A&E Provision: Shropshire and Mid-Wales

Mark Williams Excerpts

Wednesday 11th January 2017 Commons Chamber

[Daniel Kawczynski]

I thank my hon. Friend for his intervention. He is absolutely right. In fact, my colleague from just across the border, my hon. Friend the Member for Montgomeryshire (Glyn Davies), always joins us at our meetings with our hospital trust. We almost think of him as a Salopian. [Hon. Members: “Steady!”] Not quite, but he does so much to represent his constituents in Wales, who already have to travel long distances to get to the Royal Shrewsbury hospital. He might correct me if I am wrong, but I think that some of them, from the extreme west of his constituency, already have to travel for over an hour to access A&E services in Shrewsbury. So any movement even further away from Shrewsbury would be completely unacceptable to his constituents.

[Mr Mark Williams (Ceredigion) (LD)]

I come from a peripheral position, further to the west of Montgomeryshire. I congratulate the hon. Gentleman on securing this debate and stress the importance of getting this right, because it has an impact further to the west. If this issue is not resolved, it will impact on the capacity of my district general hospital in Aberystwyth to serve the people of mid-Wales as well. It is crucial to address this issue.

[Daniel Kawczynski]

I concur with the hon. Gentleman, and I am grateful for his intervention.

I shall start to end because I want to give the Minister as much time as possible to answer these questions. Let us not forget that if we get this right, it could result in an investment of £300 million into the NHS in Shropshire. I do not know about all my colleagues—I know that my right hon. Friend the Member for North Shropshire has been an MP for longer than me—but I certainly do not remember a time during my 11 years as an MP when we have had such an investment in the local NHS. As I say, if we get this right, we could see an investment of £300 million in Shropshire to implement these changes.

I know that there is more work to be done to secure this money. I know that more work will have to be done in innovative ways, both locally and nationally, to secure all the funding. If we do not sort ourselves out, however, we are going to get further and further behind, while other areas in the United Kingdom—this is not an issue peculiar to Shropshire—that are going through this process in a more cordial and mutually effective way are going to jump the queue, and Shropshire will be left right at the end. I am not prepared to see that happen.

Finally, Telford Council would obviously have us believe that as part of this programme, women and children’s services have to be moved from Telford to Shrewsbury, because the main A&E will need to have women’s and children’s services next to the main A&E provider at the Royal Shrewsbury hospital. The council says—this is an important point that I want the Minister to note—that because these services were moved from Shrewsbury to Telford a few years ago, such a move would lead to the waste of £28 million. It repeatedly talks about this through the local media. No, no, no. It is not a waste. The building will be used for other purposes, and all the equipment in it, which is easily moved, will be moved to Royal Shrewsbury hospital. So I refute any proposal that there has been a waste of the £28 million invested in women’s and children’s services because of the changes that will take place.

Dementia and Alzheimer’s Disease

Mark Williams Excerpts

Tuesday 12th April 2016 Westminster Hall

[Jim Shannon]

I would need to the wisdom of Solomon to answer that question. Personally, I do not know; perhaps it is society or how we live. People are living longer and, by the very nature of living longer, we have such problems. There are probably a number of issues involved and reasons for that. However, early diagnosis, follow-on care and end-of-life care are fundamental.

There is a need to raise awareness among people with dementia and their carers about the disruptions to vision and eye health that might be concurrent with or arise from dementia. We therefore need to emphasise the importance of regular sight tests and eye examinations.

The Mental Health Charter for Sport and Recreation has done some interesting and outside-the-box things for people living with dementia. Along with partners, they have delivered a dementia-friendly swimming initiative, which is steadily expanding across the country. That is an absolutely fantastic way to help improve quality of life. It is amazing how not-for-profits are putting in the hard graft to make heart-warming things such as that happen, often with no funding. It is amazing what a group of dedicated, selfless individuals can do, as has been mentioned.

[Mr Mark Williams (Ceredigion) (LD)]

I thank the hon. Gentleman for giving way and I apologise for missing his opening remarks. Will he take the opportunity to commend the many local communities that have sought dementia-friendly status, meaning that a visit to the shop is not too embarrassing or a stigmatising event for sufferers or their carers?

--- Later in debate ---

[Mr Mark Williams (Ceredigion) (LD)]

I had not intended to speak; I thought my name had been withdrawn from the list. None the less, having sat and listened to this debate, I would like to take advantage of the opportunity to do so. I will not take even the four minutes that you suggest, Mr Stringer.

This is an immensely personal issue for many families across the country. I reflect on a couple I know very well. The lady of the household started to forget things. She started to repeatedly cook the same menu for her husband, who got rather tired of shepherd’s pie day after day. Those warning signs led to her being referred to a memory clinic, which did indeed diagnose the early stages of dementia. Where that will lead, the family does not know. I emphasise what a harrowing experience it has been for that family. Support services are available in west Wales, where they live, but there is a concern and fear that as this terrible disease goes on, the terrible decision to which the hon. Member for South Shields (Mrs Lewell-Buck) alluded with her family might have to be made and the lady of that household will have to go into some form of residential care.

