Breast Implants

Paul Flynn Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

I am grateful to the shadow Health Secretary for his welcome of my statement and the principles behind what we are setting out to do to look after the women affected by these implants.

I do not share the right hon. Gentleman’s view that there were any mixed messages. I am sure he would have been the first to complain if I had not identified the lack of available and consistent data and not asked an expert group to look into this. As we look at countries across the world, we can be confident that we have set an exemplary standard in looking after women through the NHS and in bringing together an expert panel fully to understand what would be the best advice for women. The advice that no identified specific safety concern justified the “routine removal” of these implants was true on 23 December and it remains true today. As we have recognised from the outset and as I said on 23 December, if women are worried or concerned about the possibility of not having the implant they thought they had, that provides a perfectly reasonable basis on which to seek advice and investigation. It would be right for some women to ask for removal, but we should not assume that women are choosing to have these implants removed on the basis of clinical advice—even in France.

The chief medical officer spoke to a clinical counterpart in the Welsh Assembly Government before the publication of the expert group’s work. I have made sure that they are informed, but I have to say that the Welsh Government made an announcement yesterday without previously informing us.

[Paul Flynn (Newport West) (Lab)]

It’s called devolution.

[Mr Lansley]

It may be called devolution. I respect the devolved Administrations and always inform them of what I am doing, where it is relevant to them. We do not recognise the advice that Wales received. Sir Bruce Keogh’s expert group, which included some of the foremost experts in plastic surgery, made clear recommendations last week for patients in England and concluded that there was no significant increased clinical risk in cases where implants are not replaced.

If the shadow Secretary of State commends what the Welsh Government have done—[Interruption.] Perhaps he did not, but if he or anyone were to commend it, they would need to recognise that it runs the risk of letting the private providers off the hook. I am very clear that they should provide an equivalent standard of care. As the right hon. Gentleman made clear, there are limitations on what can be done. I do not have powers and I did not inherit powers to control what the private providers do in the private sector. I have to tell the right hon. Gentleman, however, that I have reflected on the Health and Social Care Bill, which is a positive legislative step forward. Just as it allows Monitor as a health and social care sector regulator, on which we are consulting, to look at the prudential regulation of private providers in social care, so it would allow us to consider the role of Monitor as a health sector regulator in licensing private providers of private health care. It is thus a positive not a negative step forward. There is no comparison, as the right hon. Gentleman will recognise, between the role of the private sector providing private care and the private sector in the NHS, which is subject to the same duties and obligations as an NHS provider. The Bill does not lead to an increase in private sector provision, but in so far as there are private sector providers, they will be properly regulated in the NHS.

On the role of private providers, they may be insured and there may be warranties relating to these implants. We do not have data on this aspect, but I am clear that these providers have legal and, indeed, moral obligations. I particularly commend a letter issued this morning by the leaders of the profession—the two principal professional associations—to their surgical colleagues. Having talked about the standard of care in the NHS, the letter went on to say:

“Those working in the private sector are urged to support in similar fashion. We would hope that implanting surgeons would honour requests for replacement surgery free of surgical charge”.

The private providers that have not made this offer to the women for whom they are responsible can see that their surgical associates are willing to carry this out free of surgical charge, so I see no reason why they should not now step up and deliver the standard of care that women have a right to expect.

--- Later in debate ---

[Mr Lansley]

My hon. Friend will understand that I cannot speak about the precise details of the situation with the Harley Medical Group. All I can say is that the group has told the media that it does not feel it can offer that standard of care completely, but that will have been before the professional associations wrote to their members asking them to support replacement surgery free of surgical charge. I know that the group has told members of the media that it is willing to offer to the Government that if we are responsible for the removal of implants, it will pay for implants to be available for replacement purposes. Frankly, if surgeons are willing to waive the surgical charge and the group is willing to pay for the implants, it is not too much to ask for it to be responsible for removal and replacement, where it is in the woman’s best interests to do that.

[Paul Flynn (Newport West) (Lab)]

Does the Secretary of State not regret failing to react to the call made last May for British patients to have the same protection against failures of all medical devices as that enjoyed in the United States? Is not the real scandal here, again, the chronic under-reporting by the industry and the MHRA of failures of devices and drugs? Is not the answer for this probe to look into the possibility of having a genuinely independent regulatory authority, instead of one that is entirely funded by the industry, because self-regulation is often no regulation?

[Mr Lansley]

The hon. Gentleman says that this body is entirely funded by the industry. It is true that in relation to pharmaceuticals the MHRA is funded by levies on the pharmaceutical industry, but much of the cost of the regulation of medical devices is actually met by the taxpayer. I regard the MHRA as operating in an independent fashion and its expert and scientific advice as independent from Ministers. None the less, as he says, the review that Earl Howe will lead will examine the lessons to be learned, including those about the effectiveness of regulatory surveillance and enforcement in this country, albeit that the regulatory failure occurred, in essence, in Germany, in the first instance, and in France.

Life Sciences

Paul Flynn Excerpts

Monday 5th December 2011 Commons Chamber

[Mr Lansley]

The principal impact that we are having relates to the National Institute for Health Research, which, through its contracts with the NHS and other partners, is driving the time to the first recruitment of clinical trials down to 70 days. That will get us to a competitive position. We are also working in partnership with the pharmaceutical industry, for example to look at how some of the new stratified medicines will be available. Today, we are entering into partnership with AstraZeneca, which is close to my hon. Friend’s constituency, to understand what specific compounds are likely to be of benefit to some subsets of the population with cancer through the use of targeted new medicines.

