Pharmacies and the NHS

Kevin Barron Excerpts

Wednesday 20th November 2013 Westminster Hall

[Mr Kevin Barron (Rother Valley) (Lab)]

I congratulate the hon. Member for Ipswich (Ben Gummer) on applying for and securing the debate at this opportune time. He will know that the change from primary care trusts to clinical commissioning groups means that there is indeed scrutiny in local communities of the worth of local pharmacists and of what they have been doing over many years.

I should put it on record that I chair the all-party group on pharmacy. The group receives financial support from the Company Chemists Association, the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee and the Royal Pharmaceutical Society. The lobbyists Luther Pendragon provide the group with administrative assistance. I have no personal interest in the group, other than chairing it, but I thought I should put those details on record.

Community pharmacy sits at the heart of our communities, and pharmacists are trusted, professional and competent partners in supporting individual, family and community health. An estimated 1.6 million people visit a pharmacy each day, of whom 1.2 million do so for health reasons, making pharmacists the most accessible health care professionals.

I was not really surprised to hear the hon. Gentleman say that pharmacists were not mentioned in the information he got from Southwark. Pharmacists tend to be a little add-on, and we had an example last week, with the publication of the report on A and E, which said that pharmacists might be able to help with some of the issues it raised.

Like GPs, dentists and optometrists, community pharmacies are private organisations contracted to provide NHS services to the public on behalf of NHS England. However, that is not really understood by the public. A 2011 survey by Pharmacy Voice found that 88% of people regarded GP practices as public bodies, when the vast majority are, of course, private businesses. However, only 32% of people regarded pharmacies as public bodies, which is extraordinary, given their impact on our communities.

More than 90% of the average community pharmacist’s turnover comes from the NHS. That is a higher percentage than for GPs in some parts of the country, and even some NHS hospitals do not get that much of their income from the NHS. Pharmacies often provide advice to patients free of charge, with one in seven community pharmacy consultations not resulting in a sale.

The hon. Gentleman said that we do not use pharmacies in the way people do abroad. Many years ago, when my children were quite young, and we were on holiday in places such as Spain or Portugal, the pharmacist was the first health professional people were asked to go to but, sadly, that is not the case in this country. The pharmacist was there with powers to help.

Community pharmacists are the face of the NHS in communities and on the high street, having more engagement with the public than other health care professionals. Some 99% of the population, including even those living in the most deprived areas, can get to a pharmacy by car within 20 minutes, and 96% can get to one by walking or by public transport. Pharmacists can reduce A and E waiting times by dealing with people with common conditions. The hon. Member for Plymouth—

[Oliver Colvile]

Plymouth, Sutton and Devonport.

[Mr Barron]

I am sure Hansard will put that right anyway—I could have said “somewhere in the south”. The hon. Gentleman mentioned the all-party group, and we had a session on pharmacies easing the burden of emergency care. We had several witnesses, one of whom—Paula Wilkinson—was the chief pharmacist at Mid Essex Clinical Commissioning Group. She showed us a publication that the CCG was sending round mid-Essex called “Why wait to see your doctor or nurse? See your pharmacist first!” It is part of the health care on the high street initiative that the CCG is running, and she focused the majority of her comments on that initiative, which she said nudged—that is very much Government-speak—people towards using the pharmacy first. Like another witness, she focused on the expanded role that pharmacies could play in serving patients with minor ailments.

Paula said—this is quite interesting, and I would be interested in the Minister’s comments—that for people on low incomes, prescriptions often provided a way of gaining free access to medicines that are otherwise available over the counter without a prescription. She said that meant that patients on low incomes were perversely incentivised to attend their GP or an A and E service to get prescriptions. She believed consideration should be given to providing some free medicines without prescription to those on low incomes. Clearly, if a patient has been on a medicine for a long time, that would not be that challenging, and a professional such as a pharmacist could extend the period without having to go through any rigmarole and clogging up the rest of the system.

The A and E report that came out last week showed that 40% of people who attend A and E have nothing whatever done to them, which is an extraordinary statistic. Indeed, 50% of people who are blue-lighted—an ambulance or paramedic goes out to them—are not admitted to hospital. We need to look at certain issues in primary care services and, to some extent, in the acute sector if we are to deal with such people.

Community pharmacy provides a common ailments service—we call it a minor ailments service in Rotherham —in 10% of England, and people are encouraged to go to the community pharmacy as part of that. A nationally commissioned service would reduce pressure on GP surgeries and, subsequently, on A and E. Recent reports suggest that 56 million to 57 million visits a year could be managed by pharmacists, freeing up GPs to manage more complex cases, and I agree.

