Health and Social Care Bill (Programme) (No. 2)

Owen Smith Excerpts

Tuesday 21st June 2011 Commons Chamber

[Mr Bone]

If I am put on the Committee, I shall certainly make up my own mind. I know that that concept is foreign to Labour Members, who have always done what they are told and voted how they are told. Conservative Members are different—we vote according to conscience.

[Owen Smith (Pontypridd) (Lab)]

As a member of the Committee, I point out to the hon. Gentleman that throughout all 38 sittings I watched Conservative Members dragooned by the Whips and not once voting according to their conscience, if they have one, but with their Front Benchers.

[Mr Bone]

I am afraid that I did not serve on the Committee, and my bid to get on it still stands. I hope that this new-found way of doing business will eventually make progress. If this House is ready to take back control of business, that is the way it has to be.

I welcome what the Government have done throughout this whole process, and I welcome today’s debate. I have reservations about the programme motion, and I will make up my mind on how to vote at the end of the debate. When the Bill comes back to the House on Report, I hope that there will be enough time for Members to deal with all the amendments and new clauses, because at the moment only members of the Committee can do so. In general terms, I welcome the new process and congratulate the Secretary of State for Health.

NHS Future Forum

Owen Smith Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

I say three things to my hon. Friend. First, let us be clear that there is £11.5 billion of additional cash available to the NHS over the course of this Parliament—but we have to use it better and deliver greater quality and effectiveness. The job of the commissioners and Monitor together is to deliver that—partly through tariff development in ensuring that they get those efficiencies by the price that they set, based on benchmark-to-best practice prices, but also through using their commissioning strength to design services. We all know that if we simply said every year to the NHS, “You must save money by cutting the price of what is paid to you”, its response would be to cut services, cut staffing or cut quality. In fact, achieving greater quality and effectiveness is about the redesign of clinical services—the transfer of services into the community and keeping people well at home rather than through emergency admissions to hospital. It is about clinical leadership and clinical redesign, and that is what these proposals will bring to the forefront.

[Owen Smith (Pontypridd) (Lab)]

Given the Secretary of State’s manifest interest in Wales, I invite him to come to Wales to meet some Welsh patients with me to find out at first hand which party they trust to safeguard the heritage of the NHS—Labour or the Tories. I suspect that the answer would be revealing for him. How much Welsh taxpayers’ money has been wasted on this needless reorganisation of the NHS?

[Mr Lansley]

The hon. Gentleman must know that the money available to the NHS in Wales is available to the NHS in Wales, and that it is separate from England. The Labour Welsh Assembly Government have made their own decisions about the priority that they attach to the national health service in Wales, and the result is, as the King’s Fund says, that they plan to reduce its budget by 8.3% in real terms. We are going to increase the NHS budget in real terms. The result can be seen in waiting times, which we were talking about. In England, the proportion of patients admitted to hospital who are seen within 18 weeks, according to the latest data, is 89.6%. He might like to reflect on the fact that the figure for Wales is 64.5%.

Future of the NHS

Owen Smith Excerpts

Monday 9th May 2011 Commons Chamber

[John Pugh]

I have a different explanation, which is that both interpretations can be sustained by a reading of the Bill. It is a kind of Jekyll-and-Hyde thing. I have a vision of the Bill being drafted during the day by a sane, pragmatic Dr Jekyll-like Minister, but during the night some rabid-eyed Mr Hyde with right-wing ideology breaks into Richmond House and changes many of the sentences. That is the only way I can explain the fact that the explanatory notes to the Bill provided in Committee explained very little.

The House might know that I am a long-term critic of the Bill and the White Paper before it. At the annual Liberal Democrat conference in October, I and the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) went around with a double act on the Bill—him for, me against. This is not, therefore, as the hon. Member for Easington (Grahame M. Morris) might think, a hissy fit following poor election results. Like nearly everyone in the House, I do not disagree with the Bill’s objectives: more clinical involvement, less bureaucracy and more local accountability. Like everyone else, I am concerned not about its objectives, but about its likely effects. I have met no one who takes issue with the Bill’s avowed intentions, but I have met many who dread its consequences.

According to one reading of the Bill—the Mr Hyde version—the eventual outcome of the Bill will be that the NHS opts out of direct health provision and becomes simply a funding body; NHS hospitals, services and clinics become indistinguishable from private ones; everyone competes on business terms for a slice of whatever funds the Government have allocated for health purposes; and what health care a person gets depends on what can be purchased on their behalf in a largely unconstrained, privately run health market. That is a perfectly consistent view of how a health service can be run, but in our country any party that advocates it commits political suicide. Furthermore, of course, it is likely to accentuate health inequalities and overall costs.

