Mental Capacity (Amendment) Bill [Lords]

Lindsay Hoyle Excerpts

Ping Pong: House of Commons
Tuesday 2nd April 2019 Commons Chamber

Consideration of Lords message

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I should inform the House that neither Lords amendment in the message engages financial privilege. I remind the House that the motions relating to the Lords amendments in the message will be certified as relating exclusively to England and Wales. If the House divides on either of these motions, a double majority will be required for the motion to be passed.

New Clause

Deprivation of liberty: code of practice

[The Minister for Care (Caroline Dinenage)]

I beg to move,

That this House does not insist on its amendment 1 to which the Lords has disagreed, and disagrees with Lords amendment 1B proposed in lieu, but proposes amendment (a) to the Bill in lieu of the Lords amendment.

[Mr Deputy Speaker]

With this it will be convenient to consider the following:

That this House disagrees with Lords amendment 25A proposed to its amendment 25, but proposes amendments (a) and (b) to its amendment 25 in lieu of the Lords amendment.

[Caroline Dinenage]

We now have an opportunity to deliver reforms that will provide quicker and fuller access to protections for the 125,000 people who are not currently receiving them. That is 125,000 vulnerable people without the legal protection that they deserve, whose families do not have peace of mind, and whose care providers have no legal cover for supporting them. We now have an opportunity to rectify this situation.

In February, the other place considered the 56 amendments made to the Bill by the House of Commons, the vast majority of which were agreed with. However, the Lords tabled alternatives to two of the Commons amendments, and they are the focus of our discussions.

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[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I call Kevin Foster.

[Kevin Foster]

Thank you, Mr Deputy Speaker. It is a particular pleasure to called by you to speak in the Chamber. It is also a pleasure to speak in this debate to reflect briefly on a bit of the background as to why we need this Bill. Some 125,000 people are effectively subjected to this procedure but without the appropriate legal safeguards, so I welcome the fact that both Houses are now looking to support the Bill.

I welcome the Government amendments that have been tabled in lieu of the Lords amendments, and they take on their main thrust and spirit. As I touched on in my intervention on the Minister, it will be interesting to see the timescale for bringing in the code of practice. I accept that it needs to be done properly and be consulted on and that there must be appropriate case studies, but one of the reasons for supporting this Bill is to see that come forward relatively quickly so that there is certainty. Perhaps the Minister will put a letter in the Library that sets out the timescale.

I would not expect to hear a date picked out of the air and stated on the Floor of the House—that would be unreasonable and inappropriate—but it would be useful to get a sense of the timescale, because I assume that we are talking about months, not weeks or years. It would be inappropriate to include specific examples on the face of the Bill, but it is right that the amendments look towards the creation of a clear code of practice and review, providing the opportunity for the House to consider any reviews and hold Ministers to account, because this legislation relates to our most basic right: the right to choose where we live and what we do with our time.

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[Jim Shannon]

I certainly do. The Minister has responded to the concerns of the hon. Gentleman, myself and others in a spirit of generosity, and perhaps this legislative change does that.

I welcome moves taken to make the definition of deprivation of liberty as strong as possible. What the Government have done is clear. It is vital that the definition links back to the European convention on human rights and provides a sturdy basis to protect vulnerable people. That is good news.

Members have referred to the 125,000 people who are currently deprived of their liberty without the necessary protections in place. Through this legislative change—which will not be opposed; a very helpful attitude has been adopted in the House of Lords and on both sides of this House—can the Minister indicate what will be done to reduce the backlog?

The Government have been lobbied and have consulted the Local Government Association, charitable bodies and other interested people and groups. As a result, we have a vital opportunity for long-awaited reform, and the Bill needs to be passed.

Mr Deputy Speaker, I gave you my commitment that this would be a short contribution, and I intend to keep to that. I want to finish with two quick questions to the Minister. Can she explain how the role of an appropriate person will support and protect vulnerable people in the proposed new system? Secondly, will she confirm that the needs of the supported person and their families will be put first?

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Just to help, the Minister would need leave to respond to those questions, so the hon. Gentleman is putting pressure on for something that is not available at the moment.

[Jim Shannon]

I would never put pressure on the Minister—not in a million years; I know my place. I suggest gently to her that those two things could be looked at.

Healthcare (International Arrangements) Bill (Changed to Healthcare (European Economic Area and Switzerland Arrangements) Bill)

Lindsay Hoyle Excerpts

Ping Pong: House of Commons
Tuesday 26th March 2019 Commons Chamber

[The Minister for Health (Stephen Hammond)]

I beg to move, That this House agrees with Lords amendment 1.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

With this it will be convenient to discuss Lords amendments 2, 8 to 10, 18 to 20, 3 to 7 and 11 to 17.

