Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 24th February 2015 Commons Chamber

[Norman Lamb]

Actually, we are all agreed on this. We all want free care at the end of life, but whoever is in power after the election in May will have to ensure that we understand fully the costs. There is a lot of evidence, and the evidence is growing. We are having very good discussions with groups involved in care at the end of life and we all want to achieve a solution. Of course, the truth is that very many people are receiving free care at the end of life, but they are in hospital, where they often do not want to be. I am completely with the hon. Lady in trying to achieve this.

[Paul Burstow (Sutton and Cheam) (LD)]

Eight out of 10 people say that they would prefer to die at home when their time comes. Since the Government published their White Paper and said that they saw merit in social care being free at the end of life, a succession of reports from Macmillan, Nuffield and others have shown that there are savings to be made and benefits in terms of more dignified deaths and compassion for families. Is it not time to act on the evidence and make social care free at the end of life?

Improving Cancer Outcomes

Paul Burstow Excerpts

Thursday 5th February 2015 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

Thank you, Madam Deputy Speaker. I wish to echo that very point. Some of the best debates that we have in this House, and certainly some of the best Back-Bench business debates, are ones in which people bring their own personal experience and their own stories. My hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) talked about the stories that gave him inspiration and hope. I hope that people listening to this debate will gain inspiration and hope from what he has said today. I hope, too, that those who are responsible for planning and commissioning our services and for training our medical professions gain insight from it.

We talk a lot about the concept of shared decision making, and my hon. Friend has demonstrated where that can work well and where it can fall apart. When it falls apart, the impact on the person concerned is immeasurable. I am really grateful to my hon. Friend for his unique and important contribution.

I also thank my hon. Friend the Member for Basildon and Billericay (Mr Baron) for tenaciously pursuing not just the opportunity to have this debate but this whole issue. It is undoubtedly the case that, when it comes to cancer, he has been there championing the cause. When I was a Minister, I had plenty of occasions to feel the effects of his championing. I always appreciated the way in which he pursued the matter, and I am sure that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has experienced that as well. He is always civil, always polite, but relentless in pursuing what he wants to achieve.

In this particular week, when we have marked world cancer day and had the news from Cancer Research UK that one in two of us are likely to experience cancer in our lifetime, it is absolutely right that we should be debating what more we need to do to go beyond the ambition of this coalition Government to save lives and to achieve the ambition that we set for the NHS in the next Parliament.

Part of the news that sits behind that one in two figure is the fact that we are living longer. I want to caution against the notion that, in some way, living longer is some sort of curse—all too often it is portrayed in that way—and that we should be worried about it. The other thing behind that research is that those cancers that may occur in later life are not inevitable. There are things that we all can do if we make choices about the lifestyles that we lead—whether that is quitting smoking or losing weight. When one considers that there are still 100,000 deaths a year due to smoking and that two thirds of people who are addicted to smoking become addicted before the age of 18, it is clear that we need to focus quite rightly and relentlessly on issues around prevention as well. That is why we should celebrate the news that, just yesterday, the Minister successfully took the regulations through this House that will result in a ban on smoking in cars where children are present, which will make a difference. We have an assurance from the Minister and the Government that, before the end of this Parliament, there will be a vote to have standardised packaging, which will be a real step forward in dealing with the impact of smoking.

We must do more to tackle smoking, especially in the context of mental health and mental health services, where the prevalence of smoking is so much higher. There are examples of good mental health services that have found ways to reduce smoking. None the less, there is a significant difference in life expectancy between people with severe and enduring mental health problems and people who do not have such problems.

Some reference has already been made to the health inequalities with regard to ageing, and I will come back to that. We need to recognise that there is a broader issue around the social gradient. If someone is poorer, they are more likely to be at risk from cancer, especially when lifestyle is a factor. The strategy that is being drawn up by the taskforce needs to address the whole range of health inequalities to deliver on the challenge that was rightly set and the duty that was imposed on the NHS to tackle health inequalities under the Health and Social Care Act 2012.

Sean Duffy, the national clinical director for cancer, has said that our cancer survival rates are at an all-time high, and my hon. Friend the Member for Basildon and Billericay set out the statistics that show why we should celebrate the progress that has been made over a number of years. Clearly, if half of us will get cancer during our lifetimes, we must keep looking afresh at what more we can do. That is why the announcement of the taskforce in January to look at what the next five years should hold for cancer work is absolutely right. We cannot rest on our laurels.

Again, I pay tribute to the hon. Member for Easington (Grahame M. Morris) for tenaciously pursuing the case for radiography, just as my hon. Friend the Member for Wells (Tessa Munt) has done, and I give him due respect for doing so. The strategy that is being developed must answer the concerns that he and other hon. Members have been raising for a number of years. The ability to combine different innovations—whether pharmacological or technological—is absolutely key to how we catch up and then stay ahead in terms of cancer survival rates, and it is why we need this ambition of going beyond just achieving the average cancer survival rates in Europe to strive to become the best in Europe. Better prevention, swifter diagnosis, better treatment and aftercare are all part of that.

On early diagnosis, we have heard that a quarter of diagnoses or thereabouts take place at an emergency stage—far too late—and the outcomes are bad as a result. Therefore, we need a clear commitment to fund the Be Clear on Cancer campaign throughout the life of the next Government, because awareness raising and the identification of signs and symptoms make a difference. For example, in the areas where the lung cancer signs and symptoms campaign was tried initially, 700 extra patients were diagnosed—700 people had an opportunity to live their lives longer as a consequence.

