NHS (Charitable Trusts Etc) Bill
Kit Malthouse Excerpts(8 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Michael Tomlinson
I shall turn to what I mean by “appropriate” in due course, but I think hon. Members on both sides of the House will know on plain reading of the word “appropriate” what is or is not appropriate.
Kit Malthouse (North West Hampshire) (Con)
In my mediocre experience in local government I have participated in a huge number of Government consultations. I cannot recall a single one that changed the initial decision of the Government. Will my hon. Friend acknowledge that more often than not Government consultations just go through the motions? The only one I can remember ever having an effect was by the incoming Mayor of London on removing the extension of the congestion charge in the west of London, which was overwhelmingly supported by consultees, and he did in fact enact that in the teeth of opposition from Transport for London. Beyond that, I have never quite seen the point of consultation when Ministers’ minds are made up. Does my hon. Friend agree?
Michael Tomlinson
I certainly would not agree that my hon. Friend’s experience is mediocre—quite the opposite. I understand the thrust of his point, but I disagree, because at a time when politics can be seen to be remote it is important that the public are engaged in these debates. I also think it would be wrong to say Ministers’ minds are closed. I am sure those on the Front Bench this morning would agree that Ministers’ minds are not, and should not be, closed—certainly not before a public consultation.
Kit Malthouse
Does my hon. Friend agree that my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) gave herself away at the beginning of her intervention when she referred to this money being donated by the public to the NHS? In the public’s mind, there is often a confusion between the charity and the institution that it serves, and it is therefore crucial to have these controls.
Mr Rees-Mogg
My hon. Friend puts it extremely well. That confusion is almost inevitable. In the case of charities linked to hospitals, most members of the public will expect the money that is spent charitably to be as thoroughly audited as the money that is spent by the state, and it is prudent to formalise that.
Mr Rees-Mogg
I am not sure that those are the circumstances under which the Secretary of State would use his discretion to allow the logo to be used. I am thinking more of a sign outside a charity shop that supports the NHS, saying “We support the local NHS”, with the name of the local hospital that it is supporting and the local hospital’s logo, which includes the letters “NHS”. I am thinking of that sort of circumstance. It is not about promoting the charity as an offshoot of the NHS; it is about indicating its co-operation with the NHS.
Defibrillator boxes give the name of the ambulance service—the ambulance service’s logo includes the letters “NHS”—to indicate that people should ring 999. The ambulance service will then give them the code to open the box and talk them through how to use the equipment. Most of us probably would not know how to use it without some advice. It was entirely rational to use the logo until some idiotic bureaucracy got in the way. Initially, it was very stubborn—the worst type of pettifogging bureaucracy. If the Secretary of State had had the power to cut through such bureaucracy, that could just have been done.
The circumstances in which the discretion is used would be limited to where there was genuine co-operation—where the charitable sector and the NHS are working hand in glove—and there was a benefit from using it. It is not about charities posing as the NHS where they are not part of the NHS. If the Secretary of State thought the logo was being misused, he would have the power to rescind the permission. This protected and limited power would solve a particular problem.
Kit Malthouse
I rise to speak to amendments 1, 3 and 2, which—inexplicably, given their strength—stand in my name only, as well as the splendid amendment 9 and the unfortunate amendment 4. It is a pleasure to speak under your chairmanship, Madam Deputy Speaker. In my experience, debates with you in the Chair are often the most efficient and good natured. I hope that today’s debate will be just that.
On amendment 1, when one tables an amendment, it is a great pleasure to have one’s speech made for one much more eloquently than one could make it oneself, so I am grateful to my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) for his support. Recently, there have been significant charitable scandals in this country. Much of the time of the House and of the Public Accounts Committee has been taken up with Kids Company. I have become convinced that one of the phenomena at work in that organisation was group-think. Those hon. Members who are students of psychology will know of the phenomenon of group-think: individuals in a group, often when they are led by a charismatic leader, can get lost in a miasma of consensus, in which they are unwilling or unable to acknowledge any view that departs from theirs, and indeed are hostile to outside views of their conduct.
The most famous political example was the Bay of Pigs disaster: the group around President Kennedy became trapped in group-think. We have seen commercial examples of it in the UK. Marks & Spencer and British Airways got trapped in group-think in the 1980s, when they went for massive international expansion. They did so against the views of everybody on the outside, but both boards convinced themselves that it was the right thing to do. Disastrously, Kodak and Swissair, which was once talked of as the “flying bank”, went bust because the management were unwilling to look for outside views.
Seema Kennedy
My hon. Friend takes me back to my time as a student in Paris 20 years ago, when I was very grateful for the expansion of Marks & Spencer so that I could get my English pies and pasties, but I digress. My hon. Friend is giving examples of group-think from 30 years ago. Does he not agree that the world has moved on, and that the rise of the individual makes our children—the millennium generation—much less likely to fall into that sort of psychology?
Kit Malthouse
I assume that my hon. Friend was not a shareholder of Marks & Spencer at the time. For those of us whose families were shareholders, it was a complete disaster, but I am glad that she was able to munch her pasty. The answer to her question is no; it is quite the reverse. The modern mind is much more akin to group-think, indeed to group hysteria. As politicians, we experience that daily on social media. We have all seen how small untruths, half-thoughts or theories can whip themselves up, on Twitter and Facebook, to become reality in a short space of time.
Mr Bacon
I agree with my hon. Friend. Was not one of the most profound and surprising examples of that, through the use of social media, the collective view that suddenly gained ground among hundreds of thousands of people that the right hon. Member for Islington North (Jeremy Corbyn) would be a good leader of the Labour party?
Kit Malthouse
My hon. Friend makes a remarkably good point. For Members of this House, that is a very pertinent example of the damage that social media can wreak on our ancient institutions, such as the Labour party.
The truth is that the modern mind is much more susceptible to such things, and particularly to charismatic leaders. One only has to look at the effect of Instagram, and the millions of followers that otherwise unmeritorious individuals have on it, to see how willing people are to go along with such things these days, like sheep in a herd.
Kit Malthouse
I thought so. I am grateful to the hon. Member for pedantry, who is right.
This is one of the things about which I am concerned. We saw the notion of group-think in Kids Company. A group of trustees, led by a charismatic leader, felt themselves to be invulnerable. They thought that they should not be doubted, and they were hostile to external views expressing doubt about them. One only has to review the correspondence of Mr Yentob, with his wild claims about the death and insurrection on the streets that Kids Company’s demise would cause, to see that group-think in action.
I studied politics and economics at university, specialising in the psychology and behavioural side of politics, and we studied group-think quite closely. When future students come to study group-think, they will look at Kids Company as a perfect example of it. Those involved were trapped in group-think. If only somebody had been able to step in and take control earlier, the charity and the remnants of its good work could have been saved.
Jeremy Quin
My hon. Friend is referring to the charitable sector, which has billions of pounds of assets and does a vast amount of good. Tarring every charitable board with the same brush is grossly unfair.
Kit Malthouse
No, I am not tarring them with the same brush. I am saying that all boards—commercial, charitable or even political—must bear this in mind. That is the whole foundation of our modern governance structures. It is the idea behind having non-executive directors, who are meant to be external and to provide a challenge to make executives and those more involved in the work of an organisation think more carefully about what they are doing.
Jeremy Quin
My hon. Friend will be aware that a good board contains non-executive directors to fulfil that challenge function. They are appointed by the board; they do not need to be appointed by an external body.
Kit Malthouse
The truth is that non-executives are technically appointed by the shareholders, so they are appointed by people who have an interest in the board being challenged constructively. The problem with charities is that non-executives are appointed by the board, the members of which more often than not appoint people in their own likeness. When the members of a board get trapped in group-think, they will appoint people who agree with them. Brave would be the chairman or chairwoman of the trustees who appointed somebody awkward or difficult, who might question or challenge them, particularly when one charismatic person is in charge.
Seema Kennedy
My hon. Friend clearly feels passionately on this matter, but he paints a bleak picture of a nation of volunteers and charity workers led by demagogues, where everybody follows their leader blindly. I have been a trustee and can reassure him that that is not the case. There are challenging voices. Given that his amendments would reinsert the power of the Secretary of State, he seems to lack confidence in people’s independence of mind and confidence in their charities.
Kit Malthouse
No, I do not lack confidence in people’s independence of mind. I have great admiration for my hon. Friend, who is very independent-minded and, I am sure, conducts herself extremely well as a trustee. The point is that there is a danger of group-think, and I have given a number of examples illustrating how it can come about. I am sure that happened at Kids Company.
That point is important in respect of this Bill because, as my right hon. Friend the Member for North East Somerset—sorry, my hon. Friend—said, the charities we are talking about here are different. They are not like other charities. People associate them in their minds with the institution with which they are connected. They are seen as part of the national health service. When I give to the Great Ormond Street Hospital Children’s Charity, I know that I am giving, at one remove, straight to the ward. I am not giving the money because the charity might spend it elsewhere. I know that I am giving it to that hospital. The two are inextricably linked.
