Tessa Jowell Brain Cancer Mission
Matt Hancock Excerpts(4 years, 12 months ago)
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The Secretary of State for Health and Social Care (Matt Hancock)
I would like to update the House on the progress we have made in tackling brain cancer, including on a new innovation that is now available across England.
For far too long, tackling brain cancer has been put in the “too difficult” box, and we are determined to change that. I want to pay tribute to the Petitions Committee, which did so much work on this; my hon. Friend the Member for Mid Norfolk (George Freeman), who picked up the subject in Government as Life Sciences Minister; my hon. Friend the Member for Castle Point (Rebecca Harris), the former chair of the all-party parliamentary group on brain tumours, which brought parliamentarians together; my hon. Friend the Member for St Ives (Derek Thomas), the current chair of the APPG; and, of course, Baroness Tessa Jowell, who campaigned passionately and tirelessly while battling the illness herself, and who, sadly, passed away a year ago.
Brain cancer is the most common cause of cancer-related deaths in children and young people under 19. Baroness Jowell called for all patients to benefit from 5-aminolevulinic acid, or “pink drink” as it is otherwise known: a dye that makes cancerous cells glow under ultraviolet light, thereby making it easier for surgeons to target the right areas. Trials have shown that, when the dye is used, surgeons can successfully remove a whole tumour in 70% of cases, compared to 30% of those without.
I am pleased to inform the House that we have now rolled out this ground-breaking treatment aid across England, with the potential to save the lives of 2,000 patients every year. That is part of the £33.9 billion extra that we are putting into the NHS and the NHS long-term plan. This procedure will now be expanded to every neurological centre in England. That is a fitting testament to Tessa Jowell’s memory.
It is worth pausing for a moment to remember the courageous words that Tessa Jowell used to urge us to rise above our differences. She said that this
“is not about politics but about patients and the community of carers who love and support them. It is…about the NHS but it is not just about money. It is about the power of kindness”.—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1169.]
That represents the very best of our democracy and of our Parliament. On behalf of all those who have died of brain cancer, all those—children and adults alike—who have campaigned, and all those seeking to do research, of which there is more to come in future, we are acting.
I want to mention three further areas in detail. The first is research. In the past, not enough research was done into the causes of and treatments for brain cancer. In the last year, the Government have made an unprecedented £40 million available to fund cutting-edge research of new treatments and drugs through the National Institute for Health Research. That will build on our outstanding reputation for neuroscience and oncology research, and increase the quality, quantity and diversity of brain cancer research. That funding was further enhanced by Cancer Research UK committing an additional £25 million to support brain tumour research. The size of those pledges will cement the UK’s position as a leading global centre.
Secondly, on our NHS cancer workforce, the number of specialist cancer staff in the NHS is set to grow as we put the £33.9 billion into the NHS over the next five years. Health Education England’s cancer workforce plan, and our upcoming NHS people plan, will set out in detail the steps we are taking to recruit a world-class cancer workforce. We made available an additional £8.6 million in the cancer workforce last year, and we aim to have 300 more radiographers start training by 2021.
Finally, on empowering patients, we have worked closely with the Tessa Jowell Brain Cancer Mission, Jess Mills and others to ensure patients are at the heart of all these efforts. The mission brings together Government, the NHS, researchers, pharmaceutical companies and patients to ensure that data is shared and disseminated properly so that more patients in the UK and around the world can benefit from what is learned. Due to the complexity of brain cancer, we must provide joined-up care that meets each patient’s unique needs. The NHS is focused on improving care for brain cancer patients to ensure they have access to dedicated out-patient clinics and consultations, wherever they live.
I hope the whole House will recognise the important progress made over the past year in rising to the challenge set by Baroness Jowell and the families of those who have lost loved ones to brain cancer. That progress has been possible only through the collective effort of patients, the NHS, charities and industry. That work is and will continue to be collaborative.
In her final speech in the other place last January, Tessa Jowell said:
“I am not afraid. I am fearful that this new and important approach may be put into the ‘too difficult’ box, but I also have such great hope.”—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.]
That hope was an inspiration to us all. We will rise to the challenge that she left us. We must not waiver in that task. I commend this statement to the House.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I thank the Secretary of State for an advance copy of his statement. We warmly welcome today’s announcement. His tribute to our much-missed friend and colleague was moving and powerful. It is an extraordinary testament to Tessa’s bravery that in the final harrowing months of her life, faced with a highly aggressive and very-difficult-to-treat cancer, and in full knowledge of the life expectancy associated with such a devastating cancer, Tessa led from the front to campaign for better brain cancer treatment for others. She spoke with extraordinary courage in the Lords, she brought the then Secretary of State and me together, and she convinced Ministers to shift policy, not by garnering sympathy, understandable though that approach would have been, but by persuasion based on facts and policy argument. It was typical Tessa.
Tessa would have been delighted by the Government’s announcement—some 2,000 brain cancer patients a year will now benefit from the “pink drink” solution—but she would be keen to go further still. Almost 11,000 people are diagnosed each year with a primary brain tumour, including 500 children and young people, which is 30 people every day, and more than 5,000 people lose their lives to a brain tumour each year. Brain tumours reduce life expectancy by around 20 years, which is the highest of any cancer, and are the largest cause of preventable blindness in children.
We live in hope of dramatic improvements, but further research is needed, given that less than 2% of the £500 million spent on cancer research is dedicated to brain tumours. I welcome the Secretary of State’s commitments on research, but does he agree that we also desperately need more involvement in clinical trials? The number of brain cancer patients taking part in clinical trials is less than half the average across all cancers. How will the Government encourage more trials and data sharing?
Finally, we know that the NHS remains under considerable strain generally. The 93% target for a two-week wait from GP urgent referral to first consultant appointment was not met once last year. Neurosurgery is no exception. In March 2019, the 18-week completion target for referral to treatment pathways stood at 81.3% for neurosurgery— 5% lower than the average for all specialties—which made neurosurgery the worst performing specialty. This is a question of both resourcing and staffing. I know the Secretary of State has his answer on revenue resourcing—we disagree, but we will leave our political arguments for another day—but on workforce there are vacancies for more than 400 specialist cancer nurses, chemotherapy nurses and palliative care nurses, and there are diagnostic workforce vacancies too.
Meanwhile, the staff who are there are reliant on outdated equipment, and we have among the lowest numbers of MRI and CT scanners in the world. Failing to diagnose early is worse for the patient and more costly for the NHS, so will the Secretary of State update us on when we can expect Dido Harding’s workforce plan? Can he reassure us that the cancer workforce will be a key part of that plan? On equipment and MRI scanners, can he guarantee that the NHS will see increased capital investment budgets in the spending review so that it can upgrade existing equipment and increase the number of MRI and CT scanners?
Overall, however, we welcome today’s announcement. It is a fitting tribute to our friend Tessa Jowell, and like Tessa herself will touch the lives of so many.
Matt Hancock
The cross-party tone of this discussion demonstrates what we can achieve when we work together. This is not just about Baroness Jowell, who did so much and was so brave in how she made her case—in the last few months in particular, but before that as well. It is about the many others who have worked together, including the many who were inspired by her words to work harder on brain cancer.
In truth, the amount of research money going into brain cancer—and therefore the number of clinical trials, which the hon. Member for Leicester South (Jonathan Ashworth) mentioned—was too low. There were so few clinical trials because research overall was too low. That is partly because brain cancer is a very difficult disease to treat. Just because it is difficult, however, does not mean we should not try, so we have increased the amount of research money, and I am determined to see an increase in the number of clinical trials and to make sure that the data from them is properly used and openly disseminated.
The hon. Gentleman asked about the cancer workforce. As I mentioned, of course we will need more people to treat cancer. That is partly what the £33.9 billion extra is all about.
The hon. Gentleman is also right to say that we need more early diagnosis. The truth is that, while the NHS is very good at treating cancer once it has been spotted—indeed, it is one of the best in the world—our cancer survival rates in this country need to improve through early diagnosis. That means giving more support to community services, strengthening primary care and ensuring that we have the diagnostic tools that he mentioned. We have more MRI scanners and more Linux machines for treatment purposes, but of course there is always more that we can do.
Steve Brine (Winchester) (Con)
During my time as the cancer Minister, I had the pleasure of meeting Tessa. You will recall, Mr Speaker, a very special debate that we had in the Chamber last April, when Tessa was back in the House of Commons, sitting in the Under-Gallery with her lovely family and listening to the debate.
Obviously I welcome the roll-out of 5-aminolevulinic acid—5-ALA—which allows surgeons to tackle some of the most difficult cases while ensuring that the healthy cells remain untouched. Does the Secretary of State agree that the exciting new frontier in cancer treatment is not only allowing people to survive it—more people are doing that for longer than ever before—but enabling them to live really well after treatment? It is no good surviving cancer if it is a rubbish time afterwards. Is that not the real promise of this?
Matt Hancock
My hon. Friend is a former colleague and dependable Minister, and I regret not having mentioned the work that he did in my opening remarks. The hon. Member for Leicester South said that he and my predecessor as Secretary of State had worked together on this issue, but the person who did the hard yards was my hon. Friend, and I pay tribute to him.
My hon. Friend is completely right: it is not just about surviving cancer, but about living well both with and after it. We must make sure that we learn that lesson and put the needs of patients at the heart of the process—not only their medical needs, but their non-medical and social needs. One of the humorous and amusing things that Tessa would talk about was the importance of the shape of the wig and the colour of the headscarf to a person who is going through chemotherapy, and that should be at the heart of treatment.
Neil Gray (Airdrie and Shotts) (SNP)
I welcome the statement, and thank the Secretary of State for giving me advance sight of it. I join Members on both sides of the House in remembering Dame Tessa Jowell, her lifetime of public service and, of course, her brave campaigning during the final months of her life.
This research funding is very welcome, and it was good to see Edinburgh University’s Dr Steven Pollard involved with the Tessa Jowell mission. Will the Secretary of State expand on what he said about research spending being UK-wide, and on the implications of that? Will he also say something about how his Department has worked with the Scottish Government in this important area?
I am sure that the Secretary of State is aware of the statement made this morning by Medac, which manufactures the “pink drink”, and its concerns about medical supplies post Brexit. Will he update the House on the work that he is doing to ensure the smooth continuing supply of that very important medicine?
Matt Hancock
It shows the power of bringing people together that we can agree with the Scottish National party’s Front Bencher on the importance of this agenda. I am delighted that the research spans the whole UK. The National Institute for Health Care Reform is reserved, and health research takes place throughout the country, and indeed internationally—throughout Europe and the world as a whole. Much of the best research is global, and that must continue. I shall be happy to work with colleagues in the SNP Government to further this mission and this end. Innovations of this kind are of course available to the NHS in Scotland, but the decision on whether to roll them out there will be a matter for Scottish Ministers, as that element is devolved.
As for the question of Brexit, I have absolutely no doubt that whatever form Brexit takes, we will do everything we can to ensure the continued and unhindered flow of medicines. We did an enormous amount of work to ensure that was the case ahead of 29 March. I have seen the comments the hon. Gentleman mentions from the company that supplies this drug. I see absolutely no reason to think that Brexit should have any impact at all on the ability to use this cutting-edge drug to save people’s lives.
Rebecca Pow (Taunton Deane) (Con)
First, may I thank everyone in Taunton Deane who was involved in raising money for the new MRI scanner? It was a huge local team effort. May I also welcome today’s announcement and the use of this dye, which will potentially save 2,000 patient lives and which is to be rolled out into all those neurological centres? That is wonderful news and demonstrates that where there is a will in this place there usually is a way.
I also want to highlight the following. Does the Secretary of State agree that when we are talking about this issue, we should also remember cancers that spread from other parts of the body to the brain—it is called metastasis? This is a very complex area and it needs more input in just the way that we have looked at this issue. Does the Secretary of State agree that we ought to look at that in more detail? Unfortunately, I speak about this from experience, with a close family member being involved.
Matt Hancock
I know about my hon. Friend’s, sadly, personal experience with this horrible disease and pay tribute to her for speaking up because it is not easy. She is right to raise another frontier that we must cross, and I am fully open to research bids in this area to work not just on brain cancer but on brain cancer that is a secondary cancer, because that is a very important area to get right, too.
Helen Hayes (Dulwich and West Norwood) (Lab)
I welcome the announcement today and the progress made over the past year since Tessa so sadly passed away. I also welcome the announcement as someone who lost both my paternal grandparents to brain cancer. I want to pay tribute in particular to Tessa’s daughter, Jess Mills, who has worked with unswerving determination and energy to drive forward progress in Tessa’s name over the past year. May I say on behalf of my constituents in Dulwich and West Norwood, who Tessa represented for 23 years, how proud we are of her powerful legacy on brain cancer and the difference her work will make for thousands of people for generations to come? Throughout the whole of Tessa’s 23 years in Parliament, she was a tireless champion of King’s College hospital, which is currently in a very challenged financial position. May I encourage the Secretary of State in continuing his commitment to £33.9 billion of additional funding to look at how this national support may also be marshalled to secure Tessa’s legacy at local level?
Matt Hancock
Baroness Jowell’s successor in her parliamentary seat speaks very powerfully and the hon. Lady is right to highlight the role of King’s in this research. King’s has been developing this treatment for years, and as a result of its work, it can now be rolled out nationally. It is a hospital that, as the hon. Lady says, needs to address some of its local challenges, but we should not take away from some of the globally cutting-edge work that it does and the positive impact it has: potentially 2,000 people alive each year who would otherwise die. That is testament to the importance of this research.
Sir Peter Bottomley (Worthing West) (Con)
The first person I know who had a brain tumour and cancer and died was John Davies, who had been the MP for Knutsford shortly after I was first elected.
The NHS website is very good about the possible symptoms of brain tumours. May I strongly recommend that everyone who thinks they may have a worry consult their medical practitioners so that either they can be cleared or they can get early treatment, and is it not right that early diagnosis is the best way forward for those who may have the condition?
Matt Hancock
My hon. Friend is absolutely right about that: early diagnosis is critical to improving the proportion of people who survive cancers, because of course it is easier to treat people if diagnosis is early. We are reviewing all cancer screening programmes because they are not working well enough; the National Audit Office set that out in some detail recently, and we accept those findings. We want to get early diagnosis and screening right, and it is a top priority for the new Public Health Minister, my hon. Friend the Member for South Ribble (Seema Kennedy), to make sure we do so that more people can survive.
Sarah Jones (Croydon Central) (Lab)
As the Secretary of State said, last weekend marked a year since the death of Tessa Jowell. We all heard the moving interview that Jess did at the weekend, which showed the commitment that she still has for taking on this issue and fighting for her mother’s legacy. On 19 April last year, we were in this place for a Back-Bench debate, with Tessa sitting in the Under-Gallery. I had sponsored the debate, alongside the right hon. Member for Old Bexley and Sidcup (James Brokenshire), and I should also like to thank you, Mr Speaker, for helping us at that time. We heard many moving speeches, and we were all glad to be there to pay our tributes to Tessa.
I am privileged to sit on the board of the Tessa Jowell Brain Cancer Mission, and I want to thank the Department of Health and Social Care for its support and for the roll-out of the pink drink that we have all been talking about. That is one of the many important initiatives that the mission has prioritised. Will the Secretary of State give us his assurance that the Department will provide the same amount of support and commitment to the other initiatives that we have identified? He has talked about some of them. They include the national roll-out of the integrated multidisciplinary care model, support for the first adaptive trial for brain cancer and the Tessa Jowell fellowship programme for oncologists. The NHS is one of the few care systems in the developed world that does not train or employ experts in brain tumour treatment. Rather, brain tumour patients are typically cared for by colleges and radiologists who predominantly treat other cancers. This strategic programme is really important, as it will revolutionise the skills in the health service to tackle this difficult problem.
Finally, I worked for Tessa Jowell, and I also worked for Mo Mowlam. They were two of the most powerful, wonderful women in this House, and they both had brain tumours. We need to find a faster cure, to ensure that people with brain tumours live well for longer so that women like those two amazing parliamentarians can continue to contribute for much longer. I thank the Secretary of State for the work that he has done, and I ask him to carry on doing it.
Matt Hancock
The hon. Lady expresses the thoughts of the whole House. She, too, has done an awful lot. I should of course have mentioned my right hon. Friend the Member for Old Bexley and Sidcup (James Brokenshire), who used his enforced sabbatical from the Cabinet due to cancer to push this agenda. I add his name to the tributes. It is absolutely true that campaigners on this subject who have had personal experience of brain cancer either themselves or in their loved ones and friends, as I have, feel very strongly about it, and this is absolutely not the end of the drive. I wanted to update the House on what we have done in a year, but there is still plenty more to do.
Chris Bryant (Rhondda) (Lab)
Melanoma is one of the cancers that can metastasise into the brain, because it can travel either through the blood or through the lymphatic system. We also know that, although it can kill, especially in the circumstances we are talking about, it is very preventable. I just wonder whether there is not considerably more that the Government could do to ensure that every child covers up in the sun and that more people use sunscreen, perhaps by taking VAT off sunscreen that is higher than SPF30 or SPF50. We must also ensure that we have enough dermatologists in this country to check moles and other growths that people might have on their bodies.
Matt Hancock
Yes, I agree with all that. Of course, protection from too much exposure to the sun is part of the prevention agenda in healthcare, as well as being an absolutely sensible thing to do.
Wes Streeting (Ilford North) (Lab)
Like others, I want to congratulate the Government and everyone involved in the Tessa Jowell Brain Cancer Mission on making a painful anniversary for Tessa’s friends and family a bit more bearable for knowing that her vigour and energy are still very much alive and kicking through the mission. This is also a painful time of year for my constituents, Scott and Yang Lau, who lost their young daughter Kaleigh to a diffuse intrinsic pontine glioma, a particularly pernicious brain tumour that largely affects children. They are working with Jess Mills on fighting that particular form of brain tumour. What more can the Department do, generally and specifically through the Tessa Jowell Brain Cancer Mission, to focus on childhood brain tumours, particularly rare tumours such as DIPG, so that other families do not have to suffer what my constituents and others have had to go through?
Matt Hancock
The hon. Gentleman is right to say that, and I send my condolences to his constituents. The truth is that brain cancer is one of the most, if not the most, predominant cancers among children. Although it is relatively rare among all cancers, that is not true among children. Thousands of people still die from brain cancer, which is why it was right that Parliament and Tessa Jowell came together to highlight the lack of research in the area—something that we are determined to put right.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
May I too thank the Government for today’s statement? I was heartened by the answer given to the hon. Member for Worthing West (Sir Peter Bottomley), because early diagnosis is incredibly important. There are certain things that people can recognise, such as the effect on vision. Ironing a pinstripe shirt, for example, can lead to an odd effect, which is an early sign. Early screening in built-up areas and cities is quite easy, but it is harder in rural areas, so I make a plea for the Government to consider sparsely populated regions such as mine.
Matt Hancock
The hon. Gentleman is right that screening is vital. One of the reasons why we are looking at the whole screening programme is that the use of technology has not been nearly good enough. For many people, but not all, that can be valuable, especially in rural areas. Technology is not only used for the screening itself, but for notification and for ensuring that we get to everybody who needs to be reached. Professor Sir Mike Richards is undertaking the review of all screening, and I would be happy to put Sir Mike in contact with the hon. Gentleman to ensure that the review properly considers the impact of rurality on the need to get screening to everybody who needs it.
Mr Speaker
I thank the Secretary of State, the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), and all colleagues for both the content and the spirit of the exchanges that have just taken place. Let us hope that Tessa’s husband David and children Jess, who has rightly been referred to, and Matthew will derive some succour from knowledge of the continuing interest in Tessa’s passionate crusade that exists in the House. We know in our heart of hearts that that continued interest will endure for as long as is necessary, both because of the supreme importance of the cause and because we are united across the House in this. We have huge respect for the courage, stoicism and unrelenting determination to make progress on this subject that Tessa Jowell, in extreme adversity, exhibited at all times.
Oral Answers to Questions
Matt Hancock Excerpts(5 years ago)
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Grahame Morris (Easington) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
Our radiotherapy modernisation programme has so far delivered 80 upgrades or replacements, with more to come.
Grahame Morris
One in four people currently receive radiotherapy—a number that will increase if the Government achieve their early diagnosis targets. Ministers dispute that 20,000 people in England annually miss out on appropriate access to life-saving radiotherapy. What is the Secretary of State’s estimate? Will he commit to meeting representatives of the Radiotherapy4Life campaign to discuss how we can improve radiotherapy provision in England?
Matt Hancock
I am absolutely happy to meet the group. According to the latest figures, about four in 10 of all cancer patients are treated with radiotherapy; it is a critical treatment to tackle cancer. As I say, there has been an investment programme to replace and upgrade radiotherapy equipment, with 80 upgrades or replacements over the past three years, but there is clearly more to do to make sure that people with cancer get the best possible treatment.
Sir David Evennett (Bexleyheath and Crayford) (Con)
Matt Hancock
Yes, that is exactly right. That is why we have put in place the new LINACs—linear accelerators, the equipment that is being rolled out across the country in a £130 million programme. We are always looking at what more we can do to help people to beat cancer.
Tim Farron (Westmorland and Lonsdale) (LD)
Will the Secretary of State agree to look personally at the case for a new satellite radiotherapy unit at Westmorland General Hospital, tied to the Rosemere unit in Preston? I had the privilege last week of driving my constituent Kate Baron to her treatment at Royal Preston Hospital. Wonderful treatment though it is, it is a three-hour round trip that she has had to take on 15 separate occasions—I went with her only the once. Hundreds of people in the south Lakes have to make debilitating, lengthy round trips to get treatment day after day, which is damaging to their long-term health and to their ability to access radiotherapy at all.
Matt Hancock
I am grateful to the hon. Gentleman for raising that point. He did not raise the individual case with me in advance, but I can see the point he is making. The public health Minister, who is responsible for cancer policy, will be very happy to meet him.
Lilian Greenwood (Nottingham South) (Lab)
George Freeman (Mid Norfolk) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
Providing patients with modern digital services that are safe, effective, convenient and personalised is central to our NHS long-term plan.
George Freeman
I thank the Secretary of State for that answer and for the energy that he brings to this brief. Does he agree that digital health not only improves healthcare systems but also provides a platform for place-based and population-based prevention, better diagnosis, patient empowerment, novel mental health therapies and accelerated access to the innovative treatments that I introduced as a Minister? This is now being pioneered in some parts of the country. Will he meet me and the Birmingham health partners to look at an interesting idea for digital place-based health impact bonds?
Matt Hancock
Yes, I am always happy to meet my hon. Friend to talk about interesting new policy innovations like that. It sounds right up my street. In fact, I met the Mayor of the West Midlands combined authority to discuss this subject only last week. There is a huge amount of enthusiasm and energy in this policy area, which will enable us to improve patients’ lives across Birmingham and, indeed, the whole country.
Andy Slaughter (Hammersmith) (Lab)
As the Secretary of State knows, because he is a member, the Babylon Health GP at Hand digital service is based in Hammersmith and Fulham. By the end of this year, it will have run up a deficit of about £35 million for my clinical commissioning group. Given that the clinical commissioning group is cutting GP hours and closing an urgent care centre overnight because it is so short of funds, when are we going to be reimbursed for that £35 million?
Matt Hancock
I do not recognise the number that the hon. Gentleman talks about, but we are changing the way in which the GP contract works to ensure that this new technology can be most effectively harnessed to deliver patient need in a way that also works for the NHS. I am slightly surprised that he has not yet got up to say thank you for our announcement on primary care services in his part of London, which we are going to be expanding while stopping the closure of A&E. A little bit of gratitude for that would also go down well.
Huw Merriman (Bexhill and Battle) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
Wherever possible, the National Institute for Health and Care Excellence aims to publish recommendations on new drugs within a few months of licensing and now publishes draft guidance on cancer drugs even before licensing. Many thousands of patients have benefited from rapid access to effective new drugs as a result.
Lyn Brown
The Secretary of State will know that Maryam is now nine months old. We have been waiting nine long weeks for NICE to announce a decision that I am told it has already made. Spinal muscular atrophy babies have been waiting 16 months for the care they need, which is longer than many SMA babies live without treatment. There is another closed-door meeting tomorrow. If NICE finally decides to provide Spinraza on the NHS, how long will it be before Maryam and the other babies get their first dose?
Matt Hancock
The hon. Lady rightly raises an important case, and I have met her about it and followed it closely. As she says, there is work ongoing and happening this week to try to make progress. NICE is currently developing technical appraisal guidance on the use of the drug Spinraza, to which she refers. We are working to ensure that we can get it right.
Simon Hoare (North Dorset) (Con)
As chairman of the all-party parliamentary group on multiple sclerosis, may I urge my right hon. Friend to ask NICE to expedite its perfectly proper processes on the licensing of cannabis-based drugs, particularly for the treatment of multiple sclerosis, Parkinson’s and motor neurone disease?
Matt Hancock
Yes. My hon. Friend raises another important area where progress is being made on the ability for people to get access to drugs that could help them. We now have a medicinal cannabis programme in place, as we discussed in this Chamber a couple of weeks ago, so that those with acute conditions and with clinical support for using medicinal cannabis can get it. We are also working as rapidly as we reasonably can to normalise the ability to use medicinal cannabis within the NHS.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
Kuvan, Orkambi and Spinraza—these are just three life-changing drugs to which thousands of patients are being denied access on the NHS. Patients have waited far too long for the drugs they desperately need, and for some, as we have heard, it is a matter of life and death. Does the Secretary of State agree that the NICE appraisal process for rare diseases is just not fit for purpose?
Matt Hancock
I do agree it is important that NICE constantly tries to get those decisions made objectively, robustly and as fast as possible. There is cross-party support, and I hope continuing cross-party support, for these judgments being made independently so that they are taken not by Ministers but by clinicians. We can all agree that this has to be done as quickly and as efficiently as possible.
Sir Nicholas Soames (Mid Sussex) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
Mr Speaker, I share your ambition in reaching Question 17 to be able to say that the long-term plan for the NHS sets out ambitious goals to embed a culture of quality improvement of which my right hon. Friend would be proud.
Sir Nicholas Soames
Thank you very much, Mr Speaker, for getting this far down the list of questions. I know that my right hon. Friend the Secretary of State has a serious ambition to try to drive this plan forward, but it is unacceptable that best practice is not better disseminated throughout the NHS. It is completely unacceptable that there are such wide divergences in standards between hospitals, and it requires the everyday attention of the Secretary of State himself to drive this change through.
Matt Hancock
I agree entirely and enthusiastically with my right hon. Friend. The need to improve services in the NHS just to bring them up to the best that is in the NHS is vital and urgent. We can lift the quality of care that all our constituents get simply by learning from the best. We have schemes such as the “getting it right first time” programme, which is brilliant at teaching hospitals how to do things the way the best hospitals do them, and we want to see more.
Dr Philippa Whitford (Central Ayrshire) (SNP)
A recent report in the British Journal of Surgery demonstrates that the introduction of the Scottish patient safety programme resulted in a 36% drop in post-surgical deaths. Will the Secretary of State join me in congratulating all the surgeons, anaesthetists, theatre teams and ward staff who achieved this, and would he like to visit Scotland and see the programme in action?
Matt Hancock
I always love visiting Scotland and would love to come and see this programme in action; I have heard and read about it. In improving quality across the NHS, we need to improve the ability of the NHS to look everywhere—outside the NHS in England, as well as at other hospitals—to find and emulate best practice.
Mr Speaker
This is a general question about best practice in the NHS, into which the hon. Member for Bosworth (David Tredinnick) could legitimately shoehorn his concerns about acupuncture, chiropractic therapies, osteopathy and other non-drug based, non-addictive options for pain management, about which I think he is keen to expatiate.
David Tredinnick (Bosworth) (Con)
Matt Hancock
Mr Speaker, I am glad that you have used your considerable flexibilities to bring this question in, because I wanted to say that NICE is in the process of developing a guideline on the management of chronic pain, which will look at the biological, physiological and social factors, including some treatments mentioned by my hon. Friend. There is progress in this space, and I am glad that we have been able to raise this matter in the House today.
Rachael Maskell (York Central) (Lab/Co-op)
As well as looking at best practice in the NHS, it is vital that we look at best practice in social care. Given that 70,000 people with dementia were admitted to hospital unnecessarily with falls, dehydration and infections just last year, how is the Secretary of State going to put a laser-beam focus on standards in social care?
Matt Hancock
The hon. Lady is absolutely right. I am glad that this discussion of improving quality across the NHS and social care has united the House in its enthusiasm to see best practice and ensure that people learn from it. We have seen an awful lot of learning in social care, as most social care is delivered by private sector providers, but there is more to do and there are different levers that we can pull. When social care providers lose their good or outstanding status, they also often lose their contracts, so there is an awful lot of pressure on them to learn from best practice around the country, and I would only emulate that.
Antoinette Sandbach (Eddisbury) (Con)
Mr Laurence Robertson (Tewkesbury) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
It is the goal of the Department to support everyone to live longer, healthier lives. I will be working right across the health and social care sector to deliver the goal of five years of extra healthy life for people in the UK. In doing that, I am delighted that we will now have on the ministerial team the enthusiasm and assistance of the Under-Secretary, my hon. Friend the Member for South Ribble (Seema Kennedy).
Mr Robertson
In achieving those goals, the Secretary of State will be concerned that while many patients can obtain GP appointments for emergency cases on the same day, quite a lot of people have to wait three or four weeks for non-emergency appointments. Can the Government do anything to improve that situation?
Matt Hancock
Yes, I entirely understand my hon. Friend’s concerns. We are acting to make sure that there is better access. We have a review of access to primary care. But, more than that, the biggest increase of the £39.9 billion of extra taxpayers’ money that we are putting into the NHS is in GP access, primary care and community care to make sure that we get ahead of the curve and help people to stay healthy rather than just treat them in hospital.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
Can the Secretary of State explain why 200,000 nurses have left the NHS since 2010 and why today we are short of 40,000 nurses?
Matt Hancock
The good news is that we have record numbers of nurses in the NHS. We have more staff in the NHS than at any time in its history. While of course in any very large organisation like the NHS there is always turnover, what matters is having the people we need. We are putting more money in, we are going to need more people, and we are developing a plan to make that happen.
Jonathan Ashworth
We have about 90 nurses a day leaving the NHS, so rather than posing for the newspapers by the stables like a character from a Jilly Cooper novel, why does the Secretary of State not show some actual leadership and reverse the cuts to development, reverse the cuts to training places and reverse the abolition of the training bursary so that we can start to recruit the nurses and midwives our NHS needs today?
Matt Hancock
What I will not reverse is the increase in the number of people who are helping to improve lives and save lives in our NHS. It is only because of the extra money that we in this Conservative Government have put into the NHS that we can be confident that we are securing its future to deliver better care for every single person whom we represent in this House.
Priti Patel (Witham) (Con)
Matt Hancock
My right hon. Friend is right to raise that. That money is already committed. Of the extra £33.9 billion that is going into the NHS, the biggest increase is going into community and primary care, because I understand how important it is for people to get decent access to their GP services in Witham and across England.
Patricia Gibson (North Ayrshire and Arran) (SNP)
Matt Hancock
No, the NHS is going to be there for us no matter what the outcome of Brexit is. The British people voted for Brexit, and we are going to deliver Brexit, and then we are going to get on to doing all the other things. Even over the last few months, we have been able to put extra money into the NHS to ensure that its future is guaranteed.
Paul Masterton (East Renfrewshire) (Con)
Mr Speaker
The only thing that is weighty about the hon. Gentleman, in my experience as a county colleague, is his brain.
Matt Hancock
I would be delighted to encourage that which my hon. Friend encourages. One thing that leads to people putting on weight is high levels of stress, so perhaps we could put some contentious issues behind us to reduce stress levels and allow all of us to lead healthier and happier lives.
Several hon. Members rose—
Lucy Powell (Manchester Central) (Lab/Co-op)
It was a magnificent and very important goal, Mr Speaker.
I would like to put it on record that my husband is an A&E consultant. The Secretary of State will know that one of the massive factors in gaps in rotas is that A&E doctors and other hospital doctors are facing notional tax rates of 90% or more from taking on extra shifts. It is not a very Tory policy, this. What is he doing about it?
Matt Hancock
This policy has come up a couple of times in questions today, and rightly so. I am having discussions with the Chancellor. It is a tax policy, and I do not think that my right hon. Friend would be incredibly enthusiastic about me announcing tax changes at the Dispatch Box. It is something that we are talking about and working on. It is the unintended consequence of tax changes that were designed for other parts of the economy.
Tom Pursglove (Corby) (Con)
The appropriate and safe disposal of drugs and medical equipment has recently been raised with me by my constituents in Corby. Will he keep in mind these concerns when reviewing policy in terms of both awareness of what to do and the ease with which it can be done?