[Stephen Hammond]

It is a pleasure to be in the Chamber this afternoon. We now have the opportunity to turn our attention to an issue of great importance which, I know, commands the support of the House: the issue of reciprocal healthcare. As Members know, our ability to fund healthcare abroad brings invaluable benefits to people, and it is our responsibility to ensure that we continue to make them available to the public. I thank Members on both sides of the House for their work in considering the Bill so far, including those who have spoken to me about it outside the Chamber.

The amendments deal with the global scope of the Bill. It was intended to provide the Secretary of State with powers to fund healthcare outside the UK, to give effect to healthcare arrangements and healthcare agreements between the United Kingdom and other countries or international organisations—such as the European Union—and to make provision in relation to data processing, which is necessary to underpin these arrangements and agreements. Although it was introduced as a result of the UK’s exit from the EU, it was intended to be forward-facing and not to deal only with EU exit. It offered an opportunity to implement new comprehensive reciprocal healthcare agreements with countries outside the EU.

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[Mr Sheerman]

On a point of order, Mr Deputy Speaker. The Minister and I were in an SI Committee yesterday and you will know how pressurised they are. Four SIs were all blended together, so it was very difficult to separate them and do our job of scrutinising the legislation going through this place, which is our prime responsibility. What we could not get from the Minister was absolute clarity, speaking out to the public and saying that actually the likelihood of keeping EHIC after we leave the EU is on a wing and a prayer—there is no certainty at all.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

That is not a point of order, but the hon. Gentleman has certainly clarified what he believes needs to be put on the record.

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[Mr Sheerman]

On a point of order, Mr Deputy Speaker. I like the Minister—he is a nice man—but he is reading a brief that for most of my constituents and his is absolute gobbledegook—brackets, references here and sub-clauses there. Surely his job as a Minister is to tell this House in plain English what the dangers are to their future travel—their holidays and business in Europe?

[Mr Deputy Speaker]

Let’s calm it down a little. In fairness, I think the Minister needs to get to the end of his speech. We cannot have him being interrupted on points of order; it is not good form in this House to do so. What I would say is, “Who knows?” because I cannot predict what the Minister is going to say. He may well get to the points the hon. Gentleman feels are not being addressed.

[Andrew Griffiths (Burton) (Con)]

On a point of order, Mr Deputy Speaker. As a Back Bencher who is keen to see this debate develop and move on so we can get on to other equally important business, what advice can you give me to stop other hon. Members asking pointless points of order in this debate?

[Mr Deputy Speaker]

The hon. Gentleman not making another point of order might be helpful as well. Let’s just get on and move forward because it is in everybody’s best interests to hear what the Minister has to say.

[Stephen Hammond]

Much of what we discuss in this House is clearly of a technical nature, and sometimes its language is impenetrable to others who are watching. However, as the hon. Members for Burnley (Julie Cooper) and for Ellesmere Port and Neston (Justin Madders) will know, the House has had a chance to look at this in a fairly exhaustive way. They will know exactly what I am referring to, and I am sure that they will wish to refer to it in their speeches.

Using “for example” to introduce an illustrative list of things that can be done under a regulation-making power can be found in a number of other pieces of legislation. Section 11(2) of the Automated and Electric Vehicles Act 2018 states:

“Regulations under subsection (1) may, for example”.

Section 48G(2) of the Banking Act 2009 says:

“An order may, for example”.

Using “for example” is not unknown. However, we acknowledge the concerns raised about the breadth of the delegated powers in the Bill, and the Government have taken considerable steps to address those concerns via a number of Government amendments that were accepted in the other place, which I will come to shortly. In addition, we are choosing not to disagree to this amendment, to give further reassurance that the delegated powers in the Bill are no wider than necessary.

Services for People with Autism

Lindsay Hoyle Excerpts

Thursday 21st March 2019 Commons Chamber

[Wera Hobhouse]

I am pleased that the debate is taking place in the main Chamber. We had a very moving debate some months ago in Westminster Hall, but this is such an important issue that it needed to be raised here. Unfortunately I shall have to leave soon. The debate was meant to start about an hour ago, according to my diary. I am so sorry not to be able to stay, but I am so pleased that the hon. Gentleman is raising the issue now.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. I do not know who told the hon. Lady that the debate would start at that time. Someone must have misled her, because there was no set time for it to start.

[Wera Hobhouse]

In that case, Mr Deputy Speaker, I apologise.

My local authorities have some excellent care providers and support services, including Parent Carers Voice. Does the hon. Gentleman agree that services for children with autism should be financed through council budgets rather than the responsibility being pushed on to struggling families?

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[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. Many Members wish to speak, so there must now be a six-minute limit. I would also like to say that our thoughts are with Dame Cheryl, and she has been missed today but she has certainly been well represented.