My right hon. Friend the Member for North East Somerset—I hope he will forgive me for constantly referring to him as right honourable, but it is only a matter of time—is absolutely right when he says that, at some point, something will go wrong. Even with Kids Company, which did not have such links, but was in receipt of public money, there were demands on the Government to do something. Indeed, the Prime Minister was on the rack to a certain extent because he had been associated with Kids Company.
Pauline Latham
My hon. Friend might not have been in the Chamber the other night for the debate on banking regulation, but the right hon. Member for Slough (Fiona Mactaggart) said that she had been prevented from becoming a member of the trustee board of a charity because she was a “politically exposed person”. Does my hon. Friend recognise that some of us will have difficulty supporting amazing charities, such as Great Ormond Street, which are not like the one he mentions?
Kit Malthouse
Yes. I am trying to get to a position where we can have confidence in the governance of charities, and confidence that when things go wrong, there are appropriate mechanisms for someone to step in and deal with things quickly. My point is that in the case of national health service charities—that is what people think of them as—at some point, the Secretary of State will be asked to sort out problems.
We have to remember that there are practicalities involved in this. If the Secretary of State is unable to take control of the board and replace the trustees, he or she cannot get immediate access to the bank account. They cannot get anybody to sign a mandate to allow them to control the money, or even to freeze the account to stop money flowing in or out. When this hospital pass, this UXB or unexploded bomb of a hospital charity that has behaved badly or got into trouble, perhaps through no fault of its own, lands in the lap of a Secretary of State, whoever it may be—it could be one of us here on these Benches in the future, perhaps—the inability to step in and take control will have a significant political, and indeed financial, impact. That might impact on the care that takes place on the ward.
Mrs Sheryll Murray
My hon. Friend has cited one charity as an example, but does he have any recent information about any NHS hospital charities or NHS charitable trusts on which he is basing his assumptions?
Kit Malthouse
I do not, and the reason is that the Secretary of State currently has control of the appointment of trustees. That is exactly why. If I were Secretary of State—I assume that the same is true of the current Secretary of State and past Secretaries of State—I would be very careful about who I appointed, so that I was sure that I was handing that fiduciary duty to people whom I trusted and who had an element of accountability to me.
Kevin Foster
My hon. Friend is being very generous in taking interventions. I want to get to the nub of his amendments. The examples that he has cited of corporate governance, and Alan Yentob’s emotional blackmail in respect of the Kids Company charity, relate to general issues of regulation. Why should NHS charities be different? We are trying to make them independent. Why should the Bill be amended in this way? I do not think that my hon. Friend would argue that any time a business or charity goes wrong, the solution is for the Government to appoint a director, so why is he making that argument in respect of this Bill?
Kit Malthouse
I hesitate to be repetitive, but the truth is that these charities are different. Let me give a practical example. Say, for instance, that an NHS charitable trust that has become independent and that has independent trustees runs a huge appeal to raise money for a CAT scanner to go into a hospital. It gets three quarters of the way through the appeal and, suddenly, it becomes apparent that the money has gone missing. There are people queued up, waiting to use the CAT scanner. The charity may get lost in months and months of inquiry, and much of the money, which was for a dedicated purpose, may be defrayed on other things to deal with the problems—accountants, lawyers, judges, challenges from elsewhere or whatever else. We have seen that sort of thing happen before. I would want the Secretary of State to be able to step in and say, “No. We are now going to appoint trustees who will make sure the money is spent on the CAT scanner, and that people get the treatment they need.”
Seema Kennedy
I thank my hon. Friend for giving way. He is giving an excellent pitch to be the Health Secretary one day. I want to return to my previous point about his bleak outlook on the way that charitable boards and their trustees conduct themselves. There is adequate provision in charity law for interventions to take place. It is not necessary for the Secretary of State for Health to step in.
Kit Malthouse
The truth is that there have not been adequate safeguards in charity law, as my hon. Friend will know. That is why the Charities (Protection and Social Investment) Bill is going through the House at this very moment. Anybody who has followed the passage of the Bill or sat on the Committee will know that part of it will beef up the powers of the Charity Commission to give it greater control in the event of financial misdemeanour or charities getting into financial trouble. It will strengthen exactly those powers about which I am talking.
Mr Bacon
My hon. Friend the Member for South Ribble (Seema Kennedy) pre-empted me. One might think that there was no need for the amendments because the Charity Commission, which was established in law to supervise these functions, would step in. However, does not the evidence from the National Audit Office report, “Giving Confidently”, from autumn 2001, and the much later evidence from the NAO’s studies over the past two or three years on the Cup Trust and the Charity Commission more generally, show that, in practice, the Charity Commission has a track record of not doing a particularly good job? In the circumstances that my hon. Friend the Member for North West Hampshire (Kit Malthouse) describes, where swift action is needed, the existing framework is not adequate. It is not enough simply to say that what he describes has not happened yet in a way that we can readily recall. The point, surely, is that we must create the governance architecture and environment to respond quickly when it is necessary to do so.
Kit Malthouse
My hon. Friend makes a very good point. I recommend to the House his book, which is filled with examples of Government incompetence, many of which were brought about by the group-think phenomenon and a lack of good governance. He is an expert in National Audit Office reports, having pored over many of them in his time on the Public Accounts Committee in the last Parliament and, I think, the one before that.
Kit Malthouse
Fifteen years on the Public Accounts Committee—extraordinary! I therefore take his words seriously. He is right that the key is to get the governance entirely right.
I guess the point that I am making—maybe I am a lone voice, although perhaps I am joined by my hon. Friend the Member for North East Somerset—is that even with the most ideal governance in the world, things occasionally go wrong. In that instance, the Secretary of State must have the power to step in, given the critical nature of the services these charities perform and their inextricable link to the national health service.
Maggie Throup
My hon. Friend’s amendments would undermine the whole purpose of the Bill, which is to give these charities their independence. As he rightly says, the Charities (Protection and Social Investment) Bill, which is going through the House at the moment, will strengthen the protections and the governance arrangements for charities such as these.
Kit Malthouse
I acknowledge that point, but we have been round this carousel a couple of times. I pose just one question to those who are nervous about my amendments: in the event of something going wrong, who would fire and replace the trustees? No one. They become a self-governing group. One of the problems with charitable governance is that there are no shareholders to dispose of underperforming trustees. Charities have to acknowledge their own bad performance and fire themselves. In a situation where there is an inextricable link to a particular establishment, the Secretary of State needs to have the ability to step in, in extremis.
It is often forgotten that charities receive public money, and no charity is more likely to receive public money than an NHS hospital charity. Such charities are more likely to receive grants for their performance of services, projects, equipment and so on. We therefore have a particular interest in NHS charities.
Mr Rees-Mogg
I support my hon. Friend’s amendment because it is an emergency provision that would be rarely used. From the tone of the debate, there is an impression that the Secretary of State would use it the whole time. Does my hon. Friend agree that it would probably not be used more than once in 10 years?
Kit Malthouse
My hon. Friend is right. Proposed subsection (2B) in amendment 1 provides that the Secretary of State would be allowed to use the powers only by permission of the House. I am with my hon. Friend in his desire to protect the House’s privileges and powers. I did not get elected to give the Government a free run. When the good people of North West Hampshire elected me, they placed two votes: one for a Government and the other for somebody to hold them account. I will try to do that job. Should the Secretary of State wish to step in, he would have to lay a statutory instrument before both Houses of Parliament and seek their support. It could not be done easily, on a whim or through a signature on a piece of paper. It would require debate and examination, and need all of us to do our job of scrutiny and reach a settled decision to allow him to step in. I recognise that it is a fundamental step and that an element of separation should be maintained.
Kevin Foster
My hon. Friend is generous with his time. In my constituency, Torbay Hospital League of Friends has operated successfully for 60 years, raising millions of pounds for the benefit of local people. A picture is being painted of needing a step-in power, but the whole process that must be gone through to achieve it, which my hon. Friend has just outlined, probably makes the amendment meaningless. Why do these charities need such a provision when other successful charities that are linked to hospitals do not?
Kit Malthouse
My hon. Friend is a dog with a bone. As I have explained—I think five times—I believe that the charities that we are considering are different because of the inextricable link with the institution that they serve. In the public’s mind, they are just a vehicle to give the money to the hospital and the national health service. Indeed, many boast about the percentage of money given to them that will be spent on the wards of a hospital. Those charities are seen co-funding, along with the Government, the NHS. I can see that not everybody is convinced, but I hope that others will speak in support of my amendments.
As I have said, the provision would be in the House’s control through a statutory instrument. It is not as though the Secretary of State could act unilaterally. We would all have control.
