Standardised Packaging (Tobacco Products)
Nick de Bois Excerpts(9 years, 3 months ago)
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The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I am pleased to have the opportunity to respond to this important debate and I congratulate the hon. Member for Glasgow North (Ann McKechin) on securing it.
As other Members have said, tobacco use remains one of our most significant public health challenges and reducing smoking rates is a key public health priority for this Government. The burden of smoking places enormous strain on the NHS and holds us back in the battle against cancer. This is why the Government have committed to and delivered on a comprehensive set of tobacco control measures, which include a ban on smoking in cars with children present, making it illegal for adults to buy tobacco products on behalf of children, outlawing displaying tobacco in shops and working to introduce age of sale requirements for e-cigarettes. Standardised packaging is part of this strategy and I am grateful for tonight’s opportunity to provide the House with an update on this policy.
It is important to acknowledge the enormous progress that has been made so far. Smoking rates in England are at their lowest level since records began. Today, around 18% of adults are smokers, down from around half of adults in the 1970s. Almost 2 million fewer people in England are smokers compared with a decade ago. Assuming that the downward trend of the past years continues, that equates to around 15,000 smoking-related deaths avoided during the course of this Parliament.
We know that most smokers start young, and we want our children to grow up free from the burden of disease that tobacco inflicts. The very good news is that the rates of regular smoking by children in England are also falling, with 8% of 15-year-olds smoking now compared with 15% in 2009, achieving the target set out in our tobacco control plan two years early. However, around 8 million people in England still smoke, so there is no room for complacency. The hon. Member for Glasgow North is right to draw attention to regional differences in smoking rates—including in her own area, where more than one in four people smokes. I think that she will agree with me that there is a concerning link between those rates and deprivation.
I wish to pick up on what the hon. Lady said about prevarication and delay. I have always been clear about the need to follow a robust process and ensure that all issues relevant to the introduction of standardised packaging are properly considered. That includes the implications for illicit trade, as my hon. Friend the Member for Hornchurch and Upminster (Dame Angela Watkinson) mentioned, as well as the legal issues.
Jane Ellison
I am very sorry, but I have been left very short of time.
The challenges that the tobacco industry is likely to bring to the regulations have also been carefully considered. It is vital that all stakeholders are heard and all evidence is carefully considered and evaluated. Ministers must ensure that that is done as thoroughly as possible so that any decision taken is solidly based on the available evidence.
Over the past few weeks and months, the Department of Health has carefully considered all responses to the most recent consultation and taken into account all the information and evidence on the public health implications as well as the wider issues, including the legal ones. I commend my officials, who have worked tirelessly to provide me and my ministerial colleagues with essential and valuable advice with which to make a decision.
As the House has already heard, I asked Sir Cyril Chantler, an eminent paediatrician, to undertake an independent review of whether the introduction of standardised packaging is likely to have an effect on public health, in particular in relation to children. I would like to thank him again for delivering such a thorough report.
Sir Cyril’s report concludes that, if standardised packaging were introduced, it would very likely have a positive impact on public health and that the health benefits would include health benefits for children. Following the publication of his report, we also held a final short consultation in summer 2014, seeking new and additional information, relevant to the policy, that had arisen since the last consultation.
Earlier this month, the chief medical officer and chief scientific adviser, Professor Dame Sally Davies, provided me with her review of the evidence and also of the criticisms of the Chantler review that have been put forward by the tobacco industry. Dame Sally has made it clear that she
“does not believe there is evidence to show that the process or the conclusions of the Chantler review are flawed and there is now accumulating evidence to support the conclusions of the review.”
It is her view that the evidence does support the introduction of standardised packaging.
There have been particular concerns that standardised packaging would increase illicit trade. In his review, Sir Cyril addresses those concerns and concludes:
“I am not convinced by the tobacco industry’s argument that standardised packaging would increase the illicit market, especially in counterfeit cigarettes.”
Her Majesty’s Revenue and Customs has also undertaken a detailed assessment of the potential impact of standardised packaging on the illicit market. It concluded:
“We have seen no evidence to suggest the introduction of standardised packaging will have a significant impact on the overall size of the illicit market or prompt a step-change in the activity of organised crime groups.”
The assessment is expected to be published in full soon.
We are also giving careful consideration to any and all potential legal challenges that may be brought against the Government as a result of introducing standardised packaging. As the hon. Lady knows, litigation by the tobacco industry is always a risk when introducing tobacco control legislation.
The Government are committed to reducing the numbers of young people taking up smoking and to helping smokers who are trying to quit. Our comprehensive approach to tobacco control is working. Fewer people than ever now smoke and cancer survival rates are at record highs. However, we cannot be complacent. We all know the damage that smoking does to health. Tobacco causes over 80,000 deaths a year, and around 600 children in the UK start smoking every day, as the hon. Member for Glasgow North said in her opening remarks.
The Government are completely committed to protecting children from the harm that tobacco causes. That is why I am announcing today that we will be bringing forward legislation for standardised packaging before the end of this Parliament. A consultant respiratory physician told me last year that he is confident that the introduction of standardised packaging will end up saving more lives than he would be able to in his entire career.
I thank all the people who have campaigned for this policy and all those who have contributed to the consultations—the 2012 consultation and the 2014 consultation. I hope that the thousands of other clinicians who have written to me, and to colleagues, over the past weeks and months will welcome this important progress. I want to reassure the House that I will provide further details about the introduction of the policy in due course.