I want to highlight some of the challenges we have in rural Wales. There is a spectre of couples having to be parted, sometimes over very large distances, which causes agony for other members of the family who want to give support. Of course, the support that is available—often for too short periods—is invaluable to those families, but the lack of residential care in close proximity to where the families reside is a very real problem.

I reiterate the point I made in an intervention to the hon. Member for Strangford (Jim Shannon); I congratulate him on securing this debate because awareness of this devastating disease is so important. We must praise the wider community, including the community councils and district councils that have sought dementia-friendly status so that the everyday pursuits we all enjoy can still be enjoyed by everybody in society, including those with dementia and Alzheimer’s.

Community Pharmacies

Mark Williams Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Mr Mark Williams (Ceredigion) (LD)]

I note the time, Mr Streeter, and your stipulation about when Front-Bench speeches will start. I thank the hon. Member for St Ives (Derek Thomas) for initiating this important debate. As I look around the Chamber today, I see that Members from Wales, Scotland and Northern Ireland are outnumbered, which is appropriate, given the letter that was sent and the cuts that pharmacists might endure. In Wales, the issue of health is almost entirely devolved, so much of what is being discussed today will be different in Wales from in England. However, the community pharmacy contractual framework is an England and Wales arrangement, so what happens in England could impact on Wales.

The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) mentioned the issue of devolved Administrations and delays. Our understanding is that the consultation will conclude, the Minister will reflect, and an announcement will be made during the Assembly election campaign period. We will not have a health Minister in Wales if decisions made in Whitehall impact on the delivery of services in Wales. I think that it has something to do with the respect agenda and waiting for a health Minister to be in place.

[Oliver Colvile]

Does the hon. Gentleman recognise that if there were delays in Wales, Scotland or Northern Ireland, the English pharmacies would end up waiting behind that queue?

[Mr Williams]

The hon. Gentleman should address that question to the Minister. The timing represents an unfortunate mismatch, for which pharmacists in England might pay the price. The timetable is of the Government’s making, not mine, so the Minister needs to reflect on that.

I want to talk about two facets of this debate that have been touched on by the hon. Members for St Ives and for Bexhill and Battle (Huw Merriman): the issue of rurality and the impact of the cuts. The consultation document stated:

“40% of pharmacies are in clusters of 3 or more meaning that two-fifths of pharmacies are within 10 minutes walk of 2 or more other pharmacies”.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

I am sure that the hon. Gentleman is going to make an excellent point about rural pharmacies, but there is another element in my constituency, where I met my local pharmacist, Mike Maguire of Marton Pharmacy. Two of our minor injury units have closed and there is a proposal to close another walk-in centre, after the last one was closed. The collateral impact of the withdrawal of those services reduces the ability of the average patient and customer to access services. There is not only the rural aspect but the specific need at the time.

[Mr Williams]

The hon. Gentleman is right. That has been the message of many contributions. The work of our community pharmacies complements the work of the national health service. When the hon. Gentleman’s constituency is hit in the way that it has been, that represents the proverbial nail in the coffin of decent community-based services for his constituents.

On the urban point, to reiterate the point made by the right hon. Member for Rother Valley (Kevin Barron), we are talking about well-established community businesses that impact on many people in the locality. Two or three businesses clustered in the same area doing a generally good job will have an impact on the local economy, but the rural point is fundamental. We have heard about the pressures on GPs and the difficulties in getting appointments. In my vast rural constituency of Ceredigion, we have a district general hospital in Aberystwyth: Bronglais hospital. We have a good many GPs throughout the county. We also have a network of very effective pharmacists, and it is a jigsaw that works in providing good services. There are 716 community pharmacies in Wales—in high streets, villages and towns—with 50,000 people visiting those facilities every single day, proving the efficiency of the much-maligned Welsh national health service and bridging the real difficulty that people have in visiting the closest hospital or a GP for something as routine as blood pressure or cholesterol checks. It is really important that the outcome of the debate is that we support community pharmacies. That is fundamental.

In Wales we have developed our services. I visited the pioneering pharmacy of Mr Richard Evans in the town of Llandysul 11 years ago. He was clearly of the view that we could develop services much more, to relieve pressure on the national health service, and he achieved that. In Wales pharmacies have offered NHS flu jabs for at-risk groups for the fourth winter running. Almost 20,000 people in Wales benefited from that last winter. After four years of that provision in Wales, the NHS in England introduced the same service for the first time. Community pharmacies in Wales can treat about 30% of the common ailments that people would normally go to a GP for. That is a huge saving for the national health service. Pharmacies also promote meaningful public health campaigns. I visited the pharmacy in Borth, where there is a campaign on Parkinson’s disease. The staff are doing a good job talking with victims of Parkinson’s disease about their medication, and promoting awareness in the community.

Finally, having praised what is being done in Wales, in a rural area, I want to seek an assurance from the Minister that if his consultation has an effect on the three levels of services in the framework, there will be meaningful consultation with Assembly Ministers in Cardiff, and that any negotiations on changes to the contract will involve Welsh Government officials at the negotiating table. This is one of the small areas where health is not devolved, and that is particularly relevant on the Welsh border; it requires the respect agenda, on anything that the Minister concludes.

[Mr Gary Streeter (in the Chair)]

As a reward for his patience, Mr Graham Jones has eight minutes.