Pharmacists support people with long-term conditions to manage their symptoms, improving access to care for people in the most deprived areas and increasing capacity to treat patients out of hours and in the community. The Minister will be well aware of this, but about 75% of NHS expenditure goes on people with long-term conditions. This winter, quite a lot of them are likely to end up going to A and E and clogging up the system because they have, for whatever reason—they may be forgetful as a result of other problems, such as dementia—not adhered to their drugs regime at home. Managing such people in the community using professionals such as GPs, nurses and pharmacists is a better way of caring for such people. We have few systems to deal with these things, although the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) will no doubt tell us what is going on in his constituency with healthy living pharmacies, so I will not go into that. These are, however, major issues, and the strengths of pharmacists should be used a bit more.

I mentioned the question of medicines adherence. Under the present general pharmacy contract, it is pharmacists’ duty—and they are paid for this—to take in unused medicines. It is extraordinary that every year medicines costing hundreds of millions of pounds are prescribed and then are unused, for whatever reason. It is a difficult situation. The 2010 report by the York health economics consortium and the school of pharmacy at the university of London suggested that up to £500 million could be generated in England in just five therapeutic areas—asthma, diabetes, raised blood pressure, vascular disease and the care of people with schizophrenia—if medicines were used optimally. Those are all long-term conditions on which taxpayers’ money is spent. The report rightly said that sub-optimal use of medicines and waste undermine the £12 billion investment in medicines by the NHS.

Pharmacists do quite a lot of work which, although it is contracted to the NHS, is not always laid out nationally or used by local health partnerships. The hon. Member for Ipswich pointed out that pharmacists were not included in the publication that he cited. A medicines use review is a review of a patient’s medicines—prescribed and non-prescribed—to promote adherence and to support the optimal use of medicines; 2.8 million MURs were provided by community pharmacies in England in 2012-13. Since 2011, pharmacies have offered a new medicine service to provide additional support to patients who are starting to take certain medicines for long-term conditions. An evaluation of the effectiveness of the NMS is due soon, and more than 640,000 people starting to take new medicines have benefited. That is adherence —making sure that people do as their prescription sets out.

The York and London review, which is entitled “Evaluation of the Scale, Causes and Costs of Waste Medicines”, goes into the question in great depth, and clearly the problem will never be eliminated altogether. Nevertheless it is clear that in this country people sit and write out prescriptions and people take them away and effectively put them on the shelf. The patient might use the medicine for a couple of days. Perhaps they do not like the side-effects, and indeed that is unavoidable on occasion. However, some medicines are stored in bathroom cabinets, and when they are emptied the medicines are taken back to the pharmacist or thrown away, which costs the nation hundreds of millions of pounds. We must question whether some of those medicines, given that they are not used, should be prescribed in the first place. However, that is a wider issue for health professionals, not me.

More than 57 million GP consultations a year involve minor ailments. If we rolled out the scheme that currently covers about 10% of England, we could greatly reduce pressure on those services, and GPs could get on with more important things. The patients could be moved to pharmacies, and more than £812 million of GP capacity could be freed for other things.

In 2009-10, 140,000 people chose their community pharmacy to set a quit date and 62,000 had successfully quit smoking by the fourth week, which was a 13% increase on the previous year. Pharmacists give support in a wide variety of public health roles, including flu vaccinations, international normalised ratio-testing clinics—monitoring and adjusting the dose of the blood-thinning medicine warfarin—and asthma clinics.

There has been much debate in Parliament about changes in the Health and Social Care Act 2012. The Minister was on the Committee that considered the measure. Two things were writ large in that Act. First, we have now put into statute the need to reduce health inequalities—but they are not reducing. Everyone is living longer, but in terms of social class things are still going downwards. Pharmacists could work on reducing health inequalities in areas where there is known deprivation. That should be a major aim. Secondly, the Minister will remember the emphasis on population health. In view of the statistics that I have read out, I think pharmacy has a major role to play in improving population health.

Public health problems were very bad 150 years ago, and they involved the environment—bad housing, bad sanitation and bad water. The public health issues that this century will suffer from will be to do with individual lifestyles. I read out some statistics about smoking cessation and pharmacies, and I believe that community pharmacists are the gatekeepers to the national health service. Far more people visit them than any other part of the NHS and they have a major role to play. The sooner we alter the current mode of contact and move away from the situation where pharmacists get the bulk of their money just churning out prescriptions to one where they cover wider issues within communities and look after the health of the population, the better we shall be.

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[Steve Baker]

My hon. Friend is right. In the 21st century, we should be waking up to the opportunities to use technology to drive down costs and drive up service. People are so busy today, so why can they not have consultations in their offices with Skype, and why can pharmacists not prescribe to offices with Skype? The solution to these problems is for the Government to abolish whatever rules and controls they can and wherever they can, and to liberalise when abolition is not possible.

