Childhood Obesity

Nadine Dorries Excerpts

Tuesday 16th October 2018 Commons Chamber

[Ms Nadine Dorries (Mid Bedfordshire) (Con)]

Let me first declare an interest: I am currently taking part in a television experiment relating to obesity.

The United Kingdom is now the third most obese nation in the world. That is a shocking fact, especially when, as we know, the second biggest preventable cause of cancer is obesity. This is a crisis, and as always when there is a crisis, the innocent victims are the children. The obesity crisis that is hitting the UK is no exception: the victims are the vulnerable, the poor and the children.

I pay tribute to Andy Cook, the director of the Centre for Social Justice. The work of that prestigious organisation does not receive the praise or recognition that it should. A report produced by the CSJ, “Off the Scales”, provides an in-depth analysis of the obesity crisis facing the UK and makes a series of recommendations that complement the Government’s own obesity strategy report of 2016. However, the difference between the two reports is fundamental.

The CSJ report takes a holistic, headline view that is workable and suggests pathways towards the measuring of deliverable outcomes and progress. It highlights the success of implementing a joined-up cross-organisational and cross-departmental strategy to solve a problem that is costing the taxpayer more than £30 billion a year, and, more importantly, costing the lives of a future generation. It highlights some of the weak areas in the Government’s childhood obesity plan, which was published by the Department of Health in August 2016 and aimed to reduce childhood obesity rates in England over the next 10 years. It is a good plan, but it has little chance of making any impactful difference, as there is little in the way of joined-up thinking or leadership, or accountability, on the part of individual Departments.

Let me explain, in the starkest terms possible, why this issue is so important. For the first time ever, one in four children of the next generation will die younger than their parents. Nearly a third of all children aged between two and 15 are overweight or obese, as the Government report itself highlights. Younger generations are becoming more obese at earlier ages, and obesity doubles the risk of dying prematurely, so this is an incredibly serious problem. I am not sure that many parents know that, but they should, and we should be doing more to make sure that they do.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I congratulate my hon. Friend on securing this debate on such an important topic. Does she agree that this is a major health crisis affecting young children? Not only will those children die younger than their parents and before they would have expected to, but they will experience more suffering during their life due to the ill health caused by obesity.

[Ms Dorries]

I thank my hon. Friend for that intervention. She is a doctor and knows more than most about the health impacts of obesity, which include diabetes and other illnesses that are costly both to life and the Government.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Lady give way?

[Ms Dorries]

When I have ever not given way to the hon. Gentleman—and when has he ever not intervened?

[Jim Shannon]

I congratulate the hon. Lady on securing this debate about something that is a massive issue in my constituency. I am a type 2 diabetic—it is interesting that she has referred to that—and I became a type 2 diabetic because of the horrendous food I ate and the lifestyle I had as a young person, until I became a diabetic. It is essential that we address with young people the age-old principle of all things in moderation. I supported the sugar tax and changes to the way in which nutritional information is displayed. Does the hon. Lady agree that while large steps have been taken, there is more to be done to tackle this? Funding must be allocated to allow charities and Sure Start to run programmes on nutrition to teach people cheap and efficient ways of healthy eating.

[Ms Dorries]

The hon. Gentleman nearly got a speech in there. As I said, I will go on to address funding issues.

The parents on whom this issue impacts the most, and who are most likely to be affected, are those who make the poorest nutritional choices. They do not take The Times, or spend time on the internet reading the news or visiting any other sites where information about the effects of obesity on their children is likely to be repeated. They are also the parents who live in areas of higher deprivation. The fast-food, junk-food giants place more of their outlets in such areas than in areas of affluence, which makes the temptation easier and the consequences more impactful.

What can we as a Government do? I want to praise the headteacher and staff at Shillington Lower School in my constituency. Every morning after assembly, every child joins in with 15 minutes of vigorous exercise. Some are outdoors, running around the field perimeter, while others are in the hall doing boot camp with the cyber coach. That is in addition to their normal PE lessons and physical activities. The school actively encourages walking to school, and I have to say that Shillington Lower School’s efforts are there to be seen, but that is one approach, in one school in one village.

I am doing my little bit by embarking on a tour of schools in my constituency, and I am speaking to public health officers at Central Bedfordshire Council to find out how much more we can do locally in my Mid Bedfordshire constituency. However, this piecemeal approach is part of the problem. We have local council initiatives, as well as individual schools, teachers, parents, elected Mayors, public health officers, social workers and health visitors all doing their own little bit, and while that is all incredibly worth while, no one knows what the other is doing. The approach is taken on the basis of good intentions, but it is far from being an effective plan to deliver any measurable results.

This issue should be a governmental and departmental priority, regardless of Brexit and the noises off. This crisis has nothing to do with Brexit and everything to do with the lives of our children, yet there is no plan that co-ordinates a national strategy to make dealing with this issue a priority, and there is zero leadership from the top—I am very sad to say that. A national crisis requires leadership and a holistic, co-ordinated headline plan. Tackling this problem needs to be one of the Government’s top five priorities, and that needs to include funding.

The Minister is very much doing his bit, in line with the Government’s obesity plan. That is a great achievement, but sadly it is nowhere near enough to tackle the problem. The Minister is a good, conscientious and pragmatic man, and the father of healthy and very beautiful young children. I know that he personally is as worried about this as anyone else, but he is just one Minister in one Department, although I accept that his is the Department that should be leading on this, in accordance with the Government’s aims and objectives in this area. However, if we had some high-level leadership and direction, we could have all the Departments working together towards one strategy and working together as one taskforce to establish our short, medium and long-term goals to reduce the weight of the nation and in particular of our children.

In fact, the Minister is the only person who is accountable for tackling this national crisis. As “Off the Scales” highlights, there is little or no direct accountability among Departments for the childhood obesity plan, other than the Department of Health and Social Care and a small requirement on the Department for Education. What about the Ministry of Housing, Communities and Local Government? What about the Department for Digital, Culture, Media and Sport, given that sport is one of the biggest players in the fight against obesity? What about the Department for Environment, Food and Rural Affairs, the Department for Transport and the Treasury? We know that the Treasury is the place where all good ideas go to die, regardless of which party is in power, and it is not giving this national crisis serious consideration. So many people—from the wonderful staff at Shillington Lower School all the way up to the Department of Health and Social Care—are doing their own thing, but, sadly, none of this can be monitored or measured, because it is all entirely disjointed and unconnected.

The NHS has recently enjoyed a £20 billion cash injection. At present, only 0.2% of the NHS budget is allocated to Public Health England to deal with obesity and to put in place preventive strategies with regard to childhood obesity, yet the Government’s plan places huge responsibility on Public Health England to tackle this issue.

[Dr Caroline Johnson]

Does my hon. Friend agree that money spent on managing obesity is money well spent? In fact, the money that is invested in helping people to be more healthy will be recouped, because there will be less NHS spending on their ill health.

[Ms Dorries]

I think that my hon. Friend has seen my speech; my next point is that we are putting the cart before the horse.

There is a huge responsibility on Public Health England, yet it has only 0.2% of the NHS budget. The Government have reduced the public health budget by £600 million between 2015 and 2018 and increased the NHS budget for acute and hospital care. This complements my hon. Friend’s point, because they are pumping all that money into hospitals and acute care, but putting very little into strategies to prevent people from going into hospital in the first place. This imbalance in the NHS budget demonstrates how little attention and importance are being given to this crisis at the top of the Government by No. 10 and No. 11—particularly No. 11 and the Treasury.

As I said, the cart is being put before the horse. As a nation, we are allowing people to become ill. We are failing to prevent that from happening, but we are providing state-of-the-art hospitals and doctors in our amazing NHS to treat them. We should be placing our focus on preventing obesity, which is the second biggest preventable cause of cancer after smoking, and keeping people out of hospital.

Of all the nations that fund healthcare, we have one of the highest healthcare budgets in the world. We spend more each year on treating obesity and diabetes then we spend on our police, our fire service and our judicial system combined, yet we allocate only 0.2% of the NHS budget to Public Health England. When we cost out Public Health England and take out its accountable costs, we see that only a tiny fraction of that 0.2% is given over to obesity prevention and treatment in real terms. The chasm between treatment and prevention highlights the critical need for the Government to develop their approach to the delivery of public health services further and to ensure that prevention receives the investment it so desperately requires.

It is time for the Treasury to think forwards, not backwards, by reversing the reduction in councils’ public health budgets and providing local councils with the funding they need to tackle this problem head on. Local councils should be the major player in this strategy, yet they have seen their funding for public health services cut. They know their own demographics. They know the problems in their area, and they know how to deal with them. Local councils have already engaged as much as they can with this issue, and they are saving the lives of the next generation.

I cannot say it often enough or strongly enough: one in four children will die younger than their parents. If we lined up 50 parents and told them that figure, they would be shocked. Parents needs to know that information.

How much of the new £20 billion that the Government are allocating to the NHS will be made available to Public Health England and, in turn, towards funding the Government’s childhood obesity plan of 2016? As much as people scream and shout that the NHS is being starved of funding, the truth is that the recently announced £20 billion, along with savings from the £20 billion Nicholson challenge, amounts to a £40 billion uplift to treat people who are taken to hospital with illnesses induced by obesity.

Given that Public Health England has been given responsibility for decreasing the proportion of children leaving primary school overweight over a 10-year period, why is so little of the NHS budget allocated for preventive medicine? What uplift was PHE given to address this childhood obesity crisis? How is it supposed to achieve the aims and objectives set out in the 2016 plan? Does the Minister not believe that there should be a cross-departmental strategy, devised by Ministers, to set out in detail what each Department will do to achieve pre-determined goals? If that is not the case, we should engage in a national information and media drive to warn parents of the dangers of obesity. Allowing a child to become obese is almost as dangerous as putting cigarettes in their mouth.

I understand why the Department of Health and Social Care introduced a policy to cap the calories in various types of junk food, but it will not work—people will buy two. The voluntary sugar reduction targets in the 2016 plan have not been met by the main producers and providers of these foods.