Mental Health: Out-of-Area Placements

Mark Williams Excerpts

Thursday 3rd December 2015 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

It is a great pleasure to be able to raise a very important issue for debate, albeit three hours earlier than expected. It is good to see the Minister for Community and Social Care taking his seat.

I want to raise an issue of profound importance. It is a practice which I think is intolerable but which carries on every week of the year and probably every day of the year: the shunting of people around the country, sometimes a long distance away from home, at a moment of mental health crisis. Typically, someone at a moment of acute crisis would be taken into hospital but there would be no bed available for them, so they would be taken away somewhere else in the country. There are numerous stories of people being taken hundreds of miles away from home on a regular basis.

Such practice would never be tolerated in physical health services. Let us imagine, for example, someone who had had a stroke or with a heart condition being taken by ambulance and being told, “I’m sorry, there’s no room at the local hospital. We’re taking you to Cumbria from Norfolk.” It would be an outrage. It would be regarded as a scandal, so it does not happen—yet it happens every week of the year in mental health. I regard that as discrimination at the heart of our NHS and it is one of the very many examples of how people who suffer from acute mental ill health are disadvantaged by the system.

Incidentally, I make no criticism of any individual Government; this practice always happened, but there has been a rise in the number of instances, which I will come to in a little while. In many ways, someone suffering from mental ill health does not get the same right of access to treatment at a moment of need as someone with a physical health problem. If any of us in the Chamber stopped and thought about it for a moment, we would conclude that we cannot begin to justify that, and that there must be a programme designed to achieve genuine equality of access to support at that moment of need.

[Mr Mark Williams (Ceredigion) (LD)]

I congratulate my right hon. Friend on securing this debate about an area in which he has done so much work to date. The debate is about out-of-area mental health placements, but does he agree that there is also a huge problem in some of the vast health board areas—in our case in Wales—where rurality is an important factor? For instance, the closure of the Afallon mental health ward in Bronglais hospital in Aberystwyth means that constituents of mine have to travel or be sent 50 miles away—not over the easiest terrain—to the Morlais ward in Carmarthen. There is a huge problem across the country, but there is a great problem in those great geographic areas too. I do not expect my right hon. Friend to comment on the details of the Welsh national health service, but I am sure the problem is replicated in English health areas.

[Norman Lamb]

I am grateful to my hon. Friend for raising that. He makes an extremely important point. I will come on to address it in more detail later.

There is, for example, evidence of an increased risk of suicide if people are treated a long way from home and family and friends who struggle to visit them. The idea of care close to home is incredibly important in mental health. We should, as far as possible, seek to care for people at home, not take them into hospital unless that is unavoidable. There are times when that is necessary, and as far as possible there should be a place close to home.

[Mr Williams]

I know that what I am about to ask is not a central point of my right hon. Friend’s debate, but does he agree that one of the unacceptable outcomes has been the increased use of the police and police cells for holding people overnight? That has been the situation in my constituency.

[Norman Lamb]

That is a shocking practice. I applaud my hon. Friend for the work that he has done on it in his area. The idea of putting someone who is suffering an acute mental illness into a police cell, which is defined in the legislation, unbelievably, as “a place of safety”, is bizarre and ought not to be tolerated. I am pleased that the Government have indicated an intention to legislate, in effect to eradicate the problem completely for under-18s and to make it an exception for adults. We managed to reduce the numbers in England by 50% in the past two years, which was considerable progress, but we need to go much further and bring an end to an unacceptable practice.

It is interesting that where local passion and drive exist, amazing things are possible. In our capital city, London, last year around 20 people in total ended up in a police cell, whereas in Sussex the number was over 400. That demonstrates that with real drive from both police and mental health services, practices can be changed and people’s lives can be made better. My hon. Friend is right to persist with the issue in Wales, just as I have tried to do in England.

--- Later in debate ---

[Norman Lamb]

Absolutely. My right hon. Friend is talking about something called street triage—I am sure that the Minister is familiar with it—which we introduced in many areas of the country over the past two to three years with a bit of pump-priming grant. Some pioneering areas, such as Leicestershire, just went ahead and introduced it before the national pilots started. The evidence is dramatic. Where we have that collaboration between the police and mental health services, with a nurse embedded in the police team, we achieve amazing results. We completely reduce the number of people being taken in under that legislation, because the nurse can find alternative solutions or provide care at home. Where it is necessary to take somebody to a place of safety, the numbers having to go into police cells falls dramatically. That innovative work was very much part of the crisis care concordat that I pioneered when a Minister, the aim of which was for the first time ever to set standards in mental health crisis care.

[Mr Mark Williams]

It would be wrong not to acknowledge in my area the Dyfed-Powys police and how the health board has embarked on such an initiative. My right hon. Friend will acknowledge that areas such as mine face the challenge of rurality and making those services available where they are needed. There is still a fear that all too often the need is not met.

[Norman Lamb]

I agree. My own county of Norfolk, with its widely dispersed rural communities, suffers from the same challenges. Sometimes having a nurse in a car with a couple of police officers does not work in a big rural area. However, we can do other things, like having a nurse embedded in the police operations room so that whenever an issue arises they can speak immediately by telephone or, if necessary, get a resource to the scene. Depending on the geography, there are ways of dealing with those challenges. We need to be much smarter in doing that. I applaud the innovation across the country.

