NHS and Social Care Commission

Mark Tami Excerpts

Thursday 28th January 2016 Commons Chamber

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

It is an honour to follow my hon. Friend the Member for Stafford (Jeremy Lefroy), who made some very good points and helpfully referred to the Barker report, which deserves to be debated. We must take a grip of some of its proposals. Although I am sure we do not all agree with everything in the report, it is a good thing to talk about.

It is also an honour to follow the hon. Member for Walsall South (Valerie Vaz). I am now a member of the Health Committee, so it is good to hear about her experiences on the Committee and to reflect on what I might do with my fellow Committee members to make sure that we are effective in driving forward the agenda of the integration of health and social care, about which she spoke so powerfully.

I thank the right hon. Member for North Norfolk (Norman Lamb), the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) for calling for this debate. It has been a good, wide-ranging and productive conversation about the future of the health service and social care. There have been extremely interesting contributions from my hon. Friends the Members for Totnes (Dr Wollaston) and for South West Wiltshire (Dr Murrison), the right hon. Member for Sheffield, Hallam (Mr Clegg) and my hon. Friend the Member for Lewes (Maria Caulfield), among others.

I share the desire and aspiration of the right hon. Member for North Norfolk to take the politics out of the NHS and discussions about the health service and social care. There are certainly situations, particularly in the run-up to elections, when there is very unhelpful scaremongering from all sides about what is going on.

[Mark Tami (Alyn and Deeside) (Lab)]

I agree with the hon. Lady. We need to look at this matter for the long term. Whoever makes such statements during election campaigns—whether it is us or the Government—the talk of death taxes and such things is not particularly helpful, because we need to form a cross-party view, given that we require long-term measures that will cost money. There is no way of getting out of that.

[Helen Whately]

The hon. Gentleman might want to hear what else I have to say before he agrees entirely with what I am saying, but we share the view that scaremongering is unhelpful.

In a health system that spends £135 billion of taxpayers’ money every year, that employs 1.3 million staff and that has over 60 million users in the British population, there is no way in which this issue cannot be political, as the hon. Member for Leicester West said. It just is political. It is no bad thing that it is political, because it means that there is a debate about it and, out of debate, we get better answers. It also means that the public are given a choice.

One concern I have about the proposed commission is that there appears not to be a consensus on what it should be about among those who support it. I have heard this afternoon that it should be about the future funding settlement for health and social care, but also that it should be about public health, the structure and configuration of the NHS—the estate solutions—the future role of mental health in the health service, prevention, and the integration of health and social care. To me, that is a problem. If the commission is to be effective and short—a period of one year is proposed—and if it is to lead to something concrete, it cannot possibly be that wide-ranging. I worry that those involved in the commission will spend a huge amount of time working out, and disagreeing among themselves about, what the commission is looking into. That process would be an enormous waste of time, money and attention—there is a limited amount of attention, brain power and resources to put into such a discussion about the future of health and social care, which is an opportunity cost.

To the extent that the commission might focus on future funding for the long term of health and social care, that is important and should be given a huge amount of attention. We need to look further out, but if anything is political, it is that question. Questions such as how much as a society we should spend on health and social care, what proportion of GDP or what amount per person we should spend, and how it should be funded—should it be taxes, charges or co-payments—are important, but they are very political. They are questions of value. It would be incredibly difficult to take the politics out of them.

In fact, it would be wrong to come to a consensus. We need a debate and we need to disagree. We need to give the public a choice. Just as the current funding settlement through to 2020—the £8 billion or £10 billion in this Parliament—was put to the public last year at the general election as part of an overall package of Government spending, taxation, debt and deficit proposals, future funding for the health and social care system should be put to the public at a future election. It is not something that should be agreed by insiders in a commission between now and the next election—the suggestion is that it should move quickly. That is a worrying proposal if I have understood it right. The public should decide that and it should be debated in the run-up to an election.

New Cancer Strategy

Mark Tami Excerpts

Thursday 19th November 2015 Commons Chamber

[Mr Baron]

I will do so by all means. Let me express my heartfelt sympathies to my hon. Friend as regards his mother. He is absolutely right that charities such as Bloodwise, as well as many others across the charitable sector, realise the importance of earlier diagnosis. I will give him one statistic that directly answers his question. I spoke at an event about bowel cancer yesterday. The statistics quite clearly show that 90% of people diagnosed in the early stages of bowel cancer survive for more than 10 years, but that figure drops to just 5% if they are diagnosed at a later stage. That is the difference that earlier diagnosis can make.

The logic behind focusing on earlier diagnosis is very simple. We have found over a number of years that the NHS is as good as any other healthcare system at getting patients from the one-year point after diagnosis to the five-year point, but is poor at getting them to the one-year point in the first place. That suggests that it is not good at detecting cancer. We lose the vast majority of those 10,000 lives in the early phase—up to one year—and then it is simply not possible to catch up. We therefore need to do more on earlier diagnosis.

Getting the NHS to focus on the one-year figures will encourage initiatives on the frontline to promote earlier diagnosis. By putting the one-year figures up in lights, we can ensure that the local NHS realises that it is being monitored. It will therefore be up to the local NHS to introduce and adapt a range of initiatives that suit the local population best, whether they are elderly people, black and minority ethnic populations or whatever. The initiatives range from everything from encouraging better screening uptakes to encouraging better awareness campaigns when it comes to education, better diagnostics in primary care and better GP referral rates, all or any of which could be approved locally to drive up earlier diagnosis.

I suggest that earlier diagnosis, as well as being better for patients, can also save the NHS money. Incisive Health and Cancer Research UK published a report last year that set out the cost savings of diagnosing a patient early. One example is in colon cancer. Stage 1 treatment costs about £3,300, while stage 4 treatment costs £12,500, which is a notable difference. If we look at the range of cancers and the number of cancer patients involved, we can see that we could save hundreds of millions of pounds if we raised our game and diagnosed cancer early.

The all-party group on cancer and the wider cancer community, including the Cancer Campaigning Group, have worked collaboratively with the Government and NHS England—I congratulate the Government most heartily on listening to our concerns—and have campaigned together to get the one-year figures into the DNA of the NHS. We have managed to get them into the NHS outcomes framework and the commissioning outcomes framework.

Last year, our efforts culminated in a successful campaign to ensure that a one-year cancer survival rate indicator is included in the delivery dashboard of the clinical commissioning group assurance framework from this April. For the moment, that is the primary mechanism by which CCGs are held to account. Many CCGs have told us that it is the primary tool they use for determining priorities at local level. With the one-year figures now up in lights in the top tier of NHS accountability, commissioners will be encouraged to take action in their local area to improve earlier diagnosis and ultimately to improve cancer survival rates.

Many people may think, “Job done. We’ve managed to get the one-year rate into the DNA of the NHS. We’ve managed to get it on the radar screen of CCGs. Is there anything else we should be doing except following through on those initiatives?” However, many of us are concerned that the recently proposed changes to the accountability system in place for CCGs may undermine this work. A few weeks ago, the Secretary of State announced a new scorecard for measuring the performance of CCGs, which will involve each CCG being awarded an Ofsted-style rating with effect from next April. Although the all-party group on cancer approves in principle the improvement of accountability, we strongly advocate, on behalf of the cancer community as a whole, that the use of the one-year figures to drive earlier diagnosis at local level is not lost throughout this process. Will the Minister outline in further detail the Government’s plan to implement a CCG scorecard and the process by which the metrics relating to cancer will be determined? Will he confirm that the focus on one-year survival rates will not be diluted?

Let me mention the reforms suggested in the cancer strategy for the patient pathway. With a growing number of people surviving cancer, it is particularly important that we make improvements throughout the whole cancer pathway, and there are two key parts to that. First, all too often patients report being treated as a set of symptoms rather than as a person, and certain groups of patients—namely older people, ethnic minorities and those with rarer cancers—report a poor patient experience. Secondly, many cancer patients lack the necessary support to get on with their lives once treatment has ended.

The all-party group on cancer welcomes the increased focus on patient experience across the NHS, but we must do more to ensure that we have the right data to drive improvement at local level. Although the cancer patient experience survey is a useful tool, too often the data are difficult to access and not widely used. The cancer strategy recommends the creation of a new metric to measure the patient experience across the whole pathway. Will the Minister set out how the Government plan to implement the strategy’s recommendation on a new patient experience metric, and say how they will ensure that data are used effectively to drive improvement at local level? Will he confirm that there will be sufficient resources for the new metric and the cancer patient experience survey?

We welcome the Government’s commitment to ensuring that all patients have access to a recovery package following their treatment, but if we are fully to address that challenge it is vital that the NHS understands where it is working well and where improvements are needed. As such, it is vital that the strategy for the development of a new quality of life metric is taken forward as a priority. Will the Minister ensure that the Government’s commitment to take forward that recommendation for the cancer strategy to develop a quality of life metric is backed up with clear plans for funding and implementation?

In the few minutes that remain, let me address a couple of key issues including rarer cancers and the cancer drugs fund. It is an interesting fact that the combined number of rarer cancers—those less common than breast, lung, prostate and bowel cancer—outnumber the sum total of those more common cancers. Services for people with rarer cancers are no less important, and we must ensure that people with rarer cancers get access to the right level of specialist expertise, irrespective of where they live. The taskforce recommendation for the creation of highly specialised multi-disciplinary teams for rarer cancers is particularly welcome. Will the Minister assure the House that that will happen, and that MDTs will be supported by technology so that they can deliver specialist care without inconveniencing patients?

