Health Service Medical Supplies (Costs) Bill

Mark Field Excerpts

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

[Mr Hunt]

Our march on to the centre ground carries on apace. [Laughter.] In response to the hon. Gentleman’s fascinating point, I gently reassure him that our approach will be fair and proportionate. This is not about bringing in wide profit controls. It is important to say that we recognise—our view is shared across the House—the pharmaceutical industry’s incredibly important role in medical advances, and we want Britain to be its European centre of operations post-Brexit. Many Members have campaigned about dementia and we hope that we can get a cure—it could happen in this country—and we recognise that profits are what fund the research that makes such remarkable changes possible.

It is important, however, that we are able to see what profits are being generated from a company’s choice between the PPRS scheme and the statutory scheme as a clue to whether the company is being fair to the NHS, which is funded by taxpayers. That is why the Bill’s measures strike the right balance.

[Mark Field (Cities of London and Westminster) (Con)]

I hope that not only the Opposition but Government Members are reassured by those comments in response to the hon. Member for Wolverhampton South West (Rob Marris). Will the Secretary of State take this opportunity to emphasise the great contribution that the pharmaceutical industry makes not only in this country but as a global player? As he says, the profit motive is important to ensuring the competition that allows for reform and the new drugs that will transform our lives and the lives of future generations.

[Mr Hunt]

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

--- Later in debate ---

[Justin Madders]

My hon. Friend is absolutely right. There was real concern about the announcement last week. From the surveys that have been taken, we know that approximately one in four people who currently use the pharmacist would go to their GP if they were unable to seek advice from the pharmacy. We know the pressure that GP surgeries, and indeed the NHS, are under. We will have to watch carefully the impact of these proposals, which I hope will not be as serious as a number of Members fear.

The impact assessment does not offer many clues. It states that the additional costs that could be incurred

“have not been quantified, as their magnitude will not be known until after consultation on subsequent regulations.”

We need to tread carefully. The Secretary of State is asking us to give him new powers before setting out exactly how he will use them. That is a far from perfect state of affairs. I hope that we will get some further clarity when the Bill reaches Committee.

[Mark Field]

The hon. Gentleman has been fair in his broad analysis of the problems that we face between the statutory and voluntary schemes. It is a salutary lesson that whenever a statutory scheme is put in place, it can easily be gamed by anyone in the industry. Is he encouraged by the fact that the Association of the British Pharmaceutical Industry supports the Government’s proposal and wants to work with the Secretary of State so that we can, hopefully, reach an agreement that will work for the future, rather than a draconian recommendation being issued by Richmond House?

[Justin Madders]

I agree that it is important that we keep the dialogue open with industry. We are proud of what the pharmaceutical industry can deliver for this country. It is a world leader and we certainly do not want to throw the baby out with the bathwater.

The Government will be aware that concern has been expressed by the medical technology sector that medical supplies are to be brought within the scope of a regime designed ostensibly to tackle a problem in the pharmaceutical industry. The medical technology sector has expressed concern that the Bill’s measures will put additional burdens on that sector and could lead to higher costs overall for the NHS. We welcome the assurances given by the Secretary of State today that the 99% of businesses in this industry that are small or medium-sized will not be unduly troubled by onerous additional reporting requirements. We hope to discuss that in further detail.

The former Minister for Life Sciences reported in February 2016 that the estimated income in England from PPRS payments in 2016-17 would be £518 million. That is considerably less than the amount received in 2015, at a time when the overall drugs bill is increasing, so that tells us that the scheme is not going according to plan. The Government have stated that the measures would save the health service around £90 million a year, so let us consider what has been going on and whether this Bill can address the issues that have arisen.

One of the benefits we have heard about is that the Bill will help to close the loophole that I referred to earlier which has led to extortionate prices being charged for a number of generic medicines. This occurs, as we heard, when a small number of companies purchase off-patent drugs for which there are no competitor products or there is a dominant supplier. They then remove the brand name, which takes the drugs out of the current pricing controls, allowing the companies to hike up the costs by many hundreds or even thousands of per cent. It is clear that some of these companies have made this strategy a key part of their business model.

In the past few months we have seen this House expose some of the worst excesses of capitalism, from Mike Ashley and his employment practices at Sports Direct, to Philip Green, but there should be a special category of obloquy for those who make themselves extremely wealthy by using loopholes in the law to prey on the sick and vulnerable and to extract obscene profits from our health service. An investigation in The Times highlighted how a small number of companies including Amdipharm, Mercury, Auden Mckenzie and Atnahs raised the cost of medicines by £262 million a year through this practice.

When a US pharmaceutical company hiked the price of HIV medication, people across the world were united in their condemnation, but it is less well known that at the same time the price of over 200 medicines more than doubled in this country, with 32 rising by more than 1,000% and in one case, as we heard, an unbelievable increase of 12,500%. An indication of how central to the business plan of some companies this practice has become can be found just by looking at their websites. The company Amdipharm boasts that it was sold to a private equity company for £367 million and talks of acquiring and commercialising niche generic medicines. Another of these companies, Concordia International, which now owns both Amdipharm and Mercury, is quite open about the fact that it

“specializes in the acquisition, licensing and development of off-patent prescription medicines, which may be niche, hard-to-make products.”

This may sound like a noble pursuit, but we know that it can in fact be code for establishing and then abusing a dominant market position to the detriment of vulnerable patients and the taxpayer.

Sugary Drinks Tax

Mark Field Excerpts

Monday 30th November 2015 Westminster Hall

[Helen Jones (Warrington North) (Lab)]

I beg to move,

That this House has considered e-petition 106651 relating to a tax on sugary drinks.

The Petitions Committee has scheduled the debate to coincide with the publication of the report by the Select Committee on Health about childhood obesity. I did not have the advantage of seeing that report when I drafted my speech, but I am sure that the hon. Member for Totnes (Dr Wollaston) will enlighten us further if she catches your eye later, Mr Hamilton. It is a great pleasure to see many members of that Committee here.

The petition was prompted by real concern about the health problems that are being caused by rising levels of obesity, particularly among children. Having looked at the matter, there is no doubt in my mind that we face a very serious situation. I am lucky to be one of a fortunate generation that saw advances in housing and sanitation, and mass vaccination programmes that eradicated or reduced the incidence of many diseases from which children used to suffer. However, we are now in danger of raising a generation who will have a lower life expectancy than that of their parents. The reason for that is down to diet, with too much fat and too much sugar—combined with too little exercise, yes, but it is mostly about diet.

[Mark Field (Cities of London and Westminster) (Con)]

Will the hon. Lady give way?

[Helen Jones]

If the right hon. Gentleman is so eager to get in, I will give way.

[Mark Field]

I am eager to get in on that point, because I think it is rather facilely simplistic to suggest that any reduction in life expectancy is just down to diet. I accept that that could be one of the factors, but, in looking at this report and others like it, it is important that we take an evidence-based approach. Diet is a factor in reduced life expectancy in some parts of the country, but it is by no means the only factor.

[Helen Jones]

The right hon. Gentleman will learn that diet is actually the major factor. I will go on to say a little more about that later. He is right that it is difficult to talk about the subject without seeming like a killjoy, so I will fess up right at the beginning: I enjoy a glass of wine with my meals, although I try to restrict it to weekends; I am martyr to my cravings for chocolate; and, like many of us in this House, I could do with losing a bit of weight. However, we should not let our own frailties put us off tackling what I believe to be a real health emergency.

I have seen a huge change in diet, particularly in children’s diets, over my lifetime. When I was growing up, pop was a treat that we got occasionally, and we usually got a bottle of it between several of us. Sweets were bought by our dads on payday. If we were out playing—most children did play out in those days—and we came in hungry, we got bread and butter and a drink of water. Now, thanks to a huge change in lifestyle, the wider availability of products and some heavy marketing to children, the situation has changed. Many adults and most of our children are not meeting the proper dietary requirements. We eat too much saturated fat and too much sugar—both added sugar, and sugar in fruit juices, honey and similar products.

