Health Service Medical Supplies (Costs) Bill

Kevin Foster Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Mr Hunt]

I am happy to give that reassurance. As I said, this industry contributes £56 billion to the UK economy, with tens of thousands of jobs. When the Prime Minister talks about where she sees our competitive advantage, she talks, first, about financial services, and life sciences is the very next industry she mentions. I completely agree with right my hon. Friend about its incredible importance, not just to this country but to the future of humanity. That is why we seek in this Bill to establish a fair relationship between the NHS, which we have to represent as we are funding it through the tax system, and the pharmaceutical industry. It is also fair to say that there have been times when some pharmaceutical companies’ practices have been disappointing, and because we want to make sure that that does not happen and that we can continue with a harmonious and productive relationship we are proposing this Bill to the House.

[Kevin Foster (Torbay) (Con)]

We agree that this is not about profit controls—about having a fair return for investment made—but about tackling an emerging business model that could almost be seen as profiteering.

[Mr Hunt]

My hon. Friend is right about that. The nice way of putting it is that we are closing a loophole. If one were being less polite, one might say that it is a shame we are having to do that. None the less, it is important to do what we are proposing to the House.

We recognise that it has been some time since the Government consulted on the options, and I wish to reassure hon. Members and those companies in the statutory scheme that we will consult further on the implementation of a payment mechanism in the statutory scheme, including the level of the payment mechanism, before the regulations come into force. We estimate that 17 companies would be affected by the introduction of a payment mechanism, with the 166 companies that are currently members of the PPRS not being affected. Our proposals would save health services across the UK an estimated £90 million per year.

The second key element of this Bill amends the 2006 Act to strengthen the Government’s powers to set prices of medicines where companies charge unreasonably high prices for unbranded generic medicines. We rely on competition in the market to keep the prices of these drugs down. That generally works well and has, in combination with high levels of generic prescribing, led to significant savings. However, we are aware of some instances where there is no competition to keep prices down, and companies have raised their prices to what looks like an unreasonable and unjustifiable level. As highlighted by the investigation conducted by The Times earlier this year, there are companies that appear to have made it their business model to purchase off-patent medicines for which there are no competitor products. They then exploit a monopoly position to raise prices. We cannot allow this practice to continue unchallenged. My Department has been working closely with the Competition and Markets Authority to alert it to any cases where there may be market abuse and provide evidence to support this, but we also need to tackle it within our framework for controlling the cost of medicines and close the loophole of de-branding medicines. Although the Government’s existing powers allow us to control the price of any health service medicine, they do not allow controls to be placed on unbranded generic medicines where companies are members of the voluntary PPRS scheme. Today, most companies have a mixed portfolio of branded medicines and unbranded generic medicines. For that reason, all the manufacturers of the unbranded generic medicines mentioned in the investigation by The Times are able to use their PPRS membership to avoid government control of their prices.

It should be said that that practice is not widespread, but a handful of companies appear to be exploiting our freedom of pricing for unbranded generic medicines where there is no competition in the market, leaving the NHS with no choice but to purchase the medicine at grossly inflated prices or to transfer patients to other medicines that are not always suitable. Alongside the Government, many in the industry would also like to see this inappropriate behaviour stamped out.

--- Later in debate ---

[Kevin Foster (Torbay) (Con)]

It is a pleasure to follow my hon. Friend the Member for Vale of Clwyd (Dr Davies) and to hear many of the points he made. He spoke of the NHS spending £262 million a year on 50 drugs; that is actually £262 million extra that we are spending on those drugs courtesy of the greatly increased prices. That really brings home the problems here and why the Bill needs its Second Reading.

As many hon. Members have already focused on a range of issues, I will focus in particular on generic drugs and some of the huge price increases we have seen. It is right to say—and this was perhaps touched on by the Secretary of State in response to the intervention by the hon. Member for Wolverhampton South West (Rob Marris)—that it is not unreasonable for a pharmaceutical company to make a profit in exchange for investment in developing a new drug and bringing it to market. But that is what our patent system is for. The patent is there to protect for a period of time the ability of the company to charge a reasonable price to reflect the risk it took in its investment.

The key point is that the drugs we are considering are now out of patent. The company has had a reasonable period of time to make its investment back. The issue is that there is only a very limited supply of them. It is only right that we deal with what is an emerging business model. There can be no two ways about it. Some of the names on the list of companies, such as AMCo and Atnahs, seem consistently to have unusually high increases in prices, in the thousands of per cent. It is clear that a business model is developing to take advantage of a loophole in the legislation and ultimately not to make a profit but to profiteer, at the expense of the NHS and people who need those treatments. I am sure we can all think of instances where drug company lobbying points to patients who are unable to get treatment; this is exactly the sort of thing that means people cannot get treatment.

It was highlighted earlier that it is slightly ironic that here we are, as Conservatives and under a Conservative Government, arguing for price controls. But this is not about intervening in a market but about intervening to deal with market failure, where the normal procedures of competition are not producing a fair or reasonable outcome either for the NHS or for the patients on whose behalf we are providing products.

I went to see the amazing work being done on brain tumour research at Plymouth University recently—the skills and the groundbreaking research that will bring real benefits. But that is not the business model of the companies the Bill deals with. Their model is to look for a drug that needs to be prescribed and has only one supply, then buy it, get hold of the supply and jack the price up. That is nothing to do with delivering new and innovative products. The Bill is therefore very welcome, as it looks to intervene in that situation.