The question for us is this: what will prevent such a situation from arising out of a Bill that appoints a competition regulator along the lines of Ofgem to promote competition, that blurs many of the lines between private and public provision, and which removes the Government’s duty to provide a comprehensive health service? Hence the importance of today’s debate, which, knockabout apart, is crucial to the wider debate on the Bill. To be alarmed by the prospect I have set out is not to oppose competition in principle. The previous Government set up competition and collaboration panels to encourage a degree of challenge in the system. In fact, if hon. Members look at their record, they will see that they were knee-deep in competition initiatives. Neither is holding these concerns to be alarmed by the presence of private business in delivering NHS services. There is not a person here who has not used a private optician or a private pharmacist when they need it. There is a long tradition of involvement by the private sector in the NHS.

Rather, to be concerned about the proposals is to be alarmed by the fear of an unconstrained, uncontrolled market in health—this is a point that has been made previously—partly because it can lead to fragmentation, potential conflicts of interest, profiteering and so on, but mainly because identifying competition as the main engine of improvement in health care ignores the simply enormous gains in service quality, cost reduction, efficiency and patient experience that can be gained through co-operation, collaboration and integration of services.

The NHS is built on the principle of co-operation, in which we, the hale and hearty, make a moral compact to support the lame and the sick. To make commercial competition the main driver of improvement in the NHS, even if it is not competition on price, would be a serious mistake. It would be to subscribe to a perverse and misguided form of social Darwinism. Competition is a mechanism; it is not an end in itself. The role of competition in the NHS, as seen by the Government, is the real issue. The problem is made a lot worse by the hopeless lack of clarity over how European competition law will apply. We struggled with that issue in Committee. We did not resolve it, and I do not think that we will do so.

[Owen Smith (Pontypridd) (Lab)]

Does the hon. Gentleman share my concern that in today’s debate, as in the long period we spent together in the Bill Committee, the Government have failed to clarify how competition law will apply? Indeed, they have sought repeatedly to imply that it will not bite any harder on the NHS. Does not that verge on disingenuousness from the Government, if not downright dissembling?

[John Pugh]

I think that that is a bit unkind to the Government. I have been to the Library and borrowed some very big books on EU competition law, and the main conclusion that I have drawn is that the law is not at all clear when it comes to the provision of public services. But that adds to the risks created by the legislation, and gives rise to the awful thought that the fate of our local services, about which we all care, could be decided not by the NHS, not by the Government and not by the public but by case law—European case law, at that—and in the courts.

If we subject clinical services to the same regime to which we have subjected non-clinical services, we will not get the innovative social enterprises strengthening existing provision that people would like to see; we will get large companies financed by private equity muscling in and challenging tendering processes, backed up by legal teams and looking for every weak link or failure to comply with EU regulations. Indeed, that is already happening with non-clinical services.

That is why there is a problem, and it is why private equity is licking its lips. We cannot additionally expect the private sector to come into this game to bid for the unprofitable, high-risk, complex work and not cherry-pick. That is not what businesses do. Good businesses pick cherries, because they need to make a profit. To suggest, as Clare Gerada of the Royal College of General Practitioners has done today, that there is not a problem of untrammelled competition in the legislation is entirely to miss the point. We are not anti-private sector, and we are not anti-competition; we want to see a level of robust pragmatism supported by those with a lifetime’s experience of running health services, and a recognition that good health care is essentially a collaborative exercise. If we cannot get that recognition and the acceptance of the professional bodies for what is embodied in the Bill, everything we say here and every amendment that we make will be utterly pointless.

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[Owen Smith (Pontypridd) (Lab)]

I am delighted to follow the hon. Member for St Ives (Andrew George) and to hear him say that, were this a Third Reading debate and the Bill had remained as it is, he would vote against it. He should not hold his breath, because we have not heard any indication from those on the Treasury Bench that they propose to listen to the reasoned and substantive opposition that we heard in the Public Bill Committee, of which I was a member and where the Government rejected all 250 to 300 suggested amendments, or to that in the rest of the country, where doctors and all the medical professions are united in opposing the Bill.

Earlier, those of us on the Opposition Benches were admonished for the sound and fury coming from us. Mr Speaker was right to admonish us for shouting, but that sound and fury is not born of cynicism; it comes from three things. The first is our outrage at how the history of what the Labour Government did in office is being rewritten and at the suggestion that this Bill represents an evolution of what we did with the NHS. It is not an evolution, but a revolution.

The second is the shameless way in which the Government are misrepresenting that which sits at the heart of the Bill. They present it as trying to bring about patient focus and GP-led improvements to the NHS, but in truth it is about competition and the Government’s belief that competition in health care, like in telecoms or the energy market, is the best way to drive improvements in the efficient allocation of resources, allowing consumer-driven demand to drive efficiency. We fundamentally contest that. We do not think that it is true in many aspects of life, but it is certainly not true in the NHS, a body built on collectivism, co-operation and integration. Those fundamental ethics—the ethos of the NHS—will be undermined by the Bill.

