NHS Provision (Brighton and Hove)

Lindsay Hoyle Excerpts

Monday 24th October 2016 Commons Chamber

[Caroline Lucas]

That would be a very interesting issue to debate. The hon. Gentleman can get his own debate on Worthing hospital, but what I know about are the particular problems that are facing Brighton and Hove, and I will point again to the particular complex needs that come together when one has a city full of young people as well as very elderly people, a lot of people with mental health problems, homelessness problems, vulnerability problems and so on. If he will give me a little more time, I will set out for him what some of the problems are in Brighton and Hove and also, crucially, what some of the answers are.

I was talking about adult social care and about the fact that, unfortunately, the Government are cutting yet more money from local authority budgets that is supposed to cover those essential care services for vulnerable people.

The Government know that social care in places such as Brighton and Hove is on its knees, and that that has very direct knock-on effect on the NHS that no amount of financial smoke and mirrors can conceal. Brighton and Hove National Pensioners Convention has begun a valiant campaign to protect adult social care services from cuts, with unions such as the GMB fighting alongside it. I really hope that the Minister is listening, because this is a crisis that lets down everyone and there is no hiding from it. Where should responsibility for this catalogue of troubles lie?

What has happened to the city’s non-emergency patient transport service goes some way towards answering that question, and I wish to look at this in a bit more detail. It also demonstrates what can only be described as an utter dereliction of duty on the part of the Secretary of State for Health and I want to repeat my call for his Department to step in and for him personally to resolve an unacceptable and untenable situation.

I am referring to a service that takes people to essential non-emergency appointments—kidney patients going for dialysis, and cancer patients going to and from chemotherapy and radiotherapy. Since April, it has been run by a private company called Coperforma and a number of subcontractors. Coperforma faced intense criticism from the outset, with patients saying that they had experienced delays reaching appointments and subcontractors reporting that they had not been paid. Two of those subcontractors, Langfords and Docklands, went bust in September, leaving some ambulance drivers with up to six weeks’ worth of wages unpaid. In early October, drivers for another Coperforma subcontractor turned up for work only to be sent home again.

Last week, the Patient Transport Service was plunged into a fresh controversy after an investigation by our local paper, The Argus, revealed that one subcontractor may not even have been licensed to operate a fleet of 30 ambulances. I have the headline from the local paper, which Members can see very clearly. It says that ambulances are now in a total shambles—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Do you want to put that paper down on the Bench? Thank you.

[Caroline Lucas]

I am sure that The Argus will be sad to see itself relegated to the seat behind me.

The subcontractor is a company called Docklands Medical Services Ltd. This is apparently a phoenix company for the aforementioned Docklands. As I understand it, the new company seems to be suggesting that it was acceptable for it to operate under the Care Quality Commission licence that was issued to its predecessor, the bankrupt Docklands. The application process for a licence is carefully designed to ensure that standards for vehicles and other safety checks and safeguards have been met. Just allowing a new successor or phoenix company to inherit a licence is setting the bar dangerously low, exposing patients and staff to unacceptable risks.

As a result of this debacle, our struggling hospital trust—yes, the one in financial special measures—has incurred £171,000 of private ambulance costs so far this year to plug the gap left by Coperforma and its subcontractors. To recoup this cost, the trust has, quite rightly, invoiced the clinical commissioning group, which appointed Coperforma. No doubt other trusts similarly affected will have done the same, with serious consequences for the CCGs’ budgets and, therefore, for the money available for other services. Whichever part of the Department of Health ends up footing the Coperforma bill, it represents an unforgivable waste of money and resources, and their diversion away from patient treatment and care.

I trust that the Minister will agree that patients in Brighton, Pavilion or anywhere else should not be paying the price for the failure of private companies that are profiting from NHS contracts. Will he therefore ensure that the CCG is not out of pocket in turn as a result of Coperforma’s mismanagement? I would also like his Department to stop passing the buck when it was his Government who passed the legislation that required services such as non-emergency patient transport to be put out to tender. It is unacceptable for no one in the Department of Health to know whether a fleet of 30 ambulances were properly licensed to transport Sussex patients for three months over the summer. When the Minister responds, will he tell us whether he agrees?

--- Later in debate ---

[Tim Loughton]

This is the first time I have intervened on the Minister, and we do have about an hour left in which to carry on this debate.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I may be able to help the hon. Gentleman. That is only if the Minister wishes to speak for an hour, because nobody else will be allowed to do so.

[Tim Loughton]

Perhaps you will therefore indulge me on this intervention, Mr Deputy Speaker.

[Mr Deputy Speaker]

As ever.