[Paul Flynn (Newport West) (Lab)]

As the policy rests on the trust in the regulatory body that was tardy in protecting patients against the adverse side effects of Vioxx and Seroxat, is it not time that we had a fully independent MHRA and not one that is funded entirely by the pharmaceutical industry? As big pharma pays the piper, is it not possible that it will call the tune for its own commercial interests?

[Mr Lansley]

I think that the hon. Gentleman is wrong about that. The MHRA operates, in scientific and expert terms, in an independent fashion. In so far as it is accountable, it is accountable to me as Secretary of State and to this House. It is not accountable to the pharmaceutical industry. If he is proposing a major transfer of costs from the pharmaceutical industry to the taxpayer, I am afraid that I do not agree with him.

Organ Donation

Paul Flynn Excerpts

Wednesday 30th November 2011 Westminster Hall

[Glyn Davies]

I thank the hon. Lady for her contribution, but I have not thought of this as being in any way a political issue. I know that there will be members of my party who will take a different view. For me, this is an issue purely outside party politics.

[Paul Flynn (Newport West) (Lab)]

Of the people who died last year waiting for organs, 50 died in Wales, and the evidence from the world experience is that the system being proposed by the Welsh Assembly will reduce that number of deaths. The hon. Gentleman has produced nothing to suggest that that is not the case.

[Glyn Davies]

I thank the hon. Gentleman for his intervention, but I simply do not accept that. The evidence actually shows the opposite of what he has just said, and he is ignoring that evidence. This is an issue of such importance to me—probably the most important issue to me since I have been a Member of Parliament—that I have looked carefully at the evidence. I do not want to be advocating a course of action that in some way negates that evidence, and I do not think that that is what I have been doing.

--- Later in debate ---

[Paul Flynn (Newport West) (Lab)]

This debate reinforces the view that Assembly Members never actually leave the Assembly, but continue their debates here in Westminster. This morning’s debate is not for us. The Government have 400 commitments in the coalition agreement; if they have 401 commitments then there is even less chance that they will deliver on this. There is no likelihood of change.

[Glyn Davies]

I reassure the hon. Member that this issue was never raised during the eight years I served as a member of the Welsh Assembly.

[Paul Flynn]

It is now a live issue in the Assembly. We are not the Assembly, we are a British Parliament, and I question whether this is an issue of primary concern. Of course we should talk about it, but sadly any possibility of reform is remote in this Parliament, although it is a live issue in Wales. This debate has been called in order to influence the debate in Wales and it is questionable whether it is a legitimate use of parliamentary time.

[Guto Bebb (Aberconwy) (Con)]

I congratulate my hon. Friend the Member for Montgomeryshire (Glyn Davies) on securing this debate. On whether this is an issue to be debated in Westminster or in the Welsh Assembly, is the hon. Member for Newport West (Paul Flynn) implying that no contribution to the debate can be made in a Westminster context? There is a real question mark as to whether the Assembly has the legislative competence to deal with the issue.

[Paul Flynn]

I served in Parliament before there was a Welsh Assembly, unlike the two hon. Gentlemen. Since it has come into being I have absolutely never, at any time, become involved with, made speeches on, or interfered in those responsibilities of education and health in Wales, which are the responsibility of the Welsh Assembly. We have to accept that and realise that there are Welsh Assembly responsibilities and other responsibilities here. I do not want to labour that point, however, because there is a more important point to be made—

[Guto Bebb]

Will the hon. Gentleman give way?

[Paul Flynn]

No, I will not. I have been asked to be brief. We must get away from what we are hearing from prattling prelates and procrastinating politicians and look at the real issue. We cannot talk about a system that is working well, as was suggested this morning, when 1,000 families were bereaved last year in the UK and 50 families were bereaved in Wales. I will not talk about one family in my constituency where a young woman died waiting for an organ transplant because it is too heartbreaking a story, but I want to say something about the reality. Despite all the fine theories and words ahead, what is happening to real people in our constituencies?

Some of us listened to the testimony of Matthew Lomas and his mother when they came to Parliament a month ago. It was a dreadful story of suffering that moved us all. Matthew and his brother were born with congenital heart defects and they both had pacemakers. Matthew was suddenly getting a great deal of pain and discomfort and was taken to the hospital, where the diagnosis was a sombre one. His heart was growing and he would eventually die. He was told that on a scale of one to 10 his chance of surviving was at 9.9, and the family prepared for Matthew’s death. They were told that a heart transplant was a possibility, so they arranged for him to go to Birmingham’s Queen Elizabeth hospital, where he had a series of assessments. When the doctor told them that he would have to have a transplant, his mother said:

“Matt and I stared at each other it was so surreal. Had we both heard the same thing? We didn’t talk. Matt may have wept, I can’t be sure. I felt numb and could only think about my son who I had just been told was dying.

The sister came back in. ‘Had you been expecting to hear that?’ she asked gently. ‘No!’ we said together. It was the first thing we had said since hearing the awful news. ‘I thought Matt would need a new pacemaker.’ I said.”