Jeremy Quin
I apologise to my hon. Friend: I rise not to support his amendment, but to oppose it, particularly on the point that he is making. His time is valuable. Does he really think that it is a good use of it for orders on this subject to be laid before this House and the other place, and for the matter to be considered on that grand scale? If he must vest these powers with the Secretary of State, does their exercise need to come back to this Chamber?
Kit Malthouse
I have the utmost respect for my hon. Friend, but that was a slightly odd intervention, given that much of the Bill is about one hospital and it is taking up many hours of debate in the House. I do believe that those kinds of things are serious, and, frankly, he and I have sat on Statutory Instrument Committees on much more trivial matters that take up the House’s time.
Wendy Morton
I take exception to the point about the Bill taking up the House’s time. It covers not only Great Ormond Street hospital, which is only one clause in it, but the group of special NHS charities. There are about 16 in total; there were 20. In the bigger scheme of things, there are around 260 NHS charities throughout the country, which all do fantastic work, and the Bill really deserves the debate, and the discussion about some interesting amendments. Although I will speak later, I will not support my hon. Friend’s amendments.
Kit Malthouse
My hon. Friend makes a mistake. I did not object to the time; my hon. Friend the Member for Horsham (Jeremy Quin) objected to time possibly being used on these matters. I am perfectly happy. I think that the Bill is very good and I support its broad thrust.
Mrs Sheryll Murray
Will my hon. Friend confirm that, when he said that the Bill relates to a single NHS charity, he was referring to one clause? It would help if he clarified that because I got the impression that he said that the Bill related to one specific NHS charity.
Kit Malthouse
My hon. Friend is right. I correct myself. One clause relates to Great Ormond Street and the rest of the Bill clears up some anomalies. The debate is not about Great Ormond Street’s requirements, but about other ancillary bits in the Bill. One wonders whether the rest of the Bill could have been included in the Charities (Protection and Social Investment) Bill, and we could have had a short measure about Great Ormond Street, but that is a matter for the Bill’s promoter and sponsors.
Kit Malthouse
No, I would like to move on to amendment 2. I am conscious that others wish to speak.
Amendment 2 would address a particular issue that I have come across in my constituency work. The only national charity that is located in North West Hampshire is the Macular Society. It is quite small and raises about £5 million or £6 million a year, most of which goes into research. One of the complaints of the Macular Society, which obviously deals with sight-related illnesses, is that enormous charities for sight and blindness, such as RNIB and Guide Dogs for the Blind, which raise many tens of millions of pounds—more than £100 million each—put hardly any money into research. Although they are engaged in blindness in its wider sense, they do not use their muscle to improve the lives of those who are afflicted by blindness or partial sightedness through trying to find cures and therapies.
The Macular Society and others complain about that and the fact that, if there was more research, we might be able to do something about the conditions. Part of the reason for the lack of research must be the disconnection with the organisation with which the charities should engage. For example, although I have not looked, it would doubtless be helpful to Guide Dogs for the Blind if it had representatives on its board from the scientific community and some hospitals, such as the Western eye hospital, because then the charity might be compelled to put money into the right causes.
The amendment seeks to ensure that, when an NHS charity is attached to a particular hospital, that hospital is allowed to put at least one trustee on the board. The charities need to stay connected. They need to have a line of communication and to be able to see the right priorities in the organisation rather than decide on their own pet projects, which they foist on the hospital without negotiation. The disconnection between charity and purpose can often happen, and it seems to be particularly pertinent to blindness.
Wendy Morton
On the point about making these appointments, it would be helpful if my hon. Friend clarified to exactly which bodies the Secretary of State would have powers to appoint under the amendment.
Kit Malthouse
I am sorry, but I am actually talking about amendment 3, not amendment 2. I am getting myself confused because, in usual British fashion, the amendment paper has the amendments in the wrong order. I will deal with my hon. Friend’s point when I get to amendment 2.
Amendment 3 would simply ensure that, if any hospital has a charity attached, it has the power to appoint one trustee. That seems sensible. Many of those charities will already have such a provision in their trust document. The amendment would just to make sure of that.
Amendment 2 states that in “exceptional circumstances” the Secretary of State should have the power to
“appoint one or more trustees”.
That returns me to my primary point about when charitable trusts go rogue or off the reservation, or where charitable trustees become locked in a group-think situation. Rather than dismiss them all and take control, the Secretary of State may feel that it is more appropriate to appoint one or two people from outside who can add a bit of ginger to the board’s discussions, and challenge what they are doing.
For example, a particularly powerful charity that is attached to an NHS hospital might feel that it is flush with cash and that it needs to intervene in a dispute with its doctors, or that it may have cause to campaign politically against some of the things that the Government are doing. It might want to lobby on the NHS settlement by region. When trustees or charities stray into that area—there has been a lot of consternation about that across the House with regard to particular charities—the Secretary of State may reserve power in those exceptional circumstances to appoint one or two trustees to challenge that view.
Nigel Huddleston (Mid Worcestershire) (Con)
My hon. Friend is making some valid points. Does he agree that instead of a laser focus on the number of trustees in charitable organisations, the motivation, character and skills of those trustees is the important element to investigate?
Kit Malthouse
My hon. Friend is right, and anyone who is putting together a board of trustees wants to ensure that it contains a full range of skills and experience. As I have said, trustees appoint themselves. No one externally is taking a wider view of how broad the ambit is of those people’s experience, how fruitful or consensual their discussions are, or whether they are being challenged. We all know of charities that are made up from small numbers of people. Often, those jobs are undervalued and take a lot of work. The people who act as charity trustees are often heroic, and there are too few of them. Many people will not take on such onerous duties, so there are often small numbers of trustees, particularly in some of the smaller charities such as friends of hospitals and so on. In such circumstances it behoves the Secretary of State to keep a weather eye, and when problems with a local charity are brought before MPs and we wish to raise them with the Secretary of State, we must be able to do so in the knowledge that he or she will be able to do something and appoint somebody to challenge or change things.
Jeremy Quin
My hon. Friend paints a very dangerous picture. He was referring to circumstances in which a charity strays into inappropriate political activity, but that is purely the remit of the Charity Commission. In such circumstances, the last person who should be intervening is the Secretary of State—we would be inviting them to wade into a political quagmire.
Kit Malthouse
That may be so, but—I hesitate to stress this point again—in my view these charities are different. They trade off the advantage of being associated with the national health service. People see them as part and parcel of the health service; they are not viewed as separate in the way that Oxfam or the Guide Dogs for the Blind might be. If something is called the Great Ormond Street hospital charity, people see it as a wing of the national health service.
Craig Whittaker (Calder Valley) (Con)
My hon. Friend raises a point about charities going off and lobbying. Does he feel that enough safeguards were included in the Transparency of Lobbying, Non-party Campaigning and Trade Union Administration Act 2014, which was designed specifically to prevent charities from taking non-transparent action?
Kit Malthouse
This is a difficult area. Some charities are composed in such a way that their entire purpose is a social mission. For War On Want or the Child Poverty Action Group, for example, decisions made by politicians are intrinsic to their objectives. Other charities, including some in the health sector, are more about providing funds and ancillary support to hospitals, and that kind of political campaigning is not intrinsic. I am not knowledgeable about the 2014 Act, but since my hon. Friend has raised it I will go and have a look. He may well be right to suggest that it contains enough protections, but I maintain my point that the special status of these charities, and the fact that they raise their money because of their association with the NHS, means that the Secretary of State must maintain some kind of toe-hold. To set those charities completely free is asking for political disaster at some point in the future.
The second part of amendment 2 would mean that if all trustee positions were vacant for three months, the Secretary of State could—and indeed should—appoint some new trustees to kick-start the organisation. That obviously will not happen often, but much of the business of this House involves planning for the unexpected. If a charity were for some awful reason to lose all its trustees at once—perhaps they are all off on a fact-finding mission together and there is a horrible accident; who knows what may happen, but let us pray to God that it does not—the Secretary of State will have the power to appoint people.
Seema Kennedy
I apologise to the House for being repetitive, but my hon. Friend has a vision of doom for the trustees and others. I once applied to be a trustee of Great Ormond Street hospital, and there were hundreds of applications. Those places are filled, and the amendment provides for a situation that does not seem to have any basis in fact.
Kit Malthouse
I apologise if that is a vision of doom, but much of our life in this House involves dealing with the stream of human misery that comes through our letterbox daily. We have urgent questions and statements on all manner of horrific events here and overseas, and much of our legislation is to plan for the unexpected, which seems sensible. Much of our legislation dates back many hundreds of years, and I hope that this Bill will last for a similar period. Who knows whether there will be trustee vacancies in the generations to come. I hope not, but if there are, it would be sensible for the Secretary of State to appoint someone. At the moment, there is nobody else to do it.