[Mr Barron]

The majority of patented goods that the national health service buys are a recognition not just of cost, but of the pharmaceutical industry’s worth to the British economy—including exports, manufacturing base and so on. We export around £7 billion of pharmaceutical goods a year. Might a free market endanger that?

[Steve Baker]

We may be in danger of straying into philosophically deep water about what free markets do and do not do. Clearly, because of the moral imperatives of health care, we cannot have an unimpeded market. We have made political decisions to ensure that no one goes without health care. That has consequences, and we should accept them.

The way to deploy scarce resources in the service of the public is to allow the price system, as well as profit and loss, to run as freely as possible. When we talk about something’s worth, price is too often ascribed to things that are not subject to market transactions. Only through exchange can it be established how people value things. I do not want to go on for too long, so I will leave that to another debate, perhaps the one on the Budget.

I want to encourage the Government to liberalise and to look more closely at what can be done to enable pharmacists to set up wherever they need to in order to serve the public best.

Mid Staffordshire NHS Foundation Trust

Kevin Barron Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. These problems of high mortality rates date back very many years, and nothing, or too little, was done to sort them out. We must therefore make sure that we have a system where that cannot happen. Concealing poor care does not protect the reputation of the NHS, because in the end it gets out and destroys public confidence. I hope his constituents will feel that today’s announcements will create a new culture of openness and transparency that gives them confidence, so that if these awful things were ever to happen again—we hope they do not—we would find out quickly and action would be taken.

[Mr Kevin Barron (Rother Valley) (Lab)]

Having spent nine years as a lay member of the General Medical Council and five years chairing the Health Committee, I have heard little this afternoon that is likely to change the culture inside the national health service. May I refer the Secretary of State to the report on patient safety that the Committee produced in the previous Parliament? We considered the idea of having a statutory ombudsman to whom people could complain and who would have the power to investigate, even anonymously, instead of this situation in which doctors, particularly young doctors working in hospitals, dare not complain about what senior doctors are doing because of the attack on their career structure. We really must get some independence into this. We can have good words, we can talk about candour, and we can wish a lot of things, but changing the culture of the NHS is not done by statements or by legislation in this House; it is done by working inside the NHS. I am afraid that at the moment the system works against changing the culture owing to career structures and everything else. We need some independence in all this so that people can really learn how to change. New Zealand would be a good example to look at.

[Mr Hunt]

All I can say to the right hon. Gentleman is that Robert Francis himself stated this morning that we have announced a comprehensive collection of measures that

“will contribute greatly towards a new culture”

in the NHS. He is persuaded that this will make a very big difference.

Independence is a vital part of this change, so what are we doing to create it? For the first time, we will have an independent chief inspector of hospitals who goes anywhere he likes in the system to try to root out poor care. That person will be the nation’s whistleblower-in-chief, and their job will be to find out about these things inside hospitals. We are creating a culture in which it is in the interests of hospitals and doctors to be open and transparent, and that is another significant change. I do not want to underestimate the scale of the challenge we face, but I think most people would say that in the past 12 months we have seen one of the most fundamental attempts to change the culture of the NHS in its 65-year history.

Urgent and Emergency Care Review

Kevin Barron Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

My right hon. Friend is absolutely right about that. We do need parity of esteem between mental and physical health. The situation puts particular pressure on A and E departments, including the one closest to this House, at St Thomas’s hospital, where people said that the biggest single worry they have and the biggest single thing that makes it difficult for them to meet their targets is the lack of quick access to psychiatric services. We are looking at this matter and he is right to highlight it.

[Mr Kevin Barron (Rother Valley) (Lab)]

The Minister said that changes taking place in urgent and emergency care are done locally for local need. What does he think of the following statement made by Sir David Nicholson last week before the Select Committee on Health? He said:

“We are bogged down in a morass of competition law…we have competition lawyers all over the place telling us what to do, which is causing enormous difficulty.”

Does the Secretary of State not agree that the Government were warned about that when they brought in the Health and Social Care Act 2012? They were told that competition law was going to create chaos in the NHS, and it is doing exactly that.

[Mr Hunt]

I think the right hon. Gentleman will find that some of the competition law powers that are being used and are causing Sir David worry were actually from the Enterprise Act 2002, which we are now looking at to see whether we can sort it out.

Tobacco Packaging

Kevin Barron Excerpts

Thursday 7th November 2013 Commons Chamber

[Mr Evans]

That is exactly what is going to happen, and I think one hon. Member intervened to say that that is part of the evidence from Australia. A lot of people like brands, such as Benson & Hedges or Regal, but others will go for the own-brand—whatever is cheaper. If it is £1 cheaper than the more expensive brands, that is what they will go for. Some people, I swear, will smoke the dust off the floor if it is sold at £1 cheaper than a branded pack. The point my hon. Friend raises therefore has got to be looked at as a possibly unintended consequence of bringing in standardised packaging.