The hon. Member for Washington and Sunderland West (Mrs Hodgson), who, again, is a tenacious pursuer of ovarian cancer issues, is absolutely right to ask why, on the basis of the pilot evidence from 2013, we are not pursuing ovarian cancer in the Be Clear on Cancer campaign. I hope that the Minister will answer that and perhaps give us the prospect of good news. The hon. Lady certainly persuaded me when we took the decision to hold the pilots, and I would want to know why we should not pursue it. Certainly, the pilots that she referred to suggest that there is good cause to do just that.

I was struck in preparing for the debate by the research published by Cancer Research UK looking at what could be achieved with earlier diagnosis if we strove to eliminate inexplicable variations in England. In other words, if we had diagnosis rates at the best level just in England everywhere—for colon, rectal, ovarian and lung cancer—it would benefit 11,000 patients and save the NHS £44 million. If we could do that for all 200 cancers, it would help 52,000 people. It is within our grasp to do massively more if we learn just from the best in our own country, let alone striving to be the best in Europe, which we would become if we did that. I very much welcome the work that CRUK and Macmillan are doing with NHS England to deliver that.

My hon. Friend the Member for Basildon and Billericay talked about the unacceptable cancer death toll among older people and the over-reliance on chronological rather than biological age in making judgments. As the then Minister who took the decision that there should be no exemptions from the equality duty with regard to age discrimination for the NHS, I think that that is not acceptable. Chronological age should not be used; the person and their individual circumstances should be considered in judging which treatments should be available.

It is therefore also vital that we recognise that in later life, because of complex comorbidity and frailty, there are additional needs, sometimes social needs, that are not properly taken into account. While I was the Minister with responsibility for cancer, I was pleased to help launch the work that Age UK and Macmillan were doing to pilot new ways of ensuring that more older people would gain access to cancer treatments. It would be useful if the Minister could say where that has gone and whether it will be continued. I hope the work will be looked at when the taskforce draws up its strategy.

[Mr Baron]

As a Minister, the right hon. Gentleman was always a great champion of cancer. One accepts the complexity arising from comorbidity, but does he believe that the under-75s cancer mortality rate indicator should be looked at again as a means of helping to redress the issue?

[Paul Burstow]

Personally, I think that at some point there must be a legal challenge as to whether that places ageist assumptions at the heart of the NHS. The fastest growing part of our population are the over-85s. How on earth can it be that we do not have statistics that allow us to know how well that older part of our population is being treated for cancer, let alone anything else? When one considers that when the NHS celebrates its 100th birthday, there will be over 100,000 centenarians in this country, it is clear that we need to start catching up in the way in which we use data to ensure that we are not discriminating inappropriately on the basis of the person’s date of birth. I agree that the indicator needs to be looked at.

The hon. Member for Easington also mentioned the cancer drugs fund. After the election there should be a thorough evaluation of the impact of the cancer drugs fund over the past five years. It was a good initiative; it plugged a gap, but unfortunately the gap that it was plugging is now not being filled because there has not been a change in the way we pay for drugs. It could play a part in underpinning combinatorial innovation of the sort that the “Five Year Forward View” mentions.

On the hon. Gentleman’s reference to free end-of-life social care, I have not changed my view. When I wrote the care and support White Paper, we made it clear that we saw much merit in free end-of-life social care. Because of the reports that have been published since, I believe that the evidence has grown even more compelling that this is not a cost to the NHS. It would be a benefit to the NHS. I know that my right hon. Friend the Minister of State who has responsibility for care and support has taken that view as well, and I hope we can see progress on that too.

As the Member of Parliament for Sutton and Cheam, it is a source of great pride to me that I live in a constituency which has a hidden gem—the Institute of Cancer Research. As I am sure hon. Members in all parts of the House know, that is a world-beating research facility, taking research and discovery from the lab to the bedside in collaboration with the Royal Marsden hospital, which is on the same site—a phenomenal site which is looking to expand further. It does fantastic work, including genetic testing, which is an area that I want to raise with the Minister.

The institute has been a pioneer in mainstreaming genetic testing, particularly around BRCA1 and 2. It has developed a good practice model that can mainstream genetic testing into existing oncology appointments. The potential of that is amazing—four times the volume of activity can be delivered through this new pathway at twice the speed and half the cost. In other words, we can gain the benefits of genetic testing without apparently having to spend more money, but delivering much more targeted and insightful diagnosis and onward treatment as a result. That pathway exists. It has been developed, refined and tested, but it has not yet been widely adopted, despite the fact that it is freely available. I wonder what more could be done to make sure that it is more freely adopted. Perhaps the Minister could say how the strategy might help take that forward.

This debate needs to be set in a broader context. If we are to achieve an ambition of matching the best in Europe over the life of the next Parliament, we must address the funding pressures that are acknowledged in the “Five Year Forward View”. This Government have started to acknowledge that with what Simon Stevens described as the “down payment” of the £2 billion announced in the autumn statement, which will come in from this April, but we know that we need to give the NHS certainty about funding for the life of the next Parliament.

All of us who are responsible for articulating different party points of view on health policy need to be clear with the NHS and with the public about what we would do with regard to funding. I am therefore pleased that the Deputy Prime Minister and the care and support Minister have set out how the Liberal Democrats would provide the £8 billion requested in the “Five Year Forward View”. I look forward to the debates we will have over the coming weeks on how others would achieve the same thing, which we need. This debate, however, is an important way of shining a light on the progress that has been made and the opportunities to make further progress.

I thank the hon. Member for Basildon and Billericay for securing the debate and the Backbench Business Committee for allowing it. This is what it makes clear: yes, there has been progress, but there is still much more to come.

