Contaminated Blood and Blood Products

Peter Bottomley Excerpts

Thursday 24th November 2016 Commons Chamber

[Sir Peter Bottomley (Worthing West) (Con)]

I pay tribute to my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and to the hon. Member for Kingston upon Hull North (Diana Johnson). Without them, we would not have come as far as we have. With them, we have come a long way, although there is still more to do. I do not want to repeat what they have said, but what I will say is that the House of Commons Library has produced a very useful debate pack which I recommend to Members. The reference is CDP-2016-0227. I also commend the Tainted Blood website, whose timeline and chronology remind us that the first known case of a haemophiliac being infected with hepatitis C was discovered in 1961. We know that the development of blood products was designed to help haemophiliacs, but it actually harmed them.

I know a bit about this subject indirectly. On the day of the State Opening of Parliament in 1975, my wife received eight pints of blood, and went on to join us in the House of Commons. That was before Factor VIII had been spread around. The first member of my family knowingly to take an AIDS or HIV test was my mother. She had had a pancreatic operation and received a lot of blood, and later, when she heard what was going on, she said that she was going to get herself tested.

When I was a Northern Ireland Minister in 1989-90, I got in touch with the then director of the Haemophilia Society, because a friend of mine had been infected with HIV and AIDS after his haemophilia had been treated. I spent a long time doing the best I properly could, in my role as a Minister in a different Department, to give advice on how to try to bring the issues into the open. I pay tribute to my constituents and friends who are living with hepatitis C, HIV or AIDS and who have given me an insight into their circumstances.

I want to make a couple of points which will be obvious to those who think about them. First, is it not possible for something to be written in the medical notes of all the people who have been infected to prevent every hospital, clinician or care giver they encounter from going through questions such as “What is your drinking habit?” , “Why have you got this liver problem?”, and X and Y and Z? It seems to me that one of the first things to which people should be entitled is an understanding that their circumstances do not require them to tell strangers, several times a year, what has caused them to be in need of care and help.

Secondly, while I welcome the advances in dealing with hepatitis C, some specialist treatment requires people who live some distance from London to come to specialist hospitals here, and to arrive reasonably early. Travel and accommodation costs—including those of the person who is accompanying them, to whom they are married or who is caring for them—will need to be met. We need to find some way of ensuring that when members of this group in particular require specialist treatment, they are not put to abnormal difficulties in finding accommodation or paying for their needs. I think we can be more sympathetic than that.

Some of these people are very young, or were very young when they were infected. They are not people of my age, approaching their retirement years—not that I am hoping to retire soon. They may have felt lonely because they did not feel they could have an active social life. Some probably had no particular interest in pursuing higher education given the degree to which they could work and, as well as physical health issues, they probably needed other therapy. People should go out of their way to put arms around them—act not just like a two-armed human being, but like an octopus and get right around them and try to meet all their needs in a way that they find acceptable.

I wish colleagues in the Department of Health well. These are not easy issues to tackle. I know perfectly well that the Treasury has a job to do in trying to oversee every little change in departmental spending, but I hope the Prime Minister will do what her predecessor did, and, after a few months of letting the debate settle down, meet my right hon. Friend the Member for North East Bedfordshire, the hon. Member for Kingston upon Hull North and representatives of the Haemophilia Society and ask, “Are we getting it right? Is there more that we should do?” The Prime Minister is able to bring together the Department of Health, the Department for Work and Pensions and the Treasury and ask, “What more can we properly do to get rid of most of the problems?”

I have a question for my hon. Friend the Minister that I hope she will be able to answer today or in writing. Are the Government still giving help to the Haemophilia Society? The load on that society has been increased by this work. Its briefings and involvement have been important to Government and those affected, and to those of us trying to represent both. I hope that if the society is being put to extra costs, the Government will see if they can provide the funds they used to provide—I think they provided £100,000 for five years.

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[Chris Stephens (Glasgow South West) (SNP)]

It is a pleasure to take part in this debate and to follow my hon. Friend the Member for South Down (Ms Ritchie), who has consistently spoken with passion about this issue. I thank the hon. Member for Kingston upon Hull North (Diana Johnson) for securing the debate and for chairing the all-party group on haemophilia and contaminated blood.