[Tim Loughton]

I have no problem with the principle of outsourcing. The Minister is absolutely right that the level of outsourcing may go up and may go down, because it should be based on the quality of an alternative provider that is able to provide a quality service at an affordable price and is best placed to do so at the time. Will he acknowledge the whole issue with Coperforma? It has been a major issue for all of our constituents. Vulnerable people relying on regular treatment have just been left at home or dumped elsewhere, and have not been able to access services. This has been going on for so long that, when we put a contract to such organisations, much better due diligence needs to be done. There also needs to be a fall-back plan, because given that the ambulance service, which declined to take on the contract in the first place, is now clearly not in a position to take it on anyway, there is little option for somebody else to take on the service urgently and provide the level of care that our constituents desperately need and that has just not happened in this case.

Baby Loss

Lindsay Hoyle Excerpts

Thursday 13th October 2016 Commons Chamber

[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Just before I bring in the next speaker, may I suggest that, although I am not imposing a time limit, we should aim to speak for no more than 10 minutes? In that way, everybody will have a fair speech time, and things will be equal across the Chamber.

NHS Sustainability and Transformation Plans

Lindsay Hoyle Excerpts

Wednesday 14th September 2016 Commons Chamber

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I think we can spot that the hon. Lady has just given way to a Government Member and now she is giving way to an Opposition Member. We do not need the cheering to go with it.

[Steve McCabe]

I want to check this with my hon. Friend. The last time I checked, Simon Stevens had said that STPs were designed to make up the £22 billion shortfall that the Government are not prepared to put in. Is that not the case?

--- Later in debate ---

[Ms Abbott]

In some cases, even local GPs have not been fully involved in decision making. Hon. Members may not take that seriously, but I assure them that their constituents will. [Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. It is up to the hon. Lady whether she wishes to give way or not. Shouting and screaming will not help with the debate, because Members on both sides want to hear. I am sure that, when she wants to give way, she will do so, but screaming will not help, and it certainly does not help my ears.

[Ms Abbott]

GP leaders in Birmingham said that it would appear that plans by the STP to transform general practice, and to transform massive amounts of secondary care work into general practice, are already far advanced. Only at this late stage have they been shared with GP provider representatives.

--- Later in debate ---

[Richard Fuller (Bedford) (Con)]

On a point of order, Mr Deputy Speaker. Is it a requirement for a Member of this House to know the difference between a debate and a monologue?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

It is for me to make that decision. I am quite happy for the shadow Secretary of State to decide whether she wishes to give way or not. In fairness, this is an Opposition debate, and the hon. Lady is leading it. Let us not have any more pointless points of order. I am worried about how many Members want to speak; I want to try to get everybody in.

[Ms Abbott]

So when the STPs talk about efficiency, they actually mean cuts. Increasingly at the heart of these STPs are asset sales of land or buildings to cover deficits. No wonder the leader of Hammersmith and Fulham Council, Stephen Cowan, has said of his local STPs that

“this is about closing hospitals and getting capital receipts”.

He went on:

“It’s a cynical rehash of earlier plans. It’s about the breaking up and the selling off of the NHS.”

--- Later in debate ---

[Dr Wollaston]

Members on both sides of the House are aware of how valuable and important community hospitals are to our constituents. Taking that a step further, I would say that the best bed for any patient is their own bed, provided that they can be given the right package of care close to home. We know that there are many people even in community hospital beds who do not need to be there. They are there for want of the right social care package that could enable them to be at home.

In welcoming STPs, we should be realistic about the financial challenge that they also face and the costs sometimes of providing those services. That is a huge challenge for them. In my area alone the STP is facing a £572 million shortfall by 2021 if no action is taken. I can understand why, for example, it will look at the relative cost of providing care to people in acute hospitals, in community hospitals and at home, and make an argument that sounds very reasonable about how a larger number of people could be much better cared for at home.

I return to the point that the hon. Member for Central Ayrshire (Dr Whitford) made. Access to the transformation part of the sustainability and transformation plans is necessary to be able to put those services in place and very often to build the infrastructure that we need. For example, in Dartmouth in my area, the possibility of providing more care closer to home within a community hub will require the up-front funds to build a new centre that allows the workforce to be developed and more services to be provided closer to home. Unfortunately, what we often see is the closure of a much loved facility without the new service in place.

As the sustainability and transformation plans progress, I would like to see a genuine focus on the opportunities to provide more care closer to home. I fear that we will miss that opportunity because, as we have heard, £1.8 billion of the £2.1 billion sustainability and transformation fund is going towards the sustainability bit, for which read “plugging provider deficits”, and only £300 million is left nationally to put in place all these plans.

We know also that part of the way that the Government have managed to fulfil their promise to NHS England in respect of the funding that it asked for has been by taking funding out of capital budgets because those are essentially flat cash, and also by taking money out of Health Education England budgets and public health budgets. It concerns me that many of the principles behind the sustainability and transformation plans are put at risk by other parts of the system being squeezed. We have heard the point about prevention. Central to the achievements of the sustainability and transformation plans is the prevention piece—the public health piece. It is a great shame that public health budgets have been squeezed, limiting the ability of those aims to be achieved.

