NHS Bursaries

Natascha Engel Excerpts

Wednesday 4th May 2016 Commons Chamber

[Madam Deputy Speaker (Natascha Engel)]

Order. Before I call the first Back-Bench speaker, I should say that we are going to have a time limit of seven minutes to start with. The debate finishes at 4.27 pm and a large number of people wish to speak.

World Autism Awareness Week

Natascha Engel Excerpts

Thursday 28th April 2016 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Natascha Engel)]

Order. We will start with a time limit of six minutes and see how we get on.

Contaminated Blood

Natascha Engel Excerpts

Tuesday 12th April 2016 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Natascha Engel)]

Order. We are now getting closer to five minutes as the informal time limit on speeches. I ask Members to keep to five minutes, because otherwise we will not get everybody in.

Access to Medical Treatments (Innovation) Bill

Natascha Engel Excerpts

Friday 29th January 2016 Commons Chamber

[Heidi Alexander]

I have listened carefully to the debate on this group of amendments. Although I know that the hon. Members for Bury St Edmunds (Jo Churchill) and for Newton Abbot (Anne Marie Morris) have concerns about creating excessive bureaucracy, I think those concerns are somewhat overstated. The Bill already requires consultation before regulations are made. I am seeking to ensure that the appropriate organisations are able to have their input into the process. However, in the spirit of cross-party working for which the Minister has developed a fondness this morning, I beg to ask leave to withdraw my amendment 8 and not to press amendment 9.

Amendment, by leave, withdrawn.

Clause 3

Responsible Innovation

Amendment made: 2, page 2, line 26, leave out clause 3 —(Chris Heaton-Harris.)

Clause 4

Effect on Existing Law

Amendment made: 3, page 3, line 19, leave out clause 4 —(Chris Heaton-Harris.)

Clause 5

Interpretation

Amendments made: 4, page 3, line 40, leave out “this Act” and insert “section 2”.

Amendment 12, page 3, line 42, leave out paragraph (b).

Amendment 13, page 3, line 44, at end insert—

‘(1A) For the purposes of section 2(2), the kinds of medical treatment that may be innovative medical treatments include (amongst other things)—

(a) the off-label use of an authorised medicinal product, and

(b) the use of a medicinal product in respect of which no marketing authorisation is in force.

(1B) In subsection (1A)(a), the reference to the off-label use of an authorised medicinal product is a reference to the use of the product—

(a) for a purpose other than one for which its use is specified,

(b) in relation to a person who is not within a description of persons for whom its use is specified, or

(c) in any other way in which its use is not specified.

(1C) In this section—

(a) “authorised medicinal product” means a medicinal product in respect of which a marketing authorisation is in force;

(b) “marketing authorisation” and “medicinal product” have the same meanings as in the Human Medicines Regulations 2012 (S.I. 2012/1916);

(c) “specified”, in relation to a medicinal product, means specified in its marketing authorisation.”’—(Chris Heaton-Harris.)

Amendment 15, page 4, line 1, leave out subsection (2) and insert—

‘( ) References in section 2 to medical treatment include references to treatment carried out for the purposes of medical research (but nothing in section 2 is to be read as affecting the regulation of medical research).”—(George Freeman.)

This amendment makes it clear that the database for which clause 2 provides may contain information about treatments carried out for the purposes of medical research (including, for example, in the context of a clinical trial).

[Madam Deputy Speaker (Natascha Engel)]

We now come to amendment 5. With the leave of the House I will put the questions on amendment 5, 6 and 14 together.

[Chris Heaton-Harris]

On a point of order, Madam Deputy Speaker. I was under the impression that amendment 5 would be called only if amendment 15 was not carried. Please could you give me some clarification on that point?

[Madam Deputy Speaker]

The hon. Gentleman is right; we will take amendments 6 and 14 together.

Amendment made: 6, page 4, line 3, leave out ‘this Act’ and insert ‘section 2’.—(Chris Heaton-Harris)

Clause 6

Extent, commencement and short title

Amendment made: 14, page 4, line 8, leave out ‘Sections 1 to 5’ and insert ‘Sections 1, 2 and 5’.—(Chris Heaton-Harris.)