I visited Clitheroe grammar school a few months ago and the issue of why the Government have delayed introducing standardised packaging was mentioned. I thought about it for a while and then I said to the pupil concerned, “Right: how much cannabis and ecstasy is consumed in the UK?” The pupil said, “Oh, quite a lot,” to which I said, “I think you’re probably right. Do us a favour: describe to me the packaging on cannabis or ecstasy.”

I ask Members to think about that for a second. What is the packaging for cannabis or ecstasy? There is no packaging. They come in foil or see-through bags, or in an envelope, perhaps. Clearly, people are not buying these products because of the packaging, standardised or otherwise. They buy them because they want them. That is a strong counter-argument to the proposal to get rid of branding.

[Mr Kevin Barron (Rother Valley) (Lab)]

Surely the answer to the question is that if those things were legal, health warnings would be on them, and quite right, too.

[Mr Evans]

Certainly there is no health warning on cannabis and ecstasy, and we know they kill a lot of people.

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[Mr Kevin Barron (Rother Valley) (Lab)]

I congratulate the hon. Member for Harrow East (Bob Blackman) on securing this important debate. Like him, I am an officer of the all-party group on smoking and health, and I also believe that tobacco control transcends the usual party differences. In my years in the House, that has certainly been the case for anti-tobacco policy.

Members will know that back in 2006 the previous Labour Government conceded a free vote on ending smoking in enclosed public places. The vote was won by a majority of more than 200, which showed that the proposal had strong support. The Government might want to find a similar means of getting themselves out of their awkward position, as they have been accused of being in bed with the tobacco industry because they have blocked the introduction of standardised packaging. The Children and Families Bill, which is now in Committee in the other place, might present such an opportunity.

The hon. Member for Harrow East rightly drew our attention to the fact that most smokers start their lethal addiction when they are children and that, for many years, the tobacco industry has advertised and marketed its products to make them as attractive to young people as possible. We all know that eight out of 10 smokers start by the age of 19 and that more than 207,000 11 to 15-year-olds become smokers each year. One in two of them, if they remain smokers, will die a premature death. In this country, in the region of 100,000 premature deaths a year are caused by the habit of smoking.

I am sorry that the hon. Member for Ribble Valley (Mr Evans) is no longer in the Chamber. He made the argument that the 12 million smokers in this country were all adults. Of course, most of them are adults—that is absolutely true—but at what age did they start smoking? Statistics on the number of people who start smoking at the age of 21 are insignificant. I started smoking years before I could legally buy cigarettes. I was smoking at the age of 12, and I stopped at the age of 24. The vast majority of people I was at secondary school with smoked. We were just trying to emulate other people. I also came from a poor, working-class family, and in theory there was not the money to buy cigarettes, but we used to find it. I say to the hon. Member for Hornchurch and Upminster (Dame Angela Watkinson) that if we look at the incidence of smoking now, social classes 4 and 5 have the majority of smokers and of premature deaths.

The importance of packaging is well understood by the tobacco companies. They dodge the existing health warnings and packaging requirements with great skill and ingenuity. I draw the attention of the House to the packaging of Benson & Hedges Silver Slide. Benson & Hedges in this country is owned by Japan Tobacco International, one of the big four international companies. People slide the cigarettes out of the pack, so it is not the standard packaging that was around when I was smoking back in the 1950s and 1960s. The outside of the Silver Slide package looks pretty normal but, unlike most packs, it is opened by pressing the side opening where it says “Push and Slide”, which exposes a tray containing the cigarettes. Printed on the tray are the words:

“I owe my success to having listened respectfully to the very best advice, and then going away and doing the exact opposite”,

which is a quote from G. K. Chesterton. The initials B&H are highlighted for a little extra brand identity on the slide. I suggest that the design has the obvious purpose of reinforcing a key tobacco industry marketing message that has been used with success for many years, particularly to recruit young people to smoke and to discourage quitters. That message is pretty simple—smoking is cool and an act of rebellion, and it is adult and transgressive. The hon. Member for Harrow East rightly pointed out that that marketing strategy is set out clearly in the internal documents that were published as a result of the US master settlement agreement with the industry.

[Alex Cunningham]

Is my right hon. Friend aware of the advertising in America for Vogue cigarettes, which says:

“The Vogue cigarette style was based on 1950s couture. The cigarettes that are preferred by women from across the world. Their lengthened appearance is an attribute of their femininity”?

Does he think that that is another example of the industry aiming to glamorise smoking?

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[Mr Barron]

It is indeed. The packages themselves are there to attract young women. I have an empty packet in my office that demonstrates exactly that. The idea that packaging is not used to sell products or advertise them effectively is nonsense. The Silver Slide design is intended deliberately to undercut the health warnings that the law now requires on each packet.