Thirdly, the Bill is a completely unnecessary intervention. We did not need a top-down reorganisation of the NHS, because we got record patient satisfaction and increased productivity in all the ways that matter, as described earlier by my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson). Crucially, we have a far more efficient and better-resourced system than previously. That prompts the question of why the Government are pursuing this change. They are doing so because they fundamentally believe that the way to drive the NHS forward is an unfettered market and greater deregulation.

That brings me to my substantive point. I want to rebut the notion which we have heard repeatedly from the Government that competition will not bite harder on the NHS as a result of the changes. The Government have told us repeatedly that nothing in the Bill says that competition will impact on the NHS to any great extent. As we all know, however, in 100 of the 300 clauses Monitor is established as an Office of Fair Trading-style competition overlord for the NHS, because as soon as the NHS is opened up to multiple entrants in the market and there are multiple providers of health care services in this country, we will no longer be able to argue that it is a state service that ought to be protected and therefore should not be subject to the vagaries of the market and EU competition law. As soon as we allow multiple health providers into the market, we will have to apply EU competition law, and European case law and arguments between lawyers will inevitably lead to the progressive fragmentation of the NHS.

There is one other point with which I want to take issue. Privatisation is a pretty difficult word to bandy about in politics, but I do not shy away from using it in this debate. We are going to see a progressive and creeping privatisation of the NHS. To argue about marketisation and privatisation is to argue about semantics. We will increasingly see many more aspects of the NHS either in the hands of or being delivered through the private sector. Earlier, the Secretary of State asked us to point out where in the Bill it showed that there would be an increased number of private providers in the NHS. My challenge to the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), who is now back in his place, is to point out to me where in the Bill it says that we will not see more private providers entering the marketplace. The Bill provides for that to happen and what will arise from that is the break-up, fragmentation and, eventually, privatisation of the NHS. Those on the Government Front Bench know that—

[Madam Deputy Speaker]

Order.

NHS Reorganisation

Owen Smith Excerpts

Wednesday 16th March 2011 Commons Chamber

[John Healey]

This is a debate. People in the country and in the NHS are worried not about what we did in government—they saw the massive improvements under Labour—but about the application of competition law, domestic and European, in full force to the NHS for the first time. The hon. Lady is serving on the Public Bill Committee. She will have the chance to get her head around that, as she clearly has not done so yet.

[Owen Smith (Pontypridd) (Lab)]

My right hon. Friend has anticipated the point that I was going to make. As we heard clearly in Committee yesterday—the Secretary of State ought to read the Official Report—his Minister, the right hon. Member for Chelmsford (Mr Burns), let the cat out of the bag. Hitherto the NHS has been insulated from European competition law. As there are more entrants to the market, competition law will have to apply—competition red in tooth and claw—followed by the break-up of the NHS.

[John Healey]

My hon. Friend is right. We have misinformation and confusion. If the Health Secretary disagrees with his Health Minister, I suggest that they have a word about it after the debate.

In the end, perhaps Nye Bevan was right. When Clement Attlee suggested that the NHS opening should be celebrated as a national institution supported by the whole nation, he said, “The Conservatives voted against the National Health Act, not only on second but the third reading. . . I don’t see why we should forget this.”

It is time for the Health Secretary to tell us why he is spending £2 billion on an NHS reorganisation when front-line staff and services are being cut. How many hospitals will be forced to close because of these reforms? Why is he handing such powers over our NHS to new national quangos, competition lawyers and the EU? Why is there no democratic voice in commissioning? Why is he allowing profit to be made in commissioning essential health services? Why is he removing any limit on private patients paying to jump the queue for treatment in NHS hospitals?

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[Mr Lansley]

The hon. Gentleman has now learned that, if one is trying to pray somebody in aid, it is best not to insult them at the same time.

We have made it clear that we need to protect the NHS now and for future generations through modernisation. Under the Labour party—

[Owen Smith]

Will the right hon. Gentleman give way?

[Mr Lansley]

Ah! Now we really do have somebody who can explain why in Wales the Labour party is cutting the NHS budget while we are increasing it. Come on!

[Owen Smith]

That is happening as a result of the very difficult decisions being taken in Wales, having seen the Welsh Assembly budget cut by £1.8 billion by the right hon. Gentleman’s Government. What we are not doing in Wales, however, is effectively privatising the NHS, exposing it to competition law or stuffing the mouths of private companies with public gold.