[Mark Field]

As the father of two young children aged seven and four, I entirely endorse what the hon. Lady has to say about the prevalence of treats for today’s youngsters compared with that which our generation grew up with. Does she accept, however, that the issues here are the responsibility of parents and of the companies who produce such goods? Many of those companies have shown a level of responsibility, and the average size of confectionery such as the Mars bar has fallen as time has gone by. There is more information on all such products about the amount of fat and sugar that they contain. In many ways, we are living in an age of more responsible and more informed consumers, both young and old. That is where the responsibility lies, and that responsibility has been put into place to a large extent—

[Fabian Hamilton (in the Chair)]

Order. I remind hon. Members that interventions should be kept brief, and that they should be questions.

--- Later in debate ---

[Helen Jones]

That is right. I have already said that clearer labelling has a role to play, but the Government need to understand and recognise the link between obesity and food poverty, which is not—before anyone misquotes me—to say that all poor people are obese or that all obese people are poor. The children who are most at risk are concentrated in the most deprived areas of the country. The same is true of adults. Figures provided to me by the Library show that there is a stark division. For instance, 32.7% of adults in Hartlepool are obese; in the Chilterns, it is 17.7%. In Barnsley, 35% of people are obese; in Cambridge, it is 14.7%.

The noble Lord Prior recently said in the other place that he found it puzzling that obesity is growing while people are using food banks. Let me try to explain it simply to him. If people live in an area where shops do not sell reasonably priced food, fruit and veg, and they cannot afford the bus fare into town, they are more likely to buy cheap, fatty products. If people are fuel-poor, it is difficult to cook healthy meals, as it is if they are time-poor. I have just said at a public engagement event that there are women in my constituency who are working two or three part-time jobs, trying to make ends meet. Most poor families are good at managing their budgets, but if they do not have time to cook and are worried about waste, they are more likely to buy easy things that can be cooked quickly—we need to recognise that. I would do the same in that situation, and it is why we need to invest more in preventive measures and to subsidise healthy foods, rather than unhealthy foods.

If we look at the detail of the Chancellor’s autumn statement, however, the public health grant will continue to fall. Some 25% of the grant goes on sexual health services, and 30% goes on drug and alcohol services, which are demand-led statutory services that cannot be cut. If we add the child measurement programme, child medical examinations and health protection, there is not much left over. That is why the Local Government Association has said

“councils don’t have enough…to do the preventive work needed to tackle one of the biggest challenges we face.”

The Government also need to look carefully at what has happened to their obesity strategy. The strategy was launched with great fanfare in 2011, but since then, as the National Obesity Forum has said,

“little has been heard of the strategy”.

The National Obesity Forum has asked for a “much more determined approach”. Even the Change4Life programme, which does not address obesity but helps to prevent people from becoming obese in the first place, has found its budget cut. We have heard much about the public health responsibility deal, which is currently under review. I hope the Government will seriously look at the deal, because all the indications are that, as presently constituted, it is not working.

Simon Capewell, professor of public health and policy at Liverpool University, called the public health responsibility deal a “predictable failure” and

“a successful strategy for food companies who wanted to maximise profits.”

It is right to work with the industry as one strand of our approach, but it is not right to give industry the final say on what happens because, as the Health Committee said in the last Parliament,

“those with a financial interest must not be allowed to set the agenda for health improvement.”

We need a much tougher responsibility deal.

[Mark Field]

Will the hon. Lady give way?

[Helen Jones]

No, I will finish now if the right hon. Gentleman will forgive me. He has made several interventions, and he can make a speech later.

[Mark Field]

Do you want a debate?

[Fabian Hamilton (in the Chair)]

Order.

--- Later in debate ---

[Mark Pawsey]

rose—

[Mark Field]

rose—

[Dr Wollaston]

In tandem! I am spoiled for choice.

--- Later in debate ---

[Mark Field]

Does my hon. Friend recognise that one concern that some of us have about a tax on sugary drinks is that although it seems an attractive idea as a one-off, it would set a precedent? There would then be moves to outlaw discounting, impose portion sizes and implement similar rules. [Interruption.] Many of us believe in the idea of freedom and the responsibility of the consumer, and do not like the idea of the Government imposing that sort of change.

[Dr Wollaston]

In an ideal world, I agree, it would be nice not to have to do any of that, but I return to the point about whether the Government also have a responsibility for the health of the nation’s children. Should the Government step back? Should any of us feel that it is acceptable to condemn one in four—a quarter—of the most disadvantaged children in Britain to a lifetime of ill health? If we can do something simply to nudge people a different way, should we not consider the possibilities, and ask how different those children’s life chances could be? As I said, such a tax would not be regressive because there is always an easier, untaxed alternative. We are talking not about telling people that they cannot have a product that they enjoy but about nudging them to choose a healthier one.

There is an interesting phenomenon whereby education, for example, is sometimes taken up by the people in society who are already healthier, which can inadvertently end up widening the health inequality gap. We should target measures to help those who are suffering the most harm. As for this being regressive, look at who is suffering the most harm. Is my right hon. Friend happy with the situation as it stands?

--- Later in debate ---

[Dr Wollaston]

I thank the hon. Gentleman for his intervention, but the point is that we wanted to respond to the issue about whether a sugar tax is regressive. It is much more challenging to use a direct replacement for the sugar, which would mean zero sugar for those kinds of products. That was partly why we took that view.

However, the approach that we recommend for the kind of products that the hon. Gentleman has mentioned is one of reformulation. During the last decade, there has been a successful programme of reformulating salt within our processed foods, but such a change takes time, because we have to adjust the nation’s palate gradually. Yes, we can make bigger step changes if we replace part of the sugar in one go, but there is sometimes something about the chemistry of sugar within cookery that means a sugar substitute does not do the same job. We wanted a tax where a sugar substitute did the same job as sugar, in effect.

I am confident that reformulation will be part of the Government’s response, because there is clear evidence that it works. Having said that, we know that it works better when there is some teeth to it, so I urge the Minister to go further than the responsibility deal and have something with real teeth. Things worked better when we had the Food Standards Agency and a bit of a stick in the background to make such changes happen, and industry wants a level playing field.

[Mark Field]

It is only fair that we give some credit to the industry, as my hon. Friend has done, particularly for the changes that have been made in relation to salt products. However, it seems to me somewhat insidious that, as we heard in an earlier contribution, the financial interests are being questioned, as though health professionals, who are often well funded by public funding, did not have a financial interest in this particular debate, as well as—[Interruption.]

[Fabian Hamilton (in the Chair)]

Order.

[Mark Field]

A significant number of health charities also have a big financial interest in this debate, and it is right that that interest should be balanced against those with clear financial interests in the industry.

[Fabian Hamilton (in the Chair)]

Order.

National Health Service

Mark Field Excerpts

Wednesday 21st January 2015 Commons Chamber

[Mr Hunt]

Let me tell the right hon. Gentleman why the agency bill has gone up. It has gone up because hospitals are trying to recruit doctors and nurses to tackle the problems of Mid Staffs that he left behind. As they improve their staffing, they will gradually get more full-time nurses, but in the short term, they do not want to put patients’ lives at risk.

I want to return to the situation this winter. To relieve the immediate pressures, we have given the NHS a record £700 million, which has allowed it to recruit an extra 796 doctors, 4,700 nurses and 3,094 other staff, making a total of 8,590 additional staff, and to increase bed capacity by 6,400. We have more staff, more beds, more GP appointments and more GPs in A and E than ever before for winter.

What is the impact of the extra support that we have given the front line? The target is to see and treat people in A and E within four hours. Compared with the last full year for which Labour was in office, 3,000 more people are being seen, treated and discharged within four hours every single day. The mean time that people wait for a first assessment has fallen from 77 minutes to 30 minutes, and nine out of 10 people, even under the pressure of the additional visits, continue to be helped within four hours. That performance is better than anywhere else in the United Kingdom—and, indeed, better than in Canada, Australia, New Zealand, Sweden and any other country in the world that measures A and E performance.