I rise in this debate as a Scottish Member representing a Scottish constituency for two reasons. First, I want to speak on behalf of constituents such as Cathy Young, a stage 1 widow and member of the Scottish Infected Blood Forum. Like me, that group wants not only to express solidarity with those in other parts of the UK who find themselves in a different scheme, but to make the reasonable point that Scottish Members may find that they have constituents who are victims of infected blood and are covered by two different schemes, because the infection took place not in Scotland, but elsewhere in the UK. That is an important point. Members from other parts of the UK will find that they have constituents who are part of the Scottish scheme and benefit more as a result. Cathy wrote to me last night to say:

“I think for me personally, being a widow, obviously those still living with the horror of this disaster must be financially looked after, and not with payments that people feel that once again they’re just being fobbed off, but I would like both widows, and the deceased person’s estate, like children or parents of children who have passed away, to be recognised, and not with the insulting payment being offered. Our community deserve and demand the respect that has been denied us, and the justice that is long overdue. I send my total support to all those infected and affected by this disaster.”

Secondly, I want to raise issues relating to the proposed Scottish scheme that require this place to complete some work so that those infected in Scotland can receive their compensation. The Haemophilia Society points out that

“The Scottish scheme is comparatively more generous. The Scottish discretionary support scheme will also be better-administered, with patient involvement in governance; a goal to minimise means-testing and assessments; and a commitment to continue existing ongoing payments and ensure no beneficiary is worse off under the new support arrangements.”

According to analysis, the Department of Health could adopt many aspects of the Scottish scheme and still fall within the allocated budget. The all-party group calls on the Government to adopt those measures, particularly in relation to bereaved partners, and to reverse their plans for appointing a profit-making private administrator for the discretionary scheme. Any additional funds required to support those affected could be found, as the motion states, from the 2013 sale of the Government’s stake in Plasma Resources UK.

There are other differences between the schemes. Annual payments for those with HIV and advanced hepatitis C will be increased in Scotland from £15,000 to £27,000 to reflect average earnings. Those with both HIV and hepatitis C will have their annual payments increased from £30,000 to £37,000 to reflect their additional health needs. When a recipient dies, their spouse or civil partner will continue to receive 75% of their annual payment. Those infected with chronic hepatitis C will receive a £50,000 lump sum, which is an increase on the previous £20,000, meaning that there will be an additional £30,000 for those who have already received the lower payment. A new support and assistance grants scheme will be established in Scotland to administer and provide more flexible grants to cover additional needs. Scottish Government funding for the scheme will be increased from £300,000 a year to £1 million a year. As recommended, the Scottish Government will aim to deliver the new scheme through a single body so that those affected no longer need to apply to more than one body for funding.

However, the timing of the Scottish-wide payment system will depend on both Her Majesty’s Revenue and Customs and the Department of Health. Will the Minister outline what discussions the Department has had with HMRC about passing the relevant tax orders so that payments can be made to those entitled to compensation? They should be able to receive it with the minimum of fuss and should not be liable to tax. That has to happen whichever mechanism is used to make the new payments. To use the existing scheme to make the new payments, all four nations of the UK must agree, but only Scotland is signed up at the moment.

There are some important decisions to be taken before the Scottish scheme is established. They include changes to the threshold for receiving ongoing support, a re-examination of the ability of those with incomplete medical records to apply, an appeals procedure for those who think they should be in the Scottish scheme—that might apply to people resident in Scotland who were infected elsewhere, but want to apply to the Scottish scheme—a procedure for converting ongoing payments into a lump-sum settlement, and consideration of how the new discretionary scheme will operate in practice. The affected community will broadly welcome the replacement of the five trusts with a single scheme administrator, but the news that the new administrator of the proposed English scheme is likely to be a profit-making private company, which was not mentioned in the consultation documents, will be met with considerable concern. The tender process for a new scheme administrator started in September 2016. It was expected that the new administrator would take over in May 2017 following a transition period, but it appears that the deadline is now being pushed forward.

It is of grave concern to many hon. Members that Atos and Capita have attended Department of Health meetings to discuss bidding for the contract. It will be of utmost importance that the new supplier understands the complex needs of scheme beneficiaries and deals with all correspondence sympathetically. We all have concerns that if, as is likely, the successful bidder is a private company, it is not clear how the discretionary aspects of the scheme will be delivered. While the Department will own and publish a set of principles for discretionary support, as well as holding the budget, it will be up to the scheme administrator to consider applications for grants and other support. The Scottish scheme has the alternative option of a scheme administrator with more beneficiary involvement, and the original all-party group report recommended a similar thing. The Scottish discretionary support scheme will be better funded, as its funding is set to more than treble, while the English scheme will see a more modest 25% increase in 2018-19.