Legislation—even new laws on packaging—will not solve all the problems relating to tobacco. Effective tobacco control depends not just on Government action; local authorities also have a key role, which is why we gave local government responsibility for public health. It is best placed to take forward local plans, based on local circumstances. We see a wide variation between the levels of smoking in our nation—during pregnancy and among young people—and we see that the policy of local action has been vindicated. Local authorities, supported by Public Health England, can advise on effective local action and share experience of what works.
Standardised packaging has the potential for huge public health benefits, but we must not forget that other measures will also contribute to reducing smoking rates. I remind the hon. Member for Glasgow North that Sir Cyril Chantler’s report advises that any policy of standardised packaging must be seen in the round as part of a comprehensive policy of tobacco control measures, and that is how I see the potential for standardised packaging working in this country. Effective tobacco control depends on taking a multifaceted approach, and that is what we are doing.
Only this morning, I was speaking to a number of local government leaders and hearing their reflections, and I know that many local authorities as well as health charities have also addressed the Government on this subject. Legislation to end tobacco displays has already been implemented for large shops such as supermarkets, as I mentioned. All other shops selling tobacco, including corner shops, will need to end their displays of tobacco on 6 April. The display of tobacco products in shops can promote smoking by young people and undermine the resolve of adult smokers trying to quit—and we know how many adult smokers are trying to quit.
While I have the Floor, I can give the House an update on smoking in cars. We laid the regulations to end smoking in private vehicles carrying children on 17 December 2014. The regulations have been considered by the scrutiny Committees, and I expect that we shall have a date for the debate soon. The regulations make it an offence to smoke in a vehicle if a child is present, and for a driver to fail to stop someone smoking in such situations. They provide for the police to be able to enforce against these offences and, if approved by Parliament, the regulations will come into force on 1 October 2015—again, as part of a comprehensive tobacco control strategy. We will also continue social marketing work in this area, with Public Health England running campaigns to raise awareness of the health harms and of the new offences. It is not my desire that people should be fined as a result of ignorance, and I want to ensure that as many people as possible are aware of the new policy.
As I mentioned earlier, we have also introduced legislation to make it illegal for an adult to buy or attempt to buy tobacco for anyone under the age of 18. Through regulations we plan to extend the scope of this offence to cover e-cigarettes. The Department is currently consulting on those draft regulations to introduce age-of-sale requirements for electronic cigarettes, as we already have for tobacco, and that consultation will close on 28 January.
I thank colleagues who have attended the debate, many of whom have expressed strong views about this policy. All of those views have been extremely carefully considered. The hon. Member for Glasgow North referred to the desire to make UK-wide legislation. I can confirm that I will be speaking to my ministerial colleagues in the devolved Administrations and I hope they will follow us to make this a UK-wide measure.
We will bring the regulations before Parliament in this Parliament. Should Parliament support the measure, we will be bringing the prospect of this country’s first smoke-free generation one decisive step closer. I thank the House for its attention tonight and colleagues for all their input into this policy making. I commend the policy to the House.
Question put and agreed to.
Oral Hormone Pregnancy Tests
Nick de Bois Excerpts(9 years, 6 months ago)
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Yasmin Qureshi
I entirely agree with my hon. Friend about the cover-up.
We have recently discovered another document in the Kew archive: a letter from the 1960s about the minutes of a meeting of the General Medical Services Committee, in which Dr Inman was involved. It says that there was worry about a request by the Committee on Safety of Medicines that doctors should be monitoring adverse reactions to medication. Doctors were a bit concerned about that in case they might be liable for negligence actions. The minutes say that doctors should stop recording adverse reactions, and, even more significantly, that those who have recorded any such evidence should have it destroyed. That fits in with the constituents, including mine, who have said that when they, as parents, have gone to their doctors to get their records, they are somehow mysteriously missing.
A British medical director of British-based Schering Chemicals, which is a subsidiary of Bayer Schering in Berlin, urged the withdrawal of the hormone pregnancy drug primodos in 1969, but his plea was rejected by the company. In the same year, the author of a survey for the Royal College of General Practitioners also recommended the withdrawal of the drug, but he, too, was turned down. Until this day, Bayer has refused to take any responsibility.
Jason Farrell, the Sky News reporter I mentioned, has met the statistician, Dennis Cooke, who was contracted by Schering in the ’60s. In a report, of which he still has copies, he compared the increase in the sales of primodos with the number of recorded deformities in newborns, which, he says,
“show a rather alarming direct and strong correlation.”
Schering stopped promoting primodos in 1970, and prescriptions fell from 120,000 in that year to 7,000 by 1977, when it was withdrawn. National statistics show that birth deformities declined during that period as well.
Another person I want to allude to is Professor Briggs. Many times, whenever it has been contacted about this, Bayer has referred to the court case of 1982. It is important to explain to the House that the damage claims brought by the victims were discontinued in the 1980s because some of the medical witnesses defected to the defendants, Schering Chemicals, so the case had to be withdrawn. Some of the victims say that the so-called experts who went over to the Schering side had an interesting story. One of those was Professor Briggs. Some years after the case collapsed, The Sunday Times published an interview with Professor Briggs by Brian Deer, a journalist, in which he accepts that he had in the past “fabricated” studies and carried out
“scientific fraud on a large scale”.
That is on the internet and can be read by anyone.
On a CD that has been kept under lock and key—there is an injunction on it—Professor Briggs is heard confessing:
“Difficulties would be encountered if doubts expressed about hormone pregnancy tests were made public. These were exactly the same hormones as the contraceptive pill and would have cast doubt on the safety of hormones which would extend doubt on the safety of the Pill. This would have a major influence on worldwide family planning which could be a real human disaster. It could cause panic among millions of women worldwide which could result in thousands of pregnancies.”