It is also right that to be able to tackle the problem we need information. Let us be blunt; if a company is looking to put its product price up by 12,000% it is not going to be particularly co-operative with an inquiry into whether that is fair, so it is right that the Secretary of State will have powers to require that more information be supplied.

[Rob Marris]

I am grateful to my new friend, another socialist, for giving way. May I tempt him to suggest some other areas of the economy where he and what I must now call his Christian Democrat fellows would be prepared to address the issue of profiteering, as we on the Opposition Benches would?

[Kevin Foster]

The hon. Gentleman tempts me, but I see you are now in the Chair, Mr Deputy Speaker, and you are very tough on any irrelevant points or points off subject, so that could be very dangerous territory.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

And you shall not be tempted.

[Kevin Foster]

That is good to know.

We have seen work the Government have done in other sectors, for example, on information in the energy sector. The Bill deals with a particularly unique practice, where there is, in effect, only one customer, the NHS, and only one supplier. I am struggling to think of many other industries where that is replicated. That is why these price rises are so disgraceful. This industry is about profiteering from illness and pain. There is nothing else like that.

[Rob Marris]

May I suggest another industry it might be worth looking at, where this situation obtains, namely the defence supply industry—not all of it, but parts of it?

[Kevin Foster]

I thank the hon. Gentleman for that intervention. As a member of the Public Accounts Committee I have spent plenty of time looking through examples of defence procurement that went wrong. The Minister might be new to the Department of Health but he certainly is not new to defence procurement. It is noticeable that much of what now makes its way to the PAC for a review of what went wrong concerns legacy issues—for example, the military flying contract—rather than modern procurement. But I am conscious that with Mr Deputy Speaker in the Chair I need to get back to the price of drugs for the NHS.

Looking through the evidence it is clear that the current system of regulation is not effective. Companies can, in effect, put their branded products into the voluntary scheme and use that as a way of jacking up costs for their generic products. That is just not right. As other Members have touched on, we are facing demands and pressures on the NHS. I have no problem with companies that give a good service charging a fair price and making a fair return on their investment.

That is clearly not what is going on with this business model. We can see numerous examples, in particular in the chart put together by the House of Commons Library, which shows increases of thousands of per cent. across a number of products. It is impossible to believe that such increases are going on for any of the input materials for those products. As we have said, this is flagrant racketeering and profiteering at the expense of patients and of people in pain. Even if the drug is still provided, that money should have been spent on other NHS services.

I am therefore pleased at the almost unanimity breaking out in the House on the proposals. They will clearly need to be discussed in more detail in Committee. But it is the right time for the Bill. It is not about tackling fair and legitimate profits but about getting rid of profiteering, which is why it has my full support.

--- Later in debate ---

[Barbara Keeley]

No, but I think the hon. Member for Torbay was talking about companies that are not doing any research, but just buying up generic products and profiteering from them. There has been general condemnation of those sort of companies on all sides.

[Kevin Foster]

I want to be clear about this point. I think the shadow Minister would probably agree that certain names keep on popping up, particularly in The Times investigation, of companies that seem to be regularly involved in some of the most eye-watering price increases and involved in the mixed model. This Bill is about tackling anyone else who might be thinking of following that kind of business model as a way of exploiting the NHS for money.

[Barbara Keeley]

Very much so.

The hon. Member for Bury St Edmunds (Jo Churchill) welcomed the Bill and talked about the fact that individual CCGs could save £1 million on unused repeat prescriptions. A number of different forms of savings could clearly be made. She talked about the pressure on social care, and I join her in my concern about that. The right hon. Member for Chelmsford spoke earlier about an ageing population and the need for drugs, but older people also do not want to be isolated. It is worrying that 16,000 cases of malnutrition were found last year with an average age of 64 among those cases. People need social care, and I hope that the new Chancellor will listen and bring forward funding for social care in the autumn statement, because people need more than drugs.

As my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) made clear earlier, Labour supports the broad aims of the Bill and what the Government are seeking to achieve—better control of the cost of medicines. However, as my hon. Friend also outlined, we have a number of concerns, and I hope that the Minister will address them in his closing speech.

As well as taking the understandable measures to collect pharmaceutical data and manage costs, the Bill also introduces provisions to manage the purchase of other medical supplies. I was glad to hear the Secretary of State raise in his opening speech the issue of the impact on the medical supply sector, but I have heard concerns expressed that the medical technology sector sees the new information measures as “onerous”. The hon. Member for Erewash (Maggie Throup) mentioned that, too. There is a concern that measures in the Bill fail to take into account the unique characteristics of medical devices and the medical device industry. I hope that they will start to be taken into account as the Bill progresses. There is seen to be a danger that the measures will put additional burdens on that sector and the NHS, and lead to higher costs. I hope that that is not the Government’s intention; it would be ludicrous if costs were increased by a Bill that is designed to manage them.

We need to bear it in mind that the medical technology industry employs around 89,000 people in the UK, has an annual turnover of over £17 billion and has seen employment growth of around 11% in recent years. Some 99% of the UK’s 3,310 medical technology firms are SMEs, with 85% of them having a turnover of less than £5 million. The cap levels at which data could be collected were mentioned earlier. We should bear it in mind that we are talking about an awful lot of small companies.

The Bill imposes a regulatory burden on all companies in the supply chain. The reporting requirements will affect all firms producing medical supplies, including the very small organisations. The issues we have extensively discussed on pharmaceutical pricing bear no relation to the price of other medical supplies. The example of a particular type of product was mentioned earlier, but they are or seem to be treated the same way in the Bill.