Before I conclude, I want to discuss some concerns relating to matters raised by the hon. Member for Worthing West (Sir Peter Bottomley) and health records. People who were infected during this disaster do not have the words “HIV” or “hepatitis C” on their death certificates, which is understandable due to the stigma attached to those conditions at the time. Will the Government or the scheme administrator consider that issue? There are people who were infected whose death certificates say something different, but their medical records will show that infection.

[Sir Peter Bottomley]

The hon. Gentleman makes a very good point. He might be about to put another question to the Minister, but in case he does not, I will. How will the Government try to get to the spouses of people who might have died 25 years ago? Those spouses might not know about this offer, because not everyone is involved in the networks.

[Chris Stephens]

That is very important. It is also up to us, as Members, to raise that issue with our constituents through newsletters and all the rest of it. The hon. Gentleman is right that there are people who lost their partners years ago and do not know about the scheme. I thank him for his intervention and I hope the Minister will consider that point.

There are clear points to address because we must ensure that the compensation is not subject to tax, as that would be ludicrous. We must also deal with the issue of the death certificates. Thank you, Mr Deputy Speaker, for allowing me to speak. I thank all hon. Members who have contributed to this first-class debate.

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[Diana Johnson]

I will try to be brief. I thank, and am grateful to, hon. Members from across the Chamber for their excellent contributions. I spoke for quite a long time at the beginning, but I missed out some very important points, including the fact that the new scheme will be in place only until the end of the spending review in 2021, and that is of concern to many people. I was also remiss not to welcome my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) to her new role. She is a good friend and this is the first time that I have been in a debate with her as the shadow Minister for public health.

I know that the issue under discussion is not part of the Minister’s policy area, but I was pleased that she offered some reassurance on particular areas, including that any budget underspend by the trusts and charities in the new scheme will stay in the Department of Health budget and not go to the Treasury. I hope that it will be used to help beneficiaries. Her comments about death certificates were also welcome.

I am still very worried, however, about the tendering process that the Government seem to be set on pursuing to decide the scheme’s new administrator. It would be absolutely wrong if the they chose a private sector provider to do that.

I welcome the stage 1 hepatitis C payments.

[Sir Peter Bottomley]

Does the hon. Lady agree that, whoever administers the scheme, if there are anomalies or cases that come outside the rules, they should be free to tell the Government that they should change them?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

May I interrupt? The winding-up speech is meant to be very brief. I do not mind, but there is a big debate to follow with a lot of speakers, and we are eating into that time.

Reducing Health Inequality

Peter Bottomley Excerpts

Thursday 24th November 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move,

That this House calls on the Government to introduce and support effective policy measures to reduce health inequality.

In her first speech at Downing Street, the Prime Minister referred to the “burning injustice” of the difference in life expectancy between the richest and poorest in our society, and to her determination to tackle it. The purpose of this debate is to try to assist the Government in making that a reality, but I also urge her to look at the gap in healthy life expectancy. Based on Office for National Statistics data from 2012-13, the healthy, disability-free life expectancy of a woman born in Tower Hamlets is 52.7 years of age, while that for a woman born in Richmond upon Thames is 72.1 years of age. That is a gap of about 20 years. The social gradient for disability-free life expectancy is even greater than that for mortality. I ask the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), to consider the issue not only as one of social justice, but as one that adds hugely to NHS costs and to economic costs more widely. There is a compelling economic and social justice case for tackling it.

What should the Minister do? In a nutshell, she should follow the evidence and start immediately, beginning with the very youngest in society—in fact, she should start with them even before they are born—and take a whole life course approach, following all the wider determinants of health. She should also take a cross-Government approach, with leadership at the highest level of the Cabinet. She needs to take the long view—many of the benefits will become evident in 20 or 30 years’ time—while not ignoring the fact that there will also be quick wins. She needs to look at everything that needs to be done to tackle the situation.