Later he claims:
“Drugs such as these would never be allowed to be on the Market today, given what we ‘now know’ and following what we know about Potential Hazards to the developing Foetus.”
Those comments were made in a documentary called “The Primodos Affair”, which has never been aired because Schering took out an injunction. Why did it do that? What did it have to hide?
There is further curious evidence regarding other witnesses. Dr Smithills approached a drug company for which he was doing research work on the drug Debendox. He suggested that he would approve the drug and that a funded research project would be an appropriate reward. Dr Inman opened a research centre soon after the case, after he left the Committee on Safety of Medicines. And guess what? Professor Briggs also opened a research centre in Australia soon after the case.
I have no hesitation in saying that those witnesses were bought off by Schering. It is amazing how all of them ended up opening research centres, which, as everybody knows, costs money.
Obviously, the situation is not this Government’s fault, but no Government have taken action over the years. Given the weight of evidence, why did the regulators not warn the doctors? According to internal correspondence from the Committee on Safety of Medicines, it admits that it has
“no defence for the 8 year delay”.
Interestingly, the authorities in Sweden, Finland, Germany, the USA, Australia, Ireland and Holland issued warnings and took action on the drug as early as 1970, five years before any warning was issued in the UK, despite the fact that the first group that knew about the problem was the Committee on Safety of Medicines.
One of the things thrown at the victims is the claim that there is no link, but there is a link: so many statistics show a correlation and so many doctors saw what happened. There seems to have been a complete failure on the part of the body appointed to monitor medication. It could have taken action but failed to do so, so the Government of the day were culpable.
Interestingly, Schering discontinued the product and stopped using it for pregnancy tests. Surely that suggests that something was wrong with the drug; otherwise, it would not have been taken off the market.
It is said that justice delayed is justice denied. We have found out in recent years about cover-ups in relation to so many tragedies, including thalidomide, Hillsborough and the sexual abuse of children in care homes and institutions. The 1960s and ’70s seem to have been an era of cover-ups, wherever we look, and victims in those cases campaigned for years and years to get an inquiry. The case under discussion has been going on for 30 to 40 years. Is it not about time for the victims—there are thousands of them—to get the justice they deserve?
Nick de Bois (Enfield North) (Con)
I congratulate the hon. Lady on the work she has done to secure this debate and her work with campaigners. She is drawing a contrast between this and previous cover-ups. To support her point, I should like to point out that, in this new age of transparency, we seek not a public inquiry but an independent panel, which should be well within the Government’s gift.
Yasmin Qureshi
I entirely agree with the hon. Gentleman. I thank him for all the support that he has given me and all the work that he has carried out in the campaign on behalf of his constituents.
I want to end by paying tribute to Marie Lyon, who has already been mentioned, and the victims association for all its work, as well as hon. Members who have given their help and assistance. I want to name-check two hon. Members who, because of their positions, are not able to speak in the debate: one is my hon. Friend the Member for Garston and Halewood (Maria Eagle), who is in the Chamber; and the other is the Minister for Government Policy and Chancellor of the Duchy of Lancaster, the right hon. Member for West Dorset (Mr Letwin), who is not here today.
Nick de Bois (Enfield North) (Con)
It is a pleasure to follow the hon. Member for Coventry North West (Mr Robinson). He may be troubled—or pleased—to know that I have spoken after him on more occasions than I have any other Member, which means that I have probably listened to more of his speeches, and he has had to listen to more of mine, than absolutely necessary.
It is a pleasure to support this debate and the case made by the hon. Member for Bolton South East (Yasmin Qureshi). I know that she has made considerable efforts in this very distressing matter. With all the cynicism about politics today, if we ever need a reminder of how active constituency MPs can play a positive role for their constituents, the evidence of this debate makes the case better than anything else I could say.
A constituent of mine, Chris Gooch, approached me some time ago about this issue and her daughter, Emma-Victoria. I echo what my hon. Friend the Member for Aberconwy (Guto Bebb) said—that the sense of responsibility that parents feel in such circumstances is magnified by the fact that they cannot as yet even be certain that the decision that they took in good faith, fully trusting the medical authorities and the drugs manufacturers and confident that regulation would protect them, has had such a dramatic effect on them and, more importantly, their offspring.
Chris Gooch made this point to me: “When I went to the GP, I did not ask for medication. I went to get confirmation of pregnancy. I knew nothing of what tests were available, but have since found out that a totally safe urine test was already available. So why was I given something that had been raising concern among professionals for many years and with no warnings given to GPs?” That sums it up. How is it possible that people can have gone with confidence to a GP they trusted, hoping for confirmation of a joyous event in their lives, and been handed two pills, without prescription, that had a legacy that will live for ever? I hope that the House will be able to make a contribution to lifting the veil of secrecy over this issue by persuading the Government to hold an inquiry.
Let us remind ourselves about that drug. One dose of primodos equates to 13 morning-after pills or 157 oral contraceptive pills. I am no medical expert, as many will testify, but it strikes me as somewhat perverse that a pill with such high levels of medication should be used as a pregnancy test. Surely that is a cause for concern.
Our motion is very simple and the hon. Member for Coventry North West has been kind enough to spell it out. We understand the constraints on government but we hope, particularly as this Government have been determined to shed transparency on so many issues that have been clouded for decades, that this relatively simple and reasonable request for an independent panel to look into the paperwork, history and documentation not in the public light will be accepted. Let me try to anticipate some of the points that might be raised in objection.