While the NHS is straining every sinew to meet high standards, the public will not accept the cynical politics that demands that we call it a crisis in England, while refusing to call it a crisis in Wales, where Labour is in charge and the problems are far worse. According to the House of Commons Library, in Wales, double the number of people are kept waiting in A and E, and nearly double the number of people wait too long for an urgent ambulance. For Labour, poor care matters only when there is a political point to be scored. For a party that aspires to run the NHS, that is simply not good enough. How Nye Bevan would turn in his grave if he knew that the party that founded the NHS was turning its back on patients with such contempt in his own back yard!

[Mark Field (Cities of London and Westminster) (Con)]

Although I appreciate that there will inevitably be a battle between the two parties to a certain extent in this debate, the Secretary of State is at his strongest—this is what I hear from all the health care professionals in my constituency—when he talks about his patient-centred vision for the health service of the 21st century and when he looks away from the here and now and towards the future that we all know is desperately needed by all our constituents: a patient-centred NHS. I hope that he will say a little more about that.

[Mr Hunt]

I will, and that is what this is about—putting patients first. That is why we need important reforms such as ensuring that every vulnerable older patient has a named accountable doctor—I will mention that later in my remarks—and why we must remove barriers between the health and social care systems.

Type 1 Diabetes (Young People)

Mark Field Excerpts

Wednesday 30th April 2014 Westminster Hall

[Mark Field (Cities of London and Westminster) (Con)]

From our joint experience on the Intelligence and Security Committee, I am well aware that the right hon. Member for Knowsley (Mr Howarth) has a robustness at times, and perhaps he would have liked to be judge and jury in today’s debate. I congratulate him, above all, on bringing the subject to the House. I am well aware that, as alluded to earlier, these are issues that are very close to his heart, and he speaks with immense knowledge and passion about this particular affliction.

I wish to contribute a few words to the debate, because the subject has been raised a number of times with me at constituency level in recent months. As we have heard, type 1 diabetes is a chronic and life-threatening auto-immune condition, which is caused when the body mistakenly attacks the insulin-producing beta cells in the pancreas. It is a separate and distinct condition from the more common and perhaps more widely known type 2 diabetes.

Estimates put the number of people in the UK with type 1 diabetes at as high as 400,000, which means that each and every MP in the UK has, on average, some 500 constituents suffering with type 1. As recently as 2010-11, it was thought that the direct and indirect cost of type 1 diabetes alone to the UK was around £1.9 billion; judging by the growing rate of increase, it is feared that by 2036 that figure could rise to some £4.2 billion each and every year.

A few months ago, a mother in my constituency wrote to me explaining exactly what life was like, day by day, hour by hour, caring for her young child with type 1 diabetes. She described how her experience reminds her daily of the urgency and importance of finding a cure. My old friend and colleague on Kensington and Chelsea council, Rupert Cecil, has a delightful 10-year-old daughter, whom I have got to know throughout her life; she has similarly suffered from type 1 since infancy and requires constant monitoring. Rupert and his wife, Juliet, have tirelessly raised funds for and awareness of the condition since Polly was diagnosed with this life-threatening and incurable illness at the age of two and a half.

From the outside, Polly is just like any other 10-year-old, but a close look may reveal a wire poking out from under her school uniform and attached to something resembling a money belt. This is the insulin pump that Polly relies on from day to day. It is the artificial pancreas to which the right hon. Gentleman referred. She is attached to it each and every day and will be for the rest of her life. Without it, she could not survive longer than 24 hours. In addition to her insulin pump, her parents must test her blood by pricking her finger at least five times a day. They often have to wake her in the middle of the night to give her glucose if her sugar levels have dropped dangerously, or some insulin if they are running high. That is the daily tightrope that is walked by each and every parent of a young child with type 1 diabetes.

[Ian Lavery (Wansbeck) (Lab)]

I understand what the hon. Gentleman is saying about his friend’s young child, but many young people, particularly in areas of social deprivation, cannot access insulin pumps unless they buy them, and I believe that they cost around £1,500 or £2,000. If people do not have the money, many of them suffer greatly.

[Mark Field]

That is a fair comment and I hope the Minister will comment on it.

I want to touch on an imaginative and innovative scheme in my constituency at St Mary’s hospital, Paddington, which is part of the Imperial College Healthcare NHS Trust and which I visited recently. I hope that it will not only raise awareness, but reduce the cost to which the hon. Gentleman referred. During my recent visit, I discussed the everyday realities for diabetes sufferers.

The International Centre for Circulatory Health is based on the St Mary’s hospital campus of the Imperial College Healthcare NHS Trust, just behind Paddington station. Imperial college has published some of the lowest amputation rates in the world from its diabetic foot service, led by Dr Jonathan Valabhji. It has a large diabetes technology centre that is closely linked with a research programme developing closed-loop insulin delivery for type 1 diabetics and novel continuous glucose sensor devices. Its clinical technology research is led by Dr Nick Oliver, who talked me through the pioneering work he is doing to develop the artificial pancreas system for everyone with type 1 diabetes. I hope that that will also reduce the costs to which reference was made earlier.

That ground-breaking research aims to offer the next best thing to a cure for type 1 diabetes patients in the future. I saw for myself how a small, discreet device, connected to the blood stream via micro-needles, can monitor glucose levels. When paired with insulin and glucagon pumps, the artificial pancreas should be able to give diabetics an approximate response to blood sugar levels close to what a body would normally produce. With consistent levels of insulin delivered, sufferers are liberated from the constant monitoring and worrying that comes with the daily management of the disease. The St Mary’s site is just one research centre forming part of a global effort that could help to change the lives of many of the 400,000 people who are living with type 1 diabetes, and save the NHS a significant proportion of the money that is currently spent on treatment.

The artificial pancreas system has three components. Two, the insulin pump and continuous glucose monitor, are available. However people with type 1 diabetes face difficulties trying to access insulin pumps despite a supportive technology appraisal from the National Institute for Health and Care Excellence. Indeed the national uptake of insulin pump therapy stands at just under half the NICE benchmark, set as long ago as 2008, which is extremely low and means the UK is lagging behind many western countries. There seems to be consensus among those working in diabetes research that greater investment from the Government is vital to drive developments in this area. At present, our Government invest less per capita than the US, Australia and Canada in type 1 diabetes research.

I am aware that there is some joined-up thinking, not least by my right hon. Friend the Minister for Universities and Science, but I would be grateful if the Minister here told us how the Government will work to ensure that the sort of treatment for type 1 diabetes sufferers will be matched up to the level of other western nations, what more can be done to fund pioneering research, and how we can roll out the level of service received by patients at Imperial college to patients throughout the country.

I am pleased that so many hon. Members are here today. We all have our contribution to make and I look forward to hearing what they have to say. The 400,000 sufferers and their many millions of relatives and carers will be cheered that we are treating the issue seriously.

[Mr Dai Havard (in the Chair)]

Thank you, Mr Field, for managing your time well with an intervention.

Health Care (London)

Mark Field Excerpts

Wednesday 8th January 2014 Westminster Hall

[Mark Field (Cities of London and Westminster) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate the hon. Member for Westminster North (Ms Buck) on securing this valuable debate. Although her conclusion was perhaps a little more hyperbolic than mine would have been in the circumstances, we work closely together, along with her hon. Friend, the hon. Member for Hammersmith (Mr Slaughter), to do our best for all our constituents. Over the past year or so, as we have tried to put our constituents first, we have had concerns about elements of the negotiations on this matter.

For all the lively debate about health care provision here in the capital, there is one thing on which we can all agree, as the hon. Lady made clear in her contribution: the pressures on the national health service here in London are huge and getting bigger. They are set to increase substantially, not only because the population is ageing but because of the hypermobility and hyperdiversity of that population. In the past, that was perhaps typical of inner London alone, but it now applies to the entirety of the capital.

At times, the national health service can seem a little like a national religion, whose traditions must not be questioned under any circumstance. In my view, if one good thing has come from the terrible events in Mid Staffordshire, it is that we can perhaps start to have a more honest and less ideological debate about where the NHS is performing well, where it is letting people down and how it can better tackle the future challenges to which the hon. Member for Westminster North referred.