NICE Appraisals: Rare Diseases Treatments

Lindsay Hoyle Excerpts

Thursday 21st March 2019 Commons Chamber

[Lyn Brown]

rose—

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. Whether the Minister wishes to give way is up to the Minister and we must let him finish his speech.

[Steve Brine]

Indeed, Mr Deputy Speaker; some people just cannot help themselves.

NICE operates two separate programmes for the assessment of new medicines. First, there is a technology appraisal programme through which NICE assesses the vast majority of new medicines. Secondly, as has been said, there is a highly specialised technologies, or HST, programme that is reserved for the evaluation of very high-cost drugs for the treatment of the very small number of patients in England treated in a handful of centres in the NHS. Decisions on whether a medicine should be routed to NICE’s mainstream technology appraisal, or the HST programme are taken through an established topic selection process that includes consideration against published criteria and engagement with a wide range of stakeholders. When NICE recommends a drug for use through either route, NHS organisations are legally required to provide funding so that it is made available to patients.

Today, we have heard concerns that NICE’s technology appraisal programme is not suited to the assessment of medicines for rare diseases, with some calls for individual drugs to be assessed through the HST programme instead. We have also heard calls for a third appraisal route for rare diseases not eligible for the HST programme. I have listened very carefully to all of them and will reflect on them all. There is some sense in a lot of what has been said. Indeed, over the last 20 years, NICE has made positive recommendations in 75% of its appraisals of orphan medicines. By comparison, NICE recommends around 80% of medicines for more common diseases.

I shall give the House two recent examples, because of course we only ever hear about the examples that are stuck or refused. NICE has been able to recommend orphan medicines for neuroblastoma, a cancer of the nerve cells that affects children—this has been widely welcomed—and for primary biliary cirrhosis, a progressive liver disease. Moreover, through its HST programme, NICE has to date been able to recommend a further eight medicines for NHS patients outside of the standard appraisal route. In each case, NICE’s recommendation is subject to a managed access agreement negotiated between the drug company and NHS England.

There will always be cases where NICE is unable to recommend a medicine because the price set by the company does not reflect the benefits that it brings. That is a fact. Hon. Members have of course spoken about the rare diseases of people in their constituencies—they are doing their job—but NICE is an independent body and it should be allowed to develop its guidance free from politicians. The hon. Member for Heywood and Middleton said that that was her initial instinct before she became a politician. That is the foundation of NICE’s reputation as a world leader in its field, and it is in the best interests of patients that it does that.

The hon. Member for Blaydon, in introducing the debate, raised concerns about Kuvan, the treatment for phenylketonuria. NICE has initiated an appraisal of Kuvan, and officials from NICE, NHS England and our Department have been reconsidering the appropriate assessment route in the light of the new available information that the hon. Lady mentioned. Riley is right: we have to make this fair. I am told that a final decision will be taken promptly—I urge that again from the Dispatch Box today—and with the minimum impact on the timescale for NICE’s assessment.

The hon. Members for Strangford, for Bristol East and for Dudley North have all spoken about the issue of Orkambi so many times and so well. It is incredibly frustrating and disappointing to Ministers, just as it is to them and everyone else, that Orkambi is not available to NHS patients in England at the moment. I understand and share that frustration. This is why my right hon. Friend the Secretary of State held a meeting with Vertex, NHS England and NICE a couple of weeks ago. I was at that meeting, at which the parties again discussed how best to reach a conclusion. I am pleased to say that they are meeting again today to continue the discussions and decide on the next steps. Decisions about the availability of drugs in Scotland are of course a devolved matter, and that is up to Scotland. I understand that no decision has been taken on routine funding for NHS patients in Scotland, but the hon. Member for Motherwell and Wishaw asked me to look again at the Scottish system. I will do that and I will ask the Minister responsible for this policy area to do so.

The hon. Member for North Tyneside and others raised the issue of the drug Spinraza for the treatment of spinal muscular atrophy. I understand that NICE’s independent appraisal committee met earlier this month to consider its recommendation on Spinraza following new evidence being put forward by the company. NICE wrote to the company and patient groups last week to say that it was not yet able to provide an update on the outcome of the meeting, but that it would provide an update soon. Again, I encourage that to happen even sooner. I recognise that the protracted process in this instance is hugely frustrating for patients and their families and, whatever our differences across the Dispatch Box, of course I feel the deep hurt that the hon. Ladies who spoke on the subject have laid out. I hope they will appreciate that a final decision has not yet been made and that NICE must be allowed to complete its work free from political interference.