She told the story—which some hon. Members will have heard—of the dreadful things that happened from then on. There were false alarms; a call from Birmingham came at 2 o’clock in the morning. They prepared themselves and started to drive up the motorway, only to be told when they were halfway there that the heart was not suitable. There were many other false alarms along the way. Eventually the transplant did occur—I find it difficult to read the whole story so I will cut it short. The family went through agony as the young man approached death. He was fitted with a device that would keep him alive for 28 days, but death was a certainty at the end. By good fortune—not from the wisdom of politicians or prelates—he survived. He is at home now and has a life expectancy of five years.

Another constituent of mine, a young woman the same age as Matt, died last year because there was no heart available. I believe we must say—because the overwhelming evidence is there in spite of what the hon. Member for Montgomeryshire (Glyn Davies) said this morning—that the weight of the medical evidence shows the best way forward, and that is the decision that the Welsh Assembly is about to take. For goodness sake, instead of going along as we are—particularly today—serving the few rather than the many and talking about our various political differences, let us realise that this is an area in which we politicians can save lives and lift the burden of anxiety from families waiting for organs. We know that all of the evidence—the fair evidence, not the procrastinating evidence we have heard this morning—shows that there will be more organs available. For goodness sake, let us allow the Welsh Assembly a free run to get on with it and lead the country as it has in the past with other reforms. We hope that England and the rest of the United Kingdom will follow suit when the reforms produced by the Welsh Assembly are proved to be a great success.

Epilepsy

Paul Flynn Excerpts

Tuesday 29th November 2011 Westminster Hall

[Paul Flynn (Newport West) (Lab)]

It is a pleasure to serve under your chairmanship for the first time, Mr Scott. I warmly congratulate my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) on obtaining this debate and on his splendid contribution, which covered the ground of all the campaigning groups working on behalf of those with epilepsy.

It is a great pleasure to follow the most important and worthwhile speech that will have been made in the House today, whatever happens in the Chamber. It is enriching for us to have the hon. Member for Blackpool North and Cleveleys (Paul Maynard) in Parliament. We are not members of the same party, but I will happily embrace him as a friend and call him such. Hearing at first hand from those who suffer from illnesses or disabilities is of enormous value to us. There is nothing better than to hear from the hon. Gentleman about the simple changes that might be necessary, such as blunting sharp corners and taking simple precautions, to avoid the tragedies that occur all the time. I welcome his presence in the House. If this House is to restore our greatly damaged reputation—it is of profound importance to us all that we win back the trust and confidence of this country—we need more Members such as the hon. Gentleman with experience that can give us diversity. The House must become more representative of the nation in every way.

My reason for speaking in this debate relates to a matter involving two constituents and lifelong friends of mine, Gwyn and Gill Thomas. I knew one of their daughters, Rhian, throughout her brief, radiant life. Her parents were devoted to her. On a visit to Florida, the place where Rhian was happiest, she died suddenly during the night. There was no warning or expectation, and Gwyn and Gill were left shocked, as would we all at the untimely death of one of our children, and bewildered by what had happened. As in many cases when a family experiences terrible grief, they have become enthusiastic campaigners to ensure that no one else suffers in the same way as they have suffered. They wish to avoid this being repeated in other families—a strong and understandable reaction. My hon. Friend the Member for Birmingham, Selly Oak has mentioned the concerns, and I have heard about them first-hand in the House from other parents who have lost young people in similar circumstances.

Channel 4 covered the case of the Casey and Ilia fatalities, which involved two families who suffered in a similar way. Erin Casey was aged 19 and Christina Ilia was aged 15—one a university student and the other a schoolgirl. The sheriff concluded that, had Erin been told of the risk of sudden unexpected death in epilepsy, she might have picked up her prescriptions and complied more with her medication—she might not have died. Had there been supervision in the form of nocturnal devices, which have been discussed, Erin might have wanted them and might not have died. On the death of Christina, the sheriff found that, had she and her parents been told of the risk, they would have discussed and considered the possibility of providing night supervision, possibly by use of alarm. If Christina had had such supervision, she might not have died during the night. The judge recommended that there should be a discussion of SUDEP in order to reduce the risk at diagnosis, unless there was serious harm to the patient. The timing of the discussion should be deferred, but needs to be planned. The role of a specialist epilepsy nurse is vital, and the failure of the authority to provide a specialist nurse service was viewed as contributing to the death. Those points were well made in the television programme and must be of concern to us all.

My hon. Friend has given a list of the possible remedies—drugs and how they should be used, and the existing advice—that appear to be available. Part of my constituents’ additional agony as a result of their bereavement is that they were not informed of many of the things that they have heard about since Rhian’s death. They want to go out and make sure that everyone else is aware of the possible remedies that could avoid such tragedies in the future. As with many other subjects discussed in the House, my views on this issue are the result of constituents’ problems. I thank the persistence of the campaigning of my constituents and all others who are determined that everything possible is done to avoid these unnecessary deaths.

--- Later in debate ---

[The Minister of State, Department of Health (Paul Burstow)]

I, too, am pleased to serve under your chairmanship, Mr Scott. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing the debate and on being so persistent in applying for it week after week until, finally, being successfully in the ballot for Adjournment debates. The hon. Gentleman is right to bring the matter back to the House for a debate and I am grateful to all hon. Members who have contributed. The personal testimony and the testimonies we have heard on behalf of constituents speak to the devastation that the condition can bring to families and the people who suffer from it.