I have enormous respect for the Secretary of State for unashamedly refocusing the NHS around patients rather than protecting the sanctity of the system. Thankfully, the patient experience at some of our central London hospitals is, as the hon. Lady rightly pointed out, a world away from what happened in Mid Staffordshire. The diversity of population and the presence of top-flight medical schools and universities, particularly in central London, inevitably draw global talent to our local hospitals.

I am often staggered by the quality of facilities here, whether the state-of-the-art birthing unit in St Mary’s or the Royal London, the beautiful Maggie’s cancer centre at Charing Cross or the brand new oncology unit at Barts in my constituency. Only yesterday, a constituent wrote to me about his young nephew’s recent stint in hospital. He said:

“Given it seems it is ‘in vogue’ to be ‘anti-NHS’ I wanted to let you know that my recent experiences with the high dependency unit at Chelsea and Westminster Hospital”—

that hospital is outside my constituency, but obviously caters for a lot of my constituents in the south of Westminster—

“were nothing short of exemplary. I am sure that my nephew’s speedy recovery was probably all down to the standard of care he received.”

More often in my constituency, non-emergency services fail to be so patient-focused. Londoners are spoilt for choice in so many aspects of their lives, and as a result they have the idea that they should expect to get a full choice in everything. Why should they not expect a similar consumer-driven, flexible and responsive system when it comes to primary care—one that allows them swift access to a GP or provides small surgical procedures outside hospital?

We have read a lot in recent days about the number of non-emergency cases being presented at A and E departments. I think that that is in part due to the hassle factor associated with the existing GP system. With the hypermobility of population in London, many people never bother to register with a GP, and those who do all too often find that they cannot get an appointment for days or at a time that is convenient for someone with a busy working life. It is therefore often a perfectly logical decision for those people to spend a few hours in A and E, where they are at least guaranteed to be seen.

Thankfully the story is rapidly improving for my constituents. The Central London clinical commissioning group has just extended its seven-day GP opening service from three practices to five. People are able to walk in and book a same-day appointment at those practices. They do not have to be a member of the practice to use the service, and registration with their own GP will not be affected. I also know that plans are afoot to locate more GPs within hospitals in London. That type of modern and practical response really needs to be rolled out more widely.

There are problems with the health service in central London, which my colleague the hon. Member for Westminster North has so carefully outlined. My own constituency will hopefully be affected for the better by the huge changes to be brought in by the “Shaping a healthier future” programme. That programme began some five years ago to respond to the challenges of a rapidly increasing population and the variation we were seeing in the quality of acute care. It has caused most controversy in its proposals to close a number of A and E departments.

My constituents are grateful, as are the hon. Lady’s, that St Mary’s hospital in Paddington has been confirmed as one of five north-west London hospitals to provide advanced comprehensive acute care. I am assured that there is a strong business case for even greater investment on that site and exciting plans are afoot in that regard.

The Minister needs to be aware, however, that there have been issues of communication over the relocation of elective surgery, as was raised earlier. I accept much of the wisdom in the reconfiguration of services in north-west London to allow for specialist centres, rather than having hospitals that are jacks of all trades.

I accept that that is easy for me to say, given that two local hospitals in my constituency, Chelsea and Westminster and St Mary’s Paddington, are not affected, and I know that the issue is a great concern for many Members, who are hearing such concerns from many constituents. But I suspect that the perceived success or failure of any reorganisation of this sort will come down to smaller things: how well plans are communicated; how quickly alternative, out-of-hospital services are in place; and how transportation is organised for patients, many of whom are impoverished or will have to travel further and rely on public transport.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

On the acceptability of reconfiguration, we should never forget that many communities in London have a strong emotional attachment to a hospital that could have been in existence in some shape or form since the middle ages. That is why reconfiguration must go forward carefully and on a purely medical basis if it is to succeed in London.

[Mark Field]

That is right to an extent. I know that the hon. Lady spoke in a debate that I led in the House almost a decade ago on Barts, which is located in my constituency and has a special place in the hearts of many millions of Londoners—and, indeed, of people throughout the United Kingdom. The truth is that at that juncture, the private finance initiative was the only funding game in town and we all went along with it, but that £1 billion PFI has now caused major financial issues that, I am afraid, affect not just Barts but hospitals throughout the north-east of London, as the hon. Lady is well aware. We all feel a bit depressed about that knock-on effect.

We have to accept that in London, broadly speaking, we do pretty well as far as hospital care is concerned. Being absolutely candid with everyone, because I know what it is like, in central London we have a very good service, and it is partly outer London that suffers as a result. That is because of the strength of the links to which the hon. Lady rightly referred—the passion that we have for our historic hospitals—and the amount of resource that is pushed into central London because the hospitals there are teaching hospitals with consultants, former consultants and alumni who are willing to make a strong case for the existence of those hospitals. Dare I say it, that makes it easier to make the case for Barts than for a hospital out in Romford or Whipps Cross, or one in the hon. Lady’s constituency.

We all have to face those issues. They have not arisen as a result of the reorganisation of the past three and a half years; this has been the situation in the capital for probably 40 or 50 years. I am aware that even in the latest reconfiguration there has been a sense that central London has got off slightly better than the middle portion of outer western London.

I turn to finance. There was a good outcome before Christmas for north-west London on commissioning allocations, as all of our CCGs received an uplift to offset inflation. However, I want to raise concerns about the funding formula used to determine allocation. The formula fails to take into account the needs of the large homeless population in Westminster, which places massive pressure on acute services. Rough sleepers are far more likely to attend accident and emergency; they attend six times more often than any normal member of the population. They are admitted to hospital four times more often and stay in hospital three times as long.

The formula also ignores the fact that CCGs are responsible for all attendances at urgent care centres or walk-in centres and for the costs of patients covered by reciprocal funding arrangements with other countries. Westminster welcomes more than 1 million commuters and visitors each and every day, many of whom will need health advice and care while they are here. It is important that a future funding formula recognises the impact of that on local health care services.

The proposed formula will exclude spending on community care. That cannot be correct considering the important move to provide more high-quality care at home and in the community rather than simply in hospitals. I welcome the Government’s assurances that the Advisory Council of Resource Allocation formula will not be accepted in its current state and that changes to the funding of CCGs will be fully consulted on in future.

I turn to public health spending. A draft formula for local authorities was set out in the “Healthy Lives, Healthy People” consultation, which was published on 14 June 2012 and recognised that further work was needed on adjustments for age, fixed costs and non-resident populations. However, initial modelling by London councils suggests that Westminster would have a drop of 57% in public health funding. Central London and Westminster have unique population characteristics that make it more difficult to make public health improvements. They include the age structure, with a greater focus on working age and children, and levels of mental health problems and homelessness. Those are not properly reflected in the current formula.

The formula also fails to take account of substance misuse services, many of which fall outside the pooled treatment budget, which focuses on opiates and crack treatment. It also ignores the wider health and local authority investment needed to manage the individual family and community impact of drugs and alcohol on health and well-being.

Westminster experiences a high level of population churn—I accept that many other London boroughs are in that boat—and that leads to additional demands for services, including NHS checks and other screening programmes.

[Glenda Jackson (Hampstead and Kilburn) (Lab)]

Will the hon. Gentleman give way?

[Mark Field]

Other hon. Members want to speak so, if the hon. Lady will forgive me, I will finish with a request to the Minister. I would welcome an indication from the Government of when we can expect more clarity on how future public health allocations will be determined. I would also appreciate confirmation that the formula consulted on in June 2012 will not be used to determine public health funding allocation in future.

[Mrs Anne Main (in the Chair)]

I will call the Minister and shadow Opposition spokesman at 20 minutes to the hour. About five hon. Members want to speak. That means, bearing in mind time for interventions, about seven minutes for speeches. That is just a suggestion.