[John Glen (Salisbury) (Con)]

It is a great pleasure to contribute to this important debate, because so many of our constituents are eager for us to grasp the underlying issues relating to cancer, to explore how to deal with the inadequate service they sometimes receive, and to address some of the challenges we will face in future. As has been mentioned, Cancer Research UK said this week that one in two people will be diagnosed with cancer. As we heard in the moving testimony from my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti), sometimes that diagnosis comes out of the blue; it is random and unrelated to previous medical history. We need to recognise that, but we also need to look at the public health challenges. I will therefore focus my remarks on two points: first, the important role that public health has to play; and secondly, how we can ensure that patients have access to timely diagnostic procedures, regardless of where they live.

Four in 10 cancers are thought to be preventable, which is why it is crucial that we view prevention as one of the best cures and work relentlessly to pursue what is required to reduce the number of people who suffer from cancer. We need to work at changing attitudes to prevention across the population, and keep pressing the message that cancer is not always a disease of chance. The 2011 strategy rightly placed an emphasis on that and on delivering a “whole society” approach. In my constituency, NHS nurses run an excellent annual fair to raise awareness of the link between cancer and factors such as smoking, diet and lifestyle. That proactive initiative by a group of local nurses offers a targeted solution. It is combined with clear national campaigns, such as the successful Be Clear on Cancer campaign, which enable us to reach as many people as possible.

I become very weary when Ministers bring forward sensible measures for dealing with some of the drivers of cancer, only to hear an outbreak of great ideological proportions about what we should be doing. It is undoubtedly critical that we continue the vital research into new treatments, but we must also remember that reducing the prevalence of smoking in the UK by just 1% could prevent 3,000 cases of cancer a year. I therefore welcome the decision to introduce standardised tobacco packaging, at a time when around 600 children start smoking every year. I welcome that on the basis of evidence and as a pragmatic decision, but I also want to challenge the assumption that somehow everyone has a free choice about whether to start smoking. I think there are many communities, in my constituency and up and down the land, where peer pressure to start smoking plays a crucial role. If there is anything we can do to reduce the attractiveness of smoking—which we know is so addictive and distinct from other health pressures—we should get on and do it.

Next, I want to highlight the crucial role of GPs. They are the gateway to wider diagnostic and treatment services, and we need to invest in them. We must invigorate their leadership and role in guiding patients to healthier lifestyles and earlier diagnosis, and therefore to earlier treatment and better outcomes. In 2011, as part of the cancer outcomes strategy, the Government provided £450 million of funding to help GPs access diagnostic tests earlier. The benefit of this investment is clear and will save about 12,000 extra lives every year. However, there are significant inequalities in referrals for diagnostic tests. There is a ninefold variation across GP practices in referring patients for the CA 125 test to identify ovarian cancer, and a fivefold variation in referrals for the PSA test used to identify prostate cancer. I visited a group of GPs in my constituency who were somewhat frustrated when they read the comments of the Secretary of State about wide disparities in diagnostic rates. However, this is not about criticising GPs but about recognising that we have unacceptable differences across the nation. NHS England has proposals to enable patients to self-refer for tests, and to establish multi-disciplinary diagnostic centres that allow patients to have several tests done at once. Those are welcome steps, as is the commitment from the Chancellor in the autumn statement to increase the proportion of funding allocated to GPs.

I pay tribute to the work done by charities across the UK to raise awareness and funds for research—in effect, to carry out life-saving interventions to ensure that even when forms of cancer are very rare, the best possible treatment is accessed. I know from my own modest experience—last week I was a blood stem cell donor—that Delete Blood Cancer UK, the Anthony Nolan Trust, and Love Hope Strength do an enormous amount of work to find matches for patients with blood cancer. On 17 March, we will hold another recruitment event in the House to get more people registered. I commend that to all Members present and to all colleagues. Only half the people in this country who have blood cancer find a match, so we can make a small contribution in that way.

I will conclude by focusing on a concern that I have deep inside me whenever we have a debate on the NHS. The fundamental dynamic is one where the supply of treatments and new procedures is ever growing, people are living longer and longer, and demand will increase. Everything we talk about relies on more money going into the NHS, whether that is more transparency, greater awareness of what cancer rates exist across the country in one year, or how we can differentiate the quality of outcomes for 85-year-olds and 65-year-olds. Wherever we know that inequalities and differences exist, there will be yet more pressure to fund more services and more work. We can try to counter this through bigger public health campaigns and greater awareness of how to live—how not to eat, smoke or drink too much—but we also need to be honest about what the NHS can tolerate in this never-ending dynamic of increased supply of services, increased demand, and increased expectations. The right hon. Member for Sutton and Cheam (Paul Burstow) talked about our coalition partner’s commitment to put up £8 billion, and he welcomed the fact that there will be £2 billion more from April.

[Paul Burstow]

The hon. Gentleman is making the important point that we must debate the resourcing of the national health service. I made the point that removing inexplicable and unfair variation in access to early treatment for cancer will not cost more, but will save money.

[John Glen]

Absolutely, and I was going to come on to that. My fundamental point is that we must change the appetite of the nation for the NHS. Yes, we want it to be there when random events take place, but we must also recognise that if we are to promote better health, everyone in this country has a responsibility as individual citizens to reduce the demands on it. Unless we do that, every five-year forward view will imply further and further increases. We need to be realistic about the fact that, unless we make real changes, we as a country will be presented with profound challenges.

GP Services

Paul Burstow Excerpts

Thursday 5th February 2015 Commons Chamber

[Caroline Lucas]

I accept that, of course. When I talk about privatisation, I guess what I am referring to is constant fragmentation: the way in which NHS England, CCGs and others are still struggling to get a streamlined process, which makes it more difficult for patients to be seen when they need to be seen and by the person who needs to see them.

[Paul Burstow (Sutton and Cheam) (LD)]

The hon. Lady is now drawing a very important distinction between some fragmentation and fracturing in how decisions are made. That criticism has been levelled at the legislation, but it is not the same criticism she was making initially, which was about privatisation. We know that only 6% of NHS activity and expenditure goes into the private sector.