Our whole approach in the crisis care concordat was rather different from the traditional Government approach, which is sort of to impose a straitjacket. The crisis care concordat said, “These are the principles. You come up with your plan for implementing them, working with the police, mental health services and the local authority, in a way that works for your locality.” That generated the most amazing degree of innovation across the country, and real progress has been made. Although I initiated it, I have enormous admiration for the people on the ground who got on and did it. It was inspiring.

NHS Mental Health Care

Mark Williams Excerpts

Wednesday 11th February 2015 Westminster Hall

[Mr Mike Hancock (Portsmouth South) (Ind)]

I am delighted to be able to have this debate with you in the Chair, Mr Pritchard; I am sure that on this occasion you will not be disturbed by colleagues making signals to you, trying to stop you from calling me to speak. The debate is very important, and I have been trying to secure it for some time. It is fair to say that there is widespread concern about mental health services in this country, and concern about how things have declined. Promises have been made by successive Governments to take more interest in this issue.

Since 2010, there has been a steep fall in the number of mental health nurses. Up to 4,000 have been lost, leaving a skill gap within the NHS. Nearly 2,000 beds have gone, a drop of 6%, while demand has risen by up to 30%. The Government must ensure equal access to mental health services and that the right treatment is available for people when they need it. The Government and NHS providers must ensure a commitment to parity of esteem that is directly reflected in the funding of commissioning services, work force planning and patient outcomes, and must ensure there are enough local beds to meet demand.

[Mr Mark Williams (Ceredigion) (LD)]

Will the hon. Gentleman add to his list of requirements the needs in rural areas, which often compound the problems that he has talked about in relation to the loss of beds in hospitals and lack of alternatives? Often the alternative is a prison cell overnight, which is completely unacceptable.

[Mr Hancock]

Absolutely. I agree with that entirely and I will come to it when I talk about my own personal experiences of spending a long time in a mental hospital trying to recover from a mental breakdown. I know only too well the issues that the hon. Gentleman has raised.

The urgent action plan that is needed cannot be put off for another five years. It needs to be put in place and direct action needs to be taken. There must be a sustainable and long-term work force planning strategy that acknowledges the current challenges facing the mental health world at the present time. We cannot leave it. You yourself, Minister, stated that only 25% of young people with mental health problems have access to mental health services, which you described as “dysfunctional and fragmented”—

Tobacco Packaging

Mark Williams Excerpts

Friday 12th July 2013 Commons Chamber

[Anna Soubry]

I can assure the hon. Gentleman that Mr Crosby has not had any conversation with any Health Minister on this issue. This really is a complete red herring. I can also inform him that I am very proud of the fact that we have banned cigarette vending machines, which will mean that people under the age of 18 in particular no longer have access to cigarettes by virtue of that site of sale, and I am also pleased that by 2015, we shall be ensuring that the ban on displays of cigarettes, which are currently banned in supermarkets without the provision of shutters, will be extended to smaller shops.

[Mr Mark Williams (Ceredigion) (LD)]

One hundred and fifty thousand youngsters are estimated to have taken up smoking since the end of the Government’s consultation, so the time scale is important. Can the Minister reiterate her assurance that this is not being kicked into the long grass, albeit in the outback, as we fear it may well be?

[Anna Soubry]

As I have explained, there has been no change of policy at all. What we have decided to do, based on the consultation, but most importantly based on what the Australian Government have done, is to look at that evidence as it emerges. I have spoken to the Australian high commissioner—[Hon. Members: “Oh!”] Hon. Members on the one hand claim that this is serious—

Carers

Mark Williams Excerpts

Thursday 20th June 2013 Commons Chamber

[Mr Mark Williams (Ceredigion) (LD)]

I thank the Backbench Business Committee for giving us this timely opportunity to talk about the role of carers in society. All the organisations that the hon. Member for Banbury (Sir Tony Baldry) talked about were UK-wide organisations. If I may, I will talk from a Welsh perspective, representing as I do the great Ceredigion constituency, although I appreciate that the Minister will not be able to address all the matters that are rightly devolved to our National Assembly in Cardiff.

As we have heard, this year’s carers week seeks to highlight how those in the UK’s carer population are coping with their role as a carer and how well the Government are supporting them in that role. That is a huge issue and it is of growing importance. There are currently 6.5 million carers and that is predicted to grow to 9 million carers in 25 years’ time. We need to ensure that people in the wider population are prepared for their future caring responsibilities.

I represent a rural constituency and we talk a lot in mid and west Wales about rural isolation. If we add to that the isolation that carers experience, it is a highly toxic mix and a huge challenge. That is coupled with the challenge of identifying carers, which the hon. Member for Worsley and Eccles South (Barbara Keeley) spoke about. I represent a huge tract of rural Wales that has scattered and sparse communities, including 147 villages. That makes it even more challenging to identify people and to build the networks that my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) talked about.