Third Reading

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[Chris Heaton-Harris]

On a point of order, Madam Deputy Speaker. Would it be in order for me to thank Abigail Bishop-Laggett, my member of staff who has worked so hard on getting the Bill to this point?

[Madam Deputy Speaker (Natascha Engel)]

That is a very nice comment, but not a point of order.

Question put and agreed to.

Bill accordingly read the Third time and passed, with amendments.

NHS (Charitable Trusts Etc) Bill

Natascha Engel Excerpts

Friday 22nd January 2016 Commons Chamber

[Jane Ellison]

rose—

[Madam Deputy Speaker (Natascha Engel)]

Order. Before the Minister responds, I should point out that the subject of defibrillators is some distance away from any of the amendments. The hon. Gentleman might like to save it for Third Reading.

[Jane Ellison]

I am sure we all recognise the truth of your judgment, Madam Deputy Speaker, but the example was given earlier of an NHS charity that had championed defibrillators in the local community, and I think that that is how the topic was introduced. My hon. Friend the Member for Mid Worcestershire (Nigel Huddleston) has made a good point, and I shall be happy to give him more information about the proportion of the fund that the British Heart Foundation has been able to spend on the training that he described.

I hope that what I have said about the amendments has been of assistance to the House.

Childhood Obesity Strategy

Natascha Engel Excerpts

Thursday 21st January 2016 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Natascha Engel)]

Order. Before I call the next, very experienced, Member to speak, let me remind less experienced Members that when there are time limits, the first two interventions are compensated for and the clock stops, but after that the clock continues. I just want to ensure that no one gets a horrible fright.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Natascha Engel)]

Order. I am afraid I have to lower the time limit on speeches to seven minutes now.

Cities and Local Government Devolution Bill [Lords]

Natascha Engel Excerpts

Monday 7th December 2015 Commons Chamber

[The Secretary of State for Communities and Local Government (Greg Clark)]

I beg to move, That the Bill be now read the Third time.

I would like to thank—[Interruption.]

[Madam Deputy Speaker (Natascha Engel)]

Order. The Secretary of State is moving the Third Reading.

[Greg Clark]

I thank all hon. Members from both sides of the House who have contributed to the development of the Bill, particularly those who participated in the extensive scrutiny on the Floor of the House both in Committee and on Report. The House will observe that we have followed the principle of listening to the views of Members, both in Committee and on Report. We made several improvements to the Bill after having heard serious representations from those across the House. I want to put on the record my thanks to my officials and to the Clerks, who have guided us adroitly through every clause.

I also want to thank councillors of every party and business leaders from across the country who have helped to give this Bill the momentum it deserves by embracing the localism agenda that began in the last Parliament. Important though the Bill is, it is worth noting that it is not the only means by which devolution is being advanced. For example, the Chancellor’s announcement that 100% of business rates would be retained by local government, rather than sent to the Treasury, is a significant step forward for the greater independence of local government.

I want the Bill to commence several things. I want it to allow the often latent potential for economic growth across all parts of the country to be better unleashed. The Bill and the process that we have introduced have brought businesses right across the country into close collaboration with their local authority leaders. The degree of enthusiasm for this has been gratifying.

The Bill allows reform where civic leaders and councillors desire it. It is a Bill that proceeds from the bottom up, rather than the top down. That makes it a novel Bill in the history of legislation concerning local government that this House has considered. It is a Bill that does something that previous Governments have baulked at, which is to transfer deliberately powers that Ministers and Governments have held and exercised in Westminster and Whitehall to authorities across the land. The insight of the Bill is that those objectives can be achieved together if local people are given their voice and allowed to set their arrangements in their own way.

The breakthrough is the recognition that not all places need to be the same. One of the glories of this House is that we know that each of our constituencies is very different from the others. No two places are the same. A world in which policy is identical in every part of the country is a world in which policy is not well set for particular parts of the country. Each place has a different history, different strengths and different capacities.