Jeremy Quin
In these hopefully extremely unusual circumstances, does my hon. Friend envisage that, once again, the process could drag through both Houses? If a charity tragically loses all its trustees, are we expected to go through the full rigmarole of full parliamentary scrutiny? That seems strange.
Kit Malthouse
I do not think that I have attached that requirement to this straight appointment. If there are no trustees, who objects to the Secretary of State making those appointments? Can anyone think of anybody better? I certainly cannot. Possibly the chief executive of the hospital, but given that they are probably appointed under the influence of the Health Secretary, why not allow the Health Secretary to do it?
Tom Tugendhat (Tonbridge and Malling) (Con)
My hon. Friend is generous in allowing interventions. Barely 150 years ago we abandoned press-ganging for the Royal Navy, yet we are now reintroducing it for the charitable sector. It strikes me as odd not to “encourage” the Secretary of State or chief executive to recruit more trustees, but rather to force them to do so. As my hon. Friend rightly said, trustees are volunteers who step forward and step up for the community. They do something that is above and beyond their social duty every day, and we should encourage them in that. He is right to place such an important weight on that, but I question the legislative requirement of making the Secretary of State able to make those appointments. He seems to be asking not for the Secretary of State to be able to ratify a volunteer, but rather for them to go out and call somebody in from the fields, factories and cities and tell them to take up that position. That is slightly losing the focus. If the Secretary of State is not required to do that, all we need is for people to have the opportunity to volunteer, in which case the chief executive or Secretary of State can merely advertise the post.
Kit Malthouse
That is exactly what I am proposing. If there are no trustees for three months, the Secretary of State will have the power to appoint someone. They could run an advert, or decide to press-gang somebody if they want—they can choose their own method. The point is that somebody has to do it.
An interesting technical point that Members who belong to Conservative associations may know is that if an association runs out of trustees its members can appoint a new trustee in a special general meeting. Great Ormond Street charity has no members. There is no group of people who can appoint a trustee, so if it all falls vacant the thing effectively dies. In my view, the amendment is very sensible and I am amazed it is causing such controversy. This very sensible amendment would allow the Secretary of State to appoint one or more trustees to get the thing going again.
Craig Whittaker
I need to challenge my hon. Friend on the assumption of “Who else better than the Secretary of State?” Of course, our current Secretary of State is a very highly esteemed colleague of great standing—I do not question that at all. What I question is the previous string of people who have appointed politically biased appointees to various quangos around the country. Surely he can see that a Secretary of State would have the potential to be not the best person to make the decision.
Kit Malthouse
My hon. Friend will make a great diplomat when the time comes. I agree there is the possibility of misbehaviour by politicians, but we politicians come with a great advantage. We have had a few thousand people vote for us and those few thousand people can vote us out if they think we have behaved badly. There are not many other people in public life who come with that brake on their behaviour.
Kevin Foster
I will make this my last intervention. My hon. Friend has been very generous. With the provisions in the Bill I was expecting today to go off on a trip to Neverland. Instead, with all the death, doom and disaster in this speech I feel we are in an episode of “EastEnders.” Does he not agree that there is a very large area of charity regulation to deal with things going wrong and difficulties emerging? Charities will still be subject to that. Merely allowing the Secretary of State to appoint the odd trustee will not deal with any systemic problems. That is what the wider area of regulation is there for.
Kit Malthouse
Many years ago, my mother and father went on a camping trip in Europe. On their first night, they pulled in, in their Thames van, to what they thought was a campsite. In the dark, my father attempted to pitch the tent. Every time he tried to hammer a tent peg into the ground it went “Ping!” and disappeared off into the darkness. Only in the morning did he realise he had been trying to hammer the tent pegs into a concrete tennis court. That is how I feel this morning.
I have tried to explain many times now that these charities are different. They come with a badge upon them that says to the public they are partially in the public sector. Secretaries of State will always have an eye to their conduct, because what they do will impact politically and financially on the national health service and on whichever party happens to be running it at the time. I realise that, in the eyes of the sponsors, I might be pushing water uphill. Most people know I am a relatively optimistic person and I am hesitant to put these pessimistic circumstances to the House; nevertheless, someone has to do it.
I will move on now, finally, to other amendments. Amendment 9, in the name of my hon. Friend the Member for North East Somerset, seems eminently sensible and reflects exactly the point I have been making about the special connection. In these days of the internet, it is quite easy to download the NHS logo from any hospital website, affix it to a piece of paper and fire it off to raise money. I am sure it has, on occasion, been used fraudulently to raise money. I therefore completely support his wish to have some kind of control over the use of the logo, the name and the brand.
Giving that power to the Secretary of State seems eminently sensible to me, not least because these charities maintain most of their fundraising ability through their connection with the NHS. The leverage is extremely powerful and very useful. Many will raise millions and millions of pounds off the back of their connection with the NHS and they should be encouraged to do so. The judicious use of the brand, the logo and the name is absolutely to be supported, but it needs to be done in a relatively nimble way. The only way I can think to do that is via the permission of the Secretary of State, so I support the amendment.
Unfortunate amendment 4 deals with consultation. As I said in my intervention earlier, during my career in local and city politics consultation became the bane of my life, and of my residents’ lives. We all knew, when we participated in a consultation, that the decision had broadly been taken already and that the politician or Department in question was largely going through the motions to make sure they were not judicially reviewed or challenged.
Of course, the notion of consultation was promulgated by the Blair Government. It is a characteristic of our managerial, technocratic politics. Where we have a House filled with conviction politicians who know what they believe, and that what they believe is right for the country, they do not need to go out and consult. They consult once every four or five years through general elections and display the philosophical sheet-anchor that sits underneath every decision they make. However, when politicians drift from their basic principles into unknown waters, they feel a bit uncertain. They feel a need to consult, to be told what to do and to get a feel. That is what politicians do these days: they have focus groups and polls. They consult constantly about their image and what they should and should not do.
I would therefore like to play a small part in doing our bit to rein back the amount of consultation. We could get to a situation where this House becomes redundant. With the advent of technology, the thing that naturally follows consultation is permanent referendums where everybody can vote from their desks, and we do not need to have a House that discusses and debates from points of experience and different aspects. I therefore firmly oppose the amendment.
Michael Tomlinson
Is my hon. Friend not being, once again, overly pessimistic this morning? Does he not recognise the benefits of public consultation, such as the very one that produced this Bill?
Kit Malthouse
No, I am not being pessimistic. I am, I hope, exhorting a message of confidence and optimism that we as politicians should have some sense of belief in what we do. We take our chances—sadly, only once every five years now, rather than once every random number of years—and have confidence. Like my hon. Friend, I want to be a champion for the power and the outlook of this House, so that we do not have to go out and consult constantly, that we are based in a philosophy of which we are sure, and that people understand why our decisions are made given what they have seen of that philosophy.
Mrs Sheryll Murray
My hon. Friend mentions his experience in previous roles of engaging in unnecessary and lengthy consultation procedures. How much of a financial burden does he feel they have been on the taxpayer?
Kit Malthouse
I cannot give my hon. Friend an exact figure, but it is enormous. Many, many hundreds of millions, if not billions, have been spent on consultation where, broadly, minds were made up beforehand. I well remember, back in 2002, the then Mayor of London, Ken Livingstone, consulting on bringing in the congestion charge. He, of course, had already made the decision. In fact, during the consultation the gantries to put the cameras in were already going up. Of course, the response from the public came back overwhelmingly against—nobody wanted it. We could all see the disaster it would be, not least because it was not a congestion charge but a tax on central London. He just shoved it in anyway.
I led the judicial review against the congestion charge in the High Court and sadly failed. The only chink in the armour we could find was the environmental audit, which was useful to me then but is a vehicle that Ministers and other politicians go through to tick the box. We find ourselves, as a country, in this enormous box-ticking exercise. So uncertain are we of what we should and should not do, and so wary are we of the vagaries of public opinion and fashion, that we feel the need to consult constantly.
The wider point is that it communicates to the public an uncertainty about political institutions and therefore undermines respect for them. When people talk about the politicians they respect, they always talk about—even though they did not agree with him—the great Labour Member, Tony Benn. Tony Benn always used to say, “Say what you mean and mean what you say.” I do not think Tony Benn ever consulted about anything in his entire life. He had his beliefs pretty much set at an early age and he delivered them. Everybody knew where he stood. Our former great leader, Margaret Thatcher, was exactly the same. A lack of consultation with her party colleagues might have done for her in the end, but consultation on the broad thrust of policy was anathema to her. She displayed and promoted what she believed. On that note, I commend my amendments to the House.