I do not have time to go into a huge amount of detail. I have been asked lots of questions during the debate, but I have little more time than the people who have spoken today. I thank Members for speaking so passionately and I hope that they will welcome the forthcoming review of NICE’s methods and processes over the course of this year for both its technology appraisal and its highly specialised technologies programme, which is at least partly what today’s motion calls for. It would not be appropriate to pre-empt the review by commenting in detail on what it should look at, but I will ensure that it is directed towards the motion before us today and to the transcript of today’s deliberations. I now want to give time to the hon. Member for Blaydon, who introduced the debate, to close it in the time that we have left.

Mental Capacity (Amendment) Bill [Lords]

Lindsay Hoyle Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[Chris Bryant (Rhondda) (Lab)]

I beg to move amendment 1, page 5, line 10, at end insert—

“(3A) Before making any regulations under subsection (3)(b), the Secretary of State must lay before Parliament a report on—

(a) the likely effects of the provisions of this Act on persons undergoing rehabilitation for brain injuries, and

(b) the interaction between the provisions of this Act and the processes for prescribing for brain injury rehabilitation therapy.”

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

With this it will be convenient to discuss the following:

Government amendments 5 to 32.

Amendment 2, in schedule 1, page 15, line 24, at end insert—

“(d) the effects of any treatment undergone by the cared-for person, including prescription brain injury rehabilitation therapy.”

Government amendments 33 to 37.

Amendment 49, page 16, line, leave out from “out” to the end of line 16, and insert

“by the responsible body.”

This amendment would require the responsible body to carry out the consultation in all cases.

Government amendment 38.

Amendment 50, page 17, line 13, at end insert—

“(ca) the arrangements are being authorised under paragraph 16 of this Schedule, or”

This amendment would require an AMCP to review all cases where the responsible body is authorising arrangements based on a statement provided by a care home manager.

Government amendment 39.

Amendment 48, page 18, line 21, at end insert—

“Authorisation charges

24A No charges may be made in relation to the steps taken in determining whether the responsible body may authorise the arrangements for the cared-for person.”

Amendment 3, page 18, line 35, at end insert “or

(c) at the end of a period of prescription brain injury rehabilitation therapy undergone by the cared-for person.”

Amendment 4, page 20, line 4, after “met” insert

“taking into account any treatment to be undergone by the cared-for person, including prescription brain injury rehabilitation therapy.”

Government amendments 40 to 46.

Amendment 51, page 23, line 1, leave out paragraphs 39 and 40 and insert—

“39 (1) The responsible body must appoint an IMCA to represent and support the cared-for person if–

(a) one or more of sub-paragraphs (2), (3), (4) or (5) applies, and

(b) sub-paragraph (6) does not apply.

(2) The cared-for person makes a request to the responsible body for an IMCA to be appointed.

(3) The responsible body has not identified an ‘appropriate person’ to support and represent the cared-for person in matters connected with the authorisation.

(4) The responsible body has identified an ‘appropriate person’ to support and represent the cared for person in matters connected with the authorisation, and they have made a request to the responsible body for an IMCA to be appointed.

(5) The responsible body has reason to believe one or more of the following—

(a) that, without the help of an IMCA, the cared-for person and any appropriate person supporting and representing them would be unable to understand or exercise one or more of the relevant rights;

(b) that the cared-for person and any appropriate person supporting and representing them have each failed to exercise a relevant right when it would have been reasonable to exercise it;

(c) that the cared for person and any appropriate person supporting and representing them are each unlikely to exercise a relevant right when it would be reasonable to exercise it.

(6) The cared-for person objects to being represented and supported by an IMCA.

(7) A person is not to be regarded as an ‘appropriate person’ to represent and support the cared-for person in matters connected with this schedule unless—

(a) they consent to representing and supporting the cared-for person,

(b) they are not engaged in providing care or treatment for the cared-for person in a professional capacity,

(c) where the cared-for person is able to express a view about who they would like to represent and support them, the cared-for person agree to being represented and supported by that person,

(d) where the cared-for person is unable to express a view about who they would like to represent and support them, the responsible body has no reason to believe that the cared-for person would object to being represented and supported by that person,

(e) they are both willing and able to assist the cared-for person in understanding and exercising the relevant rights under this Schedule, including with the support of an IMCA if appropriate.

(8) The ‘relevant rights’ under this schedule include rights to request a review under Part III of this Schedule, and the right to make an application to the court to exercise its jurisdiction under section 21ZA of this Act.”

This amendment would broaden the provision of advocacy, ensuring that advocates are provided as a default unless the cared-for person does not want one.

Government amendment 47.

[Chris Bryant]

I will speak to amendment 1 and the three other amendments in my name and the names of several colleagues.

I want to start with enormous praise for the national health service, which in many cases makes the key decisions on everything that we will talk about today. Sometimes those are very difficult decisions, including for families, and they need to be managed with care and sensitivity. Ensuring that we have the right law in place to enable clinicians to make the right decisions is vital. I was on the Public Bill Committee for the Mental Health Act 2007 under the Labour Government, and I remember many of the rows and difficulties then. Ensuring that legislation fits the complicated circumstances of real life is not all that easy, and in particular, the definition of what might be proper treatment is not readily come by.