A lot of statistics have rightly been rehearsed to illustrate those points as part of today’s debate. They are undoubtedly very compelling and, as has rightly been said, quite depressing. They show that although we have known for a long time what needs to be done, it does not appear to be implemented as consistently as it should be across the country. There are places that follow the NICE guidelines and consequently make a difference, but over many years other areas have failed to invest or see the matter as an area of priority. That is not a comment on previous Governments’ records, but an acknowledgement of the difficulty in an organisation as large as the NHS of ensuring sufficient focus on something as important as this.

The hon. Member for Hackney North and Stoke Newington (Ms Abbott) paid tribute to the work of the all-party group on epilepsy. I come across many APPGs in pursuing my ministerial responsibilities; they are, truly, an important part of how this Parliament makes sure that the voices of many seldom-heard groups—or groups certainly not heard often enough—are heard by Ministers and the Government.

I will try to ensure that I respond to all the points that have been made. I have been encouraged to speak for as long as is necessary to do just that.

[Paul Flynn]

Will the Minister give way?

[Paul Burstow]

There is an objection to that point. I give way.

[Paul Flynn]

Members have, very generously, given the Minister 40 minutes to reply to the debate, which is rather longer than Ministers usually have. Will he find time in that 40 minutes to commit to the practical, affordable remedies that have been urged on him by the many charities involved in SUDEP?

[Paul Burstow]

I hope to do just that, and I hope to do justice to the points that the hon. Gentleman and other hon. Members made in the debate.

At least one hon. Member—my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), who initiated the debate we had about a year ago—has contributed to the debate on this issue again. The message I took from last year’s debate was clear, and I take it again today. There is a real sense that we need change in the system. We need change that delivers a real focus on issues such as epilepsy to ensure that clinicians and the service respond properly to the evidence, act on the evidence, and translate it into services that are fit for purpose. At the moment, the service continues to fail hundreds of thousands of people living with epilepsy, at a huge cost to them personally and to their families. When we debated these issues a year ago, there was some uncertainty about how the Government’s plans for reform would deliver improvements. I would like to spend a little time today setting some of them out.

--- Later in debate ---

[Paul Burstow]

It was kind of the hon. Gentleman to intervene, because it allows me to answer his final question. The Department continues to work with the charities and to discuss their concerns, and I am happy to arrange a meeting to have such discussions.

[Paul Flynn]

rose—

[Ms Abbott]

rose—

[Paul Burstow]

I will give way to the hon. Gentleman while the hon. Lady frames her questions—she clearly has one or two—and I will then give way to her.

[Paul Flynn]

I have listened with great attention to the Minister. I am aware of his record in opposition as a doughty campaigner for many causes. The Government are obsessed with change and upheaval in health service structures. Can he provide some practical assurance that by the end of their term of office, if they go to 2015, there will be fewer sudden unexpected epilepsy deaths?

[Paul Burstow]

I have referred to the focus on outcomes and the establishment of an outcomes approach not just to commissioning services, but to how we measure the performance of services. That provides hope of an improvement. The issue is not just a high-level one. I have not talked about specific statistics today, but sitting behind each and every indicator in the outcomes framework for the NHS are hard metrics that are being used to identify variations between parts of the country. We have seen in other services—for example, cancer services—how powerful the publication of atlas data, which shows performance in different localities, is at challenging clinical teams and challenging commissioners to commission differently and better. I genuinely believe that that approach and the focus on outcomes and data are key drivers to improving future performance.

Organ Donation

Paul Flynn Excerpts

Wednesday 9th November 2011 Westminster Hall

[Paul Uppal]

My hon. Friend is correct: I do not sign early-day motions. On the opt-out, we have made some progress, and we should continue on that route, but increase the pace. I have seen some of the research from various task forces. Some work in 2008 suggested that there was no substantive evidence that going down that route would increase organ donation. That is probably a matter for debate another time, but my personal opinion is that we must deal with it sequentially. Let us get to 2013, then see where we are.

[Paul Flynn (Newport West) (Lab)]

If anyone is in any doubt about the desperate suffering at the moment, they should look at the evidence from my constituent, Matthew Lammas, and his family, who came to the House and talked about their six months of agony while he waited for an organ to become available. There were calls in the middle of the night, and drives of sometimes hundreds of miles with disappointment after disappointment. He came near to death, but finally and happily, he was given the heart that he needed, and he is surviving. Anyone who believes that the issue can be pushed aside should read about that family’s terrible suffering because of the lack of organs. For those who did not attend the meeting, the story is available on my blog. Unfortunately, another constituent died due to lack of an organ.

[Paul Uppal]

I thank the hon. Gentleman for his intervention. No one in the Chamber would in any way, shape or form underestimate the suffering of those who need a transplant. I am a trustee of a Sikh temple, and I have been approached specifically about the matter and people’s real concern about it. I have felt the pain that many families feel. We may leave the main thrust of the debate today, but I am sure that we will revisit the issue. I accept completely what the hon. Gentleman says, but for the time being we must go along the path of sequential progress.

Ritalin

Paul Flynn Excerpts

Tuesday 25th October 2011 Westminster Hall

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

It is a pleasure to see you chairing the debate, Mr Howarth. I secured the debate because I want to talk about how we treat behavioural problems such as attention deficit hyperactivity disorder in children, and, in particular, about the increasing use of drugs to treat those problems.

I have been tabling questions on this issue for some months. I am sure that it is a complete coincidence that this morning, just a few hours before the debate, the Government announced an extra £32 million for children’s mental health therapy, including talking therapies. That news will be welcomed by parents and professionals, because it is important—a point that I want to stress—to have a range of treatments available for young children who suffer from this condition. Will the Minister confirm whether that is new money, or whether it is part of the wider £400 million announcement, made in February, on mental health? If it genuinely represents extra resources for mental health therapy for children, that is of course welcome. I also welcome its happy coincidence with this debate today.