Several hon. Members rose—
Kit Malthouse
By no means was I trying to give the impression that charity workers and trustees across the UK are not doing brilliant work. Most of them are well-minded, and efficient in disposing of their duties as they should. As I am sure the Minister will agree, much of our legislation involves dealing with exceptions. Most people live their lives largely untouched by legislation in this House—although more and more they are touched by legislation from over the water in Europe—but we are dealing with exceptions. All I was trying to do was to deal with an exceptional circumstance where a negative situation may arise, and I have nothing but admiration and optimism for the vast majority of charities, charitable workers and trustees.
Jane Ellison
That is a helpful note of clarification. I sense we all felt that beneath the Private Frazer amendment lurked a Private Walker amendment instead. My hon. Friend is right to draw our attention to some very high-profile exceptions to the general rule. His exposition of the challenges that some high-profile charities face was compelling. It is helpful for us to have that on the record and to go forward with consensus on the merits of being a charity trustee.
Amendment 3 seeks to give the Secretary of State the power, in the regulations he may make, to make provision consequential on the removal of the Secretary of State’s powers to appoint trustees in clause 1(1) to make
“provision for one trustee to be appointed by the NHS institution, service or function for whose benefit the charitable trust exists.”
The guidance to NHS charities, produced jointly by the Department of Health and the Association of NHS Charities, suggests that the constitution of the new independent charity could provide for at least one trustee on the board being appointed by, or from, the NHS-linked body. It is a suggestion, rather than a binding obligation, that the new charities constitution should make this provision. The constitution of the new independent charity is a matter best decided by those nearest to the beneficiaries. In the case of an NHS charity with separate trustees, the board of the linked NHS body must support the terms of the conversion, including the terms of the new charity’s constitution, for the Secretary of State to agree to the revocation of their appointment. In the case of a charity with corporate trustee arrangements, it is self-evidently the board of the relevant NHS trust or NHS foundation trust that agrees the constitution of the new charity—again, offering that safeguard.
Ultimately, this is all about independence and local autonomy. The level and the nature of the agreement between the NHS body and the new charity needs to be a matter of local agreement. It is a matter for the local NHS and the charity to agree a constitution for the new independent charity that best meets the needs of beneficiaries.
Amendment 3 has similar technical difficulties to those I outlined in relation to amendments 2 and 4. It is unclear to which bodies amendment 3 relates, and what is meant by
“the NHS institution, service or function”.
A service or function referred to in the amendment cannot appoint a trustee. Again, I am afraid that such regulation-making power would not be workable.
Amendments 5 and 6 seek to remove the requirements that the regulations, which may make provision consequential on the removal of the Secretary of State’s powers in clause 1(1), would have to be subject to the affirmative resolution procedure if they amend legislation. Instead, the two amendments propose that the removal of the Secretary of State’s powers should be subject only to the negative resolution procedure. We believe that the affirmative resolution procedure is the appropriate form of oversight for these regulations. Parliament should have the opportunity actively to debate and vote on secondary legislation that amends primary legislation. Making such regulations subject only to the negative resolution procedure would not provide an appropriate level of parliamentary scrutiny.
There has rightly been much discussion this morning about the appropriate level of parliamentary scrutiny—and indeed the meaning of the word “appropriate”—but I think there was a strong feeling in the House that there are moments when parliamentary scrutiny is very important, particularly when it can be done with the level of detail we have seen this morning. I believe the current level of parliamentary scrutiny provided for in the Bill for this regulation is appropriate, and there are a huge number of precedents to support this approach.
I thank my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) for tabling amendments 7 and 8. The amendments seek to provide that the regulations that may be made by the Secretary of State under clause 2(1) to transfer trust property from appointed trustees for an NHS trust or NHS foundation trust back to the NHS trust or NHS foundation trust, should be subject to the affirmative resolution procedure. The amendments would also require that such transfers be accompanied by a statement by the Comptroller and Auditor General—again, a title that attracted a bit of debate in itself—that he is satisfied with the treatment of public assets and funds envisaged in the regulations.
Junior Doctors Contract
Kit Malthouse Excerpts(8 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Alistair Burt
The hon. Lady’s commitment to the health service is very clear from her background and everything else. I ask her to recognise that the 2008 contract is outdated and challenging. By 2012, we reached the stage where people had to negotiate around it because it was unsafe. After three and a half years, we have got to where we are. The idea that the process should start again is just unfeasible and very unfair on doctors working long hours who need to be relieved of that. She talks about the DDRB as a mediator. No, it is not a mediator, but it does provide the independent basis for the recommendations, which the BMA took part in, on which to negotiate. Anyone concerned with patient safety would say the time for direct negotiations to restart and take up the Secretary of State’s offer is now.
Kit Malthouse (North West Hampshire) (Con)
Will the Minister remind the House how many entirely avoidable deaths occur at the weekend every year, so that Members can reflect on where their primary concern should lie?
Alistair Burt
Medical studies have demonstrated that there are a number of extra deaths at weekends. The disputes about that are intense, but the medical profession recognises that the absence of facilities, the absence of consultant cover on the level it ought to be at, and the absence of diagnostic tests and other things, make entry into the health service at the weekend less secure than it would be at other times of the week. It is very important to change that. That is what the public voted for at the general election and that is what they expect the Secretary of State to deliver. That that should be held up by an industrial dispute, essentially by a union digging its feet in and not taking the opportunity to negotiate, is unfortunate and bad news for the patients my hon. Friend referred to.
Off-patent Drugs Bill
Kit Malthouse Excerpts(8 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Marcus Fysh
That is a good point and one I will come to in a moment.
One of my Yeovil constituents, Heather Moore, wrote to me this July, asking me to vote in favour of the Bill. She wishes it to become law not only because it would give patients wider access to the benefits of new treatment options, but because it would give financial advantage to the NHS by providing some very low-cost treatments. At this time of pressure on health services from demography and budget pressure, the improvements in cost-effectiveness that could stem from the Bill are essential.
A similar private Member’s Bill, sponsored by the previous Member for Cardiff North in the last Parliament, made it to Second Reading but was regrettably stopped short of becoming law. I believe that today’s Bill outlines an even more compelling case for approval, since it specifies the need for the Government to seek licences for off-patent drugs in new indications.
Kit Malthouse (North West Hampshire) (Con)
Like my hon. Friend, I am extremely supportive of the Bill—it is a very sensible measure—but there is a difference between what is being proposed and what is already available. I am patron of the Andover and Rural District branch of the Multiple Sclerosis Society. As I understand it, these cheaper generic drugs are already available for prescription off label. I think the Bill is trying to make the point that that is not being advertised enough to the clinical community and that the addition of a licence for particular treatments would promulgate their effectiveness much more widely. If I have missed the point of the Bill, please forgive me, but it seems to be as much about information as the ability to prescribe. The two are not mutually exclusive. We can provide more information to clinicians and provide licences at the same time.
Marcus Fysh
My hon. Friend makes a good point. The General Medical Council says that, traditionally, doctors have been reluctant to do that, partly because they may be wary of prescribing drugs for new uses owing to the increased level of personal liability that they may encounter.
Providing a way to overcome this reluctance, where efficacy has been demonstrated through licensing, deals with the argument made by the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), in the debate on the previous Bill that the current law best meets the individual clinical needs of patients. The flexibility clinicians currently have to prescribe medicines, which my hon. Friend described, is fine, and it is each doctor’s solemn prerogative, but it should not be used as a structural excuse not to pursue new treatments where they have been shown to be effective for non-clinical reasons. In practice, that can encourage a lack of consistency and assurance for the patient because of the lack of NICE approval in the form of a technology appraisal. NICE is, in fact, in a very good position to conduct studies that test efficacy on particular subsets of patients, with their consent.
A partnership in my constituency between Yeovil District Hospital NHS Foundation Trust, Somerset clinical commissioning group, South Somerset GP federation and Somerset County Council was selected this March by a rigorous NHS England process to be one of 29 partnerships spearheading new ways of working—a vanguard project in finding new models of care. This partnership, called Symphony, is looking in particular at the integration of health and social care, bringing together GPs, hospitals, community hospitals, mental health and social services, and is focused on joint commissioning based on outcomes for patients. The intention is for the lessons learned in implementing this new model to be taken on board in replicating the integration process across Somerset and beyond. We need to learn the lessons and move forward together—fast.
I believe that this vanguard, which is led by very committed and talented people in each partner organisation—I congratulate and encourage them today—could act as a leader not only in developing this new care model, but in working with NICE in its role under the Bill to conduct technology appraisals for new uses of off-patent drugs.
This has particular application to one of the most difficult issues of our time—the fact that our population is ageing rapidly. There are areas of Somerset, as elsewhere in the country, where a majority of people are of retirement age—and that is likely to increase dramatically over coming years. The management of conditions that are becoming more prevalent as our population ages must be taken forward with every tool available to us.