Ceredigion county council is attempting to rise to that challenge. It is taking part in this year’s carers week. The carers officer, Heather West, has informed me of an internal campaign that it has run to highlight the change in the known number of carers in the county. There was a 10% increase between 2001 and 2011 to 8,603 carers. There is also a huge number of people who provide care in excess of 50 hours a week. The numbers have grown and are set to grow further. The challenge in rural areas is to build networks so that we can initiate the support that is needed.

I am sure that hon. Members have read the Carers UK report. That research shows that seven out of 10 carers in the UK state that they were not prepared for all aspects of caring. Eight out of 10 were not prepared for the emotional impact of caring. Eight out of 10 were not prepared for the changes to their lifestyle because of a new caring role. Seven out of 10 carers were not prepared for the change in the relationship with the person for whom they care. I met somebody in my surgery a few weeks ago who, in the wake of his golden wedding anniversary, received the bombshell that his wife had a terminal condition. That couple had envisaged having a parity of caring roles in their old age. To have that responsibility shift in such a dramatic way to the husband was a huge shock. Seven out of 10 carers were not prepared for the financial impact of their caring role. As we have heard, 6,000 people take on new caring responsibilities every day.

The landscape has changed. In a previous life, 25 years ago, my first job was down the corridor in the House of Lords. I worked with pioneers in the carers movement, such as Baroness Nancy Seear and Baroness Jill Pitkeathley, who were trying to get official recognition for the term “carer” in statute. They achieved a great deal and we have achieved a great deal, but there is a long way to go.

In January this year, Ceredigion county council launched its e-learning carer awareness course, which can be done online. As is necessary in west Wales, it is fully bilingual. I took it this week. The course consists of four main sections: “Who cares?”, “Carers and the law”, “Meeting the needs of carers” and a test. That concept was initiated by Dudley metropolitan borough council and has been adopted by 40 local authorities across the UK. It is an excellent way to prepare people for the role of carer. It is just one small tool that can raise awareness. Many of my constituents are online and can access such courses.

The council is holding various events across the county focused on the “Prepared to Care?” theme. It has a widely distributed and widely read newsletter to update Ceredigion’s carers if they cannot attend the events.

The authority has also taken the opportunity of carers week to promote the Carers Count, Count Me In campaign, which seeks to register the 8,603 carers in the authority who were identified by the 2011 census data, only a small proportion of whom are officially registered. The aim is to get all carers registered with the Ceredigion carers development office. The sound logic behind that is that the more carers who are registered, the stronger the voice they will have in our area and with the local authority when campaigning for resources from the Welsh Assembly Government. It will also ensure that carers are recognised and valued, and that they have better services to equip them for the role. This year, the staff of the county council who juggle work and caring responsibilities, many of whom did not realise that they were carers, were targeted and a number did join the register.

A fantastic partnership has emerged between our carers development office and Aberystwyth university. They are researching the barriers and challenges in relation to carers needs assessments from the carer’s point of view. The research aims to highlight the support and advice that is available to carers and hopes to make the system more accessible. Critically, it will be independent research so that it can present an accurate and unbiased picture of what life is like for carers in our county.

Aside from preparing us to care, carers in my constituency also raised the issue of the spare room subsidy, or bedroom tax, during carers week. The carers office of Ceredigion county council has spoken to a large number of worried carers who are having to deal with new payment requirements even though they require a second room because of their extensive caring demands. A number of them are going through the appeals process, having already applied for discretionary housing payments. Although the local officers are doing their utmost to support carers, I think that the rules are inappropriate for such constituents. Above all, the stress caused by such matters and—to be frank—the stress that a number of welfare reforms have created for carers in our community gives me a great deal of anxiety.

In July, Carers Wales will hold a number of local sessions across Wales to meet local carers and try to allay some of their fears. Concerns have also been expressed about the attitude of banks to Court of Protection enduring power of attorney, and the mismatch between the banks’ policy and its delivery on the ground has caused a huge number of practical difficulties for carers. The Government can assist our carers in all those areas, and alleviate—at least in part—some of the stresses and strains that they experience.

As I have said, the debate has moved on and more people in the country are fully aware of what being a carer means—MPs certainly are from our casework every week and the people who come to our surgeries, and a new role needs to be pursued with employers and in the world of work. I wish the Government well in what they are doing, and I hope they will look at what I believe have been some helpful precedents across the border in Wales.

Cancer Care (England and Wales)

Mark Williams Excerpts

Tuesday 12th February 2013 Westminster Hall

[Alun Cairns]

I am grateful for the right hon. Gentleman’s valid point. I absolutely endorse the role that independent and charitable organisations can play; I quoted Breakthrough Breast Cancer. Emotional support is exceptionally important, and that relates to my point about delays in receiving treatment. A consultant can reassure people on many occasions, give a realistic assessment of the condition and provide the wider support available from some of the charitable organisations that have been mentioned.

[Mr Mark Williams (Ceredigion) (LD)]

Will my hon. Friend acknowledge the importance of care in the recovery of cancer patients? Statistics from Macmillan Cancer Support reveal that 19% of 18,000 newly diagnosed cancer patients in Wales were deemed to lack that kind of support, not just during diagnosis or treatment but, critically, in aftercare.

