My hon. Friend the Member for Lewisham East (Heidi Alexander) gave a passionate and well-informed speech on the merits of the EMA. She summed it up very well when she said that the EMA’s leaving us is bad, but our leaving the EMA will be far worse. She was right to highlight the risk of delays for patients accessing new medicines. She said that business and patients need clarity, which is something that has come through clearly from all the Members who spoke today.

My hon. Friend the Member for Barrow and Furness (John Woodcock) spoke with great sincerity about the important business in his constituency. He is a fervent advocate of other businesses and sectors there, so we know that he will not let the matter lie. The announcement in the summer must have come as a real blow, given that Ulverston, and his constituency, are quite isolated from other populations, and in the light of the potential for damage to the local economy when so many high-skilled jobs are at risk. My hon. Friend will obviously want to ask the Minister to be clear about the assistance necessary to get the best from a pretty bad situation. The conversations that he will want to have with Ministers will be similar to those that every Member will have about industries in their constituencies affected by the Brexit decision.

The hon. Member for Central Ayrshire (Dr Whitford) spoke, as always, with great authority on health matters. She highlighted the fact that we are already slipping down the pecking order, and spoke from personal knowledge. In addition to the certainty that patients and businesses need, she highlighted the fact that universities, as well as EU nationals, need certainty. We should not forget, either, the 61 people working for the EMA who may be transferring to Amsterdam. They, too, need certainty about their future. The hon. Lady noted the risk of tariffs being introduced on drugs that have come into the market in the past seven years, if we crash out of the EU on WTO terms. It would be useful to hear from the Minister whether any assessment has been made of the potential cost of the tariffs, and whether he envisages that that cost would be dealt with by the Department of Health, or that individual patients would be expected to pay more for the inevitable additional cost of the drugs.

I doubt whether, when our constituents cast their votes in the referendum, the many issues that we have discussed today would have been at the forefront of their minds. Regulation of medicine is an integral part of our relationship with the EU, but it was not mentioned on any buses. The closest that we got to any debate on the impact of Brexit on the health sector was the £350 million a week that would be spent in addition to existing expenditure. It is sad to see that no advocates of leave are here today to explain how the situation fits into the big picture that they were so keen to propound at the time. Of course it has become apparent since June 2016 and from today’s debate that there is a threat to jobs and investment in the science and research sector. As my hon. Friend the Member for Torfaen (Nick Thomas-Symonds) succinctly pointed out at the start of the debate there is also a threat to access to new medicines; that is a serious unintended consequence. I certainly have not heard any Brexiteers suggesting that our current system is not advantageous to us as well as the other 27 EU member states. It is therefore difficult to overstate how critical the future of medicines regulation is to the economy and, more importantly, to the millions of patients in the UK who will need the medicines whether we leave the EU or not.

It might seem a long time ago now, but in July last year, just after she was appointed to her present role, the Prime Minister said:

“It is hard to think of an industry of greater strategic importance to Britain than its pharmaceutical industry”.

That of course remains very much the case. As my hon. Friend the Member for Bishop Auckland said, we have been exceptionally successful in that sector. The industry has a turnover of more than £60 billion per year, generates exports worth £30 billion and gives us a trade surplus of £3 billion. It employs 220,000 people in this country, and 25% of the world’s top prescription medicines were discovered and developed in the United Kingdom. It is of huge economic importance, and it says something about the sorry state of affairs we are in that Members feel the only way to get any clarity on the future of that vital industry is to have Ministers come to Westminster Hall to debate the issues.

Together with the direct economic impact is the effect on millions of patients, who rely on our co-operation with the rest of the EU to get access to safe, effective and affordable medicines. As we have heard, 45 million patient packs of medicine a year move out of the UK to the EU and 37 million move in the opposite direction. That is an awful lot of movement on which we need the Government to provide clarity. Those benefits, and others that hon. Members have spoken about today, are under threat not only from the relocation of the EMA, but from our exit from the EU if that is not handled more carefully.

Losing the EMA from London is of course a huge blow, not just to the economy of London but to our pharmaceutical sector more widely, for the reasons we have heard. The benefit that it brings to any national economy is evident from the fact that 19 other cities across Europe were in the running to become its new host. In addition to the loss that we will experience from the agency’s physical removal, it also poses a number of challenges and threats to medicines regulation across the EU. Indeed, The Pharmaceutical Journal recently warned that

“a worst-case scenario could permanently damage the medicines regulatory system, leading to a public health crisis”.

Although the EU27 decided not to relocate the EMA in eastern Europe, after a survey of staff found that an alarming 70% to 94% of them would not be willing to relocate there, the move to Amsterdam could still present a risk, in the sense that the survey found that up to 40% of those currently employed at the agency would not be prepared to move.