The hon. Member for Ribble Valley talked about adverts and bill posters, and said that he could only understand the part at the bottom. When I introduced a private Member’s Bill in 1994 to get rid of tobacco advertising and promotion, it was pretty clear that most of the adverts on billboards were not understood by some people. They were deliberately designed for the inquiring mind. There would be a picture of a piece of silk with a cut halfway down the middle. The advert did not say Silk Cut cigarettes; it did not have to. However, who are the ones with inquiring minds? They are young people. Tobacco companies did that deliberately for many years, and the G. K. Chesterton quote is to get young people to say that they can take this on, and that they are not bothered about what people say.

In Australia, it has been decided that there should be no branding on tobacco packaging other than the product name shown in a standard font, size and colour. No other trade marks, logos, colour schemes and graphics are permitted. Colours and graphics have been selling cigarettes in this country for decades. In Australia, cigarette packs should not carry attractive designs and should therefore come in standard shape, size and colours, and the colours should be as unattractive as possible. There should be prominent health warnings front and back, in pictures as well as writing, and there should be a phone number and web address on every pack to help smokers to access quit services.

There are 100,000 premature deaths a year from tobacco smoking in this country. If those deaths had been caused by anything else in the 30 years that I have been in Parliament, this House would have been sitting 24 hours a day, seven days a week, until we could find a way to stop it. It is no good the Government saying that they will wait. We know what tobacco marketing has been like for decades. We have stopped most of it, and we should stop this advertising at the point of use as well.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

In an area such as Salford, 1,000 young people—the figure was 1,100 in Barnsley—will start to smoke this year. If I am called to make a speech, I will talk about that. Ten months, a year or 18 months of delay will cause 1,000 or 1,500 young people in an area such as mine to start smoking, and that is a tragedy.

[Mr Barron]

And another 207,000 nationally will start this habit a year.

One might ask why people buy a packet of cigarettes when it has a warning on it, but this is an addiction. All sorts of addictions sadly roll over common sense, and tobacco is no different. Stopping young people starting is crucial, and that is working. Smoking rates for young children are diminishing now, as are rates for adults, partly as a result of taxation and partly because we are stopping tobacco companies promoting cigarettes.

There are no figures to show that counterfeiting is more likely with plain packaging. Earlier this year, the Japanese company came to the House and told us that there would be more counterfeiting, but there is no evidence of that. It showed us—I have one in my pocket —a counterfeit packet. It looks like any other Benson & Hedges packet, so counterfeiting happens now. Standard packaging could include features to protect against counterfeiting, and it is for the House to regulate to introduce them. Hon. Members should not use the arguments that have been sold by the tobacco companies year after year. When it was found that tobacco related to massive numbers of deaths, the companies were still questioning that decades after the event—they still do now. They use this House to do it on occasions and, I have to say, it is wrong. When there are 100,000 premature deaths a year, we as legislators have some responsibility to alleviate the problem. I know that smoking is addictive and it is difficult for people to stop.

[Dame Angela Watkinson]

Does the right hon. Gentleman agree that no young child can become addicted to cigarettes unless their parents provide them with the money to buy them?

[Mr Barron]

My father used to provide me with cigarettes; the only thing was that he did not know about it. I used to go in his packet of Woodbines and take one out, and he did not count them very often. That was how I started smoking on the street at a very early age. If we put the price up, of course it will reduce the consumption of cigarettes, but we need to stop young people starting.

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[Guto Bebb]

The hon. Lady completely misrepresents my view. I said clearly at the outset that the temptation for young people is much enhanced if the product is affordable, and I think she fully understood my point.

It is important to recognise the problem of illicit and smuggled products because evidence—yes, to be tested and argued about—has been presented to suggest that plain packaging will actually make it easier for these products to be made available. I am fully aware that there are arguments on both sides. However, what is being said in this debate is, in effect, that the Government’s decision to wait to look at the evidence from Australia somehow indicates that they are in league with the tobacco companies. I find that quite distasteful.

I genuinely approach this debate from the point of view that I would like the number of people who smoke to be reduced—to nothing, I hope. I have never smoked, and if any of my children smoked I would be absolutely furious. Indeed, I lost my father to lung cancer at the young age of 63. My children never saw their grandfather simply because of his smoking. If the evidence was clear that plain packaging would be the answer, I would be supportive. I find it very odd that Members are saying that looking at the evidence is somehow condemning people to die. That is emotional and unacceptable language.

When Populus recently surveyed a number of police officers about whether they thought that plain packaging would be helpful, 86% of them clearly stated that they thought it would make it easier for illicit tobacco products to be supplied and that those products would be targeted at young people who could afford them. Sixty-eight per cent. of the police officers thought that plain packaging would lead to an increase in the size of the black economy in relation to tobacco products. A full 62% thought that an increase in cheap tobacco products would result in an increase in the use of tobacco products by children. Those are very interesting and important findings from a poll of police officers. Are their views correct? We need to look at the evidence and consider very carefully whether it supports them.