Is it not time to introduce a mandatory approach? I am aware that the money raised by the sugar levy—I probably should have mentioned this earlier—is to be allocated to implementing some of the aims and objectives set out in the 2016 plan, and the Government’s approach is a welcome step, but where and to whom will that money go? Will it be allocated to local councils? Is it enough?

As we have seen with food producers that are not meeting the requirement to reduce sugar in food, will the same happen with the sugar levy? Will it actually make a difference? Will it give us the funding that we need to tackle this crisis? I would say not, because we are basing our plans on something subjective and unknown. We do not know how much the levy will raise. We do not know whether producers will reduce sugar in drinks and food. We do not know to what degree the sugar levy will work. As this is such a crisis, should we not be looking at more quantifiable measures?

Where will the money go? Is it not time to consider the recommendations of the Centre for Social Justice and develop a frontline approach? I cannot think of any Government policy on which all Departments work together and on which there is a non-political taskforce above the Departments run by an independent body to pull together policies from each Department to tackle an issue—that goes entirely against our culture—but that is what we need. Should we not work with companies that load food with sugar and set them mandatory goals, not voluntary goals, to reduce the amount of sugar over a period of time? Should we not introduce financial penalties? We have seen producers of products such as breakfast cereals do just that, but the problem is that it is not happening fast enough, it is not consistent and it is not equitable, because only some producers are doing it.

Only by adopting a long-term approach that is nationally led and locally driven, with the councils involved and heading it, that is overseen by an independent body outside the influence of party politics and that is championed by committed political, cross-party leaders will an effective childhood obesity plan ever be delivered. I do not want to chuck a bucket of cold fizzy drink over the Minister’s 2016 plan, because it is a great initiative and I hope it will make some difference, but I hope he understands my concern that the money just is not there to tackle this problem head on now. I go back to the substantive point in what I have just said: 0.2% of the NHS budget going to Public Health England, despite the sugar levy and the taxes we are going to raise, is just not saying, “We are committed to doing this,” and the money has to go to local councils.

Management of NHS Property

Nadine Dorries Excerpts

Wednesday 4th July 2018 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

I beg to move,

That this House has considered the management of NHS property.

It is a pleasure to serve under your chairmanship, Ms Dorries. [Interruption.]

[Ms Nadine Dorries (in the Chair)]

Order. Mr Zahawi, the debate has started.

[Karin Smyth]

I recognise that the management of NHS property is not the most enthralling subject, but many hon. Members from across the country will recognise that it is a growing problem in their constituencies. The problems are varied and many. My focus today will be on the community and primary care estate.

I will not talk about bricks and mortar or leaking pipes, or outline the detailed and manifold operational challenges posed by an NHS estate that in many parts of the country still relies on pre-1948 infrastructure. Instead, I want to talk about the places our constituents go to when they need care, where they welcome their children into the world and where they say a final goodbye to those they love. They are places where some of our most precious memories are forged, capable of delivering huge happiness and hosting unimaginable grief. They are hard-wired into our emotional DNA and the fabric of the communities in which they sit. They are places that are paid for by our constituents through their taxes, which our constituents feel ownership of and an enormous attachment to. It is in this difference that the notion of local or personal ownership is blown apart. The harsh reality is that our constituents do not own these properties. Moreover, they do not even have a say in how they are run or in their future.

Who owns them? Who runs them? How do they operate? How can users or stakeholders such as MPs influence change? Those questions are hard to answer as control of these special buildings is opaque to the point of absurdity. The lines of accountability are unfathomable and, as so many colleagues will know, incredibly frustrating to deal with. I have spoken to numerous colleagues across the House about these issues.

Junk Food Advertising and Childhood Obesity

Nadine Dorries Excerpts

Tuesday 16th January 2018 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

I congratulate my hon. Friend the Member for Erewash (Maggie Throup) on an excellent speech.

Our thinking on this issue has been somewhat muddled in the past, and I encourage the Government to be bold as they work to improve their child obesity strategy further. There is a huge public interest here. As taxpayers, we all have to support the NHS; something like 10% of the budget of NHS England is involved with obesity-related issues, whether that is type 2 diabetes or a range of other health conditions caused by obesity. So every one of us, as taxpayers, has an interest in this issue.

It is also an issue of social justice, in that—unlike at any other time throughout history, really—it is now the poorest children who are the most overweight. We have flipped what has happened throughout history, when it used to be the poor who were thin and emaciated, and the better-off who were plump and well fed. We cannot allow an unemployable underclass to grow up—children who are obese, who go on into adult life being obese and have a low self-image and low self-confidence, who then struggle to get work as a result, and who have a low income or are on benefits. We are talking about the loss of a lifetime of opportunity if we do not grasp this issue, so it really matters.

It is serious. Lord Patel, who chaired the House of Lords Committee on the future sustainability of health and social care, told the—[Interruption.]

[Ms Nadine Dorries (in the Chair)]

Order. I remind Members that conversations are for outside. Thank you.

[Andrew Selous]

Thank you, Ms Dorries. Lord Patel told the Commons Health Committee on 24 October last year that the United Kingdom had the second worst obesity problem in the world, after the United States of America. I want to see action on a range of issues. Credit where credit is due—the sugary drinks levy has been successful, but the Government are now measuring nine types of food. We look forward eagerly to the release of that data in March this year. If we have established the principle with sugary drinks, there is no reason why we should not extend that approach to other foods, so that it will lead in the main part to reformulation, as the hon. Member for Sheffield Central (Paul Blomfield) said earlier.

I had a good meeting with Kellogg’s a couple of weeks ago. It is making serious efforts to make their breakfast cereals have much less sugar, so there is movement in the right direction, and by extending the framework of the sugary drinks levy to other foods, we could encourage that process further, which would be helpful.

If the Government are worried that there will be devastation in the food and drinks industry, they should take heart from what happened in Thailand. We know from a recent study by the University of Bangkok what happened when Popeye was featured a lot on television in Thailand. Of course, Popeye—as we all know from our own childhoods—ate lots of spinach and one particular television programme showed children developing fantastic muscles through eating lots of spinach. Those children who watched lots of Popeye programmes doubled their intake of spinach and other green vegetables. So, if some food and drinks manufacturers end up making less harmful foods, perhaps we will see an increase in the healthy and nutritious part of our food industry, which we all want to encourage and we all want to see have a great future in this country.

Like my hon. Friend the Member for Erewash, I do not think that only one measure is the solution to this problem. I welcome the specific focus of this debate on ramping down advertising to children, but there is a whole range of measures we can take, including clear food and drink labelling. The traffic light system labels should be on all food in our supermarkets. They are clear and easy to understand; the public can understand them. Also, when we go into a restaurant, why not make the number of calories in what we are ordering available? That would give people information.

We could do so much more in planning. I would like to see health as an objective in planning policy, and to see local authorities having the ability to turn down planning permission for unhealthy fast food outlets right next to schools. We cannot beat the food industry over the head and then allow a proliferation of shops selling unhealthy food right next to our schools. We need to be measured, we need to be fair and we need to have a policy that applies across government.

I would like the Minister to get on an aeroplane and go over to Amsterdam. I am extremely grateful to the Centre for Social Justice for drawing our attention to the Amsterdam healthy weight programme. The Minister looks as if he has not had that much foreign travel, so perhaps we can get him on a plane to Amsterdam before too long. It would not be a jolly; it would be a very serious piece of work. We do not need a pilot or to try a few things here or there, to see what works. We have four years of hard data from the Netherlands, showing that if there is a city-wide approach, led by political leaders, progress can be made. In Amsterdam between 2013 and today there has been a 12% reduction in the number of obese children across the board and an 18% reduction in obesity among the most deprived children. Mayor Eric van der Burg has shown that with political will, a ban on advertisements of fast and junk food in every metro station in Amsterdam, consideration of the built environment, and consideration of health in every policy, progress can be made.

I have raised the matter with Simon Stevens in the Health Committee, and I raise it now in the presence of the Minister: let us see action. We do not need to reinvent the wheel; a model just the other side of the channel has delivered results and we need to replicate that here.

We need to support our health professionals as well. There is an initiative called “make every contact count”, in which every clinician—at the GP surgery or in hospital—is supposed to talk about healthy lifestyles and weight at every opportunity but, in reality, it rarely happens, as they are overworked and time-pressured. Nevertheless, we need to hold firm to that, and to help GPs have sensible and sensitive conversations, recognising that people may find it a difficult and sensitive subject. It is not about embarrassing or upsetting anyone. I am lucky to be able to eat like a horse and look like a rake, but I recognise that not everyone is like that. This is a challenge; many environmental factors make it difficult for many families.

We need to encourage our schools to do the right thing. I pay tribute to Ardley Hill Academy and Linslade School in my constituency. They both have a fantastic graphic on the wall of different types of drink, showing the number of sugar lumps in each. The bottle of water at the end has, of course, none. What an amazing graphic.

--- Later in debate ---

[Conor McGinn]

We are talking about TV, and we have heard a lot about advertising, but it is important to look at what happens between the adverts: the programming. Some 18 months ago, ITV launched a very good initiative called “I am Team GB”, where it switched off the channel for an hour. Some 2,500 sports clubs across the UK opened their doors and more than 4 million people were motivated to take part in sport. Research shows that food-related programming promoting a healthy lifestyle has as much if not more of an impact than advertising. In issuing charters, it is important that the Government also regulate that programming so that we see a joined-up approach with good programming that promotes healthy living.

[Ms Nadine Dorries (in the Chair)]

Order. I remind Members that interventions should be interventions and not speeches.

[Kirstene Hair]

I completely agree with the hon. Gentleman. We need a collaborative approach, and not just one reform needs to take place.

Internet usage overtook TV viewing among children for the first time in 2016. As we know, advertising can be more tailored than ever. Custom-made adverts are being beamed relentlessly at easily influenced children, which is without a doubt having the desired effect for those who promote such adverts. It is therefore time for a shift in focus. The battle to ensure that children are exposed as little as possible to unhealthy food advertisements must move from TV to other arenas, especially online. Although that is more difficult, it is no excuse to sit back. That is why I am pleased that, as of June, the ban on advertisements for unhealthy food targeted at children, or featuring cartoon characters, was extended from TV to print, cinemas and online, including social media sites. The new rules are not big new onerous regulations, but simply a matter of ensuring that our existing level of regulation keeps up with the changing nature of children’s entertainment.