In the past, proceeding at the speed of the slowest has hampered efforts to devolve. Therefore, the approach that we have taken has been to invite every part of the country to make its proposals to the Government from the bottom up and to encourage those with the most ambitious proposals to advance them, while encouraging other places to find their feet and take the powers that they want for themselves and their people.

New Cancer Strategy

Natascha Engel Excerpts

Thursday 19th November 2015 Commons Chamber

[Ben Gummer]

I will, and I was about to move on to my hon. Friend’s remarks. He made a similar point—that great progress had been made but there was still much to be done. He spoke with eloquence and detail about complementary treatments, in which I have absolutely no expertise—I shall have to disappoint him on that. I know that he has written to me about the regulation of herbal medicines. I have today spoken to the Minister for Life Sciences, and I know that my hon. Friend will be receiving a full response about the various issues he has raised.

In response to my hon. Friend’s points about complementary treatments, I would say that it is very important when spending taxpayers’ money on cancer treatments that there is a solid evidence base for what we do. However, his point is well made—that the entire person needs to be taken into account when considering treatment. That can also involve people living with cancer, not just the treatment of it.

It was very nice to hear the hon. Member for Alyn and Deeside (Mark Tami) speak. It was also good to hear him speak from a personal point of view—it was good of him to share his sorrow regarding his son. On the stem cell transplantation issue that he raised, I can tell him that the recovery package as part of the taskforce’s recommendations that the Government have already moved on will apply to blood cancer patients who have undergone stem cell transplantation. The Government are very supportive of the work by the Anthony Nolan trust and other charities, but I will make sure that the hon. Gentleman gets a fuller response on the specific issues that he raised, so he can be satisfied that we have taken into account the particular difficulties and challenges facing those who have undergone stem cell transplantation.

It was a great pleasure to hear from the hon. Member for Scunthorpe (Nic Dakin). I have a particular affection for him, not only because he helped me on the way through King’s Cross the other day, but because he spoke just before me in my maiden speech—we made ours at the same time. This is a good point at which to reflect that the Member who spoke after me was the former right hon. Member for Oldham West and Royton, who is much missed in this place.

The hon. Member for Scunthorpe brought to our attention the issue of rare cancers—specifically pancreatic and blood cancers. I would like to reassure him about research. He will know that Cancer Research UK has looked specifically at the rare cancers and has prioritised work in the areas where it feels additional research funding and effort need to go, which include blood and pancreatic cancers—and, indeed, brain cancers, which my hon. Friend the Member for Castle Point (Rebecca Harris) mentioned. The hon. Member for Scunthorpe also raised the issue of GP imaging capacity, and I would like to reassure him that, as part of the ACE programme—Accelerate, Co-ordinate, Evaluate—by NHS England, imaging will be expanded within primary care. I hope that I will be able to write to him with further details.

I thank my hon. Friend the Member for Castle Point for her fascinating speech and for bringing to our attention the very sad story of her constituent Danny Green. Her point about a national register for off-label drugs was well made, and I know it is an issue that the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), is looking at actively. My hon. Friend the Member for Castle Point made a point about research,. She will be aware that it is always difficult to try to divvy up research funding, but I will make sure that her point is reflected back to my hon. Friend the Under-Secretary.

My hon. Friend the Member for Bury St Edmunds (Jo Churchill) made some very good points about joined-up care. It is certainly the case that we need to see such care across the NHS.

The hon. Member for Foyle (Mark Durkan) spoke about the cancer drugs fund, and made an interesting point about a UK-wide set of arrangements. I shall certainly pass on his comments to the Minister responsible for cancer. He also spoke about molecular diagnostics, and I would like to reassure him that, in England at least, we will significantly roll out molecular diagnostics as a result of our acceptance of the principles of the taskforce recommendations.

Finally, the hon. Member for Ellesmere Port and Neston (Justin Madders), the shadow Minister, rightly made some points about public health strategy. It is, of course, difficult to make sure that we balance the books, while keeping to our manifesto pledges. His points about tobacco and obesity were well made, and I know that the Government will be coming forward with obesity plans in short order.