Research efforts into rarer cancers must be redoubled. The Government are leading the world in their investment in genomics, most notably through their 100,000 genomes project, which is sequencing the genomes of those with cancer and rare diseases in general. It is good that the project has so far fully sequenced the genomes of 5,000 patients, but will the Minister update the House on progress with cancer patients? May I suggest that, once complete, Genomics England should independently carry that research forward for the benefit of the NHS and patients, given its excellent track record?

[Mark Tami (Alyn and Deeside) (Lab)]

Is the hon. Gentleman as worried as I am that companies that are investing in finding drugs for rarer cancers are, because of their nature, small in number, and they should not be put off investing in research to find cures for those cancers because they feel that the Government—whatever party is in power—will perhaps pull the plug or concentrate only on the more common cancers?

[Mr Baron]

The hon. Gentleman makes an excellent point, and one hopes that there is proper dialogue with all the parties concerned to ensure that what he describes does not happen. The approach to science must be collaborative. Nobody has a monopoly on good ideas, but I suggest that the Government should be congratulated on their ground-breaking 100,000 genomes project, as long as it does not freeze out research in the private sector. I hope that there is dialogue to ensure that that will not happen. If there is not, that issue needs to be raised with the relevant bodies in this place.

On the cancer drugs fund, people living with cancer need the best treatment available. We can all agree to that. Approximately 72,000 cancer patients have benefited from the fund. That testifies to the Government’s commitment. We recognise, however, that reform is needed over the longer term. We need a longer term solution to the cancer drugs fund. The Government apparently also believe that reform is essential. Recent NHS England board papers indicated a continuing overspend on the cancer drugs fund, underlining the fact that a long-term solution is needed now.

When reforms are introduced, it will be important that the spirit of the CDF—that patients are able to gain access to the treatments their doctors recommend—is maintained at a cost that is affordable to the NHS. There have been reports about NHS England refusing to discuss some offers of cost reduction with drug companies due to the rules under which the CDF operates. That needs to be addressed urgently if the overspend is to be tackled. I very much welcome—I am sure everybody else in the House does, too—the news that the CDF consultation opened today, at, I think, 1 o’clock this afternoon. I recommend, as I am sure others do, that all relevant parties participate in this very important consultation. Will the Minister provide assurances that the NHS will be supported in demanding the best possible deal from the drug companies, because that will be an important element of the process?

I want to finish by speaking about the importance of leadership and accountability, both at national and local level. The all-party group on cancer strongly welcomes both the strategy’s recommendation to introduce cancer alliances to drive improvement at a local level, and for the National Cancer Advisory Board to provide accountability at a national level. The National Cancer Advisory Board, in particular, will be important in ensuring accountability for the strategy, and that momentum and focus is retained. It is vital that this body is set up as a priority, so we can monitor progress and implementation from the beginning and set up the right structures to ensure strong accountability. Will the Minister set out how the Government plan to monitor the delivery of the cancer strategy recommendations and to measure their success?

I thank the Minister once again for responding to the debate. I know this is not his usual brief and I would be very happy for him to write to me after the debate if he does not have the answers to all the questions at his fingertips. As ever, there are a number of areas I have not had the chance to cover. Time simply has not allowed it, but I hope they will be covered by other colleagues speaking in this afternoon’s debate.

I want to finish by emphasising the opportunity presented by the new cancer strategy. By implementing its recommendations in full, and by retaining the focus on the one-year survival rates as a means of driving forward and promoting earlier diagnosis, we have the potential to deliver world class outcomes across the entire cancer pathway: to dramatically improve our cancer survival rates, to deliver care tailored to the patient and to ensure that patients are supported. But action must be taken now. Doing nothing is not an option. The challenge, as I highlighted at the beginning, is huge, but in the cancer strategy we have a clear plan for how to make it work. I urge the Government to take action now, to fulfil our manifesto commitment to implement the strategy in full, and to deliver the care, treatment and world class outcomes cancer patients deserve.

[Mark Tami (Alyn and Deeside) (Lab)]

I should start by saying that I am, with the hon. Member for Enfield, Southgate (Mr Burrowes), the joint-chair of the all-party group on stem cell transplantation.

I want to raise a few brief points in respect of the care of blood cancer patients who have had transplants and the ongoing care they receive. It is fair to say that at present the level of support can be described as patchy at best. There is a considerable lack of understanding of some of the issues that transplant patients face.

Anthony Nolan estimates that, by 2020, there will be 16,000 people in the UK living with the long-term effects of a stem cell transplant, and they will have a higher risk of secondary cancers, infections, particularly in the early stages, infertility and problems with muscles and joints. Then there is an area not touched on much: the psychological effects of both the diagnosis of blood cancer and a transplant. Graft-versus-host disease will affect the majority of patients in the early post-transplant period, but it can persist for many years. Some element of the disease is not necessarily a bad thing, because it shows the transplant is working, but if it gets out of hand, it can cause organ failure and a host of other problems that can, and do, kill patients. In the longer term, the effects can be as minor as skin irritation, but, if in the gut, they can lead to more complicated problems, resulting in the patient having to go back into hospital.

As I said, the flare-ups can occur not only in the first few years, but many years down the line, yet a survey of 27 transplant centres in the UK found that while they all provided support for a year post-transplant, only half followed up after five years. Importantly, only 28% offered mental health support. This problem affects not only cancer patients, but a whole host of healthcare issues: we address the physical side of an illness, but then the patient walks out the door without our addressing their mental health needs or asking how they are coping with the diagnosis and other ongoing problems.

Some years ago, I spoke in the Chamber about my son’s experience of having a stem cell transplant. We had to look for support and counselling. Children, particularly younger children, will have questions such as, “Why has this happened to me?” and “Why can’t I run like I used to?”, but we had to ask for that support. It was not necessarily there in the first place or as part of an overall package, as one might have expected.

I said in the Chamber that I was particularly concerned about the lack of support for children going back to school. I believe there are still no national guidelines for how schools should deal not only with returning pupils, but with other, particularly younger, children. How might they feel about seeing a child they have not seen for a while? The last time they saw them they looked like them, but now they might be on steroids or have no hair—a particular issue for girls, although it is not great for anybody. I was concerned about the poor provision and the lack of guidelines. Some schools do it very well, but some show very little understanding. CLIC Sargent has done a lot of work in this area, but we need to do more. We have to look beyond cancer. Cancer is what people are treated for, but there is a host of other issues around it. We need to look at the whole, rather than just the illness itself, and at how we support people after that illness.

We define the transplant period as 30 days prior to and 100 days after the transplant, but this assumes that all patients need the same support and have the same outcomes. It takes very little account of some of the late effects that patients will experience. No patient is the same or will have exactly the same demands, yet there is this idea that we can set an arbitrary period of 100 days, as though at the end of it we can say, “Well, everyone’s fine. We don’t need to give them the same level of support.” However, patients go to their local area and then we are back with this postcode lottery, where some get very good support but some get very little, particularly if people are not exactly sure where they should go to receive support.

I do not think that is particularly fair, so I would like—and I know Anthony Nolan would like—a system that looks a lot further than 100 days and instead looks for support for a five-year period at least. Clearly there will be different requirements within that. Hopefully, some patients will not need a great deal of support, whereas others may need a lot of ongoing support. We need the flexibility to respond to that, rather than taking a one-size-fits-all approach.

We need to do more on ongoing support, and we should not forget either that stem cell transplants are now evolving—they are a lot more common than they were—and it is not just blood cancers we are looking at. Through the work of the all-party group on stem cell transplantation, I know that this is an area that offers us a great opportunity. Equally, we cannot ignore the fact that 50% of transplant patients die within the first two years, so there is a lot of work we need to do—generally, it is not the transplant that kills them, but some of the associated problems and immunity issues.

Finally, let me say to the Minister that we need to look more broadly at how we support transplant patients, get beyond this arbitrary figure of 100 days, and support people with the physical illness but also, very importantly, with adjusting to some of the psychological issues that can arise.

--- Later in debate ---

[Mark Tami]

Does the Minister agree we should be talking about people living with cancer and the associated issues? A lot of people talk about “a cure” as if everything goes back to how it was before the diagnosis.

[Ben Gummer]

We should indeed. I found the hon. Gentleman’s remarks extremely interesting; I learned a lot from them.

I want to answer hon. Members’ questions as well as I can, although I am conscious that I am answering them on behalf of the public health Minister, who has responsibility for cancer and has considerable expertise in this area. She is sorry she cannot be here. My hon. Friend the Member for Basildon and Billericay (Mr Baron) asked some salient questions. The first was: when will the taskforce conclusions be implemented? He will know that the new national director for cancer has just been appointed, and I met her yesterday. As he knows, she is an immensely impressive women, having run one of the foremost cancer institutes in the world, and she is aware that one of her initial tasks is rapidly to set out an implementation plan. In doing that, I know she will want to speak to the all-party group on cancer as soon as she develops her plans in order to keep its members abreast of developments and to hear their views about the pace of implementation. I will ensure that officials write to Members with any further details about implementation.

My hon. Friend asked about the CCG scorecards. I understand the nervousness—I detected it in his voice—about the complex measurements and the dashboard being translated into apparently simple measurements in the scorecard. I want to give him some reassurance. The scorecards used for hospitals are immensely complex and have behind them a huge amount of data that are then distilled into simple scorings, the point of which is to provide clear accountability and transparency to patients and people living in CCG areas, who, at the moment, have no grip, because we do not give them any, on how well a CCG is performing. The expert panel looking at the operation of the scorecards will be out for consultation next month and will report back before the scorecards are put in place in April. I know it will listen carefully to his comments about one-year survival rates and the detail of how the scorecards are put together, but I am clear that the oncological experts on the panel will not want to undermine the work done on the various metrics and the dashboard.