I would like many other adaptations to the way in which we educate our young people, and advertise and market to them. For example, as a young person enters a supermarket, they are flooded with sugary deals at the doorway. They have the difficult choice between a chocolate bar or a costlier fruit pot at the snack counter, and they are encouraged to integrate a sugary treat into daily lunches through meal deals. There are endless promotions in the confectionary aisle, but few similar incentives within fruit and vegetable sections. Our retailers are some of the best marketeers in the country and hold some responsibility to act on this national crisis.

I strongly believe that the classroom must provide food education as many children do not have access to that in the home. It is not a tick-box exercise. Lifelong skills with nutrition and cooking nutritious food will in turn support the education of young people so that they consume sugar and other unhealthy foods in moderation, feeding their bodies with the fuel they need, not the fuel they want. For example, home economics is a crucial subject in secondary schools. Initiatives that primary schools partake in, such as school allotments and farm visits, are undoubtedly having the correct impact. Children with sporting aspirations quickly learn what their bodies require to perform, and the encouragement of school sports and hobbies will also play a part in education and the ability to resist junk food advertisements. As a nation we grow a wide variety of nutritional produce, and having been brought up on a farm, I fully appreciate how important it is that we support our British farming industry.

In summary, as the years go on we must remain extremely vigilant to ensure that regulations continue to keep pace with the changing habits of our young people and the environments they are exposed to daily. The problem will not disappear and could escalate at an alarming rate. Advertising affects obesity, so it is crucial for the health of our future generations and our health service that we continue to reduce children’s exposure to advertisements for unhealthy food—whether that is on TV, online, or in person just prior to making a purchase—as well as educating people from a young age about the array of wonderful healthy produce grown on their doorstep.

--- Later in debate ---

[Kerry McCarthy]

This is slightly off-topic, but Lucozade has been named public villain No. 2 after Pringles, in terms of its plastic packaging. The plastic sleeves around the outsides of the bottles mean that they are impossible to recycle. Lucozade and Ribena are particularly bad. Will the Minister mention that too when he is having a go at the company about sugar?

[Ms Nadine Dorries (in the Chair)]

Order. I will allow that, Ms McCarthy, but that is the only off-issue topic.

[Steve Brine]

It is on my list.

We also challenged the food and drink industry, with Public Health England’s sugar reduction programme, to reduce the amount of sugar in the foods our children eat most by 20% by 2020. Some of the biggest players in the industry, including Waitrose, Nestlé and Kellogg’s, which a number of hon. Members mentioned, have already made positive moves towards that target. Data will be available in March this year to give us a better picture of how the whole market has responded—we will be naming names—and to show whether we have met our year one target of a 5% reduction. We remain positive, but we have been clear from the beginning that if sufficient progress has not been achieved, we will consider further action. We rule nothing out.

We further built on the foundations of the childhood obesity plan in August 2017 by announcing the extension of the reformulation programme to include calories. The Government will publish more detail of the evidence for action on calorie reduction, and our ambition and timelines for that, in early 2018.

Our plan also includes school-based interventions, which a couple of hon. Members mentioned, including the expansion of healthy breakfast clubs for schools in more deprived areas, with £10 million per year of funding coming from the soft drinks industry levy. That is on top of the doubling of the school sport premium, which is flowing into schools as we speak, and represents a £320 million annual investment in the health of our children. The hon. Member for Bristol East (Kerry McCarthy) asked whether that cash will continue to flow as companies take action. I will come back to that point, but the Treasury has guaranteed a level of funding over the next three years, regardless of what comes in from the levy. If she wants me to write to her to put that in more detail, I am happy to do so—I have found the note I meant to read out, but we have covered it anyway. Such actions will ensure that we are tackling the healthiness of the food offer available to all families. The evidence shows that that is absolutely the right thing to do.

On marketing restrictions, another part of the jigsaw is how these foods are marketed, in particular to children, which is of course the central tenet of today’s debate. I thank the Centre for Social Justice and Cancer Research UK—I met both last week—and the Obesity Health Alliance for their recent reports highlighting the marketing of products high in fat, sugar and salt, or HFSS, to children. All are welcome updates that add to the debate.

This month marks 10 years since the first round of regulations to limit children’s exposure to marketing of products high in fat, salt and sugar, when we banned advertising of HFSS products in children’s television programming. We monitor that closely, including in my own home. At the weekend I tried to explain the premise of this debate to my children and, last night, when I phoned home, they told me that while watching a well-known commercial television channel they saw a slush drink mixed with sweets. Such products are being monitored closely in the Minister’s household as well as by my officials. When I get home, I will ask my children to show me that.

Recently, we welcomed the Committee of Advertising Practice strengthening the non-broadcast regulations to ban marketing of HFSS products in children’s media, including in print, cinema, online and on social media. That point was made strongly by my hon. Friend the Member for Angus (Kirstene Hair) in her excellent speech.

The restrictions that the UK has in place, therefore, are among the toughest in the world, but I want to ensure that in the fast-paced world of marketing—many people spoke about how quickly that world is moving—it stays that way. We heard lots of “go further” calls, including by the hon. Member for Bristol East, and that is why we have invested £5 million to establish a policy research unit on obesity that will consider all the latest evidence on marketing and obesity, including in the advertising space. That is also why we are updating something called the nutrient profile model, which does not sound exciting but is important. It is the tool that helps advertisers determine which food and drink products are HFSS and, as a result, cannot be advertised to children. The purpose is to ensure that the model reflects the latest dietary advice. Public Health England expects to consult on that in early 2018.

Secondary Breast Cancer

Nadine Dorries Excerpts

Wednesday 21st October 2015 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Thank you for giving me the chance to speak in this debate, Ms Dorries. I congratulate the hon. Member for North Warwickshire (Craig Tracey) on bringing this matter to the House for consideration. This is an opportunity for all of us to participate and throw in our knowledge. We are all fond of the Minister and we know that her replies will be positive because of her knowledge of this subject, which we have discussed on many occasions. I look forward to her response.

This issue is of the utmost importance. I am my party’s health spokesperson at Westminster, so I am well aware of these issues back home, which come much too close to many of us and indeed our constituents.

In yesterday’s debate on the availability of cancer drugs, we discussed many issues. Today we are specifically discussing breast cancer and the hon. Member for North Warwickshire is right that we should take an interest in it. Almost 80 MPs attended the breast cancer function just over a month ago.

I would like to focus specifically on Northern Ireland. The Minister will know that health is a devolved matter, but I want to give some statistical evidence on how important it is to us in Northern Ireland and how much help we need for it in Northern Ireland and on the mainland. According to the Northern Ireland Executive, breast cancer is the most common form of cancer among Northern Irish women, excluding non-melanoma skin cancer. I am sure that Members will agree that the figures are worrying: some 1,200 women are diagnosed with breast cancer in Northern Ireland each year and one in nine is expected to develop the disease at some stage in their life.

We all know about the high-profile cases in the press every week—Angelina Jolie is one and Kylie Minogue is another. We think of them because they are household names, but, by speaking about their personal circumstances, they have raised the profile of this disease. In some cases, surgical operations have been done before the disease comes. When we hear about that sort of step, we know that we are talking about something most serious.

There have been welcome developments in breast cancer treatment and care in the Province, including free breast cancer screening for 50 to 70-year-olds every three years. That new initiative, announced by my colleague, Simon Hamilton, illustrates the need for specific action on diagnosis, and early diagnosis in particular, as the hon. Member for North Warwickshire mentioned. We need to step up to the plate and instigate action wherever we can.

Breast cancer screening is an effective way to detect cancer in its early stages. Early detection is essential to increase survival rates. Just yesterday I tabled a question, asking “what steps” the Minister’s Department

“has taken to ensure that people diagnosed with cancer are (a) diagnosed early and (b) treated immediately.”

Early diagnosis and the availability of treatment are important issues. As the hon. Member for North Warwickshire outlined in his speech, there is a period of time in between them, but we need early diagnosis and early treatment—let us have the two of them together.

Complications arise and treatment is made more difficult when the primary cancer spreads to another part of the body. It is the secondary cancer that we are here—

[Nadine Dorries (in the Chair)]

Order. More speakers have requested to speak in the debate than we realised at the beginning. Therefore, accounting for the winding-up speeches, the time available has narrowed considerably to just over five minutes each. I have to push you, Mr Shannon. Having now spoken for four and a half minutes, could you begin to wind up so that we can get everyone in? That would be fantastic. Thank you.

[Jim Shannon]

I appreciate that. I spoke to you earlier, Ms Dorries, and looked at the figures. I was not aware that we would be down to five minutes, so let me focus on these points.

It is estimated that over a third of those diagnosed with primary breast cancer will develop a secondary cancer within 10 years of their first diagnosis. Again, early detection is the issue. Advancing new treatments and improving those in existence is of the utmost importance, but we must also publicise and promote research and findings on what can be done to prevent both primary and secondary breast cancer and to reduce the risks of them developing.

I see that the hon. Member for Central Ayrshire (Dr Whitford) from the Scottish National party is here to make a contribution. I know of her interest in this issue from her previous job, so I look forward to hearing what she and her party have been able to do in Scotland. That is important for the debate.

We should also look at partnerships between Governments, universities and the pharmaceutical companies. In the Minister’s response, will she say what steps will be taken to review the NICE criteria? It seems that some new drugs on the market that could be used to reduce deaths from breast cancer are held up by those criteria. Will she look at that?

I do not believe that we can put a price on life and, when it comes to these issues, we cannot make decisions based on anything other than genuine human compassion and empathy. I hope that the debate will raise awareness for those with breast cancer.

The Minister always responds in a positive fashion. We need to look at the availability of drugs, early diagnosis and early provision of medicine and medical help. We also need to raise this issue with the pharmaceutical companies and review the NICE regulations, because, by doing so, I think we will get more drugs available.