On the scale of the burden being imposed, the Government’s impact assessment is not much help. It says:

“The main costs will be on manufacturers, wholesalers and dispensers. These costs have not been quantified, as their magnitude will not be known until after consultation on subsequent regulations.”

Measures seem to have been bolted on to this Bill, as Members have mentioned, at the last minute, but because they could have a negative impact on the medical technology sector, we need to be very aware of them. The new information powers proposed by the Government are being put forward at a time when manufacturing firms are going through the uncertainty surrounding this country’s leaving the EU. These measures can only add to that uncertainty. As I said, 99% of the medical technology firms are SMEs, with 85% of them having a turnover of less than £5 million.

Notes on the financial implications of the Bill put forward a curious position that

“no policies will be directly implemented as a result of these changes. Their implementation would require additional future changes to secondary legislation and additional Impact Assessments to assess their cost effectiveness.”

Ministers are asking us to change primary legislation to give the Government new information powers, but the details and impact of those new powers on the supply chain will emerge only in future. That level of uncertainty is unacceptable, and we will seek to amend the relevant clauses in Committee if we feel that this still needs to be resolved.

Importantly, the information powers will also impact on dispensing GPs and pharmacists. I note that the BMA was not represented at the workshop held by the Department of Health on the information powers. We wait to hear, but I would find it unusual if our hard-pressed dispensing GPs would welcome the additional work required of them to provide and disclose information to the Government.

The other part of the supply chain affected by the new information powers will be pharmacists. The Government have just imposed punitive cuts on pharmacists, which we discussed in the House last week. I am still deeply concerned about those cuts. Ministers do not seem to understand what they are doing to the sector. On Friday, an independent community pharmacist in my constituency told me that he estimated that the Government cuts would cost him £86,000 a year, and that he envisaged an average cut of £60,000 for many pharmacies. That will certainly mean staff cuts, but it also means potential bankruptcies for the pharmacies that will be hardest hit.

In relation to that, and the new information powers that the Bill imposes, Pharmacy Voice told me that

“small volume pharmacies are the hardest hit by the proposals and many face a funding cut of around 20% in 2017/18 from the imposition of cuts announced…They do not have teams of administrative staff who can respond to demands for information, and the likelihood is that the NHS would insist on information being provided in a specific format.

It could be information that they do not currently analyse. For example, when a pharmacy buys stock for dispensing, it may also include purchases of medicines for sale over the counter. The overall discount the pharmacy gets on the order is not allocated to each item, and pharmacies could not provide the actual price paid per item.”

On behalf of the pharmacists that it represents, Pharmacy Voice wants to ensure that the cost of meeting the Government’s information requirements is fully funded by the NHS. It feels that the imposition of cuts has already jeopardised the future of the pharmacy sector, and that of small pharmacy businesses in particular. Can the Minister assure me that the cost of the information that must be gathered under the new information powers will not impose an additional burden on pharmacists?

The Labour Opposition support the broad aims of the Bill and the measures to control the costs of medicines, but, as I said earlier, we are concerned about the information powers that the Government want to take, which are considered to be “onerous” by the medical supplies sector. We want to be reassured that they are not. The work and the costs involved could deal yet another blow to the pharmacy sector, which, as I have said, is still counting the costs of the Government’s imposition of funding cuts amounting to 12% for the rest of this year and over 7% next year. We will table amendments in Committee relating to the work and the costs involved in information-gathering.

We also ask Ministers to give serious consideration to using all future rebates from the pharmaceutical sector to improve access to treatments for patients. A number of Members have referred to the need to examine that much bigger issue of access to drugs and treatments, and I hope that Ministers will take the opportunity to do so as the Bill progresses.

Healthcare (Devon)

Kevin Foster Excerpts

Tuesday 18th October 2016 Westminster Hall

[Kevin Foster (Torbay) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my right hon. Friend the Member for East Devon (Sir Hugo Swire) on securing the debate. I will be mindful of your comments about the time. I presume that a maximum of eight minutes will be appropriate.

[Mr Geoffrey Cox (Torridge and West Devon) (Con)]

Seven minutes.

[Kevin Foster]

I am reminded that it is seven minutes. [Interruption.] The more heckling there is, the longer I might get.

For me, this debate is prompted by what is one of the greatest successes of the NHS: the fact that life expectancies are rising. In parts of my constituency, life expectancy has reached 90, and in one ward that I represent, Wellswood, 9% of the entire population are aged over 85. That brings challenges not only in health and social care, but in relation to the wider selection of services that those who have reached that age will need in order to have a whole life and not just have their healthcare needs taken into account.

Today, however, the focus is on the health service. Clearly, the proposals announced by South Devon and Torbay clinical commissioning group have created a lot of concern across Torquay, Paignton and the rest of the bay and south Devon. In fact, public concern was so great that the first three consultation meetings that it arranged in Paignton did not go particularly well. It arranged what were obviously going to be very large meetings in rather small venues, so when I attended the first one, at 9 am, I found myself, with about 40 residents, my predecessor, the former mayor and a number of councillors, plus trade union representatives, being told that the room was full and we could not go in. Things got worse at the 4 o’clock meeting. I ended up addressing more people at an impromptu meeting on the steps of the venue than had actually got into the official meeting. Then finally, in the evening, although there was a reserved seat for me, that meant that another resident was turned away because I was there speaking. It was a shambolic start to a serious consultation, but thankfully I notice the trust has now arranged further meetings.