Ellie Reeves (Lewisham West and Penge) (Lab)
It is deeply concerning that in the past 10 years the number of prescriptions for opioid drugs has risen by 9 million. In this time, codeine-related deaths have more than doubled to over 150 a year. While I welcome moves to label opioid medicines, what further measures will the Secretary of State take to protect people from the dangers of opioid addiction?
Matt Hancock
As the hon. Lady may know, I am very concerned about this. We are working on what we can do to ensure that opioids are prescribed and used only when they are the most appropriate and right treatment. Opioids save people from significant pain and are used every day right across the NHS, but opioid addiction is a very serious problem. Some other countries have got this wrong, and we must get it right.
Jeremy Lefroy (Stafford) (Con)
I thank my right hon. Friend the Secretary of State for coming to County Hospital in Stafford on Saturday. Does he agree that he saw there the importance of small accident and emergency departments sustaining the whole of the regional health economy by giving support to the larger ones?
Matt Hancock
Yes. It was brilliant to go to County Hospital in Stafford and see the hard work and team work and to be able to thank NHS staff both in Stafford and across the country working over the long weekend. My hon. Friend is a brilliant and diligent voice of Stafford. I have already stopped A&E closures in west London. I do not think that we should be seeing the closure of small A&E units, and I will work with him on the issue.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
As the Minister is aware, I have become concerned about the rising number of suicides in my constituency. When I talk to professionals in the area, they tell me that it is not just funding that is causing some of the problems but the lack of staff. What more can the Minister do to ensure that we have the mental health staff that we desperately need?
Rachel Maclean (Redditch) (Con)
The Secretary of State has been kind enough to visit Worcestershire Royal Hospital, which serves people in my constituency. He saw for himself how small the emergency department is there. With £20 billion going into the NHS, does he agree that there is a good opportunity to look again at returning services to Redditch—in particular, the maternity and A&E departments, which have been removed?
Matt Hancock
It was brilliant to visit Worcester hospital—another medium-sized hospital, but with a small A&E department that was working incredibly hard given the facilities. I pay tribute to all the work of staff there and very much take on board the points that my hon. Friend has made.
Several hon. Members rose—
Social Media and Health
Matt Hancock Excerpts(5 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Matt Hancock)
I would like to update the House on yesterday's social media summit and the progress we have made on tackling online harms to health. We called this summit to bring together the principal social media companies, including Facebook, Instagram, Twitter, Pinterest, Google and others, as well as the Samaritans and the eating disorder charity Beat. It was the second such meeting I have held, along with the Education Secretary and the Minister for suicide prevention, on how we can protect people—particularly children—from online content that promotes eating disorders and self-harm and suicide, as well as on how we address the growing problem of anti-vaccination misinformation.
Social media companies have a duty of care to people on their sites. Just because they are global, it does not mean that they can be irresponsible. We have been resolute that we will act to keep the internet safe, especially for children, and I am grateful to the companies for their engagement.
We have all seen and heard about tragic cases of vulnerable children turning to self-harm and even taking their own lives after accessing graphic images online that promote and even encourage suicide and self-harm. In the same way, we know that online content on eating disorders can be extremely harmful to vulnerable children and young adults. I have met the parents of children, brought up in loving homes, who had no idea of the dangers that their child was being exposed to on their smartphone or tablet while they were supposed to be safe at home. We all know of parents whose children have been affected, and for all of us this is very close to home.
We must do everything we can to keep our children safe online, so I am pleased to inform the House that, as a result of yesterday’s summit, the leading global social media companies have agreed to work with experts from the Samaritans to speed up the identification and removal of suicide and self-harm content, and to create greater protections online. They will not only financially support the Samaritans to do the work; crucially, suicide prevention experts from the Samaritans will determine what content is harmful and dangerous, and the social media platforms committed to either removing it or preventing others from seeing it, and to helping vulnerable people get the positive support they need.
The mainstream media already have well-established codes of practice and training for removing material that promotes suicide and self-harm. In my experience, the British media act with great responsibility on the matter, and it is time that social media companies did the same. This partnership marks, for the first time globally, a collective commitment to act, to build knowledge through research and insights, and to implement real changes that ultimately will save lives.
The social media companies also gave us an update on the actions they have already taken. Following the first summit in February, Instagram now has a policy globally of removing all graphic self-harm imagery, and other sites have also taken action, but there is much more to do and more content to remove. Importantly, the commitments that the companies made at yesterday’s summit are what the Samaritans asked for, and they are a positive step forward. The progress that we have made so far shows that we can effect positive change, but I know that the House feels strongly that just because these companies are global does not mean that we as a House cannot determine society’s rules and expectations. On this we are prepared to act too.
My right hon. Friend the Home Secretary and my right hon. and learned Friend the Secretary of State for Digital, Culture, Media and Sport recently published the online harms White Paper, which sets out the proposed regulatory framework for addressing online harms. It sets out a new statutory duty of care to require companies to take more responsibility for the safety of their users and tackle harm caused by content or activity on their services. Compliance with this duty of care will be overseen and enforced by an independent regulator, which will be responsible for producing codes of practice that will explain what companies need to do to fulfil their duty, and the robust action they need to take to remove illegal or harmful content. The White Paper also proposes the sharing of information, research and best practice to improve the understanding of harmful content across the industry.
The summit also allowed us to discuss how we can work together to tackle another online danger: the spread of anti-vaccination misinformation. Since Edward Jenner’s discovery, vaccination has saved hundreds of millions of lives around the world. Few innovations have reduced human misery so much. After clean water, vaccination has prevented more deaths and disease than anything else in human history. The science is settled: vaccination saved lives. It protects not only our children but other vulnerable people who cannot do anything about it themselves. Failure to vaccinate puts their lives at risk. The rise of social media now makes it easier to spread lies about vaccination, so there is a special responsibility on social media companies to act.
Coverage for the measles, mumps and rubella vaccine in England decreased for the fourth year in a row last year, to 91%. There was a steep rise in confirmed measles cases last year, from 259 to 966. We forget that measles is a horrible disease. We have one of the most comprehensive vaccination programmes in Europe. The well-documented problems in America and on the continent are worse than here, but we are determined to get ahead of the problem, because failure to vaccinate has real and devastating consequences. Our action to promote vaccines is not limited to removing anti-vaccination misinformation online; we are promoting the objective facts about the importance of vaccination and increasing funding to primary care to improve access, and our prevention Green Paper will set out further actions.
Social media can be a great force for good and can help us promote positive messages, but it is the responsibility of us all to ensure that this new technology, with all its great potential and power, is moulded to the benefit of society. We will not duck this challenge. I commend this statement to the House.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I am grateful to the Secretary of State for advance sight of his statement. These social media platforms must be made to take responsibility for the harm caused by the dangerous fake news they host, because they are helping to fuel a public health crisis. He talks about the actions that platforms such as Instagram have taken since February, but I have just searched on Instagram and found images and videos of graphic self-harm; there are 8 million posts with the hashtag #suicide—from a quick glance, many are distressing—226,000 posts with the hashtag #killmyself, and 249,000 posts with the hashtag #selfinjury. I found similar pro-anorexia posts and the normalisation of eating disorders. I am sorry to have to share those examples with the House, but I think that we have to understand the scale of the challenge we face. As the father of two beautiful daughters, aged seven and five, I would be devastated if they saw such posts as they grow up.
Dangerous content should be blocked and taken down. I look forward to the Samaritans’ recommendations, so can the Secretary of State update us on the timescale? He talked about the online harms White Paper, but we need action immediately, so can he tell us when the proposed legislation will come before the House? When will the new regulator and duty of care be enforced? Can he guarantee that there will be criminal sentences for executives for serious breaches? In what circumstances would the maximum fine of 4% of global turnover be applied? If, God forbid, something similar to what happened to Molly Russell—I am sure that the whole House will want to praise her father for his brave campaigning—should happen to another child, what action would be taken against the social media companies?
I have also been able to find dangerous anti-vaccination propaganda on platforms such as Facebook, at a time when measles outbreaks are on the increase across Europe and the United States and in parts of the United Kingdom. Unvaccinated children are being turned away from schools in parts of Italy and banned from public areas in parts of New York. I would hate to see that happen here. UNICEF has warned that more than half a million children have missed their measles vaccination, which means the UK now has the third-worst ranking of all high-income countries. As the Secretary of State said, take-up of the MMR vaccine has now declined for the fourth year in a row, making coverage for the vaccine the lowest it has been since 2011-12.
I know that the Secretary of State said on the radio last week that he was considering banning unvaccinated children from schools in England, but we urgently need a clear vaccination action plan from the Government. This cannot be about penalising families. Yes, we need intervention with social media platforms when the legislation is in place, but while we wait for the legislation will he consider instructing Public Health England to launch an online social media campaign, on the platforms that are currently sharing anti-vaccination propaganda, to challenge those dangerous myths?
Will the Secretary of State also accept that our falling vaccination rates are not just about online activity? Public health services have been cut by £800 million. Our health visitors have been cut by 8% in recent years, and our school nurses by 24%. General practice has faced a funding squeeze, and GP numbers are down by 1,000 since 2015. At the same time, 2018-19 marks the first year that we have seen a reversal in the percentage of children receiving vital health check-ups on time since the measurement of these figures began: 14.5% of children are not receiving a six to eight-week review on time; 24% are not receiving a 12-month review on time; and the number of mothers over 28 weeks pregnant receiving their first face-to-face antenatal contact with a health visitor has fallen for the second year in a row. Will he therefore commit today to reversing public health cuts and restoring health visitor numbers, and will he invest in general practice so that we can meet the 95% national vaccination coverage rate, as recommended by the World Health Organisation? When does he expect us to meet that 95% rate?
Children are 20% of our population but 100% of our future. We must always put their health and wellbeing first. Yes, there has been some progress, but we need further action from the Government today.
Matt Hancock
I pay tribute to the hon. Gentleman, who has provided leadership on this agenda from his position as shadow Secretary of State. I am glad, listening to his response, that we agree very broadly on the direction we need to take. The agreement across the House is valuable in demonstrating to social media companies the clear consensus on the need for them to act, and to every parent in the land the importance of vaccination. That cross-party support is very, very valuable.
I join the hon. Gentleman in paying tribute to Ian Russell, the father of Molly Russell, whom the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), the Minister for suicide prevention, met this morning. He has been brave and eloquent in bringing these issues to light. I pay tribute to him and thank him for how he has spoken about what needs to be done. I know he is as determined as we are to ensure that action translates into saving more lives.
We agreed, after the meeting yesterday, to reconvene in two months’ time, by which time I expect further action from the social media companies. As I said in my statement, we have already seen some progress. I am glad that some of the global algorithms and global terms and conditions have been changed as a result of action taken by the UK Government. It is very important that we keep the pace up. In two months’ time, we expect to see further action from the social media companies and progress by the Samaritans on being able to define more clearly the boundary between harmful and non-harmful content. In each area of removing harms online, the challenge is to create the right boundary in the appropriate place. It is the challenge when tackling terrorist and child abuse material online, so that social media companies do not have to define what is and is not socially acceptable, but we as society do. I am delighted that the Samaritans will formally play that role on material relating to suicide prevention and self-harm, and that Beat will do so on material relating to eating disorders.
The hon. Gentleman asked about the online harms White Paper. We are currently in the middle of a 12-week consultation. I hope he and everybody listening to this who has an interest will respond to it. We are clear that we will have a regulator, but we also genuinely want to consult widely. This is not really an issue of party politics, but of getting it right so that society decides on how we should govern the internet, rather than the big internet companies making those decisions for themselves. I have to say that the tone from the social media companies has changed in recent months and years, but they still need to do an awful lot. I look forward to working with him and others across the House to ensure we can deliver on this agenda.
Maria Caulfield (Lewes) (Con)
I welcome the Secretary of State’s work on this issue. Will he comment on stand-alone posts, tweets or messages which on their own do not seem that intimidating or threatening, but which have a cumulative effect that is nothing short of bullying, harassment and intimidation that can cause mental health problems for many of our young people? Will he ask social media companies to not just look at single posts, but at the cumulative effect of people trying to intimidate others?
Matt Hancock
Yes, my hon. Friend is absolutely right. In fact, the cumulative effect of posts on mental health, in particular eating disorders, came up in the discussion yesterday. We have to look at what the social media companies call the density of content—I think my hon. Friend put it rather better as the cumulative impact of lots of different posts. Social media companies’ algorithms are powerful enough to understand that and pick up on it. We need rules in place so that action can be taken when it is spotted by those algorithms.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I too welcome the statement, the two summits that have already been held and, in particular, the announcement of funding to Samaritans. However, the scale of the task is absolutely huge. The scale of the donation to Samaritans is actually quite small by comparison both with that and with the profits the companies make. They are expected to make profits of £50 billion just this year. It is important to talk about preventing the promotion of eating disorders, self-harm and suicide, and I welcome that approach.
As chair of the all-party group on vaccinations for all, I particularly welcome, in World Immunisation Week, the Secretary of State talking about anti-vaccination. As the shadow Secretary of State said, the drop in uptake is caused not just by online, but by complacency. People have forgotten that measles is a killer. It used to kill 2.5 million people a year across the world. We have seen an outbreak in Europe, where 82,000 cases have led to over 70 deaths. It is important that we tackle misinformation. It is also important that we make it easy for busy mothers to get their children vaccinated by having health visitors and district nurses who try to help. It is partly that that has allowed Scotland to keep the rate above 95%, but we, like everywhere else, are still seeing that rate drip down and fall by 0.5% or 1%.
On the online harms White Paper, I welcome the talk about a regulator. I hope it will actually be a regulator and that there will not be voluntary or self-regulation. I would like to know when it is actually going to happen. Like many other pieces of proposed legislation, it is still in the long grass and the situation is urgent.
Matt Hancock
The regulation of online harms will indeed be statutory. As I said, we are in the middle of a consultation on how, rather than whether, to put that in place. I am sure the hon. Lady will want to feed back, although I know her SNP colleagues in the Scottish Government in Edinburgh have been kept abreast of developments.
The hon. Lady raises complacency and financial resources. I will address both points. She is absolutely right that part of the problem is a complacency about some killer diseases, partly because we have hardly known them in this country for generations. As I said in my statement, measles is a horrible disease and a killer; it is deeply unpleasant. So, too, is rubella. Rubella might be hardly noticed by a pregnant woman. There might be a rash for three or four days which comes and goes, but the impact on the baby is permanent and very, very serious. On measles, rubella and other diseases, we have to be absolutely clear with the public about the consequences not only for their children but, even worse, for vulnerable children and adults who, maybe because they are immunosuppressed or very young, cannot have the vaccination. Their lives are directly threatened by a parent who chooses not to vaccinate. We need to be very clear and stark about that.
The hon. Lady mentions that the social media companies have contributed to Samaritans. That was Samaritans’ ask for this stage of putting together the organisation and experts it needs to provide clarity on the boundary of what is and is not acceptable in this space. I would, of course, be perfectly prepared to go and ask for more if more is needed. What is more, we are bringing forward a digital services tax. Historically, the global tax system has not worked well in taxing such companies fairly, because of the nature of how they make their money. We have worked for years to try to get a global consensus on how to tax them. We are now clear that we will bring forward the tax next year in the UK, regardless of whether we can get global consensus.
Tim Loughton (East Worthing and Shoreham) (Con)
I applaud the Secretary of State for taking this initiative, and I certainly endorse the comments about the good of vaccination. However, I hope that the warm words of the social media companies that he recounted are matched by actions, because I am afraid that that is not the experience of the Home Affairs Committee, which again saw a woeful performance from the Facebook, Twitter and YouTube representatives who appeared before us last week.
Is the Secretary of State aware that it is not only a question of taking down or not allowing content on which those companies are not doing their job properly, but of the algorithms that they use actively promoting more extreme versions of what people may be searching for, whether that is material on the extreme right wing, terrorism, radicalisation or self-harm? Is he convinced that those companies will actually put their considerable money where he thinks their mouths are and make sure that serious interventions are made to stop this stuff being promoted to some of our most vulnerable citizens?
Matt Hancock
My hon. Friend is a man after my own heart on this. Am I convinced? I am convinced that social media companies have committed to it, and it is our job to keep them to those commitments. That is why I have pushed for a long time for a statutory regulator in this space, and I am delighted that the Government are bringing one forward.
For years, we in the House asked social media companies to do something, and there was an argument that, because they are global, we cannot really impact how their algorithms work. That is just rubbish. We are the legislator for this country—we set the rules, and we have a big role in setting the norms and expectations of what happens here. Just because a platform is global does not mean that it can be outside the rule of law of this country, so we will legislate in this space, and there will be a regulator that will be able precisely to keep track of those commitments and make sure that they are followed up. Having said that, the last two meetings have been positive, and we have seen changes as a result. What we have not yet seen is all this content being removed, so there is clearly a long way to go.
Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)
I welcome the work that the Secretary of State is doing. However, following the question of the hon. Member for East Worthing and Shoreham (Tim Loughton), a fellow member of the Home Affairs Committee, surely it is time to do much more on these algorithms, which push people into more and more extreme behaviour? I heard from a mum whose daughter had suffered from an eating disorder who was still being targeted with dieting videos on Instagram. That material was not too extreme to remove, but it certainly should not have been targeted at her daughter. The mum could get nothing done about it.
Our Select Committee staff set up a new YouTube account and were searching for news or politics, but they were increasingly targeted by extreme far-right material promoted by YouTube. Those algorithms push people to extremes—for profit. Surely it is time for much greater transparency and accountability on the entire business model and the way that it promotes all sorts of problems?
Matt Hancock
The short answer is yes. My responsibilities as Health Secretary are to do with the impact on health, especially mental health, and eating disorders and self-harm are part of that. A separate but connected matter is anti-vaccination messages, which are a type of misinformation, or in some cases disinformation —actively pushed false information.
The social media companies say that they are removing this material from being promoted. For instance, graphic self-harm imagery will be taken down from Instagram. Our challenge is to make sure that that is done properly, because ultimately only if social media companies change their algorithms can we make this happen. That is why the new regulator is so important.
Julian Knight (Solihull) (Con)
I welcome the Secretary of State’s initiative in this area and what he has told the House today. Through my work on the Digital, Culture, Media and Sport Committee, I have been utterly horrified looking at online content relating to bulimia and eating disorders, and to what I describe as extreme online misogyny. That relates to the algorithms that Members have mentioned. Does the Secretary of State agree that we need to see inside those companies’ black boxes? Unlike areas such as taxation, in which companies go to the easiest regime, if we set the bar high on online content, they have to comply and put their house in order.
Matt Hancock
I pay tribute to the work that the Digital, Culture, Media and Sport Committee has done in this area, both when I was Culture Secretary and since. Its work and the approach it has taken are groundbreaking, and that has played a part in the change in attitudes that we have seen from the social companies, which at least now accept that it is their responsibility, as well as the principle that they have a duty of care to people on their sites.
As my hon. Friend says, there is clearly an awful lot to do to get to where we need to be. If we step back from this whole question, the technology that has brought about social media companies is still relatively new; it is only 15 or 20 years old. Around the world, the way in which society has responded to it has not yet matured. The good social media companies now get the fact that they have such an impact on society that a regulatory framework is necessary, and in fact have welcomed the White Paper that we introduced as an approach that could be replicated around the world. My hon. Friend is quite right that, once one country or jurisdiction gets this right, it will be taken as a model elsewhere, so that, ultimately, the power of this amazing new way in which we communicate—by God, Mr Speaker, in this House we all use it—can be for the good, and we can mitigate all the downsides that come with it.
Rushanara Ali (Bethnal Green and Bow) (Lab)
I, too, welcome the Secretary of State’s statement, but for too long internet companies have been too slow to protect children from the risks of suicide and other harms such as online hate and the threat of far-right and religious extremists and terrorists. He will be aware that, internationally, companies such as Facebook have fallen very short and were accused by the United Nations of playing a “determining role” in the genocide in Burma. This is a massive problem, and it is right that Britain should lead the way. Is he speaking to his counterparts in other Departments? Will he make sure that the legislation actually ensures that companies are responsible for content, as well as ensuring that there are strong, large fines if they continue to fail?
Matt Hancock
We have proposed fines as called for by the hon. Lady, and of course this is a cross-Government effort. My responsibilities are the health impacts, but technology has an impact right across the board, including on the quality of debate in our democracy, which is a Cabinet Office issue, and with regard to terrorism content, which is a Home Office issue. The Department for Digital, Culture, Media and Sport leads across the board and the Prime Minister herself has led global debates on this. The hon. Lady is quite right to point out that there is a broad range of impacts, and we work together to tackle them.
Rachel Maclean (Redditch) (Con)
The shadow Secretary of State referred to the proliferation of pro-anorexia content online. Is the Secretary of State aware that tech giant, Amazon, sells books under the category of “pro-ana”, which purports to show anorexia as a healthy lifestyle? Does he share my revulsion that those books are available online, and will he call on Amazon to take this content down immediately? Will he look at whether tech giants such as Amazon can be brought into the remit of the online harms White Paper?
Matt Hancock
I will absolutely look at the matter raised by my hon. Friend, as it is alarming and distressing to hear about it. Amazon sells physical goods for the most part and surely has a duty of care to those who buy them, in the same way that a shop has a responsibility for what it sells. My hon. Friend makes an important point, which I will follow up. I will write to her with more details.
Christine Jardine (Edinburgh West) (LD)
I, too, welcome the statement by the Secretary of State, not least because I survived measles as a very small child and my family talked for a long time about how worrying and scary it was. On the other issue, as well as taking action against the social media companies, the long-term NHS plan talks about an increase in proportionate spending on child and adult mental health services. What will he do about that? What will the proportion be? I ask because it is crucial to fighting this problem.
Matt Hancock
The hon. Lady is absolutely right that there will be an increased spend on mental health services across England—a £2.3 billion increase. It is the fastest-growing area of spend in the long-term plan. We are investing £33.9 billion in the NHS in cash terms, and the fastest proportionate rise in spend is in mental health services. That is an important part of this, although there is an awful lot that the social media companies can do to reduce the demands on those services by reducing the negative impact on mental health. The whole House can agree that the hon. Lady being alive and here, having survived measles, is another reason why it is important to get this right. It would have been the House’s loss had the measles won.
Bob Blackman (Harrow East) (Con)
The drop in vaccination rates is not only an annual problem but a cumulative problem, as more and more young people in society are not immunised against these childhood diseases. Can I urge my right hon. Friend not only to undertake a social media campaign to encourage parents and children to take up the vaccinations, but to target the messages so that people know where they can go to get them, how they can do it and the importance medically of doing so?
Matt Hancock
My hon. Friend is exactly right; in fact, that work is under way. I should have mentioned in response to the shadow Secretary of State that Public Health England has a targeted programme of positive information. We can use data and social media better to target messages at those who need them in exactly the way that he proposes. That work is in hand.
Chris Elmore (Ogmore) (Lab)
I welcome the Secretary of State’s statement and the consultation. I am grateful to my right hon. Friend the Secretary of State for Health and the suicide prevention Minister for taking part in the launch of my all-party parliamentary group report on new filters and the impact of social media on young people’s mental health. I am also grateful to the Secretary of State for agreeing to have a meeting with me next week to discuss the content of the report. One thing that is not in the consultation and which has not been mentioned today is the idea of a social media-health alliance bringing together social media companies and other groups—not just groups such as the Samaritans but young people’s groups and social work groups—that can formulate, collate and undertake more research into the impact of social media on young people. Would he consider this idea and even take a lead in forming it, as his Department does with gambling and other compulsive disorders?
Matt Hancock
I will certainly consider it and I look forward to talking to the hon. Gentleman about the idea more next week. Dialogue in this area is critical, but we should not only have dialogue; we also need concrete legislative action, but I am grateful for what he has said about the work that has been done. I am glad that he is also working in this area, and I look forward to discussing it with him more.
Mike Wood (Dudley South) (Con)
Three million of the four million videos taken down by YouTube in the last six months were identified and removed by artificial intelligence. What greater role does the Secretary of State see for technological development in helping to reduce online harm and keep people safe online?
Matt Hancock
Artificial intelligence clearly has a role in identifying material that needs to be removed in the same way that it is now being used to remove terrorist content. We are talking to companies that may be able to do this, but we also need to identify what material should be taken down and what should be left up. Defining that boundary is critical to training artificial intelligence to do its job, hence the importance of the decision to ask the Samaritans to do the work of identifying the boundary so that we can train artificial intelligence to identify what needs to be taken down.
Alison Thewliss
Thank you, Mr Speaker. My tactic of wearing a dress so big I can hide a colleague behind it is working.
Will the Secretary of State look at the harm that celebrity endorsements on social media can do to young people? The Empowered Woman project in Scotland highlighted how Marnie Simpson of “Geordie Shore” had been plugging Thermosyn diet pills, which are marketed as “skinny caffeine”. When I asked the Secretary of State for Digital, Culture, Media and Sport about that, he said that the UK Government were looking at
“user-generated content, not necessarily commercial activities”—[Official Report, 8 April 2019; Vol. 658, c. 73.]
Celebrity endorsement veers into the commercial area, however, and has a very significant effect on young people in terms of body image and eating disorders.
Matt Hancock
My colleague the suicide prevention Minister is looking at this area, particularly endorsements of cosmetics, and I am sure she would be very happy to talk to the hon. Lady.
Huw Merriman (Bexhill and Battle) (Con)
My generation growing up might have feared bullying in the playground, but largely home was a refuge and place of safety. The problem for the current generation is that they can find themselves being bullied 24/7 because of social media. It is little wonder that when I contacted Twitter after seeing some rather libellous material it told me that in its view it was not abusive, even though it was against the law in this country. Does the Secretary of State agree that until social media companies understand that they have to operate under the norms and laws of this country, and not just abide by Californian norms, they will never reform?
Matt Hancock
My hon. Friend puts it exactly right. That is what the duty of care is all about. The argument—we hear it less and less, to be honest—that these are international companies and so will abide by somebody else’s laws, thanks very much, is wrong and out of date, as the online harms White Paper makes clear. We must establish a proper enforcement mechanism to ensure that it is the rules that this House sets—occasionally amended by the other place—that define the law of the land and that we do not have a wild west. This action to protect people’s health is just one part of the response needed to make the internet safe, especially for children.
Carol Monaghan
Thank you for calling me so early, Mr Speaker. [Interruption.] It couldn’t be any worse.
My son contracted measles one month before he was due to receive his MMR vaccine because of a dip in numbers being vaccinated, so I very much welcome the Secretary of State’s statement about tackling anti-vaccination posts on social media. Last year, the Select Committee on Science and Technology carried out an inquiry into the impact of social media on young people’s health, and one of the statistics presented to us was quite disturbing: 50% of young people between the ages of 11 and 16 had seen pornographic images, and many of them had stumbled across them. When I spoke to my 11-year-old daughter, she confirmed that she had seen images that upset her but had been too scared to speak to me about it. What is the Secretary of State doing to alert parents to the dangers of social media and to give them guidance on how to speak to their children and identify when they might have seen things online that have upset them?
Matt Hancock
Mr Speaker, that question was so good it is only a pity it was not asked earlier in our exchanges.
I want to address two important points. First, the hon. Lady’s son is a case in point of how, if parents do not vaccinate, they endanger not only their own children but other people’s. It is because of a failure to vaccinate that these diseases still exist, and it is children who are too young to be vaccinated who are at risk. She has made the case more powerfully than anybody for the importance of vaccinating and keeping vaccination rates up, and I am grateful to her for sharing that personal experience. On the second point, she is quite right that we all have a responsibility to act, and act we will.
Robert Courts (Witney) (Con)
It is a privilege to have the last word.
The whole House is concerned about the effect that the internet can have on young people’s mental health, and I welcome the action that the Secretary of State is taking. Is there truth and accuracy in the reports that Wikipedia did not attend yesterday’s summit? If so, does he share my disappointment, and does he feel that Wikipedia must take this issue seriously and engage with it?
Matt Hancock
Unfortunately, those reports are true. I share my hon. Friend’s disappointment that Wikipedia did not attend either of the two summits, despite having been invited. At yesterday’s summit, we agreed that we would get in touch with Wikipedia in robust terms, because it is not acceptable for it to shirk its social responsibilities either.
If I may say so, I think that the statement and the responses to it have shown that there is unanimity in the House. Every speaker has mentioned the need to tackle anti-vaccination misinformation and the social media organisations’ responsibility and duty of care in relation to the health—mental and otherwise—of people on their platforms. The House speaks with one voice, and the social media companies, and the internet companies that have not yet engaged should listen.
Access to Medical Cannabis
Matt Hancock Excerpts(5 years, 1 month ago)
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Sir Mike Penning (Hemel Hempstead) (Con)
(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the return of medical cannabis that was seized from Emma Appleby at Southend airport on Saturday 6 April and which is needed to treat her very ill daughter Teagan’s extreme epilepsy, and to take steps to make sure that medical cannabis is available for prescription around this great country.
The Secretary of State for Health and Social Care (Matt Hancock)
My sympathies go out to the patients and their families who are desperately seeking to alleviate their symptoms with medicinal cannabis. We are working hard to get the right approach. The law was changed on 1 November last year to ensure that it is now legal for doctors on the specialist register of the General Medical Council to prescribe cannabis-based products for medicinal use in the UK.
Whether to prescribe must remain a clinical decision to be made with the patients and their families, taking into account the best available international clinical evidence and the circumstances of each individual patient. Indeed, prescriptions have been written for the products that the family attempted to bring into the country and these have been supplied to patients. Without clinical authorisation, it is of course not possible to import controlled drugs, which is why the products were seized by Border Force on Saturday. However, we have made available the opportunity for a second opinion and the products have been held but not destroyed, as would normally be the case.
In relation to childhood epilepsy, the British Paediatric Neurology Association has issued interim clinical guidance. NHS England and the chief medical officer have made it clear that cannabis-based products can be prescribed for medicinal use in appropriate cases, but it must be for doctors to make clinical decisions in the best interest of patients, to balance the risks and benefits of any proposed treatment—including cannabis-based products—and to make a decision with patients and their families on whether or not to prescribe.
To date, research has centred on two major cannabinoids, tetrahydrocannabinol and cannabidiol. There is evidence that CBD may be beneficial in the treatment of intractable epilepsy, and over 80 children have already been supplied with CBD products in the UK on the basis of a specialist doctor’s prescription. I entirely understand how important this issue is to patients and I have met and listened to families. I know just how frustrated they are. Therefore, after meeting parents, I have taken the following actions.
First, I have asked NHS England rapidly to initiate a process evaluation to address barriers to clinically appropriate prescribing. Secondly, to improve the evidence base and to get medicinal cannabis to patients in need, I have asked the National Institute for Health Research and the industry to take action to produce that evidence in a form that will support decisions about public funding. The NIHR has issued two calls for research proposals on medicinal cannabis and I look forward to the responses to those consultations. That is in addition to the training package being developed by Health Education England to provide support to clinicians to enable them to make the best decisions with their patients.
This is a very difficult area, with some heart-rending cases. I look forward to working with all Members of this House to ensure that patients get the best possible care.
Sir Mike Penning
I thank you for granting this urgent question, Mr Speaker, on behalf of constituents around the country who need help from medical- prescribed cannabis, and I thank the Secretary of State for coming to meet the families and their loved ones who feel that medical cannabis on prescription may help.
Some of these young children—though we are not talking only about children—have 300 seizures a day. They are given drugs that do not seem to work at all. There is not a cure, but these medical oils can and often do reduce the number of seizures. Many colleagues in the House will know of the case of Alfie Dingley—the only young boy that has an NHS prescription for the medical use of cannabis oil. He is now a relatively naughty boy. He has learned to ride a bike. His sister has a brother she has never really experienced before.
This is not a cure, but these parents are absolutely desperate. When the Government did the right thing and changed the law, they thought the situation was going to get better. In my capacity as joint chair of the all-party parliamentary group on medical cannabis under prescription, I warned them that this was just the start of the journey, and that it would be a long one.
Anyone who saw the footage from Southend airport at the weekend—any father, any parent, anyone who has a loved one in their family who suffers—would understand what that family were trying to do. Cannabis had been prescribed by a consultant abroad because it could not be obtained in this country. Many families are relying on charity to raise the money—in some cases, £1,500 a month—to obtain it on prescription. As the Secretary of State knows, prescriptions are being issued by the relevant experts, but the clinical commissioning groups and the trusts are refusing to honour those prescriptions. It is a disgrace that that should happen in this country, and we should all be ashamed.
I welcome the trials and I welcome the review, but, sadly, people need these medicines now. Can we unlock the door? The Border Force staff at Southend airport were very polite and very helpful. They thought they were doing their duty. We should do our duty, and get that medical cannabis back to Teagan.
Matt Hancock
I pay tribute to my right hon. Friend and the all-party parliamentary group for their work in bringing this issue to the attention of the House and the country, and in supporting the parents involved. My right hon. Friend has been characteristically emphatic and reasonable in providing that support, and I entirely understand his concern. Meeting some of the parents as part of the APPG delegation was a very emotional experience.