My hon. Friend spoke with eloquence about genomics. It is of course true that the reason we are able to make increasingly rapid progress is that cancer is a genetic disease, and genetics and genomics are the great new frontier in medical innovation. In a sense, therefore, dealing with cancer and drugs for cancer will be the tip of the spear when it comes to developing all new drugs in the decades ahead. It is very exciting, but presents massive challenges to funded healthcare systems around the world. It is in trying to find a way of affording the new drugs that are coming online, but also releasing the unique possibilities that the NHS offers, that we think we are in such a strong position to offer opportunities both to those wanting to research cancer from an academic point of view and to those businesses and companies doing so in order to develop drugs.

The point of saying that is that the cancer drugs fund, which many Members referred to in their speeches, will necessarily have to change in response to the significant changes of the last few years. To the shadow Minister’s point about the cancer drugs fund, I would gently say that it was an innovation personally promoted by the Prime Minister in 2010. He has made a personal commitment to it, so all Members should take solace from the fact that he will be watching carefully how the fund develops. It has risen from a few hundred million pounds to over £1.2 billion. That demonstrates a commitment that was not present before the cancer drugs fund was invented. Its size is such that it now makes up a considerable part of the overall drugs spending of the NHS.

I hope hon. Members will take comfort from the fact that the consultation announced today by NHS England aims to build on the success of the cancer drugs fund, to incorporate the new structures that need to come about as a result of the significant changes in genomic research over the last five years and to align the general research, licensing and funding of drugs through NICE with the principles of the cancer drugs fund, so that we have a far more integrated system in future. I would encourage all hon. Members present to contribute to the consultation on the cancer drugs fund and thereby help to inform the second stage of its existence, when that comes about—I imagine at some point next year.

Cancer Drugs

Mark Tami Excerpts

Tuesday 20th October 2015 Westminster Hall

[Mark Tami (Alyn and Deeside) (Lab)]

My hon. Friend has outlined all the hoops that people have to leap through. If their timing is wrong, they may or more likely may not qualify for the drug. That is happening when patients are at their weakest. They are not experts, and they find themselves victims of what can appear to be a very cruel and harsh system.

[Nic Dakin]

My hon. Friend is right that patients and their families are at a critical point, which is why it is important that, on this difficult issue, we try our best to find a way forward that is sensitive to the need for such exceptional drugs in exceptional circumstances. In many ways, the Government should be praised for introducing the cancer drugs fund, but the CDF is clearly not fit for purpose when dealing with such exceptional situations, which is what is needed.

Other countries across the world are taking a leap forward in approving Abraxane for their health systems. Abraxane has been approved on price grounds for reimbursement in Austria, Denmark, Germany and Greece, and it has been given the go-ahead in the USA, Canada and Australia. There is a real danger that patients in the UK will be left behind unless they happen to be in Scotland. Removing access to Abraxane could mean that fewer patients can access trials. Moreover, we could be setting back research into a disease that for many years has had the worst survival rates of the most common cancers. This is an opportunity for a breakthrough in medical research that needs to be taken

I ask two things of the Minister, who goes about his work in an assiduous and effective way. First, can he take steps to examine the processes that NICE and the CDF use to consider drugs so that they take into account the exceptional circumstances surrounding drugs of this nature in areas where there has been no medical process or medical hope for many years? Secondly, will he meet me and the other officers of the all-party group on pancreatic cancer to explore the specific issues around Abraxane?

Adult Stem Cells and Life Sciences

Mark Tami Excerpts

Tuesday 15th September 2015 Commons Chamber

[Mr Burrowes]

I do, and I want to look at the long-term outcomes.

My co-chair on the all-party group on stem cell transplantation, the hon. Member for Alyn and Deeside (Mark Tami), is present, and our group has been looking at some of the outcomes of research. Last year we joined together with the all-party group on medical research and heard from a number of experts, not least Dr Rob Buckle, director of the UK Regenerative Medicine Platform. He said that the major challenge which remains is translating the basic science into the clinic. He said that we are still at least 10 to 15 years off routine clinical use of stem cells.

[Mark Tami (Alyn and Deeside) (Lab)]

The hon. Gentleman has touched on some of the late effects of transplantation, and the fact that we are getting patients with late effects proves that people are living longer, but we need to put more money into research and into looking at these problems, to ensure that patients live as normal a life as possible.

[Mr Burrowes]

The hon. Gentleman and I have for a number of years been party to reports recommending to Government that we need to invest in research to provide better long-term outcomes in transplantation and future therapeutic treatments.

One key area is Alzheimer’s, and some of us may have received a briefing from the Alzheimer’s Society. We know from our constituencies the huge impact of Alzheimer’s. There are 850,000 people living with dementia in the UK today, and this is forecast to rise to over 1 million by 2025 and to exceed 2 million by 2050. A technique was developed in 2012 to turn adult cells into nerve cells, which again highlights the curative potential of stem cell transplantation. That can be particularly helpful in understanding and testing potential treatments for Alzheimer’s.

The Minister will know that the estimated cost of Alzheimer’s is a staggering £4.3 billion, which is approximately 3.4% of total NHS spending in the UK in 2013. Observing the initial stages of Alzheimer’s in nerve cells can give scientists clues to help them identify genetic risk factors. It can also be used to test potential treatments to see whether the damage from Alzheimer’s can be stopped. We are a long way from that, but it is an illustration of how important it is for us to carry out further research into adult stem cell transplantation. Indeed, it is vital; it makes economic sense and will save lives.

I wish to focus on my involvement with the all-party group on stem cell transplantation and to highlight the potential of cord blood donations to transform our ability to meet the needs of every patient who requires a stem cell transplant, including black, Asian and minority ethnic patients, who have suffered from such poor transplantation outcomes. It is a scandal that, in 2010, just 40% of BAME patients were able to find a well-matched stem cell donor. That figure has increased now to 60%, which is really welcome, and the Government can take plaudits for that. The £4 million that was pledged in 2013 and the total investment of more than £12 million since 2011, along with all the investment from the charitable sector, have made a difference, but we still face a situation in which four in 10 people from the black, Asian and minority ethnic community are unlikely to find a match, which is not good enough. We must do more, and I urge the Minister to support continued and sustained investment as we approach the next spending review.

We need to focus on the outcomes. Of the 6,200 patients who will receive a stem cell donation between now and 2020, one in three will not survive their first year after transplant. Of those who do survive their first year, many will suffer a number of post-transplant complications, including relapse, infection and graft versus host disease.

Since 1993, the collection of stem cells from cord blood and bone marrow has increased at impressive rates, meeting the needs of many patients in the UK. Over the past three years, we have seen progress in a number of areas. Cord banking rates have tripled, a quarter of all cord transplants in the UK are now sourced domestically, and the cost of transplants to the NHS has decreased dramatically. But the urgent need for improvements in long-term outcomes remains. In order to make the necessary progress, the UK needs to ensure that the early-stage advancements are sustainable by investing in long-term research, which is the focus of this debate, identifying improvements to treatments and developing potentially new life-saving therapies. So what needs to be done?

--- Later in debate ---

[Mr Burrowes]

I agree with the hon. Gentleman on many of these issues. Progress has been made on collection rates, particularly among the black, Asian and minority ethnic communities, but we need to find better ways to do this. As I said, one in four people are unable to find a match. My hon. Friend the Member for Salisbury (John Glen) is himself a donor, and he can speak for himself on this. I know that others present in the Chamber have family members whose lives have been saved by people donating. I want to send out a message from the debate tonight for people to donate and to be part of the registry, so that they can help to save lives.

[Mark Tami]

This is not just about finding a match. We also have to think about the quality of the match. Everyone would like to see a 10 out of 10 success rate, but as a result of technological advances, lesser matches can now be used to help to save lives, even though they are not ideal.

[Mr Burrowes]

Absolutely; I welcome that point. We are not talking simply about increasing capacity all over the place. We must remain focused, particularly on the black, Asian and minority ethnic communities, to give them greater opportunities. We must also focus on quality and on the long-term outcomes. When a match is found, we must ensure that the transplantation happens and that there are no barriers to a good long-term outcome. We need further research if we are to achieve that.

Professor Craddock has estimated that the network will need £3.4 million of funding over four years. It is not going to be cheap, but there is a great return in terms of lives saved and good health outcomes. The lack of investment in this industry is a reflection on some of the uncertainty about the way in which we should go forward, but Professor Craddock’s approach is a trailblazing way forward.

The call to the Minister is to follow what is said in our report “Cord blood transplantation: meeting the unmet demand”. We made a specific recommendation to the Government to establish a national stem cell transplantation trials network to facilitate and promote high-quality research into cord blood as a curative therapy for patients with blood cancer and blood disorders. He will know that that is very much in line with the Government’s current strategy to develop the life sciences industry in the UK, as stated in the 2012 life sciences update. It says:

“We recognise the importance of empowering patients to participate in clinical research, and have set up the Clinical Trials Gateway, with associated mobile applications”.

We have yet to receive the Government’s formal agreement to support the all-party group’s recommendation, and I look forward to the Minister saying today that he agrees with it. I hope that he joins with the broad support from across the transplant community of well-organised stakeholders in the field who are looking to the Government to provide that lead, support and engagement, to make the UK a world leader in transplantation, research and life sciences—and that will need resources. I also ask that he meets the Anthony Nolan trust and other stakeholders to discuss this issue of research and long-term health outcomes, and the recommendation of the all-party group. We would be happy to welcome him to discuss all those things at our next all-party group meeting.

Drugs: Ultra-rare Diseases

Mark Tami Excerpts

Tuesday 16th June 2015 Westminster Hall

[Greg Mulholland]

The hon. Gentleman is right to say there are other such conditions. I will not be able to mention them all today, but other Members may wish to do so. I will concentrate on the three conditions that I have been working on: Morquio, Duchenne and tuberous sclerosis. Some 180 people suffer from those conditions. I am sorry to say that all those people and their families have been hugely let down by the repeated failure of process by NHS England and by the thick wall of bureaucracy and utter lack of accountability.