[Alun Cairns]

I am grateful to my hon. Friend for sharing those data. In interventions, hon. Members have talked not only about pre-screening, awareness, social issues and treatment, which I will focus on, but the aftercare that is needed, the emotional support that is provided, and the need for and responsibility and role of a whole host of agencies, including those in the charitable sector.

Returning to the point about treatment, I had been comparing the different approaches to breast cancer in England and Wales. The wait before seeing a consultant in England is 10 days. It is interesting to note that the Welsh Government removed 10-day monitoring in 2006. Although data are recorded locally, they are not published nationally. In the interests of transparency, it would be helpful if those data were published to allow fair and just comparisons. Waiting time targets improve survival outcomes, reduce emotional distress and improve the quality of life for people with cancer and those who turn out not to have cancer.

There are similarly alarming figures for prostate cancer. Five-year survival rates can be higher than 80%. There are no figures comparing the rates of the home nations, but the side-effects of the sort of treatment one receives for prostate cancer can be significant and can have a huge impact on future lifestyle. Again, there is a different approach to prostate cancer care in the two nations.

I want to draw attention to the availability of treatment. There was significant attention some years ago to access to brachytherapy. Even when it was finally approved by the Welsh authorities, after having been widely available in England, Scotland and Northern Ireland, the threshold for intervention was much higher in Wales. As far as I know, that remains the case.

Currently an identical debate is focused on robotic surgery. A constituent who suffers from prostate cancer, who is qualified medically and who consulted widely before making the decision with his clinicians on the most suitable form of treatment for himself, wrote to the Welsh Health Minister. He shared a copy of the letter with me, in which he said:

“I was both surprised and disappointed to find that this option is not available to Welsh men in Wales and that a significant number of Welsh men are opting to go to England, where this technology is established and available throughout the country.”

Nursery Milk Scheme

Mark Williams Excerpts

Monday 5th November 2012 Commons Chamber

[Annette Brooke]

I thank the hon. Gentleman for that intervention. I will not say which option I prefer, because I want to air all the issues, which I think are rather complex, and it is very important that they are all considered.

To return to my point about the variability in how children access free school milk, I have some figures from Bournemouth, Poole and Dorset, three local authorities, for the percentage of under-fives accessing Cool Milk, which is the agent that provides it, so it is possible that there are other ways of getting the milk. The figures are interesting: for Dorset it is 89.8%, for Bournemouth it is 25.5% and for Poole it is 46.3%. It would be worthwhile to get all the figures from the local authorities, rather than receive the answer, “This information is not collected centrally.” Some worthwhile statistical analysis could be carried out to make sure that our most disadvantaged children actually access the milk, because that is not automatically the case.

The School and Nursery Milk Alliance raises serious concerns about the knock-on effect that changes to the nursery milk scheme could have on the over-fives scheme. It is worried that a reduced take-up among under-fives will result in fewer over-fives moving on to school milk and that, if providers are no longer supplying nurseries in other settings, it will be harder for them to supply schools as part of the over-fives milk scheme.

Another point to consider is the administration process for child-care providers. At present, child-care providers or the agent they use, such as Cool Milk, which operates in my constituency, are reimbursed for the costs of the milk after they have purchased it. Whatever scheme is put in place must not put more of a burden on child-care providers, but be simple and easy to use so that nurseries and other settings are not put off taking part in the scheme.

We must consider how the milk will be delivered to the care providers. It is, of course, more expensive to deliver to nurseries in small and rural areas and to childminders working in difficult to access places.

[Mr Mark Williams (Ceredigion) (LD)]

I congratulate my hon. Friend on securing this debate. As has been said, the issue’s ramifications go much wider than England. On rurality, I represent Ceredigion and she also represents a rural constituency, and there are particular challenges when nurseries and child-care providers are based in a rural setting, where the operational costs are that much greater than in urban areas. The Member for Edinburgh North and Leith (Mark Lazarowicz) asked my hon. Friend whether she would support option 2. If she went along with that and a cap system, I would hope that she would ask for guarantees that the operational costs could be factored in so that rural people were not put at a disadvantage.

[Annette Brooke]

It is important that we take on board the additional costs in rural areas, which would become highly relevant if a capping system were to be introduced. I agree with the points that have just been made.

In any new system, it is important that nurseries and child-care settings are still able to make a choice about where they procure the milk. It is important that a supplier can ensure a suitable delivery time so that the quality of the milk remains high. In many settings the location of the milk provider will be important, with nurseries choosing a local, trusted supplier.

It is also important, when considering how best to progress and how to ensure best value for money, that we consider the requirements of the child-care providers. The consultation document repeatedly refers to pints of milk, but it must be remembered that children receive a third of a pint a day. Many settings do not have facilities to wash drinking cups, so they require milk to be supplied in single-serve packaging, and many would not be able to serve children milk if it was not delivered in those sizes, which is another cost factor. It is also important to consider special types of milk, such as kosher milk, that might be needed for religious or cultural reasons or, indeed, as an alternative if children have an allergy. I was particularly impressed with the cartons that I saw on my school visit on world school milk day, because they were really attractive and it literally was cool to drink milk.