The question of causal link, which I am told scientifically may be the case, should not be a barrier to an independent panel. Many scientists and experts have raised the possibility of a large question of doubt. Let us face it: in this place we have made policy on the basis of less evidence than that which has been put forward by panels of experts who raised significant doubts about the treatment that was available and freely given to unknowing patients.
Without running through the whole list, two or three striking pieces of evidence have stuck with me. On 4 November 1966, a consultant pathologist from Sheffield said
“The test is unreliable. It may well have been dangerous”.
On 23 June 1967, the Medical Research Council said:
“It looks like it could be another thalidomide story.”
Schering’s own specialist advice in the UK raised doubts.
Our job in this House is to reflect the wishes, concerns and priorities of our constituents. I find myself at one in asking the Government’s help to navigate through these documents and this history. It becomes very complex for all but the most persistent. It is with that in mind that I pay tribute to the campaigners, because they have not been daunted by that task. They have not been daunted by the conflicting evidence. They have not been daunted by the lack of funding, or the availability and sudden loss of witnesses to legal cases in the past. They have persevered ruthlessly to try to obtain documentation, despite having the full weight of the establishment against them so frequently and so often, that I feel the time is right for us to champion transparency. Let transparency be championed across the House, albeit that we need the Executive branch of government to implement it.
Mr Robinson
I have been briefed fully by campaigners outside this House. Marie Lyon, whose daughter was born with a very foreshortened arm, came to see me with her husband yesterday. She has been indefatigable in her briefing of MPs and we should pay tribute to her for that.
Nick de Bois
Indeed we should. I echo and support those sentiments, as I am sure we all do across the Chamber. They reflect the courage and determination of every sufferer in every family. Their bravery in confronting this and in facing the future should be honoured by the setting up of the independent panel that they rightly seek.
I want briefly to press three issues: the conduct of the manufacturer; the conduct of previous Governments; and the conduct of the profession. I believe they build a compelling case for uniting behind the motion.
In 1978, when this issue was first raised, a former Labour Member, Jack Ashley, championed the cause in Parliament. It was reported in The Times that he pressed the then Health Minister to hold a public inquiry—this was after an intolerable eight-year gap between the first doubts being raised and a warning being issued by the Committee on Safety of Medicines—but unfortunately his response set the tone for the future. He said that nothing new would learned from holding an inquiry—as we now know, thanks to the diligent work of campaigners, there was lots more to be learned, and there probably still is—and that it was not worth following up because most cases would have been dealt with. I submit that this approach—expediency over justice for victims of primodos—was not necessarily the right one to take. His tone was reflected in later ministerial statements, but Jack Ashley pressed on, and I am sure he would have been proud of the hon. Member for Bolton South East for showing the same diligence.
We need to explore what the committee did between 1967 and 1975, and it is right that we now give members of the action group the opportunity to understand what happened. What government records are lurking about? It is right that we finally establish how many people were put at risk. Where was the duty of care in government, the profession and the regulatory body? In 2014, we can at least make a modest effort to make up for the then Government’s failure to consider those points.
What of the profession? In 1967, the Medical Research Council made it clear that primodos could have been another Thalidomide—so far, so good—and warnings were expressed about the high proportion of pregnancies in 1968 following use of the drug. This should have been sufficient for the profession to press for more to be done. We know that the committee was prepared to publish information letting the profession know of its concerns, and it even concluded in a letter in 1967 that if its concerns were made known, it could reduce its use by GPs, and that this would have been no bad thing. But nothing happened. In fact, the committee referred it to a GP survey for two years, until 1969, despite being fully aware of the warnings, and nothing happened until the matter was exposed by the media in 1975. This led to warnings, and subsequently the manufacturer put a warning on the box.
In 1975, the World Health Organisation asked why nothing had been done for so long. I cannot judge what was going on at the time, but I think we will be judged on how we deal with this issue in this present time, and I hope that will be sufficient to drive the Government towards the independent panel. The company was completely aware of warnings—not just from the profession and the regulatory body with which it was in communication, but from its own staff.
I freely refer Members to my declaration on the Register of Members’ Financial Interests because I worked with medical companies before coming here. I am aware of much of the excellent research and development that has come from within this sector, but let that not cloud our judgment on this issue. We must hope that it is not just our Government and our NHS who buy into transparency; it must be the role and responsibility of our pharmaceutical companies to do so wherever they may be. We are not selling a consumer good here; we are selling a product that must secure the absolute trust and absolute faith of both the profession and the users. We should never be in the position of having to say that there has been the potential for deliberate mismanagement of information from, in my opinion, right across Government, manufacturers and regulatory bodies, leading to this most distressful and distasteful situation for people who are suffering now as a result of some of that conduct.
I hope that Schering, now Bayer, will embrace the mood of this House and voluntarily come forward with as much information as possible. In this age, that would bring more benefit than harm to corporations that are understandably concerned with their image; above all else, however, such action would enable them to fulfil a moral responsibility that has clearly been lacking in this case.
I would be grateful to know that today, notwithstanding all the other issues we can argue about and the things we could do, we can take a moral and justifiable stance to help secure justice for campaigners who have been worried, troubled and wronged for far too long. I hope that the Minister will listen favourably to that request.