Of course the Border Force staff were doing the right thing—and I am glad that they were doing it in a reasonable way—according to the existing rules, under which if a controlled drug is to be imported it needs a licence, and the import of an unlicensed controlled drug therefore requires a prescription from a specialist doctor. There are just over 95,000 registered specialist doctors in the UK. Any one of them who has the relevant experience can prescribe the drug, and it will be then allowed in. That can happen now. The guidance is not a barrier, and it is not a barrier to prescription. However, it is clear to me that this process is not working. I have therefore initiated a process evaluation, which is NHS language for looking at exactly why it is not working and what we need to do about it.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
It is shameful that we saw those scenes at Southend airport, and that families continue to suffer because the arrangements are so slow. It is, however, appropriate that we are discussing this issue on the day on which my hon. Friend the new Member for Newport West (Ruth Jones) has taken her seat, because her predecessor, my friend Paul Flynn, was an indefatigable campaigner for many important causes, including the legalisation of cannabis for medical use.
Last year Charlotte Caldwell, the mother of another sick child, Billy Caldwell, said:
“It’s absolutely incredible, it’s amazing. The compassion and speed that the Home Secretary has moved with is just incredible.”
That is the impression that Ministers sought to give, but it was a misleading impression, as the plight of the Applebys revealed this weekend.
Is the Secretary of State aware that cannabis oil is not the same as cannabis, and that it has no psychoactive or addictive effects? Is he aware that in other jurisdictions a range of conditions qualify for treatment with cannabis oil and related products, including cancer, AIDS, muscular dystrophy, Crohn’s disease, epilepsy, Parkinson’s disease and arthritis? Is he aware that the Home Secretary has previously commissioned Sally Davies to examine the scheduling of cannabis as a whole? She reported as long ago as June 2018. Is the Secretary of State aware that Ms Davies’s report has been with the Advisory Council on the Misuse of Drugs since that time? Is the House to understand that the Home Secretary has just been sitting on it?
What is the Secretary of State going to do to speed up the processes around this issue? Parents will not be impressed to hear of further reports or further enquiries. We need to resolve the Appleby case quickly, but we also need to make sure that no other families of sick children have to suffer in the way the Appleby family is suffering.
Matt Hancock
I did set out the answers to those questions in my initial response. There are a number of smaller active agents in medicinal cannabis, but there are two major ones: THC and CBD. The vast majority of those who now have access to medicinal cannabis have access to CBD, and that is different as an active agent. Clinicians have to make a judgment according to the personal circumstances and needs of the patient, and I am trying to remove all the barriers to those clinical decisions.
We have taken action. I absolutely understand the history here, because the Home Secretary and I signed off on the decision to allow medicinal cannabis to be available at all on 1 December, following the chief medical officer’s report. What we need to do now is ensure that there are no further barriers to prescription where a clinician judges that that is the right thing to do.
James Cartlidge (South Suffolk) (Con)
My right hon. Friend will be aware of the case of my constituent Indie-Rose Clarry. She is a four-year-old girl who suffers from Dravet syndrome, a very severe form of epilepsy. Her parents, Anthony and Tannine, are also crowdfunding on the internet to raise thousands of pounds to buy drugs from Holland. That is not because they are criminals, but because they love her, they want to ease her pain and they are desperate.
On Friday, as it happens, I met Indie-Rose’s consultant—not only her consultant but one of the leading specialists in the country in severe forms of child epilepsy. He made the point that there is a barrier to prescribing cannabinoids that include THC, because there is insufficient evidence in that case. Will the Secretary of State confirm that there is evidence on CBD but not THC, which Indie-Rose’s parents have found has the greatest impact in reducing seizures?
Matt Hancock
Characteristically, my hon. Friend makes an excellent point. The clinicians consider that there is a much less evidence on THC, as opposed to CBD. I have therefore instructed the National Institute for Health Research to do the research. Doing the research will of course require some cases where the drugs can be legally tested. I had already put that in place, and I am telling the House about it today.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I am glad this urgent question has moved from the Home Office to Health, where it should be, but one has to ask why drugs are being seized when they are no longer illegal—that is what changed in November.
In medicine, we use many controlled drugs, such as heroin, morphine, ketamine and diazepam which have a street value, but that has never stopped them being used in medicine. The problem is that the way cannabis was treated for 50 years means we have had almost no research and almost no experience.
The problem is also that expectations were raised in November, as if every GP would be able simply to write a prescription, but a prescription for what? We have to have a pharmaceutical quality of drug so that we know exactly how much CBD and how much THC we would be prescribing. That is not yet generally available. It is important that we look, through the Government, to get that pharmaceutical grade licensed, with reliable formulations.
This issue is under inquiry in the Health Committee, and we have heard from patients who were advised to go to Holland to get drugs, costing them £30,000 per visit. That is unacceptable. The Government will have to stimulate research, and I am grateful that calls for research are going to go out. However, we need specialist centres in paediatric neurology for children with epilepsy, we need adult neurology for multiple sclerosis, and we need pain specialists for chronic pain.
These preparations are unlicensed; that means there has been no testing on their efficacy—whether they work—and on whether they are safe. That is quite scary for doctors, particularly as if it is an unlicensed drug, they have to sign a form to say that they accept personal liability. I can tell the House that that is quite intimidating, as I have done it myself. The Government need to push for centres of excellence to help to stimulate the research they say they are calling for. That is the only way we will get randomised controlled trials, and get the answers that will lead to these drugs being licensed, rather than our just having a temporary fix for now.
Matt Hancock
In an outbreak of cross-party unity, I agree entirely with the hon. Lady. The approach she has taken is incredibly sensible; it is also the one that has been recommended to me by my clinical advisers. We need to ensure that we take an evidence-based, pharmaceutical-grade approach to prescription. I will take away her idea about centres of excellence, because I entirely see the point there. In the case of most drugs, it is the pharmaceutical industry that pushes for, and pays for, the randomised controlled trials. In this case, because the industry is in a different shape for other reasons, it is we who are making this happen, and we are pushing it as fast as we can
Richard Harrington (Watford) (Con)
I would like to thank my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) for bringing this question forward, and I thank the Secretary of State for his answer. My constituents the Levys came to see me about their daughter, Fallon, who has LGS epilepsy. Her consultant neurologist has told the family that
“the actual logistics of the prescribing has not yet been worked out”.
Why is this the case, and what can be done to ensure that Fallon has access to the necessary medication as soon as possible?
Matt Hancock
I should like my hon. Friend to write to me with the exact details of that case. The process for prescription by someone on the specialist register is well trodden; it is used for all sorts of unlicensed drugs, and it should be available. We are making a second opinion available to ensure that it can be brought to bear in cases such as these. I am interested in hearing about specific cases—this applies to everyone, not just to my hon. Friend—so that we can ensure that the appropriate clinical decisions can be made.
Mr Speaker
There was I thinking that the Secretary of State would be the first to congratulate the hon. Member for Watford (Richard Harrington) on his prodigious efforts and output as a Minister, but I am sure that that will come ere long.
Dr Sarah Wollaston (Totnes) (Ind)
I warmly welcome the measures announced by the Secretary of State today, but will he go further in discussing the importance of clinical trials and answer some of the many questions about striking the right balance between THC and CBD? We have heard in the Select Committee that some pharmaceutical companies are refusing to make their products available for clinical trials. Will he look specifically at that point? We need to ensure that safe and consistent products are regularly available and that they are of a predictable pharmaceutical grade, as we have heard.
Matt Hancock
If I may, Mr Speaker, I would like to add to my previous answer by congratulating my hon. Friend the Member for Watford, the former Business Minister, on all that he did to support business, enterprise and the case for capitalism while he was in his former job. I regret his departing from the Government, because he was a brilliant Minister.
On the question ahead of me, so to speak, the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston), is right to say that it is vital to bring forward these clinical trials, and that the pharmaceutical companies that provide the oils have not pushed forward the trials in the way that would normally happen. We have therefore stepped in to try to make them happen, but we do need the calls to be answered.
Mr Ben Bradshaw (Exeter) (Lab)
The Secretary of State talks about removing barriers, but it is clear to me that the main barrier is the British Paediatric Neurology Association itself. When its president came to give evidence to the Health and Social Care Committee a couple of weeks ago, he was arrogant, he was dismissive of the families’ experience, and he misled our Committee by denying that Members of this House had sought a dialogue with him, which he had refused. What is the Secretary of State going to do to remove the obstacle of the BPNA?
Matt Hancock
I am sure that the BPNA will have heard that testimony from the right hon. Gentleman. Of course, the BPNA is independent of Government, and we have to follow the clinical judgments made by the relevant organisations, whether a royal college or, as in this case, an association. What I have done is ensure that a second opinion is available, because the BPNA guidance is merely guidance; it is not absolute. A clinician on the specialist register can make a decision according to what they think is best for the patient in front of them.
Rachel Maclean (Redditch) (Con)
Can the Secretary of State give some more detail on the time line for this very welcome review? I am sure that we all sympathise with parents such as Mrs Appleby, who is doing everything she can for her daughter.
Matt Hancock
Yes, the call for randomised control trials and the process evaluation are both being conducted very urgently by NHS England.
Ronnie Cowan (Inverclyde) (SNP)
There are lots of warm words circulating here today. My question relates to the point that was just made. We have this problem today, but clinical trials will take six months, nine months or a year. What can we reasonably do legally to get certified products that we know will work into the hands of parents with children who desperately need them today?
Matt Hancock
I entirely understand the hon. Gentleman’s point, and I feel the same way as he does about the urgency of these cases. The need to get a second opinion can be actioned immediately, and it will be, because the crucial point is that unlicensed medicines cannot be prescribed without a clinician. There are just over 95,000 clinicians on the specialist register, and any of those who have expertise in this area can, if their clinical judgment allows, make these prescriptions. That can happen right now.
Tim Loughton (East Worthing and Shoreham) (Con)
I was very supportive of the case of Alfie Dingley and the change in the law. The Secretary of State is absolutely right that this must be based on clinical decisions. However, given that there are several hundred children suffering from severe intractable epilepsy, is not the problem that the guidance from NHS medical bodies is just too stringent? Is it true that only two NHS prescriptions have actually been issued to date? Given that Teagan Appleby has had at least a dozen prescribed drugs—I will not list them, to avoid stressing Hansard—as well as a nerve stimulator, what would be the downside of allowing her access to medical cannabis now?
Matt Hancock
My hon. Friend makes a good point. More than 80 prescriptions have been made, but that is for both THC and CBD. Of course, THC brings risks—the active elements within cannabis do bring risks. There are also benefits, as I have seen very clearly. It must be for a clinician to decide the balance of those risks. I have enormous sympathy for the families, having heard their personal testimony about the massive benefits for their children, who sometimes, as my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) said, have 300 seizures a day. Having seen that and looked them in the eye, I understand the benefits. However, it has to be a clinician who makes that judgment. I am not medically qualified and cannot overrule a clinician, but there are clinicians available who can provide a second opinion, and that is what I can ensure.
Thangam Debbonaire (Bristol West) (Lab)
I am grateful to the Secretary of State for what he has said so far, but I have spoken with a neurosurgeon in my constituency who says that one of his anxieties is not being able to give good advice to parents whom he suspects might be trying to access medical cannabis through not wholly legal routes, because he is unsure what the law is. I agree with the Secretary of State on the need for clinical evidence, so what more information can he give us on the timescale? When will we see the health education research that he talks about? In the meantime, why can we not use the evidence of clinical trials conducted elsewhere?
Matt Hancock
The evidence of clinical trials from elsewhere can and should be used. All international clinical evidence should be brought to bear on such decisions and has been in the case of CBD. As for how quickly things will happen, the answer is, as the hon. Lady would imagine, as soon as possible.
Michael Fabricant (Lichfield) (Con)
The SNP spokesman was spot on. This is about not just drugs such as ketamine and diazepam, but beta blockers, which can also be extremely dangerous in the wrong hands. Will my right hon. Friend speak to the Home Secretary and say, “Look. This is a medical treatment. It shouldn’t be a controlled drug as such”? This treatment should not be stopped at our borders, particularly when it appears that not enough people are prepared to prescribe it.
Matt Hancock
I spoke to the Home Secretary this morning about the issue, and we proposed to see it as a health matter, not a borders matter. The Border Force officers were merely following the rules, and the question is about whether the drug is licensed. If it is not licensed, but it is controlled, the question is about whether it has clinical sign-off. The truth is that the compound does have negative effects, so it must be a controlled drug. I do not support the legalisation of all cannabis. Unless one supports the legalisation of cannabis in all cases, it has to be a controlled drug, which leads us to where we are. We must get the evidence of the medical and clinical benefits that the families have emphatically explained, and I want to see this situation dealt with properly.
Caroline Lucas (Brighton, Pavilion) (Green)
Some reports suggest that even Alfie Dingley, whose case gave rise to the new legislation, probably would not be eligible for medicinal cannabis under the new regulations because they are so strict. The Health and Social Care Secretary says that 95,000 clinicians are ready and waiting to sign off prescriptions, but can he explain why they are not doing so? If it is as easy as that, surely they would be doing it, so what else will he do to look at the barriers?
Matt Hancock
We have ensured that all the patients who received access to medicinal cannabis on an exceptional basis before the law changed on 1 November can continue to access it. If that is not the case in any instance, I want to know about that so that we can fix it. Alfie Dingley would be eligible for these drugs if a clinician were prepared to sign off the benefits for Alfie, and such decisions must be led by clinicians. I am doing everything I can to get the evidence and second opinions in place and to ensure that the process works as well as possible. That is what I can do. What I cannot do—it would be unreasonable for any Health Secretary to do so—is overrule clinical decision making in individual cases. That would be wrong, and I do not think that any Member of this House would propose that I should do it.
Chris Heaton-Harris (Daventry) (Con)
A number of us have been written to by constituents about such cases, and I have corresponded with the Secretary of State about Julie and Stuart Young, the parents of Lloyd, for example. Clinical trials have been mentioned across the House, but a piece of legislation is already in place. The Access to Medical Treatments (Innovation) Act 2016, which was sponsored by me in the Commons and by Lord Saatchi in the other place, seems ideally suited to help us through this sticky situation.
Matt Hancock
Yes, we are looking carefully at how we can use that legislation as effectively as possible. Understanding the medical consequences of any use of a drug is incredibly helpful evidence for where it should be prescribed further, and that is the thrust of the 2016 Act.
Tim Loughton
My hon. Friend the Member for Daventry (Chris Heaton-Harris) was a good Minister, too.
Tonia Antoniazzi
I will not use that word, but I totally agree with my right hon. Friend. I say to the Secretary of State that this has got to stop. We cannot wait for clinical trials. There is medicine out there—get it to the children who need it.
Matt Hancock
The BPNA is going to have to answer for itself about the way in which its representatives conducted themselves in front of the Select Committee. It is independent. Understandably, in medicine the bodies that make clinical guidance do not direct the answer for that clinical guidance to the Secretary of State. I understand the hon. Lady’s strength of feeling and that of others. I also understand the strength of feeling of the parents. I understand what a desperate situation they are in, and I am trying to make sure that it can be resolved and that they can get the drugs. I make one point to the hon. Lady: the very exercise of a clinical trial requires us to get the drugs to some children. I very much hope, therefore, that the start of a clinical trial can help to get the drugs to the people who need them. We do not have to wait for the results.
Vicky Ford (Chelmsford) (Con)
Although medicinal cannabis can have great benefits for some epileptic children, we should not forget the devastating impact that cannabis can have and its long-term impact on psychosis and schizophrenia. [Interruption.] I speak from personal experience of living with an affected family member. It is right that this is dealt with on a case-by-case basis. How soon will updated training be available for our health professionals?
Matt Hancock
The updated training will be available imminently. There are risks as well as upsides, and it is absolutely right that it is clinicians who make the judgment in respect of every decision and based on the individual patient. That, I am afraid, is the way in which medicine always has been—and, I imagine, always will be—practised in this country.
Sir Edward Davey (Kingston and Surbiton) (LD)
Will the Secretary of State confirm whether it is true that if a Dutch mother brought the same medicine to the United Kingdom, she could administer it to her own Dutch child without the import licence that Emma Appleby is saying that she must have? If that is true, is this not just another example of how shambolically this policy is being implemented?
Matt Hancock
I do not know whether that is true—that is a question of Home Office policy on controlled drugs—but all in all that does not change the fact of the matter, which is that we need to resolve this issue as soon as possible.
Sir Desmond Swayne (New Forest West) (Con)
If the principal issue is that doctors will not prescribe, is there a secondary problem when there is a prescription but the bureaucracy is failing to honour it?
Matt Hancock
I have heard that accusation being made by a couple of the parents. I am advised that that is not the case, but I am very much looking into it because in these circumstances I always think we need to listen to the people who are trying to resolve the issue. I am looking into that very point.
Stephen Twigg (Liverpool, West Derby) (Lab/Co-op)
I have previously raised the case of my constituent, 11-month-old Nathaniel Leahy, who, owing to his extremely rare form of epilepsy, lives in great pain. His mum told me today:
“I am living in fear each day that Nathaniel will not make it to the next day. We were promised in November of last year that this medicine would be available.”
Does the Secretary of State understand the powerful sense of frustration felt by families such as Nathaniel’s, and will he address the question of the guidelines so that we can have fewer stringent guidelines, to benefit patients?
Matt Hancock
I entirely understand that sense of frustration. I went to meet some of the parents to hear directly from them the pain and suffering that they and their children are feeling, which I entirely understand. That is one of the reasons why we are pushing so hard to try to resolve this. Resolving the questions around the guidelines is also important but, as the hon. Gentleman knows, those guidelines are written independently of Ministers.
Charlie Elphicke (Dover) (Con)
My constituent Teagan Appleby suffers horrendously with one of the worst cases of child epilepsy in the United Kingdom. It has been heartrending to go round to her house to see her suffering. To see how her mother, Emma, copes with the challenge is inspiring.
Legal heroin, morphine, has been prescribed in this country for many decades. Why can we not have legal cannabis, too? Is it not high time that the NHS got on with changing the guidelines to make sure that medicinal cannabis is available, rather than wasting time arresting Emma at Southend airport, which is quite the wrong thing to see?
Matt Hancock
My hon. Friend represents Teagan Appleby, her family and her parents, and he speaks for the whole House in what he says. He has captured the essence of this debate. I am trying to resolve it to his satisfaction and to the family’s satisfaction as soon as possible. There are barriers to that resolution, and I am happy to work with him, with the APPG and with all others who have constituency cases to try to resolve this significant problem.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
The Secretary of State will be aware of the case of my constituent Cole Thomson, aged six, who has battled repeated epileptic seizures every night and has had terrible periods of deterioration. In order to gain the prescription, we have had to battle the system as well as the illness. Parents do not have the energy, when they are looking after a sick child, to battle the system, so can the Secretary of State ensure the streamlining of this process to make sure that specialist training is available? In the meantime, will he make available to parents a register of the specialists who can prescribe medicinal cannabis? The postcode lottery cannot go on.
Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)
I commend the Secretary of State for his statement. I, like many others in this House, have had constituents visit me to make powerful, personal cases on the impact they think cannabis oil could have for their children. Will he join me in praising the work of the campaign group End Our Pain, which has done such a good job of highlighting this issue and making sure that we in this House are aware of the situation and of the benefits it can bring?
Matt Hancock
I have already paid tribute to the APPG, and today’s urgent question has demonstrated the breadth of concern in this House. Those who are independent of Government need to make sure that they listen to this level of concern. I am certainly determined to do everything I can to try to resolve this issue.
Paula Sherriff (Dewsbury) (Lab)
It has always been the case that the Home Secretary could issue a special licence to allow the medical use of cannabis oil. I understand that the Health Secretary may be seeing him this evening, and I wondered whether he will ask him to consider this course of action.
Matt Hancock
One of the great frustrations for me, for the Home Secretary and, of course, for the families is that, before the law was changed on 1 November, that course of action was open. For a few dozen cases, the Home Secretary made those special licences to allow for the use of medicinal cannabis. He and I changed the law together to try to make sure that medicinal cannabis is available on a mainstream basis. Now it is available on a mainstream basis, as a normal drug, it therefore needs clinical sign-off. The problem is there are so many cases where that clinical sign-off has not been forthcoming. That is a source of immense frustration to me, as I hope the hon. Lady can imagine, and it is what we are trying to resolve.
Luke Graham (Ochil and South Perthshire) (Con)
Does my right hon. Friend agree that we should be led by evidence? As our scientific knowledge continues to progress, so should the views and the laws made in this House. Will he provide more clarity, not just in this instance but as new and more radical drugs become available in the near future, on how our constituents and this House could benefit and push through laws more quickly?
Matt Hancock
My hon. Friend makes a very important point. To ensure that the use of medical cannabis becomes mainstream, we need to ensure that the evidence base is there. Essentially, doctors think there is a much deeper evidence base for CBD than for THC. There is a broader point, which is that the medical profession and this House need to keep up to speed with the evidence as it is developed. In this case, that means going out of our way to develop the evidence and to have clinical trials in which some of the patients who want the drug can participate. That will provide the evidence base that allows the vast array of specialists to prescribe it.
Diana Johnson (Kingston upon Hull North) (Lab)
It was clear from the evidence given to the Health and Social Care Committee that the Government raised public expectations when they rescheduled medical cannabis. I wonder whether it is time for the Secretary of State to ensure that there is a public awareness campaign, with full information about what the Government are trying to do.
Matt Hancock
I will look at that idea and discuss it with the NHS. The training programme that we are putting in place is intended to raise awareness of the evidence and the change in rules among the profession—among doctors and the specialist prescribing doctors on the register. Ultimately, it is only with clinical sign-off that we allow any drug to be prescribed. That is where the training needs to be in the first instance, but I will look at the hon. Lady’s suggestion of doing it more broadly.
Rebecca Pow (Taunton Deane) (Con)
Anyone who goes through the heart-rending experience of seeing a very sick family member suffer will know that they would do anything to help that person, often reaching the point of desperation. People need to be confident that they can get hold of cannabis-based medicines if it is appropriate and that those medicines are safe. In this instance, there is a lot riding on the shoulders of our doctors. Will my right hon. Friend assure us that doctors are being given the right guidance to do what is right for patients, but also that they will not be blamed if something goes wrong?
Matt Hancock
Yes, I think that is exactly the right approach and it is what we are working towards.
Christine Jardine (Edinburgh West) (LD)
I thank the right hon. Member for Hemel Hempstead (Sir Mike Penning) for raising this important issue, which affects one of my constituents, Murray Gray, directly. His mother is one of those parents who is now desperate, having been given hope.
Does the Secretary of State agree that we have the evidence from abroad that these medicines can work and we have the willingness of everybody in this House to make it work, but somehow there is a gap between our willingness and our ability to make it happen? Will he assure the House that he will speak to the Home Secretary and to the devolved Administrations who have NHS responsibility to try to get some kind of action through co-operation to reassure the parents who are desperate not just because their children will suffer but because they may not survive?
Matt Hancock
Yes, of course; I am very happy to do that. Perhaps I should take this opportunity to welcome the new public health Minister, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for South Ribble (Seema Kennedy) to her post. She will, no doubt, have listened to all the questions today. She and I will be working on making this happen.
I would add to the hon. Lady’s list, because this is not just about the Home Office and the Department of Health and Social Care; it is about making sure that the independent medical establishment has confidence in the evidence that is presented. It is not enough for her and I to have confidence as lay politicians; it is important that the professionals who put their signature on the line have confidence in the evidence as well.
Mr Philip Hollobone (Kettering) (Con)
Does the Secretary of State appreciate the public’s concern that, at a time when several police forces have openly admitted that they will not take action against those involved in recreational cannabis use, the full weight of the Home Office’s Border Force is deployed to intercept medication for a seriously ill young child? Surely getting medication to a seriously ill young girl should never be a crime.
Matt Hancock
My hon. Friend makes an important point. The Border Force should not be criticised in this case, because it was following the rules: if a clinician has not signed something off it cannot come in. It is incumbent on us on the health side to sort out this problem. He makes a broader point, however, that this is a completely separate issue to the recreational use of cannabis. I do not support a change in the rules on the recreational use of cannabis; this is about the specialist provision of drugs to some children who are the most vulnerable people in society, and the need to ensure that the medical benefits of such drugs can be brought to bear on people who really need them.
Alex Norris (Nottingham North) (Lab/Co-op)
Like many colleagues, I have spoken with parents of children who have profound challenges that could be ameliorated by medicinal cannabis. They are at their wits’ end, and it is no surprise to find that some in this country resort to desperate measures. I have listened for 45 minutes now and I cannot tell the answer to this question: is the Secretary of State really saying that we have a clear, universal, safe and compassionate approach to this issue and, if we do not, when will we?
Matt Hancock
I am saying that if a patient needs medicinal cannabis, and if a clinician will sign off on that need, the prescription can happen. The guidance from the association does not override the individual judgment of that clinician. That can happen but, because it has not been happening in many cases that have been brought to light, some privately and some very publically, I am putting in place a system of second opinions to ensure that we can get that clinical decision right, at the same time as developing a stronger evidence base for the future.
Tommy Sheppard (Edinburgh East) (SNP)
Reuben Young is an 11-year-old boy in my constituency who suffers from myoclonic astatic epilepsy, which is a severe and rare form of epilepsy. His mother, Emma, is at her wits’ end. Conventional medicines do not work and she has tried to get a prescription for Epidiolex, which is a cannabis-derived medicine. She tells me that she is unable to get it because the physicians involved say that the guidelines prevent them from prescribing it. I do not know why, but for some reason the change in policy last November is not leading to a change in practice. I ask the Secretary of State to speak with the Home Secretary and to have an urgent—I mean in days or weeks—review to see how the existing guidelines can do better.
Matt Hancock
Those guidelines are not a matter for the Home Secretary; they are guidelines in the health space, although the association that writes them does not report directly to me but is independent. Those guidelines do not prevent a physician who is on the specialist register of the General Medical Council from prescribing. If anybody has been told that they do, they do not; it is up to the individual professional judgment of a specialist clinician on the register to prescribe or not.
Mary Glindon (North Tyneside) (Lab)
Lara Smith, my constituent, is really upset about what happened to Teagan and her family at the weekend. Lara travels to Holland every three months to get a schedule 2 drug, Bedrocan, for her seriously debilitating illness. It could be imported but, if it was, unfortunately, she would have to bear the licence fee. Will the Minister say whether anything can be done for her?
Matt Hancock
Yes. My heart goes out to the hon. Lady’s constituent and her family. One of the purposes of the evidence gathering that we are doing, and of the calls of the national institute for trials, is to provide the evidence on which the NHS could routinely provide those medicines. At the moment, we have the ability for specialists to prescribe in the interim, but I want to get the evidence base in place for the longer term.
Alison Thewliss (Glasgow Central) (SNP)
One of my constituents—one of many who has been in touch with me about this issue—has multiple sclerosis and found previously that cannabis helped his symptoms immensely, but he does not want to break the law and he cannot get a prescription. What would the Secretary of State advise him to do?
Matt Hancock
If the hon. Lady will write to me with the case, we will get a second opinion from a clinician who may be able to make that prescription.
Jeff Smith (Manchester, Withington) (Lab)
I agree that we need to remove the barriers for clinicians. We need evidence, but the problem with randomised control trials is the nature of cannabis. The fact that it contains many different compounds that interact makes it difficult to isolate the compounds that work for individuals. Cannabis is a unique treatment, and should really be in a licensing and scheduling category of its own to allow different approaches. I urge the Secretary of State to encourage observational trials so that we can allow patients to get access to the medical cannabis that will work for them.
Matt Hancock
We looked at observational trials, but the problem is that they do not build the evidence base that a full RCT does. A full RCT also allows some patients to get access while the trial is ongoing, so it is in fact a better proposal. It means that some patients can get the treatment now for the purposes of the trial, and then we can get a full evidence base for the long term, as was mentioned previously.
Kevin Brennan (Cardiff West) (Lab)
The law may be an ass, but it does not have to be applied in an asinine way, as it was in the case of Emma Appleby. Will the Secretary of State have words with the Home Secretary to make sure that it is not repeated? My constituent, Bailey Williams, is 16 years of age and suffers from the most severe form of epilepsy. He has multiple seizures every day. His parents, Rachel and Craig, are absolutely convinced that we need observational trials and more immediate action. I accept that this was unintended, but sadly the change in the law has made things worse, not better, for those parents. What will the Secretary of State do to turn that around quickly?
Matt Hancock
It is a source of deep frustration to me that the change in the law to normalise the use of medicinal cannabis has, exactly as the hon. Gentleman says, meant that, because a clinical decision is needed for a prescription, and because in many cases clinical decisions are not forthcoming, many parents who entirely understandably think that their child would benefit from medicinal cannabis now find that they cannot get a clinician to sign it off. That is at the root of the problems that we are trying to tackle today.
Alan Brown (Kilmarnock and Loudoun) (SNP)
Although the Secretary of State is adamant that the guidelines are not a problem, it is clear that they and the associated liability are an issue. Let us hope that the review will pick that up. Four-year-old Logan Chafey in my constituency is the only child in the whole of Europe who has chromosome 7p duplication syndrome. One of the current rules is that there needs to be a proven benefit before a clinician can prescribe medicinal cannabis. How can we get to a position where Logan can get medicinal cannabis?
Matt Hancock
He will be able to get it now if a clinician is prepared to sign off on it being the right thing for him. If that is not forthcoming now, I have announced today a system of second opinions to allow people to get the clinical sign-off that they need.
Matt Hancock
They must be taken into account. It comes down to the question of the complexity of cannabis and the many dozens of active agents in it; CBD and THC, which we have mostly been discussing today, are the main ones. Many drugs have similarly complex interactions. Modern science and medicine are capable, in a controlled environment, of getting to the bottom of which ones have the effect. That is why it is better to do a full RCT with the full scientific structure around it, rather than an observational trial. That will get the drugs to the people who need them quickly, and will provide the evidence base. I hope that that satisfies the hon. Gentleman that, in that space, we are doing as much as we can. On the timing, I want it to happen as quickly as possible.
Stuart C. McDonald
It was a very wise decision. Thank you, Mr Speaker.
I, too, have constituents who have been exiled to the Netherlands to secure medicinal cannabis for a severely epileptic child, and others who are spending a fortune importing cannabis oil from Canada to help slow the progression of a terminal brain tumour. Will families such as these soon be able to take part in proper clinical trials, as they would be able to elsewhere, so that they can have some hope and we can all benefit from the evidence that will be gained?
Matt Hancock
Yes, absolutely. If the hon. Gentleman will write to me about the specific case, I will ensure it is dealt with appropriately.
Oral Answers to Questions
Matt Hancock Excerpts(5 years, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lucy Powell (Manchester Central) (Lab/Co-op)
The Secretary of State for Health and Social Care (Matt Hancock)
The Department of Health and Social Care works across government to ensure every child can have the best possible start in life. This includes a significant increase in mental health support in schools.
Lucy Powell
I thank the Secretary of State very much for that reply. May I first pay tribute to the former Minister, the hon. Member for Winchester (Steve Brine)? I think his actions last night were very honourable, and he has been an exceptional Health Minister.
May I ask the Secretary of State also to look at how we can join up services much more strongly on the ground? Whether it is early years, child mental health or special educational needs and disability support, time and again we hear problems about how services are not joined up.
Matt Hancock
I agree with the hon. Lady on both counts. My hon. Friend the Member for Winchester (Steve Brine) was an excellent Public Health Minister, who did exemplary work and drove the agenda with great passion and determination, and he has behaved honourably in every sense.
On the point about cross-government working, the hon. Lady is completely right. The need to join up, breaking down the barriers of silos that sometimes exist between agencies, is vital. There is a huge amount of work under way in all of the areas she mentioned, and I am determined to see that work.
Tracey Crouch (Chatham and Aylesford) (Con)
On Friday, I met two clinical commissioning groups that cover my constituency specifically to discuss mental health and children’s health and wellbeing. While it is an extremely complex issue, does the Secretary of State agree with me that, with the perceived rigorous spending rules requiring health providers to spend only on pure health services, it will remain extremely challenging for them to work with other agencies to support methods, such as those to build resilience, that improve outcomes for children’s health?
Matt Hancock
My hon. Friend is absolutely right to raise this. The most forward-looking CCGs in the country are working with all sorts of partners—the voluntary sector, charities, local authorities—to deliver better services that make people healthier, even if they are not purely medicinal in the first instance. For instance, tennis lessons may sometimes help people, Mr Speaker, as may all sorts of other activities. This is all part of a broadening social-prescribing agenda to get people healthy, however that is best done.