I hope that this will be a consensual debate. I congratulate the Labour Government on the work that they did to tackle health inequalities, which is starting to pay dividends. I also pay tribute to Sir Michael Marmot for his groundbreaking work; the blueprint that he set out in 2010 holds true today and it should be the basis of everything that we do. It is about giving every child the best possible start in life and allowing people of all ages to maximise their capabilities and exercise control over their lives. It is also about fair employment and good work, healthy environments and communities, standards of living and housing.

It is about preventing ill-health as well, and that is what I want to address, because I know that many Members across the House will speak with great expertise about the wider determinants of health. Tackling the issue starts long before people come into contact with health services, but that is still an enormously important part of tackling health inequalities. As Chair of the Health Committee, I will focus on those aspects.

On preventing early deaths, we need to look at lifestyle issues, including smoking and obesity, and at preventing suicide, which is the greatest single cause of death in men under the age of 49. Public health plays a critical role. The “Five Year Forward View” called for a radical upgrade in prevention in public health. Cuts to public health budgets are disappointing and will severely impact on the Government’s ability to tackle health inequalities. The Association of Directors of Public Health surveyed its members in February and found that the cuts to the public health budget were affecting issues such as weight management, drugs, smoking cessation and alcohol, which are key determinants that we need to tackle. In my own area, part of which covers Torbay, cuts of about £345,000 to council public health budgets will result in the decommissioning of healthy lifestyle services. Those budgets affect education and active intervention, and support a network of fantastic volunteers. I regret that those cuts to public health are going ahead, and call on the Government to stop them.

I want to tackle a few key areas. First, smoking is still the biggest cause of preventable death in the United Kingdom. Every year, 100,000 people die prematurely as a result of smoking. In her closing remarks, I hope that the Minister will update the House on the tobacco control plan.

[Sir Peter Bottomley (Worthing West) (Con)]

About 25 years ago I took an interest in how many death certificates mentioned smoking, and the answer was four. The figure may be larger now, but we should encourage medical practitioners to say that the person had been an active smoker, even if it was not the primary cause of death, so that at least people can become more aware of the issue.

While I am talking about this, I will mention two other things, which my hon. Friend may be going to cover. One is nutrition at the time of conception, and the second is that we should learn the lessons of how we cut the drink-driving deaths, which was not by public programmes, but by people doing the things that actually made a difference—that cut down the incidence and cut down the consequences and cut down the deaths.

[Dr Wollaston]

Those are extremely important points. The Government can introduce policies and make sure that there are levers and incentives in the system to make that happen. The drink-drive limit is a very important example.

We are not likely to make a difference to the gap in disability-free life expectancy without tackling smoking, which is a key driver for health inequality and accounts for more than half of the difference in premature deaths between the highest and the lowest socioeconomic groups. Without tackling it, we will not make inroads.

I would like briefly to touch on obesity and on the Government’s obesity strategy, which the Health Committee has looked at. To put the matter in context, the most recent child measurement programme data show us that 26% of the most disadvantaged children leave year 6 not just overweight but obese, as do 11.7% of the least deprived children. Overall, of all children leaving year 6, one in three is now obese or overweight. The situation is storing up catastrophic lifetime problems for them, and we cannot continue to ignore that.

In our report, the Committee called for “brave and bold action”. Although I really welcome many aspects of the childhood obesity plan—such as the sugary drinks levy, which is already having an impact in terms of reformulation—it has been widely acknowledged that there were glaring deficiencies and missed opportunities in the plan.

I would like to have seen far greater emphasis on tackling marketing and promotion. Some 40% of food and drink bought to consume at home is bought under deep discounting and promotion, and that is one of the potential quick wins that I referred to. We often focus in this debate on what people should not do, and this is an opportunity to look at what they should do. Shifting the balance in promotions to healthy food and drink would have been a huge opportunity for a quick win, because one of the key drivers of this aspect of health inequality is the affordability of good, nutritious food. This would have been an opportunity to tackle marketing and promotion, and I urge the Minister to bring that back into the strategy. I also urge the Government to extend the sugary drinks levy to other drinks, including those in which sugar is added to milky products, because there is no reason why it should be necessary to add sugar to such drinks.

I also welcome the mention in the plan of the daily mile, which has been an extraordinary project. I have met Elaine Wyllie, who is one of the most inspirational headteachers one could meet, and she talked about the strategy and about how leadership from directors of public health makes a real difference. I hope that the Minister will update the House on how that will be taken forward. We should think not just about obesity, but about physical activity and health promotion, and about the benefits that they could bring to all our schoolchildren.