[Caroline Lucas]

The right hon. Gentleman is certainly right about the figures, but I would argue that the direction towards greater privatisation is adding to the problem of fragmentation. I am happy for us all to focus on the issue of fragmentation. That is the bigger point I am raising right now and it is the biggest barrier to people receiving the care they need and deserve.

Intolerably long waiting times to see a GP have become a scandal that is putting A and E under strain and people’s health at risk. The inconvenience of increasingly unacceptable waits for an appointment will mean some people simply do not see a doctor about a persistent mouth ulcer or worsening mental health problem that they are trying to get checked, meaning that serious conditions that could be treated will be missed.

One GP told me this week that she knew of two colleagues who are leaving to go abroad. For her, retention of GPs is a crucial problem. Female GPs in particular, who have children and perhaps work part time, are finding themselves having to work long into the evening and sometimes long into the night. The issue of retention is ever more pressing as more GPs retire. The current older generation of GPs is starting to do so, and getting enough young doctors to become GPs to replace them is a serious issue.

--- Later in debate ---

[Paul Burstow (Sutton and Cheam) (LD)]

I thank the hon. Member for Halton (Derek Twigg) for securing this debate. My name was on the application, but he was the person who made the argument that persuaded the Backbench Business Committee. I apologise to him for not being here for his opening remarks or for those of others who have contributed so far.

I was keen to contribute to the debate because it goes to the heart of how we make the NHS fit for the future and do more in the community. As the hon. Member for Brighton, Pavilion (Caroline Lucas) said in her closing remarks, the focus has moved from treating episodes of ill health and diseases of individual body parts to people living with a complex range of diseases. It is that complex co-morbidity that is driving the need to change how health care is organised and delivered in this country. If that does not happen, the system will become unsustainable. At the heart of that is the family doctor and their relationship with their patients and communities, which is a key component of building the system we need for the future.

About two months ago, I and my right hon. Friend the Member for Carshalton and Wallington (Tom Brake) met a group of GPs in my constituency to discuss some of the issues being aired today—Dr Chris Elliott, Dr Brendan Hudson, Dr Alan Froley and Dr Mark Wells—along with a practice nurse. I was pleased that a practice nurse was present, because although we are discussing the sustainability of GP practices, we need to recognise, as I am sure others have, that we are talking about the wider primary care family and the contribution made by many other professionals. We discussed the pressures on practices in our constituencies. The demands have been well documented, but I want to rehearse a couple. One frustration—it has long existed, but some of the GPs felt it had got worse—concerns the expectations around paperwork and reporting, which they feel have now got out of control. That needs to be kept under review and, where possible, streamlined. I hope the Minister will say something about that.

According to data available at CCG level on the performance of primary care and, in particular, access to GPs, in my patch, Sutton scores above average when it comes to getting an appointment, which is good news, but once someone has an appointment and arrives at the surgery, it turns out they have to wait longer than average to actually see their GP. So they can get there, but then have to wait far longer than is acceptable, and often in substandard accommodation. My constituency is a suburban part of Greater London and most of its GP practices are situated in larger houses that cannot accommodate the 21st century primary care we need. We need the investment from the infrastructure fund to flow through and allow for innovation.

[Dr Poulter]

I thank my right hon. Friend for his point about the money from the Government for GP infrastructure, but is there not also a responsibility on local authorities, when there is additional house building, to look at the contribution developers can make to support local GP and health services by developing GP and other community health care facilities?

[Paul Burstow]

Absolutely, and certainly in its local planning my local authority does exactly that—it looks at what the community facility needs are. In the southern part of my constituency, in south Sutton, there has been some controversy over plans for a new GP centre. It is planned on a piece of land that was NHS land but which does not sit within easy reach of public transport and is perceived to be in the wrong place. It is also less than a mile from a soon-to-be-unused hospital site that many of my constituents feel would be a more sensible location. It will be the basis of a new housing development in the coming years and so will be the perfect place for a consolidation of existing substandard GP surgeries currently based in houses.

In its briefing, the Royal College of General Practitioners has set out some of the pressures on GPs, including increased levels of stress and depression. In a ComRes poll it conducted, eight out of 10 GPs expressed concern that those pressures were leading to an increased risk of misdiagnosis. Yesterday was world cancer day but there are still serious issues with the number of people who do not get a cancer diagnosis until they are in an accident and emergency department, by which point it is far too late, and consequently their lives are cut short.

GPs are at the heart of delivering health care: nine out of 10 NHS consultations take place in a GP surgery, while the number of consultations has increased by 40 million since 2008 to 340 million. Interestingly, according to the 2012 GP patient survey, 1.2% of patients went to a walk-in centre or A and E department because they could not get a GP appointment at a time that worked for them, but that figure has now risen to 1.7%. I am sure the Minister will tell us that those are very low percentages and therefore not a cause for concern, but given the number of consultations—340 million—it does not take a very high percentage to have a significant impact on our A and E departments. Given that there are nearly 14.6 million A and E attendances, we can see that the gearing is such that ensuring sustainable and easily accessible GP and primary care services is critical to getting the balance in the system right.

I hope the Minister will say something about the piloting of 24/7 access to GPs and ensuring we have the right data to better understand which areas are under-doctored so that we do not have to rely on anecdotal evidence. There is clearly a concern about deprived and rural areas not having sufficient doctor cover, but at the moment we cannot map that accurately. I hope he can tell us what is being done to target resources to support areas crying out for better GP coverage. In addition, I hope he can say what will be done to address the fact that, despite the Government’s having identified the need to train more GPs and despite the number of places having increased significantly under this Administration, not enough places are being filled. What is being done to get up to the right number?

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I have visited a number of GP practices and I agree that while they are desperately trying to meet the increased demands, the frustration at not being able to recruit is adding seriously to their stresses and strains.