[Mark Tami (Alyn and Deeside) (Lab)]

Like the hon. Gentleman, I have been involved in the issue of Morquio. The correspondence that we have had seems to want to blame the company; the company says it has not had the information; and patients suffer. This matter has been drawn out, and we now have the news from NICE.

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[Greg Mulholland]

I thank the hon. Gentleman for his contribution. I am sure the Minister will want to consider that in his drive for an appropriate system.

After NHS England suspended the use of the scorecard on 2 December, a meeting of the NHS England clinical priorities advisory group on 15 December was called off. That is when we started campaigning for an interim process while NHS England went back to the drawing board. NHS England refused to do that, which I am sorry to say left all these families in the dark, with no idea what would happen next or in what timescale. NHS England then launched a consultation on 27 January, with a new process for deciding which drugs to fund that closed on 27 April. We still have not heard the decision. We have been told that there may be a decision on 25 June, although that has not been confirmed in writing. I hope that the Minister will give confirmation today.

Linked to that are the recent NICE recommendations, and particularly those on Vimizim. Even though we were clearly told by NHS England that its decision on 25 June would not be dependent on NICE, it now says that it will not approve Vimizim because NICE will not do so in the short term. The whole thing is a fiasco and an embarrassment. I understand the Minister’s argument that we cannot have political interference. However, the Secretary of State for Health made clear when he appeared before the Public Administration Committee in the previous Parliament that he accepts that the buck stops with him. When things are wrong and when bureaucrats are failing, it comes to his desk and to the Life Sciences Minister’s desk. I urge the Minister to take that up.

I pay tribute to the MPS Society for its amazing campaigning, and particularly to the chief executive Christine Lavery, whose son Simon had Morquio and died in 1982 aged just seven. Her passion and her colleagues’ passion have inspired me and others, and we will continue to work with them. The enzyme replacement therapy produced by BioMarin, Vimizim, is currently supplied on a free trial by BioMarin to 34 patients around the country out of a total of 88 patients, so more people with Morquio are not getting Vimizim than are.

The list price for Vimizim is £395,000 per person per year. In October, BioMarin proposed a fixed-term arrangement with NHS England to supply the drug at a lower price for a number of years. After BioMarin’s offer in October, NHS England did not even reply, despite repeated follow-ups, forcing BioMarin to announce in February that it would cease to supply the drug after 11 May; that date was then extended to 25 June. Having heard nothing, BioMarin said that it would have to withdraw the drug.

[Mark Tami]

Gracie Mellalieu in my constituency, fortunately being in Wales, will get the drug until October, but there is still that cut-off point. Is the hon. Gentleman amazed, as I was, at the total lack of engagement from NHS England, even when that offer was made?

[Greg Mulholland]

It is absolutely disgraceful and I urge the Minister to properly take that up. We have not had answers or justifications, although there can be no justification for NHS England behaving in that way. NICE’s decision not to recommend approving Vimizim in the short term has already been deemed to be flawed by those involved, including the MPS Society and clinicians, because it fails to consider BioMarin’s offer and has assumed that the cost of the drug will be the original £395,000. How has that happened? NICE also took months to put together the interim guidance, but has given only until next Tuesday to receive the extra evidence that it has asked for. Surely that is an unfair timeline for response.

As of 28 April 2015—which, incidentally, is a year after Vimizim was approved by the European Medicines Agency, meaning that it is approved in 20 European countries, including France, Germany and the Czech Republic—the drug was still not available in the UK, because NHS England has failed to put in place arrangements for funding it. Does the Minister not share the sense of frustration, anger and disbelief that the NHS refuses to fund the drug when so many of our neighbours do? More fundamentally, Earl Howe gave patients an assurance that their access to the drugs that they need would not depend on the cost per quality-adjusted life year measure. Can the Minister tell us why his Department has gone back on that assurance? That is exactly what it appears to have done.

I appreciate that the Minister has taken the time to meet us, but I remind him of the 11-page letter that he asked the organisations to send him some 11 weeks ago. We expected him to respond to that, as it was a complaint about NHS England’s handling of the matter, yet he simply passed it on for NHS England to respond to. That is not what we asked him to do, and the response does not address the points that we made to him, at his request, about how NHS England has failed people. I ask him again to reply directly and properly, and to investigate the mishandling of the situation by NHS England.

Duchenne muscular dystrophy has been mentioned. Again, I highlight the campaigning of organisations such as Muscular Dystrophy UK, Joining Jack, Action Duchenne, the Duchenne Family Support Group, the Duchenne Children’s Trust, Alex’s Wish and the Harrisons Fund. Those groups share the MPS Society’s frustration at the process. As many hon. Members know, Duchenne muscular dystrophy is a condition affecting only boys, and numerous potential treatments are in late clinical trial. Translarna, in particular, received conditional approval funding in the EU in August 2014. This clearly effective drug is being funded in a number of countries, including Greece, even given its economic situation, yet we are still no closer to hearing whether it will be funded here. I hope to hear positive news on that drug today.

I pay tribute to the Tuberous Sclerosis Association and the work of Jayne Spink and her colleagues. For those who do not know, tuberous sclerosis is a condition that causes the growth of tumours in organs, including the brain, eyes, heart, kidneys, skin and lungs, and a range of associated health problems, including epilepsy, learning difficulties and behavioural problems. The drug everolimus has been found to be effective in shrinking the tumours, extending life and improving quality of life, but although it was licensed for use in patients with tuberous sclerosis in February 2013, NHS England has failed to draw up a prescribing policy. At least two people have already died since the drug was licensed; Chris Kingswood, a consultant nephrologist, said that Julie Brooker’s death in January 2013 was “absolutely preventable” if she had been given access to everolimus.

NHS Specialised Services

Mark Tami Excerpts

Thursday 15th January 2015 Westminster Hall

[Mark Tami (Alyn and Deeside) (Lab)]

Thank you, Sir David. I thought that I would probably be next. Your knighthood was the very least that you should have been awarded; I think that that was even more creeping than everybody else’s contributions. I thank the hon. Member for St Austell and Newquay (Stephen Gilbert) for securing this important debate.

I will confine my comments to stem-cell transplants. As many other hon. Members have done, I declare an interest, because I am the joint chair of the all-party group on stem-cell transplantation. My eldest son, Max, had a stem-cell transplant some seven years ago, so I also speak from personal experience. Approximately 1,600 patients a year receive a transplant from an unrelated donor or a family member. Transplants are certainly not an easy option. When my son had one, someone asked me, “Why did you take the easy route?” If that is the easy route, I cannot imagine what the difficult route is like. It certainly was not easy; it is a highly risky process and there remains a high chance of mortality. Success rates have improved, however, and great progress has been made over the years. For many patients, a transplant is the only choice that they have to save their lives.

Most blood cancer patients will receive the protocol of chemotherapy and other drug treatments. That will be the preferred route for most patients, and most now have very successful outcomes. For some, however, the protocol is not appropriate and it will not work. Depending on their particular condition, the long-term outcome under that therapy is that they will relapse, so transplant is the only option. Some patients for whom chemotherapy was seen as the correct option will also relapse, and once that has happened, transplant is the preferred option. I emphasise that that is the case for a limited number of people.

Patient experiences and outcomes from transplant are very varied. Some will suffer a whole host of problems, and some may not. There is not a uniform outcome for every patient. The transplant episode, from an NHS point of view, is defined as a period beginning 30 days before transplant and ending 100 days after transplant, and services are commissioned nationally. After that period, funding for patient care returns to the local level, although patients will probably still get ongoing treatment at specialist transplant centres. The period of 100 days may be appropriate for many patients, but it is not appropriate for all. Some patients will have a very different experience and respond differently, and they will not come out the other end fine.

More than 50% of patients will experience graft-versus-host disease. Some minor graft-versus-host is expected, and it at least shows that the transplant has taken and that something is going on; it is fighting to establish a proper graft. If it gets out of hand, however, it can cause organ failure and, in the worst cases, death. The severity of the disease depends on how close a match the transplant is. The best match is always sought, but it can sometimes be difficult. I put on record the great work done by Anthony Nolan in getting people on the register. I emphasise that this is one of the few areas in which it is possible to save a life by giving something without having lost one’s own life, and it is an incredible experience.

[Sir Bob Russell]

Anthony Nolan asking people to go on the donations register is a wonderful aspect of life in the 21st century. Does the hon. Gentleman agree that there is a specific issue for people from ethnic minorities, and specifically for people of mixed ethnicity, because the number of people who can be matched is so small?

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[Mark Tami]

I agree, and that is a fact that few people know. A white person has a 70% to 80% chance of finding a match. For some ethnic groups, the chance of finding a match can be as low as 30%. For those of mixed race, depending on what that mix is, it can be even worse. We need to do much more work in those areas to try to explain that. It is the same with giving blood, where there is also a problem. The two are connected, but there is a big problem there, and we need to do a lot of work on it. Transplants are also being used for sickle cell disease, which is an important area that has already been mentioned.

Many of the graft-versus-host issues appear during the early days, but that is not always the case. Flare-ups can happen many years later. Hopefully they will become less severe as time goes on, but we cannot say that they will stop at a particular time—100 days or any other arbitrary figure. GVH is not the only problem; most transplant patients will contract a series of infections due to their immune system being compromised as a result of the treatment they have to receive to ensure that the transplant is in the best position to take. Those infections might not prove particularly dangerous to the rest of us, but they could prove fatal to a transplant patient. In the longer term, secondary cancers are another issue that has to be faced. However, without the transplant these patients would not be alive even to think about such issues, so we always need to put matters into proportion.