The Health Committee stressed in our report the importance of making health a material consideration in planning matters when money is so restricted. I do not think that to do so would be a brake on growth; it would be a brake on unhealthy growth, and it would give local authorities the levers of power when they are making licensing decisions and planning decisions for their communities. That is something that Government could do at no cost, but with enormous benefit.

The Health Committee is actively considering how we reduce the toll of deaths from suicide. The Samaritans have identified that men living in the most deprived areas are 10 times more likely to end their life by suicide than are those in the most affluent areas. Many factors contribute to this—economic recessions, debt and unemployment—but when we try to tackle health inequality, we will not make the inroads that we need to make unless we look at the inequality in suicide, particularly as it affects men. Three quarters of those who die by suicide are men. I hope that the Minister will look carefully at the emerging evidence from our inquiry as the Government actively consider the refresh to the strategy, and that they will do so at every point when they look at how to tackle health inequality.

I would like the Minister to look at the impact of drugs and alcohol on health inequality. The fact that there are 700,000 children in the United Kingdom living with an alcohol-dependent parent is a staggering cause of health inequality, which has huge implications for those children’s life chances and for the individuals involved. Again, alcohol has a deprivation gradient; the two are closely linked.

There is evidence about what works, and we have had encouraging news from Scotland. The Scottish courts, I am pleased to say, have ruled that minimum pricing is legal, although I am disappointed that the Scotch Whisky Association has yet again taken the matter to a further stage of appeal. As soon as those hurdles are cleared, I think it would be a great shame if England undermined the potentially groundbreaking work being done in Scotland by failing to follow suit and introduce minimum pricing at the earliest possible opportunity; if we failed to do so, people would be able to buy alcohol across the border.

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[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

I rise to express my enthusiastic support for the work of the Health Committee under the superb leadership of the hon. Member for Totnes (Dr Wollaston). I also pay tribute to the Prime Minister for her description of health inequalities as a “burning injustice” and for placing the issue at the top of her agenda, which was virtually the first thing she did as Prime Minister of this country.

This is an unusual debate. Usually in this Chamber, Back Benchers press the Government to take something on as a priority, but this is more of a top-down issue. The need to tackle health inequalities has been forcefully expressed by the Prime Minister, and through this debate we are trying to translate those words into effective action. For those of us who have grappled with the nuts and bolts of trying to tackle the obscenity—that is what it is in the 21st century—of health inequality, the Prime Minister’s words were, as the hon. Lady said, enormously encouraging, because they demonstrated the leadership that the issue requires if the awful statistics are to be properly addressed.

I want to set the matter in its historical context to demonstrate the difference in approach that spans the 37 years between the appointments of Britain’s first woman Prime Minister and its second. Although health and life expectancy improved dramatically for everyone following the creation of the NHS in 1948, there was a strong suspicion by the 1970s that persistent health inequalities existed and that they were defined largely by social class. There was, however, an absence of easily understood statistical evidence on which to base a clear assertion. In 1977, the then Health Secretary, David Ennals, commissioned the president of the Royal College of Physicians, Sir Douglas Black, to chair a working group that would report to Government on the extent of health inequalities in the UK and how best to address them. The report proved conclusively that death rates for many diseases were higher among those in the lower social classes. Stripped bare, it was the first official acknowledgment that the circumstances into which a person was born would largely determine when they died. That remains the thrust of the argument expressed by the Health Committee’s report, except that it has quite rightly added the new dimension, which was highlighted by the Marmot indicators of health inequalities in November 2015, of the difference made by the number of years spent in good health. There is an extraordinary gap between the most and the least disadvantaged of almost 17 years.

By the time the Black report was published, a new Government had been elected. They displayed their enthusiasm for tackling health inequalities by reluctantly publishing fewer than 300 copies of the report on an August bank holiday Monday in the depths of the summer recess. In his foreword to the report, the new Health Secretary could not even raise the enthusiasm to damn the report with faint praise; he simply damned it and virtually ignored it, and that remained the case for 18 years.