[Mr Lansley]

Let us remember that, when we decided to support the NHS here, through the Barnett formula by extension, money was provided to the devolved Administrations, but the hon. Gentleman confirms that a Labour-led Welsh Assembly Government chose not to invest in the NHS, while we in England chose to do so. I urge Welsh voters to remember that when they come to the elections in May.

Under the trade union thumb, Labour is turning its back on modernisation in the NHS, but the NHS cannot be preserved for the future and protected by neglect; it is not something that sits in a static format. It has to change to improve. When the number of managers in the NHS doubled under Labour, when results for patients in many conditions remain way below those achieved in other countries, and when the number of patients placed in mixed-sex accommodation runs into the thousands every month, the NHS needs to change.

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[Tom Blenkinsop]

rose—

[Owen Smith]

Will the Secretary of State give way?

[Mr Lansley]

No, I have given way to the hon. Gentleman before. [Interruption.] He only gets one shot.

Let me make it very clear. Our cuts in bureaucracy—

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[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is a great pleasure to speak after the great tour de force that we heard from my right hon. Friend the Member for Charnwood (Mr Dorrell). He dispelled a huge number of the myths that the Opposition have been trying to put forward today and during our entire Committee proceedings on the Health and Social Care Bill—one would almost believe that they had not been in power for the past 13 years. It is clear that one of the main reasons why we need to reform the NHS is not just to build on what the previous Government have done in terms of using private sector providers, but to make sure that we put a lot of things right. We are cutting bureaucracy and putting more money into front-line care—that is one of the main purposes of the Bill.

Before I develop my arguments about bureaucracy, I wish to pick up on what my hon. Friend the Member for Gainsborough (Mr Leigh) said in his intervention. He talked about the challenges of dealing with an ageing population. This country undoubtedly faces a big problem in providing health care as a result of many people living a lot longer, although that is a good thing. A lot of people have multiple medical comorbidities as they get older and they need to be looked after properly. The key financial challenge to the NHS is in ensuring that we look after our ageing population, and properly resource and fund their care, so when we cut bureaucracy and put more money into front-line patient care, that is what that is about.

When we talk about the need to ensure that the NHS has local health care and well-being boards—an NHS that is more responsive to local health care needs—it is a response to the fact that some parts of the country, such as, Eastbourne or my county of Suffolk, have an increasing older population, who need to be properly looked after in terms of funding. That is why it is so important that this Government have committed £1 billion to adult social care and are increasing that. It is also why we are putting an extra £10 billion into the NHS budget over the lifetime of this Parliament—the Labour party would not have done that.

On bureaucracy, it is worth reminding the Labour party of a few things it did when it was in power. Under Labour the number of managers in the NHS doubled. In 1999, there were 23,378 managers and senior managers in the NHS, but that figure had almost doubled by 2009, having increased to 42,509.

[Owen Smith]

rose—

[Dr Poulter]

The hon. Gentleman might wish to listen to this, but I will take his intervention.

[Owen Smith]

The hon. Gentleman has returned to this point about bureaucracy many times during our proceedings in the Public Bill Committee. Does he not share my concern about our shared ignorance as to how many managers and how much bureaucracy there will be under the new structure in the GP consortia and in the regional presence of the national commissioning board? Does he know what bureaucracy there will be under this Bill, because I do not?

[Dr Poulter]

What we do know—the hon. Gentleman would do well to listen to this—is that the NHS currently spends £4.5 billion on bureaucracy, and that could be better spent on patient care. Under the previous Labour Government PCT management costs doubled by more than £1 billion to £2.5 billion, and that money could be better spent on patient care. By scrapping PCTs, we will have more money to give to GPs to spend on patients and front-line care, and that can only be a good thing.

Labour Members would do well to listen to a few more of the statistics on NHS bureaucracy that I am about to read to them. Under Labour, the number of managers increased faster than the number of nurses in the NHS. How can that possibly be right? Managers were paid better than nurses in the NHS. In 2008-09, top managers in NHS trusts received a 7% pay rise whereas front-line nurses received a rise of less than 3%. The Labour party was obsessed with bureaucracy, management and top-down targets, and we would much rather see that money spent on patients and front-line patient care.

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18:55

Division 233

Ayes: 224

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Labour: 218
Democratic Unionist Party: 2
Liberal Democrat: 1
Green Party: 1
Independent: 1

Noes: 305

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Conservative: 269
Liberal Democrat: 35

[Owen Smith (Pontypridd) (Lab)]

On a point of order, Mr Deputy Speaker. You were not in the Chair at the conclusion of the Opposition day debate, but the Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow), used barely half his allotted time in winding up, as he was clearly short of arguments to defend his position on the important subject under discussion. That left many of us who have plenty to say on the subject short of time to speak. Will you work through the usual channels, Mr Deputy Speaker, to make sure that in future either Ministers use all their time or Back Benchers are given more time to speak?