--- Later in debate ---

[Jane Ellison]

I am afraid that I do not have time to give way. We can speak after the debate; I apologise.

A lot of other things are going on in that area, but I will leave just a few seconds to my hon. Friend the Member for North Warwickshire. However, I reassure Members that this subject is of huge importance to the Government.

[Nadine Dorries (in the Chair)]

There are 30 seconds left for Mr Tracey.

Ampthill Primary Care (Parking)

Nadine Dorries Excerpts

Tuesday 30th June 2015 Westminster Hall

[Nadine Dorries (Mid Bedfordshire) (Con)]

I beg to move,

That this House has considered Ampthill primary care and parking.

It is a pleasure to bring this debate here under your chairmanship, Mr Howarth. I spend many hours sitting in the Chair that you are in at the moment, so it is a pleasure and delight to be on the other side, representing Ampthill residents and GP surgeries. It is also a delight to have this Minister—my friend and constituency neighbour—answering the debate. It is worth putting it on record that he is not only one of the nicest and kindest MPs in Parliament, but someone who is absolutely deserving of his position. It is an honour to present this debate to him.

I would like to begin by discussing Ampthill. I hope that I will not disclose anything that I should not here, but my right hon. Friend and I have bumped into each other in my constituency on more than one occasion, not least when he was checking out the new Waitrose store opposite the area that I am about to discuss. I would like to set the scene by talking about the Ampthill surgeries and the problem we have, before I go on to some of the finer points.

Just off Oliver Street in Ampthill is about an acre of land, on which sit three GP surgeries, a fire station and a nursery and playschool. It is an incredibly busy area. Unfortunately, only a few months ago, for reasons that I do not fully understand, a car left one of the car park places and went through the windows of the GP surgery into the waiting room. There is a constant feeling of panic, anger and fear in the car parks. I myself have witnessed on a number of occasions cars not only mounting the kerbs, but mounting the kerbs—it is a very narrow kerb; there is limited kerb—where elderly people are walking. I was myself the subject of a road rage attack at the GP practice just a few months ago. There is nowhere for people to park when they visit the doctor, so people become very distressed. Many drive away, which leaves the GP appointments unfulfilled. Many just abandon their cars to get into the doctor’s practice, which causes chaos. Many people become very stressed and agitated, and start shouting not only at the receptionist, whose fault it is not that there are no car parking spaces, but at each other out in the car park.

At 9 o’clock in the morning, there is a stream of cars arriving to drop children off at the nursery and playschool. Around the outside of this area of land are the doctors’ practices, with their allocated car parking, but in the middle of this very congested area is the shabby prefabricated building that is the playschool. A constant stream of traffic is coming in to drop children off and going out again, leaving people with appointments from 9 am in a desperate state as they try to get to the surgery.

During the general election campaign, I was visiting my doctor’s surgery with a member of my family. I could not park, so I dropped my mother off to go in and was hovering around trying to get a place when a couple knocked on my car window and begged me to do something about the car parking. Then I was driving along and someone else did exactly the same thing. The fact is that I had already tried to do something. I had brought the situation to the attention of the local Central Bedfordshire Council. I set up a petition in the GP surgeries and was astonished that within no time thousands of people had signed the petition, which I will present to Parliament. People are desperately concerned that something very serious is about to happen in that car park area.

I ask the Minister whether, as part of the solution that I will come to, he will come with me to see the area so that he can understand what I am talking about, because I think it has to be seen to be understood. It has to be seen to be believed—how bad it is. He could talk to some of the reception staff, who are on the end of patients’ anger, upset and stress and have to answer to the doctors as to why people cannot get in for their appointments or blood tests—because they simply cannot get out of their cars.

The situation is exacerbated because the doctors’ surgeries in Ampthill are so good. The doctors are excellent; the reception staff are too. We all know the gatekeepers from hell who usually have those jobs in a doctor’s surgery. We do not have that in Ampthill surgeries; we have compassionate, understanding and extremely helpful staff in those surgeries. I think it would be good for the Minister to meet those staff and hear their story as well, because I will need his support to find a solution.

In their wisdom, SEPT—South Essex Partnership University NHS Foundation Trust—decided earlier this year to reallocate 20 district nurses to this incredibly congested area, so that it would be used as a base by those nurses, with their cars, even though there was nowhere for them to go. So an already very tense situation was made 20 times worse by 20 more cars turning up daily in the area. People are already afraid and an accident has already occurred, so for that to happen as well is exasperating for everyone concerned, staff and patients alike.

Some action has to happen, and soon. The status quo is not acceptable. I wanted this debate today because I wanted to put this on the record. I want it on the record, if something does occur in this area, that the problem had been noticed and people had been notified and that, on behalf of the doctors, staff and patients, I, Central Bedfordshire Council and others were trying to reach a solution to ensure that something did not occur.

There are a number of options. I will describe what would be the best scenario for this area, because the GP practices are not in the best condition. They are in shoddily erected, prefabricated buildings. People will know the kind of thing I am talking about; when a town is growing, infrastructure is hastily put in place. They are not the best facilities. The ideal solution would be for us to have a polyclinic—a new, purpose-built facility. We could amalgamate the three surgeries and have one new facility that provides enhanced services compared with what we have now. A number of patients, such as those needing INR—international normalised ratio—testing and other testing, have to travel to Bedford for services that, in this day and age, should be available at their GP practice.

The ideal solution would be a brand-new, off-site, purpose-built GP practice. That is what I would like to push for, because it is what Ampthill needs, and it needs it because it is growing. New houses are being built. It is a very popular, central destination in Mid Bedfordshire. It is very close to Flitwick train station. Interestingly, the patients who attend Ampthill surgeries come from areas in a 20-mile radius. They come from as far away as Wootton, Toddington, Flitwick and Barton-le-Clay. Patients from all over the area attend Ampthill surgeries. In fact, one of the people who are leading the campaign and part of the patient representative group is a patient who lives in Wootton. Because of the excellence of the GP practices, they attract patients from a wide area. The ideal scenario is for us to recognise what a good GP, primary care situation we have there, and to take that and move it to a purpose-built building.

Another scenario would be to demolish the shabby prefabricated building that is the playschool and move the playschool somewhere within Ampthill where there is not the constant congestion and traffic fumes all day long around the facility or the enhanced danger that comes from such dense traffic going in and out of the area. That is another solution—to move the children away. There are buildings in Ampthill that could be used in any of those situations.

The solutions are not easy, but no solution ever is. I have found, as an MP and in other aspects of life, that whenever anyone proposes an obvious solution to a problem, someone will always come along with 100 reasons why it cannot happen. Too often, people who would otherwise be required to put a great deal of imagination and effort into finding a solution simply say, “We can’t do that.” We must dispense with the words “We can’t do that, because” and look for ways we can do this. We need to come up with imaginative proposals, knock down a few barriers, chuck a few of the excuses out of the window and find a solution. I am concerned about the fact that too many people are treading water. Instead of meeting their responsibility to find a solution, they are finding excuses for continuing with the current untenable situation.

If anybody suggests as a reason for inaction that there is no popular support, I have a petition with the signatures of thousands of people, all of whom expect action. Ampthill residents expect something to happen. There has been extensive new development in Ampthill, from Fallowfield to Ampthill Heights, but most of the section 106 money from those developments went into education. I do not decry that fact; I simply point out that in Ampthill not everybody has children, but everybody needs to use the NHS facilities. The elderly do not have young children, but they are some of the biggest users of NHS surgeries. The GP receptionist told me that many people ask for late evening appointments so that they can avoid the pre-school traffic, because they think that parking will be less congested. Unfortunately, the situation is quite bad at that time of night, because that is when everybody comes out of work and wants a GP appointment.

The local feeling is that we need to find a solution, and a polyclinic would be an ideal one. More than anything, however, we need money. I know that NHS England has money from section 106 allocations that belongs to Ampthill residents. That money is sitting in NHS England. I am not sure exactly how much it is, but I have been told various amounts, from £8,000 upwards. It belongs in Ampthill, and it should be spent on primary care in Ampthill. There is no better cause to spend it on than the parking situation at the Ampthill surgeries.

Other people have to come to the table, including Central Bedfordshire Council and the GP practices. As fundholders, they should bring their allocation. The whole thing should not rest on the shoulders of the GP practices, Central Bedfordshire Council or NHS England, however; we need partnership working to find a solution. I have asked my right hon. Friend the Minister whether he would come and visit the surgery. What I would prefer is a meeting, with him, the fundholders, Central Bedfordshire Council and NHS England, and me, so that we can all work together to thrash out the solution we need for Ampthill, to make visiting the GP practice—something that nobody ever does willingly or happily—a less stressful, tense and sometimes turbulent affair. We must do that soon. I hope my right hon. Friend will agree to that, and I hope he agrees with me that it is a good way forward.

I also hope that my right hon. Friend might have some ideas of his own, and that he might be able to bring to the table something that will reassure the fundholders, the patients, the doctors, the receptionists and the councillors. I pay tribute to the councillors in Ampthill, who have done their bit to try to sort out the problems. I spoke to Mike Blair and Paul Duckett about the matter only recently, and I know that they have tried to do their bit, but they keep meeting a brick wall of: “We can’t do this, because—”. I hope the Minister will help me to bash down that brick wall and find a solution, so that we can work in partnership to resolve this difficult situation. Let us hope that if we do that, we can prevent a tragic and disastrous scenario of the sort that may result if we tread water for much longer.

[The Minister for Community and Social Care (Alistair Burt)]

It is a great pleasure to serve under your chairmanship, Mr Howarth. Some years ago, I canvassed for the Conservative party in your by-election. I have many happy memories of that time, not least because I had the opportunity to meet regularly almost all the Conservative voters in the constituency, none of whom prevented you from being here.

I thank my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) warmly for her kind remarks, and I congratulate her on securing this important debate. She was right about a number of things, including my knowledge of Ampthill, where I have indeed bumped into her. She has been an excellent colleague and partner in a variety of matters that affect Bedfordshire, and our two constituencies abut each other. I know Ampthill well because I regularly run in the park and use the tidy tip. The significance of that is that the main street to the tidy tip from my home in Wootton is, of course, Oliver Street, so I know it extremely well. In the world of the future, new technology will make it possible for viewers of our debates to see maps of areas that we are discussing. It would be easy to project a map into a televised debate such as this. However, as we are in a Chamber full of words rather than pictures, I can merely allude to that idea.