Oral Answers to Questions
Nick de Bois Excerpts(9 years, 6 months ago)
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Nick de Bois (Enfield North) (Con)
Will the Minister confirm that unlike the PFI agreements for my neighbouring hospitals in north Middlesex and Barnet, which were negotiated badly and ineffectively, the rebuild of Chase Farm hospital will be funded by proceeds from its own land sale and Treasury money, not PFI?
Dr Poulter
My hon. Friend makes an important point. Hospitals should always look to their own efficiencies first by improving procurement practices and freeing up surplus land to fund local schemes. His hospital has done that very effectively, and it has not pursued the policies of the previous Government, which have put so many trusts into difficulty.
Care Bill [Lords]
Nick de Bois Excerpts(10 years, 2 months ago)
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Karen Lumley
One of the big successes is the creation of local commissioners. In my patch, Jonathan Wells has continually stood up for the people of Redditch in this reorganisation. Will the Minister clarify how much involvement the commissioners would have in any administration case?
Forty days is a short time indeed. As I said earlier, I agree with the principle, but I do not think that it has been thought through enough. No one would want an unsafe hospital in their patch, but we all want an NHS that treats our constituents at a local level if possible. The Minister has allayed some of my fears, and I thank him for that, but there is a great deal of concern in my constituency.
Nick de Bois (Enfield North) (Con)
I am grateful for the opportunity to discuss amendment 30 and new clause 16. I realise that it will come as a disappointment to Government Members but I will support amendment 30 and new clause 16. Let me explain why, and I hope that I can avoid drifting into the scaremongering that has been associated with this issue.
For me, the concern has always been about public trust in reconfigurations. As many hon. Members will know, I have been through 10 years of discussions and consultations on reconfigurations. That first started under the then Labour Government, and I agree with my hon. Friend the Member for Wycombe (Steve Baker), who suggested that there was a wonderful alliance of faith and trust professed by the Opposition in the effectiveness of consultations. For the record, we had the most shameful consultations at the beginning of the process on Chase Farm, and not much changed after the change of Government in 2010.
Steve Baker
To be clear, I think these consultations are a fiction and sham that do not make any difference to the progress of events in the NHS. In fact, they cruelly mislead the public into thinking that they have any say at all.
Nick de Bois
I am grateful for my hon. Friend’s intervention and I understand where he is coming from. Certainly in the early days under the tenure of the predecessor of the shadow Health Secretary, we were presented with consultations that listed 10 options for the reconfiguration of Chase Farm, one of which included retaining the A and E services. It disappeared from the list before anyone had had a chance to consult. A selected group of stakeholders was then invited to a meeting that, funnily enough, was not held in Enfield or Barnet. It was held in central London during working hours, meaning that very few people could attend—certainly not the public. I share the shadow Health Secretary’s view that that consultation was utterly flawed and it led to the decision to downgrade my hospital being made by his predecessor in 2008. Hopes were raised with the moratorium that was introduced by the coalition Government, but they were then sorely dashed. I have described my displeasure and the distress of my constituents who had their hopes raised in that shameful episode, the likes of which litter the history of Chase Farm over the past 10 years.
Richard Drax
In Swanage, we too had a consultation that was a disaster. It was binned, thank God, but another one has been started. It is taking a year, if hon. Members can believe it—a year of waiting, cost, experts and so on. This is another problem with the NHS: unfortunately, people do not trust consultations and when they happen they cost a fortune.
Nick de Bois
And the answer is not just with consultations. The issue facing us today, and why I cannot support clause 119, is simply this: the argument on reconfigurations, with the greatest respect to all hon. Members, will not be won by politicians or even by senior managers in the NHS. There has to be a clinically led argument from GPs upwards throughout the acute sector. For many, many years they have not made the case. The process has been littered with broken promises over the years, regardless of the good intentions of politicians. I can do nothing tonight that would suggest a further breach of trust by weakening the power of consultation, even though I accept that consultation has not had its finest hour—or, in my case, its finest 10 years.
I have faith that the voice of the British public, and the intent behind the Health and Social Care Act 2012 in particular, on which I was engaged over many weeks, is to bring clinical decision making to the front line and to empower local people, local authorities and patients further. That has been a great step. The second reason why I find it difficult to run with clause 119, and why I support the amendment tabled by the right hon. Member for Sutton and Cheam (Paul Burstow), is that he recognises the need to extend the consultation to all key stakeholders, not least to those in trusts that could be affected through no fault of their own, to extend their powers as well. That went to the heart of the 2012 Act. Indeed, we are blessed with two former Ministers in the Chamber, with whom I spent many happy hours on those Benches—it was not acrimonious at all. This was a core principle behind what we were trying to do.
Let us deal with the exceptional cases. I accept entirely that there is no master plan to run through configurations on the basis of the proposed changes, but I cannot ignore the fact that the proposed legislation we are being asked to approve allows for changes to be made in circumstances that would leave a democratic deficit and subjugate clinical judgment because of a stressful financial situation.
Bob Stewart
Where is the limit? That is what worries me. It is like pouring water on a tile—one cannot stop it. It might go much further than the adjacent trust area; it could go anywhere.
Nick de Bois
Yes, indeed. Again, I am trying to be as balanced as I can. I recognise that no single institution can stand in isolation, and I think that that is broadly accepted. However, to make decisions within 40 days on institutions, when we do not know which institutions will be affected or how they will be affected, is demanding too much of a service that is so valued by the public.
Jeremy Lefroy
Does my hon. Friend accept that there are some extremely important issues that cannot be resolved in 40 days, or even 400 days? For instance, the royal colleges are prescribing services that require more and more consultants to run rotas, which means that in district general hospitals it becomes even less possible to provide these kinds of services. These things are taken out of the hands even of politicians.