With no more time available to me, I would like to thank Members for their full, excellent and expert contributions to this fascinating debate. I hope that the Government have shown the kind of progress and commitment to this important area that they are so keen to see.

[Madam Deputy Speaker (Natascha Engel)]

That leaves one minute for John Baron to conclude the debate.

Off-patent Drugs Bill

Natascha Engel Excerpts

Friday 6th November 2015 Commons Chamber

[Albert Owen]

On a point of order, Madam Deputy Speaker, the Minister said earlier that, according to the procedure of this House, he is able to speak until 2.30 pm. I think that is incorrect. Can you give me some guidance? If the Minister sat down one minute before 2.30 pm, would my hon. Friend the Member for Torfaen (Nick Thomas-Symonds) be able to put the question so that we can have a vote and the democratic will of this House can be heard?

[Madam Deputy Speaker (Natascha Engel)]

The hon. Gentleman is absolutely right. That is not procedure, but it is the choice of the Front Bencher how long they speak for. He has put it on the record.

[Alistair Burt]

I am happy to be corrected in relation to procedure. The procedure of the House allows the Minister to speak until 2.30 pm. [Interruption.] I am not obliged to do so—that is correct—but I am choosing to do so because I believe that I would not be performing my duty if I were to allow a Bill that I think is wrong and potentially harmful to go through.

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[Madam Deputy Speaker]

I think what is happening is that the Chamber is getting very passionate and very heated. Members on both sides of the House ought to calm down the debate a bit. We are discussing very serious matters and we are being watched not just by people in the House but by people outside the House as well. I think all of us need to calm down a little bit.

[Alistair Burt]

I withdraw the remark immediately and apologise to the hon. Member for Glasgow North West (Carol Monaghan).

I am seeking to find a bit of space to explain, in the face of a House that plainly does not accept it, why the Government hold their position. I am very anxious to convey it, because I believe there is a risk that people outside will take the view that something is preventing people from getting access to drugs that they may want. I think that that position is wrong, and that is why I want to make clear the Government’s position.

Since last year, the Government have had a series of meetings with the people involved. We have received input from the MS Society and the General Medical Council. It is clear from the conversations the Government have had that this is a very complex area with a number of factors at play, including easy access to robust evidence for prescribers; information about licensing status and what it means; and clear and more accessible information for researchers and charities on how to get research findings into the system and through to licensing, if that is the approach they wish to follow. What is also clear is the genuine commitment to work together to make those things happen and to investigate whether there are other non-legislative improvements that can be made to support appropriate medicines use and benefit NHS patients.

We know that there are issues with access to medicines, but they are in no way unique to unlicensed or off-label medicines use. There are areas where there is far too much variation in the use of licensed, NICE-appraised medicines, and we are working hard with the NHS to address that, but there is no single magic bullet. The measures before us today are more likely to impede access than to facilitate it. What is more, they would be of benefit to only one medicine, one condition and one group of patients at a time.

We are committed to working with NHS England, the Medicines and Healthcare Products Regulatory Agency, NICE, the GMC, the all-party group on off-patent drugs, and patient and professional groups, to address the issues that the round-table group identified. MHRA, NICE and the GMC are committed to working together to improve the understanding of the differences in licence status and how clinicians can practically work with that. The GMC is preparing a topic for its website to dispel myths and confusion about off-label prescribing and to explain how its guidance applies. NICE and the GMC are also considering further joint work to support clinicians in discussing and sharing knowledge.

As doctors may prescribe unlicensed medicines where it is necessary to do so to meet the specific needs of individual patients, and given that patients need sufficient information to allow them to make an informed decision along with their doctor, NICE is looking at making more use of patient decision aids further to support implementation of its clinical guidelines, to help individuals work through the pros and cons of different treatment options.

We are looking at how we might provide better information to help researchers and other stakeholders know how they can propose subject matter for NICE’s clinical evidence summaries and for updates to NICE guidance. NICE will be working with the “British National Formulary” to ensure that off-label uses are included where there is robust evidence to support them and that they are presented in a standard way to help clinicians to use them.