Often lobbyists get a really bad press. My experience of lobbyists in this field is entirely positive, including those working for the pharmaceutical industry, who do an amazing job in providing new drugs that can save people’s lives and manage their conditions much better, and the many charities in this field. When lobbyists are decried, I sometimes want to point out that they play an important part in ensuring that Members of Parliament know exactly what they are doing when it comes to legislation.

All the amendments that I have tabled relate to acquired brain injury. I am aware that several other colleagues who are members of the all-party parliamentary group on acquired brain injury are here today. I do not want to make an apology for that, but I want to explain why I have tabled these amendments. It is partly because I believe that acquired brain injury, though recognised and understood by some, is something of a hidden epidemic in Britain.

Something like 1.4 million people in this country are living with an acquired brain injury. A new person presents at accident and emergency with a brain injury every 90 seconds. Many of these injuries have lasting effects that are completely invisible to an ordinary member of the public. For instance, the person standing in front of us in a queue who is being difficult might look as if they are drunk or just being difficult, but they may have a brain injury. We would have no idea, and the person feels trapped and finds the situation as difficult as we do. The more we come to an understanding of acquired brain injury in this country, the better.

There are many different causes of brain injury, including road traffic accidents, accidents about the home and stroke. One cause that has been brought home to me recently is carbon monoxide poisoning. Not only the high level of carbon monoxide poisoning that follows an incident, but a sustained low level of carbon monoxide due to poor central heating systems or facilities or something like a Calor gas burner in a home, can end up causing a long-term brain injury. This particularly affects some of those who live in the worst housing in the land, and who are the poorest and least able to afford, for instance, to have their boiler mended or assessed every year.

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[Chris Bryant]

My hon. Friend makes a very good point. One of the things about rugby league and about rugby union, which I know rather better, being from south Wales—[Interruption.] I do not think it is parliamentary to tut-tut from the Chair, Mr Deputy Speaker, if you don’t mind my saying so. The truth is that many of the players today are bigger, stronger and faster, so the impacts may be much more significant than they were in the past. Curiously, when we watch some of the commentary on Twitter and Facebook about matches, we see a kind of rejoicing in the physical pain that people are going through, and I think we really need to roll that back. We need to roll that back so that we are actually caring about the players. Quite often the players themselves will be desperate to go back on. It should not be the player who makes that decision; it should be an independent doctor who makes it. [Interruption.] I think you want to intervene on me, Mr Deputy Speaker.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

The tut-tut was to say that the hon. Gentleman would benefit from knowing both types of rugby. The only thing I would add, just to help his case, is that in rugby league a player is taken off for a full assessment by a doctor and not allowed back on. That is the benefit on which rugby league is leading the sport.

[Chris Bryant]

I am glad I took that intervention. It is unusual to get an intervention from the Chair, but I think we welcome this new style of chairing.

[Mr Deputy Speaker]

It was a clarification.

[Chris Bryant]

I am tempted to make a point of order! No—you are absolutely right, Mr Deputy Speaker.

The key thing is to have the same protocols for all sports, so that there is the same protection. A child might play rugby league one year and rugby union the next; if there are different protocols, that will undermine the whole system. Incidentally, the point also applies to a whole range of other sports—hockey and ice hockey, as well as American football, in which there is growing interest in the United Kingdom. We should not let the issue be led by litigation, which is what has happened in the United States of America: we should let it be led by the medical science, which is rapidly changing.

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[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

A lot of people want to speak, but we have to finish at 6 o’clock, so we only have 90 minutes.

--- Later in debate ---

[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

The opening two speeches have taken 55 minutes, and we have to finish at 6 pm. I recognise that a lot of other people want to speak, and I certainly do not want to put pressure on the Opposition spokesperson, who also wants to make a speech. When other people come in, please remember that we want to get through everybody.

[Barbara Keeley]

We should not be in this position of having less than two hours on Report. This Bill has been rushed. We were in the same position on Second Reading, and it is absolutely unacceptable for such an important Bill to be rushed through as it has been today. I spoke to the Minister about this yesterday. She could have chosen to bring the Bill back on a different day, and I am sorry that she has not.

I am every bit as concerned about this Bill as I was on Second Reading. It remains deeply flawed. It weakens the current safeguards for people who lack capacity, and we have not even had a clear answer to the question that the hon. Member for Totnes (Dr Wollaston) just asked about the current backlog of DoLS applications. It is not clear how that will be cleared.