Tobacco Products (Plain Packaging)

Mark Field Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Mark Field (Cities of London and Westminster) (Con)]

As my hon. Friend the Member for Harrow East (Bob Blackman) has made clear, the Government, at the behest of the very well funded, vocal and influential health lobby, are examining whether to introduce plain packaging for the nation’s tobacco industry. I, for one, believe that that is an entirely unjustified step and that it would create an unsettling precedent—the state prohibiting the producers of a legal product to use its legally protected and valuable branding. It is a serious challenge to all those who believe in free markets, enterprise and the economic system of capitalism.

I would very much agree with what was said in the earlier exchanges: if it is such a terrible product, have the honesty, as many in the health industry do not, to say that the whole product should be banned. I would accept that if it is felt to be such an unhealthy product, it should be banned, but we would also then be going down a road that would probably, before long, affect the alcohol industry, fatty foods and so on. That is not a state of affairs that I would like.

[John Glen (Salisbury) (Con)]

Would my hon. Friend not wish to make a distinction between moderate consumption of alcohol and fatty foods, which is perfectly tolerable, and moderate consumption of cigarettes, which have an appalling effect, no matter how many are consumed? There is a real distinction.

[Mark Field]

No doubt the health lobby would quickly suggest that alcohol and fatty foods were equally intolerable, even at the lowest level.

Let me make it clear at the outset: I accept fully that tobacco is addictive, but it is a legal drug for adults. I am the father of two young children—a son of five and a daughter of two—and I would not want them to take up tobacco, not least because my late father also died of lung cancer. In passing, it is worth making the observation that our coalition partners and the Opposition would allow 16 and 17-year-olds to vote, but not to purchase cigarettes. The age restriction for tobacco, of course, has risen from 16 in recent years.

I accept that tobacco smoking is subject to commensurate regulations and restrictions. No one should sensibly want to see children take up smoking or should encourage them to take up the habit. I believe that we should do all we can to discourage, to educate and ultimately to prevent those under the legal age from taking up smoking. However, I also believe passionately in the concept of freedom of choice. The decision of whether or not to smoke should remain that of an informed adult, without gratuitous interference from the state.

One should not forget that tobacco is already one of the most highly regulated products in the world. The introduction of plain packaging would almost certainly amount to a regulation too far, and the so-called “denormalisation” of tobacco is not a sufficiently valid policy decision to justify such action. Any decision by the coalition Government must be unequivocally evidence-based. To contemplate taking such a significant measure for a legal product, the evidence base must be rock solid and reliable, with a guarantee that it will have the outcome intended.

I must confess that I am very pleased that the Department did not place a bid in this year’s Queen’s Speech, and that the Government, with a very libertarian junior Minister as we know, have sensibly delayed making a decision until it is clear what impact plain packaging has in Australia, where a plain-packaging law has been introduced. In my view, it makes sense to see how that experiment works first, before following their lead.

Any decision must be categorically made on the basis not of who shouts loudest or which side of the debate is able to muster the largest number of automated e-mail responses. The enforced introduction of plain packaging would infringe fundamental legal rights that are routinely afforded to international business. It would erode some important British intellectual property and brand equity, and it would create a dangerous precedent for the future of commercial free speech in areas such as alcohol and, indeed, within the food industry.

There is so much more that I would like to say, Mr Hollobone. It has been an interesting debate. I accept that my contribution is on a different path from those of many other Members here, but it is a voice that perhaps needs to be heard in this debate, which we will no doubt have in the months and years to come.

--- Later in debate ---

[Stephen Williams (Bristol West) (LD)]

I congratulate my hon. Friend the Member for Harrow East (Bob Blackman) on securing the debate. He is my honourable friend in a different context, as an officer in the all-party parliamentary group on smoking and health, which I have chaired for the past three years.

We have two debates in Parliament that will attract public attention today—this one and the debate on lobbyists this afternoon. I think that we could move seamlessly from one to the other, because the fact that the Government have stalled on this important public health measure is proof positive of the effectiveness of the lobbying industry. The industry must see it as a triumph that it has caused the Government to stop and think again.

Over the past 18 months or so there has been frantic and frenetic lobbying by the tobacco companies to stop the Government introducing legislation to standardise the packaging of cigarettes. That is because it is the last remaining marketing ploy that the tobacco companies have. They have used the same arguments they made about the ban on smoking in public places and the display ban: that it will destroy small shops, and lead to a huge increase in smuggling and criminal activity. Those arguments were wrong then and they are wrong now.

[Mark Field]

Will the hon. Gentleman give way?

[Stephen Williams]

The hon. Gentleman has spoken, so I will follow the Chair’s mandate and not give way.

Other people are lobbying against the policy, such as Unite the Union. I took part in a debate during the recess on BBC Radio Bristol with a shop steward from the tobacco packaging factory in east Bristol. He said that if legislation went ahead that factory would lose hundreds of jobs. I say to the hon. Member for North Antrim (Ian Paisley) that I see no problem at all with being a constituency MP—Imperial Tobacco, one of the largest tobacco companies in the world, is based in Bristol—and arguing against the tobacco trade, because tobacco kills people in my city and kills people from poorer communities. It is a public health tragedy that smoking now disproportionately affects poorer people in society. The middle classes have largely followed all the health warnings and given up smoking.

--- Later in debate ---

[Mark Field]

Will the hon. Lady give way?

[Ms Abbott]

I am afraid that I cannot.

We know that half of lifetime smokers will die from smoking, that it remains the largest preventable cause of cancer, that it causes one in four deaths from cancer and eight in 10 deaths from lung cancer, and that smoking is the biggest cause of health inequality. That is what makes tobacco packaging different and makes the measures so important.

On children, the key to the debate is not whether a change in packaging would make established smokers alter their habits, but the attraction that packaging holds for children. The question is one of child protection: although adults can make their decision about smoking, society has a responsibility, which some speakers have ignored, to protect children. Even Members who do not accept that must agree that we have a responsibility to bear down on the millions of pounds a year that it costs the NHS to deal with the consequences of smoking.

We have seen important local leadership on smoking. A lot can be done locally, which is why it is so important to move public health to local authorities. I want to name the leader of Newcastle city council, Nick Forbes, and Fresh North East for their innovatory work.

This is one of those issues on which what is done upstream—Government measures—has the most impact. In the lifetimes of everyone in the Chamber, levels of smoking have gone down, and attitudes to smoking have changed. When I was a child, people smoked on the television, in films, in meetings and in offices, none of which is now acceptable. That shows what we can do in public health with a mix of moral suasion and legislation, but there is more to be done, and I believe that the packaging measure is the last brick in the wall.

It is important to make the point that we are discussing UK packaging. As part of my role as shadow public health Minister, I have been to Europe—to Brussels and so on—to talk about the issue. In Brussels, people are clear that one reason why the tobacco industry is so exercised about packaging is not profits in the UK, but the example that UK legislation would set to the rest of the world, including the huge markets in China and Africa. What is at stake is not a marginal decrease in profit here; it is the big problem of profits forgone in the huge markets elsewhere. That is why it is so important for us in Parliament to set the right example—not just for the health of British people or because of the costs to the health service, but for the rest of the world.

In closing, I congratulate such organisations as Cancer Research UK and Action on Smoking and Health that have been ceaseless in bringing the facts before the public and MPs. We know that the issues are difficult and that the Government face the money and power of big tobacco. To be candid, that is why my Government in the end allowed a free vote. If this debate can get one important thing rolling, it should be pressure on the Government at the highest level to allow Parliament to discuss the question: let us debate and decide. The health of Britain’s children and the general population depends on it and the spiralling cost of the NHS depends on it, as does the health of people all over the world, to whom we can set an example with exemplary legislation on cigarette packaging.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is a pleasure, as ever, to serve under your chairmanship, Mr Hollobone. I echo the remarks of many speakers by congratulating my hon. Friend the Member for Harrow East (Bob Blackman)—a long-standing friend, if I may say so—on securing the debate and on his excellent speech. As he knows, I have been called many things, but I have never been called “very libertarian”, and I am still in a state of shock at that description.