Local concern about Paignton hospital is so great because of the breadth and importance of the services that it provides, not least the beds that many people are discharged to from Torbay hospital. When the Public Accounts Committee did its recent report on delayed discharges, Torbay had one of the best records. I am sure that my right hon. Friend the Member for East Devon would reflect that, sadly, the Royal Devon and Exeter did not. That is not so much about the hospital’s own services as about its ability to discharge to a social care setting.

We have already seen the impact that the consultation has had in terms of beds. Qualified staff have decided to seek jobs elsewhere, seeing the numbers of beds already reduced. During the consultation, the fact that there are hundreds of beds in residential and nursing care homes in Paignton was cited. I took the time to ask the obvious question: how many of those are actually vacant at the moment? The answer that I got back—this was a snapshot taken two weeks ago—was that 12 of the beds are vacant, yet two are in places that are accepting no new placements at the moment and four are in a place that specialises in caring for children. That causes real concern that we will see more delayed discharges at our local hospital if the proposals for Paignton go ahead.

Many residents of Paignton are concerned about the wider clinical services provided there, not least the minor injuries unit. The suggestion made in the consultation is that if a minor injuries unit closes at Paignton, residents will travel to either Totnes or Newton Abbot. I am sure that we will hear from my hon. Friend the Member for Newton Abbot (Anne Marie Morris) that the facility there is in excellent condition, but the reality is that that involves travelling past the acute hospital at Torbay, with its A&E department. I think it is far more likely that there will be more pressure as a result of people who would have been at the minor injuries unit in Paignton ending up at A&E in Torbay—the very place that we want to discourage people from going to unless they need to be there. There are also services such as X-rays and other clinics that many local residents find convenient and that support local GPs in delivering excellent healthcare.

My other concern about the consultation document is that although it is very detailed about what will be taken away from the south Devon area, it is not detailed at all about what will replace it. For example, there is talk of a clinical hub in Paignton, but no location. There is talk of doing more through GP surgeries, yet many of the practices are in buildings that predate 1948 and are in effect converted houses—not places that would be able to provide extended facilities for healthcare.

I find it very concerning when I speak with local people about what engagement there will genuinely be as part of the consultation, not least given the meetings arranged for small venues and the way that much of the questioning really produces only one logical answer. No one is going to say, “Yes, I’d like to spend the night in hospital,” but we would spend the night in hospital if we felt that we needed to be there. This is about ensuring that people have genuinely been able to express their views. That is why I hope that my hon. Friend the Minister will take a close look at the consultation being undertaken.

In closing, I emphasise the point that has been made about recruitment. The movement of qualified staff out of Paignton the moment the proposals to close the hospital were mooted speaks to a wider problem of recruitment across health and social care in south Devon. Although seeing the Torbay and South Devon trust receive Fair Train’s gold standard work experience accreditation last Friday was welcome, more still needs to be done to convince people that careers in health and social care are just that: careers. Many male jobseekers in particular see a job in that field as an entry-level job that they would not progress from, yet there are so many opportunities there. This is another concern for me, as it is for colleagues. We can put things down on paper, but if, in the social care market locally, there are not the providers, there is not the quality of provider and, bluntly, the vacancies that we already have for GPs are spreading across other health professions, then whatever position we come up with in the consultation will not be able to be implemented unless we address those long-term challenges in our economy.

[Sir Hugo Swire]

Does my hon. Friend share my concern about recruitment in social care and care homes: that a lot of staff are, of course, from the Philippines and other countries around the world? We must all hope that that is taken into account when the UK comes up with a new immigration policy.

[Kevin Foster]

I thank my right hon. Friend for his intervention. It is worth saying that the outcome of the EU referendum and Brexit is probably not going to affect those from the Philippines, given that the Philippines is not a member, but I fully accept the point that we have for too long relied on importing healthcare professionals—doctors and others. We have to have a debate about whether it is ethical for us basically to be depopulating parts of the third world of much-needed doctors, nurses and other trained medical professionals and to be relying on other countries’ training schemes to provide the numbers of healthcare professionals we need. The key point is that we want our own young people to be taking up those opportunities, as well as having the services provided.

I can see you indicating that my time is coming to an end, Mrs Main, or has come to an end. I will finish with one plea: I want to see Paignton hospital and Paignton people’s services continuing into the future.

Oral Answers to Questions

Kevin Foster Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Hunt]

I do not recognise the picture the hon. Lady paints about opposition to STPs. We need to ensure we have good plans that will deliver better care for NHS patients by bringing together and integrating the health and social care system, and improving the quality of out-of-hospital plans. While we are in a period where those plans have not been published there will obviously be a degree of uncertainty, which we will do everything we can to alleviate, but she is right to say that these plans are very important for the future of the NHS. The process has our full support.

[Kevin Foster (Torbay) (Con)]

The Secretary of State will be aware of the concern in my constituency about the future of Paignton hospital, which prompted hundreds to turn up to a recent meeting. Does he agree with me that it is vital the clinical commissioning group, in publishing its plans, does not just publish what it will remove but the details of what it will replace them with?

[Mr Dunne]

Considerable efforts are going into sorting out some of the historical challenges in the provision of both acute and community care in Devon. I hosted a meeting for a number of colleagues who are concerned about this and I am happy to continue to engage with colleagues across the county.