[Paul Burstow]

It is said that we need about half of all trainees to go into general practice and, at the moment, only 2,700 of the more than 3,250 places that are available are being filled. That is an issue, but it sits in the context of a global workforce pressure when it comes to medical staff. The opportunity to fill this gap by recruitment overseas will be difficult as well.

I am conscious that others wish to speak so I shall end by asking the Minister to address the issues of access, of how we make sure that more deprived areas do not suffer a double disadvantage by not having access to good quality primary care and of what will be done to ensure that we cease to have this distortion of funding priorities caused by a payment-for-activity system in our acute sector and a contracting model for primary care that has disadvantaged primary care for too long and led to this reduction in funding that other hon. Members have talked about. I look forward to the rest of the debate and the Minister’s response.

Human Fertilisation and Embryology

Paul Burstow Excerpts

Tuesday 3rd February 2015 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

Mitochondrial disease shortens lives, causes serious disability and leaves heartache in its wake. Now, thanks to the world-class research led from the university of Newcastle, we have the potential of innovation in IVF that could make a real difference for thousands of families in this country.

We have not arrived at this moment of decision in a rush. This House made provision in the Human Fertilisation and Embryology Act 2008 for regulations to be brought to this House

“to prevent the transmission of serious mitochondrial disease”.

Since those debates there has been a lengthy process to consider the benefits, the risks, the ethical issues and public consent. All these matters should be carefully considered. What all this work has revealed is broad public, ethical and scientific support for approving mitochondrial donation.

Clearly, safety is paramount. That is why the procedure has been scrutinised on three separate occasions by independent panels of experts. No evidence has been found to suggest that these techniques are unsafe. Are they ethical? Mitochondrial donation does not alter the essential personal characteristics or traits. It gives the gift of freedom from mitochondrial disease. It does not confer on a third person the parenthood that has been claimed in this debate. It is not about a third parent.

I have received many e-mails and letters from constituents on both sides of the argument, and I understand and respect those who have principled objections to the approach. I was struck by what the Right Rev. Dr Lee Rayfield and the Rev. Dr McCarthy said in a recent letter to The Guardian:

“The HFEA has made clear that even if parliament were to permit these two techniques, no licences would be issued until there was sufficient assurance from expert reviewers that mitochondrial donation is ‘not unsafe’”.

For me, that assurance—

[David T. C. Davies]

Will the right hon. Gentleman give way?

[Paul Burstow]

No, I must not. We must make progress.

That assurance from the HFEA is important. It means that although today is an important milestone in addressing mitochondrial disease, it is not the end. I was struck by what the Church of England said in its response to the HFEA’s consultation. The Church of England is not opposed in principle to these proposals. Its opposition is not absolute. It makes it clear that it is supportive in principle. As a Christian, I take heart from that.

For myself, I am persuaded that we make our decision today with the benefit of a thorough process, including thorough parliamentary scrutiny, and we have a robust regulatory framework. Today’s vote does not open the doors to mitochondrial donation as a matter of routine in clinics. Rather, we grant the HFEA the responsibility to consider on a case-by-case basis and weigh the expert scientific and medical advice. On every occasion safety and efficacy will be considered as a consequence of the regulations—the very concern that many hon. Members have cited as their reason for objecting to these proposals. I hope hon. Members will support them.

The Minister was right. This is about light at the end of the tunnel for thousands of families in this country. It is about the prospect of life lived, life realised, and about the potential opportunity to live.

[Several hon. Members]

rose—

Child and Adolescent Mental Health Services

Paul Burstow Excerpts

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

Ultimately, it has to be down to clinical decisions. Indeed, the whole thrust of policy, which was very much started under the right hon. Gentleman’s Government and during the period that he was Secretary of State for Health, is to devolve decision making about the make-up of services to local areas. That approach has been maintained. Ultimately, he would probably agree that such issues cannot all be determined in a Whitehall office.

None the less, the right hon. Gentleman raises serious concerns. I have tried to engage with him on them and am happy to talk to him and meet him further. I share his concerns about the lack of sufficient response to the concerns he raises, but I will repeat one other point I have made: the emphasis of policy should be on building up crisis response services and better and stronger community support services to reduce the need for in-patient care as much as possible. It is not therapeutic to put children and young people on in-patient wards, and particularly not away from home.

[Paul Burstow (Sutton and Cheam) (LD)]

I can recall many Labour Health Ministers telling us from the Dispatch Box that local decisions were made by primary care trusts and were not a matter for them. Will the Minister consider what he has told us about the CAMHS review? He has been frank about the fact that CAMHS are dysfunctional and broken. Surely the review is the opportunity to lay down a route map and set out how we can deliver the preventive early intervention services that prevent the crisis from occurring in the first place and the need for the admission. Do we not need that so that when there is a spending review after the general election, there is clarity about the investment needs for children’s mental health?

[Norman Lamb]

I think my right hon. Friend is referring to the children and young people’s taskforce that I established last summer. He is right that this provides us with an incredibly valuable opportunity to modernise the way in which we organise and commission children’s mental health services. There are many fantastic professionals working in children’s mental health services, but in my view they are let down by a dysfunctional system with horribly fragmented commissioning, which is a long-standing problem. Because we are involving experts and campaigners from outside and, critically, children and young people, we have a great opportunity to get services modernised and effective and focusing particularly on prevention.

NHS Major Incidents

Paul Burstow Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

I can reassure the hon. Lady that we have provided a huge amount of extra money to deal with the problems in the wake of what happened at the former Mid Staffs Trust. We are continuing to give every support we can to Walsall and Stoke and other trusts. We have more doctors and more nurses and major changes are happening. The problem in Mid Staffs went on for four long years, and we do not want to wait that time before sorting out the problems.