Nick de Bois
Indeed. My hon. Friend makes his point very well and I bow to his superior judgment.
I am also concerned about a point that was raised earlier. As everyone knows, I have absolutely no clinical or medical background, and it has always come as a surprise to me that I have spent so much of my time in the Chamber talking about these subjects. In business, there is a fairly simple calculation that assesses the solvency of a business; the strict definition is if someone is not able to meet their liabilities or knows that they are not able to do so in the short term, they are considered insolvent. They then go into administration and the processes kick in.
We are talking about a very different picture here in which a judgement has to be made about institutions that may or may not be considered unfit to continue. Under those circumstances—however much I accept that there are good intentions and not the devious plots that are being suggested—it means that much is left open to doubt. Therefore, it is with a very heavy heart that I will be on the other side when we go into the Lobby—when I have worked out which side that is. But I do so based on my 10 years of experience of what has been a very difficult exercise in my constituency.
David T. C. Davies
I listened with great interest to my hon. Friend the Member for Enfield North (Nick de Bois) but I will be supporting the Government 100% tonight because I have great confidence in what the Government have achieved with the NHS. I say that because I have seen the alternative; I have seen what has happened to the NHS when it is run by Labour, because that is the problem that I and many of my constituents face at the moment in Wales.
My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) came forward earlier with a petition from the left-wing pressure group 38 Degrees. Health campaigners have been talking today about the amount of salt that we take but one has to take dangerously large pinches of salt with anything that comes out of that organisation. These people purport to be happy-go-lucky students. They are always on first name terms; Ben and Fred and Rebecca and Sarah and the rest of it. The reality is that it is a hard-nosed left-wing Labour-supporting organisation with links to some very wealthy upper middle-class socialists, despite the pretence that it likes to give out.
It is 38 Degrees who were coming out with all sorts of hysterical scare stories a few years ago about how the Government were going to privatise the NHS. It took out adverts in newspapers, scaring people witless that that was going to happen. Of course the organisation has forgotten all about it now because there was never any intention to do that. We will never privatise the NHS because we believe in public services in this party. A couple of months ago, 38 Degrees came out with more scare stories about how it was going to be gagged because of another piece of legislation that the Government were putting through to bring about fairness in elections. It said that we would never hear from it again, and yet here we are a few months later with yet another host of terrible stories, scaring members of the public quite unnecessarily. I do not think that we have to take any lessons from 38 Degrees, nor hear any more about their petition.
I am backing the Government tonight because I know that the Secretary of State has done an enormous amount to drive up standards in the NHS even as they fall in Wales. It is this Secretary of State who has presided over falls in waiting lists to 18 weeks in England. People are lucky in Wales if they can get to the target of 36 weeks. There has been an increase in funding when it has been cut in Wales and there is much better access to cancer drugs in England than we have in Wales.
New clause 16 refers to the need to confer with members of neighbouring boards. We have health boards, not trusts, in Wales. I hope the Secretary of State will confer with the boards in Wales about these changes. The only criticism that I have of the Government is that they have been so successful in improving the NHS in England that large numbers of people now contact me every single day, in Wales and in my constituency, asking for the right to be treated by the NHS run by the coalition Government and not by the NHS run by the socialists in Wales.
I ask the Minister and Opposition members to look at an article in the Western Mail today by a woman called Marianna Robinson who has spoken about the difficulty she has had in trying to get treatment and how desperately she wants to be treated in Bristol. There is a place for her in Bristol but she is not allowed to have it. I ask Ministers, and perhaps Opposition Members, to think about what we are doing here. I would like to see patients in Wales who wish to be treated in England being allowed to go to England and get treatment, with the money then being taken off the block grant to the Welsh Assembly. If Opposition Members—
Oral Answers to Questions
Nick de Bois Excerpts(10 years, 5 months ago)
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Sir Tony Baldry (Banbury) (Con)
13. What progress his Department has made on improving out-of-hospital care for frail elderly people.
Nick de Bois (Enfield North) (Con)
17. What progress his Department has made on improving out-of-hospital care for frail elderly people.
The Secretary of State for Health (Mr Jeremy Hunt)
Improving the quality of out-of-hospital care is the biggest strategic long-term change that we need to make in the NHS. It will help to make the NHS sustainable. Reforming the GP contract is the first step, but we also need to make major progress on integrating the health and social care systems.
Nick de Bois
Enfield CCG is working closely with Enfield council to try to deliver integrated health and social care, particularly for the elderly and the frail. Noting our higher-than-average elderly age demographic in the borough, will the Secretary of State take steps to ensure that those efforts are supported with extra funding?
Mr Hunt
My hon. Friend knows that the funding arrangements are decided independently of the Government, by NHS England, which will make its decision at a board meeting before Christmas. He is absolutely right to suggest that the funding formula should reflect not only social deprivation but the age profile of constituents, because the oldest people are of course the heaviest users of the NHS.
Changes to Health Services in London
Nick de Bois Excerpts(10 years, 6 months ago)
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Mr Hunt
I respect those views and the right hon. Lady for her campaigning. I understand why the people of Lewisham were unhappy about those changes but, as Health Secretary, I had to take a decision in the interests of all patients in south London. That was the first time the powers—the trust special administrator powers—were used. My interpretation was different from the courts, but I respect them as the final arbiter of what the law means. However, when we have to make difficult decisions about turning round failing hospitals—south London has some of the most serious problems in the country—it is important that the local NHS can take a wider health economy view of what changes are necessary. As I have said, I will respect what the Court has decided, but it is important that I continue to battle for the right thing for patients.