I know that many Members wish to speak so I shall move on and make some asks of the Minister, if I may. There is more that the Government can do. We on the Health Committee were very disappointed that none of the witnesses who came before us from NHS England, NHS Improvement or the Department of Health was able to set out the impact of cuts to social care on health planning. We need to do much better at quantifying the cost to the NHS of cuts to the social care budget.

The Minister needs to take the long view on prevention and help the service by implementing policies that could help local authorities to make changes. For example, I suggest making health a material consideration in planning and licensing, in order to provide the levers to make a difference. We need a much greater focus on workforce, because the STPs cannot achieve their aims if the workforce to achieve them is not in place. Finally, will the Minister kindly visit my area to look at the proposals in the sustainability and transformation plans in south Devon, and at the opportunities and how we would achieve them?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. The next speech, in the same way, will not have a time limit, but after that it will be five minutes. Some people will not get in. Please explain to them why those who took advantage of the time did so—it is totally unfair.

--- Later in debate ---

[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. There is now a five-minute limit.

--- Later in debate ---

[Norman Lamb]

I will give way very briefly to the hon. Gentleman—[Interruption.] I am being given a clear signal by Mr Deputy Speaker that I should not—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. You have only 30 seconds to go.

[Norman Lamb]

I take your point, Mr Deputy Speaker, and I am sorry for my ill discipline.

I will conclude by saying that this is the right approach but it will be undermined because of the rushed process which does not involve the public, because it does not take people with it on the journey and because there is not enough money to deliver the transformation that is required.

[Several hon. Members rose—]

[Mr Deputy Speaker]

Order. I am dropping the time limit to four minutes in order to get everybody in.

--- Later in debate ---

[Helen Whately (Faversham and Mid Kent) (Con)]

I welcome the new ministerial team to their places. I also welcome the shadow Secretary of State, the hon. Member for Hackney North and Stoke Newington (Ms Abbott), but may we have a more constructive debate about healthcare in future? She should not talk about cuts. She knows perfectly well that this Government will be putting an extra £10 billion a year into the NHS by 2020. That is not a cut. That is £10 billion extra of taxpayers’ money. Will she please not mislead people by talking about cuts? As she well knows, her party did not commit to spending anything like that on the NHS.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

I do not think that an hon. Member would try to mislead another. That is not a word that we would use.

[Helen Whately]

My apologies, Mr Deputy Speaker. I did not mean to use that word. The hon. Lady mentioned the £22 billion shortfall set out in the “Five Year Forward View” analysis, so will she clarify whether her party is now planning to make that up? If so, where will it find the money from? That was not entirely clear in her comments.

I will move on, because I sincerely believe we need a far more constructive debate about the real challenges the NHS faces and how to improve the care it provides to our constituents. The NHS is under pressure—no one here is denying that. I know it as well as anyone, as my grandmother spent five of the last six months of her life recently in hospital, and if the system had been better she would not have been there and would have had a much better end to her life. We know that people are living longer, with multiple conditions: about 70% of NHS spending goes on dealing with long-term conditions. The treatments available have increased vastly and are therefore more expensive than they were in the past, and patients expect far more of the NHS.

The NHS should not constantly be criticised, as is so often the case, as it is seriously rising to the challenge. It is performing thousands more operations, with thousands more patients being seen every day. In addition, in response to what happened at Mid Staffs and other such incidents, tens of thousands more doctors and nurses are working in the NHS. Skilled staff do not come about overnight; training takes years. A lot is therefore being done also to address the pressures on the NHS workforce. None of that should be overlooked, although it is also costly.

I ask us all to focus on talking about how the NHS rises to the challenges it faces, doing so in a financially sustainable way. We do not have a blank sheet of paper for this; the “Five Year Forward View” was published in 2014. As you may well know, Mr Deputy Speaker, I have previously asked questions about what was happening to drive forward that review at the pace and scale needed. The STPs are a vital part of the process, as across the country they are about putting the five year forward view into practice. They are doing that in an important way, looking at the place and the whole population, bringing together a diversity of organisations across the NHS and involving local authorities. We are talking about organisations that are rarely in the same room. In Kent, organisations have come together where previously people have literally not spoken together—chief executives have not previously been in the same room together. This is really important. The STPs are also putting public health at the core of the future plans for health and care across the region, and they are looking not just at treatment but at how the population can be healthier and how we can reduce health inequalities.

Finally, I urge all colleagues to do what I am trying to do, which is make sure that the STP in their area rises to the challenges and delivers the care that we all want for our patients in future.

Land Registry

Lindsay Hoyle Excerpts

Thursday 30th June 2016 Commons Chamber

[Lucy Allan (Telford) (Con)]

It is a pleasure to be called to speak in this really important debate. I thank the right hon. Member for Tottenham (Mr Lammy) for securing it, and all Members who have spoken in a very collaborative way—that is the way forward on issues such as this.