My main focus is on the use of drugs to treat ADHD and similar conditions. The main drug that we usually talk about in this field is Ritalin. Ritalin is a brand name for methylphenidate hydrochloride, and it is this whole family of drugs that I want to talk about. I want to set out the trend of increasing use of these psychotropic drugs to treat ADHD, and the growth in their use for very young children—sometimes in breach of National Institute for Health and Clinical Excellence guidelines. I want to spell out why many in the field believe that this trend is likely to continue. Finally, I will issue a plea to the Minister to carry out a proper, comprehensive review of the use of these drugs involving professionals from the medical, psychology and teaching fields, as well as the families of those who have been prescribed the drugs.

[Paul Flynn (Newport West) (Lab)]

Had the young Mozart been on Ritalin and the young Beethoven been on anti-depressants, we would probably never have heard of them. Does my right hon. Friend agree that trying to drug children into conformity and uniformity is the enemy of creativity?

[Mr McFadden]

My hon. Friend makes an eloquent point. I do not take the view that the drugs cannot work. I am not qualified to say that, but there are serious questions to be asked about the growth in their use.

The increasing use of these drugs has not just happened in the period since last year’s general election. I am not here to make a party political point. This has been going on for many years and is part of an international picture, so it is not the responsibility of a single party or a single set of politicians. Some professionals and parents believe that these kinds of drugs can be effective and have a role to play where ADHD is correctly identified, although it is also true that some psychologists believe that there is significant over-identification and diagnosis of ADHD in children. The real question is whether the drugs are considered alongside other appropriate treatments, and are used as a first option, or only after alternatives have been properly explored and considered. Let us look at the trend in the number of prescriptions in England in recent years.

A written answer in July showed that between 1997 and 2009 there was a more than sixfold increase in the number of prescriptions for methylphenidate to the point where, in 2009, 610,000 prescriptions were issued. The number had almost doubled in five years. There is no doubt that there is an increasing reliance on these drugs to treat behavioural problems in children. Methylphenidate is not always used on its own. It can often be combined with other drugs, so that the child ends up taking a cocktail of powerful drugs to control their behaviour in different ways during the course of the day.

What lies behind this trend towards the medicalisation of child behaviour problems? Why are we prescribing more and more drugs to treat such problems? Do we really believe that there has been a sixfold increase in the occurrence of ADHD and similar disorders in recent years, or are these drugs being used to treat behavioural patterns that were dealt with in different ways by parents and teachers in the past? Is the increasing labelling and categorisation of behavioural problems increasing the tendency to treat children with drugs?

Sue Morris, director of professional training and educational psychology at the university of Birmingham, recently said:

“It’s not uncommon for the diagnosis of ADHD to be based on parental reports - without observation of the child in a home or school environment. The prescription of drugs certainly shouldn’t be the first step in treating the disorder. Sometimes drugs are being used in the absence of talking therapy and psychological assistance, and that is wrong.”

There is clear guidance from NICE on the use of these drugs:

“Drug treatment should only be initiated by an appropriately qualified healthcare professional with expertise in ADHD and should be based on a comprehensive assessment and diagnosis.”

NICE also makes it clear that methylphenidate

“is not currently licensed for use in children less than 6 years old”.

NICE makes it clear that it should be discontinued if there is no response after one month, and that treatment should be suspended periodically to assess the patient’s condition. What evidence does the Minister have that this guidance is being adhered to? Are these drugs always used as part of a comprehensive assessment and diagnosis? Are they used as the first option, or only after alternatives are considered? Are they given only to children aged six and over? Are children routinely taken off them after one month if they are not effective? Is their use periodically suspended to assess the patient’s condition?

I suspect that the Minister does not know the answers to many of these questions. In fact, when it comes to the number of children under the age of six being prescribed the drugs, I know that he does not know because the Department of Health has already told me. That is not a reflection on him personally, but it exposes a gap in our knowledge that must be filled. Why is it, despite the clear guidance from the Department of Health about the appropriate age for use of these drugs, that the Department does not know how many children under the age of six are being prescribed the drugs?

Evidence from the Association of Educational Psychologists suggests an increase in the use of methylphenidate for very young children. An informal survey of their members in the west midlands suggests that more than 100 children under the age of six in that region alone are on some form of psycho-stimulant medication. As we do not ask for someone’s age when a prescription is written, the Department of Health has told me that it cannot say whether its own guidance is being adhered to. I am sure the Minister would agree that that is an unsatisfactory situation. We have clear guidance from the Government, but no clear knowledge about whether that guidance is being breached on a regular basis. That is not an acceptable situation and the Government must establish a clear picture of what is going on.

I am not asking the Minister to ask the age of every person issued with a prescription, but it would be possible, through a proper survey of practitioners, to establish how much prescribing involves very young children. Will the Minister commit today to carrying out a proper research survey of professionals in the field to establish the degree to which the guidance from NICE is being adhered to and to establishing a clearer picture, particularly with regard to the use of these drugs by children under the age of six?