[Mr Barron]

The latest figures from HMRC, at a mid-point estimate, show that the market share of illicit cigarettes has fallen from 15% in 2006-07 to 9% in 2010-11. There is no evidence that this is not going the right way; it is enforcement that we lack.

[Guto Bebb]

The right hon. Gentleman should perhaps read the report by the Public Accounts Committee, which presented evidence that there has been an uplift since 2010-11. I thought that the whole point of this Chamber was to debate on the basis of the facts, and that we liked evidence to be up to date. If he wants to quote evidence from 2010-11, that is absolutely fine, but I refer him to the PAC report, which has updated figures. It is interesting that he would probably be very supportive of today’s PAC report on universal credit, but when the facts do not suit him he seems to ignore them.

The key thing we need to remember is that time and again this place has legislated in haste. There is a significant question mark over both sides of the debate. What the Government have said is very simple: let us see the evidence and consider it. If the evidence from Australia and other countries that decide to go down this route proves that there has been a reduction in the use of tobacco products, a reduction in illicit tobacco being taken into the country, a fall in the availability of illicit products, and a fall in the number of smuggled products, it would be worth taking the issue extremely seriously and moving to legislate. However, the argument advanced by some hon. Members is about their prejudice rather than the facts. We should congratulate the Government on being willing to wait and legislate correctly rather than acting in haste and possibly contributing to and supporting the behaviour of people who are making tobacco products available to young people not at £7.50 or £8 but at £2.50 or less.

We should consider very carefully what is tempting young people to take up smoking. I am very clearly of the view that the temptation is not necessarily branding but more likely to be price. Labour Members might like to have a good feeling about doing something in this place to help young people, but they should do it on the basis of facts, not their ill-informed opinions.

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[Jake Berry]

I guess that the reason why people wear seat belts is that it is a criminal offence not to do so. If the hon. Gentleman is suggesting that smoking in cars should be made a criminal offence, that just reinforces my point about the desire of certain people on the other side of the debate to ban smoking. If that is what people want, we should have an active debate about it and give people who smoke legitimately an opportunity to have their say.

During this Parliament alone, the Government have increased NHS funding by £12 billion, given people access to the cancer drug fund and protected public spending with regard to local authority public health budgets. That is good progress and I am proud to be part of a Government delivering it. Limits on the display of tobacco products have also recently been introduced in larger stores. Anyone who has been to a supermarket recently will have seen the white signs that slide backwards and forwards to disguise tobacco products, and they will be introduced in smaller retailers in 2015. I support that and think it is a good thing.

The ban on vending machines in pubs is particularly good. I started smoking by buying cigarettes by the men’s loo in a pub in Liverpool, where I was brought up. It is the easiest way to buy cigarettes under age, so I am delighted with and support the ban. The way in which the Government have continued to increase the tax on cigarettes has also been good. I think that making them more expensive discourages people from taking up smoking. I support all that action, but such action must be based on benefits.

[Mr Barron]

I started on my anti-tobacco crusade 20 years ago this year when I promoted a private Member’s Bill. In all that time, the only person I have heard say that if tobacco was discovered now it would be banned was the then Conservative Secretary of State for Health, who now sits in the other place. As far as I know, it has never been part of the anti-tobacco campaign in this country to say that we want to ban people from smoking. What we want to do is prevent them from starting and save lives.

[Jake Berry]

I think it is right to say that if tobacco was discovered today it probably would be banned. I also think that if alcohol was discovered today it probably would be banned. That does not mean that we should seek to do so.

I am very pleased with the progress the Government have made. The evidence shows that we have reduced to a record low the number of people who smoke, but there are still things left on the to-do list. First and foremost, we need to look at the evidence from Australia. If it demonstrates that plain packaging has reduced the amount that people smoke, we should take it up and I would not oppose it. I do not accept, however, that that has yet been proven. Part of being in this House, in government or in opposition is to have an evidence-based debate about outcomes. I do not think that we have the evidence or that the outcome will be a reduction in the amount that people smoke. We also do not yet know the impact of disguising packages in supermarkets, which may have the effect we seek without increasing the regulation on the tobacco industry.

We need much more rigorous enforcement against under-age sales. It is illegal to buy cigarettes under the age of 18. People under that age can have consensual sex and they can go to Afghanistan to fight in the Army, and the Opposition and the Liberal Democrats think that they should have the right to vote, but they are not allowed to buy cigarettes. We should have much more rigorous enforcement of the existing laws against selling cigarettes to under-18s, rather than rush to introduce new laws on plain packaging and banning smoking in cars.