Nick de Bois (Enfield North) (Con)
The Secretary of State, his predecessor and the Prime Minister are well aware of my continued opposition to the decision to downgrade Chase Farm. However, today, will he join me in condemning the shadow Secretary of State, who has said that Chase Farm is closing? It is not closing. Against my wishes, there is a proposal to downgrade the A and E unit. The hypocrisy and politicking is worse because the previous Labour Government initiated the process and authorised the downgrade in the first place.
Mr Hunt
My hon. Friend speaks wisely. It is disappointing that we are not having a more intelligent debate. When Labour was in power, it closed or downgraded 12 A and E units in 13 years. The then Government realised that there were problems. He is right that they started the problem in Chase Farm. That is why, when we are facing such difficult decisions, it is important to have a responsible debate. I accept that MPs have views on their constituencies, but we have to start looking above the parapet to the wider interests of patients. That is a difficult thing to do, but I would have hoped for more leadership from the shadow Secretary of State, who used to be Health Secretary.
Oral Answers to Questions
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Mr Speaker
Order. I am always pleased to hear the hon. Gentleman, but I simply point out to him that Calderdale is rather a long way from Morecambe and Lunesdale. Calderdale is the subject of the question; therefore, it is essentially closed. I hope that that is helpful to him and the House.
Nick de Bois (Enfield North) (Con)
13. What progress has been made on implementation of the Barnet, Enfield and Haringey clinical strategy.
The Minister of State, Department of Health (Norman Lamb)
The local NHS continues implementing the Barnet, Enfield and Haringey clinical strategy, which was approved by the Secretary of State in September 2011 following a review by the independent reconfiguration panel. Enfield council has recently issued an application for judicial review of local clinical commissioning group plans. Unfortunately, I am therefore limited in what I can say in that regard.
Nick de Bois
Department of Health Ministers know well of my continued opposition to the decision. However, does the Minister understand that it is crucial that the investment in primary care first promised by the Secretary of State in 2008 is in place before the reconfiguration takes place? Will the Minister confirm that patients will have access to a doctor on the Chase Farm site 24/7?
Norman Lamb
First, I acknowledge my hon. Friend’s campaigning on behalf of his constituents—he has worked very hard. I understand that, as part of the case for change and for reconfiguring health services at Chase Farm hospital, a doctor will be available to see patients at Chase Farm 24 hours a day, seven days a week. However, given that my right hon. Friend the Secretary of State for Health has been named as a defendant by Enfield council in the judicial review, it would not be appropriate for me to comment further at this time.
Accident and Emergency Waiting Times
Nick de Bois Excerpts(10 years, 11 months ago)
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Mr Hunt
I thought that the shadow Health Secretary might try to do that, so let me give him the figures. I have the figures provided by the Department of Health finance department, based on the latest GDP deflators, as published at the Budget. Spending in the NHS—not the budget—in 2009-10 was £99.7 billion and for 2012-13 it is forecast to be £106.6 billion. That is a cash increase of £6.9 billion and a real-terms increase of £0.6 billion, so there is a real-terms increase in the NHS budget. The shadow Secretary of State does not agree with the real-terms increase of £600 million in the NHS today; there would be a Labour cut in NHS spending and I suggest that he might want to correct the record, as I am afraid he has got this wrong.
Nick de Bois (Enfield North) (Con)
My right hon. Friend knows, as his predecessor does and as the Prime Minister does, of my consistent opposition to the downgrading of Chase Farm hospital. Does he agree with me that it is utterly inacceptable for the hon. Member for Hammersmith (Mr Slaughter), who is no longer in his place, to suggest otherwise in this Chamber?
Accountability and Transparency in the NHS
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Andy Burnham
I will give way one final time—to the hon. Member for Cannock Chase (Mr Burley).
Rosie Cooper (West Lancashire) (Lab)
I welcome the opportunity to speak in this debate on our national health service. I resolutely believe that we should have an open and honest debate on how we can each contribute to restoring faith in the national health service, and that we should not play politics with the findings of the Francis report.
Increasingly, there is a deeply concerning creeping veil of secrecy across the public sector—local government, education or health. The application of greater accountability and transparency is the solution, ensuring that the interests of the public remain the singular and overriding No. 1 priority in public service delivery. As a society, we display a huge and deep faith that the NHS is intrinsically good, and we want unquestioningly to believe that at all times it is acting in our best interests. The findings of the Francis report, as they should, shake that faith and belief in the NHS to its very core. Francis should be commended for his report—an extensive and comprehensive forensic examination of Mid Staffs and the structure of the NHS.
I will be as brief as I can and focus on one tiny element: listening to patients, the people who pay for the NHS, and hearing what they are saying and acting on it. We do not need to keep on looking for a black cat in a dark room. Switch the light on! It is no good the Secretary of State simply repeating that we must listen to patients and their families. What assurance does he have that, until the next crisis, they are listening? In hearing after hearing of the Health Committee, senior people associated with the NHS trot out that the regulator is responsible and that the Care Quality Commission needs to deal with it. I never, ever thought I would feel sorry for the CQC, but, when everyone else ducks, it is supposed to catch the ball. We do not need to create another bureaucracy; we simply have to make work—really work—something we already have by giving it real teeth and enough resources to make it effective.
I agree with the comments of Dame Julie Mellor, the parliamentary and health service ombudsman, when she said that she hoped that the Francis report
“will trigger a debate that will support our view that good complaint handling should be at the heart of the NHS.”