We have talked a lot about the physical impact of a transplant, but the psychological effects are often ignored, and there is perhaps a lack of support. Transplants are a difficult process, particularly for children. My son was in hospital, off and on, for two years, which is a big chunk of a nine-year-old’s life. Even for adults, transplants are a major step. We need to do a lot more to address the psychological effects by providing better counselling. Some support is provided in hospitals, and I have experience of that, but once people leave hospital they have to search long and hard to get support. It is a fact that transplant patients have a higher rate of suicide than the rest of the public.

[Kerry McCarthy]

I visited the cystic fibrosis unit at Bristol, and one of the key problems for people from remoter, rural areas is accessing the ongoing support, or even the drugs, that they need. In the cities there may be a concentration of patients with the same illness or a unit that specialises in treating it, and one of my concerns about co-commissioning is that a CF patient somewhere in Devon or Cornwall will have very few other patients nearby. The problems that such patients already have with being remote from the hospitals that treat them will be exacerbated if there is a local element.

[Mark Tami]

I totally agree. Thankfully, not many people have these conditions, so particularly in rural areas, someone might be the only person with the condition, and accessing support may be much more difficult.

After the 100-day cut off it becomes far more problematic for both the patient and the health provider. The term “postcode lottery” has been mentioned a lot today, and it is certainly the case when accessing support. After such a traumatic procedure, a postcode lottery is the last thing that people need. We must move away from the arbitrary 100 days, which does not fit what the patient actually needs. We need a more flexible approach that focuses on the patient, rather than just some figure that we seem to think may or may not cover the majority of people.

Support should go arm in arm with a proper transplant pathway that addresses how we look after transplant patients after those 100 days, or whatever figure is used, for as long as necessary. I have always been struck by the fact that we spend a vast sum on each transplant on the medical and hospital side, probably hundreds of thousands of pounds by the time we finish, but when the patient leaves that environment, the level of support is very poor. We need a more joined-up approach, particularly for children. A few years ago I spoke in an Adjournment debate in the House on support for children who have had cancer and are returning to the school environment. I was shocked that there are no national guidelines on how we reintroduce children. It is a scary, traumatic process not only for them but for their classmates, particularly if they are very young. Their classmates might suddenly see a child they have not seen for a while looking very different. Some schools are very good and some are absolutely hopeless in the support that they give. I am going slightly off the subject but the Department of Health and the Department for Education must work together, rather than arguing about who is responsible for providing such support.

My last point concerns patients who have had a transplant but unfortunately have relapsed. A transplant is not an easy option, and it is traumatic enough, but when the transplant fails, perhaps a year or two down the road, the patient is faced with a bleak outcome unless another transplant is available. Indeed, when a transplant is first performed, a proportion of the cells will be kept to have another go, if I can put it in those terms, in the event of such an outcome. That will obviously apply only to a limited number of people, but for that limited number of people it is their only hope. In the past we have seen that a second transplant tends to go ahead because the number of people affected is not particularly vast, but in England a second transplant now has to be provided by the NHS England individual funding request process. I understand that in recent months a number of those requests have been declined. I also believe that NHS England does not intend to address the issue until April 2015 at the earliest, although it recognises that there is an issue. When it does, I do not know how long it will take to decide what to do or, indeed, what the outcome will be. That is unacceptable. It is not too dramatic to say that lives are being lost because of that delay and this unnecessary process.

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[Norman Lamb]

I can reassure my hon. Friend on both those points. Openness, transparency and engagement with patient groups are incredibly important, and I would always argue the case for them.

Collaborative commissioning would be an open offer; it would be an opportunity to keep up momentum for high-performing CCGs that are keen to deliver more for their local communities. NHS England is looking to pilot or trial these innovative arrangements in 2015-16—nothing more than that.

NHS England has established a specialised commissioning co-design group, including members of the NHS commissioning assembly, with advice coming from clinical and patient experts, to develop further the details of the collaborative commissioning approach. NHS England will also support CCGs to ensure that the commissioning system remains stable during the transition to any new arrangements.

NHS England is now embarking on a comprehensive programme of patient and stakeholder engagement to support the implementation of these changes; I think the hon. Member for Mitcham and Morden made a plea for that engagement to happen.

[Mark Tami]

It all sounds very good; localism is always thrown around as being a positive thing. My concern is that it still creates uncertainty. From the patient’s point of view, the uncertainty must be whether they will be able to access the treatment they need where they live.

[Norman Lamb]

That is a legitimate concern and fear, but the arrangements have the potential to avoid that risk, so that those concerns and fears are not realised; I will expand on that in a moment.

Guidance will be issued later this month setting out the detail of the proposed changes, alongside the criteria that determines which service is commissioned at which level. The engagement programme will include a number of patient and public engagement events and workshops in February, led by regional and area teams, to help to co-design the process for implementing the changes with CCGs. I encourage involvement with that programme, and as part of it NHS England will seek views on the criteria to decide which service is best commissioned at which level.

NHS England acknowledges that people are concerned about the re-emergence of a “postcode lottery”—the hon. Member for Alyn and Deeside specifically mentioned that point—as a result of a more collaborative approach. In particular, people are concerned that specialised services could once again be commissioned in a variety of ways across the country, resulting in patients experiencing difficulties in accessing services.

I totally understand why people have that anxiety, but let me be clear that NHS England would remain the accountable commissioner for any services commissioned collaboratively with CCGs. My hon. Friend the Member for St Austell and Newquay referred to the Health Committee’s concerns about the previous arrangements. However, because NHS England would remain the accountable commissioner and because commissioning would be done collaboratively, I think that concern has been sufficiently addressed.

Since April 2013, NHS England has achieved significant progress in developing a set of nationally consistent service standards and commissioning policies, which have been widely welcomed. They ensure equity of access to high quality services; the point about access was referred to by a number of hon. Members. These standards and policies will still apply for specialised services that are jointly commissioned by NHS England and CCGs, and NHS England will continue to improve on those in the years to come. I think that the shadow Minister, the hon. Member for Copeland (Mr Reed), also raised concerns about access and I hope that he finds what I have said about it reassuring.

For any services that are fully devolved to CCGs, allocations will be made on the basis of activity. Data from NHS England area teams would be used to trace historical activity levels and CCG funding allocations would be based on those, with adequate adjustments for population increase.

The purpose of the move to collaborative commissioning is to support more effective joint working and to allow discussions about service redesign to take place across the local health economy, engaging both national level and local level to try to build capacity.

In the short term, patients should not notice any difference to the service they receive, and in the medium to long term NHS England is confident that these changes should result in improvements, rather than a deterioration—including improved outcomes for patients, more integrated pathways and a better patient experience. We continue to work closely with NHS England as it develops these proposals and engages with all those involved in the commissioning of specialised services, including CCGs, individual patients and—critically—patient groups, area team commissioners and providers of services.

I thank all hon. Members and the sole right hon. Member here today, the right hon. Member for Wolverhampton South East, for contributing to this debate in a constructive way. The issues that have been discussed are of real concern, and it is right that they should have been raised. However, I think we have the potential to improve the way in which the system operates.

Contaminated Blood

Mark Tami Excerpts

Thursday 15th January 2015 Commons Chamber

[Sir Oliver Heald (North East Hertfordshire) (Con)]

The hon. Member for Newport East (Jessica Morden) has explained this tragedy extremely well. I first became aware of the issue in the early 2000s when I was a member of the all-party group on hepatitis C. I would like to pay tribute to the work of Jim Dobbin, whose memorial service it was yesterday. He was a great campaigner on a number of health issues and will be sadly missed.

I congratulate my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) on doing a wonderful job to secure the debate, and on working so hard on this issue. A constituent of mine recently told me that attending a meeting chaired by him in the House had left her more reassured than ever that he, and the group of MPs involved, would eventually obtain a decent settlement for all victims and their families.

I have a very old friend who has haemophilia. He has kept me informed on the issue over many years but is not very well these days. I would like to pay tribute to my constituent Mrs Ward. She campaigns on the issue on behalf of her family, who have been very badly affected by it. It is an issue of compassion; it is an issue for our generation; it is an injustice and a scar on the NHS. It has to be resolved.

We all feel for the people who are continuing to struggle with the aftermath of this decades-old mistake. The right hon. Member for Cardiff Central (Jenny Willott) made the point that this blight can run down the family for years. Obviously we understand the background of the original lack of understanding and the medical challenge to treat people with haemophilia, not knowing with security that the blood was safe. It is good that Governments have now recognised the extreme harm and the disaster that this was for victims, for which compensation was necessary. The arrangements put in place in 2011 were a major step forward.

I want to make three points. The first is that the APPG’s excellent report highlights the confusing system for compensation, with the five separate bodies all receiving Department for Health funding. There are two private companies and three registered charities; it is too opaque. I hope Ministers will see whether there is some way of improving the signposting to ensure that people can find their way through it.

The second point is that even if one understands the funding to which one is entitled, the process of claiming it is difficult, confusing and onerous.

[Mark Tami (Alyn and Deeside) (Lab)]

Does the hon. and learned Gentleman agree that people need help through the difficult and complex process to ensure they get the outcome they deserve?

[Sir Oliver Heald]

Yes, I do agree. The hon. Gentleman will know that there were people who underwent treatment for hepatitis C, but somehow the NHS has lost their records. That affects their applications. As the hon. Gentleman says, some way must be found to support people in this complex process.