[Mr Deputy Speaker (Mr Nigel Evans)]

How long the Minister wishes to speak for is not a matter for the Chair. The Minister spoke, the debate came to an end, and a vote was taken.

Health and Social Care Bill

Owen Smith Excerpts

Monday 31st January 2011 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

I rise to support the Bill, because I support the two big ideas behind it. The first of those is the increased focus on outcomes, which is long overdue and very welcome. For those who suggest that there is no need to improve the NHS or to worry about the issue of outcomes, I shall just highlight this country’s relatively poor cancer survival rates—as some hon. Members will know, I have a particular interest in cancer. Improvements have been made over the years, but those improvements go back over 30-odd years and other countries have improved, too. This country still flounders in the lower divisions of the international cancer league tables, and that situation has to be wrong.

The all-party group on cancer focused on that issue in 2009, finding that patients who reached the one-year survival mark in this country stand as much chance of getting to the five-year survival point as patients in other countries, but that our one-year survival rates are very poor indeed compared with those of other countries. That tends to suggest that the NHS is as good as others, if not better, at treating cancer once it is detected, but very poor at detecting cancer in the first place.

Part of the problem is in the area of early diagnosis, which is why we recommended focusing on one-year survival rates. We suggested introducing an outcomes benchmark that focuses the NHS on the one-year survival rate, because late diagnosis makes for poor one-year survival figures. If we can get the NHS focused on that, many patients will benefit. Therefore, we are delighted to see that both one-year and five-year benchmarks have been introduced in the outcomes framework for 2011-12. We very much welcome that, but I believe I am right in saying that the 2011-12 outcomes framework covers only colorectal, lung and breast cancer. We have lots of data for other cancers, such as prostate cancer, and I urge the Government to think seriously about extending the cancer types covered in the 2012-13 outcomes framework. The risk is that if we do not do so and we include just a narrow range at a national level, that will make for a lack of priority at the GP level.

As for GP commissioning, bringing commissioning decisions closer to the patient has to be a good idea; patients have got to benefit from that. Some people say, “GPs see only about eight new patients a year. What could they possibly know about commissioning cancer services?” I would turn that around by asking how many cancer patients the chief executives of primary care trusts see. They are commissioning cancer services at the moment. That point needs to be discussed.

[Owen Smith (Pontypridd) (Lab)]

Given the hon. Gentleman’s interest in cancer, I am sure that he will know that the point is that the cancer networks often aid commissioners at all levels in providing this care and they are dissolving before our eyes right now as a result of these changes. GPs will not have the experience to commission care in respect of rare tumour types.

[Mr Baron]

I agree with the general gist of what the hon. Gentleman is saying, but I would not say that the cancer networks are dissolving. I have raised this important point many times in the House—perhaps he was not in the House when I intervened on the Secretary of State—and what I would again ask my Front-Bench team about is the funding gap. I understand that the funding for the cancer networks ends in 2012 and there is a gap until the GP commissioning takes full effect. The answer given to me from the Dispatch Box today was that the national commissioning board will be up and running by 2012. The problem with that answer is that the national commissioning board will give guidance but the arrangements for the people who will actually make the commissioning decisions, the GPs at the front line, will not be truly effective until 2013 at the earliest—that will probably happen in 2014.

The worry is that in that gap a lot of expertise could be lost to the cancer community as a lot of expertise within those cancer networks decides to walk out of the door. I again ask the Government whether there is any way in which we could bridge that gap in order to ensure that GPs are better able to make informed decisions about the commissioning of cancer networks, because those networks contain an awful lot of expertise that we would not wish to lose.

I am fated to ask that question of the Minister of State, Department of Health, my hon. Friend the Member for Chelmsford (Mr Burns) again, as we are fated to discuss the issue. I appreciate that cancer is not his specialty, but I would like to get an answer on that point. There is a difference between the national commissioning board taking responsibility for guidance and the GP consortia actually taking responsibility for the commissioning. That point has to be addressed carefully, because various cancer charities have already reported that some 50% of the staff of cancer networks are thinking of leaving or have been told that they will be leaving within the next 12 to 18 months as part of a cost-cutting exercise. We need to address the point sooner rather than later.

In the remaining minute allowed me, may I quickly discuss eye health? I am wearing my hat as co-chair of the all-party group on eye health and visual impairment. I welcome the clauses that place primary ophthalmic services with the national commissioning board, which is likely to devolve enhanced optometry services to GP commissioners. That is the right decision and those working within the medical profession welcome it. However, I suggest two areas where we need to establish a national system. The first relates to glaucoma referrals under the NICE guidelines and the second relates to community-based acute services—in other words, those managing red eye and minor eye problems. The Secretary of State visited the school of optometry in Cardiff and, apparently, he liked what he saw. Can we ensure that those national guidelines are in touch, because otherwise we get a fragmented service and patients may suffer as a result?