I have received representations from a number of different organisations from the child-care and dairy industries. Although they understand why the Department is conducting a review, many of them, such as the School and Nursery Milk Alliance, are concerned that, while the Government are committed to protecting the entitlement of children to milk in early-years settings, proposed changes to the scheme could reduce the actual number of children receiving the milk. It is important that we maximise the number of children taking up the offer.

I know that the organisations will have submitted detailed responses to the consultation, so I just want to touch briefly on the different options and some of their pros and cons. Under option 3—the e-voucher system—child-care providers would no longer have to pay for milk and then claim reimbursement. They would instead be credited with a prospective monthly payment equal to the number of pints required multiplied by a fixed reimbursement rate, which would be set at an average market price per pint. The National Day Nurseries Association has voiced concerns that this kind of scheme might place additional administrative responsibility on providers. I ask the Minister to consider that, particularly given the Government’s commitment to reducing the burden on early-years settings that is currently being consulted on by the Department for Education.

Having garnered opinions, it seems that option 4—direct supply—is least favoured by those in the industry. Anticipated problems that have been raised with me include the cost of the operation; the fact that a national tender may quickly become uneconomic because while the supply of larger settings may be relatively straightforward, cost is quickly added when significant numbers of smaller, local, rural deliveries are required; denial of choice; the impact on local suppliers and dairy farmers; and the impact on the quality of the milk—I have heard time and again about the importance of fresh rather than UHT milk being supplied.

Bodies such as Dairy UK, Dairy Crest and the National Day Nurseries Association favour option 2—capping the price paid for milk—but they are concerned that a cap at the levels suggested by the Department might mean that many settings are not able to afford to have milk delivered at that price and so will opt out of the scheme, meaning that fewer children receive their milk. Dairy UK has suggested a single price cap in the region of 65p to 69p per pint, which it hopes would allow for the delivery of one-third of a pint packages of milk to smaller, rural and remote settings.

I am very pleased that the Government are committed to keeping free milk for all children under five years old in a day-care or early-years setting for two or more hours a day. I understand the need for a review of the scheme to ensure value for money, and I look forward to reading the Government response to the consultation, which I am sure will have taken into account a number of the concerns that have been raised in the House today. I urge the Minister to use this review as an opportunity to widen participation in the scheme so that more eligible children receive the milk to which they are entitled. I strongly believe that everyone who is entitled to the milk and wants it should be able to have it, as that is beneficial to the child and ultimately to the nation, with perhaps fewer costs and burdens on the NHS. As a final request to the Minister, will he say whether any European Union money or subsidies would be available to support this excellent scheme?

Organ Donation

Mark Williams Excerpts

Wednesday 30th November 2011 Westminster Hall

[Glyn Davies]

I thank the hon. Gentleman for his intervention, but I simply do not accept that. The evidence actually shows the opposite of what he has just said, and he is ignoring that evidence. This is an issue of such importance to me—probably the most important issue to me since I have been a Member of Parliament—that I have looked carefully at the evidence. I do not want to be advocating a course of action that in some way negates that evidence, and I do not think that that is what I have been doing.

[Mr Mark Williams (Ceredigion) (LD)]

The hon. Gentlemen has been very careful. He has cited the experience of Belgium and Spain. Would he also cite the experience of the survey held by the Kidney Wales Foundation, looking at 22 different countries, comparing the rates of donation and concluding that presumed consent would increase the rate of donation by up to 30%?

[Glyn Davies]

I thank the hon. Gentleman for that intervention. I referred to Spain because that is the example that all those who seek presumed consent have quoted for many years. I then referred to Belgium because when it was shown that the evidence from Spain did not support that argument, the example then used was Belgium. If there is evidence from 22 more countries, then I will have to see the results from them as well. I just do not accept that the international evidence supports the move to presumed consent at all.

--- Later in debate ---

[Mr Mark Williams (Ceredigion) (LD)]

Thank you, Mr Crausby. It is a pleasure to serve under your chairmanship this morning and I will be as brief as I can. I must congratulate my hon. Friend the Member for Montgomeryshire (Mr Davies) on securing this debate. I know that he has taken a keen interest in this matter over many years and he spoke with customary conviction while presenting his case. I do not agree with his case, but nonetheless I respect his conviction.

[Guto Bebb]

Does my hon. Friend agree that there is a way in which we can present this argument that has been made by my hon. Friend the Member for Montgomeryshire, and to the contrary by the hon. Member for Newport West (Paul Flynn)?

[Mr Williams]

The hon. Member for Newport West (Paul Flynn) also spoke with characteristic passion, and he spoke with passion about constituents, which is an important point to make. Another important point to acknowledge is that this is not a partisan issue. I happen to support the stance taken by the Welsh Assembly Government. It is not a Government that my party is part of, but I support the initiative of both Health Ministers in the Assembly, who happen to be Labour Members.

I will briefly explore the Assembly Government case and endorse the work of the British Medical Association. I will also highlight the work of the Kidney Wales Foundation, the British Heart Foundation, Diabetes UK Wales, the British Lung Foundation and the Kidney Welsh Patients Association.

[Glyn Davies]

Will the hon. Gentleman give way?

--- Later in debate ---

[Mr Williams]

I am not going to give way to the hon. Gentleman. I will proceed because many others want to speak.