One of my constituents tells me that new treatments for curing genotype 1 hepatitis C have been approved, but access seems to be granted only on “compassionate grounds”. Apparently, that excludes that constituent. She describes it as a “painful irony” that the problems that led to the NHS providing contaminated blood in the first place are now denying a survivor the appropriate treatment. I hope the Minister will look into this case, so that rather than having to prove compassionate grounds it can be dealt with as an entitlement.

The tragedy of this is deeply upsetting, and we must step up to tackle its legacy. The Penrose inquiry is expected to report soon, and its findings will, I am sure, be considered carefully by the Government. We are all pleased that these steps are being taken and that there has been progress, but this has not yet led to closure. That is necessary for the survivors, and it is necessary for the survivors and their families to have the support and dignity that they deserve. It is incumbent on our generation to sort this out, and this is the place to do it.

Aerospace Industry

Mark Tami Excerpts

Tuesday 2nd September 2014 Westminster Hall

[Sir Peter Luff]

That is true in the civil and defence markets—long lead times are a characteristic of new aircraft development. That is why the AGP is intended to span 15 years, and why it is vital that it receives cross-party support, to ensure support continues throughout future Administrations. Therefore, I have a central and, I hope, easy question for the Opposition. Do Her Majesty’s loyal Opposition hold true to the principles to which Labour worked in the last Parliament, and do they still endorse the broad approach being followed by the Government in this Parliament, subject to the kind of detailed questions that we are asking today?

I cannot avoid the sensitive issue of the understandable rivalry between Airbus and Boeing. I bow to no one in my respect and admiration for Airbus UK and its management team. I bitterly regret that the British share in the ownership of this fine business was lost when BAE Systems unwisely divested its shareholding. As a result of that decision, we have to work all the harder to ensure that we keep, and if possible increase, the UK’s share of each Airbus aircraft that is built. Airbus employs around 10,000 people directly in the UK: 6,000 at its site in Broughton, north Wales; and 4,000 at Filton, in Bristol. Broughton manufactures the wings for all Airbus civil aircraft; Filton designs the wings, as well as designing and testing the fuel systems and landing gear. Filton is also the manufacturing site for the wings of the A400M military transport aircraft, which will soon go into RAF service as Atlas. The Airbus supply chain involves another 1,000 UK companies; Airbus is one of the UK’s biggest inward investors in R and D, with 2013 investment at around £480 million; and there is the new North factory in Broughton.

[Mark Tami (Alyn and Deeside) (Lab)]

I join other Members in saying that I am very pleased the hon. Gentleman has managed to secure the debate. I will make a point before he moves off the issue of BAE Systems. He clearly said that he regrets the sale by BAE Systems of its share in Airbus. In hindsight, BAE Systems may have taken a different road, but one of the problems that was harming Airbus in this country was that BAE Systems cried wolf so many times, threatening to sell its share—it said it was not selling the share, then threatened to sell it. Does he accept that that, too, was not a sustainable position?

[Sir Peter Luff]

The hon. Gentleman makes an important point. We are talking about the long-term commitment to this sector; long-term commitment to ownership also matters very much. I strongly endorse what he said.

Of course, the new North factory in Broughton was opened by the Prime Minister three years ago. That factory shows the continued commitment of Airbus to the future of UK manufacturing and R and D. The company deserves the kind of high-level endorsement demonstrated by the Prime Minister. However, we need to give that endorsement practical substance by attacking non-compliant World Trade Organisation subsidies of Boeing and by robustly supporting export campaigns for Airbus aircraft.

Let us move briefly to Washington DC and, in a sense, to Washington state. At the end of July, it was astonishing to hear a senior Boeing executive tell a congressional hearing about

“the economic and employment benefits Europe has achieved with aerospace using massive state support over the past four decades”.

The old biblical phrase about the mote and beam comes to mind. The land of the free does not always extend its commitment to freedom to free trade.

Sadly, an ongoing dispute before the WTO regarding US and EU support for large civil aircraft manufacturers remains a real threat to the competitive position of Airbus. In essence, the WTO has found that European repayable launch investment loans to Airbus are legal and WTO-compliant but that many US grants, contracts and tax concessions to Boeing between 1989 and 2006 were WTO-inconsistent. Against this background, it is bewildering that, in blatant disregard of the 2012 WTO findings, Boeing has been awarded the single largest targeted tax break in US history, amounting to nearly $9 billion, in order to underwrite development and production of the new 777X aircraft in Washington state. The 777X is a serious competitor to Airbus’s wide-body A350 XWB and A380 families. This latest tax break for Boeing essentially allows it to develop the new aircraft for free, which places Airbus and its suppliers at a huge competitive disadvantage. It means that fair competition is not possible for products such as the A380. The “massive state support” happens not in Europe but in the USA. Will the Minister assure me that the UK Government will use their strong influence with bodies such as the European Commission and the WTO, and work with other Governments, to ensure that there is a level playing field in which UK companies can operate, with a fair global legislative environment?

Having said all that, Boeing builds excellent planes and it will remain a force to be reckoned with for the foreseeable future. We may think that the US Government’s use of subsidies is outrageous, but we still respect the technical skill of Boeing and the success of its aircraft. As the Defence Minister with responsibility for equipment, I was determined that all the major defence suppliers—including Boeing, Lockheed Martin and Northrup Grumman—should be made to feel entirely welcome in the UK and were encouraged to invest here, so as to work ever more closely with our supply chain.

In that spirit, we should recognise the way in which Boeing has thrown itself into the UK, supporting the AMRC at Sheffield and, for example, the Royal Aeronautical Society’s excellent “Build a Plane” challenge. The views of the major US players in aerospace—defence and civil—who value our supply chains so highly must be properly understood if we are to ensure that British suppliers can play a significant part in their future products. Yet the very name “Boeing” seems virtually to have been exorcised from AGP documentation, with only the briefest and most cursory of mentions. We want British technology to be so compelling that Boeing has no choice but to increase UK content on its planes, but we will get to that point only if we properly understand its needs, too. What are we doing to ensure we have that understanding?

I turn to exports. Industry insiders tell me that official support for sales campaigns is absolutely vital for the aerospace industry. From my time at the Ministry of Defence—I look to my hon. Friend the Member for Aldershot (Sir Gerald Howarth) in this regard as well—I have supported, in India, Turkey, South Korea, and elsewhere, the excellent work of the UK Trade & Investment Defence & Security Organisation. Sadly, UKTI is seen as being

“a long way from being optimal on the civil side.”

Specifically, the industry needs more advanced information on when Ministers are travelling on trade missions and not just to have what one chief executive described to me, in a description I recognise all too clearly, as

“a complete obsession from a media/comms perspective for ‘announcables’.”

Aerospace contracts take a long time to negotiate and cannot just be pulled out of a hat because a Minister happens to be visiting a particular country. As that same chief executive said to me,

“The UK diplomatic service is one of the best in the world; my colleagues from overseas regularly say that to me, the PM has a high regard on the global stage—we should use it more. He has said to us on several occasions that he is happy to be the number one Airbus salesman—it’s just that sometimes the back-up from UKTI is lacking.”

Another company has emphasised to me that advance warning of ministerial visits abroad and of trade delegations here to help support sales campaigns is just not being given, although that happens regularly—routinely—in other European countries such as France. On exports it seems we could do much more. Will the Minister pledge to look at that issue?

When politicians speak of SMEs, they often mean the very smallest firms, employing perhaps 10 or 20 people —members of the Federation of Small Businesses, say. Much of the debate about the aerospace industry appears to the outsider to revolve around the original equipment manufacturers on the one hand, and SMEs on the other. Discussion of the former usually focuses on the pursuit of new programme investment, in the case of purely indigenous companies, or on the methods by which non-indigenous companies can be persuaded to invest in the UK, embody original intellectual property in the minds of UK employees and deal with the constraints of the US international traffic in arms regulations regime.

Discussion of SMEs quite properly tends to concentrate on increasing their market access. However, in such a debate the industry layer below that of the OEMs but above that of the SMEs tends to be ignored. This layer, made up of companies that we could call the large sub-prime suppliers, includes companies such as Marshall Aerospace and Defence Group, Cobham, Meggitt, Ultra Electronics and Martin-Baker, most of which are completely British; the value they generate flows directly into the British economy and the Exchequer.

I acknowledge that many of these companies have particularly strong positions in defence aerospace, but I will be asking shortly whether we are right to think of the defence and civil markets in such distinct compartments. Any serious analysis of the future of the UK aerospace industry should take account of the large sub-prime suppliers and their contribution to the UK economy, national security and prosperity as well as to innovation, skills and training. Are we focusing sufficiently on the large sub-prime businesses in the AGP strategy?

We must also ask whether the British supply chain is sufficiently robust. Monday’s Financial Times reported that there were concerns about the ability of the UK supply chain to cope with the rapid upturn in orders. Industry chief executives have expressed concern to me about the lack of ambition of some of their suppliers, which are content to remain static but are risking stagnation or worse through an absence of plans for growth. Others have expressed concerns about the stability of small suppliers and said that they are forced to use two different suppliers for the same component to ensure stability of deliveries—and that second supplier is generally not a British one. There may be a need to provide not just finance to the smaller SMEs, as the AGP promises, but management consultancy on growth strategies and possible consolidation with other suppliers. I suspect more active intervention in the supply chain will be needed. Will the Minister consider that?

Is it right to limit the scope of the AGP’s work to the civil aerospace market? I ask because I am sure the linkages with defence aerospace, and space in particular, should be more explicit. Indeed, the Office for National Statistics classifies activity in this area as

“manufacture of air and spacecraft and related machinery”.

The Library briefing note reminds us that support for the sector from successive Governments owes much to the need to sustain the defence aerospace sector.