The question of age is not only about the youngest children. The sharp increase in the use of these drugs in recent years means that we now have a generation of teenagers who have taken psychotropic drugs for years. What happens when they reach adulthood? What are the long-term effects and what is the appropriate alternative treatment for people trying to come off these drugs after a number of years? In its review, NICE concluded:

“Given that ADHD is a chronic condition which may require long-term treatment, there is a need for further data on long-term outcomes of drug treatments.”

There is significant regional variation in prescribing patterns, with the BBC reporting a few years ago that the highest prescribing area prescribed 23 times more than the lowest. I can understand that in any health system in which people are asked to use their judgment prescribing patterns will not be uniform, but 23 times more is a very large difference, and there is similar variation abroad. In the United States, for example, the closer someone lives to the east coast the more likely they are to be diagnosed with ADHD and prescribed these kinds of drugs.

An important feature of the growth in the use of methylphenidate to treat behavioural disorders is the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition”—DSM-IV. The manual breaks down and categorises various psychological and behavioural disorders and has significant international influence. In 2013 it will be replaced by DSM-V.

Some people believe that such publications exacerbate a trend towards the over-medicalisation of behavioural problems. The British Psychological Society, for example, has expressed serious concerns about DSM-V. Its response to the impending introduction of the fifth edition states:

“The Society is concerned that clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.”

It goes on:

“Diagnostic systems such as these therefore fall short of the criteria for legitimate medical diagnoses. They certainly identify troubling or troubled people, but do not meet the criteria for categorisation demanded for a field of science or medicine”.

What is the Department of Health’s response to those serious concerns? How does the Department intend to work with the professions on the introduction of DSM-V, and does the Minister share the concerns of the Association of Educational Psychologists and the British Psychological Society that it might exacerbate the trend towards the medicalisation of behavioural problems?

It is for all those reasons—the growth in the number of prescriptions, the evidence that they are being given to very young children, the wide regional variations in their use, and the lack of firm data and evidence about the long-term effects of combining these drugs with others—that the Association of Educational Psychologists has called for a review of the use of the drugs. The review should involve paediatricians, child psychiatrists, GPs, teachers, parents and other relevant voices. We must get to the bottom of what lies behind the increased use of the drugs, and establish whether we are dealing with childhood behavioural problems as best we can.

The association’s call for a review is a call I echo today, and I hope that the Minister can confirm that the Government will undertake such a review, before the introduction of DSM-V in 2013. I hope also that he will be open-minded about my questions. I welcome the money for children’s mental health therapy that has been announced today, but it does not mean that we should ignore the questions raised in this debate. If recent trends of growth in the use of the drugs were to continue, we could end up with more than 1 million prescriptions for them, each year in England. Would the Minister be comfortable with such an outcome?

Having highlighted the growth in the use of the drugs and raised concerns about their being taken by very young children in particular, I am essentially asking the Minister to do two things. First, will he commit his Department to carry out a proper research project into the use of the drugs, including the age of the children receiving them? Secondly, in the light of the huge growth in prescriptions, will the Government carry out a proper review of practice in the field, as called for by the Association of Educational Psychologists, before the new guidance comes into effect in 2013? Those requests are moderate and measured, and I look forward to a positive response.

Swine Flu

Paul Flynn Excerpts

Monday 10th January 2011 Commons Chamber

[Mr Lansley]

It would normally be ordered between March and May.

[Paul Flynn (Newport West) (Lab)]

H1N1 deaths are especially tragic because they involve people with expectations of a long life. Last year, 65,000 deaths were anticipated but fewer than 500 died with swine flu and 150 died of swine flu. If the priorities of the health service are not to be distorted, should not we approach this problem with a sense of both caution and proportion?

[Mr Lansley]

I share the hon. Gentleman’s deep regret. H1N1, unlike many previous flu strains, does not particularly impact on the elderly; it impacts on younger people and on younger adults in particular. That is the principal reason why we are seeing a relatively larger number of people occupying critical care beds. The NHS response has been to accelerate the provision of critical care capacity and of ECMO beds in particular.

Health (CSR)

Paul Flynn Excerpts

Thursday 11th November 2010 Westminster Hall

[Paul Flynn (Newport West) (Lab)]

I am very grateful for the opportunity to speak in this debate and I congratulate my right hon. Friend the Member for Rother Valley (Mr Barron) and my hon. Friend the Member for Easington (Grahame M. Morris) on their very illuminating speeches.

I will not follow the lines that my right hon. and hon. Friends have taken. However, I note that the comprehensive spending review has been described as generous by some. If we want to see a generous settlement in next year’s spending, it is the settlement that has been given to the landowners and farmers of the country, especially when one recalls that the price of wheat has gone up by 47% and the price of lamb has gone up even more. Not only will the £3 billion that was given out in handouts to the farming industry be protected but it will probably be increased by 3%. Now, there is generosity from a Government.

When one considers what is behind this CSR, one is filled with a sense of despair; we have a new Government with new myths and new jargon, and we will have new errors too. An example of a piece of new jargon is that the National Institute for Health and Clinical Excellence is about to be emasculated and replaced by something called “value-based pricing”. It sounds attractive, but we know that it will not work because the pharmaceutical industry supports it and the pharmaceutical industry has a long record over the years of demonstrating that the only thing that it supports is increased prices and an increased share of the cake for itself. That is what has gone on.

At least with NICE, we had a modicum of control over the increases in the price of pharmaceutical products and the increasing share that the pharmaceutical industry had of the NHS; a share that the industry took away for itself, consequently depriving other parts of the NHS.