My hon. Friend is absolutely correct in her description of Oliver Street. It is a tight street, which is closely parked. Whichever direction they travel along the street, drivers will at some stage have to stop behind parked cars and allow traffic from the other direction to pass. In the area surrounding the surgeries, there is a cluster of buildings and some car parking arrangements that my hon. Friend has described well. I emphasise that I know the street well, and I shall be happy to respond later to her comments on the car parking problems.

I shall start by talking about GP services. My hon. Friend referred in a recent blog post to the growth taking place in Ampthill. She has described the primary care group as “the Cinderella of Ampthill” and said that it has had none of the recent investment or money associated with that growth. I want to address the issue of GP care being a Cinderella service and the question of investment in Ampthill. I pay a particularly warm tribute to all who work in primary care, not least in Ampthill, and in general practice: the GPs, the practice nurses and all others who work for patients. Primary care is the bedrock of the NHS, and although we are all familiar with what happens in hospitals, too often we seem to take for granted the service that patients receive from primary care.

My hon. Friend spoke about primary care in the widest sense, and I echo that. Primary care is much wider than general practice; it is all the day-to-day healthcare provided by healthcare professionals, and thus it includes such professions as district nurses, pharmacies, dentists and other ancillary occupations. Accordingly, as my hon. Friend has said, the trend is for the expansion of primary care facilities to be more than simply GP surgeries, and the Government have recognised that. Recently, in his first speech about general practice during this Government, my right hon. Friend the Secretary of State reaffirmed the Government’s commitment to the primary care infrastructure fund. That is a fund of about £750 million spread over the next four years, which offers practices the opportunity to seek investment in premises for development and the like. Such investment is sought by way of a competitive bid, and that is being taken forward in various waves. If the practices involved have not put in a bid, it is a matter for them. Clearly, £750 million spread across the country will not solve everyone’s problems, but it recognisees the need for some practices to seek to grow and for their premises to have the sorts of ancillary functions that we will all start to take for granted as, hopefully, fewer people go to acute hospitals for treatment that can be carried out elsewhere. The modern practices of the future will do that.

Easy access has to be part of that future. There is no point in seeking to do minor ops at the various ancillary services provided in the community if people cannot park. My hon. Friend spoke about the wide range of places from which these practices draw their patients. Ampthill has a population of about 6,000, but the practices have a total of some 20,000 patients, so the majority of those patients will clearly not be walking but coming by car. It is therefore necessary to ensure that adequate facilities are available. Ensuring adequate parking will be important for the premises of the future.

Primary care probably has the widest scope in healthcare, and it includes patients of all ages, from every socioeconomic and geographic origin and with all manner of acute and chronic physical, mental and social health issues, including multiple chronic diseases. Consequently, a primary care practitioner must possess a wide breadth of knowledge in many areas. Some 90% of all NHS patient contacts take place in general practice, which is why it is important to ensure that modern general practices, and the practices described by my hon. Friend, have everything they require. What many of us think of first when we think about the primary care profession in this country over recent years is that it has developed a wide skill base and body of knowledge. GPs provide a complete spectrum of care within their local community for problems that combine physical, psychological and social components. They attend patients in surgery and primary care emergency centres, if clinically necessary, and they visit patients’ homes. GPs must be aware and take account of all factors when looking after patients.

In his recent speech, the Secretary of State made it clear that he recognises that GPs need to call on an extensive knowledge of medical conditions to be able to assess a problem and decide on the appropriate course of action. They must know how and when to intervene through treatment, prevention and education to promote the health of patients and their families. Recently, the Commonwealth Fund, an independent institute based in the United States, declared that the NHS is the best healthcare system in the world. Although many people assume that to be because of our acute hospital care, the bedrock for the research on which that determination was based turned out to be family care and general practice, which is a further reason for addressing the needs of general practice—in the widest possible sense, from availability to ease of access—as my hon. Friend has done.

Most GPs are independent contractors to the NHS. That independence means that, in most cases, they are responsible for providing adequate premises from which to practise and for employing their own staff. As we have heard from my hon. Friend, GPs are determined to do the right thing in relation to parking. It is noticeable that the three surgeries that serve Ampthill’s population of 6,000, and patients from the wider area, are located within yards of each other in the middle of town. There is already parking for staff and patients, and there is a bus service with a bus stop nearby. Oliver Street is a main through-route in Ampthill. It is busy and narrow, and the presence of a fire station, an ambulance station, a nursery and a school in the vicinity all contribute to heavy traffic, particularly at certain times of the day.

[Nadine Dorries]

I missed out a point that I want to put on the record. A fire engine was recently prevented from leaving the fire station because of congestion caused by cars coming in and out of the pre-school off Oliver Street, which is near the practices. A fire engine being trapped and unable to leave a fire station owing to traffic density is not good.

[Alistair Burt]

There are things that we are able to do and things that we are not able to do. The general traffic issues in the town are, of course, a matter for other authorities beyond the Department of Health, but my hon. Friend makes a perfectly fair point.

In the Houghton Close area, there is pressure on parking for both practice staff and patients. GP practices, as independent contractors, are responsible for providing adequate premises and for employing their own staff. In passing, I want to say a word about the way in which such practices look after their patients, which is entirely relevant. Good things are happening in primary care and in Ampthill. The key test of that is the GP patient survey, which gives patients a chance to comment on the performance of the practice where they are registered. Patients say that the three Ampthill practices—the Oliver Street, Houghton Close and Greensand surgeries—have a good story to tell. Overall, across all measures, the three practices are averaging around 90% satisfaction. Most of us would love to have that degree of satisfaction, although, Mr Howarth, you have that in your constituency, as indeed does my hon. Friend. No score of the practices is below 84%, and the scores are much higher in many domains. For example, all of Greensand’s scores are 90% or above, with 96% reporting satisfaction with their overall experience of the surgery. It is therefore clear that today’s debate concerns what patients agree are good, all-round, high-performing practices. While addressing their needs, I congratulate each practice on its commitment to providing the best service to patients, of which, to a degree, the subject of this debate is an element.

There is pressure on parking in the Ampthill area, which is why there have been recent moves, encouraged by my hon. Friend, to consider what can be done about it. In matters such as land purchases that affect the public sector, it is often advisable to take advice from the district valuer. The Ampthill practices have had discussions with the town council about purchasing a grassed area next to the fire station which they hope to convert to additional parking. NHS England is prepared to contribute part of the cost. However, the decision on whether to buy or sell the land is not for me or anyone in Whitehall; it properly belongs to the prospective purchasers and the landowners.

The town council has made a request to NHS England to fund the purchase and set up a car park to increase parking capacity in the area. The land, once purchased, would not be for the sole use of the practices but would be open to all users. The estimated cost of the land is between £8,000 and £9,000. NHS England has agreed to fund some 25% of the cost, which is believed to be a fair portion of the practices’ proposed usage of the area, with no commitment to recurring costs. NHS England was also asked to provide funding for maintenance of the parking facility. Although NHS England is prepared to contribute to the purchase cost, it is not prepared to fund the maintenance costs because it will not be the dominant or exclusive user.

My hon. Friend made a fair point about the recent addition of some 20 practice nurses in the practices at the request of NHS England, which carries a certain amount of obligation. I therefore hope that we will be able to go back and see what more can be done. In February 2015 the town council’s planning committee considered the matter and advised the practices to discuss it directly with the fire service’s landowners. I will therefore encourage the continuation of that process. We have discussed the matter further with NHS England, which is prepared to think again about the costs involved. Following this debate and the representations we have made, the way is open for my hon. Friend to further discuss the situation directly with NHS England, the town council and Central Bedfordshire Council. I am grateful for the advice of the leader of Central Bedfordshire Council, James Jamieson, to whom I spoke last night. I am pleased to accept the invitation to visit the area more formally, which will give me a great opportunity to speak to the practices involved, to see the situation on the ground and to consider whether there is anything further we can do.

Although this matter is not fundamentally the responsibility of the Department of Health, I acknowledge our interest in ensuring that these practices have what they need to provide what is obviously an excellent service to constituents, to consider the opportunity for purchasing proper parking facilities and to help and liaise in some of the discussions that will take place under other people’s auspices. Finally, I will have a chance to see the situation on the ground, rather than passing through on the way to the tidy tip or another run in glorious Ampthill Park.

I thank my hon. Friend for bringing this matter to the House today. Thank you for your chairmanship, Mr Howarth.

Question put and agreed to.

Respiratory Health

Nadine Dorries Excerpts

Tuesday 3rd February 2015 Westminster Hall

[Several hon. Members]

rose—

[Nadine Dorries (in the Chair)]

Order. We will have a series of votes starting at 3.31 pm, so it would be great if Members could bear that in mind if we do not want to have to suspend the sitting and then return.

NHS Patient Data

Nadine Dorries Excerpts

Tuesday 25th March 2014 Westminster Hall

[Grahame M. Morris (Easington) (Lab)]

I congratulate my hon. Friend on securing this timely debate, which is raising some important issues that we need clarity on. We have just come from a seminar in which the Health Committee had some expert witnesses. Does she agree with the conclusions put forward there about the need for clarity before we go ahead with this data collection? I am thinking particularly about the cyber-security review, safeguards on anonymous or pseudo-anonymous data, separating out purposes for controls, a tighter definition of the care data—

[Nadine Dorries (in the Chair)]

Order. Mr Morris, this is a 30-minute debate, so can you keep your intervention short, please?

[Grahame M. Morris]

I will. I just want to mention governance arrangements as well.

--- Later in debate ---

[Grahame M. Morris]

My hon. Friend is being very generous about interventions. Again, she makes an excellent point. We need an effective audit trail. If these data sets are being sold on, we need some effective control. That should be stopped. I hope that the Minister—

[Nadine Dorries (in the Chair)]

Order. Barbara Keeley.