This is important because people assume that health has improved for everyone since the 1940s—it has, by and large—yet during those 18 years, many of the problems that Black highlighted actually got worse. For instance, in the early 1970s, the mortality rate among young men of working age in unskilled groups was almost twice as high as that among those in professional groups; by the early 1990s, it was three times as high. The most awful statistic—this began to emerge in the 1980s—was that the long-term unemployed were 35 times more likely to commit suicide than people in work. It would be inconceivable today for a Health Secretary to be as dismissive of an issue that is so critical to the life chances of so many.

We are also more aware today than we were then that healthcare is only part of the problem. Indeed—the Minister has a difficult job—it is a minor part: the proportion has been calculated at between 15% and 25%. The epidemiologist Professor Sir Michael Marmot, the world’s leading expert on this subject, has established the social determinants of health. The Acheson report of the late 1990s explained:

“Poverty, low wages and occupational stress, unemployment, poor housing, environmental pollution, poor education, limited access to transport and shops”—

and the internet—

“crime and disorder, a lack of recreational facilities…all have an impact on people’s health.”

Beveridge’s five giants—disease, want, ignorance, squalor and idleness—were a more pithy and poetic way of describing the problem. Beveridge’s brother-in-law, the historian and Christian socialist R. H. Tawney, set the template that we should follow. He said the issue was

“not…to cherish the romantic illusion that men are equal in character and intelligence. It is to hold that…eliminating such inequalities as have their source, not in individual differences, but in its own organization”.

The Marmot report, which I commissioned as Health Secretary in 2008 to inform policy from 2010 onwards—unfortunately, the electorate decided that we would not be in office to carry this out—recommended six policy areas on which we should focus: the best start in life; maximising capabilities and control; fair employment and good work; a healthy standard of living; healthy and sustainable places and communities; and a strengthened role for and provision of ill-health prevention. Marmot advised that those six areas should be focused on with a scale and intensity proportionate to the level of disadvantage, which he called “proportionate universalism”. The coalition Government accepted all Sir Michael’s recommendations. However, they responded with a policy— “Healthy Lives, Healthy People”—in which the focus was on individual lifestyle and behavioural change. That, as Sir Michael has pointed out, is only one facet of the problem, just as the NHS is only one part of the solution. Moreover, the only piece of cross-Government co-ordinating machinery, the Cabinet Sub-Committee on health, was scrapped in 2012.

The Health Committee’s report on public health and today’s debate, together with the Prime Minister’s pledge, give us a fresh opportunity to capitalise on the brilliant work done by Sir Michael Marmot and his Institute of Health Equity at University College London, and on the political consensus that I am pleased to say now exists on this issue, by forging a fresh and dynamic response across the Government to tackling health inequalities. One of the Committee’s recommendations, as has been mentioned, is that a Cabinet Office Minister should be given specific responsibility for leading on this issue across the Government. I have a more radical suggestion: the Prime Minister herself should take personal responsibility for this issue. The Prime Minister is also the First Lord of the Treasury and Minister for the Civil Service, and previous Prime Ministers have taken on other ministerial positions—Wellington was also Foreign Secretary, Home Secretary and Colonial Secretary, and Churchill was Prime Minister and Defence Secretary. It would set a wonderful example if the Prime Minister followed up her words by saying, “I’m going to lead on this. I’m going to chair the cross-Government Committee that tackles health inequalities.” That level of leadership is needed, because only then will there be meaningful cross-departmental work to tackle these inequalities.

I echo the Health Committee’s view that devolving public health to local authorities was the right thing to do. Not everything in the Health and Social Care Act 2012 was approved by Opposition Members or many other people, but that change was the right thing to do. The cuts in authorities’ budgets—£200 million of in-year cuts—must be restored and I suggest that the ring fence is extended at least to the end of this Parliament. With local government having so many problems, I fear that breaking the ring fence for public health will mean that the money goes elsewhere and is not focused on these issues.

As I have said, only a minority of health inequality issues involve the Department of Health, but I want to highlight one that quite certainly does. The biggest cause of the hospitalisation of children between the ages of five and 14 is dental caries: 33,124 children went into hospital to be anaesthetised and have their teeth extracted in the past year. Incidentally, that is 11,000 more than for the second biggest cause of the hospitalisation of children, which is abdominal and pelvic pain. Believe it or not, it was the 12th highest cause of hospitalisation of tiny children below the age of four.