Chris Elmore (Ogmore) (Lab)
The Secretary of State will be aware that, last Monday, I published my report, with the Royal Society for Public Health, on children’s mental health and social media. May I place on the record my thanks to him for his tweet in support of the report? I have asked Education Ministers and I will be doing this with the devolved institutions as well, but would he agree to a meeting with me—and with the Mental Health Minister, the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price)—to look at the report and the recommendations so that we can start working across Departments and across devolved institutions?
Matt Hancock
I would be very happy to meet the hon. Gentleman and his all-party group on social media and young people’s mental health and wellbeing. It is an incredibly important topic. We must make sure that social media is safe and that we protect children’s mental health, which the evidence increasingly shows can be negatively impacted by the wrong use of social media. Social media can be a great, powerful force for good, but it also has its downsides and we need to mitigate those, and there is a lot more coming from the Government soon.
Theresa Villiers (Chipping Barnet) (Con)
May I ask the Secretary of State to meet the Sport and Recreation Alliance to hear its ideas on how we ensure children and young people lead healthier and more active lives?
Matt Hancock
Yes, I would love to. I think this is an incredibly important agenda. It ties in directly with the question from my former ministerial colleague when I was at the Department for Digital, Culture, Media and Sport, my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch). There is lots to do on this agenda.
Dr Rosena Allin-Khan (Tooting) (Lab)
There has been an alarming rise in the need for the use of baby banks for children. While I am proud that organisations such as Little Village in Tooting are doing such amazing work, it is shocking that we even need baby banks in this day and age. Does the Secretary of State agree with me that it is a stain on this Government and highlights the drastic inequalities seen in our society?
Matt Hancock
We are determined to do everything we can to support people, especially at the time—in the first 1,000 days—that is so critical to people’s whole lives, and that is an incredibly important part of the work. Improving maternity services is important, but the link-up with other broader agencies is also important, and we should not denigrate or downplay the vital role that charities too can play in supporting people.
David Tredinnick (Bosworth) (Con)
I thank my right hon. Friend for coming to Hinckley to see co-ordination and social prescribing in action. Will he be taking steps to further develop personal budgets, which save money and improve lives?
Matt Hancock
Yes, absolutely. Driving the social prescribing agenda, which is based on increasingly strong evidence of the power of social prescribing to help people stay healthy and get them healthy again when they are ill, will also involve wider use of personal budgets. Almost 1 million people have personal budgets.
Dr Paul Williams (Stockton South) (Lab)
I join my hon. Friend the Member for Manchester Central (Lucy Powell) in paying tribute to the very hon. Member for Winchester (Steve Brine), and I also pay tribute to my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders). Has the Secretary of State seen Professor Clare Bambra’s research in the Journal of Epidemiology & Community Health this month, showing that inequalities in infant mortality between deprived and more affluent areas fell between 1999 and 2010 when there was a Labour Government, and then increased from 2011 to 2017? Is it not true that only Labour has the range of co-ordinated, cross-governmental policies that reduce inequalities in child health?
Matt Hancock
No. The NHS long-term plan has a whole swathe of policy to reduce health inequalities. The best thing we can do to reduce health inequalities is ensure that more people are in work, and the record number of jobs that have been delivered is a vital part of that agenda.
Derek Thomas (St Ives) (Con)
Sir Desmond Swayne (New Forest West) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
The data that my right hon. Friend asks for is not available, but it is important that we take action to make sure the right drugs are available for the right people.
Sir Desmond Swayne
Was it intended to make them as rare as hens’ teeth? What measures is the Secretary of State taking to support clinicians in actually prescribing?
Matt Hancock
I met the parents of some of the children whose needs are best met through the use of medicinal cannabis. My heart goes out to those who are fighting for this cause. We changed the law in the autumn to try to make it easier, and I am looking very closely at what we can do to make sure that the intention of that decision is met.
Mr Ben Bradshaw (Exeter) (Lab)
The Health Committee heard last week that patients are dying unnecessarily and up to a million families are being driven to criminality by getting medical cannabis illegally, and the situation has got worse since the Government changed the law in November. When are these families going to get access to medical cannabis for their children and other sufferers that they would have access to if they lived in Germany, the Netherlands, Canada or the United States?
Matt Hancock
As the right hon. Gentleman knows, I supported and indeed participated in the decision to ensure that access was made legal in the autumn, and I am working right now on trying to make sure that some of the challenges in the system are unblocked. Ultimately, these things have to be clinician led, but my sympathy is with those who are campaigning, whom I have met, because I know of the anguish that this problem is causing.
Mary Glindon (North Tyneside) (Lab)
Mr Stephen Hepburn (Jarrow) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
On 11 March, I held a meeting with all the parties to discuss how best to ensure that people with cystic fibrosis and their families can benefit from the best drugs as soon as possible. Vertex, the National Institute for Health and Care Excellence and NHS England met on Thursday and have agreed to take those discussions forward.
Mr Hepburn
Does the Secretary of State support immediate interim access to Orkambi while the negotiations are going on, and has he asked NHS England, NICE and Vertex to consider this option?
Matt Hancock
We are having constructive discussions—I am delighted that finally Vertex has agreed to participate in them; the parties have committed to providing the data needed for an objective assessment of the drugs in question, and I look forward to the discussions proceeding effectively.
Rachel Maclean (Redditch) (Con)
A constituent of mine came to see me in my surgery. He had been born with cystic fibrosis and told me what a transformative effect the drug had had on him. He was lucky enough to be accepted on the trial, but he says we need to raise awareness because millions of people are not getting the drug. What response can the Secretary of State give to him and fellow sufferers?
Matt Hancock
My hon. Friend’s constituent is absolutely right about raising awareness of the issue and the need for these drugs. I know the impact that cystic fibrosis can have on people and of the hope that these drugs will save lives. We have made a significant offer to the pharmaceutical company, Vertex, to allow these drugs to be provided in the UK, and I very much hope we can come to an agreement.
Catherine McKinnell (Newcastle upon Tyne North) (Lab)
On NICE decision making, my young constituents Nicole and Jessica Rich have the life-limiting rare condition Batten disease. Last month, NICE turned down a proven treatment for the condition after a year of deliberation. I and several cross-party colleagues wrote to the Secretary of State to ask if we could discuss this urgent matter, but we received a reply from the Under-Secretary of State for Health and Social Care (Baroness Blackwood), saying that she could not meet us because of diary commitments. This is insulting. Will the Secretary of State meet us to discuss this urgent issue?
Matt Hancock
Yes, of course I will. I understand exactly where that process has got to. It concerns a different drug from the one in the question, but it is also a very important consideration for a number of people.
Luke Hall (Thornbury and Yate) (Con)
Will the Secretary of State agree to or consider temporary interim access to Orkambi while the negotiations continue, and has he had any discussion so far on that subject?
Matt Hancock
I am happy to consider all options that can secure access in a way that provides value for money based on an objective assessment of what is clinically right. That is the basis of our discussions.
Kerry McCarthy (Bristol East) (Lab)
I am glad that the Secretary of State is taking a personal interest in this matter. In Thursday’s debate, I mentioned the case of Oli Rayner, who gave evidence to the Health Select Committee. He fell ill in his 30s and was given Orkambi just to make him well enough to undergo a lung transplant operation. Is it not ludicrous to wait until people are virtually at death’s door before being prepared to give them the drug?
Matt Hancock
That is one very important consideration. Having met people suffering from cystic fibrosis and heard directly the stories they tell about the impact on their lives and how it potentially shortens their lives, I think it is very important that we find a solution, which is why I was so determined to bring the parties together.
Stephen Crabb (Preseli Pembrokeshire) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
The new five-year national action plan to tackle antimicrobial resistance contains the commitment to support more research into new and alternative treatments, including vaccines and diagnostic tests, to promote broader access to vaccines for both humans and animals.
Stephen Crabb
Stopping the spread of diseases such as TB by using vaccines will play a key role in tackling AMR worldwide, so what plans does my right hon. Friend have for building on the excellent work of the UK Vaccine Network, with all the funding that goes with that, to ensure continued UK leadership in vaccinology?
Matt Hancock
My right hon. Friend is right to raise this issue. Of all the challenges facing the world, the risk that antibiotics will fail to work in the future is a huge one that we cannot afford to allow to come to pass. We are putting significant research money into the production of new antibiotics and ensuring that we roll out vaccines so that antibiotics do not have to be used.
The use of antibiotics in the chicken population in the United Kingdom has fallen by more than 70% over the last five years. This is doable: we will provide the money that is necessary to ensure that people can use antibiotics well into the future.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
May I beg the Secretary of State to snap out of the trance that he now seems to be in and wake up to the fact that many of the key researchers in this area are going back to their European homes because of the threat of Brexit? We are losing Spanish nurses, for instance, on whom my constituents absolutely depend for healthcare. Up and down the country, our health system is haemorrhaging talent because of the Secretary of State’s lack of action. Wake up, Secretary of State, and smell the coffee!
Matt Hancock
I am afraid that I profoundly disagree with the hon. Gentleman, who used to be so sensible. Antimicrobial resistance is a global problem and we contribute to global funds, because only by coming together as a whole world will we be able to tackle it— and that is what we are going to do.
Andrew Lewer (Northampton South) (Con)
Justin Madders (Ellesmere Port and Neston) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
It is a great pity to see the hon. Gentleman back up there on the Back Benches as he was such a force—and a rare force—for reason and progress on the Opposition Front Bench until recently.
Standards in the NHS should be based on clinical evidence, and NHS England’s proposals will be rigorously field-tested to gather further evidence on clinical, operational, workforce and financial implications, all with the goal of improving the quality of care.
Justin Madders
I thank the Secretary of State for his tribute—although it is not going to change the question I am going to ask. He will be aware that since July 2015 the four-hour A&E target has not been met and last month saw the worst performance on record, so regardless of any clinical reviews, is it not time that Ministers admitted that the four-hour A&E target has effectively been abandoned?
Matt Hancock
Of course, we are aiming to meet and improve against the targets, including with the injection of the extra money—£34 billion extra in cash terms over the next five years. At the same time, we must make sure that the standards to which we hold the NHS are the right ones clinically for the times, and that is what this review of standards is all about.
Mary Robinson (Cheadle) (Con)
Helen Whately (Faversham and Mid Kent) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
Primary and community care are set to receive an additional £4.5 billion a year of taxpayers’ money as part of the NHS long-term plan, to ensure that we can get the best possible access to GPs.
Helen Whately
In parts of my constituency, it is very difficult for people to see their GP. For example, in the area of Park Wood, there is just one GP for 4,000 patients. I welcome the extra money going into primary care that my right hon. Friend just mentioned, as well as the additional GP training places and the fact that a Kent medical school is coming our way, but we need more nurses, physios and other health professionals in primary care. What is he doing to ensure that people can see the right health professional when they need to do so?
Matt Hancock
This is an incredibly important agenda that is close to my heart. It is at the core of the prevention of ill health to ensure that we have the right primary care services. Yes, that includes more GPs, but it also includes more of the other health professionals who support them. We have 1,000 extra non-GP clinical staff already working in general practice compared with just two years ago, but there is much more to do.
Derek Twigg (Halton) (Lab)
But what is the Secretary of State doing about retaining GPs? This is a real problem, and we have seen more and more GPs taking early retirement in recent years. What is he doing specifically to support retention?
Matt Hancock
This is a core question that Baroness Dido Harding’s workforce review will be looking into, and work is going on right across government to try to fix it.
Kevin Hollinrake (Thirsk and Malton) (Con)
GPs are the first line of defence against superbugs and antimicrobial resistance, and the Secretary of State is already proving to be a world leader in this area. The idea of a resistance tax has the support of other world leaders including Lord O’Neill and Dame Sally Davies. Would he consider this approach?
Matt Hancock
I am happy to look at all approaches to how we can reduce the overuse of antibiotics to preserve them so that they work effectively where they are needed. Of course GPs have a role to play in that, and the number of antibiotics prescribed by GPs has fallen in recent years, but again there is much more work to do.
Jim Shannon (Strangford) (DUP)
Will the Minister outline whether his Department is willing to enter into an agreement with medical students to wipe out their student loans if they contract to carry out five years of GP service?
Matt Hancock
That is an interesting proposition and I would be happy to talk to the hon. Gentleman more about the idea. I was in Northern Ireland last week looking at medical services there and at what we can learn, and that might be another idea.
Jeff Smith (Manchester, Withington) (Lab)
Vicky Foxcroft (Lewisham, Deptford) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
We are pursuing a multi-agency approach to prevent and tackle serious violence. Healthcare is of course one of the important and relevant agencies that need to work together right across government to reduce knife crime.
Vicky Foxcroft
The Government are committed to a public health approach, but we heard the Secretary of State dismiss it just a few weeks ago. What assurances can he give that he is now fully signed up to the approach? What evidence is his Department collating? How is the Department working with the Home Office to ensure that we have a long-term strategy for keeping our young people safe?
Matt Hancock
I am a huge fan of the public health approach to tackling knife crime. In fact, I was in Croydon yesterday to talk to charities and to students at Croydon College about the role the NHS can play in tackling the scourge of knife crime. I am a big fan of this agenda, and I look forward to working with the hon. Lady and colleagues from across the House.
Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)
Stephen Crabb (Preseli Pembrokeshire) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
We all in this House have huge admiration for the dedicated staff who work night and day to deliver world-class care to patients in our NHS. We should recognise that today marks the 75th anniversary of the publication of the White Paper on the establishment of the NHS, delivered in this House by a Conservative Minister, under a Conservative Prime Minister.
Stephen Crabb
The prescription of powerful painkillers has soared, as has the number of overdoses and deaths from these prescription drugs, with some of the worst statistics in the poorest areas of the country. What is my right hon. Friend doing to reverse this worrying trend?
Matt Hancock
My right hon. Friend is absolutely right to raise this. There has been a rise in opioid-related deaths, and we need to work across government to tackle the problem. Public Health England is reviewing prescription drug dependence, including opioid dependence, and we recently announced a review of over-prescription in the NHS to make sure patients are taking the right medicines for the right amount of time.
Barbara Keeley (Worsley and Eccles South) (Lab)
There are still 2,295 patients who are autistic or who have learning disabilities in hospital in-patient settings, despite a Government pledge in 2012 that no one would be in inappropriate settings by 2014. In 2015, the Government said they would close up to 50% of these in-patient places, and they failed to meet that pledge, too, because of a lack of social care funding. Will the Secretary of State now commit to proper social care funding for this programme and renew the pledge to end the misery of these placements by 2022?
Kirstene Hair (Angus) (Con)
Matt Hancock
I will certainly do that, and I am very surprised and disappointed to hear what my hon. Friend has to report. I pay tribute to her work in leading on this agenda, including setting up the all-party parliamentary group. She has campaigned hard to get the Scottish Government to act. Given the progress we have made on the target—by 2021, 95% of children and young people with an eating disorder receiving treatment within one week for urgent cases and four weeks for routine cases—we are on track to meet it. That is something we should be discussing, at the very least, with our Scottish colleagues.
Gavin Newlands (Paisley and Renfrewshire North) (SNP)
Matt Hancock
We have a range of work going on to improve access to innovative new treatments, both pharmaceutical treatments and the broader treatments that the hon. Gentleman describes, including ensuring, through an accelerated access collaborative led by the former Labour Minister Lord Darzi, that we drive innovation and that those innovations are taken up by other parts of the NHS.
Several hon. Members rose—
Greg Hands (Chelsea and Fulham) (Con)
Matt Hancock
My right hon. Friend was not only a very good Whip, but is a very good constituency MP. He has made his case very well. “Shaping a healthier future” is no longer supported by the Department of Health and Social Care, NHS Improvement or NHS England. The NHS will look at parts of the proposals that are in line with the long-term plan, such as the aspects that are focused on expanding the treatment of people in the community. As for the changes in A&E in west London that are part of “Shaping a healthier future”—for instance, those at Charing Cross Hospital, which he mentioned—these will not happen.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Daniel Kawczynski (Shrewsbury and Atcham) (Con)
Will the Secretary of State give an evaluation of the “Future Fit” programme? We have secured more than £300 million for investment in our local hospital trust. What is his understanding of where the “Future Fit” programme has got to?
Matt Hancock
I have called in the independent review panel and asked it to consider all the evidence, at the request of the local council, to ensure that we properly assess all the evidence. We have made the money available, but we must ensure that the plans are the best ones possible for both Shrewsbury and Telford.
Ian Mearns (Gateshead) (Lab)
Fiona Bruce (Congleton) (Con)
Can Ministers outline the latest steps to support the children of alcohol-dependent parents? In the forthcoming alcohol strategies, will greater support be promoted for the families of alcoholics, who are often best placed to help to reduce alcohol harm in their loved ones?
Matt Hancock
Absolutely. My hon. Friend is right to stress the role of families in supporting the children of alcoholics. We made progress on that and were able to announce funding just last week. I pay tribute to my hon. Friend the Member for Winchester (Steve Brine) for all his work—I enjoyed doing it with him—to do everything we can to support the children of alcoholics.
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
Matt Hancock
The relative funding across the country for different areas is assessed independently, and by law NHS England makes that assessment. I am happy to write to the hon. Gentleman with the precise details of how those allocations are devised—I am sure that he has got them; they are widely available—and an explanation of the conclusion that NHS England independently reached.
David Tredinnick (Bosworth) (Con)
What is being done to improve co-ordination between orthopaedic surgeons, osteopaths and chiropractors to reduce the burden on surgeons?
Matt Hancock
It is an important part of the agenda that we look right across the piece at interventions that can benefit patients. I know full well, not least because I am married to a former osteopath, the positive impact that that can have.
Mr Adrian Bailey (West Bromwich West) (Lab/Co-op)
In a debate on 24 January in this Chamber, many contributors outlined the dangers of using graded exercise therapy in treating ME. What conversations has the Department had with NICE on that issue before the proposed publication of the revised treatment guidelines in October 2020?
Julia Lopez (Hornchurch and Upminster) (Con)
I met the Secretary of State to discuss my campaign for a new health centre in Hornchurch and I welcome his subsequent announcement that NHS trusts can apply for NHS property assets. Will my right hon. Friend let me know how and when they can make those applications and whether he will consider fast-tracking any bid we make, given how close we were to receiving capital funding?
Matt Hancock
There is no better advocate for Hornchurch in the Chamber than my hon. Friend. She made her case with passion and commitment and I was very impressed by it. I will write to her with the full details, once they are published, of exactly how the process will work, and I look forward to working with her.
Tim Farron (Westmorland and Lonsdale) (LD)
The north-west of England has only half the number of ambulances per head of population as London. In rural Cumbria, the situation is far worse. Will the Secretary of State agree to our proposal for an additional two ambulances for Westmorland so that we can keep our communities safe?
Ms Karen Buck (Westminster North) (Lab)
With a throwaway answer to the right hon. Member for Chelsea and Fulham (Greg Hands), the Secretary of State has just pulled the west London strategic health framework, which has governed the delivery of hospital and community services for most of the last decade, absorbed tens of thousands of hours and cost hundreds of millions of pounds. Why has he not thought it appropriate to bring forward a statement so that the many of us who are concerned with this issue have an opportunity to interrogate the many very serious implications that this has for the delivery of healthcare across west London?
Matt Hancock
The hon. Lady and the hon. Member for Hammersmith (Andy Slaughter), who is sitting next to her, have run, over a number of years, totally inappropriate scare stories about what they said were potential changes to A&E in west London as part of “Shaping a healthier future”. It has been one of the worst aspects of local parliamentary campaigning and I am absolutely clear that the changes in A&E in west London as part of “Shaping a healthier future” will not happen. However, there are elements of “Shaping a healthier future” that are about more community services and treating more people in the community. We look forward to working with the local NHS on those parts of the proposal.
Andrew Griffiths (Burton) (Con)
Will the Secretary of State, on behalf of this House, thank doctors and nurses in the NHS for the amazing news that death rates from breast cancer are falling at a faster rate here than in the six largest countries in Europe and that, since 2010, death rates have fallen by 17.7%? He will know that I raised the issue of my constituent Nicola Morgan Dingley, who is suffering from terminal breast cancer. He very kindly wrote to me. Will he agree to meet Nicola so that she can describe to him the challenges faced by women with triple negative breast cancer?
Matt Hancock
Yes, of course, I would be delighted to meet my hon. Friend and his constituent. He is right that the fall in deaths from breast cancer is huge progress that we have made as a country. I pay tribute to the work of the NHS on that but, of course, every such death is a tragedy and we need to do yet more.
Andy Slaughter (Hammersmith) (Lab)
“Shaping a healthier future” was the biggest hospital closure programme in the history of the NHS, with the loss of two major hospitals, including Charing Cross in my constituency. It was fully supported by the Conservative party not only nationally, but locally, as the right hon. Member for Chelsea and Fulham (Greg Hands) well knows. After seven years, millions of pounds wasted in consultants, staff leaving through insecurity and 2 million people across west London threatened with the loss of essential and world-class hospitals, is that it today? Abandoning “Shaping a healthier future” is a victory for the people of Hammersmith, for the Save our Hospitals campaigners and for our Labour council, but there has been appalling judgment by a succession of Governments and Secretaries of State. Will this Secretary of State now apologise to my constituents?
Matt Hancock
It is astonishing, is it not? My right hon. Friend the Member for Chelsea and Fulham (Greg Hands) has made this case with objective clarity and reasonableness, is supporting his constituents and led to a very positive outcome, keeping the A&Es open but still doing the positive work in the community, and all we continue to get is information that I regard as erroneous from the hon. Gentleman, who has campaigned in the most terrible way on this over many years.
Andrea Jenkyns (Morley and Outwood) (Con)
A nine-year-old constituent of mine, Lydia Heptinstall, is a very brave sufferer of hypermobile Elhers-Danlos syndrome. She suffers from joint pain, headaches and numerous other symptoms and cannot do the things that other children can do. Will the Minister meet me to discuss Lydia and what the Government are doing to raise awareness of this condition?
Matt Hancock
Yes, of course, I would be very happy to meet my hon. Friend and talk about her constituent’s concerns.
Alison Thewliss (Glasgow Central) (SNP)
I am wearing purple today for Epilepsy Day. What assessment has the Secretary of State made of the causes of ongoing shortages of epilepsy medications? What action is being taken to address those problems and what impact will Brexit have on the supply of those medicines?
Matt Hancock
I, too, am wearing purple—purple socks in my case—to support this important campaign. Of course, we have done enormous amounts of work across the NHS. I pay tribute to the NHS and to suppliers for working to ensure that, whatever the Brexit outcome, there will be the continued supply of medicines, but there is one thing that the hon. Lady can do if she really wants to make sure that we put this issue to bed once and for all—vote for the deal.
Several hon. Members rose—
Eurotunnel: Payment
Matt Hancock Excerpts(5 years, 2 months ago)
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Andy McDonald (Middlesbrough) (Lab)
(Urgent Question): To ask the Secretary of State for Transport to make a statement on the payment of £33 million to Eurotunnel over no-deal ferry contracts.
The Secretary of State for Health and Social Care (Matt Hancock)
I would like to update the House on the settlement that the Government have reached with Eurotunnel, which will help to deliver the unhindered supply of vital medicines and medical devices in the case of a no-deal Brexit.
The best way to ensure a smooth and orderly exit from the EU, both for the NHS and for the wider economy, is to support the deal that the Attorney General is currently finalising. Anyone in this House who cares about the unhindered supply of medicines should vote for that deal, but leaving the EU without a deal remains the default position under the law, and it is incumbent on us to keep people safe. It is therefore vital that adequate contingency measures are in place for any Brexit scenario.
Preparing for a no-deal exit has required significant effort from the NHS, the pharmaceutical industry and the whole medical supply chain, and I pay tribute to their work and thank them for their efforts on these contingency measures. The settlement struck between the Government and Eurotunnel last week is an important part of these measures. Because of the legal action taken by Eurotunnel and the legal risks of the court case, it became clear that, without this settlement, we could no longer be confident of the unhindered supply of medicines. Without this settlement, the ferry capacity needed to be confident of supply was at risk. As a Government, we could not take that risk, and I doubt anyone in this House would have accepted that risk, either. With this settlement we can be confident, as long as everyone does what they need to do, that supply will continue unhindered. Under the settlement, Eurotunnel has to spend the money on improving resilience, security and traffic flow at the border, benefiting both passengers and business.
The Department for Transport, on behalf of the whole Government, entered into these contracts in good faith. Our duty is to keep people safe, whatever complications are thrown up. Although we continue to plan for all eventualities, it is clear that the best way to reduce all these risks is to vote for the deal in the days to come.
Andy McDonald
Once again, the Transport Secretary is not in his place to answer a question directed to him. His disregard for taxpayers and this House is clear. On Friday he reached a £33 million out-of-court settlement with Eurotunnel to provide services in the event of a no-deal Brexit because the Government were going to lose the case.
The Transport Secretary’s decision to bypass procurement processes in awarding a contract to Seaborne Freight, a ferry company without any ships, breached public procurement rules, and Eurotunnel had the Government over a barrel. Will the Minister now detail the total cost to taxpayers of this decision, including legal costs? How much money will be paid up front?
Eurotunnel will seemingly make Brexit-related improvements at Folkestone. Can the Minister say exactly what sort of agreement the Government have with Eurotunnel? What makes him think that this contract with Eurotunnel will not be challenged on anti-competition grounds? A former Department for Transport adviser said:
“there is a risk it could be construed as another piece of public procurement without open and transparent competition.”
That would risk further legal action and yet more public money being squandered.
Even in this golden age of ministerial incompetence, the Transport Secretary stands out from the crowd. He leaves a trail of destruction in his wake, causing chaos and wasting billions of pounds, yet he shows no contrition, no acknowledgment of his mistakes and no resolve to learn and improve. He is now ridiculed in The New York Times. The mayor of Calais has banned him from his town. The Transport Secretary has become an international embarrassment. The Prime Minister is the only person in the country who retains confidence in this failing Transport Secretary, and she does so only because of her own political weakness. The public deserve to know: how many more calamities is the Prime Minister prepared to tolerate? How many more billions of pounds will she allow him to waste before saying, “Enough is enough”? This country cannot afford this Transport Secretary. He should be sacked without delay.
Matt Hancock
In listening to that, I notice that the hon. Gentleman did not disagree with the decision we made on Friday. That decision was to ensure that we have the ferry capacity in place so that whatever happens in the Brexit scenario we can have the unhindered supply of medicines. That is the duty of this Government and that is why the whole Government came to this decision. He asked some specific questions, which I answered in my statement. However, let me reiterate: this is a legal settlement with Eurotunnel; the maximum cost is £33 million, as was set out clearly on Friday; and the purpose of the decision is to ensure that unhindered flow of medicines. So, as I said in my statement, the purpose of this is to make sure that whatever happens in Brexit people can be safe. I was happy to support that decision, which everybody in this House would have made in the same circumstances.
John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)
Many of my constituents are concerned about the supply of medicines after Brexit. What reassurance can the Secretary of State give me that the supply of medicines to harder-to-reach places such as Scotland will continue after we leave the European Union?
Matt Hancock
My hon. Friend is absolutely right to ask about the unhindered supply of medicines. The first thing he can do to ensure that that supply continues, with no risks to it, is to support the deal in the meaningful vote, as he has done before. Secondly, we are working with all parts of the country and with the devolved authorities on this. Although ensuring that we have these supply chains in place in any Brexit scenario is a UK Government matter, we are working with the devolved Administrations, especially to ensure that the flow reaches all parts of the country.
Alan Brown (Kilmarnock and Loudoun) (SNP)
I wish to echo the question: where is the £2.7 billion man? I have asked him to step aside several times, I have challenged the Prime Minister to sack him and now he has his own social media hashtag—FailingGrayling. Surely now is the time he has to go.
Apparently, we hear that this is not compensation for Eurotunnel but a contract for vital services. If they were so vital, why did it take Eurotunnel going to court to get a contract? Why was Eurotunnel overlooked in the first place? The secrecy on this is a real concern. How much documentation is still hidden away from public view? If the no-deal contract is not invoked, how much money will still be paid to Eurotunnel? Why on earth would the Health Secretary entrust the transportation of life-saving medicines to the Transport Secretary?
Bechtel is set to sue the Government over the HS2 tender process. What other departmental procurement risks still exist? After his efforts at the Ministry of Justice cost us £600 million, the Transport Secretary has allowed Virgin Trains East Coast to walk away owing £2 billion; he has blamed Network Rail for mishaps when he is in charge of the organisation; and he has culpability for Southern rail, for the £38 million Northern rail timetable fiasco and for the £800,000 ferry due diligence contract, where due diligence was not carried out on the company with no ships. He has tried to argue that the Seaborne fiasco has not cost the taxpayer any money. Only for this Transport Secretary can this £33 million be just the tip of a financial iceberg. What does it take for him to be sacked—or to do the decent thing and walk away?
Matt Hancock
Unlike in the question from my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont), what I did not hear in the hon. Gentleman’s long question was a statement about whether he supports the decision or not. I think that is because he does support the decision to ensure we have what we need to get the unhindered supply of medicines. More than that, he and his Scottish National party friends complain endlessly about a no-deal Brexit, yet they do not do what is needed to avoid a no-deal Brexit, which is to vote for the deal.
Mr Kenneth Clarke (Rushcliffe) (Con)
It is always a pleasure to see my right hon. Friend the Secretary of State for Health and Social Care, although rather a surprising one on this occasion. The usual reason for settling an action is to minimise your losses when you are obviously on a loser in defending it, but I am relieved to hear that this was done in order to ensure the safety of medicines. As we are on that subject, can he give me some reassurance about the long-term future for the regulation and approval of medicines in this country? If and when we leave the EU—we look as though we are bound to do so—we of course leave the European Medicines Agency, which is leaving this country, and I am not clear what our long-term arrangements will be. Are we going to seek some association with the EMA system, or will we be setting up a totally new British system to replace it? Can he guarantee continuity of the proper regulation of medicines while that process is under way?
Matt Hancock
The short answer to that is yes. The medium length answer is that we will ensure that medicines can be licensed in this country with no further burdens than under the EMA system by matching some of the EMA processes, but in a no-deal scenario we would also be looking to introduce our own processes so that some medicines could be brought and licensed here before they could be licensed in Europe. Indeed, changes to this area is one of the examples of advantages from Brexit, which I am sure my right hon. and learned Friend will be delighted to hear about, because they mean that we can grasp some of the opportunities that the future of medicines presents. The long answer is so long that I will be happy to write to him with full details and place a copy of the letter in the Library of the House.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
There is something quite wrong here. I have been in the House for quite a few years—usually people say, “Too long,” but I have been here a long time. This almost seems to be an abuse of the House. The fact is that the Opposition asked for an urgent question on the Eurotunnel payment of £33 million. I do not know what £33 million means in Suffolk, but in Huddersfield it would make a hell of a difference in regenerating our local economy. I am not calling for the Transport Secretary’s resignation because he is a symptom of something deeply wrong with this Government. They are totally incapable of arranging their policies ready for Brexit. That is the truth of the matter. There is total chaos on the Government Benches because they had not predicted what was going to happen with Brexit, and they are showing no ability to cope with post-Brexit conditions, what is happening in the Eurotunnel and so on.
Matt Hancock
The hon. Gentleman is normally a sensible man, but I could not disagree with him more on this one. The point of this settlement is to ensure that we have the unhindered supply of medicines, so that, whatever the Brexit scenario, people can get their medicines. This was a cross-Government decision and I am here, as the Health Secretary, because it is medicines that will be carried on these ferries. If the court case had gone against the Government and the court had struck down these contracts, we would not have been able to be confident about the supply of those medicines. I think it is incumbent on any Government to ensure that they can deliver that. There is something else we can do to deliver the unhindered supply of medicines and he can do it too; it is within his gift—he can vote for the deal.
Mr Marcus Fysh (Yeovil) (Con)
I welcome my right hon. Friend’s sensible contingency planning for any eventuality, but may I highlight that it is important to focus on all the routes across the channel and everything related to that? Although it is good that Eurotunnel is being focused on, it is worth looking at the transit system as a way to smooth the procedures on the main ferry routes across the channel also.
Matt Hancock
Yes, and that is exactly what these contracts, with which we can now proceed because of the settlement, do. Essentially, they provide for more capacity away from Dover-Calais so that medicines can be routed into the UK and, indeed, onwards to Ireland through other routes. They allow for that. I am glad of my hon. Friend’s interest in this matter and hope he will vote for the deal.
Lilian Greenwood (Nottingham South) (Lab)
The Secretary of State for Transport may have ducked today’s questions, but I am pretty sure that my Committee will still require his answers. If there is a Brexit deal or, indeed, if there is no Brexit, how much of our taxpayers’ £33 million do the Government expect to recover from Eurotunnel?
Matt Hancock
Of course, the medicines are going on these boats that we are procuring and that makes this a serious health matter. The hon. Lady is perfectly within her rights to ask these sorts of questions. The truth is that the £33 million is the maximum figure. It may not be as high as that, but we have been clear about the full exposure.