As is the case for many other Members who have spoken, the Land Registry has been an important employer in my constituency for many years. It is part of Telford’s fabric and success story. As Members may know, Telford is a new town, built in the 1960s on the coalfields of east Shropshire. Today, it is a thriving, dynamic, vibrant town at the cutting edge of new technology, with inward investment and innovation, but that has not always been the case.

Back in the 1980s, when the Land Registry came to Telford, it was an unemployment blackspot. The Land Registry gave Telford a much needed boost. Throughout its history, Telford has found ways of overcoming obstacles and meeting the challenges it has faced. The Land Registry has played a really important part in that, which is why my constituents have a genuine attachment to it and a genuine concern for its future.

I have met employees and their representatives to get a full understanding of those concerns. Although some people have sought to make this an ideological and political issue, my constituents, Land Registry employees and their families are rightly most concerned about retaining jobs in Telford and securing the Land Registry’s future. I share those concerns. As a constituency MP who is passionate about Telford’s future, securing those jobs for Telford matters to me most. The employees I have met are long-serving, highly experienced members of staff who have gained invaluable experience, expertise and knowledge of their roles over the years. They make an important contribution to that successful business.

Telford is a great place to live and work. Businesses move there all the time. It has a unique rural-urban identity, in the heart of rural Shropshire but with a vibrant urban twist. Close to the M54, with good links to Birmingham, it has clean air, green spaces and a quality of life second to none. Most of all, it has a community of hard-working people who want the best for their families and for Telford’s future. We live in a modern, changing world that will constantly evolve. Telford is used to change, and has always adapted to it, and that flexibility and resilience lie behind the success story that Telford is today. Like any successful business, the Land Registry will continue to evolve and modernise, as an efficient business.

I am grateful to the Secretary of State for Business, Innovation and Skills for taking the time to listen to me and hear my constituents’ concerns at a recent meeting. I will do everything I can in this place to ensure that Land Registry jobs stay in Telford. Although I have no ideological opposition whatever to any particular ownership structure, I could not support any sale that was not value for money for the taxpayer or risked jobs in my constituency. I recognise that no decision has yet been made. The consultation has only just ended and the responses are being considered. I do not want to get distracted by any ideological or party political arguments on this. I am sure that Members on both sides of the House agree that people and jobs are what matter, not politics.

As I have completely lost my place, I will ad lib. I once again thank the right hon. Member for Tottenham. I was slightly concerned by some parts of the motion, as over the past few weeks we have seen rather a lot of fear and scaremongering, which does not help my constituents, whichever side it comes from. I would really welcome a collaborative, cross-party approach on this, where we do not talk about dirty money, or tax havens, or the proceeds of crime—that does not benefit my constituents. I urge all Members to reflect on the fact that if we are to ensure that the Land Registry retains its current structure we must work together to urge the Government to consider all the issues that have been raised and take note of everything that colleagues have said.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I understand that the spokesperson for the Scottish National party has already spoken, so I now call Bill Esterson.

Defending Public Services

Lindsay Hoyle Excerpts

Monday 23rd May 2016 Commons Chamber

[Bob Blackman (Harrow East) (Con)]

It is a pleasure to follow the hon. Member for Washington and Sunderland West (Mrs Hodgson). I also place on the record my appreciation of the memorable maiden speech of the hon. Member for Sheffield, Brightside and Hillsborough (Gill Furniss). The connection between those two hon. Members is that I look forward to visiting their football teams next season and not having to suffer attending St James’ Park.

The Queen’s Speech contained some 21 Bills. I do not intend to refer to all of them in the time available to me, but I want to mention some and to express my views about some that appear to be missing. It is almost de rigueur to discuss the EU referendum in our speeches, and I look forward to the Government needing to bring forward legislation to disentangle us from the European Union once we, the British people, have set ourselves on to the path of freedom and democracy.

As for today’s debate, I particularly want to talk about the national health service and not only some of the key issues contained in the Queen’s Speech, but some things that do not require legislation. The Bill to ensure that people who do not pay taxes in this country have to pay their way when using the NHS should be welcomed across the House. We all recognise that the NHS requires additional funding and needs resources, but it is a national health service that the people who live, work and play in this country rely on for their health; it is not an international health service to treat the rest of the world. I hope that that Bill will receive support right across the House, including from the Opposition.

I congratulate the Health Secretary on achieving an end to the negotiations with junior doctors that paves the way for a proper seven-day NHS. I went looking around my constituency at the weekend on behalf of constituents who want a weekend GP service, but no GP surgeries were open at all. That is the reality. GPs widely advertise as being open Monday to Friday, but no GP service is available in my constituency on a Saturday or a Sunday. If someone is ill or needs medical treatment, there is no choice but to attend A&E, leading to increased pressure on the emergency services. Equally, it is important that the Health Secretary negotiates terms with GPs that ensure that a service is available for people needing routine medical procedures at the times of day and on the days of the week when people want the service to be provided and not just when it is convenient for GPs.