From front-line experience, I believe that to be both true and essential. During my time as chair of Liverpool Women’s hospital, a standing agenda item at the public monthly board meetings was a summary of all complaints received that provided an overview—not in minute detail, but an overview—of each complaint and the outcome: upheld or not upheld. Most importantly, there was a column that stated what action was taken. Employing this system of regular review ensured that the board had oversight, asked questions, could spot trends, be assured that action was taken and demonstrate to patients and their families that they were being listened to.
Nick de Bois
Does the hon. Lady accept, notwithstanding the efforts made in the hospital she mentions, that when MPs take up complaints on behalf of constituents and try to get to the truth behind them, we are faced with tremendous bureaucracy and resistance?
Rosie Cooper
Yes, and if MPs have problems, God help members of the public and patients.
We had to demonstrate that we were really listening to patients. The medical and managerial staff had to take ownership and responsibility for complaints. They knew that at each board meeting they could be questioned and challenged. If we accept that there are large parts of the system that work well and focus our time and resources on areas that do not, we can raise standards and tackle deep-seated problems. As chair, I sought to build in assurance and be transparent about complaints; to solve them, not hide from them, and ensure that everyone was accountable right up through the management structure. I never believed in no blame; I believed in fair blame. Each time a problem was resolved properly, we became a better hospital. We were rightly proud that on the front page of the Liverpool Echo Liverpool Women’s hospital was called an NHS gem. Sadly, the main board’s complaints report stopped after I stepped down as chair.
We do not need to reinvent the wheel or have more reorganisation in the NHS, but we must make the complaints system work. From that important but simple action, culture changes happen and become embedded in the organisation. We then have real change, real transparency, real openness and real accountability—something we can all be proud of.
Nick de Bois (Enfield North) (Con)
I will never forget the last time I saw my mother. It was three days before the general election in 2005. She had secondary cancer, but she was a fighter, though I make no comparison between her circumstances and the Francis report and the horrors that people went through at Stafford.
There are many reasons why someone might remember the last time they saw their mother, but my experience is overshadowed by a sense of guilt. During my mother’s long stay in hospital—she had been in and out—my brother, who lived abroad, had often been with me and he persistently picked up that the pervading culture on the ward was that he who shouted loudest got attention. My mother would describe how much pain and discomfort she was in—other Members have mentioned similar problems—and say, as elderly people do, “Don’t make a fuss.” To his credit, my brother dealt with it by shouting loud. On that last day, my brother was not with me because he had returned abroad. Unfortunately, I did not shout that day. I went back to the election and my mother sadly died. I am not drawing a comparison with what happened in Stafford, but many patients and relatives will recognise that one has to shout loudly to get heard. That points to a problem with the culture.
In 2005, to their credit, the last Government were increasing spending on the health service. However, that suggests to me that the answer to improving outcomes and care is not about money. We can pour a lot of money in, but it will not do the trick. It has its role, but it is not the final driver. I hope that one of the legacies of Francis will be that we can recognise that the debate needs to move on. It should not be a bidding war between different political parties and ideologies about money. It should be about the thing that matters most: will patients get better, will they receive quality care and will they be treated with respect and dignity, come what may? If we drive a mature debate in this country, we can achieve outcomes on that basis.
As Opposition Members have said, perhaps we can step aside from politics. I am not naive and I do not believe that that will happen. However, every time we debate these matters, let us remember that we have a far greater chance of achieving what we are here to do, which is to provide a health service that is the envy of the world, if we have a mature debate. I say cautiously and with respect that in the light of Francis, our health service cannot currently be the envy of the world, but its ideals are most definitely the envy of the world. We have a duty in this place to set the standards that will make it the envy of the world once more.
I am very conscious of the time, but I would like to make one quick point. We have heard a lot about the culture, but we cannot change it just like that. Culture is thoroughly and utterly inbred within any institution. It starts with the new people it trains—that includes the people who are there now—and it touches everything that it does. Everything that an institution does should reflect its culture, and changing the culture therefore takes time.
Where I disagree with some in this House is in my belief that leadership is where culture starts. This House, managers in hospitals and trainers all have a role to play. However, every time I consider the role of the current chief executive, Sir David Nicholson, I come back to the point that although he has voiced sentiments that I welcome in that he said that to achieve care we need an open, transparent and care-led culture, that it is vital for staff to be seen as an asset, and that it is vital for staff to be able to challenge their leaders, the reality is that he is a command-and-control manager. That is his legacy and others have paid a price for it. I believe that his departure, whenever it may happen, is absolutely necessary to change the culture because we need to start at the top and feed it throughout the business. I say that with a heavy heart, because I do not believe that we should be chasing scalps. However, as I said at the beginning, we should be chasing the ultimate outcome of serving our patients and that is one way of doing it.
NHS Commissioning Board
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Norman Lamb
The regulations as currently drafted are absolutely clear about the importance of avoiding the conflicts of interests that the hon. Gentleman has described.
Nick de Bois (Enfield North) (Con)
Does the Minister agree that the mantra that we are hearing from Opposition Members confirms that their party remains obsessed with process and means rather than outcomes for patients, which are what drive this party and our reforms?
Norman Lamb
Indeed. That is precisely the lesson to be learnt from Mid Staffordshire hospital and the Francis report. The last Administration and the top-down culture of targets lost sight of the importance of the quality of care for patients, but the current Government are absolutely intent on always putting the patient first, and that is what this legislation is about.