Junior Doctors: Industrial Action

Kevin Foster Excerpts

Monday 5th September 2016 Commons Chamber

[Mr Hunt]

I was nervous mentioning the fact that the Government have made 107 concessions when I saw that my hon. Friend might be in the Chamber because I knew that, for him, that would be 107 too many. His broader point is absolutely spot on. The working terms and conditions for Saturdays for junior doctors in this new contract are better than they are for nurses, police officers, fire officers and for those in many other parts of the economy. That is why I think it is a fair deal that everyone should recognise and welcome.

[Kevin Foster (Torbay) (Con)]

I know that the Secretary of State will agree that what sums up this dispute is that, under the existing contract unless the new one is brought in, we could be treated by a doctor working their 91st hour in a week. Does he agree that it is absolutely bizarre to see this level of strike action called when even the BMA’s own council was so divided over whether to support it?

[Mr Hunt]

That is absolutely right. What my hon. Friend is alluding to is the fact that, in the new contract, we are reducing the maximum hours that any doctor can be asked to work in any one week from 91 hours to 72 hours. There are all sorts of other safeguards that benefit safety. He is right. This should not be happening, and I urge the BMA to reconsider.

Junior Doctors Contracts

Kevin Foster Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

My hon. Friend speaks wisely, as ever, on this. The fact is that we have moved a very long way to meet one of the BMA’s biggest concerns: that there should still be premium pay on Saturdays. For doctors who work regularly at weekends this is a very good deal—better than that for pretty much anyone else in the public sector. That is why we think that the reasonable thing to do would have been to accept the deal and not to call these wholly unnecessary strikes.

[Kevin Foster (Torbay) (Con)]

I know my right hon. Friend will agree that a dispute over pay cannot justify a threat to withdraw emergency cover. Will he confirm that after the new contract comes in no doctor will be treating patients while working their 91st hour in the same week, and that he will be looking at the availability not just of junior doctors but of other support services that are needed to deliver the seven-day services we have pledged to provide?

[Mr Hunt]

Absolutely. My hon. Friend is quite right to point out that the seven-day NHS vision is not just about junior doctors but about support services for junior doctors that will make the provision of care to their patients at weekends not just better for those patients but much more rewarding for them. It is immensely frustrating for doctors not to be able to get diagnostic tests back quickly because it is the weekend. We want to sort out all those problems. That will be better for doctors and better for patients.

Brain Tumours

Kevin Foster Excerpts

Monday 18th April 2016 Westminster Hall

[Wendy Morton (Aldridge-Brownhills) (Con)]

It is a pleasure to serve under your chairmanship this afternoon, Ms Buck. Along with others, I congratulate the hon. Member for Warrington North (Helen Jones) on introducing this debate. Maria Lester should also be congratulated on raising this issue; I do not wish to state the obvious, but without her petition there would have been no debate here today, so we would not have had the opportunity to share many personal stories and to raise this important issue with the Minister. It has also been an opportunity for me personally to learn more about this subject. As a newer Member of Parliament, I am still struck by how often constituents come to us and share their very personal experiences and stories with us; it is often very moving and very touching.

An earlier speech touched on people’s ignorance of this subject matter. In doing research for today’s debate and in sitting here listening, I, for one, have learned an awful lot—and I am sure I have an awful lot more to learn. As we heard today, the Petitions Committee released its report on funding for research in March. That report called for more investment in research into brain tumours and revealed the distress of many sufferers and their families whose lives have been devastatingly affected. It also helpfully explored the reasons behind the historical underfunding of research under successive Governments. I was quite shocked to read that brain tumours are the ninth most common cancer in the UK and they kill more children and adults under 40 than any other cancer—yet, while the incidence is increasing, there has been little extra allocated to research. That is one reason today’s debate is so important.

[Kevin Foster (Torbay) (Con)]

My hon. Friend makes powerful points. While I congratulate my constituent, Peter Jordan, on his efforts—he recently completed the Plymouth half marathon to raise funds for this cause—does she agree that, given the figures she has mentioned, what we need to see is real commitment from the Government to funding research?

[Wendy Morton]

I am grateful to my hon. Friend for his intervention. Yes, I do hope that the Government are listening today. We must continue to raise this matter. As a local MP, I recently read a heartbreaking email from a grandmother about her grandson. I then received an email from a mother, telling me about her son. At that point, it hit home that the grandmother’s grandson was the mother’s son. It highlighted to me that it is not just sons, daughters or grandchildren who are affected, but cousins, aunts, friends and colleagues; it extends way beyond the immediate family. Those emails compelled me to come along today and speak in this debate. The young boy sadly passed away, aged just 14, after surgery, chemo and radiotherapy, seven years after being diagnosed with a high-grade tumour. I cannot imagine how that family must have felt. Sadly, as we have heard from the many examples shared with us today, that family is not alone.

Charities, clinicians and scientists do amazing work. My hon. Friend the Member for Torbay (Kevin Foster) spoke about people who raise money through charities, doing sponsored runs, marathons and all manner of things for causes that are very close to their hearts. Yet, although technological advances help, brain tumours remain very difficult to treat and continue to take many, many lives each year—too many lives. I conclude simply by saying that I am looking forward to the Minister’s response, especially on how to raise awareness, how to improve research and, ultimately, how to improve the outcome for patients and their families.

--- Later in debate ---

[Nicola Blackwood]

The right hon. Gentleman, and friend, has made an important point and I hope the Minister will respond to it. However, we should note at this stage that the overall story of childhood cancer over the last 30 years is positive. Eight in 10 children with cancer survive five years or more, compared with just three in 10 during the 1960s. We should congratulate the Government on that because it is clear that the work and funding we put into fighting cancer is money well spent. As we have heard, unlike most cancers, brain tumours are on the rise and research is underfunded, and because the money spent on cancer is effective, we must put that right.