The NHS’s cumbersome investment decision-making process must also be disentangled. The Royal National Orthopaedic hospital, which I am proud to champion, has been making a case for its rebuilding for some 30 years. Six years ago, we received confirmation from the coalition Government that money was available to do exactly that. However, despite draft outline business case after draft outline business case and so on, we are still waiting, six years on, for the business case to be signed off. It is ridiculous in this day and age that our NHS is spending more money on management consultants to make decisions than on consultants to deliver medical treatment. I hope that our health team can resolve the problem without the need for legislation by ensuring that we cut through red tape and enable decisions to be made—a business-like approach to running the NHS without introducing any form of privatisation whatsoever.

I warmly welcome the proposed sugar tax, because it is a great means of driving behaviour. For most people, the sugar content of many drinks is masked, which is clearly unhealthy for people of all ages, young people in particular. The change is a sign of the way things are going. Something that seemed to pass without too much celebration last week was that we finally got clearance to introduce standardised packaging of tobacco products when the court case brought by the tobacco companies collapsed in the High Court. That is good news. I was also pleased by Axa’s decision to remove the £1.7 billion of its policyholders’ money that was invested in the tobacco industry. It quite rightly said that investing in tobacco products was destroying its customers’ health and it then had to pay out on insurance claims to support those customers. That shows the way things are going. I hope that the Chancellor will consider not only the sugar tax, but a levy on tobacco companies through increasing the cost of a packet of 20 and then ensuring that all the money raised goes directly to funding local health initiatives to stop people smoking and to prevent them from starting.

I also welcome the digital economy Bill. For the unaware, I had the honour of working for BT for 19 years before being elected to this House. Back then, I promoted the idea of BT having a universal service obligation to provide superfast broadband. In fact, broadband full stop would be a start, and speed could be increased thereafter. My constituency is on the edge of London, yet it has a series of housing estates, built more than 20 years ago, in which it is impossible to get broadband—that is outrageous. We have people who work in the City of London, in very responsible jobs, who would like to work from home but are unable to do so because BT fails to provide broadband of a reasonable speed. In this day and age, it is outrageous that they should be deprived of that fundamental service, on which we all rely. As we ask more and more people to work from home, so that they do not congest the roads and do not have to travel to an office to do their work, they should have the facilities to be able to work from home, if they so wish. I look forward to that becoming more and more a focus of attention for the Government.

I also welcome the neighbourhood planning Bill. As hon. Members on both sides of the House have said, we need to build more houses in this country for people to live in. I strongly supported the Bill that became the Housing and Planning Act 2016, which creates the environment in which houses can be built. The neighbourhood planning Bill clears up the issue and prevents the process whereby plans are clogged up and development is prevented from taking place. We should set out our plan, and I support the Government’s plan to generate more and more housing for younger people to be able to purchase and so get their foot on the ladder of property ownership.

One of the most fundamental local services is refuse collection. Although localism is welcome, it cannot be appropriate that, right across London, and probably across the country, people who move, probably every six months, because of private rental arrangements suddenly find that the refuse collection systems and the colours of the bins are totally different depending on the borough. They are therefore totally confused as to what should happen. As a fundamental service to people, we should seek to ensure that we have a sensible waste-collection service in this country; we should sort out who pays for it and how it is collected. At the moment, it is one area where local decisions can be made but clearly there are vast differences in the quality of services being provided.

I am also pleased that the education Bill will be coming forward, and I am glad that the Government have wisely dropped their decision to force schools to become academies. I welcome academies being created, but forcing schools to do that would be the wrong thing to do. Finally, I will just mention the counter-extremism and safeguarding Bill, in the short time I have left. I have—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Unfortunately, that short time ran out.

Contaminated Blood

Lindsay Hoyle Excerpts

Tuesday 12th April 2016 Commons Chamber

[Peter Heaton-Jones]

rose—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I believe that there was an informal time limit of seven minutes, and the hon. Gentleman has a minute to go. If we cannot get it down to six minutes, I will have to impose a formal time limit, which I do not want to do.

[Peter Heaton-Jones]

I understand, Mr Deputy Speaker; thank you.

My hon. Friend the Member for Taunton Deane (Rebecca Pow) makes the perfectly reasonable point that time is running out, and that these people find themselves in an impossible position. I do not seek to extend this process unnecessarily, but the 15 April deadline cannot and must not be the end of the story. It cannot be a deadline after which a decision is simply handed down. Let us give a proper, respectful hearing to those who believe that an injustice is about to be done, and let us try to put this right.