As my hon. Friend the Member for Lewisham East said, it is not an easy process to move an office wholesale. Some things will stop, and there will be a loss of some highly skilled specialist staff, who will be difficult to replace. An EMA spokesperson said that

“while some job losses can be absorbed within the business continuity plan...beyond a critical threshold, the Agency will no longer be able to fulfil its mandate to protect the health of European citizens.”

I am sure that no one voted for that on 23 June 2016. Good staff will inevitably leave the EMA rather than relocate their homes, their children’s schools and the careers of their partners. That will be an important factor. As the journalist Dr Ben Goldacre put it,

“these highly specialist staff are like trees: they take a long time to grow, and they put down roots.”

In the short term we may benefit from some of those specialist staff staying in the UK, possibly at the expense of the EMA and the future success of European regulation; but let us be in no doubt that in the long term it will be to our detriment, because we will struggle to attract the best.

Before the Brexit talks even move on to the future of medicines regulation, the Government have a duty to act now to protect our vibrant life sciences sector. One of the key reasons why so many countries were competing to host the EMA is that its presence makes pharmaceutical companies far more likely to locate in the host city. Many of those companies will have a UK base, and, as has been mentioned, will be beginning to think about future plans; so what steps are the Government taking today to persuade those companies to stay in this country, and not just to retain their staff but to make investment decisions that will benefit the economy? As my hon. Friend the Member for Bishop Auckland said, the industry is international and highly mobile, and we cannot afford to lose investment through the big hole of current Government policy. When we leave the EU, we will potentially face a divergence from the current medicines regulation system across Europe. The challenge for the Government is to keep that divergence to a minimum or eliminate it altogether.

One of the first issues, which we have already discussed, is the likelihood that the Medicines and Healthcare Products Regulatory Agency will lose up to a third of its income, as that comes from its work as a rapporteur body for the EMA. Can the Minister confirm that that funding gap will not have to be bridged from the existing, already insufficient Department of Health budget? What estimate has been made of additional resources that may be required in the worst-case scenario?

We have already heard that in July a letter from the Health and Business Secretaries in the Financial Times confirmed that the Government will prioritise achieving regulatory co-operation in the article 50 negotiations, and that was welcome, although, as the Financial Times is not a party to the negotiations, it could be argued, from a cynical point of view, that it was merely window dressing. We take it at face value, however, and as a clear commitment to try to achieve as much co-operation as possible. Perhaps when the Minister responds he will say what progress has been made since that time. Will he also say whether Ministers or officials from the Department of Health form part of UK representations in negotiations with the EU? I appreciate that he will not be able to go into some of the details, but given the shared desire across the House to make progress and achieve as much harmony as possible in that area, can he put some flesh on the bones and say what exactly the Government will seek to achieve as we move forward? The Minister will understand that the big pharma companies are looking for a clear indication of the likely shape of the future relationship as soon as possible, and as we have heard, decisions are being made now. I hope that he can shed some light and provide clarity on that when he responds.

Will the Minister address Members on the jurisdiction of the European Court of Justice? If it cannot be used to adjudicate on licensing appeals, as appears to be the Government’s position at the moment, how will the two systems closely interact? Is there any possibility of a joint adjudication process? Operating alone in our own separate market would be not only extremely costly, but inevitably disastrous for patients. If pharmaceutical companies are forced to go through a separate regulatory system, as well as the NICE process, just to access what will be, in the big scheme of things, a fairly small market, we could find ourselves at the bottom of the list when new medicines are released. Pharmaceutical companies might view the UK as a lower priority than getting drugs into the bigger markets of the US, the EU or Japan. That might be a particular concern where the potential market for medicines is naturally small, such as with those for rare diseases. As already stated, we are already becoming a less attractive market for the life sciences sector, both for companies in the UK and for future investment decisions.

That is a very serious and bleak picture, and I hope that when the Minister responds he can reassure the House that ideology will not trump the best interests of our economy and our health service. My hon. Friend the Member for Bishop Auckland had seven questions—I lost count of the number asked by my hon. Friend the Member for Lewisham East, but there were many. I have a few of my own, and hopefully they will be a little more straightforward to answer—yes or no will probably do for most of them. In particular, I would like the Minister to guarantee today that after 1 April 2019 patients will have the same access to medicines as they do now, and that they will not face longer waits to access new treatments. Can he also guarantee that another part of the Department of Health’s budget will not be used to make up any shortfall in MHRA’s finance?

The Minister may not be aware that we held a debate on this subject just over a year ago, and many of the concerns raised then have been raised again today. All Members today have spoken with one voice about the need for clarity and certainty, and I hope that the Minister can provide us with that now.

[Geraint Davies (in the Chair)]

A lot of questions have been asked, and fortunately we have the time for a lot of answers.