We are committed to working with the research community to set out the pathways and options for bringing research evidence to the attention of clinicians more systematically. This will involve working with a number of bodies in the research community, including the Association of Medical Research Charities, and I know there is a commitment to do so. The outcomes of the accelerated access review will also feed into that.

Let me say a little on the detail of why I do not think the Bill is the right way forward and about what is the best way forward. The Government do not support the Bill, just as the then Government did not support the virtually identical measure introduced by Jonathan Evans last year. I want to be absolutely clear about why that is the case: when it comes to the primary objective, which is to make sure that our NHS can treat everyone according to the most up-to-date and robust evidence, the hon. Member for Torfaen and I are in complete agreement. However, legislating in this way is not the way to achieve that goal.

There are clear benefits in using licensed drugs based on evidence about their safety profile, side effects, efficacy and so on. The guidance from the Medicines and Healthcare Products Regulatory Agency and the General Medical Council is clear that a licensed medicine being used within its licence indications should be the first choice for patient care, and that is exactly as it should be. However, the guidance also makes it clear that clinicians are free to use their clinical judgment to treat their patients with a licensed medicine used outside its licensed indication—off-label prescribing—or, indeed, an unlicensed medicine where such a medicine is the best clinical choice for the patient or there is no licensed medicine to meet the particular need. In fact, the guidance from the MHRA and the GMC sets out a hierarchy of medicine use.

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[Ian Blackford]

On a point of order, Madam Deputy Speaker. Will you give us some guidance? Given the feelings being expressed throughout the Chamber, what can we do to move a closure motion so that the views of the House can be expressed properly in this debate?

[Madam Deputy Speaker (Natascha Engel)]

The hon. Gentleman is perfectly entitled to move a closure motion, and it is for the Chair to decide whether or not to accept that motion.

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[Hon. Members]

Hear, hear!

[Madam Deputy Speaker (Natascha Engel)]

As I said previously, I am not prepared to accept that the Question be now put.

[Albert Owen]

Further to that point of order, Madam Deputy Speaker. The Minister has definitely run out of arguments and he has indicated that he wants us to run out of time. What help and support can you give us to have a closure motion, so that Members who have stayed here today at the request of their constituents can have their names put on the record?

[Madam Deputy Speaker]

Two closure motions have now been moved and twice I have said that I am not prepared to accept them. I am afraid that is just how it is.

[Patrick Grady (Glasgow North) (SNP)]

Further to that point of order, Madam Deputy Speaker. Given what you have said, let the record show that at least 13 Scottish National party Members have given up their Fridays in their constituencies to come here on behalf of their constituents. This is an outrageous abuse of parliamentary procedure.

[Madam Deputy Speaker]

Can we please stop it there? Two Members have tried to move the closure and I have refused to put the Question. If any more Members try to put that Question, they will be challenging the Chair.

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[Hon. Members]

Five, four, three, two, one.

[Madam Deputy Speaker]

Order! Enough now.

Access to Medical Treatments (Innovation) Bill (Money)

Natascha Engel Excerpts

Tuesday 3rd November 2015 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

On a point of order, Madam Deputy Speaker. Is it in order for the Government to be neutral on a Bill if the payroll vote is whipped for that vote?

[Madam Deputy Speaker (Natascha Engel)]

That is a matter for the Government, rather than for the Chair.

[George Freeman]

The debate on Second Reading raised a large number of issues, which clearly need to be addressed and I have no doubt will be addressed in Committee. We cannot second-guess where that Committee will get to or the shape of any Bill that might subsequently return to the Floor of the House.

The costs associated with this Bill, were it to be implemented in its current shape, arise from the establishment and maintenance of a database by the Health and Social Care Information Centre. Early discussions on costing with the HSCIC, which is leading on the construction of a number of databases and data streams crucial to the operation of the NHS, have provided an indicative costing of between £5 million and £15 million for developing the database of innovative medicines that the Bill anticipates.