[Paul Burstow (Sutton and Cheam) (LD)]

Clearly, patient safety must be paramount. We must ensure that any guidance supports the ambition that exists on both sides of this House for a more integrated system that takes into account the capacity across the whole service. Does the Secretary of State agree that what we also need is clarity and certainty over how the NHS and social care will be funded over the life of the next Parliament so that we realise the ambition and potential of the Care Act 2014 and we deliver Simon Stevens’s NHS plan?

[Mr Hunt]

I totally agree with the right hon. Gentleman. I am sure, too, that he will agree with me that the best way to give the NHS certainty over funding in the future and the increase in funding that it needs to implement the five-year forward view is a strong economy, and it is only this Government who are able to deliver that.

Standardised Packaging (Tobacco Products)

Paul Burstow Excerpts

Wednesday 21st January 2015 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

This is a very important debate. As the chair of the all-party group on smoking and health, may I say to the hon. Lady that what we need to hear from the Minister tonight is that the Government write-around has started and that the regulations will be laid, so that we can have a vote?

[Ann McKechin]

The right hon. Gentleman is right about that, because these regulations, which need to be laid by the end of this month if they are to be approved in time by the Joint Committee on Statutory Instruments and the Secondary Legislation Scrutiny Committee. That is why we need to use the precious time that we have in this Parliament between now and the end of March to save lives and reduce the burden on the national health service. I hope the Prime Minister, his Government and the Minister who responds will listen to that call and start to act on behalf of everyone.

National Health Service

Paul Burstow Excerpts

Wednesday 21st January 2015 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

It was a pleasure to listen to the right hon. Member for Holborn and St Pancras (Frank Dobson). I was particularly struck by the point he made about the important case for investing in our health and care system. I dare say that the note that he mentioned will in due course be published under the 30-year rule, and that we shall then have a chance to read the full text. It must be said, however, that it took nearly four years for the argument he was advancing to be understood and acted on, and that those were lost years during the a 13-year Labour Administration.

[Frank Dobson]

I should point out that, partly as a result of earlier negotiations, we had secured an increase of £20 billion.

[Paul Burstow]

I may return to that point later, but first I want to talk about my own experiences of my local national health service, and in particular about a visit that I paid to my local trust, Epsom and St Helier University Hospitals NHS Trust, at the beginning of the month. During the visit I had a chance to meet staff, including A and E staff. I pay tribute to the hard work that is done in the trust, and especially to the work that is done in the A and E department. Last week Epsom and St Helier was placed sixth among all the London trusts in terms of the time for which people were having to wait in A and E, when measured against the standard, and, according to figures that were published yesterday, 99% of people are seen within the standard four hours. That is an example of great performance. The trust is facing great pressure, but it is doing a fantastic job none the less, and that side of the story ought to be told. We ought not to focus only on hospitals that may not have learnt some of the lessons that have been learnt by my local trust.

The A and E staff members whom I met made it clear that there was no single cause of the pressures in their department. In fact, the precise mix of factors varies from one hospital to another, and from one area to another. St Helier, however, has made excellent use of the winter funding it has received. It has added capacity to A and E, and has introduced examples of good practice. For instance, there are daily reviews of patients to ensure they are being given the right treatment in the right place; patients who are ready to be discharged are identified on the previous day so that arrangements can be made in good time; and there is a system of “ward buddies”, enabling corporate staff to provide additional administration support at times of extreme pressure—such as the present time—in order to assist safe discharge. A further welcome boost is the news that an extra £325,000 has been provided to assist people’s safe discharge to their own homes or to step-down care.

A piece of work examining the position in the Sandwell and west Birmingham area revealed huge variations between attendance rates by practice. Its authors found that some people considered A and E attendance to be the norm, and that a fifth of attenders made a conscious decision to go to A and E on the previous day. They also found that many A and E attenders believed that it was not even worth trying to access primary care in the first place. There are issues relating to communication, understanding of the system, and how we explain it. That cannot be dealt with in a universal, national way; it must be tailored to patients’ preferences and their expectations of the system at local level. That piece of work has already helped those in Sandwell to think about how to target messages more effectively in order to ensure that people have access to the support they need at the time they need it.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

Does my right hon. Friend agree that there should be a proper investigation into winter planning in each area? As he says, factors vary greatly. In my area, for instance, the factors affecting Addenbrookes hospital are very different from those affecting the Lister hospital in Stevenage. I think that planning needs to improve. This year, the same thing happened throughout the country. The A and E departments asked for £700 million, the Government gave it to them, and yet there have been all these problems.

[Paul Burstow]

I think it important for the system to learn lessons from the areas where winter planning has worked well, and for us to ensure that those lessons are transferred and replicated around the country. The NHS is not always as good as it could be at ensuring that lessons are not just stuck in one place.

[James Morris (Halesowen and Rowley Regis) (Con)]

Will the right hon. Gentleman give way?

[Paul Burstow]

I must make some progress if others are to have a chance to speak.

The NHS has grappled with a productivity challenge during the current Parliament, but it should be noted that it was first set up and signed off by the last Administration. The target was £20 billion, and it was to be delivered within a shorter period than the coalition Government set in their 2010 spending review. The Labour productivity programme was set in 2009, and it was clear then that the NHS was on notice that it faced a very tough settlement regardless of which party was in government after the 2010 general election. Reducing management overheads has been a key part of our efforts to balance the books during this Parliament. Focusing on the management overhead costs of the commissioning side of the NHS in the legislation that went through the House at the beginning of the Parliament was sensible, and increasing clinical involvement in commissioning was another important move.

[Frank Dobson]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will not, because I want others to have a chance to make their speeches. I hope that the right hon. Gentleman will forgive me.