Members of the Select Committee on Welsh Affairs received the request for legislative competence on this matter, although mercifully that was superseded by the referendum result, which conveyed greater powers to the Welsh Assembly. That is why it is now able to proceed in the legislative way that it is. The debate has, of course, been triggered by the publication of the White Paper by the Assembly Government on 8 November, which proposes a soft opt-out organ donation scheme for Wales, with a view to that becoming fully operational in Wales in 2015. Both contributions we have heard this morning have acknowledged the tragically large waiting lists for donors: 10,000 people UK-wide, 500 in Wales. The wider public support was acknowledged by the hon. Member for Montgomeryshire.

It was also acknowledged that earlier committee work had been undertaken in the National Assembly, and the committee was not exactly ringing in its endorsement of a soft opt-out proposal, although it did not rule that out. The then Health Minister opened the matter to public consultation, and some 81% of respondents in 2009 indicated that they were supportive of a soft opt-out scheme.

Despite those statistics and the overwhelming public approval for a scheme, tragically only 29% of us have signed up for organ donation. There has been much mention of the international comparisons. I will not dwell on them, other than to cite again the comparison highlighted by the Kidney Wales Foundation. It looked at 22 different countries with opt-out schemes—not just Belgium or Spain—and found that over 10 years there was a 25% to 30% higher donation rate than for informed consent schemes. I appreciate what has been said about an evidence-based scheme, but we must not be selective in the evidence used. That is critical—we need to look at the whole picture.

I strongly contend that a soft opt-out approach must not be seen in isolation. The Assembly Government is not arguing that a soft opt-out scheme alone will work and do the job that we all wish to see. As the hon. Member for Llanelli (Nia Griffith) said in her intervention, we need to heighten publicity, which is absolutely critical. Initiatives such as the use of the Driver and Vehicle Licensing Agency, so that when people apply for a driving licence they are asked whether they wish to join a scheme, would play an implicit part in a soft opt-out scheme.

[Jonathan Evans]

Will the hon. Gentleman give way?

[Mr Williams]

I will carry on, because I am conscious of time.

Critically, the Assembly Government has also responded to the need to increase infrastructure to cope with transplants. It is clearly developing that: the transplant directorate of the University hospital of Wales in Cardiff is the only transplant organisation responsible for kidney and pancreas transplantation in south and mid-Wales. In March, £2.4 million was spent on the Cardiff transplant unit, which has been opened with a dedicated transplant team and with new recruits of surgical and nursing staff. The Assembly Government also committed £1.5 million to implement the recommendations of the organ donor taskforce. Infrastructure and public information, coupled with a soft opt-out scheme, is the key.

Finally, and critically, we need to address the ethical issue. The soft opt-out scheme has been described as somehow being ethically improper. I think that is probably the view—I hope I do not do him a disservice—of my hon. Friend the Member for Montgomeryshire. That view has certainly been expressed by the Archbishop of Wales. I would not dare to describe him in the glowing way that the hon. Member for Newport West did; I am a member of his Church, and I deeply respect the Archbishop of Wales. He has highlighted the issue of the relative power of the state and the individual.

As a Liberal—call me an old-fashioned liberal—I very much want to see the emphasis on individual choice. The hon. Member for Clwyd South (Susan Elan Jones) alluded to that point in her intervention. There will still be choice—the choice to opt into a scheme is still there. The archbishop’s article in the Western Mail stated:

“Organ donation…ought to be a matter of gift. If one takes organs without consent, on the assumption that a person is tacitly assenting by not opting out, then that is no longer a free gift to others. An organ donation ought to be precisely that…an act of love and generosity.”

I agree with those sentiments, but I do not accept that opting out in any way conspires against the spirit of generosity. That is where public information and the awareness issue are so important.

What we need to do, which is what the Assembly Government seek to do, is to extend that spirit of generosity so that it becomes the norm and so that the discussions that every family will have to have throughout people’s life about such matters are very much the reality. That puts the onus on the individual to make informed choices, and that should be highlighted. A point has been made about relatives and members of families. The soft opt-out option means—this has been made open to consultation by the Welsh Government—that there is a specific role for members of bereaved families, whose views will be taken into consideration.

I perhaps started this process as an intuitive supporter of soft opt-out. I remember going to a meeting organised by the hon. Member for Cardiff West (Kevin Brennan) earlier this year, when we met people who were waiting for transplant operations. There is a healthy impatience, certainly in the Assembly Government and among others of us, to see the issue resolved.

The hon. Member for Newport West talked about his constituency cases. One benefit of the House rising early yesterday was that I was able to watch a little more television than usual. I watched an excellent documentary last night about a young couple from Exeter: 21-year-old Kirstie has been waiting several years for a lung transplant. She struggled through her teenage years, and she even struggled through her wedding day while being unclear whether she could actually survive the day. The highs and the lows—the highs were that on two occasions she received telephone calls saying that a donor was available; the lows were realising that the donor was not appropriate. Miraculously, as she reached the end of her life, a suitable donor was found, and Kirstie is now recovering and enjoying an increasingly full life. Sadly, many of our constituents are not so lucky, which is why many of us are very impatient and why the National Assembly Government have taken the lead in pushing for a soft opt-out option.