[Barbara Keeley]

I, too, hope that the Minister will address that.

I want to give an example of data use approved by the Data Access Advisory Group of the Health and Social Care Information Centre, because I think that it is instructive. Minutes from the group’s July meeting show that the advisory group approved the use of hospital episode statistics data for HSpot Ltd and its FindMeHealth application. HSpot Ltd had requested HES data, including consultant codes, with the intention of publishing those data online to enable patients to compare procedures by hospital and clinician. Online information about FindMeHealth says that it is

“a new independent UK comparison site offering choice…to the growing number of people who are choosing to self-pay for private healthcare.

FindMeHealth compares prices across the top self-pay procedures and gives users access to the very latest data from NHS and private sources”.

What we have here is a kind of “Go Compare” website for private health care.

Much was said about uses of patient data in the debate on the Care Bill. The Minister said that information from the HSCIC

“may be disseminated for the purposes of ‘the provision of health care or adult social care’ or ‘the promotion of health’.”—[Official Report, 10 March 2014; Vol. 577, c. 136.]

Does the Minister think that the definition that he gave us extends to the HSCIC granting the release of patient data so that commercial companies can run comparison websites on the top self-pay procedures?

We need much greater transparency, and I thank hon. Members present for the questions that they have put on this matter. We need greater transparency from the Health and Social Care Information Centre, but we also need it about the other data sources and the other places where data are held. The chair of the information centre, Kingsley Manning, said in his speech last week that one of its key measures of success might have been that it was

“safely below the radar of public attention”,

but that organisation is no longer below the radar of public attention. Indeed, the organisation has become the story because of the errors that it has made, which mean that hon. Members and the public have discovered just how their confidential medical data are being used by insurers, by commercial companies and even on systems in the United States.

If people look at social media, as I did last night, they will see that there are many comments about just how much distrust people now feel towards the HSCIC. The organisation, as I said at the start, has claimed an “innocent lack of transparency”, but others accuse it of evasiveness and half-truths. As I have detailed, giving misleading answers to the Health Committee on established facts about who works for the organisation does not help.

All that has to change. Hon. Members, including me in this speech, have talked about ways in which the situation should and must change, and I hope that the Minister understands the vital need for that.

--- Later in debate ---

[Grahame M. Morris]

The Minister is arguing that the scheme is an extension of what happened before, but there is clearly a quantum difference. There is general agreement that it is a wonderful thing to have data sets for research and public health purposes. The difficulty that the public have, about which we need to restore confidence, is when that information is being used for marketisation—for marketing purposes—by commercial reusers. I am not reassured by the Minister’s comments, but he has an opportunity to correct the problem in the House of Lords.

[Nadine Dorries (in the Chair)]

Order. Mr Morris, that is a very long intervention.

[Dr Poulter]

It is difficult to reply fully to such debates when we have very lengthy interventions, of which the hon. Gentleman is very fond. I would like to spell out to him what the quantum difference is. The Government have, through the 2012 Act, put in place safeguards for data protection that the previous Government never had. In particular, under the 2012 Act, data can be used only for the benefit of the health and social care system. We have put in place the safeguard that people can opt out from having their data collected and used. Those safeguards were not in place when the previous Government—

Oral Answers to Questions

Nadine Dorries Excerpts

Tuesday 25th February 2014 Commons Chamber

[Jane Ellison]

Although the Abortion Act does not mention gender specifically, the Government are clear that abortion on the grounds of gender alone does not meet the criteria set out in the Act. If evidence comes to light that doctors or organisations are sanctioning abortions for that reason alone, we will refer it to the police.

[Nadine Dorries (Mid Bedfordshire) (Con)]

The Minister is quite right that the Abortion Act does not state that the practice is illegal. Organisations such as Marie Stopes International operate under an ethical and professional framework in which they state that they will not perform abortions on the basis of sex selection. However, the chief executive of BPAS has said that

“there is no legal requirement to deny a woman an abortion”

if she wants to abort a female. The Government commission abortion services from BPAS and Marie Stopes. Does the Minister not think it is about time to have a closer look at BPAS, which is headed by a chief executive who condones sex-selection abortions?

[Jane Ellison]

That is exactly why we want to reissue the guidance on this matter. I cannot add to what I have said. I say with complete clarity that the Government’s view is that sex-selection abortion—abortion on the grounds of gender alone—is illegal and we will report it to the police if we are given evidence of it.

Group B Streptococcus (Newborn Babies)

Nadine Dorries Excerpts

Thursday 7th November 2013 Commons Chamber

[Nadine Dorries (Mid Bedfordshire) (Con)]

I am delighted and honoured to have secured this debate on group B streptococcus, which is also known as group B strep or GBS. GBS is the most common cause of serious infection in newborn babies. In the UK, it is the most common cause of meningitis in babies in their first weeks of life. With prompt and aggressive treatment, most sick babies will recover from GBS infection, but even with the best medical care, about 10% of them will die, and some of the survivors will suffer lifelong problems, including 50% of those who recover from GBS meningitis.

The subject was last raised in the House 10 years ago by my right hon. Friend the Member for Witney (Mr Cameron), who is now Prime Minister. There has been some progress but, given his current position, it would be encouraging if we could see more. I shall quote his words at the end of my speech.

The rate of confirmed cases of group B strep infection in newborn babies increased by almost 50% between 1991 and 2010. The true rate of infection, which includes cases that are not confirmed through the identification of the bacteria, but in which GBS is strongly suspected by clinicians, is likely to be several times higher. The issue is therefore not only serious, but one that is becoming more serious.

We have known for a long time that the key risk factor for a newborn baby in developing GBS is the mother carrying GBS at delivery. The UK guidelines state that if GBS has been detected during the current pregnancy from a swab or culture from a pregnant woman, she should be offered intravenous antibiotics in labour to minimise the risk of GBS developing in her newborn baby.

The UK’s risk-based strategy to reduce GBS infection in newborn babies was introduced by the Royal College of Obstetricians and Gynaecologists in 2003, but there is no evidence that it has appreciably reduced the incidence of this devastating infection. In 2003, there were 229 reported cases of GBS infection in babies aged nought to six days; in 2011, there were 281 cases. On that evidence alone, I suggest to the Minister that the risk-based strategy has failed demonstrably and that we need to consider new alternatives.

One UK case study found that 21% of women carried GBS, and that 22% had risk factors for GBS infection developing in their newborn baby and would therefore be offered intravenous antibiotics in labour. However, only 29% of women with risk factors actually carried GBS. Using risk factors alone means that a high proportion of women not carrying GBS will be offered intrapartum antibiotics, while many actually carrying it will not.

--- Later in debate ---

Motion made, and Question proposed, That this House do now adjourn.—(Claire Perry.)

[Nadine Dorries]

Researchers stated:

“The most striking finding that has implications for clinical practice and policy is the low sensitivity of risk factor based screening, compared with PCR or culture tests in predicting maternal and neonatal GBS colonisation—”

[Andrew Selous (South West Bedfordshire) (Con)]

I warmly commend my hon. Friend on bringing the issue before the House. I have a constituent who lost a child as a result of it, so it is something that I take seriously. Is my hon. Friend pleased, as I am, to see that Public Health England is now adopting gold standard enriched culture testing in its eight regional laboratories? Does she welcome that as a small advance in this important area?

[Nadine Dorries]

I welcome my hon. Friend’s intervention, and I will go on to talk about the gold standard culture medium.

The researchers continued that the sensitivity of such screening was

“below that which we considered to be a minimally acceptable sensitivity for our study—which calls into question the validity of the current UK policy. Moreover, consistent with previous evidence of practice variation, the risk factor-based screening policy was poorly adhered to, with one-third of women with indications for IAP not treated.”

Despite those authors and numerous others recommending routine screening as cost-effective in the UK, the UK national screening committee continues to recommend the risk-based approach.

Most countries that have national strategies against GBS infection offer routine antenatal testing for GBS. Those countries have seen the incidence of early onset disease fall dramatically, such as by more than 80% in the US and Spain. That compares favourably with the result of the risk-based approach in the UK under which, as I have said, the number of infections has increased. If we know that the risk-based strategy we are adopting is not working because infections are beginning to increase, yet countries such as Spain are seeing an 80% reduction, should we not consider the cost-effectiveness of moving to a system that we know will reduce the number of poorly babies in our intensive care units that have GBS-induced meningitis and other complications?

Studies show that testing for GBS in late pregnancy, as well as offering tests to women found to carry GBS or who have other recognised risk factors, is more cost-effective than the current risk-based strategy. A risk-based strategy is poor at predicting women who will be carrying GBS in labour, and therefore women for whom antibiotics in labour would potentially prevent devastating infections in their newborn babies.

Recently published research shows that although women want to be informed about GBS and offered testing for it during pregnancy, that is not happening. At less than £12, the tests are not that expensive, and the antibiotic recommended during labour if a woman is found to carry GBS in pregnancy is cheap and cost-effective. It is penicillin, which is shown to be exceptionally safe, as well as being a narrow-spectrum drug that is unlikely to cause greater resistance later.

Most NHS pathology services currently use culture media that are general purpose and identify GBS in only about 60% of carriers. At the request of the chief medical officer, Dame Sally Davies, the enriched culture medium test that my hon. Friend mentioned will be made available throughout England from 1 January 2014. That will identify about 90% of carriers, and it is the gold standard for that purpose, under Public Health England’s regional laboratory standard operating procedure. The results of the GBS test are about 85% predictive of carriage status for up to five weeks. It should be used to identify GBS carriage wherever there is an indication. These sensitive tests have not previously been widely available within the NHS when requested by the health professionals and pregnant women.

I have some key questions for the Minister. Will he use this debate as an opportunity to make a statement welcoming the gold standard enriched culture medium test for group B strep carriage, which is being made available from January 2014 and which can be used to assess carrier state if there is an indication? From this point on, how does the Minister plan to reduce the incidence of GBS infection in newborn babies when the current risk-based strategy, introduced in 2003, has been shown not to be effective? Is there a target rate for GBS infection in newborn babies? I have always derided targets, but in this case setting a target for the reduction of GBS infections may be a way to introduce routine testing.