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[Mr Barron]

If the other place legislated to introduce standardised packaging, we would be able to have a vote in this Chamber. May we have a free vote, just as the current Prime Minister argued for a free vote on smoking in public places?

[Jane Ellison]

The Government are following discussions in another place closely. Beyond that, I am not able to comment in this debate, but we are well aware of those discussions and Ministers are participating in them.

Australia introduced standardised packaging in December 2012, and New Zealand and the Republic of Ireland have committed to do that. In addition, other academic studies are emerging about the effects of that policy.

The UK has a long and respected tobacco control tradition internationally, although at times in this debate it has been possible to miss that point. Under successive Governments the UK’s record has been good, and we will continue to implement our existing plan to reduce smoking rates while keeping the policy of standardised packaging under active review. The tobacco control plan for England sets out national ambitions to reduce smoking prevalence among adults, young people and pregnant mothers. As the plan makes clear, to be effective, tobacco control needs comprehensive action on a range of fronts.

I will talk a little more about this in the context of devolved powers of public health to local government, but there is a slight danger that by focusing only on one aspect of tobacco control, we forget that there are other—and indeed more—things that we could do. Even if it was possible to say today that we would do this tomorrow, we would still be debating how we could effectively control tobacco and stop children taking up smoking. As various hon. Members have said, including the right hon. Member for Rother Valley (Mr Barron), this is an ongoing battle to protect children’s health.

Accident and Emergency Departments

Kevin Barron Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

We have not heard any kind of policy from the Opposition today, or any suggestion as to what they would do differently. We have presented to the House a package of short-term and long-term measures, designed to address the immediate and the underlying challenges. It is a very comprehensive package, but it is going to be a very tough winter and I would urge all responsible politicians from all parties to row in behind the package, which I think will make a very big difference on the front line.

[Mr Kevin Barron (Rother Valley) (Lab)]

If the 2004 GP contract was to blame for the current crisis in A and E, could the Secretary of State explain why, in 2009-10, over 98% of patients were seen within four hours?

Managing Risk in the NHS

Kevin Barron Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

I would not close my mind to that suggestion, but I think it important also to take account of what Keogh said about other similarities between those hospitals—and, probably, between them and Mid Staffordshire. What they have in common is geographic isolation. Hospitals serving smaller market towns are not supported by the same clinical networks as others, and may find it more difficult to attract qualified staff. I agree with the hon. Gentleman that there are a number of important issues that need to be considered.

[Mr Kevin Barron (Rother Valley) (Lab)]

My right hon. Friend knows well, and knows personally, that in the past two months there has been a marked change in the coalition Government’s approach on the national health service. It started with the absurd argument that the problems in accident and emergency departments were the result of the 2004 GP contract. Is it not more likely that what is happening is that Mr Lynton Crosby is telling Government Members to squeeze the lead that Labour has had over the Conservative party for many decades on the NHS, and attacking NHS workers, scaring patients and attacking the Opposition is what they are trying to do? They ought to be ashamed of themselves for being involved in it.

[Andy Burnham]

It used to be, “We love the NHS”—the Prime Minister said, “I love the NHS”—but now it is about running down the NHS. I say to the Secretary of State, in all sincerity, that he will not improve patient care by continually blaming doctors and nurses. As I have said before, the NHS is fragile right now because of his reorganisation, and it cannot keep taking these knocks on a daily basis. The blame game is destructive and polarising, and it has to end. He is in real danger of losing any remaining good will in the NHS work force, and none of us and, more importantly, none of our constituents can afford to see those crucial staff become fed up, lose heart and walk away. Government Members can throw whatever they like at me, because that is politics, but I will not allow the NHS and its staff to become collateral damage in this orchestrated political campaign.

Hospital Mortality Rates

Kevin Barron Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

My hon. Friend is right. There were high mortality rates in his hospital in six of the nine years they were measured under the last Labour Government, and there were problems with A and E and with inappropriate medical interventions. He can say to his constituents today that the Government have identified the problem and have been transparent about it, and we will be accountable for sorting it out.

[Mr Kevin Barron (Rother Valley) (Lab)]

How many health professional regulatory bodies has the Secretary of State met since the publication of the Francis report?

[Mr Hunt]

I think I have met most of them, but I have certainly met the General Medical Council and the Nursing and Midwifery Council, and I have talked to them about the reasons they are finding it difficult to remove doctors and nurses from their lists when there are questions about their poor performance.

Oral Answers to Questions

Kevin Barron Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Kevin Barron (Rother Valley) (Lab)]

Is the Secretary of State aware of the increasing problems there are in A and E because of alcohol? If so, will he tell us what he is going to do about it?