Damian Green (Ashford) (Con)
If we can essay a transport-related question, could my right hon. Friend give me some assurance that the extremely important cross-channel rail link will continue as it is now, under any circumstances, after 29 March? On the medical front, can he say what steps his Department has taken on radioactive isotopes and particularly important medicines? I have constituents who are very concerned about that.
Matt Hancock
Of course, we very much hope that the train will also continue to operate as now and we have received such assurances. When it comes to radioisotopes, we have also procured flights and aircraft capacity to ensure that those goods and those parts of the medical supply chain that need to be brought in faster and cannot be stockpiled can also be brought through.
Tracy Brabin (Batley and Spen) (Lab/Co-op)
Can the Secretary of State tell us precisely how much of the £33 million being paid to Eurotunnel is being contributed by the Department of Health and Social Care?
Matt Hancock
This was a cross-Government decision. It is all taxpayers’ money, at the end of the day.
Mr Marcus Jones (Nuneaton) (Con)
It is important that people with long-term health conditions are reassured that they will have access to the right medicines, so my right hon. Friend is right to make sure that there is proper access across the channel. What are the pharmaceutical companies doing to keep a greater stock of reserves over and above those that they usually hold?
Matt Hancock
We have a multifaceted approach to making sure that we have an unhindered supply of medicines, and stockpiling is of course another important part of that. The vast majority of the 12,300 medicines that are commonly used in England can be stockpiled. For those that can be stockpiled, we asked for a six-week stockpile to be put in place, and we have plans in place for almost all of those. For the very small number remaining, we are putting plans in place right now. We are doing all that with the confidence that by the time we get to 29 March, so long as everybody does what they need to do between now and then, we will be able to have confidence in that unhindered supply.
Joanna Cherry (Edinburgh South West) (SNP)
The Secretary of State is making the mistake of insulting the intelligence of those of us who have been pursuing this issue for the past two months. What happened on Friday was nothing to do with the unhindered supply of medicines: it was an out-of-court settlement to avoid the British Government’s being found in breach of the law of competitive tendering. Will the Secretary of State confirm that even in the event of a deal, not a penny of that £33 million will be recoverable, because it is not for a contract but for an out-of-court settlement to avoid a finding that his Government were in breach of the law?
Matt Hancock
On the contrary: this is all about the unhindered supply of medicines, because that is what we will be doing with the boats.
Vicky Ford (Chelmsford) (Con)
I do not know when you last travelled through the channel tunnel, Mr Speaker, but when I came back on Saturday 5 January there was complete chaos at Calais, with miles of queues and hours of delays, so I am glad that Eurotunnel is going to improve its investment in our borders and security. Will the Secretary of State confirm that if the money is not spent on improving our borders and security, it will be paid back to the taxpayer?
Matt Hancock
I can go even further than that: it will not be paid over unless it is being spent on security, resilience and other measures, so we will get some of the improvements that my hon. Friend seeks.
Steve McCabe (Birmingham, Selly Oak) (Lab)
With all due respect to the Secretary of State for Health and Social Care, surely the House and the taxpayer are entitled to hear today what the main mistake made by the Secretary of State for Transport was that has resulted in this unnecessary pay-out of £33 million. Where does this latest shambles rate in the Secretary of State for Transport’s top 10 catalogue of ministerial mishaps?
Matt Hancock
Frankly, I do not think we should really pay much heed to such a statement, rather than a question, unless the hon. Gentleman is going to vote for the deal as well.
Kevin Foster (Torbay) (Con)
It is always a bonus to see my right hon. Friend the Secretary of State for Health and Social Care at the Dispatch Box answering questions, particularly today. On the deal and making sure that we have a secure supply of medicine, will he reassure me that he will continue to ignore some of the noise and party political point scoring and focus on making sure that the NHS can function in whatever circumstances it faces after 29 March?
Matt Hancock
There is a notable difference in tone, is there not, between those who care about ensuring that people get the supply of medicines in future, and those who want to make political points out of it but do not oppose the decision we are discussing.
Layla Moran (Oxford West and Abingdon) (LD)
I find this utterly extraordinary, because in the Public Accounts Committee hearing on this matter, the permanent secretary said:
“I am confident that our process was lawful, and obviously the Department and I acted on legal advice in determining how to take that process forward”.
If we were so confident in that legal advice, why was this settlement reached at all? Actually, is this not an admission of a catastrophic failure in stakeholder management?
Matt Hancock
No. It is clear that we needed to ensure that there were no risks around the two contracts for the capacity that we need to bring in an unhindered supply of medicines, whatever the Brexit scenario. I do not know whether the hon. Lady thinks it would have been worth bearing the risk of a court case, which may well have struck down the capacity to make sure that people who have serious and life-threatening conditions can get the medicines that they want. She implied that she was against such assurances, and I think that would have been a mistake.
Neil O’Brien (Harborough) (Con)
I support the withdrawal agreement—it is a good deal—but I also support our being ready for no-deal eventualities. I was reassured by the Secretary of State’s answer to the question from my hon. Friend the Member for Nuneaton (Mr Jones) about stockpiling medicines that can be stockpiled, but for those that cannot be stockpiled, what action is the Secretary of State taking to be sure that they can be air-freighted rather than have to come through the tunnel?
Matt Hancock
My hon. Friend is quite right to support a deal and the action that we have taken in case there is no deal. That is the position that anybody who cares about the unhindered supply of medicines should take. When it comes to those medicines that cannot be stockpiled, we have contracts for flights to ensure that those medicines can be flown in. We have in place a flight from Birmingham to Maastricht, and the return journey, obviously, to ensure that we can get those short-term medicines in.
Diana Johnson (Kingston upon Hull North) (Lab)
This must be making parliamentary history this afternoon. We have two urgent questions about the same incompetent Minister causing mayhem and chaos in two different Departments and he does not even have the face to come here and front it out—and we are left with Hancock’s half hour! Let me ask the Secretary of State for Health and Social Care: is any of the £33 million going to be reimbursed from his budget to the Department for Transport?
Matt Hancock
This was, of course, a cross-Government decision, which is why I am here. It is the medicines that will be using that capacity. In the Hancock family, we are very proud of “Hancock’s Half Hour”, and we thought that Tony was a very funny man.
Mr Speaker
It is worth pointing out that that Hancock was deliberately funny.
John Howell (Henley) (Con)
The Secretary of State has talked about medicines, but there are also prescribed foods—for example, the gluten-free food on which some people depend. What will the situation be for those foods?
Matt Hancock
Of course that matters enormously, too. Although medicines are the category 1 prioritised goods that will be using the extra procured capacity safeguarded by this settlement, there are other measures being undertaken by the Department for Environment, Food and Rural Affairs to protect the supply of foods.
Paula Sherriff (Dewsbury) (Lab)
That £33 million would pay the annual salary of 118,000 nurses, and God knows we need them. The NHS has 40,000 nursing vacancies in the NHS in England. Does the Secretary of State for Health think that the cost of the latest blunder of the elusive Secretary of State for Transport is money well spent?
Matt Hancock
Well, I do think that it is very important that we spend what is necessary in order to have the unhindered supply of medicines. [Interruption.] The hon. Lady shakes her head, but would she, in these shoes, put at risk the unhindered supply of medicines? Of course she would not, so she must agree with me that this was the right decision to take.
Tom Pursglove (Corby) (Con)
My right hon. Friend has dealt with the channel aspect, but one of my constituents, Jeff Screeton, has a small business that specialises in small-scale freight on domestic passenger rail services. That includes medical items, particularly items that need to move quickly. Might he be interested in this work, particularly from the domestic transportation side of this contingency planning?
Matt Hancock
Yes, I would be very happy to talk to my hon. Friend about that business.
Graham Stringer (Blackley and Broughton) (Lab)
This expenditure is only necessary because of the sheer incompetence of the Secretary of State for Transport. I have sat and listened to him in this Chamber and listened to him in the Transport Committee, and after every fiasco his defence is that it has not cost the Exchequer any money. The fact is that this has cost the Exchequer £33 million. Has he not run out of runway and should he not resign?
Matt Hancock
No, the decision to settle this case in order to provide for the unhindered supply of medicines, which I am sure that, like me, the hon. Gentleman, agrees is important, was the correct judgment and the correct decision, because we need to make sure that we keep people safe.
Dr Matthew Offord (Hendon) (Con)
Although it can never be comfortable to give a settlement to any organisation, I have to agree with the Father of the House, my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke), that it is better to draw a line under this and move on. [Interruption.] The hon. and learned Member for Edinburgh South West (Joanna Cherry) is chuntering. I shall have to defer to her knowledge of losing cases in the legal courts. Can the Secretary of State tell me whether it is correct that Eurotunnel has said it will use this money to provide increased resilience at the Dover port?
Matt Hancock
Yes, my hon. Friend is correct. He makes a broader point: people watching these proceedings, people who have serious illnesses, and people who rely on medicines every day to keep them alive will be amazed by those Members who will not vote for the deal and therefore make a no-deal exit more likely, and by those Members who just cause political noise rather than admitting that, in the circumstances, they too would have settled this case. We are hearing a lot of that from those on the Opposition Benches. On the Government Benches, however, we are hearing from Members who care deeply about making sure that people get the medicines that they need.
Justin Madders (Ellesmere Port and Neston) (Lab)
Does the £33 million include all the possible expenditure under this agreement, or are there any additional costs, such as legal fees, that need to be added on top? If there are, how much are they?
Matt Hancock
The settlement is £33 million. Of course, there are lawyers, and legal time was also needed inside the Department. That happens all the time in order to try to make sure that we can keep people safe, which is the whole purpose of this exercise.
Alison Thewliss (Glasgow Central) (SNP)
The reality is that the Secretary of State is engaged in deflection. We are now in a situation where this country risks running out of vital medicines for each and every one of our constituents because of this Government’s relentless pursuit of a no-deal hard Brexit that will ruin this country. Is it not the case that this money that we are having to pay out is emblematic of the chaos in this Government and the incompetence of this Government and that our constituents will go without medicine because they cannot get their act together?
Matt Hancock
If the hon. Lady really, really believes what she just said, it is incumbent on her to vote for the deal.
Jo Stevens (Cardiff Central) (Lab)
The Health Secretary really is taking one for the team in this urgent transport question. Incidentally, where is the Transport Secretary?
Matt Hancock
The Transport Secretary is working hard on making sure that we can improve the transport system.
Nic Dakin (Scunthorpe) (Lab)
And the Secretary of State almost said that with a straight face. What went wrong and who is taking responsibility for it?
Matt Hancock
This is a cross-Government decision. The purpose of this settlement was to ensure the unhindered supply of medicines. I am the Health Secretary and it is my job to do everything that I can, in all circumstances, to ensure that there is that availability of medicines. I am sure that, whatever the Brexit scenario, the hon. Gentleman’s constituents who need medicines would rather that we made this settlement to ensure that we have the confidence that we can deliver that.
Dr Roberta Blackman-Woods (City of Durham) (Lab)
I have recently been to see the Secretary of State for Education to lobby him for desperately needed resources to rebuild schools in my constituency and I was told that there is no money. Can the Secretary of State tell me how incompetent I need to be to walk away with £33 million for my constituents?
Matt Hancock
I am sure that the hon. Lady’s constituents will need to be confident that there is medicine for them, whatever the scenario is under Brexit, and that is what this settlement is all about.
Ronnie Cowan (Inverclyde) (SNP)
Is the Minister aware of the number of healthcare companies that are reluctantly extending their bank credit so that they can stockpile goods and components because of the lack of forward planning by this Government? What can he do to help those companies and also to help the banks that have to lend on longer terms than they normally would have an appetite for?
Matt Hancock
I mentioned in my statement that the pharmaceutical industry has stepped up to the plate and acted extremely responsibly in order to put in place the stockpiling that is necessary for a contingency in the event of a no-deal Brexit. All of us in this House can do something about the potential of a no-deal Brexit: we can vote for the deal.
Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
I know that the Health Secretary dreams of being Prime Minister, but to his great surprise, and to ours, he woke up as the Transport Secretary’s fall guy this morning. Trying to explain to constituents what is happening in this place is really hard. Trying to explain why a Transport Secretary has not been fired or has not resigned for effectively taking a decision that has lost the taxpayer £33 million is really difficult. Why is it that the Health Secretary cannot get up and simply apologise for the Transport Secretary’s error here? It would go such a long way to restoring confidence in politics. At the moment, this shows Parliament and the Government at their very, very worst.
Matt Hancock
I think I have mentioned that the point of this settlement was to ensure the unhindered supply of medicines, which is very much a matter for me as Health Secretary. People watching these proceedings will also be astonished that the Labour party can argue against a settlement such as this when it is refusing to vote for the deal that could ensure that we have a smooth and orderly exit and that the plans and the contingency plans for a no-deal Brexit are not necessary. Mr Speaker, the hon. Gentleman should vote for the deal, too.
Carol Monaghan (Glasgow North West) (SNP)
I do not know what is more embarrassing: that the Secretary of State has the brass neck to sit there this afternoon, or that his entire Front-Bench team are nodding along with his “Jackanory” stories.
Since the Secretary of State insists that this is about the supply of medicines, I am going to ask him, for the second time in a fortnight, about radioisotopes. Last time he said that there was no problem because we could fly them in. Can he now tell us how we can get radioisotopes supplied to us if we are not a member of Euratom?
Matt Hancock
Access to radioisotopes is precisely through the aviation route—that is exactly what I said to the hon. Lady last time, and I say it to her again today.
David Hanson (Delyn) (Lab)
Was the Secretary of State for Transport advised by any officials that his decision to award a contract to Seaborne Freight would result in a challenge in the courts by Eurotunnel?
Matt Hancock
This is not linked to the Seaborne Freight contract; this is about ensuring that the contracts that are in place are able to deliver the unhindered supply of medicines in whatever Brexit scenario.
Martin Docherty-Hughes (West Dunbartonshire) (SNP)
I do not know about you, Mr Speaker, but I think this is the worst “Hancock’s Half Hour” I have ever seen—and it is in colour for the first time. The Secretary of State, in response to the hon. Member for Middlesbrough (Andy McDonald)—I am grateful to him for securing the urgent question—advised the House that he has been speaking to the devolved Administrations. When did it come to pass that the Government of the United Kingdom of Great Britain and Northern Ireland have to discuss out-of-court settlements to get medicines with the devolved Administrations?
Matt Hancock
I am not sure that the hon. Gentleman had a question in there, but all I will say is that of course discussing the supply of medicines with the devolved Administrations is important, to ensure that those supplies reach all parts of the UK. The devolved Administrations support the wish to ensure that we have in place the capacity to deliver that unhindered supply, and I think that he should support that too.
Drew Hendry
The streak continues, Mr Speaker.
I am going to be more charitable to the Government, because I think they blatantly realise that having no Secretary of State for Transport is infinitely better than having the one they have got. We have listened to the Secretary of State for Health and Social Care’s fairy tale about medicines today, but will he at least have the decency to admit that £33 million is a lot of money, especially to people facing hardship on universal credit, the disabled and the low-waged?
Matt Hancock
It is very important that we always remember that this is taxpayers’ money. One of the duties of Government is to use taxpayers’ money to keep people safe, and that means having an unhindered supply of medicines, which is what we on the Government Benches are working so hard to deliver.
Douglas Chapman
This is not about the deal; this is all about incompetence at Government level, with £50 million for the original no-ships contract and a further £33 million in legal compensation to clear up the Eurotunnel mess. Now that the Government have found the magic money tree, how much is coming to Scotland, since we actually have ferries that we want to run?
Matt Hancock
I find it astonishing that Members on the Opposition Benches continue to make the case that this is not about medicines; it is all about medicines, because that is what we are going to be putting on this capacity in the event of a no-deal Brexit. It is about ensuring that, whatever happens on Brexit, people can still be safe. That is why this cross-Government decision was the right one to take. I think it is the same decision that anybody in the House would have taken were they in this place.
Several hon. Members rose—
Mr Speaker
The hon. Lady has made her point with considerable force and alacrity, and I have no doubt whatever that she is totally sincere, because she came up to the Chair to register her displeasure. I think that the Secretary of State was mildly carried away with the theatricality of the occasion, and he is very accustomed to jousting from the Dispatch Box. Ordinarily I have found him a most good-natured individual, so I think it unlikely—very unlikely indeed—that he would willingly impugn the integrity of a very committed and conscientious Member of Parliament in the hon. Lady, because at heart he is a very gracious chap. He may well wish to proffer an apology to her—[Interruption.]
Matt Hancock
Come on then. Further to that point of order, Mr Speaker. The first thing to note following these points of order is that—
Mr Speaker
Order. I am not inviting the Secretary of State to give a sort of general response, in the style of a Second Reading debate, to everything that has been said. If he wants to respond in relation to personal offence being taken, he can. That would be appreciated.
Matt Hancock
The point I was making, Mr Speaker, which I think I made a few times, is that those who care about having unhindered supply of medicines should vote for the deal, because that is the best way to ensure that people can be kept safe. That is all that I was implying by my comments.
Mr Speaker
Well, the Secretary of State has said what he has said, and colleagues will make their own assessment of it. I thank him for coming to the Dispatch Box.
Mr Speaker
I think that the right hon. Gentleman’s question was more rhetorical than not, and there was not really a question mark at the end of it. I can only say, for my own part, that when discharging my duties to the best of my ability this morning, I was rather under the impression that the urgent question was about the cancellation of the contract on account of legal action and that it was to do with Seaborne Freight. It may be that my interpretation was notably eccentric, but I do not think so. I think I was pretty clear what it was about, and that my assessment was shared by the team that accompanies me at the 12 o’clock meeting on a Monday morning.
Matt Hancock
On a point of order, Mr Speaker. You are an esteemed and eloquent Member of this House, as you often say to us, and you have just made a comment about what this case was about. Can I be very clear? The reason we settled this case, as I said to the hon. Member for Middlesbrough (Andy McDonald), was to ensure that the freight capacity purchased from DFDS and Brittany Ferries continues, in order to have the unhindered supply of medicines. That is what the settlement was a about.
Mr Speaker
No, no—I am not arguing the toss with the Secretary of State. I said earlier that he placed his own interpretation on what he judged to be the gravamen of the matter. That the question was about the cancellation of the contract and that it was about Seaborne Freight is, I think, so manifestly clear as to brook no contradiction by any sensible person. That it also related to the delivery of medicines is a perfectly arguable point. The Secretary of State has made his own point in his own way, and if he is satisfied with his own efforts and goes about his business with an additional glint in his eye and spring in his step, then I am very happy for him.
Oral Answers to Questions
Matt Hancock Excerpts(5 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Peter Kyle (Hove) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
On 30 January, we announced that we will increase access to PrEP, doubling the number of people who can receive this potentially life-saving HIV prevention drug.
Peter Kyle
Funding for HIV prevention has become quite complex, with a complex mix of central funding and local authority funding. Cities such as Brighton and Hove still have the highest contraction rates outside London. Will the Secretary of State meet me and the Terrence Higgins Trust to understand how that is impacting us on the frontline and tell us what more can be done?
Matt Hancock
Of course I would be delighted to meet the hon. Gentleman to discuss this matter. In the long-term plan, we made it clear that we are looking at commissioning arrangements for sexual health services. I am delighted that the number of new cases of HIV has been falling and that we have been able to declare that by 2030 we want the UK to have zero AIDS. That is an achievable, but hard, goal, and I will work with anybody to make it happen.
Dr Sarah Wollaston (Totnes) (Con)
Does the Secretary of State share the widespread concern about the variation in availability of PrEP treatment, which is surely an unacceptable situation?
Matt Hancock
There is a variability in availability. Of course the current model of delivery is a trial—we have doubled the size of that trial but it is still a trial that runs until 2021. I am very happy to work with my hon. Friend as well as with the hon. Member for Hove (Peter Kyle) to try to make sure that it is as available as possible.
Andy Slaughter (Hammersmith) (Lab)
Hammersmith is one of the sites that is now closed. When will PrEP be made freely available? Here we have a drug that has almost 100% effectiveness and that will save money for the NHS through HIV protection. When will we see it available to anyone who needs it?
Matt Hancock
As I have said, last month we doubled the availability of PrEP, which is an important step in the right direction.
Will Quince (Colchester) (Con)
Colchester is one of the sites that is now closed to men who have sex with men who want to access the HIV prevention drug PrEP. When will the Government’s commitment, made almost three weeks ago, to double the number of places on the PrEP trial be implemented across all trial sites?
Matt Hancock
It is being implemented as we speak. I am very happy to talk to my hon. Friend about when it will be rolled out in Colchester.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
I welcome the Government’s commitment to end the transmission of HIV in England by 2030. However, HIV reduction was not mentioned in either the prevention plan or the long-term plan. How will the Government reach that ambitious goal without a concerted and fully costed strategy?
Matt Hancock
We do have a concerted and fully costed strategy. Indeed, I have given the commitment of ending new AIDS cases by 2030 with a plan around that. The long-term plan goes into detail about new ways of commissioning sexual health services. This is a very important area, and, as the hon. Lady says, it is an important part of the prevention agenda, and we will make sure that we get it right.
Several hon. Members rose—
Jeremy Lefroy (Stafford) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
We are increasing the NHS budget by £20 billion, or £33 billion in cash terms, over the next five years. This major investment will support the NHS to continue to deliver world-class care. The long-term plan set out a vision for the NHS, ensuring that every penny will be well spent.
Jeremy Lefroy
I thank the Secretary of State very much for his answer. Local accident and emergency departments, such as at County Hospital in Stafford, are absolutely vital for the long-term plan of the NHS. What can he do to ensure that funding is there for these departments because they need an awful lot of block funding and not so much payment by procedure—or payment as you go?
Matt Hancock
My hon. Friend, who is an advocate for Stafford beyond compare and an advocate for its A&E—he has personally put much effort into saving it and ensuring that it is in good shape—rightly makes the point that paying per person who comes through the door does not accurately reflect the costs of providing A&E, so we are moving to a much greater proportion of block funding for A&Es, with a smaller element that varies according to the costs of serving everybody, to ensure that the finances follow the need.
Laura Smith (Crewe and Nantwich) (Lab)
The latest figures show that more than one in five patients visiting Leighton Hospital A&E in Crewe has had to wait for more than four hours, yet instead of receiving support, the trust has been financially penalised, unable to access capital support to fund improvements to its A&E, while at the same time losing out on the performance element of the provider sustainability fund. Can the Minister explain how the Government are supporting Leighton Hospital?
Matt Hancock
We are supporting Leighton Hospital through the delivery of the long-term plan and the extra £20 billion—£33 billion in cash terms—the first £6 billion of which comes on stream in April, in two months’ time. It is true that a record number of people are going to A&E. We have to make sure that the record numbers being treated within the four-hour target are supported, but that we also support hospitals to do yet more.
Lucy Allan (Telford) (Con)
In Telford, we have been waiting five years for the chance to ask the Secretary of State to call in for review a highly controversial plan called Future Fit. We now have that chance, and the Secretary of State has been really generous with his time in listening to MPs’ concerns. The local council, however, has still not yet made any submission to the Secretary of State. Can he confirm that without that submission he cannot call in that scheme for review?
Matt Hancock
My hon. Friend has made the case very powerfully for the future of Telford Hospital, and I have enjoyed working with her, but it is true that the call-in powers that I have as Secretary of State can be exercised only when a scheme is referred to me by a local council. Should that happen, I will consider it very carefully.
Ms Angela Eagle (Wallasey) (Lab)
Will the Secretary of State now come clean with the House and admit that the Lansley Act, which fragmented the NHS into tiny pieces, caused huge inefficiencies; and that successive Governments, including the one of whom he is a member, have starved the NHS of resources, which has caused a lot of the problems that our constituents face in increased waiting times and increased pressure on staff?
Matt Hancock
We care about securing the future of the NHS. That is why we are putting £20 billion extra into it over the next five years—£33 billion extra in cash terms. Yes, we will consider proposals being made for legislative changes, but what we care about is making sure that the NHS gets all the support it needs, and not just political nonsense.
Richard Drax (South Dorset) (Con)
Does my right hon. Friend agree that one of the vital components to ensure the long-term future of the NHS is community hospitals? Will he meet me to discuss what can be done to recruit more qualified staff, so that beds at the Portland Community Hospital can be reopened?
Matt Hancock
I would be very happy to meet my hon. Friend to discuss that, because community hospitals have a vital role to play in the future of the NHS as more care is delivered close to home.
Mr Dennis Skinner (Bolsover) (Lab)
It was not insignificant, what happened between ’97 and 2010 under a Labour Government. They trebled the amount of money going to the national health service. It was a system of hypothecation, whereby a 1% increase in national insurance went directly to the national health service, and nobody else fiddled with it.
Matt Hancock
It is unusual, but I am delighted to be able to agree with the thrust of the hon. Gentleman’s question. As he knows, we both come from Nottinghamshire mining stock, and it is surprising that we do not agree on more, but we do agree on the importance of having a properly funded NHS. That is why we have put the largest ever, longest ever cash injection into the NHS, because we care that it should be fit for the future.
Christine Jardine (Edinburgh West) (LD)
Ian Murray (Edinburgh South) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
Leaving the EU with a deal remains the Government’s top priority, but we are preparing for every eventuality. I am confident that if everyone does what they need to do, the supply of medicines will continue unhindered.
Nick Smith
Will the Secretary of State say how much has already been spent since the NHS no-deal contingency plans were active, and what the overall bill will be?
Matt Hancock
Yes. About £11 million has been spent already. The NHS is not generally buying the extra medicines that are going into the elongated stockpiles, but the pharmaceutical industry is. We will of course eventually buy most of those medicines for the NHS. There have been costs to the pharmaceutical industry as well, but the cost so far to the taxpayer is £11 million. I expect it will remain at about that level, or a little higher.
Vicky Ford (Chelmsford) (Con)
Some of my constituents with diabetes have contacted me about supplies of insulin. Will the Secretary of State give us an insulin-specific answer?
Matt Hancock
Yes. Whereas across all medicines we have requested that the pharmaceutical industry has an extra six weeks of supplies in case of a no-deal Brexit, in the case of insulin the two major providers have already made stockpiles of at least double that. That shows that those with concerns about access to insulin can know that the plans we have in place for insulin are being enacted even more strongly than elsewhere.
Ian Murray
But the Secretary of State is refusing to provide any reassurance to constituents up and down the country, and particularly to my constituents. I got an email yesterday from a constituent—I have no shame in quoting this—who said:
“I have type 1 diabetes, as does Theresa May, and the supplies of insulin, needles and blood testing equipment all come from Europe. Insulin is perishable. Without it, so am I.”
Will the Secretary of State come to the Dispatch Box and say to my constituents that, whichever disease they have and whichever medical supplies they require, they will get them even if we leave the European Union with no deal? Would not the best thing to do be just to rule out no deal?
Matt Hancock
I have already given the assurance that if everybody does what they need to do, I am confident that supplies will be unhindered. In the case of insulin, the stockpiles are already double what we requested. However, on the point about the deal, the hon. Gentleman has a really important point about ruling out no deal being the best thing for people’s supply of medicines. He knows as well as I do that if we want to rule out no deal, we need to vote for a deal, so he and everybody in this House should vote for the deal.
Dr Philippa Whitford (Central Ayrshire) (SNP)
The serious shortage protocol statutory instrument would allow pharmacists to dispense alternative drugs when there is short supply, but, crucially, without consulting a GP. The problem is that they cannot access patients’ records and might dispense a drug that has previously caused serious side effects. Is the Secretary of State really expecting such extensive shortages that phoning a GP will be impractical?
Matt Hancock
This change is to respond to the shortages that happen from time to time regularly in the NHS. Given that the supply of 12,300 drugs is typical across the NHS, there are always some logistical challenges. This protocol is to try to ensure that we can respond to those challenges as well as possible. Pharmacists are highly trained in what they do and perfectly able to carry this out as proposed.
Dr Whitford
The problem is that the key issue is not consulting the GP. The medical legal responsibility for any problems normally lies with the prescriber, yet the General Medical Council was not even consulted on this SI. Does the Secretary of State really think that such a significant change should be pushed through with a negative resolution and no scrutiny and debate?
Matt Hancock
Well, it is getting scrutiny and debate now. The change that is being proposed is about making sure we can get people the drugs they need. Of course the responsibility is on the pharmacist to ensure that it is the appropriate drug and, if necessary, that the GP is involved. However, it is absolutely right that we make changes to ensure that we have an unhindered supply of medicines whenever there are shortages—whether that is to do with Brexit or not.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
The Secretary of the State spoke with his characteristic self-confidence about the supply of insulin, but at the end of last week Diabetes UK said that
“despite reaching out directly to the Department of Health…we still have not seen the concrete detail needed to reassure us…we cannot say with confidence that people will be able to get the insulin and other medical supplies they need in the event of a no-deal Brexit.”
Why is Diabetes UK wrong and the Secretary of State right?
Matt Hancock
Diabetes UK is not a supplier of insulin. Of course, it plays an important role in representing those who have diabetes. We have given Diabetes UK reassurances, including, for instance, that the stockpiles we have for insulin are more than twice as long as we proposed and as required. That is an important assurance.
Jonathan Ashworth
I hope the Secretary of State will contact Diabetes UK to give it those reassurances directly.
On the various no-deal medicines statutory instruments that the House will debate today and on other occasions, the Government’s own impact assessments say that, in a no-deal scenario, the NHS will pay more for drugs, UK firms will face more red tape, and NHS patients will go to the back of the queue when it comes to international innovation. Given that the consequences of no deal would be so devastating for the NHS, will the Secretary of State—as, apparently, the Justice Secretary will—resign from the Government if it means blocking no deal?
Matt Hancock
If the hon. Gentleman really cared about stopping no deal, he would vote for the deal. There is something else that is worth saying about this shadow Secretary of State. He is a reasonable man—he is a sensible man—and I like him. My politics are probably closer to his than his are to those of the leader of his party, so why does he not have the gumption to join his friends over there on the Back Benches in the Independent Group, instead of backing a hard-left proto-communist as leader of the Labour party?
Bim Afolami (Hitchin and Harpenden) (Con)
Tommy Sheppard (Edinburgh East) (SNP)
The Secretary of State for Health and Social Care (Matt Hancock)
To provide the best care, the NHS needs the best technology, and we are therefore bringing together leaders of the digital agenda across the NHS under a new organisation called NHSX. We are also publishing a new code of conduct for the use of artificial intelligence in the NHS. NHSX will report jointly to the NHS and to me, and it will lead this vital agenda so that the NHS can be a world leader in emerging technologies that help to cut costs and save lives.
Tommy Sheppard
Meanwhile, in the real world, Scottish Care reports that 30% of social care staff in the highlands are nationals from other European countries. They are paid the real living wage of £9 an hour as a matter of public policy, but that is well short of the Government’s proposed limit of £30,000 for new immigrants in the future. Will the Secretary of State fight in the Cabinet to change that policy, or is he content to let these new immigration policies choke off the supply of labour to our social care sector?
Matt Hancock
We welcome people working in social care from the EU and from the rest of the world, and we need to ensure that that can continue, but we also need to ensure that we can train people locally to work in social care. That is incredibly important.
James Heappey (Wells) (Con)
Matt Hancock
My hon. Friend makes an incredibly important point. As important as new technology is and new ways of working and nurse practitioners are, we still need more GPs, and we need more GPs especially in rural and coastal areas. The targeted enhanced recruitment scheme offers a £20,000 salary supplement to attract GPs to parts of the country where there are serious shortages, including in Somerset.
Neil Coyle (Bermondsey and Old Southwark) (Lab)
Matt Hancock
I want to see this being implemented as soon as possible. It has already started, but we need commitment from local authorities as well as the NHS to deliver. I am very happy to work with the hon. Gentleman and all other interested Members to see it happen.
Dr Sarah Wollaston (Totnes) (Con)
Peter Kyle (Hove) (Lab)
Matt Hancock
Thankfully, the recruitment both of nurses and doctors is going up, which demonstrates that people do want to work in the NHS, and so they should because it is an amazing place to work and it has a great mission, which is to improve the lives of everyone.
Giles Watling (Clacton) (Con)
Matt Hancock
My hon. Friend is absolutely right: the £20,000 bonus is an important part of the solution, but so is having more GPs, and the fact that we have a record number of people going into GP training at the moment is great news that Members in all parts of this House should welcome.
Toby Perkins (Chesterfield) (Lab)
Matt Hancock
Of course the nature of being in a GP practice is changing. For a long time practices, which are essentially private businesses, also had the benefit of rising property prices that brought additional income on top of their income from the NHS. That is no longer the case because property is so expensive, so many people are changing the way that GPs are employed, so they are directly employed rather than through practices. That move is happening, but it is just one of the many changes we are seeing to try to make sure that being a GP is sustainable, and clearly things are starting to improve because a record number of people are choosing to become GPs.