The AGP could learn directly from the Defence Growth Partnership, too. As noted in “Delivering Growth”, recently published by the DGP, the UK’s defence value chain comprises all suppliers of equipment, support and technology for defence, including defence aerospace, and includes the enabling functions of Government, ranging from test facilities to regulators, and the UK’s strong academic and science base in universities, research bodies and technical institutes. This is a profoundly capable resource, but a diverse one.

The DGP intends to harness the power of the value chain in a more co-ordinated way, to enhance responsiveness, agility and competitiveness in meeting customer needs. In addition to leveraging the existing value chain, it aims to maximise the synergies with other sectors and attract new companies into defence—particularly SMEs that can bring fresh thinking into the sector, but might otherwise struggle with market access. This is the kind of approach that we see in all industrial strategies, but I do not see it in the AGP.

In the 2010 Select Committee report, we looked at defence research and expressed concern about the sharp reductions being planned by the last Government, concluding that

“If we are looking at developing UK national capabilities for future defence requirements, it is self evident that if there is less being spent on research and technology now, we will have less UK capability in future.”

We also stated:

“While defence research is primarily the responsibility of the Ministry of Defence it is important that the Government acknowledges the fact that defence research has an impact on other areas of R&D, especially other high-tech industries. The Department for Business, Innovation and Skills should be involved in any discussions about funding for defence research to ensure that the impact of any reductions on advanced manufacturing industries is minimised.”

As Minister with responsibility for defence equipment, I was proud to put a floor under the Department’s spending on science and technology and prevent any further cuts, but our spending on defence S and T remains far too low.

In defence aerospace, much of the activity will have a direct read-across to the civil sector, particularly, for example, when it comes to sustaining relevant skills and fostering innovation. The rigid policy separation between defence and civil markets owes much to departmental boundaries, but also to a disappointing sense that promoting defence is not quite as acceptable as promoting civil aerospace. No such concerns cloud the minds of US policy makers and Boeing is again the beneficiary. It is time we grew up and joined up the parts of aerospace more convincingly.

That leads me to my final comments on the importance of sustaining the engineering skills of the aerospace sector. This was one of the most compelling sections of the 2010 BIS report and, more than four years on, there is not a word I would alter. “Lifting Off” gives a graphic account of the skills shortages and the demographic problems facing the sector. However, what I find profoundly disappointing is the apparent lack of acknowledgment that these are the problems of the wider engineering sector, too. Yes, the strategy outlines actions of Government and industry to address the issue—I welcome unreservedly the 500 masters-level postgraduate places announced in the scheme and the development of high quality, employer-led apprenticeships—but as EngineeringUK says, the UK, at all levels of education, does not have either the current capacity or the rate of growth needed to meet the forecast demand for skilled engineers by 2020.

The Royal Academy of Engineering and EngineeringUK estimate that by 2020 in the UK there will be demand for between 1.28 million and 1.86 million engineers and technicians. Approximately 640,000 graduate engineers will be required by 2020 across all sectors of the economy. Seven out of 10 jobs will be to replace the ageing work force. UK higher education institutions currently produce only 21,000 engineering graduates and UK industry creates only 66,000 engineering apprenticeships each year.

Against that background, it is profoundly worrying that each of the published industrial strategies, including the AGP, seem to regard skills in their sectors in isolation. The progress report on the AGP this year speaks of

“improving the image of the”

aerospace

“sector to make it a more attractive career choice”.

Companies have briefed me proudly on their own contribution to solving the aerospace skills shortage, but the Government and the Royal Academy urgently need to work for consolidation and co-ordination of the plethora of schemes, to build a coherent, comprehensive cross-engineering approach.

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[Mark Tami (Alyn and Deeside) (Lab)]

It is a pleasure to serve under your chairmanship today, Mr Hollobone.

Manufacturing and aerospace are clearly vital to the economy of north-east Wales and the north-west of England. At the heart of that, as has been mentioned, is Airbus at Broughton, where there are more than 6,000 jobs at one plant. Importantly, there are thousands more in the supply chain. We do not talk enough about the supply chain, although I am pleased that other hon. Members have done so today—without it, the primes would not be able to produce the goods. We should give it more support and discussion.

Airbus alone supports more than 100,000 jobs in the supply chain, and if we included the other aerospace primes the number would be very high. That area of activity is high quality and export-driven; it raises billions of pounds for the UK every year, and the jobs are of high quality as well.

If such a level of employment is to be maintained, and if there is to be expansion and growth, we need to improve our skills base. Even during the economic downturn, companies told me that they found it difficult to find skills at the level they need. Apprenticeships are important in that context; in the past three years in the UK, Airbus alone has enrolled 4,000 apprentices. It is telling that 70% of its senior managers were apprentices at one time. We need to send a message—I am pleased that other hon. Members have mentioned this—that apprenticeships are not something for kids who do not get to university because they are not bright enough. They are very important. We need to adopt more of a German model, where it is not a case of university for some and apprenticeships for others. We need a programme where it is more possible for people to transfer between the two. Most employers would probably say that the ideal person has a university qualification but has worked or done some training in the workplace—not someone who has been nowhere but the classroom, but someone who has skills they can use and the benefit of a university education.

We have a long way to go to catch up. For every pound that the UK spends on research and development, France spends £10 and Germany spends £15. Many hon. Members have mentioned the Aerospace Growth Partnership, which is doing a good job. It needs more, and we should help it more, but the key, as has been mentioned, is the fact that it has cross-party support.

A problem in the past has been that whoever came into government chucked things out and brought other things in, which led to uncertainty. Big employers—even small employers—do not know whether to invest in the relevant area, and whether the Government will still support them. A classic example of what I mean is the area of composites. The UK failed to invest in the coming material for aircraft. I was pleased that Lord Mandelson grasped that and realised that we should provide support. If we had not done that—we were well behind the Spanish and Germans, and I think we still are; we need to do much more work—we would have been in a difficult position.

The importance of the A400M, which has already been mentioned, was civil as well as military, because it demonstrated that we could do the relevant work with composites. The A350 extra-wide body will be 53% composite. Our colleagues in Europe—our partners in Airbus—would love to get their hands on that work. The Spanish and Germans have made no pretence about it. We are fortunate to have it, but I do not think that, just because we have built the wings for years, we can assume that we will always get them in years to come. We are only as good as our last aircraft, or our potential to produce the next one. Clearly the next big challenge for Airbus will be the replacement for the A320, which is the workhorse of so many airlines. If we were not to get that work, the longer-term future for Airbus in the UK would be bleak.

[Sir Gerald Howarth]

I am glad that the hon. Gentleman mentioned the Airbus A320. I happened to fly in one of the test models. It was, of course, a good example of Government and industry working together; the Thatcher Government put £250 million into the programme. Margaret Thatcher took a lot of persuading, but eventually even she agreed that Government intervention on that was a good idea.

[Mark Tami]

I totally agree. Going even further back, I remember when an Industry Secretary had the choice whether to keep the Airbus share or go for Concorde. He went for Concorde, which, in hindsight, was probably not the best choice. There will be crucial choices for the UK about Airbus in the coming years; the new A320 is almost certain to be a wholly composite aircraft, with structures different from those we are used to.

There is a big challenge for us out there, but there are also other threats to Airbus. The hon. Member for Mid Worcestershire (Sir Peter Luff) mentioned unfair competition. There is nothing wrong with competition, which is good in many ways, but unfair competition is bad and threatens the future of an important industry. For years, the US dominated both the civil and military aircraft markets and I suppose it thought that no one would ever challenge it. Airbus did, however, and it now accounts for a large share. New players such as China, Canada, Russia and Brazil are all looking for a segment of the market, so we cannot assume that the big players will remain unchallenged.

We need only to look at the 747, which was funded by the American Government as a military transport aircraft. Boeing actually received all the funding and had many of its costs paid and then—surprise, surprise—somebody decided that people could also be put on it and that it could be used as a civil airliner. Airbus and Boeing have both been to the World Trade Organisation. Such processes are always long and drawn out, but the WTO found in 2012 that many of the US subsidies were not allowable under WTO rules. Back in 2011, the WTO found that repayable launch investment was, but there was some issue with the interest rates.

The EU has sought to address some issues, but, as the hon. Gentleman made clear, the Americans have done the exact opposite and decided to give the biggest ever single tax break of $9 billion to Washington state, which will then hand it on to Boeing to pay for the development costs of the 777X, which is exactly what was done with the 747. That is happening at a time when America is looking to Europe for an agreement about more competition and more open markets.

To be honest, the problem is that the US wants to compete freely in our markets, but it does not think that we should be able to compete in theirs. We have seen that before, such as when BAE Systems tried to break into the American defence market. Probably the worst example was the air tanker competition in the US, which was won convincingly by Airbus, but Boeing then went crying to the US Government, who then stopped the competition and changed the rules so that Boeing could be the only winner. Surprise, surprise, the contract went to Boeing.

I certainly do not want us to return to a system of closed markets because that would not be good for Airbus or our industry, but we need a level playing field. We cannot have a system in which we are expected to play by the rules when others are not; many jobs will be lost, plants will close and we will return to Boeing, or whatever company, ruling the roost once more. We want open markets for our companies to compete in and can expect that America does as well, but the situation cannot be unfair. I hope that our Government will be far more forthright with Europe and will work with it to ensure that we stand up and make our case, because it is vital to the future of the industry.

I want to refer to another threat—the hon. Member for Mid Worcestershire may disagree with me on this: our future in Europe. I am particularly worried because Airbus is an example of the perfect way in which Europe can work together. Were we outside the EU, I have serious doubts that we would have the same level of investment. I am not saying that the plants at Filton or Broughton would close tomorrow or that we would lose existing orders, but we would jeopardise future investment as the Germans, the French and the Spanish would make a strong case for investment to be made within the European Union and not in an outside country. Those who are calling for our exit need to consider the implications for jobs.