The Minister said at the start of Committee that she would work constructively with other parties on this Bill, but that has not been reflected in our experience. She has dismissed many of the serious concerns raised both by Opposition Members and by the many charities and representative groups outside the House with an interest in the Bill.

I said in Committee that our amendments were the bare minimum required to ensure that the Bill is fit for purpose. The Government rejected all our amendments in Committee, and, despite some movement on one or two issues since, the Bill retains the majority of the significant flaws it contained on Second Reading. It is sad that, having been through all the stages, this is where we are.

We have tabled further amendments to address some of the glaring holes that remain in the Bill, and I thank all the stakeholders who have helped us, including the Alzheimer’s Society, VoiceAbility, Mencap and Lucy Series. Without these amendments, we simply do not believe that the Bill is fit for purpose, and we oppose it progressing further.

Prostate Cancer

Lindsay Hoyle Excerpts

Wednesday 6th February 2019 Commons Chamber

[Simon Hoare]

rose—

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. May I just read out the deferred Division result?

[Simon Hoare]

We wait with bated breath.

[Mr Deputy Speaker]

Absolutely.

I have now to announce the result of today’s deferred Division. In respect of the question relating to long- term investment funds, the Ayes were 302 and the Noes were 262, so the Ayes have it.

[The Division list is published at the end of today’s debates.]

I must inform the House that there were errors in calculating the number of votes of Members for English and Welsh constituencies and for English constituencies in Divisions yesterday on the police grant and the local government finance report. On the police grant, the figures for the England and Wales-only vote should not have been announced as 289 for the Ayes and 242 for the Noes; they should have been announced as— Ayes 289 and Noes 244. On the local government finance report, the figures for the England-only vote should not have been announced as 270 for the Ayes and 208 for the Noes; they should have been announced as— Ayes 270 and Noes 206. The results are unaffected.

[Simon Hoare]

A restless nation will sit easier in their armchairs knowing that, and we are grateful to you, Mr Deputy Speaker, for your public service announcement.

To respond to the intervention from the right hon. Member for Alyn and Deeside (Mark Tami), I think he is absolutely right that we—not just Ministers, but health practitioners and all of us in our communities—need to stress again and again the widening range of treatments, the recovery rates and the extra lifespan one can have after early diagnosis and treatment. I suppose it is a perfectly legitimate historical response to have to such a diagnosis, but we need to end once and for all people saying, “Well, that’s it. I’ve had my chips.” To say, “You know, let’s see what we can do with the rest of it”, and in effect give up, is absolutely the worst thing that one could do.

May I raise the subject of diagnosis with the Minister? To pause there, I am not saying this to ingratiate myself with my hon. Friend, but the understanding and sensitivity that he brings to these issues and, indeed, to his wider portfolio commands respect across the House. I think we are very lucky to have him, and I am particularly pleased that my hon. Friend is the Minister replying to this debate.

Appropriate ME Treatment

Lindsay Hoyle Excerpts

Thursday 24th January 2019 Commons Chamber

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I call Carol Monaghan to move the motion. She has up to 15 minutes. Given that so many Members wish to speak, I shall be very grateful if they do all that they can to help each other.

--- Later in debate ---

[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. If each hon. Member can stick to four minutes, we will get everyone in, and everyone will get equal time.

Healthcare (International Arrangements) Bill

Lindsay Hoyle Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Monday 21st January 2019 Commons Chamber

Consideration of Bill, not amended in the Public Bill Committee.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I should inform the House that notification has been received that the Scottish Parliament has agreed to the legislative consent motion in respect of this Bill. Copies will be available in the Vote Office.

New Clause 1

Annual report on the cost of healthcare arrangements

‘(1) The Secretary of State must lay before Parliament an annual report setting out all expenditure and income arising from each healthcare arrangement made under this Act.

(2) The annual report laid under subsection (1) must include, but is not limited to—

(a) all payments made by the government of the United Kingdom in respect of healthcare arrangements for healthcare provided outside the United Kingdom to British citizens;

(b) all payments received by the government of the United Kingdom in reimbursement of healthcare provided by the United Kingdom to all non-British citizens;

(c) the number of British citizens treated under healthcare arrangements outside of the United Kingdom;

(d) the number of non-British citizens treated under healthcare arrangements within the United Kingdom;

(e) any and all outstanding payments owed to or by the government of the United Kingdom in respect of healthcare arrangements made before this Act receives Royal Assent; and

(f) any and all administrative costs faced by NHS Trusts in respect of healthcare arrangements.

(3) The information required under section 2(a) and 2(b) above must be listed by individual country in every annual report.”—(Justin Madders.)

Brought up, and read the First time.

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

I beg to move, That the clause be read a Second time.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

With this it will be convenient to discuss amendment 1, in clause 5, page 3, line 44, leave out subsections (5) and (6) and insert—

‘(5) Any statutory instrument which contains regulations issued under this Act may not be made unless a draft of the instrument has been laid before Parliament and approved by a resolution of each House.”