In fact, that legislation did not change the configuration and organisation of hospitals, although that is how it is routinely portrayed by Opposition Members. As a result of the change to commissioning, £1 billion a year is now being saved, and there are 13,000 more front-line staff in the NHS. Having laid the blame for the pressures on A and E on a reorganisation of the NHS, which is the central proposition advanced by him today, the shadow Secretary of State then tells us that the solution is another comprehensive reorganisation. Is he now suggesting that that is not the case?

[Andy Burnham]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will, unlike the right hon. Gentleman on many occasions earlier.

[Andy Burnham]

The right hon. Gentleman clearly was not listening to my speech. The central proposition is that what I described as the “root cause” of the A and E crisis was the imposition of devastating cuts in social care, which are leaving people unsupported in their own homes. Will the right hon. Gentleman now say—because he was there—that it was wrong of him and his colleagues to allow social care to be cut in that way, given that the cuts are now presenting the NHS with an enormous productivity and efficiency problem?

[Paul Burstow]

The right hon. Gentleman is right to raise that question. I wanted to ask him a question that relates directly to his point, and, indeed, answers it. I hope that he will agree with me—and, indeed, with the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb)—that we need a fundamental review of NHS and care spending, in the round, and that finances in that area need to be addressed before the spending review that any Government will carry out later in the year. We need to ensure that we are clear about the level of investment that will go into our health and social care system. So far, I have heard no clear indication from the right hon. Gentleman of his relative spending priorities when it comes to health and social care, and they need to be made clear if we are to establish a consensus.

[Andy Burnham]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will give way once more, but then I must make rapid progress.

[Andy Burnham]

My answer to the right hon. Gentleman’s question is that I want a single service: a single service for the whole person. I want a national health and care service. We should no longer have two budgets; we should have a single budget, and we should then use the money as best we can to support people, starting in their own homes—and we are going to invest an extra £2.5 billion.

The right hon. Gentleman did not answer the question that I asked him. I asked him whether he and his Government colleagues, in those early days, made a mistake in allowing social care to be cut to the bone? Every week I am accused of saying that it is irresponsible to give real-terms increases. The right hon. Gentleman allowed social care to be raided. Should we not receive an apology for that today?

--- Later in debate ---

[Paul Burstow]

Let me deal quickly with that and then come on to what we need to do next.

As a result of the 2010 spending review, we invested £7.2 billion extra in social care over the life of this Parliament. I regret the fact that not every local authority has fully spent that resource on social care, and although the right hon. Member for Leigh (Andy Burnham)wants to make this an issue of blame I want to try to try to analyse the problem. It has already been said that some local authorities have struggled purposefully to reorganise their services to make the best use of the resources available and have delivered better outcomes, not least by investing in services such as re-ablement, which significantly reduced the call on ongoing care services.

It was right for the Government to put the resources in and make the commitments we did and it was right in the autumn statement this year to commit the £2 billion for the NHS as a down payment to deliver Simon Stevens’ NHS Forward View. Although that is good news, I want to flag up a couple of concerns. First, there needs to be clarity about the funding commitment in every subsequent year during the course of the next Parliament. We have had some indications from the Labour party and some from the Liberal Democrats, but we have not yet had clarity from the Conservatives about how they would address the £8 billion gap.

Secondly, despite the commitment of £7.2 billion for social care during this Parliament, not all that money has got through to social care. I acknowledge the efforts that councils have made already, but we cannot ignore the fact that social care has been a poor relation of the NHS not just during this Government’s lifetime but under successive Administrations of parties of both persuasions over a very long time. I have asked the Secretary of State to ensure that social care benefits from some of this £2 billion and urge him again today to do just that. It is unacceptable that some councils are paying fees for care that condemns staff to rates of pay below the national minimum wage and it is no wonder that as a result we have among the highest staff turnover rates of any part of our economy and that it is so difficult to recruit.

To conclude—although I could go on a little longer—I want to address the comments made by the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson). In a debate that had been about much heat but not a great deal of light, he cast important light on one of the key challenges for whoever is in government after the election, which is how we ensure that we reform our mental health care system to deliver the parity of esteem the Government have set out as an ambition and have started down the road of delivering. We still have a long way to journey, however.

We still have a separation in our health care system between the service that delivers for physical health and the service that delivers for mental health, yet those two things are inextricably linked. We know that half of lifelong mental health problems start in adolescence and need to be addressed at that point. The goal of parity of esteem, which is shared across the House, is right. We need parity of esteem in outcomes, rights and resources and I welcome the investments made by the Government, the commitment to continue the improving access to the psychological therapies programme that was started by the previous Government and has continued under this one, the launch under this Government of a children and young people’s IAPT programme and the emergency care concordat. I thank the Minister of State, who is on the Front Bench today, for launching the children and adolescent mental health services review, which must provide a route map for reforming CAMHS for whoever sits in the Secretary of State’s office after the general election. If it does not, it will have failed in its task. We need a plan and we need that plan to be implemented through the spending review after the general election.

The debate has highlighted yet again that we are yet to reach consensus in this Chamber on how to improve our NHS. There are people of passion and commitment on both sides of the House who have in their heart and at their core a desire to maintain a national health service that is free at the point of use and available on the basis of need. We need to extend that to ensure that our social care system is no longer left behind in the way it has been by successive Governments.

[Several hon. Members]

rose—

--- Later in debate ---

[Dr Huppert]

The hon. Gentleman can intervene if he wants to talk about why PFI is a great thing, but otherwise I will move on.