[Sir Peter Luff]

I am grateful to the hon. Gentleman for his fine speech. Just for the record, I strongly agree with his point about membership of the European Union and the particular impact on the aerospace sector.

[Mark Tami]

I thank the hon. Gentleman for that. Such a move would affect not only Airbus, but also the many thousands in the supply chain.

[Mr Laurence Robertson (Tewkesbury) (Con)]

The hon. Gentleman is making a good speech. However, the biggest employer in my constituency is GE Aviation, an American company that has been visited by ex-Ministers. There was concern about its plans when it took over the plant, but it has heavily invested in it.

[Mark Tami]

I clearly welcome that. As I have said, it is good that we have American companies over here, but I would like to see more British companies buy companies in America, although that often seems difficult. There are great opportunities for us, but there are threats as well. We must learn the lessons of the past. We have lost many manufacturing companies that we thought would go on for ever, and many will never return. Aerospace is a great opportunity and we must grasp it and invest, not just let it fall by the wayside.

Children and Families Bill

Mark Tami Excerpts

Monday 10th February 2014 Commons Chamber

[Luciana Berger]

I thank the hon. Gentleman for that intervention. I will talk later about the toxicity of smoke in an enclosed vehicle, because many studies have shown that children are susceptible to passive smoke in the back of a car in a way that they are not in a building or in the home.

Each year around 300,000 GP appointments are attended as a direct result of children suffering from illnesses linked to passive smoking, 10,000 have to be admitted to hospital and, according to a 2010 report by the Royal College of Physicians, roughly 40 families lose infants to sudden cot deaths. If the health and tragic human costs were not justification enough, it is estimated that treating children for the effects of passive smoking costs our NHS some £23 million every single year.

[Mark Tami (Alyn and Deeside) (Lab)]

Will my hon. Friend give way?

[Luciana Berger]

I will give way one more time.

[Mark Tami]

I am old enough to remember when it used to be okay to smoke on underground trains and on planes. Does my hon. Friend agree that society has moved on and that this proposal is just part of that?

[Luciana Berger]

I thank my hon. Friend for that contribution. I will mention some of the comments that children have made about that and outline why young people feel so strongly about this important measure.

A significant proportion of the effects of passive smoking felt by children are linked to passive smoking in a car, not least because—this relates to the intervention made by the hon. Member for St Albans (Mrs Main)—tobacco smoke in a small, enclosed car can create levels of pollution that are up to 35 times greater than the level deemed safe by the World Health Organisation. A single cigarette in a car can create concentrations of smoke up to 11 times greater than those in a smoky pub of old.

We are not talking about a small number of cases. Many people have contacted me in recent days, some of them suffering from many of the conditions I have mentioned, including asthma, to say that they wish a ban had been introduced when they were children. Other people have said in recent weeks, “Surely no adult smokes in a car with children.” Unfortunately, according to the British Lung Foundation, nearly half a million children are exposed to potentially toxic levels of smoke in cars every single week. That number is based on children aged between 11 and 15. If we take babies, infants and primary school children into account as well, the number is likely to be even higher. According to a study by SmokeFree Sports in Liverpool, the area I represent, around a quarter of nine and 10-year-olds reported being exposed to smoking in cars.

That brings me to the crux of my argument about why the proposal is justified. This is about children, who often do not have a choice about how they travel and cannot speak out. In 2010, a third of children surveyed said that they were too frightened or embarrassed to ask an adult not to smoke with them in the car. If we want to protect future generations from the dangers of smoking, we need a comprehensive approach.

I agree with the Minister when she says that we need better education and that we have to improve public awareness. Adults and parents have a duty to act responsibly, but we know from experience that when education is accompanied by legislation, it can help bring about profound changes in behaviour. That is why we already have laws on what people can and cannot do in cars, from not using mobile phones at the wheel to compulsory use of car seats for children under the age of five. It is why our existing smoke-free legislation already makes it illegal to smoke in the workplace or in public vehicles. The proposal to protect children from smoking in cars would build on that precedent.

Umbilical Cord Blood

Mark Tami Excerpts

Monday 31st January 2011 Commons Chamber

[Mr Burrowes]

I am very grateful for that intervention. The hon. Lady and I share an interest in both sickle cell anaemia and the thalassaemia issue. The UK Thalassaemia Society, whose headquarters are in my constituency, has great interest in this area and, in particular, in the black and minority ethnic communities, who are not able to get matches through the bone marrow register and are acutely in need. That is particularly the case for mixed-race families, who struggle to find any match and are sometimes wholly reliant on a cord blood solution. That is why it is welcome that over the years the previous Government and this Government have increased the number of collection centres to make more of those units available.

However, more needs to be done because, sadly, where Britain once led, it is now falling behind the United States, France, Germany and Spain. All those countries now outstrip our cord blood collection, inhibiting our research capacity. There are 700,000 births each year in the UK and in almost every single instance the cord blood is discarded as medical waste. I am not proposing routine collection, but we must question the health and economic value of throwing all these potentially life-saving cords away. I welcome the fact that the Government are nudging people to agree voluntarily to donate their organs upon death, and I would encourage a similar nudge in encouraging mothers to consider donating umbilical cord blood.

Progress has been made, but more needs to be done. There are 1,600 people waiting for a stem cell transplant, but the unmet need in annual terms is only 440 transplants per year. A bank of just 50,000 umbilical cords would provide the bulk of that need. Sadly, simply increasing the size of the adult register is not an alternative to having cord blood. We already have access to more than 16 million donors on registers worldwide. The work of the Anthony Nolan Trust and others helps us to access that adult register, but we would need a UK adult register of a similar size to approach the effectiveness of a 50,000-unit cord blood bank.

[Mark Tami (Alyn and Deeside) (Lab)]

I thank the hon. Gentleman for his earlier comments. It is difficult to talk in financial terms about such issues, but with patients who do not get a transplant, there is a huge ongoing medical cost for their treatment, whereas a transplant could save that money, which could then be reinvested in the health service.

[Mr Burrowes]

We often talk about investing to save, but this is an area in which investment would save both money and lives. I shall go into that in more detail.

A report on transplantation by the UK Stem Cell Strategic Forum, ably chaired by Professor Charles Craddock, was published in December 2010 by NHS Blood and Transplant. The Minister discussed the report, which makes important recommendations, with the all-party group on the day of its publication. The report recommended, first, investing in expanding Britain’s cord blood bank capacity to 50,000 units. Those proposals have been properly costed and the costs have been balanced against effectiveness by NHS Blood and Transplant. For an investment of £50 million, spread over five years, Britain could have that 50,000-unit cord blood bank.

--- Later in debate ---

[Anne Milton]

I thank my hon. Friend for that intervention. It would be terribly simplistic to think that it is just a matter of donors coming forward. We know from organ donation—it is also the case for umbilical cord blood—that it is important to streamline the processes, because there are unacceptable delays. The report’s recommendations cover the whole process from beginning to end. I do not underestimate the need to raise the importance of this issue. Many hon. Members can play a critical role in their local areas and with their local media by highlighting the importance of organ donation.

[Mark Tami]

Will the Minister give way?

[Anne Milton]

I am conscious of the time but happy to give way, because the hon. Gentleman has done a lot of work on this issue.

--- Later in debate ---

[Mark Tami]

Does the Minister agree that Anthony Nolan has done an awful lot—particularly with the introduction of spit and swab tests—to help people to take that first step on the ladder? Before, when it was a case of just giving blood, that put a lot of people off, particularly males, such as myself, who are rather squeamish about these things, but it is very important to get the maximum number of people to take that first step forward.

[Anne Milton]

Yes, absolutely. The hon. Gentleman is quite right to highlight yet again the work of Anthony Nolan, which is crucial, but I urge him and all male Members to remember that they have nothing to fear from needles and no need to be squeamish about those things; it is about potentially saving lives.

It is a challenging time financially, and we cannot put that behind us. It is important that we get the UK back on a secure financial footing, and that means funding will be tight, but I want to reach out further to our partners in charities to see how we can work together. We are not short of offers in that field. My hon. Friend the Member for Enfield, Southgate will know that I am shortly meeting Cord Blood Charity to see what part it can play, and Anthony Nolan is making every effort to provide additional funding for the important work that I have spoken about.

On Government funding, the Department of Health will provide some £4 million in additional funding to help with service development, but, more than that, we will continue to help in other ways, bringing together key stakeholders to ensure that all opportunities to bring about those further improvements and to implement those recommendations are taken. We are also working towards increasing the size of the cord blood bank by funding NHS Blood and Transplant to increase the bank to 20,000 units by 2013—an increase in stored units of almost 100% since 2008. I know that my hon. Friend would like to me go on, and as part of future strategic planning I shall ask NHS Blood and Transplant to consider the options for developing the bank even further, with the final goal of reaching a stock of 50,000 stored cord blood units, accessible to all NHS patients.

In the development of that new commissioning structure within the NHS, we will listen closely to the recommendations of the forum report, with respect to improving NHS practices and commissioning. The forum has met since the report’s publication, and I hope that it will continue to meet to advise the sector on best practice and to provide innovative solutions to implement those recommendations. I shall keep closely in touch with all those who have shown such a close interest.

Improving the health care pathway for stem cell transplantation to treat life-threatening diseases is a vital part of that work. I use those words cautiously, but I want to see NHS patients having access to the best possible services. We are meeting my hon. Friend soon to discuss the issues raised in the report and some that have come out of this debate. As always, his contributions to the debate are welcomed, highly respected and, like those of many Members, motivated by the best possible intention, which is to save lives.

Question put and agreed to.