A report written by the governors at Yeovil district hospital in October last year shows that there has been an increase in the number of local patients with suspected cancer. Indeed, Somerset has one of the highest proportions of cancer prevalence in England. This may come as no surprise, as it is a very attractive place to live and work, and it has attracted many people moving from other parts of Britain, with many choosing to retire in the area.
I strongly support the new cancer drug fund that this Government have implemented, which has given more cutting edge treatment options to those with cancer, but we can go further by increasing access to new treatments through off-patent drugs, which can be much cheaper.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I was interested to hear the hon. Member for Torfaen (Nick Thomas-Symonds) mention the research into zoledronic acid. I took part in the AZURE study, which indeed means that this bisphosphonate, which strengthens bone, will help bone to avoid getting invaded in the first place. We already use it in breast cancer for patients who have bone metastasis, but it provides a perfect example of where a second use can be found.
The hon. Member for Newton Abbot (Anne Marie Morris) expressed concern about prices going back up, but that simply does not apply. These drugs have been through the whole process, so we know about their safety and their side-effects; they are now cheap and generic. They are made by lots of different companies, and the reason they do not get licences is that it is simply not worth while because the companies cannot put the price back up. If a formulation is changed—if it was a tablet and is now an injection, or if it was an injection and is now a tablet—it is possible to apply for a new patent. If it is exactly the same drug, even with a new use, the company cannot get a new patent. It is not willing to spend the money on sponsoring it.
I have heard people say, “It is in the guidelines”—and believe me, many of these drugs are in NICE guidelines. NICE guidelines say exactly what was said at the beginning of the debate, which is that tamoxifen should be made available to patients who are at high risk of breast cancer. However, it is not licensed for them.
I am a breast cancer surgeon, and in my practice we carry out an operation called sentinel node biopsy. Instead of taking all the lymph nodes out of a woman’s axilla and giving her lymphedema—which some Members will have seen, either in their families or in their constituents—we try to remove only one or two, and we use dyes to target them. One is a blue dye called patent blue dye. It is so old that it is not even made in this country any more, and it literally costs pennies, but it is unlicensed. One of its possible side-effects is anaphylactic shock. That is very rare, thank goodness, but there it is. According to all the UK guidelines, that is the approach that must be taken to breast cancer patients.
I used to have to sign a form before every case that I handled, stating that I accepted personal financial liability if the patient suffered. Eventually I said, “Wait a minute: I am not putting my house on a piece of paper for every case when I would be in trouble if I did not handle that case.” Thankfully, my health board was eventually willing to underwrite it.
The idea that guidelines give us protection is unfortunately not true. When guidelines were introduced, the medical profession was reassured that they did not handcuff a clinician, and if a patient was treated off-guidelines, because patients do not fit in cubbyholes, there would not be an issue. Similarly, following guidelines slavishly does not give any protection. Doctors carry legal responsibility for any drug that they prescribe. So the specialists will prescribe off-patent drugs, and we will be using them.
Kit Malthouse
I am slightly confused. Doctors are absolutely responsible for what they prescribe, but only if they do so negligently. The hon. Lady would not expose herself to litigation if she had, for instance, used the dye on a patient who then suffered from anaphylactic shock if that had been an appropriate and responsible thing to do given the patient’s condition at the time.
NHS (Charitable Trusts Etc.) Bill
Kit Malthouse Excerpts(8 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Wendy Morton
The charity continues to receive royalties. In fact, there are many productions of “Peter Pan” around the country in the run-up to Christmas, and the charity continues to receive royalties or agreed donations when such productions are performed. We must ensure that the charity continues to get those royalties, which makes the Bill even more important.
J.M. Barrie donated all rights in “Peter Pan” to Great Ormond Street hospital in 1929. He died in 1937, but the hospital enjoyed a further 50 years of royalties. On the eve of the copyright expiring, the J.M. Barrie bequest acquired its unique legal status, as a direct result of Lord Callaghan’s amendments to the Copyright, Designs and Patents Act 1988, which ensured that, despite the copyright in the work expiring on 31 December 1987, the special trustees for Great Ormond Street hospital would have the rights to royalties in respect of all commercial publications or public performances of “Peter Pan” and would hold them on trust for the purposes of Great Ormond Street hospital. The relevant provisions are found in section 301 of and schedule 6 to that Act.
The royalties are now held in perpetuity, so J.M. Barrie’s generous gift will continue to benefit very sick children and their families for as long as the hospital exists. My Bill seeks to support the continued legacy of this great children’s author from Kirriemuir in Scotland. I do not know whether any Member present in the House today has heritage or roots in Scotland, but there is certainly a link back to north of the border.
Kit Malthouse (North West Hampshire) (Con)
I am very supportive of the Bill. Does my hon. Friend think that the move by hospital charities to more independent status without Government appointment makes it more likely that other significant authors of children’s books will see value in such bequests? She will know that there is a Scottish author who has made hundreds of millions of pounds from children’s books and may be more likely to bequeath some of her royalties to charities. The measure might make influential authors such as Julia Donaldson—I understand that £1 in every £5 spent on children’s books in the UK is spent on a Julia Donaldson book—generous towards hospital charities in the way that J. M. Barrie was.
Wendy Morton
Let us hope so. Many artists and authors around the country have preferred charities to which they donate and give their royalties, but by highlighting the work of J. M. Barrie and Great Ormond Street Children’s Hospital Charity the measure may, fingers crossed, lead to more of them doing so.
Mr Rees-Mogg
I was confusing my authors of children’s literature. I got “Winnie-the-Pooh” right; I was just attributing it to the wrong man. I am grateful to my hon. Friend for that correction. So I do not have an interest to declare. I must de-declare my interest in relation to the topic on which I was talking.
Leaving such a legacy is a wonderfully generous thing to do, along with the flexibility in allowing the copyright law to be adapted so that one play can provide resources for a hospital, where the two come together. We all know the story very well. The childhood story of Peter Pan, ever-youthful—Madam Deputy Speaker, as I look at you, I see the ever-youthful Deputy Speaker—is a great one to combine with a children’s hospital, which is there to care for children at their weakest time, not just those from London, but those from across the country, as we have heard.
Kit Malthouse
My hon. Friend makes an interesting point. I wonder whether he supports legislation that would automatically extend the copyright of written works when donated for charitable purposes. I referred earlier to various authors, particularly children’s authors, who may now consider with greater likelihood leaving their copyright to hospitals and the like after their deaths. If they knew that the copyright would be automatically extended for the charity’s benefit, it might encourage even more of them to do so. Does he agree?
Antoinette Sandbach
I entirely agree with my hon. Friend. One important step being taken by Alder Hey is in ground-breaking research, and the charity allows it to get funding that will help in those aims.
The new facilities at Alder Hey are extraordinary, designed in part by former child patients. A group of children aged 10 to 22 who had stayed in the hospital contributed towards the design of the new Alder Hey in the Park. I invite Members from across the House to consider visiting the hospital to see the invaluable work that it does. As my hon. Friend the Member for Aldridge-Brownhills said, funding from NHS charities contributes to innovation and research.
Kit Malthouse
Perhaps I should declare an interest. I was born in Alder Hey hospital and had a myringotomy there when I was eight—a surgical procedure where the eardrum is taken out to drain excess fluid. Grommets are now used instead.
On independence, one thing that is critical to the success of charities is the tax relief that they attract, which is a serious incentive for donors. Does my hon. Friend agree that if a charity has its trustees appointed by the Secretary of State and is working closely with, in effect, an organ of the state, an NHS hospital, there might be some question about whether that charity should be entitled to tax relief, given that it is effectively part of the state, and that the move to greater independence is likely to make any challenge to that status recede?
Antoinette Sandbach
Indeed. My hon. Friend the Member for North East Somerset made a similar point. It is important that that independence is seen, is effective and is understood in the public domain. Sadly, there are some examples of NHS charities that are deeply influenced by their boards and are not seen to be independent in the way that my hon. Friends described.
Some £2 billion worth of assets are under the control of NHS charities and there is a combined annual income of about £30 million. These are significant sums which, as has been pointed out, are intended for the benefit of patients, and should not go into administration and the endless accounts and tick box exercises that are required if two parallel charities are run side by side. The Charities Commission has great expertise in the oversight of charities and in ensuring that charities’ income goes to the appropriate causes for which they were set up.
My hon. Friend the Member for Aldridge-Brownhills made an important point about the unlimited liability of charitable trustees, which is a very big personal risk. If anything goes wrong, such as some awful fraud, charitable trustees with unlimited liability have personal liability and could lose their homes and everything they own. As a result, some people are unwilling to become trustees of such charities. My hon. Friend’s Bill allows some protection, if trusts choose to have it, giving trustees limited liability. That is likely to broaden the range of people prepared to take on these roles.
It has been noted that this is trustees week, and a constituent of mine, Jeannie France-Hayhurst, is a trustee of the Alder Hey charity who provides a great deal of service. I know that she would encourage and would want others to encourage people from a wide range of backgrounds and a broad range of experience to get involved in their local charities.