This amendment would make all regulations issued under this Act subject to the affirmative procedure and require approval from Parliament before they become law.

[Justin Madders]

We want to ensure that there are appropriate safeguards with regard to costs, not least because the Bill currently gives the Secretary of State authority not only to facilitate a continuation of existing arrangements, but to enter into any number of bilateral agreements with individual member states, with very little opportunity for parliamentary scrutiny. It also provides the authority to strengthen existing reciprocal healthcare agreements with countries outside the EU, or to implement new ones across the globe, in line with the Government’s aspiration to develop trading arrangements with countries beyond the EU. There is therefore a potential for the establishment of multiple complex agreements.

New clause 1 addresses the important point that the Bill before us is rightly intended to provide for all reciprocal healthcare arrangements in the future, and to provide for all eventualities. As we know, a no-deal Brexit could lead to a multitude of new bilateral agreements within the EU27, let alone the rest of the world. At this stage, none of us can be clear about how many of those agreements will come into being. We cannot assess their likely cost or impact, and, indeed, the Government’s own impact assessment is inadequate in that regard. It suggests that the cost will be similar to, or lower than, the current £630 million per year.

Mental Capacity (Amendment) Bill [Lords]

Lindsay Hoyle Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Paul Blomfield]

Does the Secretary of State accept that that access to an advocate should not be necessarily subject to a best interest test, as is being proposed, but should be a right?

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. Just to help everybody, let me say that we have 11 speakers, we still have to hear from the Opposition shadow Minister and we have the wind-ups. So I hope we can take that into account, although I recognise that the Minister is being very generous.

[Matt Hancock]

Thank you, Mr Deputy Speaker. These are very important points—

[Mr Deputy Speaker]

Order. Perhaps I will have to set it out differently. What I am trying to say is that we have 11 Members to speak and we could try to give them some time. Important as this and giving way all the time is, it is very important that we hear from other people.

[Matt Hancock]

Noted. Returning to the point made in the intervention, of course if there is an objection, there is a right in this case. So there is an escalation process in the event of an objection.

Before I end, I want briefly to deal with the Opposition’s reasoned amendment, because I hope we are able to show in this debate that all the points they raise have been considered. I hope the House will not mind my taking a moment to address each one briefly. First, they make the claim that somehow the Bill has been rushed through and insufficient pre-legislative scrutiny has been carried out. The Bill follows the Law Commission spending three years developing the new model, consulting extensively. The Joint Committee on Human Rights then conducted an inquiry and pre-legislative scrutiny. The Local Government Association, Age UK and Sir Simon Wessely have all backed the new legislation now. The LGA says:

“The Bill provides a vital opportunity for long-awaited reform”

and it needs to be passed. So we need to get this Bill on the statute book, because every extra delay risks depriving someone of their liberty and their right to freedom unnecessarily, and I do not want to see that happen.

Secondly, the amendment claims that the Bill

“enshrines a conflict of interest in relation to independent providers of health and care services”.

Again, that is not the case. Every authorisation must be reviewed by somebody who does not deliver day-to-day care and treatment for the person in question. We plan to go further by tabling Government amendments that will require authorisations in independent hospitals to be reviewed by an external approved mental capacity professional. Finally, the reasoned amendment claims that it is concerned about clearing the backlog in the current system. Well, so are we, and that is what this Bill does. Anyone concerned about the backlog and the current system should back the Bill with enthusiasm.

The claims that this Bill does not put the interests of the cared for person first or address the interface with the Mental Health Act have been addressed already. The very reason we need this legislation is so that we can put their interests first, because they cannot afford to wait for the recommendations of the Mental Health Act review to come into effect, in a Bill that will inevitably take time to develop, because of the need to do this on a consultative and broad basis. While welcoming the probing, I very much hope that the Opposition and every Member of this House will support this Bill, because it strikes a careful balance between liberty and protection. It offers vulnerable people a brighter and better future. We have listened to concerns and we continue to be open to ideas. We have sought to amend and improve the Bill as it has progressed through the other place, and we will make further amendments in this House. I therefore hope that this opportunity to change the system for the better is one that the House recognises. I also hope it will recognise that doing nothing is not an option. That is why I am proud to commend the Bill to the House.

--- Later in debate ---

[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I must now introduce a six-minute limit on speeches.

HIV and World AIDS Day

Lindsay Hoyle Excerpts

Thursday 29th November 2018 Commons Chamber

[Lloyd Russell-Moyle]

I thank my right hon. Friend for his intervention, and I totally agree with him. There are some countries in the world I may now struggle to travel to because of this announcement. It is important that we continue to make international efforts. I do not have time to talk about all the international aspects here. I commend the work of the HIV/AIDS Alliance and plan to come back to this House in future months to talk about its ENDAIDS 2030 Festival, which is really important.