I want to focus on childhood cancers, for obvious reasons. Despite causing more than a third of childhood cancer deaths, brain tumours receive only 6% of childhood cancer funding. Childhood cancers account for less than 1% of cancer diagnoses in the UK and of that 700 children are diagnosed with a brain tumour every year. It is the most common form of cancer affecting children and the most lethal, killing 160 children every year.

We must consider childhood cancer funding in its own right because children’s cancers are biologically very different from adult cancers and to treat them effectively requires specifically tailored research and treatment. The effect of the funding shortage, ethical challenges and small cohorts mean that 50% of childhood cancers are part of a clinical trial and the remainder are treated using standard treatment guidelines such as the Milan protocol. There are risks with that approach.

As we have heard, cancer treatment is a brutal regime and can cause long-term disability. That is particularly true of childhood brain tumour survivors, 60% of whom are left with life-altering disability. In a few cases like Skye’s, these effects can be fatal.

[Kevin Foster]

My hon. Friend is making some powerful points, as other speakers have. Investment in this area is vital. The costs of caring for those lifelong disabilities as well as preventing deaths are why the Government should invest in this area—invest to save money in the long run.

[Nicola Blackwood]

My hon. Friend makes a good point. This is not a subsidy; it is an investment that will reap a return.

Currently, there is no formal infrastructure to collect and share data about standard treatment guidelines. Consultants working incredibly hard to save the lives of young patients struggle with their inability quickly to access information about the potential adverse effects of very tough treatment regimes. In all my correspondence about this with NHS England and others, the response is, “We’re trying, but it’s very difficult.” That is not good enough because all life-saving cancer innovations are difficult and, given the stakes, I simply cannot accept that the problem is insoluble. The architecture for collecting the data is in place, but the lack of formal data collection requirements and a single responsible body can have devastating consequences.

Currently, the National Cancer Registration Service and Public Health England are developing a pilot to improve data gathering and I welcome that, but it seems that it will be retrospective. It may yield research benefits, but it falls short of the real-time data necessary to guide clinicians. When Skye’s consultant noted that he was deteriorating fast, she could not easily find out whether any other children on the Milan protocol had experienced the same side effects and she was reduced to phoning colleagues ad hoc to ask their opinion one by one as Skye got worse. In the end, it was too late.

In so many ways, we are making tremendous strides in the UK in tackling cancer, including childhood cancer, but the absence of monitoring the adverse effects of standard treatment for childhood cancer can lead to lifelong disability and death. In an ideal world, all childhood cancers would be the subject of a full clinical trial, but we must recognise the challenges associated with research into childhood cancers where cohorts of rarer cancers can be incredibly small and ethical issues are more complex, making it difficult to recruit participants. This means that even with increased funding, which is clearly essential, some childhood cancers will have to be treated through standard treatment protocols.

I hope the Minister—I believe he is a man of action—will listen to the arguments that all of us here have made today about funding concerns and take action to rectify data gathering and standard treatment protocols. If those adverse effects are properly collected, recorded and shared, we may be able to avoid more cases like Skye’s and to increase survival rates of childhood cancers even more.

Contaminated Blood

Kevin Foster Excerpts

Tuesday 12th April 2016 Commons Chamber

[Kevin Foster (Torbay) (Con)]

It is a pleasure to follow the Father of the House, the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), and to be able to follow on from all the work done to bring this debate to the Floor of the House. I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) on securing it; it was a pleasure for me, as a member of the Backbench Business Committee, to support the proposal that this debate be held today.

Contaminated blood and the impact on victims was one of the first issues to come into my inbox after I was elected. Someone came to my surgery who had had a condition but had been otherwise healthy, only to find that they were to have decades of pain and disability because of the treatment they had for that condition—that is almost heartbreaking. Virtually all their life prospects have disappeared because of a treatment they received that they thought would make them better.

It is worth examining the scale of this disaster in our NHS system. We are talking about 4,700 people with bleeding disorders and 28,000 other people becoming infected with hepatitis C; and 1,200 with bleeding disorders and 100 other individuals getting HIV. Of course these people were getting that condition at a time when the medical understanding of it was very limited and the life expectancy was incredibly short. Thankfully, many people have benefited from the advances in medical science since 1985, which have allowed them to keep living, but they still face all the issues that come with that illness and—let us be candid—the stigma that still comes with it from those ignorant about what can cause it.

The issue is about looking at the time that has elapsed. I am sure that, like me, my predecessor, Adrian Sanders, who pursued a number of cases diligently during his time as the MP for Torbay, would not have expected that after 18 years his successor would still be talking about this issue and still be having to speak up for the constituents affected by this scandal, at least one of whom is in the Gallery today. We know that a patchwork of five schemes is in place, and reference has been made to that. To be fair, £390 million has already been paid out, but the impact on these people has been so devastating that it is right that we are looking again at what the appropriate level of compensation is.

It was appropriate that last year the Prime Minister issued an apology. That is something so simple, but it took until 2015 for it to happen. I agree that we are not in a court of law today, but it is right that we seek to provide some form of justice to those who for so long have found themselves on the receiving end of life-changing conditions.