In my constituency, Eddisbury, we have two good examples of local charities. One is the Tarporley War Memorial hospital, which was set up many years ago. It is independent of the NHS and is entirely funded by the community through charitable fundraising and charitable giving. That is exactly the type of activity that my hon. Friend the Member for North East Somerset was talking about, allowing communities to come together and work to deliver services in their area. The hospital specialises in the rehabilitation of the elderly, intermediate care and palliative care. It has 17 beds and is extremely well supported in my constituency. There is a wonderful double-decker bus that drives around with vintage clothing for sale. The bus parks in towns and villages in my constituency on a set day every week—in effect, a mobile shop to which members of the public can come. It is a wonderful sight and is entirely staffed by volunteers, like much of the other fundraising that goes on to support Tarporley War Memorial hospital. It is a great example of an independent charity that can support the delivery of NHS functions.
The hospital is used by local GPs to provide clinics closer to those who need their services. Staff from the local hospitals, such as the Leighton hospital and the Countess of Chester hospital, can travel to Tarporley War Memorial hospital and provide outreach services such as maternity services, dressings clinics and minor injuries treatment. It is a great example of how an independent charity can stand on its own two feet and provide great support and services to the local community.
The other charity in my constituency which exemplifies that is St Luke’s hospice, which is based in Winsford. It describes itself as a small hospice with a big heart, and I can vouch for that. It, too, is looking at ways of extending the palliative care that it provides and broadening the services that it delivers in the local community. It has fantastic outreach services which support those who are frail, those with failing health, those who are ageing, dying or grieving, and those who have dementia. It has broadened its remit from palliative care and is looking at how it can deliver services closer to constituents’ homes. I commend the hospice for its work. I know that my hon. Friend the Member for Weaver Vale (Graham Evans), who is not here today, has fundraised extensively to support St Luke’s hospice, as have many other neighbouring Members of Parliament who know the invaluable service that it delivers locally.
Mental Health (Armed Forces Veterans)
Kit Malthouse Excerpts(8 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Dr Cameron
I thank my hon. Friend for a very well-made point. I certainly urge the Minister to commit himself to research on that issue.
In the context of referral and assessment, it has been suggested that there are still problems caused by a lack of understanding and awareness among many mainstream health care professionals of how to deal with the issues that veterans present. There is a tendency to rely on prescribing medication, and, according to Combat Stress, there is a problem of low rates of referral to its service by GPs and community mental health teams. The British Medical Association has drawn attention to the chronic undermanning of Defence Medical Services, which is reported to have had a detrimental effect on morale, motivation, and the retention of doctors. The association says that adequate resources are a key factor in ensuring the best quality and consistency of mental health care in the long term. It believes that the issue should be addressed as a matter of urgency, given the need for appropriate and sustained long-term funding.
The Royal College of Psychiatrists has highlighted the need for better trauma-related treatment from the NHS. It reports that many veterans rely on small charitable providers that sometimes do not have the resources to be trained in evidence-based therapies, which should be consistent with the current evidence-based practice. The Royal College has also raised the need to evaluate the effectiveness of current follow-up service. The Murrison report recommended a telephone or face-to-face check on how someone was doing a year after they had left service. Currently, however, all that happens is that a letter is sent to the last known address of the service leaver, telling them that they can phone or see their GP if they have an issue. It is suggested that there may be a need for investigation into the uptake of this service and whether this correspondence is in fact being received.
The Government therefore need to address issues of help-seeking, stigma, referral processes, assessments and availability of appropriate treatments. There are also issues of co-morbidity and the requirement for integrated approaches across services including health, criminal justice, forces and social care. There is, in addition, a reported lack of service provision for partners and children of service personnel, who may also suffer mental health issues owing to the nature of their family member’s job. I am pleased that the Scottish Government have put in place a veterans commissioner for Scotland to begin to address some of these issues, but I would like to see similar credence given across the rest of the UK.
Kit Malthouse (North West Hampshire) (Con)
I congratulate the hon. Lady on securing this debate on such an important subject. I have Army headquarters in my constituency and strong services links in Hampshire. So desperate were a group of veterans in my constituency that they started their own organisation, Veterans in Action, who have just this month launched PTSD awareness month. I am wearing their little badge, which looks not dissimilar to an SNP badge, I have been told. The hon. Lady put her finger on the problem earlier in her speech when she said that there is not enough awareness out there about these issues, particularly among medical staff. I hope, therefore, that she might support an initiative such as awareness month in the future.
Dementia Care Services
Kit Malthouse Excerpts(8 years, 8 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Kit Malthouse (North West Hampshire) (Con)
As a Dementia-Friendly Hampshire ambassador—I am not quite a champion, but an ambassador—I welcome the debate and remind my hon. Friend of the Government’s commitment just before the election to creating a dementia research institute somewhere in the UK within the next five years. Does he agree that it would be helpful if the Minister updated us on the funding envelope for that, and the implementation plan for it over the next four and a half years, given that time is running out for its creation? I have to declare a slight interest, as the idea was fermented at City Hall. I may have had a hand in it, and therefore have a stronger motive to see it come to fruition.
Edward Argar
I am grateful to my hon. Friend, and I am beginning to think that I must be careful about what I think, because yet again a Member has touched on a paragraph I was about to begin. He is absolutely right. The Government’s dementia research funding now stands at £66 million. That is double what it was in 2010, but we need to be clear that we must not stop there. I was pleased that earlier this year the Government reaffirmed their commitment to doubling the dementia research spend by 2025. That is vital, and I know that Members on both sides of the House, in the spirit of constructive support, will help to hold the Government to that. Will the Minister commit to collating information on that spend centrally, and to publishing it annually, so that we can track progress? Coming to my hon. Friend’s point, I would be grateful if the Minister updated the House on the plans for a dementia research institute to drive forward research in a truly world-leading way. I pay tribute to my hon. Friend for the work he did in City Hall, and as a Deputy Mayor, in pushing that agenda forward.
Finally and most importantly—I declare an interest as a member of the Alzheimer’s Society—I pay tribute to such organisations as the Alzheimer’s Society, Alzheimer’s Research UK, Age UK and myriad others for the work they and their members do to ensure that we in this House and society never forget this cause, and that we continue to support the tens of thousands of people with dementia—and the voluntary carers, who are the real heroes and heroines. We have a duty to recognise what they do, and to do everything we can as a country to support them. I look forward to the Minister’s comments on what we can do to support carers.
I will close by quoting from a moving and powerful article by Alice Thomson about her father’s dementia. It was published in The Times this summer. She said:
“Old age shouldn’t be seen as a humiliation but more as the other bookend to your childhood; a time when you can rely on the help and patience of others to reach the end but can also still be a central part of family and community life”.
I echo those words and ask the Minister, the Government, all of us and society as a whole to continue to rise to the challenge and to make that a reality for all those who have dementia in this country.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I commend the hon. Member for Charnwood (Edward Argar) for securing this debate on what is probably one of the biggest challenges we will face over the coming decades. There is no easy answer, north or south of the border or on either side of the House. I think we all fear it. Previous generations have feared other illnesses and avoided them. They talked about consumption instead of TB, or about “the big C” instead of cancer. Most of our generation are less afraid of cancer than of Alzheimer’s. We are afraid of disappearing, or of being married to someone who simply is not who they used to be. That is a fear we all live with.
The Scottish National party welcomed the then Government’s introduction of a national dementia strategy in 2009. The Scottish strategy came in 2010. We set out clinical standards the following year and updated our strategy in 2013. We reached the 64% diagnosis target in 2013, when England was diagnosing 48% of those with dementia. I commend the fact that that has now risen to 59%, although there is obviously more work to do. Northern Ireland was diagnosing 63% of sufferers. What happens to someone when they are diagnosed? Think of the fear that we all have, and then imagine the bombshell that diagnosis is.
There is no easy answer, but we have done a few things in Scotland that we feel have worked. All our health boards now have a linked member of staff, like the cancer nurse specialists we have for breast cancer, which was my specialty. Since 2012, we have had the older persons’ acute care plan, which looks at secondary care and modern hospitals. I welcome the talk about dementia-friendly towns and villages—I will go home and throw down that challenge to my area, because that is not something I have come across.
In the past 18 months, our hospital has been completely redesigned, with colour zones and images of what everything is, instead of just words. Toilets, beds, kitchens—how to find one’s way around is all visual. We also have champions in every single ward. All that has really changed things. We have reduced length of stay from 22 days to eight days; we have reduced falls by half, and we have reduced returns to A&E from 26% to 8%. These relatively cheap, simple changes actually save a lot of money.