I make it clear that I am no great fan or supporter of the nanny state. I do not have a particular problem with standardised packaging, because that does not relate to the nanny state. As we have heard in the many excellent speeches from Members of all parties, the issue is the protection of children, not preventing anybody from smoking or going out to buy cigarettes. It is about protecting young people from the attraction of taking up smoking.

It is important that I declare my interest. My father, a lifelong smoker, died at the age of 56 from lung cancer. I do not think that there was any doubt that that cancer was caused by his lifelong addition to tobacco—to smoking. I say with considerable shame, if I may put it that way, that until just over five years ago, I, too, was a smoker; both my brothers continue to smoke. I am not for one moment saying that if people are not or have not been smokers, they cannot engage in the debate, because that would obviously be complete nonsense, but they have to have been a smoker to understand the perverse psychology of smoking.

We know that 8 million people in this country continue to smoke and that the overwhelming majority of them want to stop. It is an admission of some weakness within us, which I think is the power of nicotine. It is often said that nicotine is more addictive even than heroin. Although I have never directly experienced heroin, when I was a criminal barrister I had enough clients to know how powerful heroin and cocaine are. Goodness me, even they would say that nicotine is a dreadful substance in its addiction. That accounts for why so many smokers, like me, found it so difficult to give up.

I want to make it clear that like so many smokers, I took up smoking before the age of 18. I accept that I sound very weak when I say—this is one of those moments where one almost wants to confess—that the power of the packet had an effect on this 17-year-old from Worksop who was working in a toy shop, which, bizarrely, sold cigarettes in those days. Younger people listening to this debate will be amazed to hear that a toy shop could sell cigarettes, but those were the days.

I have never forgotten the first time that I bought a packet of cigarettes. I deliberately chose a packet of St Moritz because they were green, gorgeous and a symbol of glamour. Do hon. Members remember the madness of those advertisements that talked of the cool fresh mountain air of menthol cigarettes? Those were the days that some of us remember because of our age. I distinctly remember the power of that package. It was the opening of the cellophane and the gold and the silver that was so powerfully important to many people who, as youngsters, took up smoking. I say that to my hon. Friend the Member for Bury North (Mr Nuttall) who says that he has never met anyone so drawn; well, he has now, because I am that person, and I am not alone by any means.

[Mark Field]

There is little doubt that if alcohol were synthesised for the first time today, or if we discovered sugar for the first time, it would be banned. The Minister has made the case about nicotine. Ideally, does she want the product banned? She talked about protecting young people. What age is she talking about? In America, for example, alcohol is banned for anyone under the age of 21. Is that the age she is considering, especially as we could outlaw both tobacco and alcohol at university when people are at an impressionable age?

[Anna Soubry]

My hon. Friend is most naughty. He asks me in a short period of time, when I have other matters to address, to answer about three or four questions all at once, most of which are completely irrelevant. We cannot say that there is a correlation between alcohol and tobacco; of course there is not. One can enjoy a glass of wine on an occasional basis. Indeed there is evidence that it can help certain people with their health. I am talking about the gentle consumption of alcohol or sugar. Indeed there is nothing wrong with eating sweets for goodness sake or even chips and other fatty substances. It is all a question of how much one eats; it should be part of a sensible and well-balanced diet. There is nothing in support of cigarettes or tobacco. It is about as barmy as saying, “If you want to help yourself after a stressful day, have a fag.” Cigarettes—tobacco—kill people and harm people’s health. Get it!

Induced Abortion

Mark Field Excerpts

Wednesday 31st October 2012 Westminster Hall

[Nadine Dorries]

I am afraid that I have to disappoint the right hon. Gentleman—I discussed this with one of his colleagues yesterday—because I believe the law on abortion should be equal in all parts of the Union. Abortion law needs to be reformed in the UK, and there needs to be parity across the board. If any abortion provider is to come to Northern Ireland, Marie Stopes is probably the best bet. Marie Stopes is one of the most professional and non-advocacy-driven abortion providers. It has no political ideology and is concerned only for the health of the woman, and it operates in a professional manner. So I think that, if Northern Ireland is to have an abortion provider, Marie Stopes are the people to have. The law here needs to be reformed, and there needs to be parity on both sides of the water.

This year alone, three abortion clinics have been closed down. This is my last point: we must bring abortion law before the House because it needs to be reformed.

Following today’s debate, I have already applied to the Backbench Business Committee for a longer, dividable debate to be held next May. I am using today’s debate to give notice of that future debate. I want to give pro-choice and pro-life supporters ample time to prepare, to gather their research and to set their stall ready for a debate next May.

[Mark Field (Cities of London and Westminster) (Con)]

I join other Members in praising my hon. Friend for bringing forward this issue.

Is not one of the problems that—my hon. Friend alluded to this when she talked about pro-life and pro-choice Members of Parliament—this whole debate has become so unbelievably polarised? Many Members of Parliament see both sides of the argument and feel that our voice is often squeezed from the debate. It is particularly important that the voices of the vast number of legislators who, as she rightly says, should have a say on this matter are allowed to be heard, rather than the entire debate being polarised in the way that she describes.

[Nadine Dorries]

My hon. Friend is absolutely right. It is the almost ghettoisation of pro-life and pro-choice that has over the years prevented rational and reasonable discussion of abortion.

I am attacked by both pro-life and pro-choice, because I support abortion up to a certain point but I want independent counselling to be provided to women who seek abortion and I would like the upper limit to be reduced. So I fall foul of both camps. It is important that MPs such as my hon. Friend come forward—he has views that encompass both sides of the argument—as they can be more rational in their presentation.

I have applied to the Backbench Business Committee for a debate on a votable motion next May. Of course, a Back-Bench vote does not amend legislation. If the result of the vote endorses a reduction to 20 weeks, however, it will inform the Government that perhaps it is time to bring the 1967 Act back to the House on Government time.

Adult Social Care

Mark Field Excerpts

Monday 16th July 2012 Commons Chamber

[Paul Burstow]

That is interesting, because the White Paper that was published seven days before the general election was called carried no details on who should pay, what they should pay or when they should pay. It contained no details of that sort, and I urge people to read it and compare it with the White Paper, draft Bill and other details that we published just last week. In 13 years, when the money was available, the Labour Government did not do anything; they left it until the last seven days and even then did not come up with the details.

In the space of two years, this coalition Government have advanced further and faster than any in the previous 20 years on addressing a wide range of issues and challenges and backing that with tangible action. Unlike what happened with Labour’s royal commission, so firmly kicked into the long grass, this Government have accepted all the recommendations of the Dilnot commission as the basis for a reformed system. Many of those recommendations are translated into the legislation that we published last week. Crucially, the Government accept the principles of a capped cost system as the basis for protecting people from catastrophic costs. Labour’s motion seems to suggest that Labour does, too. I want to make it clear that we are keen, still, to engage with the official Opposition and other stakeholders in reaching a final settlement on this question of the boundary between the state’s responsibility and the individual family’s responsibilities for meeting care costs.

[Mark Field (Cities of London and Westminster) (Con)]

Does the Minister not recognise that any cap, be it at £35,000 or £60,000, as was initially proposed by Dilnot, is likely within a very short time to be wholly inadequate, given the funding constraints that we are under? The harsh reality is that people who wish to preserve an inheritance for their children—that is an understandable desire—must recognise, as must their children, that those children will have to take on the burden of looking after aged parents, in both time and financial terms. It sounds like a hard truth, but it needs to be put on the record, because otherwise we are not going to get any further forward in dealing with this matter.

[Paul Burstow]

The hon. Gentleman expresses an opinion that is held by many people, but the Government’s position is not to take that view. We take the view that a cap on care costs is an important component in a redesigned system for funding in this country. What we have said clearly is that we have to address how that is paid for as part of a spending review. That is why we believe that both a cap and an increase in the means-test threshold provides the necessary assurance for a family to plan and prepare for care, and provides the mechanisms by which the financial services industry can grow and develop to offer appropriate products.

[Mark Field]

Is there not a problem with what the Minister has said? I understand that this is an incredibly difficult issue, which we all have to deal with. I have lost both my parents. One died at the age of 70, only 18 months ago, at a time when we were on the cusp of putting her into full-time care, which would have been ruinously expensive. Is not the problem with all this that if we put in place today any system with a fixed cap, it will almost certainly be superseded by events and will then be seen as unjust for future generations?