Tom Tugendhat (Tonbridge and Malling) (Con)
Paul Masterton (East Renfrewshire) (Con)
The internet and social media have provided huge opportunities and positives for our young people, but we have been far too slow to react to the negatives, including cyber-bullying and issues around body image. Will the Minister responsible for suicide prevention, or my right hon. Friend the Secretary of State, confirm that they are taking a truly cross-Government approach to this issue and that they will seriously tackle the role of the tech companies?
Matt Hancock
Yes; my hon. Friend is dead right to bring up this subject. The rise in material promoting self-harm and suicide online is dangerous, and it needs to be stopped. I am delighted that, under pressure from this House, Instagram has now decided to take down that material, but there is much more to do. In this country, it is this House that makes the rules, not the global companies.
Bill Esterson (Sefton Central) (Lab)
The greatest damage from prenatal exposure to alcohol is often done in the first few weeks of pregnancy, yet three quarters of women in the recent Bristol University study said that they drank alcohol while pregnant. Will the Minister commit to ensuring that the chief medical officer’s advice is given loud and clear by all health professionals: do not drink alcohol if pregnant or trying to conceive?
Royston Smith (Southampton, Itchen) (Con)
Southampton is above the English average with nearly 6% of GP appointments being missed. Nationally, missed appointments cost the NHS more than £200 million a year. Does my right hon. Friend agree that a standardised online booking system featuring a reminder function with the option of cancelling or rescheduling an appointment would save money and reduce waiting times? Does he have any plans for such a system?
Matt Hancock
Yes, I do. This is one of the sorts of things that NHSX will drive forward. A decent IT system can reduce missed appointments in GP practices by a third—[Interruption.] So, while Opposition Members snigger about using modern technology and want to go back to the past, over here we are providing the best technology for the NHS for the benefit of patients.
Louise Haigh (Sheffield, Heeley) (Lab)
A recent answer to a parliamentary question from my hon. Friend the shadow Minister confirmed that in nearly half of cases of mental health crisis, it is not NHS staff but the police who are conveying people hospitals. Will the Department conduct a review into the impact that this is having on people in mental health crisis?
David Tredinnick (Bosworth) (Con)
A report in The Lancet in March 2018 found that most drugs and injections are useless for lower back pain. What will my right hon. Friend do to find alternative treatments?
Matt Hancock
I pay tribute to my hon. Friend, who recently announced that he will be standing down at the next election, for the amount of attention he has given to broadening people’s minds and to looking at what works and what the evidence shows works. We know, for instance, that social prescribing can help people and ensure that they get the support they need, and he has made a great contribution to that debate.
Rosie Cooper (West Lancashire) (Lab)
After reviews by ACAS, Capsticks and Dr Bill Kirkup, will the Minister outline how he intends to deliver justice for both staff and patients of the Liverpool Community Health NHS Trust? How will he ensure that the board members who disgracefully refused to give evidence to Kirkup will be held to account and made to give evidence in future investigations?
Stephen Morgan (Portsmouth South) (Lab)
Mental health services need proper staffing, but 2,000 mental health staff are leaving the NHS every month. How do the Government expect to achieve any ambitions in the long-term plan without adequate staff?
Matt Hancock
The hon. Gentleman is right. When we put a large amount of money into a service, we of course need more people to deliver it. That is most acute in mental health, which is getting the biggest increase in funding—£2.3 billion of the £20.5 billion overall. I assure him that the Minister responsible for mental health and suicide prevention, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), is working night and day to ensure that we attract the people we need to deliver the services that our people deserve.
Mr Mark Francois (Rayleigh and Wickford) (Con)
May I ask a question in memory of my late friend Stephen Horgan, who died a few years ago from a rare form of blood cancer with just a few months’ notice? In his memory, I am a now a supporter of Bloodwise, an excellent charity that raises awareness of rare cancers. Asking on the charity’s behalf, will the new workforce plan for the NHS include clinical psychologists, particularly those with cancer knowledge, to make the absolute best use of the welcome new resources, which I am sure Stephen’s family also welcome?
Matt Hancock
Yes, my right hon. Friend puts it extremely well, because he reminds us of who we are here to serve when discussing questions of health and of cancer. He is right to raise this matter, and I can absolutely confirm what he asks for: we will deliver in Stephen’s memory and in the memory of others who have died. That is what gives us the strength to carry on and try to deliver and improve services for everybody.
Carol Monaghan (Glasgow North West) (SNP)
The Secretary of State talked earlier about a six-week stockpile of medicines, but radioisotopes for cancer diagnosis and treatment cannot be stockpiled. I have asked many times about the future arrangements for radioisotopes post-Brexit, so will the Secretary of State detail them now?
Matt Hancock
In the event of a problem at the Dover-Calais strait, we will bring in radioisotopes by air, and we have already contracted an aircraft to ensure that that happens. That part of the planning is well advanced.
Mark Pawsey (Rugby) (Con)
On Thursday, with Rugby’s mayor, I had the great pleasure to open the new Brownsover surgery, which came about because of the hard work of the patient action group. Will the Secretary of State welcome the work of patient groups in delivering NHS services?
Matt Hancock
I am absolutely delighted to welcome the work of the group, which has raised so much money, and of my hon. Friend, who stands up and makes the case for Rugby. More broadly, we should welcome all those who want to make a contribution to our hospitals and hospices. We take a broad-minded and open approach to welcoming people who volunteer hours or raise money to improve our great NHS.
Oral Answers to Questions
Matt Hancock Excerpts(5 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Tommy Sheppard (Edinburgh East) (SNP)
The Secretary of State for Health and Social Care (Matt Hancock)
We do not want a no-deal scenario in our exit from the European Union, but it is incumbent on us to prepare in case. We asked medical suppliers to stockpile a further six-week supply over and above normal levels, and that work is going well. We will continue to work to ensure the unhindered supply of medicines in all Brexit scenarios.
Wes Streeting
The Prime Minister’s threatening of this Parliament and the country with no deal is entirely reckless, irresponsible and unnecessary. It is also causing unnecessary fear and anxiety among a range of clinicians and patients who rely on the consistent supply of life-saving drugs. The Secretary of State says that the Government are stockpiling medicines for up to six weeks. Will he do the right thing and commission an independent assessment of those plans so that patients can be reassured? Better still, will he go back to the Cabinet and say that no responsible Health Secretary would allow no deal to take place, no responsible Prime Minister would allow no deal to take place, and this House will not allow no deal to take place?
Matt Hancock
It is incumbent on me as Health Secretary and on my team to ensure that we prepare for all potential scenarios. Of course, because of the overwhelming vote of the House in favour of the withdrawal Bill, no deal is the law of the land unless the House does anything else. If the hon. Gentleman is so worried, the best thing that he and all his friends can do is vote for the deal tonight.
Ian Murray
Would it not have been a better use of taxpayers’ money to have spent hundreds of millions of pounds on frontline patient care rather than on no-deal planning? The Secretary of State has just said to my hon. Friend the Member for Ilford North (Wes Streeting) that the Government have to prepare for all possible scenarios. A responsible Secretary of State would rule out one of those scenarios, which is no deal.
Matt Hancock
As I said, thanks to the votes of Members in all parts of the House, no deal is a matter of the law of the land. They can’t get away from it: if they don’t like no deal, they need to join me in the Lobby tonight, and vote for the Prime Minister’s deal.
Tommy Sheppard
In Scotland, 6% of all social care staff are nationals of European countries. In England the figure is 8%. In Scotland, despite the Scottish Government paying the real living wage of £9 an hour, that comes nowhere near the £30,000 threshold proposed for a tier 2 visa. Can the Minister tell us here today what action he will take to avert a staffing crisis in social care?
Matt Hancock
We have brought into place already the EU settlement scheme to ensure that those EU workers who are working in social care and in the NHS can and should remain here and continue to contribute, as they do so valuably.
Vicky Ford (Chelmsford) (Con)
I know the Secretary of State wants to avoid a no-deal scenario, but can he look at the case of prescription foods, which my constituent Cait, who has PKU, relies on for keeping her life, and make sure they are also covered by no-deal planning?
Matt Hancock
We are working to ensure that the prioritisation of not just medicines, but medical products and other things needed for the health of the nation, is taken into consideration. There is detailed work under way that is clinically led; the medical director of the NHS is heavily engaged in that work and works very closely with the Department on it. I am very happy to go through the details of my hon. Friend’s constituency case to make sure that that is also being dealt with appropriately. I am glad that, because she does not want no deal, she will be voting with the Government tonight.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Legislation was passed two years ago so that the Secretary of State could end profiteering by some drug companies. Now drug shortages after a no-deal Brexit could mean soaring costs across UK health services, so why have the Government not set the regulations from this legislation so that we can use the powers and avoid a black market in medication?
Matt Hancock
We have already taken action to ensure that the cost of drugs is reduced. I am very happy to write to the hon. Lady with the extensive details of the agreements that have been made. The legislation is indeed important; so, too, is working with the drugs companies to make sure that we keep those costs down and yet also get the drugs that people need.
Dr Whitford
As the precursors of medical radioisotopes have a half-life of less than three days, they cannot be stockpiled. I have frequently asked the Government how they will maintain a steady supply if there is a no-deal Brexit. Can the Secretary of State answer—and please don’t say “Seaborne Freight”?
Matt Hancock
No, absolutely, we have ensured that there will be aircraft available, and air freight, to make sure that we can get those isotopes that have a short shelf life and cannot be stockpiled, and that there is unhindered supply. I make the following point to the hon. Lady and her colleagues, with an open mind and in a spirit of collaboration: if she is worried about no deal, which she seems to be, she and her party should support the Government tonight.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
The Secretary of State boasts of being the world’s biggest buyer of fridges to stockpile medicines, but if sterling drops because of the Government’s mishandling of Brexit, the parallel trade in medicines could mean that stockpiles rapidly deplete as medicines are quickly exported back into the EU. Will he impose restrictions and suspend the necessary export licences that he is responsible for? Otherwise, he risks his fridges standing empty.
Matt Hancock
Of course, we have the legislative tools and powers the hon. Gentleman describes at our disposal; we know that. Nevertheless, stockpiling is going according to plan—it is going well—and the pharmaceutical industry has responded very well, with great responsibility. But I say, rather like a broken record—[Hon. Members: “You are.”] Yes, and it is important that I say it again and again and again. There is one route open to the House to avoid no deal, which Opposition Members purport to be worried about. They cannot complain about no deal unless they are prepared to do something about no deal, and to do something about no deal, they need to vote with the Government tonight.
Jonathan Ashworth
If the Secretary of State has those powers, he should use them now. This is going to be the biggest disruption to patient safety we have ever seen. He is also proposing emergency legislation that means patients might not get access to the medicines their GPs prescribe. Can he tell us whether an insulin patient will be able to get their prescription within a day of presenting at a pharmacy? He is the Secretary of State for Health; why will he not do the responsible thing and rule out no deal, which will do so much damage to the NHS and patients?
Matt Hancock
Because of the votes of most of us in the House, including the hon. Gentleman, no deal of course is the law of the land unless the House passes something else. He is a reasonable man. He is a mentor of the old Blairite moderate wing of his party. He is absolutely a centrist. I do not believe that, privately, he believes in the hard-left guff that comes from other Opposition Front Benchers. He is a very sensible man and I like him an awful lot, so after this session and before 7 o’clock tonight, why does he not take a look in the mirror and ask himself, “In the national interest, is it best to vote for the deal and avoid no deal, or is it best to play politics?”
Mr Speaker
Order. Let me say very gently to the Secretary of State, who is renowned for his charm in all parts of the House, that his likes and dislikes are a matter of immense fascination to colleagues, including the Chair, but what is of greater interest is his brevity.
Rebecca Pow (Taunton Deane) (Con)
The Secretary of State for Health and Social Care (Matt Hancock)
In September, we announced £145 million to upgrade NHS facilities for winter and, last month, £1 billion as part of the NHS long-term plan. Future capital spending decisions will be for the spending review.
Mr Wragg
I am grateful to my right hon. Friend for his answer. He will know the importance of Stepping Hill Hospital to my constituents. Will he work with me and others to ensure that the hospital can secure additional capital investment to expand accident and emergency, improve outpatient facilities and provide additional car parking?
Matt Hancock
I look forward to working with my hon. Friend and his local colleagues on what we can do to support Stepping Hill Hospital further. He is an assiduous representative for Hazel Grove who makes the argument very clearly, both to me and to the NHS Minister, who has already heard from him on several occasions. We did manage to provide £1 million for upgrades to Stepping Hill Hospital ahead of this winter and we understand the case that they make.
Colin Clark
Since 1980, Aberdeen University has been at the forefront of MRI development. May I invite the Secretary of State to visit Aberdeen medical facilities to see the fast field-cycling scanner, a development of national importance to stroke diagnosis?
Matt Hancock
Yes, I love going to Aberdeen and look forward to another reason for going to the north-east. Of course, Aberdeen University and the UK have been at the cutting edge of this innovation for years and must be for years to come.
Rebecca Pow
I first thank the Department for supporting me in my case for upgrading the theatres at Musgrove Park Hospital.
Having skilled staff to work in these places is really important and the University Centre Somerset is one of just two places piloting the nursing associates programme. It is growing really well and it is a vital stepping stone between healthcare assistant and nurse. Will the Secretary of State join me in congratulating the college on how well the programme is going and meet me to discuss the option of a degree course?
Matt Hancock
Yes, absolutely. We support nursing associates and I am delighted to see the rapid expansion that is taking place. We want more universities and higher education institutes to come to the fore to provide that sort of education. I cannot wait to meet my hon. Friend.
Mr Speaker
Including, of course, as the right hon. Gentleman knows from his recent meeting with me, the University of Buckingham in my constituency.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
One of my constituents, who is 17, seriously ill with breathing difficulties and in need of urgent specialist care, is waiting for a room to be available at the Royal Brompton. Is the Secretary of State aware of any delays and whether these have been caused by not having sufficient NHS facilities at the Royal Brompton to meet such urgent demand?
Matt Hancock
I have not heard any of the details of that case before now. If the hon. Lady will write to me, I will be very happy to talk to her and engage with her on what we can do for her constituent.
Tim Farron (Westmorland and Lonsdale) (LD)
It is 12 long months since the Government closed their consultation on whether to upgrade NHS radiotherapy facilities. Meanwhile, in south Cumbria, cancer patients have to make daily round trips of up to four hours for weeks on end to receive treatment. When will the Government respond to the consultation and when will they invest in satellite radiotherapy provision in places such as Westmorland General Hospital?
Matt Hancock
We will respond to the consultation very soon. We wanted to get the NHS long-term plan published first, because clearly the two are strongly linked. I pay tribute to the hon. Gentleman’s work chairing the all-party group on radiotherapy and I look forward to working with him.
Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
Plymouth is pioneering health and wellbeing hubs—a new type of NHS facility. I am most excited about the new one in Plymouth city centre, which will include directly employed GPs and mental health, sexual health and dentistry services. We have submitted a funding application to the Minister. When will he be able to fund and support that pioneering project, a new type of NHS facility delivering in some of our poorest communities?
Matt Hancock
The hon. Gentleman’s neighbour in Plymouth has already brought this to my attention and made the case very strongly for it. I am still waiting for the “Thank you” for the new facilities at Derriford Hospital, but I am a massive supporter of the work that is going on in the local area and the NHS in Plymouth will go from strength to strength under this Government.
Dr Sarah Wollaston (Totnes) (Con)
The maintenance backlog across the NHS is deeply worrying. It affects equipment as well as buildings. Two of the 10 operating theatres at Torbay Hospital remain out of action. Would the Secretary of State meet me to discuss the impact that that is having on patient care? It is increasing waiting lists and leading to very short-notice cancellations to make way for emergency cases. Torbay Hospital has a £34 million maintenance backlog. It is deeply worrying.
Matt Hancock
I am very happy to meet my hon. Friend, who makes a very important point. Of course, future allocations of capital are for the spending review. I look forward to working with her to try to sort out the problems in Torbay and across the board.
Diana Johnson (Kingston upon Hull North) (Lab)
A consultation is taking place about the closure of Faith House GP practice on Beverley Road in Hull. It is partly about the premises being less suitable for delivering modern healthcare, but also about how difficult it is to recruit GPs. What will the Secretary of State do about GP services being removed from communities? How will he support the development of GP services in those areas?
Matt Hancock
The £4.5 billion extra in the long-term plan that is going to primary and community care is absolutely targeted at solving problems like that. As it happens, I know Beverley Road in Hull quite well; I had family who lived there. It is very important that the services in primary care and in the community are there and are available to people to ensure that that crucial element of our prevention agenda is strengthened to keep the pressure off hospitals, too.
Suella Braverman (Fareham) (Con)
Matt Hancock
Yes, I would love to do that. I will raise it with Mike Richards, who is running a review of the future of screening services. I am sure that the whole House will want to join me in congratulating my hon. Friend on her forthcoming use of maternity services in the NHS.
Karen Lee (Lincoln) (Lab)
Mr Clive Betts (Sheffield South East) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
Last week we launched the NHS long-term plan, which delivers on the vision for how the extra £20.5 billion that we are putting into the health service will be spent to get the best return for the taxpayer. The long-term plan is built on the principle that prevention is better than cure, and there will be a new focus on personal responsibility that reflects and complements the responsibility that the NHS has to us all.
Mr Betts
Looking to the last financial year, I am sure that the Secretary of State has seen a National Audit Office report that says that auditors gave a qualified opinion on 38% of local NHS bodies, expressing concerns about overspending and value for money. The Comptroller and Auditor General said:
“A qualification is a judgment that something is seriously wrong”.
Does the Secretary of State accept that many of these problems are down to local bodies struggling with the effects of austerity and real-terms cuts to their funding? Does he also accept that he is ultimately responsible for spending in the NHS, and does he accept responsibility for the totally unsatisfactory state of affairs that the NAO has identified?
Matt Hancock
That is a very big question, and the very big answer comes in the form of the £20.5 billion that is going in, but it is not just about the money. We also need to ensure that, at all levels, we strengthen the leadership capacity in the NHS, because the best hospitals that deliver the best services, that hit their targets and that are the best clinically are also the ones that have the best financial results. Strengthening leadership, making sure that the money is available, as appropriate, and ensuring that we deliver for patients are at the core of the long-term plan.
Mr Robert Goodwill (Scarborough and Whitby) (Con)
Yvonne Fovargue (Makerfield) (Lab)
Matt Hancock
The hon. Lady is absolutely right that these waiting time targets need to be improved upon, which is one reason why we are putting so much extra taxpayers’ money into the NHS. Of course, waiting times also need to follow clinical need, and we are taking advice on that.
Alan Mak (Havant) (Con)
Genome sequencing and other fourth industrial revolution techniques play a key role in the detection and treatment of cancer and other diseases. How is the NHS adopting those new techniques?
Matt Hancock
The use of new technologies is drilled through the new NHS long-term plan. Genome sequencing holds great opportunities to improve the health of the nation, and my hon. Friend is a great advocate for it.
Vernon Coaker (Gedling) (Lab)
Matt Hancock
The biggest proportional increase in spending in the NHS—it has taken place faster than the average rate, over a five-year period—is in mental health services, alongside the increase in primary care and community care. That money will come on stream with a £6 billion cash injection for the NHS overall in April, in just over two months’ time. So we are getting on with it, but there is a lot of work to be done.
Julia Lopez (Hornchurch and Upminster) (Con)
NHS Property realised £43 million when it sold St George’s Hospital in my constituency, yet a £17 million bid for a new health centre there has not been successful. Will my right hon. Friend commit himself to looking at that again in order to convince communities that they benefit when local NHS assets are sold?
Matt Hancock
Absolutely. I look forward to working on that with my hon. Friend and local commissioners, and also to working with my hon. Friend before the spending review, when the next round of the capital allocations will be set.
Ms Marie Rimmer (St Helens South and Whiston) (Lab)
Matt Hancock
Yes, 100%. That is exactly what is in the plan, and I am delighted to have such support. This is precisely the direction in which we need to go in integrating care to ensure that patients are served better, whoever is the ultimate funder of the service.
Tracey Crouch (Chatham and Aylesford) (Con)
In the event of an out-of-hospital cardiac arrest, access to a defibrillator can make the difference between life and death. Although there are tens of thousands of defibs across the United Kingdom, the majority are not known to the ambulance service, so will the Minister join me in welcoming the British Heart Foundation’s efforts to map the location of all defibs so that ambulance services can direct people to their nearest heart restarter in an emergency and, hopefully, we can save more lives?
Mrs Pauline Latham (Mid Derbyshire) (Con)
What advice can the Minister give to elderly and vulnerable people who missed out on the first wave of flu jabs? Are they still available?
Dr Rosena Allin-Khan (Tooting) (Lab)
While working a night shift in A&E this weekend, I was struck by the fact that I was working alongside so many members of staff from our EU—Italian, Irish and Spanish. I am proud that St George’s Hospital is paying for the visas of those vital staff post Brexit, but can the Secretary of State tell me why the financial burden of retaining them and improving their morale is falling on NHS trusts and not the Government?
Matt Hancock
I welcome what St George’s is doing, and I welcome all the people from the EU who are working in our NHS—in greater numbers than on the day of the referendum. They are welcome here, and I look forward to their working here long into the future.
Andrea Jenkyns (Morley and Outwood) (Con)
Each month I hold my memory cafés for those suffering with memory loss, dementia and Alzheimer’s, and their carers, families and friends. What support are the Government providing for those suffering with such memory loss conditions?
Mr Skinner
The Secretary of State has been very fond today of talking about the long-term plan. I am 86 years of age, and the reason I am able to ask this question is because under Labour—is he listening?—the money that went in was trebled from £33 billion to £100 billion, an increase of £67 billion. That is why I am still here: I had my operation for cancer, and it was successful; I had an operation for a bypass, and it was successful; and I had a hip replacement, and I can still walk backwards. That is the Labour story—just remember it!
Mr Speaker
Order. Before the Secretary of State responds, let me say that the ferocity and eloquence of the hon. Member for Bolsover (Mr Skinner) are legendary, but all he is really telling us is what the Chair already knew, namely that the hon. Gentleman is indestructible.
Matt Hancock
The hon. Member for Bolsover (Mr Skinner) and I both come from Nottinghamshire mining stock, and we both support the NHS, which was first proposed from this Dispatch Box by a Conservative Minister under a Conservative Prime Minister, and has been presided over by a Conservative Secretary of State for most of its life. I am delighted that those operations, including under a Conservative-led Administration, kept the hon. Gentleman ticking, because what an adornment he is—I look forward to voting with him this evening.
Several hon. Members rose—
NHS Long-term Plan
Matt Hancock Excerpts(5 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Matt Hancock)
With permission, I would like to make a statement about the NHS long-term plan. The plan sets out how we will guarantee the NHS for the future. It describes how we will use the largest and longest funding settlement in the history of the NHS to strengthen it over the next decade, rising to the challenges of today and seizing the opportunities of the future.
It is worth taking a moment to reflect on the time when the NHS was first proposed from this Dispatch Box, under the Churchill Government in 1944. Even after the perils of war, infant mortality was nearly 10 times what it is now, two thirds of men smoked and life expectancy was just 66. It came 10 years before we knew the structure of DNA and four decades before the first MRI. The NHS has led the world throughout its history, but one constant has been the core principle set out by the Conservatives in that national Government: the NHS should be available to all and free at the point of use according to need, not ability to pay.
As last year’s 70th anniversary celebrations proved, the NHS is one of our proudest achievements as a nation. We all have an emotional connection to it—our own family story—and we all owe an enormous debt of gratitude to the people who make the NHS what it is and work so hard, especially during the winter months when the pressures are greatest.
Because we value the NHS so much, the new £20.5 billion funding settlement announced by the Prime Minister in June provides the NHS with funding growth of 3.4% a year in real terms over the next five years. That means that the NHS’s budget will increase in cash terms by £33.9 billion, rising from £115 billion this year to £121 billion next year, £127 billion in 2020-21, £133 billion in 2021-22, £140 billion in 2022-23 and then £148 billion in 2023-24.
That rise of £33.9 billion, which is actually over £1 billion more in cash terms than was proposed in June, delivers on our commitment to the NHS and will safeguard the NHS for the long term and help to address today’s challenges. The NHS is facing unprecedented levels of demand. Every day, it treats over 1 million people. Compared with 2010, the NHS carried out 2 million more operations and saw 11.5 million more out-patients last year. Despite record demand, performance was better this December than last December. So we will address today’s challenges, not least with the £6 billion extra coming on stream in under three months.
As well as addressing current challenges, the NHS long-term plan sets up the NHS to seize the opportunities of the future. At the heart of the plan is the principle that prevention is better than cure. In the future, the NHS will do much more to support people to stay healthy, rather than just treating them when they are ill, so the biggest increase to any part of the NHS—at least £4.5 billion—will go to primary and community care, because GPs are the bedrock of the NHS. That means that patients will have improved access to their GPs and greater flexibility about how they contact them, as well as better use of community pharmacists and better access to physiotherapists. Improving the availability of fast and appropriate care will help communities to keep people out of hospital altogether.
The next principle is that organisations across the NHS, local councils, innovators and the voluntary sector will all work more closely together so that they can focus on what patients need. There will also be a renewed clampdown on waste so that we can ensure that every penny of the extra money goes towards improving services and giving taxpayers the best possible return.
Ultimately, staff—the people who work in the NHS—are at the heart of the NHS. The long-term plan commits to major reforms to improve working conditions for NHS staff, because morale matters. Staff will receive better training and more help with career progression. They will have greater flexibility in their work, be supported by the latest technology that works for them and be helped more with their own mental health and wellbeing. That already happens in the best parts of the NHS, and there has been a huge amount of work to support the people who work in the NHS, but I want to see it happen everywhere. We will bring in better training, mentoring and support to develop better leadership in the NHS at all levels. We will build on the work that is already going on to recruit, train and retain more staff so that we can address critical staff shortages.
The plan published today is the next step in our mission to make the NHS a world-class employer and deliver the workforce it needs. To deliver on the workforce commitments, I have asked Baroness Dido Harding to chair a rapid programme of work, which will engage with staff, employers, professional organisations, trade unions, think-tanks and others to build a workforce implementation plan that puts NHS people at the heart of NHS policy and delivery. Baroness Harding will provide interim recommendations to me by the end of March on how the challenges of supply, culture and leadership can be met. She will make her final recommendations later in the year as part of the broader implementation plan that will be developed at all levels to make the NHS long-term plan a reality.
That is the approach that we will be taking to support the NHS over the next decade, but what does it mean for patients and the wider public? It means patients receiving high-quality care closer to home. It means supporting our growing elderly population to stay healthy and independent for longer. It means more personalised care and more social prescribing. It means empowering people to take greater control of, and responsibility for, their own health through prevention and personal health budgets. It means accessing new digital services to bring the NHS into the 21st century. It means more support for mothers by improving maternity services. It means providing more support for parents and carers in the early years of a child’s life so that this country can be the best place in the world in which to be born, in every sense.
We will improve how the NHS cares for children and young people with learning disabilities and autism by ending inappropriate hospitalisation, reducing over- medicalisation and providing high-quality care in the community. The NHS will tackle unacceptable health inequalities by targeting support towards the most vulnerable in areas of high deprivation. To help to make a reality of the goal of parity between mental and physical health, we are going to increase mental health service budgets not by £2 billion, but by £2.3 billion a year. For the first time ever, we will introduce waiting time targets for community mental health so people get the treatment they need when they need it. We will also expand services for young people to include those up to the age of 25—something that never happened under the previous Labour Government.
The long-term plan focuses on the most common causes of mortality, including cancer, heart disease, stroke and lung disease. The health service will take a more active role in helping people to cut their risk factors by stopping smoking, losing weight and reducing alcohol intake. The NHS will improve the quality and speed of diagnosis and improve treatment and recovery, so that we can help people to live well and manage their conditions. We will upgrade urgent care so people can get the right care more quickly.
All in all, the NHS long-term plan has been drawn up by the NHS—by more than 2,500 doctors, clinicians, staff and patients. It will continue to be shaped and refined by staff and patients as it is implemented, with events and activities across the country to help people to understand what it means for them and their local NHS services. The experts who wrote the plan say that it will lead to the prevention of 150,000 heart attacks, strokes and dementia cases, and to 55,000 more people surviving cancer each year—in all, half a million lives saved over the next 10 years. It is funded by taxpayers, designed by doctors and delivered by this Government.
This is an important moment in the history of the NHS. Our long-term plan will ensure that the NHS continues to be there, free at the point of use, based on clinical need, not ability to pay, but better resourced with more staff, newer technology and new priorities. It will be fit for the future, so that it is always there for us in our hour of need. I am proud to commend this statement to the House.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I welcome the advance copy of the Secretary of State’s statement, but may I quickly say at the outset that Churchill’s Tory party voted against Labour’s NHS 22 times?
We welcome many of the ambitions outlined today by NHS England. We welcome the greater use of genomics in developing care pathways. We welcome the commitment to early cancer diagnosis; after all, it was a Labour policy announced at the general election. We welcome the commitment to new CT and MRI scanners; it is a Labour policy. We welcome the greater focus on child and maternal health, including the expansion of perinatal mental health services; again, it is a Labour policy. We welcome the roll-out of alcohol teams in hospitals, because, yes, it is another Labour policy.
The Secretary of State did not mention this, but we will study carefully the details of any new proposed legislation, because we welcome the recognition that the Health and Social Care Act 2012 has created a wasteful, fragmented mess, hindering the delivery of quality healthcare. Healthcare should never be left to market forces, which is why scrapping the competition regime and scrapping the Act’s section 75 procurement regulations, as proposed today by NHS England, are long-standing Labour policies. The Government should be apologising for the Health and Social Care Act. But why stop halfway? Why not commit to fully ending the purchaser-provider split? Why not commit to democratic accountability when planning care? Why not commit to consigning the whole Lansley Act to the dustbin of history?
What about the other holes in today’s announcement? Waiting lists are at 4.3 million, with 540,000 waiting beyond 18 weeks for treatment. A&Es are in crisis, with 618,000 trolley waits and 2.5 million waiting beyond four hours in A&E. So why is there no credible road map today to restoring the statutory standards of care that patients are entitled to, as outlined in the NHS constitution? They were routinely delivered under a Labour Government. Is it not a damning indictment of nearly nine years of desperate underfunding, cuts and failure to recruit the staff we need that those constitutional standards will not be met as part of this 10-year plan?
The Secretary of State boasts of the new budget for the NHS. Will he confirm that once inflation is taken into account, once the pay rise is factored in and once the standard NHS England assumption about activity is applied, there is actually a £1 billion shortfall in the NHS England revenue budget for this coming financial year? When he answers, will he tell the House—I will be listening carefully to what he says—whether he has seen or is aware of any internal analysis from the Department, NHS England or NHS Improvement that confirms that £1 billion shortfall figure?
Can the Secretary of State also confirm that despite his rhetoric about prevention, the public health budget is set to be cut again in the next financial year as part of a wider £1 billion of cuts to broader health spending, and that when those cuts are taken into account, spending will rise not by 3.4%, as he says, but by 2.7%? That will mean deeper cuts again to smoking cessation services, deeper cuts again to drug and alcohol addiction services and deeper cuts again to sexual health services when infections such as gonorrhoea and syphilis are on the rise. By the way, why is HIV/AIDS not even mentioned in the long-term plan? What was the Secretary of State’s answer when asked about public health cuts in his weekend interviews? Targeted Facebook advertising. Given that life expectancy is going backwards, health inequalities are widening and infant mortality is increasing, the public health cuts should have been reversed today, not endorsed.
The NHS long-term plan admits that
“the extra costs to the NHS of socioeconomic inequality have been calculated as £4.8 billion a year in greater hospitalisations alone.”
Does that not confirm that, for all the rhetoric on prevention, the reality is that the Government’s austerity and cuts are making people sicker and increasing the burden on the NHS? Nowhere have we seen greater austerity than in the deep cuts to social care, but where are the Government’s proposals today? They still do not have any.
With respect to social care, surely the Secretary of State agrees that:
“It is not possible to have a plan for one sector without having a plan for the other.”—[Official Report, 18 June 2018; Vol. 643, c. 53.]
Those are not my words, but the words of the Foreign Secretary when he stood at the Dispatch Box last June as the Secretary of State for Health and Social Care. I agree with him; it is a shame that the current Secretary of State does not.
By the way, the Foreign Secretary also promised that:
“Alongside the 10-year plan, we will also publish a long-term workforce plan”.—[Official Report, 18 June 2018; Vol. 643, c. 52.]