I also said that we needed understanding. These events have devastated the lives of many people, including my constituent, Sue Threakall. I shall end as I began, by quoting her words in an email. She says:

“At the moment I haven’t the slightest idea how I will be able to manage and am in complete despair. Over the last week it has occurred to me several times that after fighting this for over three decades…I really don’t want to carry on.”

I say to my constituent and to the other campaigners who are with us today: do carry on, and do keep telling us what we need to know. As my hon. Friend the Member for Norwich North (Chloe Smith), who has just left her place, said, it is by hearing the true life stories of those who have been affected that my hon. Friend the Minister, who I know is listening, will be able to take very careful note. Let us do all we can to deliver what my constituent and many thousands of others want and deserve: truth, fairness and justice.

End of Life Care

Lindsay Hoyle Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Pete Wishart (Perth and North Perthshire) (SNP)]

On a point of order, Mr Deputy Speaker. We have just concluded two days of debate on the Government’s estimates, but the estimated expenditure itself has not been debated. At 7 o’clock, we will be asked to authorise the Government’s spending plans for Departments of State—some £600 billion of public money—without there having been any debate whatsoever about them. How can that possibly be right, and what should Scottish Members of Parliament do now that we are effectively banned from voting on English-only legislation that may have a Barnett consequential? We were told that that would be considered in the estimates process, but we are not getting the chance—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Mr Wishart, you have made your point very well time and again, and I understand why you are frustrated. As you know, it has been agreed by the House and that is what the Standing Orders say. We all know that it is not the Chair who is responsible.

Access To Medical Treatments (Innovation) Bill

Lindsay Hoyle Excerpts

Friday 29th January 2016 Commons Chamber

[Nick Thomas-Symonds]

I am grateful to Members across the House for their contributions and to the Life Sciences Minister for his clear response to the six probing new clauses. I am pleased to hear that the Government will accept amendments 10 and 13. As I said in my opening speech, having off-label treatments in the Bill and the database will make a significant difference and help move things forward. I was also pleased with his reassurance to the hon. Member for Central Ayrshire (Dr Whitford) that we will continue to review the system, as, I hope, the number of off-label treatments and prescriptions increases.

In view of the Minister’s commitments and acceptance of amendments 10 and 13, I do not propose to press new clauses 1, 2 and 3. New clauses 4, 5 and 6 are in the names of the hon. Members for Bury St Edmunds (Jo Churchill) and for Central Ayrshire (Dr Whitford). I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

Clause 1

Access to innovative medical treatments

Amendment made: 10, page 1, line 3, after “treatments” insert

“(including treatments consisting in the off-label use of medicines or the use of unlicensed medicines)”—(Chris Heaton-Harris.).

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

We now come to amendment 1—

[Chris Heaton-Harris]

On a point of order, Mr Deputy Speaker. I am unsure of the process. What happened to amendment 13?

[Mr Deputy Speaker]

It comes later. It is about three pages further on in the dossier. It has not been lost, and we will be coming to it, so the hon. Gentleman can rest assured. It is there.

[Chris Heaton-Harris]

I beg to move amendment 1, page 1, leave out lines 7 to 9.

[Mr Deputy Speaker]

With this it will be convenient to discuss the following:

Amendment 11, page 1, line 18, in clause 2, leave out from beginning to “involves” in line 19 and insert

“In this section, “innovative medical treatment” means medical treatment for a condition that”.

Amendment 2, page 2, line 26, leave out clause 3

Amendment 3, page 3, line 19, leave out clause 4

Amendment 4, page 3, line 40, in clause 5, leave out “this Act” and insert “section 2”

Amendment 12, page 3, line 42, in clause 5, leave out paragraph (b)

Amendment 5, page 4, line 1, in clause 5, leave out “this Act” and insert “section 2”

Amendment 6, page 4, line 3, in clause 5, leave out “this Act” and insert “section 2”

Amendment 14, page 4, line 8, in clause 6, leave out “Sections 1 to 5” and insert “Sections 1, 2 and 5”

[Chris Heaton-Harris]

I just thought I would check about amendment 13, Mr Deputy Speaker. This whole experience has been a steep learning curve when it comes to procedure in the House. Perhaps we have invented a few things on the side as well, given how we have gone about our business here. I do not want to speak too soon, but if we could conduct all our health debates in the positive and constructive tone that has characterised these debates and the process behind the Bill, we might improve our heath service in leaps and bounds, rather than getting caught up in unnecessary politics. But that is where we are.

My amendments 1, 2 and 3 would remove, among other provisions, two clauses on clinical negligence. I want to talk about the reasons for their removal and the original idea behind the clauses. As right. hon. and hon. Members who have been following the progress of my Bill will know, many of the ideas in it came from Lord Saatchi’s Medical Innovation Bill in another place. Those ideas have not had the smoothest of journeys in this place. I have been regularly reminded by hon. Members—I thank those here today—and others outside this place that these clauses have not enjoyed the support of stakeholders.