[Paul Burstow]

The hon. Gentleman identifies one of the issues associated with the design of the introduction of a cap. It is worth pointing out that the interaction between the cap and the means-test threshold means that every family would have a different level for which they would be liable to meet their care costs. The issues relating to design are real, as are those about how to meter the system from the point someone enters it, and they require detailed work as part of the design of an effective implementation alongside the costings of it.

Hospital Services (West London)

Mark Field Excerpts

Wednesday 11th July 2012 Westminster Hall

[Mark Field (Cities of London and Westminster) (Con)]

I congratulate the hon. Member for Hammersmith (Mr Slaughter) on getting this important debate, which affects all of us who are central and west London MPs. I am sure that he regrets the necessity of the debate. Our constituencies have a number of hospitals in common and, over some time, he and I have discussed health matters that affect them. New commissioning boards, run by local GPs, will come into play from next April. The Westminster board will share its management with Hammersmith and Fulham, Kensington and Chelsea, and Hounslow, and it is currently considering how the hospital configuration in west London should work. It is the soon-to-be-defunct primary care trusts, however, that will formally make the final decision.

As recently as 25 June, the North West London Joint Committee of Primary Care Trusts considered the business case for closing four A and E departments in the north-west London region. The plans are out for consultation until 6 October, and the results will, I think, be presented to the PCTs in advance of final consideration next January. As the hon. Member for Hammersmith pointed out, it is recommended that four departments in west London be closed, including those at the Hammersmith and Charing Cross hospitals in his constituency. The plan is that people can easily be steered away from A and E and towards their local health centres and GP services. There are of course a couple of fall-back options, both of which involve closing Hammersmith, though. One also involves closing Charing Cross, and the other affects the Chelsea and Westminster hospital, which, although outside my constituency—in that of my hon. Friend the Member for Chelsea and Fulham (Greg Hands)—serves a considerable number of my constituents. The joint committee seems to favour the closure of both Hammersmith and Charing Cross A and Es.

I agree with the hon. Member for Hammersmith that there is little doubt that if Charing Cross’s A and E is closed, we will see the end of a hospital there, because it would, I suspect, be only a matter of time before the majority of the Fulham Palace road site was disposed of commercially. I have two major hospitals in my constituency, one of which, Barts, serving the eastern part of my patch from over in the City of London, is not affected by any of the considerations. The other is St Mary’s, Paddington which, ironically, is probably more important to the constituents of my neighbour, the hon. Member for Westminster North (Ms Buck), than to mine, although a significant number of my constituents in the Hyde park area and Marylebone use it as their local hospital.

The Department of Health has been mindful of the fact that hospitals in the centre of London, which serve large working populations as well as residential ones, give the NHS more bang for the buck. I have often observed that my constituency has been well served over the past decade and a half by new walk-in centres and the like. The joint committee might have been tempted to realise one of its most valuable assets on the St Mary’s site, which is, like Charing Cross, a prime piece of central London real estate. From the recommendations, it seems that that temptation has been resisted, and I am glad about that, but, like the hon. Member for Hammersmith, I am not going to take anything for granted until the whole process is over. There is, inevitably, a sense that there is an element of a zero-sum game here but, like the hon. Gentleman, I do not recognise that we should necessarily be in this place, for reasons I will set out.

My constituency next-door-neighbour, the hon. Member for Westminster North, and I would have vigorously fought any plans to close St Mary’s, because the hospital has a proud historical importance and is incredibly well served by public transport, which makes it a key local service for countless central London residents. Let us not forget, in this week of all weeks, the seventh anniversary of the terrible 7/7 bombings in London. One of the bombings was on the Edgware road, and St Mary’s, Paddington had pride of place as one of the sites that played an important part in ensuring that lives were saved. I have a great deal of sympathy, therefore, with the hon. Member for Hammersmith, as he faces two closures on his doorstep. If the closures went through, they would not, perhaps, cause me the same amount of political grief, but they would affect my constituents, many of whom receive hospital treatment from some of the institutions earmarked for closure. There would also be the ongoing effect of the substantial burden of increased pressure on the area’s existing hospitals.

I accept the clinical wisdom of trying to steer traffic away from A and Es as far as possible, but before we press ahead with closures, particularly in this part of west London, we must ensure that the alternative services are truly in place and that we are not operating on some naive hope that the pressure on A and Es will miraculously dissipate once four west London departments are removed. Until there has been a proper assessment of out-of-hours care, I question the wisdom of closing as many as four busy A and Es in this area of the capital. The plan is misguided because the population is transient, with huge numbers of non-residents spending time in central London as workers, visitors and tourists. The pressures on central London are very different from those in other parts of the UK. I can understand that the Minister does not want to hear all sorts of special pleading from different parts of the country, but I think that he will recognise that in my unusual constituency I have 70,000 UK nationals, but 920,000 people working there every day of the working week. That is an extreme example, but it is fair to say that around Ealing Broadway and Heathrow airport there are also huge clusters of people who work but do not live in the area, and that should play some part in the thought process about the closures.

I want to say a little about two slightly more parochial issues, because this is not the only health proposal that has caused my constituents alarm. One is the Royal Brompton hospital, which the hon. Member for Hammersmith mentioned. The hospital is just outside my constituency, in that of my hon. Friend the Member for Chelsea and Fulham, but it serves a lot of my constituents. I have received many e-mails and other correspondence imploring me to fight the decision to close the specialist children’s heart surgery unit at the hospital, as I am sure have other central London MPs. I buy into much of the thinking on the issue of specialist care, not just by this Government but also from before 2010. In my view, it is better to concentrate specialist services in fewer and larger centres, rather than to hold on to a widespread but perhaps more mediocre service. I know that it is easy to make that case in a constituency such as mine, where services are in parts of London that are only 10 miles apart, and I appreciate that in more rural parts of the UK we are talking about distances of many dozens of miles, but I have great sympathy with the concerns that some of my constituents have highlighted. They are particularly worried that the review of the Royal Brompton has failed to consider what a difference having child and adult cardiac services in the same centre makes to the quality of care.

My constituents will point out that the Royal Brompton is one of only two hospitals in the country where four surgeons already handle well over 500 congenital cardiac cases a year, meeting, therefore, the standards expected by professionals and the review panel’s criteria. It is the only centre in the country to have undertaken more than 1,000 interventions in a year for such diseases, and the service has consistently been rated as excellent by the Care Quality Commission, the review team and, of course, Ministers. The campaigners fear that the decision to close children’s heart services will threaten the viability of the entire trust in the Royal Brompton area. The hospital hosts the country’s largest service for children with cystic fibrosis, which requires intensive paediatric care, and also anaesthesia teams to support the respiratory team with some of the most complex cases. I hope that the Minister will continue to listen to some of the concerns.

Finally, the other parochial issue, which the hon. Member for Hammersmith also raised, relates to Imperial College Healthcare, which has an important part to play on the St Mary’s, Paddington site. If the changes go ahead, the hospital looks set, rightly, to become ever more important in that part of London. I wish to touch on the recent negative press coverage, and give Imperial the right to reply, as it were. Following the deaths of some 25 patients, my local authority, Westminster city council, has expressed concern about Imperial’s poor record keeping, and the loss of a large amount of referrals data.

I received this week a missive from Mark Davies, Imperial’s chief executive, explaining that in January the trust took the rare step of taking a temporary break from reporting its performance in meeting the 18-week waiting time target for referral to treatment, and waiting times for both cancer and diagnostics. He contends that the break was necessary to establish new and robust systems for recording and reporting patient data. Reviews of that period have found that there is no evidence of the trust missing any cancer diagnoses, and the measure was a short-term one, allowing for new configuration. The trust’s view is that the negative press coverage rather overstates the case.

The matter we are debating affects us all as Members of Parliament. We understand that it will inevitably be a partisan, party political issue to an extent, but we all hold close to our hearts the area of London that we represent, and I hope that as far as possible we will work together to get the best deal for west and north-west London as a whole.