Where is it? The Secretary of State has not done it. We all want to know where the staff are coming from to deliver the ambitions that have been outlined today. We are short of 100,000 staff. We are short of 40,000 nurses. The Secretary of State talks of doing more for mental health services; we are down 5,000 nurses in mental health. He talks of doing more for primary and community care; GP numbers are down by 1,000 and district nursing numbers are down by 50%. Now, the Home Secretary wants to impose a £30,000 salary cap on those coming from abroad to work in our NHS, ruling out nurses, care assistants and paramedics. The Secretary of State should do his job and tell the Home Secretary to put the future sustainability of the NHS first, instead of his Tory leadership ambitions, and ditch that salary cap for the NHS.
There are certainly many welcome ambitions from NHS England today, but the reality is that those ambitions will be hindered by a Government who have no plan to recruit the staff we need, who have no plan for social care and who are pushing forward with deep cuts to public health services. Patients have been let down as the Government have run down the NHS for nearly nine years. We do not need 10 more years of the Tories. The NHS needs a Labour Government.
Matt Hancock
Well, I think we discovered from that that Labour has absolutely nothing to say about the future health of the nation. The hon. Gentleman did not even deign to thank the people who work in the NHS for their incredible work. Did we hear any acknowledgement of the million more people who are seen by the NHS, of the record levels of activity going on in the NHS and of the fact that we have more nurses and doctors in the NHS than we had in 2010? He had nothing to say. He talked about the workforce. Chapter 4 of the document is all about the workforce plan. He gives me the impression that, like his leader on Brexit, he has not even read the document he is talking about.
The hon. Gentleman asked about targets and legislation. On legislation, when clinicians make proposals on what legislation needs to change to improve the NHS, we listen. We do not then come forward with further ideological ideas. We listen. So we will listen to what they have said. The clinicians have come forward with legislative proposals and we will listen and study them closely.
On the money that the hon. Gentleman talked about, it was a bit like a broken record. He asked about a £1 billion shortfall in the NHS budget. I will tell him what we are doing with NHS budgets: we are putting them up by £20.5 billion. There is an error in the analysis by the Nuffield Trust, because it does not take into account an improvement in the efficiency of the NHS. Is it true that every year we can improve the way the NHS delivers value for taxpayers’ money? Absolutely. We can and we must, because we on the Government Benches care about the NHS and about getting the right amount of money into the NHS, but we also care about making sure that that money is spent wisely. The hon. Gentleman would do well to heed the views of the NHS itself, which says that yes, the NHS is probably the most efficient health service in the world, but there is always more to do.
The hon. Gentleman argued about various budgets. The budgets in the NHS are going up because we care about the future of the NHS. The Labour party called for an increase of 2.2% a year; we are delivering an increase of 3.4% a year. Labour has nothing to say on health, as it has nothing to say on any other area of domestic business. We will make sure that we are the party of the NHS for the long term.
Mr Kenneth Clarke (Rushcliffe) (Con)
First, I congratulate my right hon. Friend on his paying tribute to the work of the late Sir Henry Willink, who served in Churchill’s Conservative Government. I met him once or twice when he became master of a Cambridge college. The Conservatives have shown respect for the NHS ever since, as he foreshadowed.
I also congratulate my right hon. Friend on the large increases in funding that are almost as big as some of the funding increases that I received when I was a Health Minister and then Secretary of State. Ever since it was founded, all Governments have increased spending on the NHS—they are bound to—and whichever party is in opposition we always have these knockabout exchanges about whether it is enough. As my right hon. Friend rightly says, what matters is how effectively the money is spent to produce the right patient outcomes. The plan appears to reflect that very well.
Does my right hon. Friend agree that the biggest pressure facing the health service is the extraordinary growth in demand, and the change in the nature of that demand, which is being caused by the ageing population, with chronic conditions playing such a large part? Does he also accept that his most urgent priority is to build further links between the hospital service, the GPs, the community services and local authority social services, so that we have people working no longer in silos, but together to produce the best package for the patient? We have achieved something, but not very much. I hope that when we produce our adult social care policy, which I hope is soon, my right hon. Friend will begin to think about some reforms to make sure that all elements of the service work together properly to produce the proper and most cost-effective personalised treatment for each individual patient.
Matt Hancock
I pay tribute to my right hon. and learned Friend, who of course did so much to set in train the modern health service that we know and whose reforms were kept and, indeed, enhanced during the period when Labour was in government. He is right about the need to run the NHS so that it can be the best that it possibly can be. Yes, we need the money, but we also need to run it well. It is no good just to argue about the money. On that he may have a surprising ally, because the shadow Secretary of State, who is currently looking at his mobile phone—well, he is not any more—said a couple of months ago:
“we need to augment the debate beyond the current mantra of ‘we can spend the most’”.
However, it appears that the Labour party only has a mantra of “We can spend the most.” We care about the money, but we care about the NHS being the best that it possibly can be, too.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I note that the Secretary of State referred to the Churchill Government in 1944, but had he looked at Hansard he might have seen that Churchill cited the Highlands and Islands Medical Service, which was the first national health service in 1913.
I welcome the long-term plan, but the integration to which it aspires is going to be frustrated if there is no reform of the internal market and the fragmentation continues. The Secretary of State cites the funding, which he describes as 3.4% per year. That is actually just back to what the NHS received prior to 2010. He talks about a million extra patients. With this enormous increased demand, does he not think that it would be more honest to describe funding per head, rather than just a total? Scotland spends £163 more per head. Perhaps he should aspire to spend the money on the patients and then perhaps the NHS would keep up.
Again, like the previous funding agreement, the funding is focused only on the NHS, with cuts to public health, no extra money for health education and still no Green Paper on social care. I totally agree that prevention is better than cure, so will the Secretary of State reverse the cuts to public health? In his own letter, which was circulated, he emphasised reducing cancer deaths, yet there was no mention of prevention at all. That is the best way to reduce cancer deaths. Public health is crucial, smoking cessation is crucial and tackling childhood obesity is crucial, so will he liaise with his colleagues in the Department for Digital, Culture, Media and Sport and set a nine o’clock watershed on advertising rubbish foods?
I agree with the aim of improving screening. Last year, the Government agreed that they would reduce the bowel cancer screening age from 60 to 50. Can the Secretary of State tell us when that will actually happen? Does he recognise that it will mean a bigger need for endoscopists and radiologists? So will he fund Health Education England to provide them and to provide the other doctors, nurses and staff that the NHS will need to deliver this long-term plan?
Matt Hancock
My response is yes on the cancer screening—it is in paragraph 3.53. I want to return to the point that was made by the hon. Lady and by my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) about the link to social care. Of course that is critical. The plan has a section on the link to social care and the social care Green Paper will then tie into the plan. Of course, the two come together and the Green Paper on social care will be provided soon.
Dr Sarah Wollaston (Totnes) (Con)
I warmly welcome this ambitious and wide-ranging long-term plan for the NHS. I agree with the hon. Member for Central Ayrshire (Dr Whitford) that so much is dependent on social care, on public health and on the workforce through Health Education England budgets, but may I add to that the situation for capital budgets within the forthcoming spending review? So much of the success of transforming services depends on the upfront funding to get things going and sometimes double running so that we can get a new service up and running before an existing service closes down. Will the Secretary of State go further in talking about the role and importance of capital budgets?
I also really welcome the triple integration—not only between health and social care, but between mental and physical health and between primary and hospital services. Could the Secretary of State confirm and support the proposal in the long-term plan that the legislative tweaks that will support that much needed integration will come from the NHS itself? I confirm that the Health and Social Care Committee remains committed to subjecting those proposals to pre-legislative scrutiny. Will he meet me to see how we can take that forward?
Matt Hancock
Yes, I would be very happy to meet my hon. Friend to discuss the legislative changes. These changes have been proposed by the NHS. The NHS wants the changes set out at a high level in the plan. Of course there is a lot of consequential work to do to turn them into a full legislative proposal. The NHS is working on that. If it does that alongside and working with the Select Committee, I would be very happy to meet with her to discuss how that might happen. This is very much the NHS’s proposed legislation and I look forward to discussing it with her.
Liz Kendall (Leicester West) (Lab)
I am glad that the Secretary of State says that he will listen to clinicians if they want to change primary legislation. I just think that many of those clinicians and many Labour Members wish that he and his colleagues had listened to us when we warned about the problems with the Lansley legislation six years ago. But let us put that to one side. The biggest challenge facing the NHS is indeed the increase in the number of older people with two, three or more long-term chronic conditions. They need more joined-up services in the community and at home. The local NHS has been asked to put forward its plans for these new services by April. It cannot do so without proper long-term funding for social care. So will we hear about that in the Green Paper before April—yes or no?
Matt Hancock
When I answered a previous question on the timing of the social care Green Paper, I said it would be provided “soon.” I certainly intend that to happen before April. My previous commitment was to do it before Christmas, so it is well advanced. But the hon. Lady is right on the legislative proposals. There is a broad consensus on the need for more integration, as my hon. Friend the Chair of the Select Committee said. The proposals that are made by the NHS in the paper are what it thinks is needed in order to deliver this integration, which I very strongly support.
Sir Nicholas Soames (Mid Sussex) (Con)
No doubt my right hon. Friend is gratified, as would be the Churchill-led National Government of 1944, by how truly remarkable and amazing the national health service, the baby of that Government, has turned out to be. Will he assure me that this money does not come without strings and that he will enforce a much better system of lessons learned and, in particular, of disseminating best practice more widely through the NHS? Finally, will he please kick the work of the sustainability and transformation partnerships into some form of prompt result?
Matt Hancock
When I referenced Churchill, I did not realise that it would be in front of his family. My right hon. Friend is quite right about the need for a just culture—a need for understanding the lessons that are learned when things go wrong—in what is a high-risk business of providing medicine and medical care. Those lessons should be properly learned and there should be transparency and openness and a culture of constantly improving the way that things are done, whether that is medically, logistically or organisationally in hospitals. That is a critical part of the review that Baroness Dido Harding will take forward. It is something that she cares deeply about, making sure that we get the culture right within the workforce not only to tackle the high levels of bullying and harassment, which are completely unacceptable in the national health service, but to make sure that there is a spirit and a culture of continuous improvement and of learning from errors that everyone makes. All of us make errors, and we should learn from them and that culture should be inculcated right across the NHS.
Norman Lamb (North Norfolk) (LD)
The Secretary of State was absolutely right to commit in his statement to ending the inappropriate hospitalisation of people with learning disability and autism, but the long-term plan itself postpones for five years the ambition of reducing by 50% the number of people who are in institutions. Mencap has described that as disgraceful. It amounts to abandoning the current plan to reduce the number by 50% by this March and it effectively tells the system to take its foot off the brake and will result in people continuing to be treated as second-class citizens, and continuing to have their human rights abused. I urge him to rethink this outrageous long postponement of an absolute imperative to get people out of institutions and to give them a better life.
Matt Hancock
I have a lot of sympathy with the right hon. Gentleman’s argument. The target for this March, which I inherited, was for a reduction of a third to a half. We are at a reduction of over 20%. The challenge has been that, while the number of people who are being moved into community settings has proceeded as per the plan, more people have been put into secure settings. This is an area that I care deeply about getting right, and I very much take on board the response of Mencap and the right hon. Gentleman to the proposals.
Anna Soubry (Broxtowe) (Con)
I congratulate the Secretary of State on his plan. As a former Minister of public health, let me say how delighted I am and how much I agree with him that prevention is better than cure. As Governments of all shades have said for a long time, the reality is that people must take more responsibility for their own health—notably to keep their weight down and to take more exercise. This is all good messaging, but the problem is that obesity and being over-weight is an increasing problem, especially among the young. What new messages—what new approach—will we have to public health if he is really going to make the sort of progress that we need to make?
Matt Hancock
My right hon. Friend is absolutely right. Throughout this statement, Opposition Members have been murmuring from a sedentary position about the public health budget. Let me address that directly. The public health budget, which was devolved five years ago with widespread acclamation across the House, has been set and will be set in the spending review. We are putting an extra £20 billion into the NHS—the scale far dwarfs individual budgets—and the whole long-term plan is about prevention being better than cure. The public health budget is important, and it is being delivered well because it is being delivered by councils in concert and tied to other subjects. The truth is that we are having the whole NHS focus on the prevention strategy, not just one individual budget; those who concentrate on just one budget are missing the point.
Several hon. Members rose—
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
I am heartened that Baroness Harding is looking at the staffing side of things, but she does have a mountain to climb. Let me remind the Secretary of State that the last time the NHS went out to recruit GPs, it ended up with fewer GPs at the end of the year than it had had before. That is not to mention the pension cap put in place by his former mentor—or maybe his current mentor—the former Chancellor, which now means that there is a problem with the retention of senior clinical staff. We can add to that list the immigration rules and pay ceiling. Is the Secretary of State lobbying the Home Office and the Treasury, particularly to deal with the £30,000 cap and the pension cap?
Matt Hancock
I welcome much of the tone of the hon. Lady’s remarks. The truth is that it is critical to ensure that we have the workforce and the people to deliver the plan. There is a whole section of this plan, as well as ongoing work, to deliver that. I want to clear up this point: in the immigration White Paper published by the Home Secretary before Christmas, as now, there is no cap on recruitment numbers for nurses and doctors. The proposal is that the cap will not necessarily apply within a shortage occupation. We will be recruiting people from around the world to work in our NHS.
Dr Andrew Murrison (South West Wiltshire) (Con)
I very much congratulate my right hon. Friend on the 10-year plan and on his announcement of the Harding review. Will Baroness Harding look particularly at the way in which pay and pensions are structured for general practitioners and pinch-point specialists within the NHS, since they are retiring or going part time at the moment—a full 10 years before the time they had anticipated when they went to medical school?
Matt Hancock
We are already looking at that subject. It is very complicated because of the nature of assets owned by GPs—their value having risen sharply over the last generation. However, we have record numbers of GPs in training. Although we need to ensure that we retain more GPs and encourage as many as possible to be full time, we have successfully breached our target; we are training more GPs than we had planned to, and that is a good thing.
Diana Johnson (Kingston upon Hull North) (Lab)
I welcome the focus in the long-term plan on the most common causes of mortality—cancer, heart disease, stroke and lung disease—and on cutting the risk factors. However, will the Secretary of State just explain to me how cuts to public health budgets and the fact that the comprehensive spending review is much later in determining the money that will be made available for public health can be part of a joined-up plan to start dealing with some of these diseases?
Matt Hancock
There is £16 billion ring-fenced for public health in this spending review. Crucially, we want the whole NHS to be focused on keeping people healthy as well as curing them when they are ill. Yes, of course it is a matter for that one budget in the spending review process, but it is also a matter of the whole £148 billion a year that will be going into the NHS.
Martin Vickers (Cleethorpes) (Con)
I welcome the Secretary of State’s plan. He will be aware that our constituents value receiving treatment as locally as possible. Will he give an assurance that he will do all he can to ensure that district general hospitals are there to provide most of these crucial services?
Matt Hancock
Yes. I am a strong supporter of district general hospitals and community hospitals. So often, local matters because it matters to patients and their families. If someone is having a highly complicated procedure, they will want to be in the very best place in the country—or, indeed, in the world—but often they will want to be close to home as well. That matters for small hospitals and district general hospitals such as the one on which my hon. Friend’s constituents rely so much.
Ms Angela Eagle (Wallasey) (Lab)
The Secretary of State has waxed lyrical today about the NHS becoming a learning organisation, being transparent and admitting its mistakes. Will he therefore set the trend and lead by getting up at the Dispatch Box and apologising to this House for the fragmentation and chaos caused by the Lansley Act?
Matt Hancock
We will listen to and learn from what clinicians say about what legislative changes are needed now. This document is all about concentrating on what is the right thing for the future, rather than the blame culture that we are trying to get rid of in the NHS.
Sir Patrick McLoughlin (Derbyshire Dales) (Con)
I very much welcome my right hon. Friend’s statement and the fact that he has been able to announce future spending so that hopefully the planning for how those resources are spent can be done properly. Will he also bear in mind that, during the period of the national health service, some 60% of the time there has been a Conservative Secretary of State, which shows very much the support and commitment of the Conservative party to the health service? Regarding the money that he is talking about, what will he do to ensure that people see and understand what is being spent locally?
Matt Hancock
As my right hon. Friend says, from its inception and the first White Paper throughout most of its history, the NHS has been supported and nurtured by a Conservative Secretary of State, and long may that continue.
Grahame Morris (Easington) (Lab)
I want to concentrate on cancer services. I have tried to be very positive and to engage with Ministers through the all-party parliamentary group on cancer, but I must express my disappointment at chapter 3. The Secretary of State referred to paragraph 3.51 on cancer, particularly in relation to some of the new investments. Practicalities and resources must be linked to the ambition to improve outcomes, so we need early diagnosis and cost-effective treatment. For example, this country has the second worst survival rate in Europe for lung cancer; only Bulgaria is any worse. The “Manifesto for Radiography” by professionals, oncologists and so on set out some specific asks, including a one-off investment of £250 million in advanced radiotherapy and an additional £100 million a year to support that investment with trained staff. I am afraid that the Government’s plans set out in the 10-year plan fall far short of that, so I do hope that the Secretary of State will look at that again.
Matt Hancock
We very much agree with the thrust and purpose of the hon. Gentleman’s remarks. In fact, paragraph 3.56 sets out how we are learning from what has happened in Liverpool and elsewhere in the country to make sure that we get early diagnosis right because, as he says, early diagnosis is absolutely critical. I will take away his specific points, but the whole thrust of the plan with regards to cancer is about increasing early diagnosis.
Justine Greening (Putney) (Con)
In a local community survey that I am doing right now, mental health is particularly flagged up by people as a priority for them, as well, so I very much welcome the Secretary of State’s continued focus on that in this 10-year plan. I also very much welcome the fact that as part of the work with the Department for Education, the trailblazer area in south-west London will enable us to really see some of the more joined-up working that he talked about. Will he set out what the additional services available for young people up to the age of 25 will mean practically? I represent a very young constituency, and that will be a key change that could benefit us.
Matt Hancock
At the moment, as somebody transitions from children’s mental health services to adult mental health services, there is often a gap in provision as they register for the adult services. The purpose of having the new care plans up to the age of 25—similar to those, for instance, for care leavers that we have brought in in other legislation—is to make sure that there is a seamless transition from children’s mental health services to adult mental health services and not a gap that many, many people fall through.
Mr Clive Betts (Sheffield South East) (Lab)
Let me bring the Secretary of State back to the issue of public health. He seems to be saying that this is only a small grant and therefore not really very important compared with spending on the NHS as a whole. May I draw his attention to the wording in the long-term plan where it says that action by the NHS
“is a complement to, but cannot be a substitute for, the important role of local government”?
That role has been undermined by £700 million of cuts to public health grants in the past five years. Will he now recognise that if we are going to get a proper joined-up approach to ill-health prevention, he needs to give a commitment that in future the public health grant will increase, in real terms, at least by the same amount as NHS funding as a whole?
Matt Hancock
I certainly did not say that the public health grant was small—I said that it was £16 billion over the last spending review period. But NHS spending as a whole, by the end of this five-year funding settlement, will be £148 billion every year. Therefore, turning the firepower of the whole NHS to keeping people healthy in the first place will play a huge role in this. Of course, the public health grant has to be settled as part of the spending review, but the idea that that is the whole of everything with regard to preventing ill-health is missing the point.
Vicky Ford (Chelmsford) (Con)
In the week before Christmas, when we mere mortals were just looking forward to a holiday, the Secretary of State did an all-night shift in Milton Keynes University Hospital and then travelled to Chelmsford, where he visited my brand new medical school and did a “Dragons’ Den” with medical entrepreneurs who are finding new ways to use technology to treat their patients. May I thank him for his super-energy, and does he agree that supporting staff and embracing innovation is also key to our NHS?
Matt Hancock
Yes, it was a joy to make that visit. We found ourselves in a new medical school in a room where the students were enjoying a dissection—my goodness, after a night without sleep it was quite a thing. It was a joy to go there with my hon. Friend and I agree with both the points she made.
Jim Shannon (Strangford) (DUP)
I, too, congratulate the Secretary of State on the NHS 10-year long-term plan. There are between 6,000 and 8,000 rare diseases. One in 17 people, or 6% of the population, will be affected by a rare disease in their lifetime—that is 3.5 million people in the United Kingdom. Will he confirm a commitment to assisting those with rare diseases, and can the NICE process for new life-saving drugs be urgently speeded up so that more lives can be lightened and saved?
Matt Hancock
I strongly agree with the hon. Gentleman. For those who have rare diseases, diagnosis takes seven years, on average, and genomics can bring that down to a matter of seven days, in the best cases. We are the world leaders in genomics and we are going to stay that way. We have reached the 100,000 genome sequence and we are going to take it to 1 million, with 500,000 from the NHS and 500,000 from the UK Biobank. He is absolutely right. This is one of the bright shining stars of the future of healthcare, and Britain is going to lead the way.
George Freeman (Mid Norfolk) (Con)
As a former Health Minister, I congratulate the Secretary of State and the Government on this statement. I particularly pay tribute to his work on mental health—I am proud that under this Government it looks as though we are finally beginning to close the gap and stop mental health being the Cinderella service—and on early diagnosis of cancer. I also welcome his espousal of the work on genomics, which I, as a former Minister for life sciences and health technology, and others were involved in setting up. Does he agree that if we are really going to drive the revolution of accountability, productivity and local engagement, the accountable care pilots offer us the chance to really measure and drive digital communities of healthcare where we reward communities that promote health and wellbeing?
Matt Hancock
Yes, I do. I pay tribute to the work that my hon. Friend did in putting together the areas of the NHS where this is already working. We want to spread that success more broadly across the NHS to make sure that we seize these very exciting opportunities as well as deal with the important day-to-day challenges that the NHS faces.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
On 29 December, two young people, one of them aged only 24, committed suicide by jumping from the Humber bridge in my constituency. Since I first commented on this, I have been inundated with comments from local residents detailing the inadequate mental health support that they have. Unfortunately, the Humber bridge is becoming a place that people choose to visit when they are feeling desperate and as though there are no other options. Partly for this reason, can I ask the Secretary of State to commit—not in 10 years, or even in one year or six months, but right now—to providing more money for the Humber NHS Foundation Trust so that we can help to support people when they are feeling so very desperate?
Matt Hancock
I will absolutely look into the request that the hon. Lady makes. The example that she gives locally in Hull is actually reflected across the country in terms of the need for greater access. For the first time, we are going to have access targets for community mental health, because it is critical to make sure that we have accountability and understand what is happening in mental health trusts in terms of access so that we can then drive policy to meet it. But I appreciate that that is a medium-term goal: in the short term, she has made a specific request for a specific organisation, and I will absolutely look into it and write to her.
Mr Marcus Jones (Nuneaton) (Con)
Mental health issues are often part of the very complex causes of rough sleeping. They are also a barrier to getting rough sleepers off the streets. Will my right hon. Friend say more about how his plan fits in with the Government’s plan to eradicate rough sleeping?
Matt Hancock
Yes, my hon. Friend is absolutely right about this. I pay tribute to the work that he did as a Minister in this area. We have put forward £30 million to support mental health services for rough sleepers. It is about so much more than just the money, though—it is about co-ordinating care and co-ordinating different agencies. There is a lot of work going on on this inside Government that he was very much involved with.
Andy Slaughter (Hammersmith) (Lab)
My clinical commissioning group has to make more than £40 million of cuts in the next 15 months and is proposing to cut GP and urgent care centre opening hours. It also has an £11 million risk thanks to the predatory private “GP at hand” scheme, of which the Secretary of State is a member. We have had GP practices suspended, palliative care beds closed, and our major hospital under threat of demolition for seven years. Will he accept that the self-regarding statement he has just made will be unrecognisable to people who work in and use the NHS, which is reeling from the crisis that his Government have caused?
Matt Hancock
I will take advice and consideration from many people, but not from the hon. Gentleman, who for seven years has run a frankly outrageous campaign based on scare stories about hospital closures that are totally unreasonable, unrealistic and wrong. He will never be somebody I listen to, because I care about improving the future, not political point-scoring.
Kevin Foster (Torbay) (Con)
Last Friday, it was a pleasure to meet the chief executive and chair of my local hospital trust to discuss the new A&E department and the new mental health ward that will be built on the site of Torbay Hospital over the next year. Does the Secretary of State agree that it also vital that we have the local services around mental health, in particular, because in the past we have seen far too many people from Devon being sent elsewhere, across the country, and that this investment will now bring that to an end?
Matt Hancock
Yes, absolutely. My hon. Friend is a brilliant advocate for Torbay and for the English Riviera, and has made the case so strongly for his local hospital. I was delighted that we could recently find the funding to support the case that he and local clinicians have made, and I look forward to working with him to make it a reality.
Karin Smyth (Bristol South) (Lab)
Before coming to this place, I was a senior manager in Bristol’s primary care trust and then the CCG. I want to pay tribute to the NHS managers who have kept the ship afloat since the Lansley reforms. Today’s plan is clear in its commitment to triple integration and seeking to free commissioners from the barriers to integration in the 2012 procurement rules, but tomorrow the CCG in Bristol will embark on a huge re-procurement process for some community services for the next 10 years based on those old rules. In the light of his plan, will the Secretary of State intervene locally and support my call to pause that divisive community services re-procurement?
Matt Hancock
I will raise the hon. Lady’s point with NHS Improvement, which considers these things. Local provision of services should, rightly, be decided by local clinical priorities, but she makes a cogent point that I will raise with NHSI, and I will ask its chief executive, Ian Dalton, to write to her.
Henry Smith (Crawley) (Con)
I declare an interest, as chair of the all-party parliamentary group on blood cancer and the APPG on heart and circulatory diseases. I very much welcome this plan’s focus on those areas. In tribute to my caseworker, Susan Lester, who sadly passed away last week from pancreatic cancer, can I have an assurance from the Secretary of State that he will continue to work with voluntary sector organisations such as Bloodwise, the British Heart Foundation and Pancreatic Cancer UK?
Matt Hancock
Yes, of course. I am sure the whole House will join me in passing on our condolences to the family, friends and colleagues of my hon. Friend’s caseworker. He is doing right by her in raising that issue in the House. Of course we will keep working with those organisations, which do brilliant work. In fact, there is an event in the Commons tomorrow with Bloodwise, which the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), will attend.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
Before Christmas, I attended the inaugural event of the Addie Brady Foundation, in memory of 16-year-old Addie, who died a year ago from a brain tumour—her second primary cancer. She was affected by a rare genetic condition called Li-Fraumeni syndrome, a feature of which is a high risk of cancer and repeat cancers. Her family, other families and an international panel of experts have been campaigning for a national screening programme for people suffering from Li-Fraumeni syndrome. Can the Secretary of State confirm whether his announcement today includes much needed Li-Fraumeni syndrome screening on the NHS, particularly for children, which would extend and save lives?
Matt Hancock
I will certainly take up the hon. Lady’s suggestion with Mike Richards, who is running a review of our screening programmes to ensure that they are all fit for purpose, run as effectively as possible and targeted at the right people.
Tom Pursglove (Corby) (Con)
I am delighted to hear my right hon. Friend talk at length about prevention. In that vein, what role does he see for initiatives such as the daily mile in schools, which allows young people to get into the thrust of getting involved in sporting activity and sets them up for life?
Matt Hancock
My hon. Friend makes an important point. Things like the daily mile, which I have participated in, are an incredibly important part of this. Prevention is about public health and the whole NHS, but it is also about more than that. We talk a lot in the House about the rights that the NHS gives us—the right to care that is free at the point of use, according to need—but we also need to talk about the responsibilities that we have, including the responsibility to use the service wisely and the responsibility to ourselves and our communities to keep ourselves healthy. That part of the debate needs to continue and be strengthened, at the same time as ensuring that the NHS is always there for us.
Mr Kevan Jones (North Durham) (Lab)
Under the Government’s public health proposals, County Durham will lose 38% of its budget—or £19 million. The Secretary of State said that we should be listening to clinicians. Clinicians in County Durham are clear that they want that budget protected. Can he tell me what those clinicians are missing? Is it not a fact that this Government are quite clearly going to remove money from deprived areas such as County Durham, while more leafy areas, including Surrey, have an increase in their budgets?
Matt Hancock
That is obviously not right. Indeed, there is a whole section of the plan on reducing health inequalities, which is extremely important.
Rebecca Pow (Taunton Deane) (Con)
I very much welcome this plan, its ambitions and the Government’s commitment to it. Does my right hon. Friend agree that one of the biggest obstacles to a fully functioning health service is the fact that information cannot be easily shared between many centres? There are myriad systems, which means that data cannot be accessed from one centre to another. When it comes to care, the professionals are brilliant and must be praised, but this situation is causing distress, and it slows diagnosis and wastes patients’ time. I speak from a great deal of personal experience, unfortunately, having spent too long in the NHS with family members. Can he give an assurance that that will be addressed by the plan?
Matt Hancock
Yes. I feel strongly about this. Chapter 5 of the plan is all about digitally enabled care. The interoperability of data between systems in different parts of the NHS is mission-critical. Over Christmas we published proposals for the interoperability of primary care systems, and we will roll that out in the hospital sector as well, so that people can access their own patient record and the clinicians who need to see it can access the whole record. Instead of having to phone each other up to find out what is going on with a patient they once had, they should be able to look at the record.
Nic Dakin (Scunthorpe) (Lab)
I welcome the Secretary of State’s recognition that the staff are at the heart of the NHS and join him in thanking them for their excellent work, but there are 40,000 nursing vacancies today. How many nursing vacancies will there be at the end of 2019, and how many will there be at the end of 2020?
Matt Hancock
I know that the hon. Gentleman takes a close interest in that, as chair of the all-party group. Obviously we need more nurses. The vacancies are, in many cases, filled by temporary staff, but that is not the best way to manage things. We need more nurses and more doctors. I am glad that we have a record number of GPs in training. In the plan, we have made provision for a 50% increase in the number of clinical placements. We have a whole programme, including the Harding review, to take this forward and ensure that it happens, because the NHS is, at its heart, delivered by its people.
James Morris (Halesowen and Rowley Regis) (Con)
I welcome the Secretary of State’s statement and in particular the continued commitment to increase funding for mental health and build on the work already done through the five year forward view. Does he agree that one of the challenges in implementing those changes is ensuring that funding gets to the frontline through commissioning decisions? That has been one of the obstacles to generating real change on the ground and achieving the goal of parity of esteem between mental and physical health.
Matt Hancock
My hon. Friend is absolutely right. We need not only more funding for mental health, which is in the plan, but more joined-up delivery of mental health services. Since the birth of the NHS, mental health services have been separate from physical health services, but treatment needs to be for the whole person—their physical, mental and social health. We need not only the money but the join-up, and my hon. Friend the Member for Thurrock (Jackie Doyle-Price), the Mental Health, Inequalities and Suicide Prevention Minister, is working closely on that.
Laura Smith (Crewe and Nantwich) (Lab)
I agree with the shadow Secretary of State completely. I do not feel satisfied that the Secretary of State recognises the urgent need to reverse cuts to social care budgets alongside this plan. Does he see that savings made by reducing avoidable admissions and delayed transfers of care could go towards delivering a more ambitious 10-year plan for our NHS?
Matt Hancock
As I have said, after I became Secretary of State, we put £240 million extra into social care, and there will be £650 million next year.
Dr Matthew Offord (Hendon) (Con)
I congratulate the Secretary of State on this announcement and particularly on the increase in spending, which is more than the Labour party promised at the last general election. The vital point of today’s announcement is the publication of the plan, which has been decided by clinicians, so that they can tell politicians what is right for the NHS. Will he thank the clinicians for that work? We want to take party politics out of the NHS.
Matt Hancock
My hon. Friend is quite right: we must focus on the substance of what is needed to deliver an NHS that will be there for us all in our hour of greatest need. That is what we should be concentrating on. I have heard some Members say, “Whatever the Government promise, we will just promise more.” That is no way to have a discussion about the future of the country and our most valued institution. Instead, we should back the NHS’s plan, deliver on it and keep the economy strong so that we can keep putting in the money that the NHS needs.
Liz McInnes (Heywood and Middleton) (Lab)
Paragraph 4.17 of the plan states:
“Mature students are more likely to have family and other commitments that make it harder to retrain without financial support.”
Will the Secretary of State therefore now admit that his Government made a huge mistake when they abolished bursaries for nurses and allied health professionals?
Matt Hancock
No; we are proposing to have more targeted support for those who need it, to ensure that we get support to the areas of nursing with the most acute shortages, such as community nursing and mental health services. That is where support is best targeted.
Bim Afolami (Hitchin and Harpenden) (Con)
My constituency is one of the 25 trailblazer areas that will have new mental health support teams working in and around schools. Will the Secretary of State give further details on what this plan will do to deliver improved mental health services on the ground, particularly for young people in schools?