The Government have been too slow to move to the new formula, which properly takes account of ageing populations. We know that the elderly cost more in terms of health care. Cambridgeshire receives £961 per head, whereas West Norfolk, for example, receives £1,255. That is a huge difference. I asked for extra money during the debate that I mentioned, and I am delighted that we have managed to secure an extra £20 million as a result of the recent allocation. That will provide much more funding for mental health, on top of the extra £1.5 million that has been provided this year and the extra £2.2 million that will be provided for IAPT—improving access to psychological therapies—next year. That will make a big difference, and will reverse some of the challenges that we face.

We need that extra cash, but we still need more in Cambridgeshire and throughout the country. Simon Stevens called for an extra £8 billion by 2020, after savings and efficiencies had been taken into account. He said that an extra £8 billion, in real terms, was needed if the NHS was to keep going. I think that that is important, and we as a party think that it is the right thing to do. One of the problems with the motion is that it does not deliver what Simon Stevens has said is needed for the NHS. I am not all that keen to support the provision of less than a third of what is needed to keep the NHS going, especially after hearing from the shadow Secretary of State that, despite what the motion says, the money is not all for the NHS but constitutes the entire offer for the NHS and social care, which also needs its own funding. We need that £8 billion.

I voted against the Health and Social Care Act 2012 as I did not agree with much of it. There are some issues, such as parity of esteem, that are very good and that I hope will never be repealed. I also disagree, however, with many of the things that the Labour party did to bring in the private sector in some damaging ways, with people being paid for things that never happened.

The fact is, as was mentioned by the hon. Member for Brighton, Pavilion (Caroline Lucas), under the previous Government medical spending on private provision went from £1.1 billion a year in 1997 to £7.5 billion in 2009-10. That is a vast increase. I have no problem with people who say that they support that and that it was the right thing to do, but to suggest that that large increase was excellent for the NHS while the fact that it has continued at essentially the same rate under this Government is a disaster for the NHS strikes me as a rather bizarre claim.

I have criticisms of this Government, the previous Government and the one before that. I want the NHS to spend more of its time focusing on patients or, even better, avoiding the need for people to be patients in the first place. That needs a trained, motivated and well-paid staff—I think they should get the money from the independent review. It needs a focus on prevention and public health and proper funding—that is, the £8 billion by 2020.

[Paul Burstow]

On that point, does my hon. Friend agree that the better care fund, which is now being launched in April, is a key way in which we can deliver the joined-up care that he is talking about and that we need to have an ambition that by 2018 all CCG budgets, primary care budgets and social care budgets are in that pot?

[Dr Huppert]

My right hon. Friend is right, of course, and I pay tribute to him for the work he has done on this and on many other health measures. We must ensure that that integration happens so things work together and that is why token amounts such as a couple of billion pounds from the Conservatives, who need to go a lot further, and the £2.5 billion across health and social care from Labour—and by the way, please correct me if I am wrong, but according to The Guardian that is from 2017 onwards —will not go far enough. We need integration through the better care fund and we need that £8 billion. That is the proper funding that is needed.

Finally, we in this House ought to have a proper debate about how to fix problems and cut back on the amount of partisan bickering that happens in this place. That does not do us proud. We are all prone to it, including me. It is much better to talk about what we can do to promote health, whether it is physical or mental.

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

I am sorry, but this says it all about the Labour party’s campaign. It talks about savage cuts to social care and then the shadow Chancellor says he is not going to do anything to reverse them. It really has to be consistent. On the walk-in centre, Labour Members were saying earlier today that they want GPs present in every A and E department and that is exactly what has happened at Salford Royal. The walk-in centre was closed so that GP services could be moved closer to the A and E at that hospital. Perhaps the hon. Lady should talk to Sir David Dalton, her local chief executive, who will tell her why this is doing a better job for her constituents.

[Paul Burstow (Sutton and Cheam) (LD)]

The Secretary of State is absolutely right to highlight the success of the coalition in delivering a better economy, which is allowing us to invest £2 billion from April this year. Will he address the point put to him about the importance of social care, and seriously consider investing some of that £2 billion in social care, not just in our health care system.

[Mr Hunt]

May I reassure my right hon. Friend by saying that I agree with him? I want to pay tribute to him for campaigning on this issue for some time, both in office and out of office. The truth is that there is a strong link between what happens in the social care system and what happens in the NHS. This year, we are putting £1.1 billion of support from the NHS into the social care budget. Next year, that increases by another £2 billion. We need to recognise that these two systems need to be brought together as one system—and with the better care fund, that is what is happening.

A and E (Major Incidents)

Paul Burstow Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I agree entirely with the right hon. Lady. The better care fund is a first step, but it is only a first step. It is happening from this April, but we have the NHS England five-year forward view, which is the long-term plan to improve community care. I agree that Salford Royal is an excellent hospital. It had £3.5 million to help it deal with winter pressures this year, but it is also a good example of how integrated care between the acute trust and local community services can make a real difference, and it is delivering some of the safest care in the country.

[Paul Burstow (Sutton and Cheam) (LD)]

May I pay tribute to the accident and emergency staff at my local hospital, St Helier, whom I met on Monday? One thing they made clear to me is that although there is no single cause of the pressures on A and E at the moment and there is therefore no single solution, they want certainty about the long-term plans for NHS funding. Although the down payment of £2 billion announced in the autumn statement was very welcome, will the Secretary of State say whether the Government or any Government in whom he might participate in the future will deliver the additional £8 billion necessary to secure the closing of the funding gap that Simon Stevens identified?

[Mr Hunt]

When we did the autumn statement last year, we asked Simon Stevens and NHS England how much they needed for their plan next year and they told us it was about £2 billion, so we made that commitment. We also said that that was a down payment on delivering the entire plan, not a one-off payment. I agree about the importance of long-term certainty over funding, but the most important thing in that regard is to have a strong economy that can deliver the money that will support our NHS. It is only Government Members who have shown that they are capable of delivering that strong economy rather than the instability that would come from disastrous economic policies.