We know of examples of that practice by the pharmaceutical industry, mostly involving anti-cancer drugs. One drug was promoted as an answer to pancreatic cancer. One of my constituents was very much involved in this field, and I did some research myself to find out exactly what that drug offered. As far as The Sun, the Daily Mail and all the other tabloids were concerned, this was a miracle drug that had to be obtained for patients and it was only the “mean” Government who were not allowing patients to obtain it. Having gone into the details of what this drug achieved, I found that it cost £16,000 a year and that it increased life expectancy by 12 days, but it caused side effects in 10% of the patients who used it, including death. The other side effects were so dreadful and destroyed patients’ dignity to such an extent that their 12 days of extra life were of no value and would possibly even have been an increased burden to themselves and their loved ones. As is the case with many other drugs now, however, that drug was being pushed by the pharmaceutical company and its agents.

If we take away the power of NICE to make objective, scientific judgments, we will have the power of the tabloids and the lobbyists replacing it, and the patients associations will all join in behind them. We will have campaigns to persuade us; we will have patients on the television making appeals, patients who will be good-looking and who will arouse our sympathy. The pressure will then be on to alter the priorities of the health service to accord with the demands of the pharmaceutical industry. This is a surrender from a reliance on objective, science-based judgments to a reliance on the prejudice-rich decisions of the tabloid press and “big pharma”. Will the Minister guarantee that the price of drugs will go down?

[Frank Dobson]

Does my hon. Friend accept that the 150 drugs that are most commonly prescribed in this country are half the price that they are in the United States, where the pharmaceutical industry, roughly speaking, determines the price of drugs? We can guarantee that prices will start to go up under the new system.

[Mr Roger Gale (in the Chair)]

Order. There is a very interesting debate to be had on those issues, but the hon. Member for Newport West (Paul Flynn) has been in the House a long time, and the right hon. Member for Holborn and St Pancras (Frank Dobson), who has just intervened, has been Secretary of State for Health and both are aware that, while the subject may be interesting, it is not to do with the comprehensive spending review, which is the title of the debate.

[Paul Flynn]

I want to address my remarks to the budget of the health service, and how it matches our priorities.

Perhaps I may move to a different subject. I should like to pursue what my right hon. Friend said. He is absolutely right that the lobbyists determine health policy in America, and will have an increasing effect on the comprehensive review, and on the demands on and priorities of the health service. However, I shall deal with another matter, which is not political in any way, because it involves decisions made by one Government, which were then approved by the pantomime horse of a Government we have now. It is about pandemics past and future. We have had a series of those, which have been costly for the health service. They go back to severe acute respiratory syndrome—a very severe and nasty illness, which killed more than half the people who caught it—through the threatened avian flu, which never lived up to its billing, to swine flu last year.

Swine flu in Britain cost the health service £1.2 billion on antivirals and vaccines. It also had other damaging effects, in that it scared the country greatly. People were frightened by the possibility of flu on the scale of the 1918 flu that killed between 25 million and 40 million people. It distorted all the priorities of the health service for a year. The health service gave attention to that rather than to the other things that it should have given attention to. It also involved the use of a vaccine that had not been trialled. The people who say it was not fully trialled are those who made it—GlaxoSmithKline and the other producers. That was a major event, and we might consider, knowing what we know now, how we got into that situation.

We were told by Liam Donaldson that it was likely that there would be between 3,000 and 750,000 deaths. He gave an average figure. We in the United Kingdom could expect 65,000 deaths, many of which would be among children. Rightly, that terrified the country and the media took it up. What was the source or basis for those figures, and the result? The result was that the number of people who died with swine flu was about 450. The number of people who died of swine flu was about 150. That compares with the 2,000 to 12,000 people—in one year it was 20,000—who die every year of seasonal flu. The swine flu outbreak was thus by any standards a minor event in Britain. Worldwide we were told to expect between 4 million and 7.5 million deaths. The total recorded was 18,000—a minute fraction of what had been expected.

In the context of the spending review, how do we prepare for another pandemic? What if we are given word by the World Health Organisation to prepare for another pandemic? Why did the WHO act as it did? It was for one reason—the definition of a pandemic changed between May and June last year. Scale 6 is the top pandemic; there is no six and a half, and no scale 7. The WHO told the press that there was a scale 6 pandemic; the press immediately went into hysteria mode and said that it was the same as the flu of 1918, and told us to prepare for tens of thousands of deaths. Until May 2009, the definition of a scale 6 pandemic was one that involved a tremendous number of deaths or serious illnesses. In June 2009 the definition was changed to take out that measure of severity and the point was made that it could involve mild flu. A pandemic would be a scale 6 pandemic depending on the geographical area in which the flu was detected. The alarming message came from Madame Chan, who was very much involved in the SARS outbreak in Hong Kong, and who expected something like SARS again. The world was expecting a flu epidemic, because we had one in 1957; there was a world flu epidemic in 1968, and another one in 1977. There was an expectation of a major flu epidemic, but we know the results now.

I want now to consider Tamiflu.

[Mr Roger Gale (in the Chair)]

Order. I am very sorry, but I must ask the hon. Gentleman to make at least a thinly veiled attempt to relate his remarks to the comprehensive spending review. We are not having a general debate about the health service.