[Bob Stewart (Beckenham) (Con)]

We have used the word “justice” all the way through this debate. I have listened to it all and I was not intending to intervene, but I must say that in fact there is no justice we can give people who have contaminated blood—that has been taken away from them. All we can do is give them the best possible help, financially and in care terms. They will never get justice, and it is improper to suggest they can—we cannot do it, it is too late, they have had that taken away and money will not compensate.

[Kevin Foster]

I thank my hon. and gallant Friend for such a thoughtful intervention. We cannot give them justice; we cannot restore them back to where they were before the impact of this scandal, but we can compensate them. We can try to mitigate the impact and give them a life that is appropriate, as best we can. Today’s debate is right to focus on that.

[Mrs Flick Drummond (Portsmouth South) (Con)]

Will my hon. Friend give way?

[Kevin Foster]

Briefly, but I am conscious of Mr Deputy Speaker’s guidance.

[Mrs Drummond]

My hon. Friend has mentioned some of the impacts, and I think there is an impact relating to housing. A lot of people with very low incomes are finding it difficult to access reasonable housing, including my constituent Sally Vickers, who has been told by Portsmouth City Council that she cannot be rehoused, despite a threatening condition caused by receiving contaminated blood. Does my hon. Friend not agree that the Minister needs to advise local authorities to make sure that the housing is adequate for such people?

[Kevin Foster]

I thank my hon. Friend for that intervention. This is also about making sure local authorities are aware of the support packages and the possible impact on benefit calculations. During my time as a councillor in Coventry I was approached by someone who was constantly being invited in for a fraud interview because they were receiving funds from one of the trusts. Those trained in these trusts have mostly retired now because of the time that has elapsed since this was put in place; the numbers involved are very small so new members of staff would not be so familiar with this. To be fair, that particular incident was resolved.

Initially, my constituents were pleased to hear that a consultation was going to happen and that £25 million would be available. They waited for it, but when it was announced it is safe to say that they were extremely disappointed. The problems, which have already been listed, include the fact that recipients could receive less than they do now, as some of the top-ups and support may be abolished. Some of the support could rely on assessments. I say that tentatively, as I have looked at this issue of repeated assessments. As a member of the Public Accounts Committee, I have looked at the work of the Department for Work and Pensions, and there is no great enthusiasm to see more people going through an annual assessment, particularly when, for many of these people, only a miracle cure will make any form of difference. The conditions are lifelong and permanent. They have been with them for decades and are not likely to be something from which they will recover.

I hope that the Government will relook at the proposals they put out for consultation, and take on board the comments from the all-party group, which have been put forward in a constructive and genuinely helpful way. I ask the Minister to take a view on what is being done in Scotland, and to explain why the UK Government do not think that the Scottish model would be appropriate here. If there is a particular reason, let us hear it. For me, it seems that the model has been welcomed and could be taken forward here.

I do hope that, after 30 years, we can finally take a step forward, deliver justice and ensure that people get the compensation for which they have waited so long. They need a resolution to these matters, which have been going on for decades.

Dementia and Alzheimer’s Disease

Kevin Foster Excerpts

Tuesday 12th April 2016 Westminster Hall

[Stuart Blair Donaldson (West Aberdeenshire and Kincardine) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I, too, congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. This subject is close to my heart, as I am sure it is for many people here in Westminster Hall, given the attendance today. I am sure that many hon. Members have a close friend or a family member who has suffered from dementia.

There is no doubt that dementia is a horrible disease that robs sufferers of their personality and their memories—everything that makes them them. The disease also puts severe strain on families and family relationships, as they try to understand and come to terms with it. As my hon. Friend the Member for Airdrie and Shotts (Neil Gray) said, it is important to make the point that dementia is not a natural part of ageing.

Some 90,000 people in Scotland are living with dementia, and we have heard today about the different factors that come into play in treating dementia, whether that is research, caring for people with dementia or supporting people who are caring for them. A number of my hon. Friends have mentioned the Scottish Government’s rights-based approach to dementia. Dementia is a disease and it can have a cure. It is great to have heard from many hon. Members about the work going on in their constituencies, whether it is universities or charities that are looking to research a cure.

There has been a lot of talk about carers as the unsung heroes of dementia care. An organisation in my constituency, the Forget Me Not Club, provides more than 500 hours of free care a week. I was amazed at the expertise that the people there had. Heather Morrison and her team do a fantastic job. They told me a couple of stories that I would like to share. They had one client who would continually stamp on the kitchen floor and the family could not work out why the person was doing that. It turned out that the kitchen floor had been designed in tiles of black and white and they thought that the black tiles were raised, so they were trying to stamp them with their feet. That was one part of their dementia. Another sufferer would not wash with soap when they went to the bathroom. It turned out that the soap was the same colour as the sink and bath. They could not see it, which was why they would not wash.

The expertise and experience of the people who work day in, day out with those suffering from dementia is so valuable, and it is so important that we praise the carers. That is why I welcome, as my hon. Friend did, the passing of a carers Bill in the Scottish Parliament earlier this year to enshrine in law for the first time the rights of carers. Furthermore, the Scottish Government’s carers strategy recognises that carers must be seen as equal partners in the delivery of care, as their support enables people to live at home, in their own communities, safely, independently and with dignity. I also welcome the Scottish National party’s pledge to raise carer’s allowance to match jobseeker’s allowance if re-elected.

We have heard that familiarisation is a very important part of tackling dementia and caring for people who have dementia. Not going into hospital and not becoming institutionalised is so important for people with dementia, which is why the Scottish Government identified, in their proposal for the national dementia strategy for 2016 to 2019, a number of challenges to be dealt with, including tackling avoidable hospitalisation, which worsens outcomes for people with dementia every time.