[Several hon. Members]

rose—

--- Later in debate ---

[Mr Burns]

First, the hon. Gentleman has unintentionally only given the Chamber half the quote. Secondly, the medical director will engage in the consultation responsibly and fully. It is—hon. Members asked about this—a full, proper and valid consultation, which is why I urge all hon. Members to take part.

My right hon. Friend the Secretary of State for Health wrote to the hon. Member for Hammersmith on 3 July—he mentioned this in his speech—on the process and the localism of the decision making, following the conclusion of the consultation, and to set out the process for service change that my right hon. Friend strengthened in 2010. For the record and for other hon. Members, I remind the hon. Gentleman of the position. The NHS in London, as elsewhere, has constantly to evaluate how services can best be tailored to meet the needs of local people and to improve the standards of patient care. The proposals in north-west London seek to do that, and the local NHS has now embarked on a full consultation with patients, the public and the local NHS. It is important to remember that no decisions have been taken.

On Monday 2 July, NHS North West London launched the full public consultation. It will last more than 14 weeks —two weeks longer than the normal period—to take into account that it spans the traditional holiday month of August. Patients, staff and the public will have the opportunity to review the clinicians’ suggestions, look at the evidence provided and have their say.

The hon. Gentleman knows that the NHS has always had to respond to patients’ changing expectations and advances in medical technology. As lifestyles, society and medicine continue to evolve, the NHS also needs to evolve. Reconfiguration is about modernising the delivery of care and facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives.

As I said, the Government are clear that the reconfiguration of front-line health services is a matter for the local NHS, which knows the needs of local people and how to deliver services far better than Ministers in Whitehall. That is why we are putting patients, carers and local communities at the heart of the NHS, shifting decision making as close as possible to patients, devolving power to clinicians and removing top-down influence.

In 2010, my right hon. Friend the Secretary of State set out four tests that all proposed reconfigurations had to pass. I trust that that will help to answer the point made by the hon. Member for Ealing, Southall about the decision-making process. Reconfiguration and the consultation process that accompanies it must have support from general practitioner commissioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice. Without all those elements, reconfigurations cannot proceed.

The health needs of north-west London are changing as its health services are increasing. The local NHS does not believe that the way that it has organised its hospitals and primary care in the past will meet the future needs of north-west London. I understand that north-west London has 8% more internal hospital space per head of population than the English average, even after excluding the specialist hospitals. Indeed, when combined with the number of beds available, hospitals in north-west London have approximately 50% more space per bed than the rest of the country. However, much of that extra space is not suitable for clinical care and costs those hospitals more money to run and maintain every day.

Under the preferred option proposed for changes to hospital services, the NHS in north-west London will invest £112 million in capital that will add capacity for expanded services, develop local hospital sites in the community and address maintenance issues. For example, I am sure that hon. Members, particularly in the Westminster and Fulham side of the area, will be acutely aware that only two weeks ago the Earl’s Court health and wellbeing centre re-opened after having £2.7 million capital invested in it to serve the local community.

Emergency services have been mentioned a lot. The quality of care and the time taken for hospitals to see and treat patients varies. A recent study showed that patients admitted at weekends and evenings in London hospitals, when fewer senior doctors are available, stand a higher chance of dying than if they were admitted during the week. Clinicians in north-west London have agreed clinical standards for emergency surgery and A and E that include providing expert consultant cover 24 hours a day, seven days a week. Therefore, patients admitted in an emergency at the weekend will have the same standard of care as those admitted on weekdays. We would like that approach to spread throughout the country. Rationalising emergency care in five north-west London acute sites will enable the NHS in north-west London to meet these standards, address service variability and save an additional 130 lives per annum, on the basis of the number of lives expected to be saved across London.

Clinicians argue that, to provide safe and effective care, they need experience of the most acute cases regularly, which means centralising services on fewer sites. A good example of that is stroke care provided in London, in respect of which significant improvements in outcomes and the quality and safety of patient care have been made. I hope that hon. Members agree that that is the right way forward.

[Mark Field]

Will the Minister give way?

[Mr Burns]

I only have one minute left; I hope that my hon. Friend will forgive me.

Trauma services have also been centralised, with a major trauma centre sited at St Mary’s and the two heart attack centres at Harefield and Hammersmith, which will continue to provide service.

Let me remind hon. Members of the process after the consultation is completed. As the hon. Member for Hammersmith rightly said, after the consultation has concluded, the responses have been considered and a decision taken, if the local authority overview and scrutiny committees do not agree and do not think the proposition is in the best interests of the local community, they have the right to communicate with my right hon. Friend the Secretary of State to request that he refer it to the independent reconfiguration panel. If my right hon. Friend does so, the panel will independently consider the proposals and advise him whether it believes that they are right for north-west London, and he can then take a decision accordingly. There is full consultation, full involvement and a mechanism to allow the matter to be pursued further after the consultation has concluded.

Care of the Dying

Mark Field Excerpts

Tuesday 17th January 2012 Westminster Hall

[Mark Field (Cities of London and Westminster) (Con)]

I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on obtaining this very important debate. We have heard a lot about palliative care and the hospice movement and we recognise what a patchwork of provision there is in different parts of the country. I take on board the warnings from my hon. Friend the Member for Portsmouth North (Penny Mordaunt) that that should not be used as an excuse to make assisted dying easier. I will concentrate my brief comments on assisted dying. In doing so, I will be taking up the challenge offered by my hon. Friend the Member for Hexham (Guy Opperman), who talked about whose choice this was. It perhaps was inevitable that, in answering that question, my hon. Friend the Member for Banbury (Tony Baldry), as the Second Church Estates Commissioner, took the view that the Almighty should make the determination. I recognise that many hon. Members present are strongly Christian, but I think that we have to face the fact that we live in a secular society. I do not think that that answer—perhaps slightly tongue-in-cheek—will do as we go forward. My own view—this is perhaps strange, given that I am a legislator and a former lawyer—is that the law is not the right place to make these changes. The empire of the law should not necessarily stretch into this area, and that takes on board elements of ethics and the fact that I have some belief.

I have a great concern that a right to die will rapidly become a duty to die for elderly folk and disabled people. The way in which a society looks after its most vulnerable says much about it, and if we fail to look after such people, and allow the law to change, even in a relatively subtle way, whatever the so-called safeguards, that will be a dangerous step.

The reality is that much of this debate is happening in the context of tremendous funding problems in not only the national health service, but care for the elderly—an issue that has appeared across our newspapers in recent weeks. In a way, those funding problems and the issue of assisted dying are almost two sides of the same coin, with people looking at assisted dying as somehow being an easy way forward on those funding issues.

My concern about the law is that it is simply not the right instrument. It will not give anything like the safeguards we need; indeed, it might make life even more difficult for members of the medical profession and the police, who will be reluctant to do the right thing if the laws that are put in place notionally to provide safeguards simply regulate their lives more stringently in reality.

I speak slightly from my own experience. It is 21 years ago almost to the month that my father died. He was diagnosed with terminal cancer seven or eight months before he died. I was his next of kin, and I must confess that I was very happy that we had a long-standing family doctor. My instructions, and indeed my father’s instructions, to our doctor were that my father did not want to die in pain, and that probably meant that he had more morphine, which might well have accelerated his death by a matter of days or perhaps even weeks. Such decisions should be made by the medical profession, but my worry is that any change we make in the law will make that right decision much more difficult, because it will be a regulated legal decision.

Above all, the problem is that, if we try to introduce such changes in the law, which is natural for us as legislators, we will end up introducing a charter for those who think there are elderly, disabled and other people whose lives have less value than those of the rest of us. That is a very dangerous way forward.

Going forward, we will all have to fight. As my hon. Friend the Member for Montgomeryshire (Glyn Davies) rightly said, there is a vocal group that is keen to change the law. All of us must now get ready for a battle to stand up for the silent majority, who think, very much as we do, that the importance of life should not be underestimated at all.