Such concerns have been around since before the Bill was even drafted. Unfortunately, the echoes of those concerns haunted the first mention of the word “innovation” in the clause, and I decided from conversations I have had that those concerns could not be quelled in time. Throughout the process, I was clear that I wanted to listen to everybody with something to say on this matter. I have met and read the briefings of everyone who has contacted me wishing to share their views, and I hope it has been evident that I have been up front, honest and very clear about my intentions. I tried to solve the concerns of Members and the medical community who believed the clause would have negative and unintended consequences. That is why I tabled these amendments.

I hope that this process reflects favourably on Parliament and shows how a piece of possible legislation can evolve with a huge amount of stakeholder engagement and with parliamentary opinion taken on board. Since the beginning, I have focused on the sharing of good practice and transparency—and, indeed, on the failures of treatments through a database. Those ideas are reflected in clause 2 and have received much support.

I wanted to maintain the camaraderie built up around the Bill and have been unable to find the support I needed for the more controversial clauses, 3 and 4. Clause 3 sets out the steps that a doctor would need to take to show that he or she had acted responsibly using the Bill. They were intended to reflect the steps that a responsible doctor could be expected to take under common law when innovating. In relation to a proposed treatment, clause 3 would require the innovating doctor to

“obtain the views of…appropriately qualified doctors”

with

“appropriate expertise and experience in dealing with patients with the condition in question.”

Clause 4 expressly preserves the common-law Bolam test, the key precedent for judging whether a doctor has acted negligently.

The two clauses received strong opposition, which I will not go into too much. However, I worked closely with many officials from the Department of Health, and I want to thank them, because I had read the briefings that were so adamant in saying how dangerous parts of the Bill would be, so it was nice to have some of the best and brightest legal and parliamentary counsel remind me again and again that they viewed them as perfectly safe and did not see them as a danger to patients.

Access to Medical Treatments (Innovation) Bill

Lindsay Hoyle Excerpts

Friday 29th January 2016 Commons Chamber

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

With this it will be convenient to discuss the following: amendment 9,  page 2, line 20, at end insert—

“(6A) Regulations under subsection (1) may not be made unless the Secretary of State is satisfied that the regulations have the approval in principle of—

(a) the HSCIC,

(b) the General Medical Council,

(c) the British Medical Association,

(d) the Association of Medical Research Charities,

(e) the Royal Colleges,

(f) the Academy of Medical Sciences,

(g) the Medical Research Council,

(h) the National Institute for Health and Care Excellence,

(i) the Medicines and Health Products Regulatory Agency, and

(j) any other body or individual that the Secretary of State considers it appropriate.”

Amendment 15, in clause 5, page 4, line 1, leave out subsection (2) and insert—

“( ) References in section 2 to medical treatment include references to treatment carried out for the purposes of medical research (but nothing in section 2 is to be read as affecting the regulation of medical research).”

This amendment makes it clear that the database for which clause 2 provides may contain information about treatments carried out for the purposes of medical research (including, for example, in the context of a clinical trial).

[Heidi Alexander]

Setting aside the fact that I question whether what is left of the Bill is necessary, if the database is to be created, it is important that we get its design right. The Association of Medical Research Charities has expressed concern that the database might adversely impact patients and medical research. For such a database to be effective, it will need to be appropriately regulated and quality controlled. I believe that it can command the confidence of the medical profession only if it is developed in consultation with it. With that in mind, amendments 8 and 9 deal with the bodies that the Secretary of State must consult and get approval from before introducing regulations establishing a database of innovative treatments.

As the Bill stands—this is set out in clause 2(1)—to make those regulations the Secretary of State need only consult the Health and Social Care Information Centre. Restricting the statutory consultees to only one organisation seems highly restrictive and is inconsistent with the Bill’s explanatory notes, which state:

“The detailed design of the database would be consulted upon with professional bodies and organisations.”

Amendments 8 and 9 would make the legislation clearer on which bodies should be consulted.

I note that the Minister was unable to support similar amendments tabled in Committee because he felt that the list was “not exhaustive”. Indeed, he went on to say:

“Although it represents a helpful list of consultees, such a provision would need to include many more organisations. While I understand the intention behind the amendment, restricting the process would not be helpful”.

The hon. Member for Daventry (Chris Heaton-Harris) then said:

“I know from my consultation on the Bill with stakeholders that we would need longer lists than those in the amendments.”––[Official Report, Access to Medical Treatments (Innovation) Public Bill Committee, 16 December 2015; c. 22-23.]

With those constructive comments in mind, I have included in the list a provision allowing the Secretary of State to consult

“any other body or individual that the Secretary of State considers it appropriate to consult.”