The hon. Member for Strangford mentioned the risks of alcohol as well as other lifestyle factors in contributing to dementia. It is important that we tackle the public health issues around that. I welcome the fact that the Scottish Government are taking steps to encourage people to remain physically and socially active, to discourage isolation and to encourage behaviour that has been recommended by the Caerphilly study.

[Kevin Foster (Torbay) (Con)]

I congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. Does the hon. Member for West Aberdeenshire and Kincardine (Stuart Blair Donaldson) agree that the Torbay Dementia Action Alliance’s memory café is exactly the sort of community initiative that can help to provide support to patients suffering from and living with dementia, and to their carers?

[Stuart Blair Donaldson]

I completely agree with the hon. Gentleman. There are a number of strategies and community initiatives. In my constituency, another initiative is live music appreciation. Dementia sufferers and their carers can go along, listen to live music and join in if they want to. That was my first interaction with the Forget Me Not Club in my constituency, and it was a great thing to see.

Finally, the Scottish Government’s national dementia strategy also incorporates Alzheimer Scotland’s five pillars model of post-diagnostic support. Alzheimer Scotland does a fantastic job in providing advice, support and all manner of things for those suffering from dementia and for their carers. Its five pillars model includes:

“Planning for future decision-making…Supporting community connections…Understanding the illness and managing symptoms …Peer support… Planning for future care.”

All the things that charities, local communities, communities and the Government do will help people to live well with dementia.

Junior Doctors: Industrial Action

Kevin Foster Excerpts

Thursday 24th March 2016 Commons Chamber

[Ben Gummer]

I disagree with the gentleman on two points. First, we have been trying to get around the negotiating table for over three and a half years, but it requires both sides to negotiate, and I am afraid the BMA has refused to do so. When only one party is at the table, negotiations cannot continue. Secondly, it is not just bad for patients; it is also bad for doctors in terms of their careers and what they want, which is to provide the best possible care for patients. That is why I urge all doctors not to withdraw emergency cover at the end of next month.

[Kevin Foster (Torbay) (Con)]

Does the Minister agree that whatever the dispute, the threat to withdraw emergency cover is one that nobody should condone, and will he join me in urging the BMA to withdraw the threat immediately?

[Ben Gummer]

I will join my hon. Friend. I only hope those on the Opposition Front Bench will also join him.

Bowel Cancer Screening Age

Kevin Foster Excerpts

Tuesday 8th March 2016 Westminster Hall

[Caroline Ansell]

I thank my hon. Friend for his contribution.

[Kevin Foster (Torbay) (Con)]

I welcome the fact that my hon. Friend has secured this debate. My mother was diagnosed with bowel cancer at 56 and, ironically, my father, who was 60 at the time, had received the screening kit five months previously. Does my hon. Friend agree that that shows the need to review the age at which people are screened?

[Caroline Ansell]

I agree, and I hope we can put that need forward today. I know that the Minister and her Department are working hard in this area and that they are all the time seeking to secure better outcomes. I hope that they might just revisit the screening age as part of that.

It has been really moving to hear from right hon. and hon. Members about their own experiences and about the losses they have suffered. Lauren is here today, having lost her mum. What a terrible tragedy that is. It feels especially poignant that we are here so soon after celebrating mother’s day.

With today’s advances in life expectancy, 56—the age at which Lauren’s mother died— is incredibly young, yet if Lauren’s mother had lived in Scotland, she would have been screened three times before the age at which she was diagnosed, increasing the chances of early detection and therefore survival. Learning that must have been a bitter blow. England has, however, led in this area. In 2006, we became the first home nation and one of the first countries in the world to offer routine screening for bowel cancer, with the faecal occult blood test, or FOBT, being sent every two years to those aged 60 to 69—later extended to 74. However, a year later Scotland implemented the same screening, with the crucial difference that it would begin from the age of 50.

The national screening committee, which ran FOBT pilots in the early 2000s, felt that 50 was the right age at which to begin to screen. It noted a lower take-up of the test in 50 to 60-year-olds compared with those over the age of 60, but recommended that the Government take measures to address that. However, when deciding on final implementation it was recognised that, due to a shortage of endoscopy equipment and with substantially higher incidence rates over the age of 60, screening would begin with that age group. It is conceded that more than 80% of those diagnosed with bowel cancer are over the age of 60.

A University of Sheffield study recommended that offering both bowel scope screening and the FOBT from the age of 60 would maximise survival rates and have the important trade-off of being cost-effective. Yet the same study also found that the FOBT would substantially lower the number of deaths by as much as 23% if it was run for 50 to 69-year-olds, whereas running it from the age of 60 only would reduce the number of deaths by only 14%. It is hard to talk about percentages but, just to bring the debate back to the personal level, that significant 9% would have included Lauren’s mum, and perhaps other people we know.

We know that there is a clear upward incidence of bowel cancer over the age of 50. The rate of bowel cancer roughly triples between one’s 40s and one’s 50s, before doubling again in one’s 60s. We all should be aware of the signs and take precautions in our diet and lifestyle to prevent and detect bowel cancer—and, yes, perhaps we ought to shed the very British attitude that we must keep calm and carry on, and seek out our GP. More must be done to improve screening uptake rates. Bowel cancer screening rates remain disappointingly low nationwide, having barely moved above those achieved in the pilot 16 years ago.