Turning back to the UK, it is the case not just that HIV is treatable, but that it is preventable with one tablet a day. A person can prevent themselves from contracting HIV with pre-exposure prophylaxis. PrEP is revolutionising the fight against HIV transmissions. It has an almost 100% success rate, a higher rate than condoms, in the prevention of HIV, and it is just one pill. We expect this pill to be soon available as a generic drug and, according to the NHS’s own analysis, it could save the health service £1 billion in preventing HIV transmissions for future generations. Astoundingly, however, the only way to access PrEP in England is through a limited trial. This is not a medical trial—those have been done and approved. This is not about financing—we know the cost. This trial, as far as I can see, is about delaying the roll-out of PrEP in England because someone meddling in the Ministry thinks that they know better than doctors when it comes to people’s health. It seems to me that this trial is more concerned about what a person does between the sheets than the health of the nation. Despite being just one year into this three-year trial, 3,000 additional places have already had to be added, and it looks like the 13,000 places will run out early next year. England now lags behind all the other nations in the UK as the only country with capped PrEP access on the NHS. There are two years to go until this trial ends, yet people cannot get immediate access to PrEP, with many clinics now having long waiting lists, and some completely full.

We know that there are cases of young men who have sought out this prevention pill and have been turned away because the clinics cannot accommodate them, and they have subsequently become HIV-positive. Those men now have to live with HIV and everything associated with it because of the misguided morality of this decision. Let us make no mistake: these are not isolated cases. The longer this Government wait to roll out PrEP properly, the more people will be diagnosed.

Will the Minister intervene to ensure that PrEP is made routinely available on the NHS in England—just like his Government have already done with Northern Ireland with direct rule, just like the Scottish Government have done, and just like a Labour Government have done in Wales? Failing that, will he at least uncap the trial to ensure that those trying to access the drug can do so? Will he reverse public health cuts, including those in sexual health, so that the Government meet demand, including that of people affected by HIV, otherwise we seriously risk undoing the really good progress that we have all made?

Just today, the latest Public Health England statistics show that the UK has met its UN AIDS target of 90-90-90, ahead of 2020, which was the date. This is amazing progress, with 92% of people living with HIV diagnosed, 98% on treatment and 97% with undetectable viral load, meaning that they cannot pass it on.

At the Terrence Higgins Trust World AIDS Day reception earlier this week, I am told that the Minister hinted that the Government were considering bolstering their ambition on HIV to committing to reaching zero new HIV transmissions by 2030. In the light of today’s statistics, now is the time to seize that opportunity of reaching zero new HIV infections and be a true global leader. Can the Minister provide details of how the UK Government plan to end HIV infections and what timescale they will commit to?

At present, one young person every day is still diagnosed with HIV and young people continue to suffer some of the worst sexual health outcomes. We cannot be complicit on this. Will the Minister agree to work with the Department for Education to ensure that relationship and sex education guidance has a strong focus on not only HIV prevention, but anti-HIV stigma? Will the Minister also liaise with Department for International Development colleagues to ensure that research funding is increased so that we can make huge gains in scientific breakthroughs to eradicate this disease globally?

In two days’ time, on World AIDS Day, I will stand with my community to mourn the losses of those who have died of AIDS. I will do so at the Brighton AIDS memorial—the only such dedicated public memorial in the country. I will stand there in the knowledge that I will live a life that so many could not. I am able to do that because of the people who have come before me: the people who have fought and lost their lives, and the people who stood up and had their lives changed. We owe it to these people to beat the disease—something we have the power to do. I hope that future generations will look at HIV in the same way that we look at smallpox and polio, as diseases that were once killers but can now be eradicated.

LGBT people often talk about coming out as something that you constantly have to do to new neighbours, friends and work colleagues. You could say the same about your HIV status. I have spent many nervous moments deciding whether to tell new friends and acquaintances about my status. The lump forms in your throat and your heart flutters, and you finally kind of blurt it out and hopefully move on. Well, Mr Deputy Speaker, I would like to thank you for giving me this platform to do just that. I thank my friends, family and colleagues for supporting me. I also thank the Terrence Higgins Trust for all its work and the support it has given me in preparing for this debate.

We have the ability to end new HIV transmissions, as well as to end stigma and discrimination—not only here, but globally. I hope we can all make that our mission. [Applause.]

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

We should not clap in the House, but I understand why people have. That was a very brave and moving speech, which will give hope to a lot of people around the world. I should also say that I broke with convention today by allowing an Opposition Front-Bench Member to speak in the Adjournment debate. Please be reassured that this is not the norm; it is a one-off.