In conclusion, I welcome this Bill, which could be transformational, particularly with its focus on outcomes. The Government will therefore have my support in the Chamber tonight.

Contaminated Blood

Owen Smith Excerpts

Monday 10th January 2011 Commons Chamber

[Mr Lansley]

I give my hon. Friend that assurance. We will take all the steps that we possibly can, not least on behalf of the bereaved families of those who died before 29 August 2003. That anomaly, among others, ought to have been rectified long ago.

[Owen Smith (Pontypridd) (Lab)]

I, too, welcome the statement—in particular the serious and commendable way in which the Under-Secretary of State has dealt with this important issue. However, the people who really need to be congratulated today are the campaigners such as the family of my constituent Leigh Sugar.

I take the Secretary of State back to his comment that the measure will apply to England only. Will he explain the rationale for that? The previous schemes applied to England and Wales, although they predated devolution. Is he saying that no additional funds will be available for Welsh patients, under the Barnett consequentials, to provide similar funding in Wales?

Swine Flu

Owen Smith Excerpts

Monday 10th January 2011 Commons Chamber

[Mr Lansley]

I cancelled no campaign; I proceeded only with the awareness campaign on respiratory and hand hygiene. An advertising campaign aimed at the general population would not have been effective, and I was advised that there was no evidence that it would be effective. We knew who the at-risk groups were, and it was possible to reach them directly rather than engaging in wider advertising.

[Owen Smith (Pontypridd) (Lab)]

Will the Secretary of State tell us what role primary care trusts and strategic health authorities are playing in dealing with the crisis? Will he explain what dismantling the SHAs and PCTs will do in terms of central planning for future crises?

[Mr Lansley]

The role of SHAs and PCTs is, as in previous years, to manage the NHS response to winter pressures. In future, the commissioning consortiums together with the NHS Commissioning Board, will fulfil similar responsibilities. In future years, there will be a stronger ability to integrate the response of the Department of Health and the Health Protection Agency, working together as one new organisation, Public Health England, which will have a stronger public health infrastructure.

Contaminated Blood and Blood Products

Owen Smith Excerpts

Thursday 14th October 2010 Commons Chamber

[Owen Smith (Pontypridd) (Lab)]

First, I join other right hon. and hon. Members in thanking the Backbench Business Committee for recognising the importance of the case that my hon. Friend the Member for Coventry North West (Mr Robinson) and I put to it. The volume and the quality of the contributions we have heard today bear eloquent testimony to the fact that the Business Committee was absolutely right to note that this is a critical issue—one that many hon. Members on both sides of the House feel has received too little attention in recent years from successive Governments. I also thank my hon. Friend the Member for Coventry North West for picking up the baton and moving the motion, which he did with great aplomb and verve, as ever.

Most of all, I should like to thank the victims and their families who have been in contact with me since we first learned that we had succeeded in securing this debate. Their kind words and support have been hugely welcome. I am delighted that so many of them managed to come here today—and, indeed, yesterday—to witness the debate. That bears extraordinarily powerful testament to the wrong that has been done to them and their families. I hope that we are doing some justice to their cases today by debating this issue so fully.

I am extremely pleased that the debate has prompted the Government to put before the House today’s statement, which is somewhat misaligned with the wrecking amendment, as my hon. Friend described it.

[Mr Robinson]

I wonder, Madam Deputy Speaker, whether you could put the point to the Minister that we are conducting the debate on the basis of the ministerial statement that has been placed in the Library rather than one made to the House. Perhaps the Minister can tell us what the basis of compensation would be if we were to implement the Archer recommendations. Is the figure £3 billion, £300 million or £1.2 billion? I have heard different figures. Does my hon. Friend agree that we cannot continue the debate without more clarity about what we are considering? The Government have stated that we are inviting them to spend £3 billion, but the figure might in fact be far less.

[Owen Smith]

I, too, would very much like that point to be addressed. I was going to ask the Minister how the £3 billion figure was calculated. The Haemophilia Society has today suggested that the figure has been calculated erroneously on the basis of a typographical error in the Archer report and that the number has been extrapolated from a false figure that Archer published regarding the volumes that were given in Ireland. So, I, too, would welcome the Minister’s clarification on that hugely important point.

[Mr Dorrell]

I entirely agree with the hon. Gentleman and other hon. Members that the number of pounds we are talking about is, to put it mildly, salient. However, is it not also relevant that the House is being asked to sign up not to a specific sum but to the principle that the compensation payable in this country should be at least aligned with that payable in the Republic of Ireland? Whatever the number, the House should not sign up to the dubious principle that whatever is paid in Ireland we will pay here.