[Mr Hunt]

There are problems, particularly in large cities and at weekends. In fact, in the case of the reorganisation of services at Trafford general hospital, one of the things that we can invest in as a result is mental health facilities in neighbouring A and Es so that people have better access to the services they need.

Children’s Heart Surgery

Kevin Barron Excerpts

Wednesday 12th June 2013 Commons Chamber

[Mr Hunt]

I congratulate my hon. Friend on campaigning for children’s heart surgery in Leeds in an exemplary way, and he deserves huge credit for the responsible approach he has taken throughout. I would be delighted to meet him and clinicians from Leeds. Many things need to be learned, but his points about the importance of the patient experience, of clinical outcomes and of an impartial process in site selection, which is at the heart of the concerns people had about this process, are ones we need to reflect on very hard indeed.

[Mr Kevin Barron (Rother Valley) (Lab)]

I welcome the statement that the right hon. Gentleman has made today. Notwithstanding the fact that we would all want the best possible outcomes from this surgery, wherever it takes place, site selection or geography is a concern for us, for the health service and for patients and their families, so can we make sure it is taken into account? If skills are seen to be weak in certain geographical areas of the UK, we should improve those skills, not think about moving people elsewhere.

[Mr Hunt]

The right hon. Gentleman makes an important point. Site selection needs to be done by people who are completely independent of any local interest in where the surgery should happen. That is the crucial point we need to learn, but the point about skills is also important.

Accident and Emergency Waiting Times

Kevin Barron Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

My right hon. Friend rightly identifies some of the contradictory chaos that now passes for Government health policy. I will deal directly with her point later in my speech.

[Mr Kevin Barron (Rother Valley) (Lab)]

In the preceding debate, the Government tabled an amendment of great worth answering all the points with regard to badgers, but there is no amendment for this debate. They have no answer and are not prepared to put anything on paper about how to get over this current crisis in A and E. Does that not speak volumes?

[Andy Burnham]

The Government have more to say about badgers than about the current crisis that NHS staff up and down the country are dealing with. That says a lot about this Government.

--- Later in debate ---

[Mr Kevin Barron (Rother Valley) (Lab)]

I was beginning to think that the debate was about A and E services in London, so I am pleased to be able to say a few words from these Back Benches. The views of people from the north on the London-centric debates we have in this country have been pretty consistent—so let me move on very quickly.

I have been active in health in Parliament over the many years I have been a Member, particularly during the previous Parliament when I chaired the Select Committee on Health. Until a few weeks ago, I had never heard anyone put the case that any problems we had in primary care, or even in secondary care, were to do with the 2004 contract agreed with GPs by the then Government.

On 21 May, I came in to hear the urgent question and listened to the Secretary of State talk about the concept that as

“a result of those disastrous changes to the GP contract, we have seen a significant rise in attendances at A and E”

and the

“direct consequence of those disastrous 2004 changes to the contract”

even though my right hon. Friend the Member for Leigh (Andy Burnham) had said that on that very day

“the chief executive of the NHS Confederation told the Select Committee on Health that there is no link between today’s pressures on A and E and the 2004 contract”.—[Official Report, 21 May 2013; Vol. 563, c. 1055-57.]

Yet today we have heard that argument again. I never heard it when I was on the Health Committee; I never heard it until this year, and I do not believe it. That is my fundamental position.

I am pleased to see that the Secretary of State has come back into the Chamber. On 21 May, my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) asked the Secretary of State how many walk-in centres had been shut since May 2010. The right hon. Gentleman said:

“I can assure the hon. Gentleman that many more walk-in centres would be shut if we had to cut the NHS budget, which is what the Labour party wants to do.”—[Official Report, 21 May 2013; Vol. 563, c. 1065.]

My hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) asked the Secretary of State

“how many walk-in centres have closed since May 2010? Will he accept that those closures are linked to the rise in A and E attendance?”

He replied

“that if we followed her party’s Front-Bench policy of cutting the NHS budget from its current levels, many more urgent and walk-in centres would have to be closed.”—[Official Report, 21 May 2013; Vol. 563, c. 1069.]

The walk-in centre in Rotherham stops people going to the A and E. It is open 12 hours a day, seven days a week, unlike doctors’ surgeries. During that urgent question, we heard talk about lights going out at 5 pm. When did GPs’ lights not go out at 6 pm at any point in my lifetime? They would start at 4 and go on to 6 pm. The lights were never on in primary care and it is such centres that are really helping.

Today, we have eventually found out that 25% of walk-in centres—that is, 26 of them—have closed. When the one in Rotherham opened, there was opposition from one of the doctors in my constituency who publicly campaigned against it, but that was all about the money that went into his private individual business. That is wrong. The Secretary of State should get off the political fence and start making decisions about what is happening to health care and our people, rather than about what will happen in 2015 at the next general election.