Will the Minister confirm that the audit of practice suggested by the UK national screening committee to establish how well the new guidance is being implemented at a national level will study the actual practice taking place in maternity units, rather than simply being an audit of policies without any check on whether they are being applied in practice, because we know that these policies are not being put into practice in maternity units? What is the time scale for the feedback and advice to trusts about how they can further improve their adherence to the RCOG and National Institute for Health and Care Excellence guidelines on the prevention of neonatal GBS disease? What provision is being made for telling pregnant women about the risk of GBS infection in their babies? What provision is being made to educate relevant health professionals about the prevention of GBS in newborn babies and the forthcoming availability of the gold standard ECM test? Do midwives and practitioners in maternity units even know that this gold standard test is being introduced in 2014?

UK guidelines recommend that when GBS carriage is found by chance during a pregnancy, it should trigger the offer of antibiotic prophylaxis in labour. Why should a woman with unknown GBS carriage status be denied the opportunity to find out if her baby is at risk?

I would like to pay tribute to the tireless work of Group B Strep Support, the charity and campaign group that has been working to raise awareness of this issue and reduce the death toll. I also have a constituent who has sadly lost a baby to GBS. The group has been a great help to me in preparing for this debate following a meeting with my constituent. Ten years ago, my right hon. Friend the Prime Minister said in his Adjournment debate:

“Group B Strep Support’s aim, which I support, is for the routine test to be offered to all pregnant women, with those who are found to have GBS at the 35 to 37-week stage being automatically offered intravenous antibiotics.”

He said to the then Minister:

“I hope that the Minister will show great urgency over the issue”.—[Official Report, Date; Vol. 408, c. 267WH.]

My right hon. Friend supported the introduction of routine testing: I echo his sentiments exactly.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I congratulate my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) on securing this debate and raising this very important issue. The death of a baby is devastating for parents and their families. It is important that we do all we can to minimise the risk of such deaths. My hon. Friend has presented a strong case, but, as I shall set out later, it is equally important that we are guided in our decisions by professional, evidence-based advice to ensure that any action taken does not lead to potentially greater adverse outcomes or unintended consequences.

Group B streptococcus is one of many bacteria that can be present in the human body. It is estimated that about one pregnant woman in five in the UK carries GBS. Around the time of labour and birth, many babies come into contact with GBS and are colonised by the bacteria. Most are unaffected, but a small number can become infected.

If a baby develops group B strep less than seven days after birth, it is known as early-onset group B strep. Most babies who become infected develop symptoms within 12 hours of birth, and it is estimated that about one in 2,000 babies born in the UK develop early-onset group B strep, or about 404 babies a year—my hon. Friend made these points earlier. Most babies who become infected can be treated successfully and will make a full recovery, but even with the best medical care, one in 10 babies diagnosed with early-onset group B strep will unfortunately die.

The infection can also cause life-threatening complications, such as septicaemia, pneumonia and meningitis. One in five babies who survive the infection will be affected permanently. Early-onset group B strep can cause problems such as cerebral palsy, deafness, blindness and serious learning difficulties, and rarely can cause infection in the mother—for example, an infection in the womb or urinary tract, or more seriously an infection that spreads through the blood, causing symptoms to develop throughout the whole body.

It is worth reflecting on how the UK compares internationally on rates of group B strep. The reported rate per 1,000 births is 0.38 in the UK; in the USA, where there is testing, it is 0.41; in Spain, 0.39; in France, 0.75; in Portugal, 0.44; and in Norway, 0.46. Even in comparison with countries where there is routine group B strep screening at 35 to 37 weeks, therefore, the UK has relatively low levels of group B strep.

It is also worth setting out some of the general improvements in maternity care that are helping to reduce group B strep and improve the quality of care available to women. We all agree that women should receive high-quality and safe maternity services that deliver the best outcomes for them and their baby. Maternity services feature prominently in the key objectives set out in the first mandate between the Government and NHS England. As set out in the mandate, we want all women to have a named midwife responsible for ensuring she has personalised, one-to-one care. To help deliver that, there has been significant investment in the maternity work force. Since May 2010, the number of full-time equivalent midwives has increased by 6.5%—just under 1,500—and in addition there are currently in excess of 5,000 midwifery students in training. There has, therefore, been considerable investment in maternity services to ensure much more personalised care and, consequently, much safer care for women and their babies.

[Nadine Dorries]

For the reasons I highlighted, we know that the risk-based strategy is not working effectively. Does the Minister not agree that in countries that have routine testing the chances are greatly improved? He drew comparisons with the US, France and other countries, but we do not know what their figures would be if they were using our risk-based strategy. The fact is that they are routinely testing, so does he not agree that only if we were also routinely testing could we make a like-for-like comparison with other countries? Also, why specifically does the UK, a sophisticated country with sophisticated maternity services, not routinely test?

[Dr Poulter]

I will come to those points a little later, but I will try to reassure my hon. Friend. Given that the majority of babies who die from group B strep are born prematurely, testing at 35 to 37 weeks would not benefit them. Tragically, they would have died in any case, so the screening test to prevent them from dying would not have been effective. I will say a little more about that later, if she will allow me to make some progress.

I pay tribute to my hon. Friend for raising this issue, because the first challenge is to raise general awareness of group B strep among the health care work force and women more generally. The Department of Health is working with the NHS, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the National Institute for Health Research health technology assessment team and the pharmaceutical industry to raise awareness of group B strep and reduce the impact of this terrible infection. The Royal College of Obstetricians and Gynaecologists has produced an information leaflet for women who are expecting a baby or planning to become pregnant, and this sets out information about group B strep infection in babies in the first week after birth and the current UK recommendations for preventing group B strep in newborn babies. In addition, information is also available on the NHS Choices website.

As hon. Friends will agree, the focus must be on preventing early-onset group B strep infection from occurring in the first place. The Royal College of Obstetricians and Gynaecologists published updated guidelines on prevention of early-onset group B strep infection in neonates in July 2012, which takes into account the latest evidence. It is important that services undertake local clinical audits to ensure the effective use of intrapartum antibiotic prophylaxis as recommended by the guidance. Following the publication of the revised guidance, the UK national screening committee suggested a formal audit of practice to establish how well the new guidance is being implemented at a national level.

The RCOG, in partnership, with the London School of Hygiene and Tropical Medicine, has now appointed a clinical research fellow to carry out a one-year audit across the UK, which will undertake a review to see how units have revised and updated their local protocols since 2006, using well-designed case studies to gather specific information about maternity unit policies by asking clinicians whether they would screen for group B strep and/or other intrapartum antibiotic prophylaxis in the circumstances described. It will also assess the extent to which current maternity information systems are able to provide data on whether women have had an antenatal culture for group B strep, whether women have been given intrapartum antibiotics and, if so, the antibiotics prescribed, the dose and duration and whether the women had particular risk factors such as intrapartum fever. The audit aims to provide feedback and advice to all participating trusts about how they could further improve their adherence to the RCOG guidelines on the prevention of neonatal group B strep disease.

Clinical audit is a tool that is incredibly valuable in improving the quality of patient care. It is something that trusts do very often on an ad hoc basis. The fact that we now have a national audit focused on group B strep disease will help to standardise practice across all maternity settings and improve the quality of care that is available, so that we can look at which women are more vulnerable and susceptible to developing group B strep and, therefore, reduce infection rates.

[Nadine Dorries]

That is encouraging news but again the focus is on women who are at risk of group B strep. I am advocating that all women should be tested for group B strep. I recommend that every pregnant woman I meet now buys a kit to test for group B strep. It is encouraging and positive to hear what my hon. Friend the Minister is saying but it is still focusing on the at-risk women, which is what the risk strategy does now. We need to move from that and away from the at-risk women. We need to move from 35 to 37 weeks and forward to full-term and routine testing of all women for group B strep.

[Dr Poulter]

I am hopeful that the audit by the RCOG nationally—something I discussed with the group B strep groups and the chief medical officer at a meeting this time last year to progress the work at a greater pace—will put us in a better position to understand in particular which women are at high risk, whether birth units are picking up on those women in a timely manner and how we can improve the situation throughout the country. In the past there has been quite a lot of variation in practice, broadly based on the RCOG guidelines, but it is important—knowing the devastating effects of this illness—that we put together a comprehensive audit tool that gathers data at a national level so we can spread good practice and good guidance throughout. If my hon. Friend will be patient I hope to address some of the broader issues about screening later.

--- Later in debate ---

[Dr Poulter]

I would be delighted to do so. It is important to consider the confounding factors that arise in any research. For example, there is some evidence of different rates of carriage of group B strep among different population groups. Also, the clinical treatment of the disease in hospitals—which is separate from the screening process—can vary from country to country. We have to set the data alongside other practices that take place at local level in order to interpret them in the right way. I would be delighted to write to my hon. Friends, and to any other hon. Members who are interested, with that broader general information.

I shall turn now to the question of routine screening for group B strep. The UK national screening committee advises Ministers and the national health service in all four countries on all aspects of screening policy, and supports implementation. At its meeting on 13 November 2012, the screening committee recommended that antenatal screening for group B strep carriage at 35 to 37 weeks should not be offered, as my hon. Friend the Member for Mid Bedfordshire has pointed out. That is the reason for the debate. The reasons given included the fact that the currently available screening tests cannot distinguish between women whose babies would be affected and those that would not. As a result, about 140,000 low-risk pregnant women would be offered antibiotics in labour following a positive screening test result. The overwhelming majority of those women would have a healthy baby without screening and treatment. In other words, a woman who had screened positive for group B strep at one point in her pregnancy might not necessarily be carrying it at the time of delivery, and up to 140,000 women a year could be given antibiotics during labour even though they did not need them.

On the back of the evidence, concern was also expressed, understandably, about resistance to some of the antibiotics used to prevent early-onset group B strep, about the long-term effects on the newborn and about the potential for anaphylactic reactions in labour. Many of us will recall the report of the chief medical officer for England, in which she expressed particular concern about the risks posed by antibiotic resistance because of overuse. The use of antibiotics on that size of population could create a risk of resistance developing, which would have adverse consequences.