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[Owen Smith]

I understand the right hon. Gentleman’s argument, which is a good one intellectually, but the rationale for the recommendation’s inclusion in the motion was, essentially, that the victims of this tragedy wanted the House to debate it. The Archer report is the only substantive inquiry that we have had. It came to that conclusion on compensation, so we felt it appropriate to ask that question of the House. However, I understand the right hon. Gentleman’s point about tying ourselves to recommendations that are made in another jurisdiction.

[Alun Cairns (Vale of Glamorgan) (Con)]

I pay tribute to the hon. Gentleman for pressing for the motion today. I am obviously keen to support him. On the debate about parity with the Republic of Ireland, the Minister in her statement talked about working with the UK’s devolved Administrations and with their Health Ministers. Does the hon. Gentleman also support the need for parity within the UK? Will he urge the Minister before us and the Minister in Wales, because we are both Welsh Members, to work on the review with the Department of Health in order to come up with at least some parity within the UK?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. It is up to Members to decide on the number of times that they give way to interventions, but I am concerned that that is going to stop other Members getting in. If we are going to have interventions, Mr Cairns, we need to make them very brief.

[Owen Smith]

I agree with the hon. Gentleman’s excellent point. One thing that I was slightly disappointed about in the ministerial statement was the fact that those discussions clearly have not taken place. Some of the statement’s specifics are very welcome, particularly its point about the terms of reference and, notably, the fact that the level of payment to people with hepatitis C might be equalised.

[Ms Abbott]

On a point of order, Mr Deputy Speaker. You will be aware that “Mr Secretary Lansley” and “Anne Milton” tabled an amendment that is on the Order Paper and includes the figure “£3 billion”. Some Opposition Members feel that this debate cannot go forward until we have some clarification of its accuracy.

[Mr Deputy Speaker]

A point of order takes up valuable time, too. I recognise that you wanted to make it, but you will have the opportunity to put the case a little later. What we ought to try to do is respect all Members. I want to try to get in all those Members who are here; I do not want disappoint them.

[Owen Smith]

Thank you, Mr Deputy Speaker. I now have very little time left, so I shall speak a little faster, if I may.

It is absolutely critical that the Minister makes it very clear in her response that she is talking about equalising the payment to people with hepatitis C with the previous payments to victims of HIV. It is also important that she consider the specificity of the recommendations, including the terms of reference. Victims’ access to nursing care and to the NHS ought to be looked at differentially. They were infected by the NHS, in effect, and therefore they ought to be treated differently when looked after by the NHS.

In the last minute of my speech, I want to pay tribute to some people in the Public Gallery today. The reason I am so interested in today’s debate is that a very brave constituent of mine, Leigh Sugar, died earlier this year. His family came to see me just days after his death to express their desire for him to be the last person who suffers in their dying days, having not been looked after properly by the NHS, and having been infected through NHS treatment.

Leigh is a classic example of a person who, as a mild haemophiliac, went to hospital—he, in his teens—to be treated for the condition and came out with a devastating disease. That disease ultimately led to his death from liver cancer. Far too many people have died before we have seen this House deliver justice, and it is absolutely critical that justice be seen to be done today. This is a moral issue, it is a matter of conscience and of justice, and we owe it to the victims, whatever the difficulties of the CSR, to see justice served so that they might be properly recognised and properly recompensed.

Epilepsy Services

Owen Smith Excerpts

Tuesday 12th October 2010 Westminster Hall

[Owen Smith (Pontypridd) (Lab)]

I thank the hon. Member for Blackpool North and Cleveleys (Paul Maynard) for securing this debate, and for speaking so eloquently and passionately. I do not hope to speak with his expertise, but I do have some expertise, inasmuch as I have a close family member—a brother—who has suffered with epilepsy over the past 15 years. I have some insight into the nature of the difficulties that he has encountered, the problems in the current NHS system, and the issues that emerge in dealing with this chronic but particular condition in that system.

My brother is one of the 500,000 people in this country who have epilepsy. They are a minority, but a significant one—that is a lot of people. He is also one of the 50% of the 500,000 who are not seizure free: he has had a seizure every month, if not every week, for all of the past 15 years. That has had a dramatic impact on his life in terms of what work he is able to do, the energy he has, and the fear that he lives with, which the hon. Gentleman described so eloquently and which all people who have epilepsy have to contend with on a daily basis, of sudden unexplained death as a result of the condition.

That is my interest. It has given me an insight into issues that have already been raised today about the postcode provision, to use the vernacular, that exists across the NHS. We have a fragmented NHS, particularly in respect of epilepsy. That is the case for many other conditions, but it is particularly true for epilepsy. The phrase “Cinderella condition” is rather overused in the press these days, but epilepsy is one of those conditions. We can genuinely say that it does not have the high profile that it ought to have and therefore does not receive the concentration that it should.