[Paul Flynn]

As to the likely spending this year, if there is another threatened pandemic, how are we to fit it into the spending review, and future spending, since we are at present tied? Do we draw the lessons of what happened last year? If another epidemic comes along, will we react in the same panic-stricken way, or act as another country did? Perhaps we should consider the present spending review in the Polish Parliament. Ewa Kopacz, who has responsibility for health, was interviewed by GlaxoSmithKline, who told her, “We are not going to guarantee this vaccine, because we haven’t trialled it properly, and if there are any adverse reactions you, the Polish Government, will be responsible.” Ewa Kopacz said, “Well, if you don’t trust it, I don’t trust it.”

The Polish Government spent about 7 zlotys on the vaccine, compared with our £1.2 billion. The result was that they had half the number of deaths per million of population that we had. I want to point out that huge financial decisions were made in the swine flu pandemic, and we should have drawn the lesson from them, but we have not. We had a review, by one Department, which was a whitewash and was approved by the Government, and which said that the reaction was proportional. It was not proportional if we compare UK spending with the spending in Poland—which was virtually nothing—given the result that they had.

Tamiflu was approved by the Food and Drug Administration in America on the basis of its being a mass placebo medicine. In December 2009 the BMJ published an article alluding, in a reference along the lines of “Somebody stole my Tamiflu research paper” to the traditional excuse that students give for not doing homework. The authors had tried to find the research that said Tamiflu was some good, but it was not there. The BMJ could not find it. The FDA in America approved Tamiflu not because it found it was useful but because it had gone into the research and found that the drug was no better than a couple of aspirins. It had no perceived proved value; but the FDA approved it because it wanted to be able to prescribe something in the event of an epidemic. They wanted to show a man in a white coat, giving a pill. It would have an advantage as a placebo—but there is no advantage.

In spite of that, in this year’s spending review we shall almost certainly spend more money on Tamiflu and the vaccines that have not been properly trialled. I am not against vaccines, which are a huge and miraculous improvement in world health, and have saved thousands of millions of lives, but there are serious doubts about the fact that we spent our money last year, and might spend more next year, on a vaccine the side-effects of which are now becoming apparent in various countries—Japan, Finland and India.

I sense that you are going to call me to order, again, Mr Gale. My point is essentially how we order our finances in the spending review. With the changes in NICE, there will certainly be another increase in drug prices. The drug bill constantly increases, in real terms and as a proportion of the health budget. That has been going on for the past 20 years. It will happen again if we hand over power to the lobbyists and big pharmaceutical companies. We are seeing it now. It has been said that instead of a postcode lottery, we have a one-way escalator to higher prices. If we surrender further to hysteria about another world pandemic or to pressure from lobbyists to buy certain drugs to the detriment of other health services, the spending review will be inadequate. The Department will spend more money on drugs—some required, some totally unnecessary—and further impoverish the NHS, creating a decline in important life-saving services.

--- Later in debate ---

[Mr Burns]

I am not scared of anything. The purpose of my speech is to outline the Government’s view on the subject, rather than simply, as in an Adjournment debate, answering every single point from hon. Members who have contributed. I will not fall into the trap of being sidetracked into answering, as in an Adjournment debate, all the points that have been raised. I will certainly deal with those that I can deal with in the time available, but I shall primarily give the Government’s view on the topic before us, so I beg some indulgence from hon. Members as they listen and learn why we have kept our pledge.

I shall start again. This year, before we spend a single penny on health, education, defence or anything else, we shall have to pay £43 billion simply to service the interest on our debts. That is £120 million a day and more than £83,000 a minute. Those who are mathematicians will realise that during this three-hour debate that will have cost us £15 million. The colossal debt racked up by the previous Government is crippling the country. That is why, through my right hon. Friend the Chancellor, we have had to act decisively to lay the foundations for setting the economy back on track. The country simply could not continue to sustain such debt and payment of debt interest.

When the Chancellor stood at the Dispatch Box last month to deliver the spending review, he set a course for sustainable finances. He set out our plans to turn the country round, so that by the end of this Parliament our national debt will be falling, instead of rising, as a proportion of national income. To achieve that, over the next four years we need to reduce public spending by £81 billion. Difficult decisions have had to be taken, and more lie ahead, but the result will be a strong economy, more jobs and sustainable public services. As I have said, just as important as reducing the deficit is protecting and improving the nation’s health.

[Paul Flynn]

On a point of order, Mr Gale. There is a tradition in this place that Ministers making the winding-up speech reply to the debate. This Minister has been speaking for 14 minutes and has not mentioned a single point made in the debate.

[Mr Roger Gale (in the Chair)]

The hon. Gentleman has been in the House long enough to know that the Minister is responsible for his own speech and his own remarks.

NHS White Paper

Paul Flynn Excerpts

Monday 12th July 2010 Commons Chamber

[Mr Lansley]

Yes, and hon. Members will see in the White Paper the way in which we can strengthen the role of Monitor. It is not just about the authorisation processes for foundation trusts, but a continuing responsibility for the quality and standard of care being provided in all our trusts, NHS trusts or foundation trusts. It is important to focus on quality, on what constitutes quality and on ensuring sufficient incentives to support quality. In addition, I hope that some of the lessons that will be learnt from the inquiry being conducted by Robert Francis QC will inform how we can put a better system in place.

[Paul Flynn (Newport West) (Lab)]

How much will be created in additional bureaucracy and new costs by dumping on GPs tasks for which they are not trained?

[Mr Lansley]

The hon. Gentleman has not talked to GPs across England who are keen to take on this responsibility. In the process, we will reduce the costs of bureaucracy in the NHS by more than £1 billion a year.