We obviously need more research and development, because at the end of the day families want a treatment to make early diagnosis worth while. Otherwise, what is the point? We have to be able to intervene. We can slow things down, but we want a drug that will stop dementia and reverse it. At some point further down the line, we will face the challenge of drug companies coming to us with an expensive drug that will do that. It will be important for the National Institute for Health and Care Excellence and other agencies to weigh up the sheer scale of dementia that we face and the money that could be saved by using even quite an expensive drug.
Kit Malthouse
One of the interesting developments over the past couple of years, which was looked at by Dennis Gillings, the international dementia envoy appointed by the G8, has been the question of whether the financial equation around the development of a drug could be changed by negotiating an international exception for its patent life, extending it by, for instance, five or 10 years. That might propel investment into research to find a cure and also make it cheaper when it does emerge, because the time for commercially exploiting it would be extended. Would the hon. Lady support such a proposal?
Dr Whitford
I absolutely would. In my previous life as a breast cancer surgeon, when I was also doing breast cancer immunology research, I watched what became Herceptin go from its development on the bench-top into common use. That took 21 years. This is something we often do not recognise when we moan about big pharmaceutical companies: they are investing in something that may turn out to be a mirage. The more that we can look at supported or shared R and D, the cheaper the drug will be when it finally comes to market. I would commend something like that.
The current problem is that most patients face living with dementia, and we must think about how we help them and their families to do that. We should be challenging ourselves to make dementia-friendly our surroundings and all the agencies that sufferers may interact with, whether through visual aids, through other people recognising them or, as the hon. Member for Stockport (Ann Coffey) said, through technology. The eHealth programme in Scotland is working on that, including devices in patients’ homes that it can interact with and establish whether the person is okay. Much of the care that people receive is the 15 minutes that the hon. Lady mentioned. How can we improve that? How can we ensure that the faces are not different every day? Some patients and families report 100 carers in a year. We should look at how we organise the care and remember who the real carers are: the family.
It is predicted that one in three of us will be carers for someone with dementia. We have a vested interest in ensuring that we look after them. The carer’s allowance is currently £60 a week, which does not even match jobseeker’s allowance, for a job that could be 164 hours a week, so we need to think of how we support carers and the work that they do. In Scotland, things are slightly different as we have free personal care, so the family does not pay for the carer who comes into the home. If that person has to go into a care home or nursing home, they do not pay for the personal care. The system has been expanded and deepened and actually allows us to keep more people at home for longer.
One problem is that care jobs attract lower earners. How can we motivate people and attract high-quality candidates if they are being paid the lowest possible amount?
Health and Social Care
Kit Malthouse Excerpts(8 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Kit Malthouse (North West Hampshire) (Con)
I am grateful, Mr Deputy Speaker, for this opportunity to make my maiden speech, particularly during a debate of such high quality. I congratulate those Members who have made their maiden speeches today, and I am particularly pleased to follow my Hampshire colleague, my hon. Friend the Member for Eastleigh (Mims Davies), thanks to whom I made quite a lot of money at Ladbrokes.
The wonder of modern technology and the labours of our friends from Hansard mean that I have read, listened to and watched a number of speeches over the past few days, and I have been impressed by many. For instance, thoughtful speeches from my right hon. and learned Friend the Member for Beaconsfield (Mr Grieve) and my hon. Friend the Member for North East Somerset (Mr Rees-Mogg) on the opening night illustrated the high quality of thinking in the Chamber, and I am pleased to be able to participate.
I am relieved that you, Mr Deputy Speaker, are in the Chair for my speech, because it is a tradition in a maiden speech for a Member to panegyrise their constituency, but 20 years ago the jewel—the glowing green emerald—that is North West Hampshire slipped through the otherwise deft fingers of the Speaker when he was the very young candidate for the candidacy there and was the runner-up to my predecessor. He will know from that experience that there can be few slices of England as fair as North West Hampshire. It has the world’s most important chalk stream, the River Test, rising and gurgling through it; it has “Watership Down” at its very heart and 60 largely thatched villages and hamlets dotted among its verdant hills. It is no surprise, therefore, that much of the constituency is designated an area of outstanding natural beauty.
In the north of the constituency lies the industrious town of Tadley—hard up against the fence of the Atomic Weapons Establishment in the constituency of my hon. Friend the Member for Newbury (Richard Benyon)—with its famous treacle fair, held just this last Sunday. In the south there is the ancient market town of Andover, made modern in the 1960s by a deal with the Greater London Council to become a London overspill town, greatly increasing the population—and, I am afraid to say, the number of Arsenal supporters.
North West Hampshire is a hard-working place with very high employment levels underpinned by a thriving small business community, but it is not without its problems. I have pledged to put my shoulder to the wheel to try and help, starting with schools, where performance is not universally brilliant. A successful future for the town will be built on the foundation of great schools, so our work must begin there. I look forward to working with the Secretary of State for Education, my right hon. Friend the Member for Loughborough (Nicky Morgan), in her vital campaign to drive up standards and ambition.
Like much of Hampshire, my constituency has strong links with the armed forces. The Secretary of State for Communities and Local Government, my right hon. Friend the Member for Tunbridge Wells (Greg Clark), whom I congratulate on his appointment to the Cabinet —we were councillors together at Westminster city council—may boast that his constituency is the ancient home of the lieutenant colonel, but I believe that I might have a stronger claim. With army headquarters sited just outside Andover and the plethora of bases and garrison towns in the area, many serving and retired services personnel have settled there, giving a military flavour to much of life in the constituency. I thank them for their service to our country.
The House has not heard a maiden speech from a Member for North West Hampshire for more than 50 years. The last one, in 1964, was given by the late Sir David Mitchell, father of my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), who sadly died last year after a distinguished life of public service. He was succeeded in 1997 by my predecessor, Sir George Young, the “Bicycling Baronet”, who was an MP already but whose Ealing Acton constituency had been abolished. Like me, Sir George had been a local councillor in London, with a young John Major, and then a member of the GLC, before entering Parliament and embarking on a glittering 42-year-long career on these Benches. I am told that he is the only Member to be hired, fired and rehired by three Prime Ministers.
Sir George’s time here was garlanded with many laurels, but it was at the constituency level that his true character shone through. His work over the past two decades has impacted on thousands of constituents. At every door I knocked on during the campaign, his industry and care were remarked upon. He has set the bar very high indeed. It has sometimes felt as if North West Hampshire had the Queen Mother as its MP, such was the regard in which he was held. He did not do it alone, of course. His wife, Lady Aurelia Young, whose father, Oscar Nemon, sculpted the magnificent statue of Churchill that stands in Members’ Lobby, has been very much a part of the team. The constituency and the country owe them a great deal.
I have tried to absorb as much of this debate as possible over the last few days, and there have been many notable and interesting speeches, but one in particular has stuck in my mind. It was given by the hon. Member for Bassetlaw (John Mann) on the opening night. In it, he said that the scandal of historical child abuse will be one of the defining issues of the next five years. He said that it would haunt the Parliament, and I agree with him.
During my many years in local and regional government in London, I have become increasingly alarmed at the social and cultural architecture in which our children live. I have tried to do my bit for them—for children in the care system, in prison or in gangs, and for children trafficked, mutilated, beaten, abused and too often killed. There are many politicians who have made a greater impact than me—not least the Minister for Children and Families, my hon. Friend the Member for Crewe and Nantwich (Edward Timpson) and the Lord Chancellor and Secretary of State for Justice, my right hon. Friend the Member for Surrey Heath (Michael Gove), whose experience and work in this area over the last five years has been exemplary. I welcome the measures in the education and adoption Bill signalled in the Gracious Speech this week.
But we have done our work in the face of profound and rapid social change in the way our children live. Their exposure and the exposure of those who have care of them to sex, violence and commercialisation is changing the way children interact with each other and with adults. The Prime Minister, I sense, feels the same, and has expressed alarm on a number of occasions. His very welcome troubled families programme, now expanded to include over 500,000 families, gives a sense of the scale of the issue. I see from the Order Paper that tonight’s Adjournment debate, called by the hon. Member for Nottingham North (Mr Allen), gives expression to a similar alarm in calling for the establishment of an institute for the study of the sexual abuse of children.
There has been much talk of this Parliament being consumed by questions of foxhunting, Europe, human rights and the Union. Even in the context of those important debates, I am with the hon. Member for Bassetlaw in believing that the horrific stories of child abuse from the past will dominate our public discourse. This House must respond by putting the future of our children, and in particular the care of our most disadvantaged and defenceless children, in front and at the centre of our considerations.
The good people of North West Hampshire have sent me here as their champion, and I intend to strain every sinew in their interests for as long as they will have me. During the time I am allowed in this House, I hope to be a champion for children, too. It was Nelson Mandela who said:
“There can be no keener revelation of a society’s soul than the way in which it treats its children.”
I am sure you will agree with me, Mr Deputy Speaker, that he was right.