I know that there were concerns that the list of specified organisations could become out of date. However, given that these regulation-making powers would likely be used only once—to create the database—I do not believe that concern is wholly justified. Indeed, if the Minister, or any hon. Member, believes that an inappropriate organisation is on the list set out in my amendments, I would be keen to know which organisation they feel should not have a say in the creation of the database.

I hope that these important amendments will address the concerns raised in Committee and that hon. Members will now be able to support them, because they will ensure that we get the design of the database right.

--- Later in debate ---

My great-grandfather, a rural vicar, said that he did not mind his congregation looking at their watches, but got very concerned when they started shaking them. I notice that my hon. Friend the Member for Daventry is just about to start shaking his watch. He is champing at the bit to ensure that he gets the Bill on to the statute book, and I will therefore conclude my remarks.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

The hon. Member for Daventry (Chris Heaton-Harris) may have to shake his watch a little longer. I call Jo Churchill.

[Jo Churchill]

I spoke earlier about the new clauses we tabled, but I did not emphasise my own need for us not to paralyse the database. It is vastly important, given the wider horizon of genomics and informatics, and we have not even touched on how it could accelerate the whole system and improve patient outcomes significantly. We need to put patients at the front and centre of the process, and allow enough flex for the system to be the best and the database to be the finest in the world. We have the finest scientists, the greatest charities and some of the best academic minds at our disposal.

The database may also revolutionise the life sciences industry, to which my hon. Friend the Member for Newton Abbot (Anne Marie Morris) has just referred. That industry generates 1% of our export market from one drug. The power for this billion-pound industry to grow and to improve health—not only in our own country, but across the world—has to be seen to be believed. It costs upwards of £1 million to take a drug to market. What on earth would incentivise a company to do that if it could not get some sort of payback? We must not tie the hands of the people who can find the answers. Many such companies start as micro-companies, spun off from the great universities of our country, but many of them fail in what they call “death valley”. Our health system needs to modernise, digitise and reform to collect, collate and use our health data in the right way.

I believe that clinical trials are vital. I would take part in one, as a dear friend of mine recently did, to give other people a better chance of beating their disease. That is why we must not constrain the database in a way that, like a straitjacket, would completely constrict the industry and academia. At the same time, we must maintain the rigour in dealing with science for which our country is so famed. I believe that the power behind that science is patient data, and every patient holds an answer. With the support of clinicians and charities, and with a strong sense of purpose from the Government, I want data to be used for the benefit of patients. I will stand here and make my point over and again for these five years if we wreck the ability for a database to be a power for good in this Chamber today.

NHS and Social Care Commission

Lindsay Hoyle Excerpts

Thursday 28th January 2016 Commons Chamber

[Debbie Abrahams]

I hope the hon. Lady will not mind if I do not. I have spoken for some time, and I am being pressed by you, Mr Deputy Speaker—[Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Not by me.

[Debbie Abrahams]

Go on, then.

--- Later in debate ---

[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. The winding-up speeches will begin in 15 minutes. I call Dr Philippa Whitford.

--- Later in debate ---

[Dr Philippa Whitford]

Just on the Commonwealth Fund analysis, the standard that the UK did badly on was actually healthy life expectancy. That is not the same as an outcome in hospital. We may have successful operations, but we have underlying deprivation and ill health.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

I just say to the Minister that I did give him the nod. I have been very generous. When we say that he has “up to 15 minutes”, he is meant to take 15 minutes. As he can see from the clock, he has taken a lot longer.

[Alistair Burt]

I beg your pardon, Mr Deputy Speaker. I have tried to accommodate interventions but I entirely take your point. I am just about to finish and am grateful for your generosity.

I take the hon. Lady’s point, but in conclusion, the Government take advice from a lot of sources on everything connected with health. If the right hon. Member for North Norfolk wants to do exactly what he suggested, he can do it, and we will listen very carefully to him, as we do to others. However, I am afraid that, at the moment, I cannot see a Government-sponsored commission. If we have more debates such as this one, the public will be better served and the House will have done its job.

--- Later in debate ---

[Mary Creagh (Wakefield) (Lab)]

On a point of order, Mr Deputy Speaker. In the past hour, we have had the news that the Lord Chancellor has scrapped the Government’s proposed legal aid reforms, which had drawn such huge protests from criminal solicitors across the country, including in my constituency. We had a debate on prison and justice issues for three hours yesterday, which would have given him ample opportunity to tell the House of the news. May I use your good offices, Mr Deputy Speaker, to ask whether it would be appropriate for the Lord Chancellor to come and make a statement to the House tomorrow, which is a sitting Friday?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

I have been given no notice today of any statement, and it is very late in the evening and we are about to finish. What I can say is that it is certainly on the record and the Government are certainly able, if they wish, to make a statement tomorrow. The hon. Lady is able to put in for an urgent question if she feels it is appropriate. I cannot promise anything, but those avenues are open to the Government and to the hon. Lady.