[Nadine Dorries]

I am interested in what the Minister has just said. As I mentioned in my speech, we are talking about a penicillin, a narrow-spectrum antibiotic. I know the Minister’s background, and he will know that GPs would prescribe it for a throat infection. This is a widely and commonly used antibiotic. Does he not think that these expressions of concern are over-egging the pudding slightly?

[Dr Poulter]

In the report that the chief medical officer published earlier this year, she made the point graphically that the overuse of antibiotics among people who do not need them can lead to resistance developing in bacteria. We know from hospital super-bugs such as MRSA and VRSA that many other resistant strains of bacteria are developing. Part of the challenge is to see responsible prescribing adopted more broadly across the NHS, to ensure that antibiotics are being targeted at the people who will benefit directly from them. The chief medical officer’s concern is that the screening that my hon. Friend is proposing could lead to many tens of thousands of women being given antibiotics inappropriately at the time of delivery, because they were not carrying group B strep at the time, and that that could result in resistance developing. We already know about the devastating consequences of group B strep infection, and the development of further resistant strains could be an unintended consequence of such screening that none of us would want to see. We need to be mindful of that possibility, as I believe the national screening committee was when it made its recommendations.

The majority of babies who die from early-onset group B strep are premature and are, sadly, born too early to be helped by screening at 35 to 37 weeks. Data from 2001 show that, in that year, there were 39 deaths due to group B strep, of which 25 occurred prematurely—that is, before the 35th week of pregnancy, when any screening would have been carried out. Those deaths would therefore not have been prevented by a screening programme.

It has been estimated that up to 49,000 women carrying GBS at 35 to 37 weeks of pregnancy may no longer be carriers when receiving treatment during labour. Studies of the test suggest that between 13% and 40% of screen-positive women will no longer be carriers at the point of delivery. There is also a potentially detrimental impact on maternity services, increasing the medicalisation of labour, with the increase in hospital births and increases in the birth rate that we are seeing. We know that once there is one intervention in labour, it can lead to other interventions and a high rate of Caesarian section when it might not have been necessary in the first place. I am not saying that that would always be the case and absolutely not with GBS—far from it—but we know that when a woman enters a medicalised pathway in a maternity unit, it can often lead to interventions that might otherwise have been unnecessary and that are sometimes quite distressing for the woman during labour. This is particularly the case when many of the women potentially put on prophylaxis would no longer be carriers of GBS.

The advice from the UK national screening committee is consistent with that of the Royal College of Obstetricians and Gynaecologists and the National Institute for Health and Care Excellence. I believe we have talked through a number of the issues about why that recommendation was made.

In the brief time remaining, it would be worth mentioning some of the research that is going on. It is estimated that a vaccine for GBS is approximately five years away from development. First-stage trials have now been undertaken, and wider population-based studies for safety and efficacy are in place in high-prevalence areas such as South Africa. I am sure we would all agree that a vaccine would be a very effective solution to GBS, and I shall certainly do all I can to push and nudge to make sure that such a vaccine is brought forward in as safe and appropriate and as timely a manner as possible.

[Nadine Dorries]

Is the Minister informing us that that vaccine would be widely available? Let me ask him once more—after everything he has said today, for which I am incredibly grateful—why does he think countries like Spain, the United States and others have introduced routine testing when we still seem to be opposed to it?

Health and Social Care

Nadine Dorries Excerpts

Monday 13th May 2013 Commons Chamber

[Nadine Dorries (Mid Bedfordshire) (Con)]

My speech will be in two halves. I shall talk first about health care issues, as this is a health debate.

I welcome the Care Bill, particularly its commitment to social care. I feel that words such as “compassion” are sometimes missing from our discussions on health care. Before I say more, let me welcome publicly, for the first time, the right hon. Member for Cynon Valley (Ann Clwyd) to her position as head of a review body that will examine NHS complaints.

As many Members know, I was a nurse in a former life, and it was a profession that I absolutely loved. I was, I think, a committed nurse. I lived in a nursing home, and often worked for more hours than I was supposed to. I would go into the hospital on my days off to visit patients who had no relatives. I was not alone in that; most of the nurses in my nursing home behaved in the same manner. I pay tribute to a nurse who started work on the same day as me, on 5 November 1975: Helen Windsor, who contacted me recently. For all these years, she has been delivering the same committed care that she delivered in 1975.

I suppose many people will say that that was a long time ago, and it was, but I think that qualities such as compassion, kindness and caring are timeless. It does not matter when they were being delivered; they should be delivered in the same way today. Unfortunately, however, I—like many other Members—regularly receive complaints from constituents about the standard of nursing care. I mentioned Helen Windsor because I want to pay tribute to the nurses who deliver good care.

I recently visited a constituent in hospital, an 89-year-old man with no relatives. It was interesting that the right hon. Member for Cynon Valley mentioned nail clippings, because I had already written down that I intended to raise the subject. That constituent was agitated because his nails were serrated and were catching on the cardigan that he was wearing as he sat in his chair. When I asked the nurse whether she could cut his nails—he said that he had been asking for it to be done himself—she replied “No, I can’t. We are not allowed to do that.” So I took an emery board out of my handbag and filed his nails myself. I know that sometimes, as Members of Parliament, we feel that we are social workers, but I had never imagined that I would extend my role to the nail care and general hand hygiene of a constituent in hospital—but I did.

Unfortunately, on a number of occasions recently I have sat in a hospital and witnessed nursing care being delivered to my own daughter. Only a few weeks ago, when she was on a hospital trolley waiting to go into the operating theatre—distressed, anxious, upset—we witnessed nurses holding conversations over her head about intimate details of their love lives and their social lives, which, while she was in pain, my daughter had no interest in hearing. Not only was she subjected to those intimate details of their private lives; she was also subjected to a lack of care. She was completely ignored on that trolley. Yes, she was about to go into an operating theatre and be dealt with, but it is when patients are in that condition that they need nursing care most. They need to be reassured. They need to be calm. They need to know that everything is going to be OK. However, there was no interest in that.

The most appalling thing that happened was that, just before my daughter went into the operating theatre, one nurse told the other that she was going to the bathroom, and then gave exact details of what she was going to do there. I cannot think of a more polite way of putting it in the Chamber. It was a totally inappropriate conversation to be having outside the doors of an operating theatre.

A constituent who recently came to see me in my surgery told me that, when in hospital following a road traffic accident, she had noticed after a few days that her bottom sheet had not been changed and was bloodstained. Each day she wrote the date around the border of the bloodstains. When she left hospital 10 days later, she left that bottom sheet for the nurses to see, with the dates written in a pattern around the bloodstains. During those 10 days, no sheets had been changed. We used to change the sheets every day, and that was possibly excessive, but I think that, given that we are constantly trying to find ways in which to deal with, beat and get on top of hospital-acquired infections, bloodstained sheets indicate a lack of care.

I do not want to labour the point about complaints, because I know that a number of other people have already done so, and I feel that it is now the remit of the right hon. Member for Cynon Valley. Rather, I want to discuss immigration and its impact. We send £53 million per day to Europe, which limits our dealings with the rest of the world—in fact, the Prime Minister is trying to tackle that issue today. Labour will not commit to a referendum. Do Labour Members not see that that £53 million a day could be spent on dementia care, on Alzheimer’s care, on young carers? There are so many things we could do with that money.

People were asked one question when we went into the Common Market: do you want to go in, yes or no? They should be asked the same question to exit. If we can go to the electorate on behalf of the Liberal Democrats with a referendum on the alternative vote in a matter of months, why do we have to wait years to offer them a referendum on an issue as big as the European Union? Do we not realise what a self-serving, self-interested bunch we seem to people out there, when we can call an expensive national referendum on AV, yet obfuscate and delay on the question of European Union membership?

It is no good saying that people are not interested in this issue, because they are: it is the subject of almost every other question I am asked when I go out in my constituency. People now know exactly how much we are spending on the European Union, and they do not believe that leaving will cost us 3 million jobs. They would like a piece of the action in China, which reported growth of some 9.5% in the past year. They want some of the action taking place in the BRIC countries. That is where they want to trade—not in a sick and failing Europe that is getting sicker by the day.

I want to add my voice to those who have spoken out on this issue, and I would definitely join the two Cabinet Ministers in voting to be out. I would vote no tomorrow, and I know many of my constituents would. I completely support the measures in the health Bill in the Queen’s Speech, which will be well received by everybody, but I want to add my voice to the case for an in/out referendum. We must find a way to deliver that. We know that the Prime Minister means what he says; but if we can do it on AV, we have to do it on the EU: otherwise, people will not believe us.

--- Later in debate ---

[Mr Barron]

It was not a Government report but a Select Committee report, and I do not remember it, quite frankly.

Community cohesion is important and has been important in this country for centuries—not just since we joined the European economic area or the EU expanded to 27 countries, with people having the right to come and work here, as indeed we have the right to go out and work in other EEA countries. A lot of this debate is distasteful and is not the truth. In a recent by-election, a political party that is not represented here and I hope will not be was saying that, as of January next year, probably nearly half the population of Bulgaria will come and work in this country. That is nonsense, and neither Back Benchers nor Front Benchers should have a knee-jerk reaction to that type of debate. We should have sensible debates about what immigration does or does not do in this country.

[Nadine Dorries]

Can the right hon. Gentleman provide evidence for his numbers? Can he tell us how he knows what the numbers will be? Can he quote from some extensive research that proves this?

[Mr Barron]

I was quoting from the rhetoric put into the daily press during the Eastleigh by-election. I think the figure given was that about 3 million Bulgarians will be coming to this country—

[Nadine Dorries]

How does the right hon. Gentleman know that that is not the figure?

[Mr Barron]

If the hon. Lady will keep quiet, I can tell her that that was what was said, but there are fewer than 8 million Bulgarians living out there. Many Bulgarians have been living and working in this country for many years, because they met criteria outwith the criteria laid down when Bulgaria and Romania joined the EU. The whole debate is disgraceful, and we should get it into some perspective.