There is clearly fragmented, unequal distribution of expertise in the NHS in terms of general practitioners, who, as the first point of call for anyone suffering with epilepsy, are critical, and nurse specialists. I believe that that is widely recognised. Like the previous Government, the current Government recognise that specialist nursing for epilepsy is under-resourced in this country and, equally, that it is an extremely important means of redressing the problem of insufficient provision of expert GPs.

It is clear that there are few centres of excellence for epilepsy in this country, and, therefore, that people such as my brother, who lives in Wales, have to travel long distances to hospitals or other centres of excellence for prolonged examinations to monitor brain patterns. He, too, suffers from nocturnal epilepsy, and therefore needs to be studied in clinical conditions in hospital to try to determine the nature of his condition and what resources might be brought to bear to alleviate it.

I, too, have some fears about the extent to which the creation of the new GP consortiums will exacerbate the problem of fragmentation and inequality of provision across the country. I can accept that, in areas where there are GPs with a special interest or particularly strong centres of excellence, there may be a beneficial effect in massing GPs together and spreading their expertise through a wider network. Equally, I can see significant potential for unintended dangers if we do not have GPs in those consortiums and we have a diminution of control over, and certainly insight into, their activities. It is unclear what the sources of commissioning will be, and who exactly will be commissioning specialist services. That has yet to be clarified, and I look forward to the Minister’s giving us some greater insight into that.

Another thing that I worry about in respect of consortiums is data. We have poor data on epilepsy: how many people suffer, the nature of their condition, how often they attend hospital, how often they are treated for acute episodes. Perhaps if their condition had been managed more effectively, it would not have reached that point. I have tabled numerous parliamentary questions about that recently, and all the answers confirm that we do not gather enough data.

There will be a further danger that we will not gather data if we fragment the NHS to the extent that is proposed with the creation of the consortiums. I hope that the Minister will give us some reassurance that information gathering will be a priority, whatever the structural make-up of the NHS, and that we will continue to see that critical piece of the jigsaw applied in respect of epilepsy care. In recent years, we have seen data gathering become an important tool for tackling other chronic conditions, notably cancer.

I worked in bioscience before coming to this House, and therefore have some insight into the science around epilepsy and the economics around the production of medicines. Prescribing of epilepsy medicines seems to involve a form of Russian roulette because our understanding of this neurological condition is deeply imperfect. For example, my brother has been through 11 or 12 medicines and combinations of medicines. Doctors still employ what is pretty much a hit and hope strategy. Perhaps I am being slightly unfair, but I believe that many epilepsy experts recognise that they do not really know which medicine will work, and therefore they try various drugs until they find the one that works for their patient. In my brother’s case, and in the case of 50% of sufferers, they often do not find the one that works, and we get into the more complicated issues around whether surgery is required.

Generic substitution is clearly an issue. We all understand that we need to make savings, and the importance of substituting generic medicines for the original brands when they are available.

[Dr Pugh]

The hon. Gentleman made a good point about data, which is worth repeating. However, there must be data on every episode dealt with through acute hospital care. His Government introduced the tariff system. Therefore, in some shape or form, the data are there—they just do not appear to be available for clinical purposes.

[Owen Smith]

The hon. Gentleman is absolutely right, and I have recently had answers from the Government about that. It is not simply a question of gathering the data. The NHS is a wonderful sponge, soaking up data. The critical thing is wringing it out and employing data to improve services. Epilepsy is a condition that has not been concentrated on, and therefore there is no emphasis on garnering data.

We must be careful about generic substitution of epilepsy drugs. I know that many sufferers agree with that. Another point is that genericisation of a market in medicines leads to changes in the economic incentives for research and development companies to produce them. There clearly are not incentives for companies to produce new epilepsy drugs. That is inevitable because of the large number of epilepsy medicines, many of which are effective, and many of which have been genericised.

Part of the answer in fixing markets that are not working has to be Government intervention to try to improve incentives. The previous Government were making effective inroads through the innovation fund and the innovation pass that they were negotiating with the pharmaceutical and biotechnology industries, which would have encouraged and incentivised further R and D into more recondite diseases and the production of medicines where there is not an immediate economic incentive.

I was therefore discouraged to hear that the innovation pass is being abandoned by the Government—it will not be taken forward. I would like to hear some reassurance from the Minister that he is aware of the issue and interested in looking at how he can work with the pharmaceutical industry to incentivise further R and D into those areas where this country does not perform well. Epilepsy is one of them. We have a higher incidence of unnecessary death from epilepsy, and, bluntly, we do not prescribe terribly well for it. It is an area where we could produce more and take advantage of the great skills in the pharmaceutical industry, and where the Government could have a positive impact.