Matt Hancock
Supporting children with mental ill health is an incredibly important part of the plan, from early intervention on anxiety and depression through to support for those with more serious mental health conditions. It means that there will be dedicated support that can link with schools’ mental health services and help signpost in what is often a complicated system. The Mental Health Minister, my hon. Friend the Member for Thurrock, has already agreed to meet my hon. Friend to discuss this further. It is an important and welcome intervention.
Paul Farrelly (Newcastle-under-Lyme) (Lab)
When our local sustainability and transformation plan was submitted in October 2017, it projected an annual deficit in health and social care in Staffordshire and Stoke-on-Trent of £542 million by 2020-21, which is more than double the £250 million projected at the time of the 2015 general election. That shows the scale of the problem, because there are more than 40 STPs across England. Will the Secretary of State write to me with some numbers to show how this long-term plan will help our local STP with the extra revenue and investment needed to transform services so that we do not face a litany of unsustainable cuts, notwithstanding those in the years immediately to come?
Matt Hancock
Of course we are putting more money in, and in the coming days we will announce the local provision increases for the first year—there is a £6 billion cash uplift in year 1. We will be working with local areas in the months ahead on the plans for years 2 to 5.
Robert Courts (Witney) (Con)
In the past few weeks I have visited Witney Community Hospital, the Windrush surgery, the Nuffield health centre and the associated nearby pharmacies, and I have seen not only their brilliant winter preparedness but how they form a hub for care close to home. Does my right hon. Friend agree that ensuring that people are treated in the community and improving public health is the way to ensure that we have free, high-quality care for everybody?
Matt Hancock
My hon. Friend is absolutely right. The community hubs being developed in many different parts of the country are critical in bringing together support and enabling early intervention. The adage that a stitch in time saves nine is almost as old as “prevention is better than cure,” but both are equal in their wisdom.
Ms Karen Buck (Westminster North) (Lab)
Money might not be everything, but transforming a service against a background of real-terms cuts is almost impossible. The Central London clinical commissioning group is in the middle of a 13% real-terms cut, the West London clinical commissioning group is having an 8% real-terms cut, real-terms cuts are being made in mental health services, and Westminster City Council has cut 31% of its funding for social care. Can the Secretary of State indicate whether inner-London residents will see any benefit as a result of this plan?
Matt Hancock
As I said a moment ago, local allocations will be published in the coming days.
Bob Blackman (Harrow East) (Con)
One of the most effective ways of reducing avoidable deaths is to stop people smoking in the first place, and to encourage those who do smoke to give up as fast as possible. How will this plan encourage pregnant mothers, 11% of whom still smoke, to give up smoking and get their partners to give up, and how will it encourage young people not to start in the first place?
Matt Hancock
My hon. Friend is absolutely right. When people are in hospital, there will now be much more aggressive provision of counselling and support to stop them smoking. It is also about targeting support, rather than treating everyone the same and giving them the same messages. It is absolutely right to include micro-targeting and to use social media to communicate with people. There are luddites who say that we should not use these modern approaches, but we on the Government Benches believe in the future.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
I am pleased that the Secretary of State is keen to improve public health and reduce health inequalities, and I assume that he will therefore support my new clause 5 to the Finance (No. 3) Bill, which is specifically about ensuring that the Government’s economic policies reduce health inequalities. On social care, is he aware that in 2017 alone 50,000 people with dementia had an emergency hospital admission because there was not adequate social care? What will he do to ensure that his plan, which we are still waiting for, will avoid such emergency admissions in 2019? Please do not say that more has been given in the Budget, because that is a sticking plaster compared with all the cuts that the Government have made in social care.
Matt Hancock
Page 32 of the document sets out details on the integration with social care that the hon. Lady rightly calls for. Clearly, ensuring better integration in cases of dementia is absolutely vital. Some parts of the country are doing that brilliantly with integrated commissioning, but we need to ensure that is spread across the whole country.
Matt Warman (Boston and Skegness) (Con)
I welcome this plan and the Secretary of State’s energy. When he visited Pilgrim Hospital in my constituency, he saw that this is not solely about money, because a huge chunk of the challenge that the NHS faces is about the workforce. Within the workforce plans in this 10-year plan, will he pay particular attention to under-doctored areas such as Lincolnshire, where it is a huge challenge to produce the same outcomes that we see in other parts of the country?
Matt Hancock
My hon. Friend is dead right. It was a real pleasure to visit Pilgrim Hospital in Boston, where my grandmother worked as a nurse for 30 years, and to meet the staff. He is absolutely right about the recruitment challenges that they face, which is why a whole chapter of the report, and ongoing work, is dedicated to improving recruitment. When we put £20 billion into a public service, of course we will need more people to deliver it.
Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
At this very moment, Derriford Hospital in Plymouth is on OPEL 4 alert—the new name for black alert. The real shame is that that is now so commonplace that it no longer always makes the news. Will the Secretary of State, who I know visited the hospital recently, explain whether the new NHS plan will address the structural inequalities in funding for the regions, especially the far south-west? Those inequalities often contribute to the underfunding of services, which is why our hospital is on OPEL 4.
Matt Hancock
I enjoyed my visit to Derriford Hospital’s night shift and learned an awful lot from it. One of the consequences of seeing what is happening on the ground is that we are providing it with a new A&E facility. We are putting tens of millions of pounds into the hospital, so it would be a bit better if the hon. Gentleman mentioned that as well as rightly raising concerns about performance. That funding was the result of the campaigning of the hon. Member for Plymouth, Devonport, who is an absolutely brilliant campaigner for his local community—[Interruption.] Yes, the Members for Devonport and for Moor View. I am a big supporter of Derriford Hospital and think it does a brilliant job, and in challenging conditions, but it is going to get a better A&E because we have provided the funding to allow it to do that.
Helen Whately (Faversham and Mid Kent) (Con)
I welcome the commitment to mental health in the NHS long-term plan, particularly the badly needed new care model for young adults, the commitment to more care for people with severe mental illnesses and the further expansion of mental health liaison services in A&E. I also welcome the commitment to more performance standards for adults with mental illnesses. Will my right hon. Friend make sure that those mental health standards are introduced sooner rather than later, so that we do not have to wait too long for the waiting time standards? Transparency is so important for the parity of esteem between mental health and physical health.
Matt Hancock
My hon. Friend is absolutely right. Those standards are being trialled at the moment. Of course we want to get them right, but we will look at the results of those trials as soon as we can.
Mohammad Yasin (Bedford) (Lab)
The Bedfordshire mental health trust told me today that the need for in-patient beds for men has increased. Will the Secretary of State urgently reinstate the in-patient mental health facilities in Bedford, which his Government removed, so that my constituents no longer have to travel at least 20 miles to access care?
Matt Hancock
Of course the provision of services locally is a matter for local clinicians, and it must be led by local clinicians. I am always happy to look at individual cases and, as with the other example, I will ask the NHS to write back to the hon. Gentleman with an explanation.
Alan Mak (Havant) (Con)
Upgrading the NHS’s technology is key to its productivity and its future, and it should include rolling out a new NHS app; phasing out outdated technologies such as fax machines; and adopting new fourth industrial revolution technologies. What progress has the Department made in those areas?
Matt Hancock
My hon. Friend is dead right. There is a whole chapter in the plan on using new technologies not only to improve care but to make care more convenient. He has been a doughty campaigner for the use of technology in health services. His trip to my local hospital to understand these issues went down incredibly well locally, and I hope he keeps pushing us to do the best we can.
Lilian Greenwood (Nottingham South) (Lab)
How can it possibly make sense that, when the Health Secretary is targeting much needed support towards areas of high deprivation, the Secretary of State for Housing, Communities and Local Government is cutting funding for social care and public health, and cutting deepest in cities such as Nottingham with high levels of poverty? Is that not actively undermining the Health Secretary’s stated ambition to improve health and reduce inequality?
Matt Hancock
In debates on the future of our nation’s healthcare, we should always start with the facts, and the fact is that social care funding is going up. It went up by £240 million this year, and it is going up next year, too.
Mr Philip Hollobone (Kettering) (Con)
Adult social care is not working properly in Northamptonshire, with far too many delayed transfers of care for elderly people. With the root-and-branch reform of local government in Northamptonshire, there is a wonderful, unique opportunity to create successful integrated health and social care pilots. Will the Secretary of State seize this opportunity and get the 10-year NHS long-term plan off to a wonderful start in Northamptonshire?
Matt Hancock
Yes. I have discussed the proposals made by my hon. Friend and his Northamptonshire colleagues with the Secretary of State for Housing, Communities and Local Government. We are both enthusiastic to see what can be done, and I invite my hon. Friend into the Department to speak to my officials about how this could be done. His proposals are, by design, entirely consistent with the proposals in paragraph 1.58 of the long-term plan, and I very much look forward to working with him and his Northamptonshire colleagues on making it happen.
Rachael Maskell (York Central) (Lab/Co-op)
Health visitors are vital to delivering early intervention and prevention, yet their numbers are in freefall—falling by 23.5%, or 2,425 health visitors, since October 2015. Health visitors are now working with dangerous caseloads, so when will the Secretary of State ensure that we have safe delivery of health visiting services?
Matt Hancock
The hon. Lady is dead right. Of course, health visitor numbers went up very sharply between 2010 and 2015. In fact there is a proposal in the plan, and the NHS will be discussing with Government the best way to commission health visitors. Health visitors are clearly a health service but, at the moment, they are commissioned by local authorities. We look forward to working with the NHS and with the Ministry of Housing, Communities and Local Government on how best we can commission health visitors in future, because they are a critical part of maternity services.
Christian Matheson (City of Chester) (Lab)
Over the holiday period, another young woman tragically died of cervical cancer, which she contracted before the age of 25; therefore, she was not able to have a smear test. Will the Secretary of State, as part of this review, remove that ridiculous and utterly arbitrary age limit so that, where a GP believes a female patient needs a cervical smear, they can have one irrespective of their age?
Matt Hancock
I entirely understand the hon. Gentleman’s argument. He is a reasonable man who makes reasonable arguments, and I will take it up with Mike Richards, who is running the screening review. I will ask Mike to write to him specifically on that point and to take it into account.
Alison Thewliss (Glasgow Central) (SNP)
As the chair of the all-party parliamentary group on infant feeding and inequalities, I am glad that the long-term plan has a commitment to improving maternity services in England. The announcement on 30 December said that the UK Government are
“asking all maternity services to deliver an accredited, evidence-based infant feeding programme in 2019 to 2020, such as the UNICEF Baby Friendly initiative”.
What does the Secretary of State mean by “such as”? UNICEF Baby Friendly is the gold standard, as recognised by Scotland and Northern Ireland, which have 100% accreditation, but England has only 60% accreditation. Does he also acknowledge the need for community-based infant feeding support, such as peer supporters and health visitors, because it cannot just stop at the hospital door?
Matt Hancock
I pay tribute to the hon. Lady’s work as chair of the all-party parliamentary group on infant feeding and inequalities. She makes a strong and passionate case for breast feeding. I do not want to let the best be the enemy of the good. The proposal she cites is a proposal from the NHS. Of course, if other such services come forward, why should we be against it? I want to be clinically led in this area, but I very much support the thrust of her argument.
Mike Hill (Hartlepool) (Lab)
The people of Hartlepool lost their A&E several years ago, and there is a powerful argument for the return of those services. On the subject of urgent care, what measures does the Secretary of State intend to take to help our overstretched ambulance services?
Matt Hancock
There is extra support for ambulance services in the plan, which is incredibly important. The targets and accountability measures for ambulances were reviewed this time last year, and we now need to make sure that the whole ambulance service gets the support it needs.
Matthew Pennycook (Greenwich and Woolwich) (Lab)
Will the Secretary of State update the House on the review of the tariff process in relation to his statement? Specifically, what will be the impact on NHS trusts in London of changes to the market forces factor? I am concerned that those changes will mean that London loses out when it comes to the funding to be allocated in his plan.
Matt Hancock
Of course we want to make sure that the funding is allocated fairly, and we want to make sure that all the different factors that count towards and cause different costs in different parts of the country are properly taken into account, whether it is rurality or the market forces factor, so called because of the differences in relative costs. I will write to the hon. Gentleman with the full details in the coming days, but what matters here is to make sure that we are clearly led by the evidence.
Mental Capacity (Amendment) Bill [Lords]
Matt Hancock ExcerptsTuesday 18th December 2018
(5 years, 4 months ago)
Commons ChamberRead Full debate Mental Capacity (Amendment) Act 2019 View all Mental Capacity (Amendment) Act 2019 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 147(a) Amendment for Third Reading (PDF) - (5 Dec 2018)
The Secretary of State for Health and Social Care (Matt Hancock)
I beg to move, That the Bill be now read a Second time.
Every Member of this House will agree that we have a duty of care to the most vulnerable in our society, and that everybody deserves to be treated with dignity and respect, no matter what their physical or mental condition. I hope that the House will also agree that liberty is a fundamental right, and that no decision on the deprivation of liberty can ever be taken lightly. Such decisions can be taken only to protect society or individuals. There are currently 2 million people in this country who have impaired mental capacity. Care homes and hospitals often have to take decisions to restrict people’s movements in order to protect them. That could involve preventing elderly people with dementia from moving, or stopping vulnerable people getting access to things that they could use to self-harm. The present deprivation of liberty safeguards are meant to ensure that people who lack the capacity to make decisions for themselves are not deprived of their liberty unfairly or unnecessarily, but the current system is broken and needs to change.
Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
What assurances can the Secretary of State give us that local authorities will be given sufficient resources to allow them to process all deprivation of liberty cases?
Matt Hancock
The resource question is an important one, and so too is the process. The question of resources and the question of what the process is go hand in hand. There has been an increase in the amount of resources given to local authorities to enable them to deliver in this area, but the question will undoubtedly arise again as we run up to the spending review.
Mr Jim Cunningham (Coventry South) (Lab)
I visited a police station a couple of weeks ago, and I found that the police lacked adequate training to deal with some of the cases that they were coming across. Has the Minister had any discussions with the Home Secretary about that?
Matt Hancock
Yes, I have. This is an incredibly important point. The deprivation of people’s liberty in a police cell when there is a lack of mental capacity—or, in certain circumstances, when there is a serious mental illness—happens far too often. The purpose of police cells is to detain criminals. Providing a system in which such people do not have to be held in police cells is absolutely critical and part of our plan.
Several hon. Members rose—
Matt Hancock
I want to make a little bit of progress.
For many reasons, the current system is broken. Too many people do not have the protections they need because of a bureaucratic backlog. There are currently more than 125,000 people waiting to be processed, and nearly 50,000 people have been waiting for over a year.
Matt Hancock
I will give way to the right hon. Gentleman, who did a huge amount of work on this as a Minister in the Department.
Norman Lamb
I thank the Secretary of State for giving way. I share his view on the extent to which the current system is broken. He will be aware that the Bill came under substantial criticism in the House of Lords, and that substantial improvements were made to it there. There is a recognition, however, that there is still a long way to go. Will he commit to working with the Opposition parties and to meeting us and interested parties beyond Parliament to ensure that by the end of this process we have an agreed Bill that will actually improve people’s safety?
Matt Hancock
Yes, absolutely I will. I know that the right hon. Gentleman met the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), yesterday to discuss this question. Of course this ought to be a collaborative process. Improvements were made to the Bill in the other place—I shall talk about those in a moment—but we recognise that further improvements could still be made. Ultimately, there is a careful balance to be struck between the need to protect people who do not have the full mental capacity to take care of themselves and the need to ensure that we do not deprive people of their liberty unnecessarily. That is a careful balance, and we should take this forward on the basis of open discussion and deliberation, rather than of a party political ding-dong.
Paul Blomfield (Sheffield Central) (Lab)
The Secretary of State is clearly right about the system being broken, and one aspect of that is the shockingly low rate of appeals under deprivation of liberty orders, which currently stands at about 1%. Although the case law has become clearer, in most situations there is a positive obligation on advocates to progress cases to court where somebody is objecting to their deprivation of liberty, either directly or even through their behaviour. In contrast, 47% of detention decisions under the Mental Health Act 1983 are appealed. The Bill’s impact assessment predicts that the number of appeals will halve under the new procedure. Given the amendments that were made to the Bill in the Lords, does the Secretary of State think that the Government should now review that figure?
Matt Hancock
All such considerations should be taken into account and looked at in Committee. We made changes to that area in the Lords, and we are determined to reach the right balance, but I take the hon. Gentleman’s important point seriously. Like anyone who has read the Bill, he will know that it makes a significant improvement in this area. Rather than cases being immediately passed on to the courts, there is a process in place both before the deprivation of liberty where that is possible, which is a big improvement, and then later on when the deprivation is questioned. I accept the thrust of the hon. Gentleman’s intervention, but the Bill makes significant progress, and if he has suggestions for how the details may be nuanced still further, we are all ears because this is very much a collaborative process.
Lyn Brown (West Ham) (Lab)
I am surprised that this Bill and the reforms to the Mental Health Act are not being considered at the same time. As I understand it, this Bill would allow clinicians and managers to detain somebody for up to three years without a renewal decision, which is much longer than is recommended for community treatment orders by the Wessely review. If both reforms are implemented, patients detained under the Mental Health Act could have the security of a shorter review period than those detained under this Bill. Will the Secretary of State tell me whether that is the Government’s intention or simply a mistake?
Matt Hancock
The hon. Lady is not quite right about the three-year period, because there are review points, meaning that it involves a twice-possible one-year extension, so she is not quite right about the relationship between that and what happens under the Mental Health Act. However, she makes an important point about the links between the Mental Capacity Act 2005, this Mental Capacity (Amendment) Bill and the mental health Bill that we propose to bring forward.
We considered putting the two Bills together, but we did not do that for two reasons. First, it would simply be a big Bill that included two separate regimes, and we would not want the full Mental Health Act powers to be applied across the board, and I think there is a broad consensus behind that. Secondly, the view of Sir Simon Wessely, who ran the review into the Mental Health Act, is that we need to get on with this while taking the time to get the Mental Health Act update right. Combining the two was seriously considered, and I considered it again when I became Health and Social Care Secretary and asked for further advice, but we came to this conclusion, which I hope the hon. Lady will support.
Mr Kevan Jones (North Durham) (Lab)
I do not disagree with Sir Simon Wessely’s conclusions about that, but the review does contain suggestions that could be transferred into this Bill. For example, the use of tribunals instead of the Court of Protection in some cases would make them a lot simpler, cheaper and better for the person involved.
Matt Hancock
The right hon. Gentleman is quite right. To start to deal with the serious number of cases that we need to make progress with, the interface between this Bill—hopefully on the statute book by then—and the Mental Health Act provisions will be considered as we develop the draft mental health Bill. The truth is that the current system causes unnecessary suffering, and the case for reform could not be more urgent. That is why we are bringing forward this Bill now. Age UK, the UK’s largest charity working with older people, says we have a crisis in the current system that is
“leaving many older people with no protection at all… If we lose this opportunity we’re unlikely to get another one in this Parliament and it is profoundly unfair on the older people and their families…to have to wait any longer…doing nothing is not an option.”
Melanie Onn (Great Grimsby) (Lab)
Has the Secretary of State had any discussions with the Justice Secretary about the application of the measures in this Bill upon those who are serving prison sentences, particularly indeterminate sentences?
Matt Hancock
I have had some discussions on that subject, and I am happy for the hon. Lady to take up that point in more detail either directly with me or with the Minister for Care, or in Committee, because there are significant interlinkages between the two areas.
The Bill builds on the extensive work and recommendations of the Law Commission. It has been fully scrutinised by the Joint Committee on Human Rights and then improved by the other place, as has been discussed. I am grateful for all that work. Ultimately, it is about striking a balance between liberty and protection.
John Howell (Henley) (Con)
My right hon. Friend mentions the Law Commission and its suggestions. What he proposes does not quite tally with all the Law Commission’s recommendations. Where are the differences?
Matt Hancock
We built the Bill on the basis of the Law Commission report, but we have put some differences into the Bill. For instance, we think the principle of prioritising people over process is important, and we have strengthened that compared with the Law Commission’s recommendations. The Law Commission improves the law but does not make policy decisions. On top of the Law Commission’s work, which is incredibly helpful, we have made further policy decisions to ensure that people are put more foursquare at the heart of the process. It is true that the Bill and the Law Commission’s recommendations are not exactly aligned, but I would strongly defend our further improvements.
Geraint Davies (Swansea West) (Lab/Co-op)
I have the privilege of chairing the all-party parliamentary group on speech and language difficulties. The Royal College of Speech and Language Therapists is concerned about the conflation of mental capacity with speech and language difficulties. It is important we have provision so that people with speech and language difficulties are appropriately assessed and are not banged up because they are thought to be dangerous. There should be enough training in light of the fact that 60% of people in the criminal justice system have speech and language difficulties.
Matt Hancock
The hon. Gentleman is absolutely right about the importance of getting highly trained social workers to make these judgments and about the importance of making sure such training is provided for and embedded in the Bill. He speaks powerfully, and I agree with how he puts it.
The Bill introduces a new liberty protection safeguards system, and it makes the authorisation simpler and more straightforward. It removes some bureaucracy and duplication, and it makes the system easier to navigate for individuals and their family. People will get their rights protections sooner, there will be greater independence when decisions are taken to restrict liberty, and the NHS and social care providers will be given a bigger role in the decision-making process so that people under their care receive the right care and their rights will be protected. It will introduce an explicit duty to consult the person being cared for and to consider their wishes and feelings.
Bob Stewart (Beckenham) (Con)
An appropriate person will be appointed when dealing with vulnerable people. Who are these appropriate people, and what will be their role?
Matt Hancock
An appropriate person will have greater involvement in any decision to restrict liberty, so their role is essentially to speak for those whose liberty is potentially being restricted. We have framed this in terms of an “appropriate person” because in large part this will be a family member or a carer, but that cannot always be the case.
Matt Hancock
It could easily be a carer, yes. Some people have no family and in others cases the family are not the appropriate people to be the spokesperson for those who are mentally incapacitated. The appropriate person—the families and carers—will have greater powers to intervene or to object. Crucially, where there is no family or an appropriate person to advocate for the individual, the person has the right to an independent mental capacity advocate. So in all cases there should be a person whose role in the system is to advocate on behalf of the person whose liberty is being restricted.
Paul Blomfield
Does the Secretary of State accept that that access to an advocate should not be necessarily subject to a best interest test, as is being proposed, but should be a right?
Mr Deputy Speaker (Sir Lindsay Hoyle)
Order. Just to help everybody, let me say that we have 11 speakers, we still have to hear from the Opposition shadow Minister and we have the wind-ups. So I hope we can take that into account, although I recognise that the Minister is being very generous.
Mr Deputy Speaker
Order. Perhaps I will have to set it out differently. What I am trying to say is that we have 11 Members to speak and we could try to give them some time. Important as this and giving way all the time is, it is very important that we hear from other people.
Matt Hancock
Noted. Returning to the point made in the intervention, of course if there is an objection, there is a right in this case. So there is an escalation process in the event of an objection.
Before I end, I want briefly to deal with the Opposition’s reasoned amendment, because I hope we are able to show in this debate that all the points they raise have been considered. I hope the House will not mind my taking a moment to address each one briefly. First, they make the claim that somehow the Bill has been rushed through and insufficient pre-legislative scrutiny has been carried out. The Bill follows the Law Commission spending three years developing the new model, consulting extensively. The Joint Committee on Human Rights then conducted an inquiry and pre-legislative scrutiny. The Local Government Association, Age UK and Sir Simon Wessely have all backed the new legislation now. The LGA says:
“The Bill provides a vital opportunity for long-awaited reform”
and it needs to be passed. So we need to get this Bill on the statute book, because every extra delay risks depriving someone of their liberty and their right to freedom unnecessarily, and I do not want to see that happen.
Secondly, the amendment claims that the Bill
“enshrines a conflict of interest in relation to independent providers of health and care services”.
Again, that is not the case. Every authorisation must be reviewed by somebody who does not deliver day-to-day care and treatment for the person in question. We plan to go further by tabling Government amendments that will require authorisations in independent hospitals to be reviewed by an external approved mental capacity professional. Finally, the reasoned amendment claims that it is concerned about clearing the backlog in the current system. Well, so are we, and that is what this Bill does. Anyone concerned about the backlog and the current system should back the Bill with enthusiasm.
The claims that this Bill does not put the interests of the cared for person first or address the interface with the Mental Health Act have been addressed already. The very reason we need this legislation is so that we can put their interests first, because they cannot afford to wait for the recommendations of the Mental Health Act review to come into effect, in a Bill that will inevitably take time to develop, because of the need to do this on a consultative and broad basis. While welcoming the probing, I very much hope that the Opposition and every Member of this House will support this Bill, because it strikes a careful balance between liberty and protection. It offers vulnerable people a brighter and better future. We have listened to concerns and we continue to be open to ideas. We have sought to amend and improve the Bill as it has progressed through the other place, and we will make further amendments in this House. I therefore hope that this opportunity to change the system for the better is one that the House recognises. I also hope it will recognise that doing nothing is not an option. That is why I am proud to commend the Bill to the House.
Barbara Keeley
I thank my hon. Friend for saying that, and it is the case.
Let me give an example. Just last week, the BBC’s “Victoria Derbyshire” programme exposed the horrific case of Rachel Johnston, a woman with learning disabilities who died after having an operation to remove all of her teeth. Rachel had a long-standing and extensive dental problem, but, clearly, could not consent to the dental work. Rather than doing the surgery in several treatments, the dentist opted to remove all her teeth in one operation, using the Mental Capacity Act to authorise the use of a general anaesthetic because he deemed it to be in her best interest. After being discharged, Rachel bled profusely from her gums, developed breathing difficulties and later died. How on earth can that treatment have been in her best interest? That case shows a need for greater safeguards, not fewer safeguards. We should not allow medical professionals to make decisions without considering the best interests or wishes of people who lack the capacity to consent to treatment.
I recognise that, as the Secretary of State mentioned, the Government conceded in the House of Lords that the cared-for person must be consulted, but there are still worrying aspects of the Bill that undermine that principle. We should ensure that individuals have access to an independent advocate. That is a vital safeguard that allows people to challenge authorisations, and it should be the default. The manner in which the independent mental capacity advocates can and should be appointed remains ill-defined and even contradictory.
The Minister in the House of Lords, Lord O’Shaughnessy, seems to have dismissed concerns raised about the application of a best interest test before the appointment of an advocate. The role of an advocate is essential to allowing individuals to access appeals and review their rights. Access to support from advocates should not depend on best interest tests, and the provisions in the Bill are far weaker than those proposed by the Law Commission. Yet despite that being pointed out in the debate in the House of Lords, the Minister there seemed unwilling to listen to advice, merely saying that it would work “in practice”. That is simply not good enough. These factors amount to a severe undermining of the concept of the individual’s best interests, which should be at the heart of the Bill but is sorely lacking.
I will now address the backlog of deprivation of liberty safeguard applications, because at the outset the Government presented the Bill as a cost-effective way of reducing it. On Second Reading in the House of Lords, the Minister claimed that the Bill would relieve
“local authorities of the…legal liability burden of more than £408 million by removing the backlog of…applications.”—[Official Report, House of Lords, 16 July 2018; Vol. 792, c. 1060.]
But he made no mention of how that would happen. Our conclusion is that by attempting to place the onus for assessments on care home managers, the Bill would remove the responsibility from cash-strapped local authorities.
The Government initially tried to pass responsibility for assessments on to care home managers, and that was clearly intended as a cost-cutting measure. That was amended in the House of Lords, but care home managers will still decide whether an assessment needs to take place and will also identify whether the person being cared for objects to a liberty protection safeguard for their own care and treatment. The British Association of Social Workers has said that this presents a potential conflict of interest for care homes, as they need to maintain occupancy and may not readily identify an objection by the cared-for person.
The BASW has a further concern about the grounds on which the responsible body would decide whether it or the care home manager would make the necessary arrangements for an LPS authorisation. There is a significant risk of a two-tier system, whereby local authorities under financial or waiting list pressures would default to care home managers completing the new duties, and other local authorities under less strain would do the assessments themselves. I think we have enough of a postcode lottery in care without adding to it through the Bill.
Care England, which represents the network of care providers, says:
“There is a lack of clarity about the role of the Care Home Manager...the separation of roles between care homes and community care provision seems designed to increase rather than reduce confusion and complexity.”
Indeed, the body is so concerned by this Bill that is has also said:
“This ill-considered Bill risks storing up a range of problems of a kind that we do not want and should be slowed or returned for redrafting.”
There remains a further dangerous conflict of interest at the heart of the Bill because of the role that independent hospitals are given in the assessment process. Despite debate in the House of Lords regarding the role of independent hospitals, under the Bill they would still be allowed to appoint their own approved mental capacity professionals. That would allow independent hospitals the responsibility to authorise deprivation of liberty for people in that same hospital for the assessment and treatment of mental disorders. That is plainly wrong.
Barbara Keeley
The Minister says no, but Lord O’Shaughnessy in the House of Lords would not consider amendments tabled by two parties to deal with that issue. It is plainly wrong and represents a very clear conflict of interest.
Moreover, the Bill currently allows for the deprivation of someone’s liberty to be authorised for up to three years without review after two initial periods of 12 months, as the Secretary of State said earlier. It cannot be right to have that period of three years without renewal. The Bill is reducing the protections afforded by the current DoLS system, which operates a maximum period of 12 months before renewal.
Barbara Keeley
Very much so. I will come on to that shortly, but I will not leave the point about independent hospitals, because it is important.
We know only too well from media reports, and the Secretary of State does too, of the torrid situation in independent hospitals that detain people with autism and learning disabilities under the Mental Health Act, and the measures in this Bill could have disastrous and far-reaching consequences. I have raised at the Dispatch Box on several occasions the appalling treatment of people with autism and learning disabilities in assessment and treatment units. I have described the situation as amounting to a national scandal, and I believe that it is still so. As many as 20% of people in these units have been there for more than 10 years. The average stay is five and a half years. The average cost of a placement in an assessment and treatment unit for people with a learning disability is £3,500 a week, but the costs can be as high as £13,000 a week or more.
As the journalist Ian Birrell has exposed in The Mail on Sunday, private sector companies are making enormous profits from admitting people to those units and keeping them there for long periods. Two giant US healthcare companies, a global private equity group, a Guernsey-based hedge fund, two British firms and a major charity are among the beneficiaries of what campaigners have seen as patients being seen as cash cows to be milked by a flawed system at the expense of taxpayers. According to a written answer I obtained from the Department of Health and Social Care, in the past year alone the NHS has paid out over £100 million to private companies for these placements. Shamefully, the Government cannot reveal how much they have spent since they came to power, because they claim that they did not record the expenditure before 2017. It cannot be right that the Bill potentially gives private companies the power to lock up vulnerable people for years at a time to feed a lucrative and expanding private health sector.
I would like to draw attention to one more issue that the Bill does not address—we have already discussed it—and that cannot be papered over by amendments. The Government commissioned Professor Sir Simon Wessely to lead a review of the Mental Health Act, which is of course long overdue for reform. However, as the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said, there is clearly a complex interface between the Mental Capacity Act and the Mental Health Act. Professor Sir Simon Wessely has made the point that there is now a worrying trend of people, particularly with dementia, being detained under the Mental Health Act when their deprivation of liberty should be dealt with under the Mental Capacity Act. His review recommended imposing a new line of objection to determine who should be treated under which legislation, but, as the hon. Gentleman said, there has been no engagement with these recommendations, which were finalised as this Bill was going through the House of Lords.
In our view, the Government must commit to a review of the interface between the two Acts, with full consultation, which has, to date, been sorely lacking. It is one thing to say that Sir Simon had a conversation with the Secretary of State about this, but that is not full consultation. The consultation must look at both hospital and community settings and provide clear and accessible rights of appeal.
Matt Hancock
Of course the interface between the Mental Capacity Act and the Mental Health Act will be considered, but Sir Simon himself favours bringing forth the Mental Capacity Act renewal now and then dealing with the Mental Health Act later. As with all of the hon. Lady’s other considerations, that has been taken into account, and this is the best way forward.
Barbara Keeley
Well, clearly we do not agree.
The reform of the Mental Capacity Act began as an attempt in good faith to reform a flawed piece of legislation that fails to protect the human rights of some of the most vulnerable people in this country, but it now threatens to infringe those rights further through this Bill. We simply cannot afford to rush an issue of this magnitude where individual liberties and human rights are at stake. Indeed, the Minister in the House of Lords himself admitted:
“We cannot introduce another Bill or piece of legislation that just creates a problem three years down the line.”—[Official Report, House of Lords, 16 July 2018; Vol. 792, c. 1110.]
But that is exactly what this Government are trying to do today. We will fail some of the most vulnerable people in society if we allow the creation of flawed legislation that needs to be replaced in just a few years. We must get this right. That is why the Government must pause the Bill, and why I urge hon. Members to vote for our reasoned amendment and ensure that Ministers get the message loud and clear.