This is a health equality issue. Almost all the children who went into hospital were from deprived communities, including 700 from the city I represent. There is a safe and proven way dramatically to reduce tooth decay in children, and it also has a beneficial effect on adults. It involves ensuring the fluoridation of water up to the optimum level of 1 part per million. The cost of fluoridation is small. For every £1 spent there is a return to the taxpayer of £12 after five years and of £22 after 10 years. The evidence—from the west midlands and the north-east, and from countries across the world—has now existed for many years. A five-year-old child in Hull has 87.4% more tooth extractions than one living in fluoridated Walsall. The whole medical profession, the dental profession, the British Medical Association and the Department of Health have recognised that for many years.

In Hull, we intend to fluoridate our water as part of a concerted policy to tackle this element of health inequality. We need the Department of Health to show moral leadership by encouraging local authorities in deprived areas to pursue fluoridation, and supporting them when they do. The Health Secretary retains ultimate responsibility for public health, including ill-health prevention. This is one issue on which he can begin the process of reducing hospital admissions by encouraging preventive action and, in terms of health inequalities, giving poor kids prosperous kids’ teeth.

[Sir Peter Bottomley]

I completely agree with the right hon. Gentleman. Has he or anyone else solved the problem of how to protect water supply companies and businesses so that they do not find themselves facing unjustified claims or difficulties?

[Alan Johnson]

I had actually finished my speech, but I will answer the hon. Gentleman’s intervention as my conclusion. I have talked to Yorkshire Water, and my understanding is that putting the focus on local authorities changes the whole dynamic of how the various conspiracy theorists can attack on this issue.

Junior Doctors: Industrial Action

Peter Bottomley Excerpts

Monday 5th September 2016 Commons Chamber

[Mr Speaker]

Order. For clarification, I must emphasise that there is no concept of giving way in respect of a statement. Although this might resemble a debate to those who are attending our proceedings from beyond the confines of the Chamber, it is a statement with a response. There are no interventions.

[Sir Peter Bottomley (Worthing West) (Con)]

She is new to her job.

[Mr Speaker]

We are always grateful to the hon. Member for Worthing West (Sir Peter Bottomley) for whatever counsel he might wish to proffer, even if it is done from a sedentary position.

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[Mr Hunt]

I thank the hon. Lady for what she did alongside many colleagues working in A&E departments over many years, but to call this an imposition is a mischaracterisation given what actually happened. The contract was not only agreed, but recommended and supported by the leaders of the BMA. Before she was elected, we had many discussions in the House about whether negotiations were possible and what I should do, and there were a range of different views. In the end, I listened—just as she has asked me to today—and sat down and negotiated a deal that was supported by the BMA’s leaders. That is why it is so incomprehensible that those same leaders—the people who represent her and her profession—have now called the most extreme strike in NHS history.

[Sir Peter Bottomley (Worthing West) (Con)]

I put it to my right hon. Friend that the choice for junior doctors or doctors in training is whether they have the old contract or the agreed contract. I have not yet had a letter from any of my doctors saying that they think the old contract is better for them, for the health service or for patients. May I therefore recommend that they sign up willingly to the new contract, that they start discussions with the BMA, and through the royal colleges, on what should happen in a few years’ time when the contract itself comes up for review and that they work to improve the non-contractual situation, which my right hon. Friend has provided a good lead on?

[Mr Hunt]

My hon. Friend is absolutely right on that. In May, the BMA leadership, with whom we were having a very open discussion, had satisfied themselves that on the concerns many junior doctors have about their working conditions, many of which I accept are wholly legitimate, we had done pretty much everything we could inside a contract and the work that needed to be done was on the extra-contractual things. I am talking about the way the training system works when people are being rotated to a different hospital every six months, the fact that some people were being sent to a different city from their partner and how bad that was for family life, and all sorts of other things that need to be sorted out. Ironically, since the introduction of the working time directive, things have got a lot worse for many people, although we do not want to go back to the excessive hours of before. Those were the things we were patiently working through, and the way that is done is through dialogue, not confrontation, which is why this action is such a step backwards.

Junior Doctors Contract

Peter Bottomley Excerpts

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

Actually, in my statement I took the trouble to praise BMA leaders. Admittedly, at the outset I did not agree with their tactics at all, but they did then have the courage to negotiate a deal and try really hard to get their members to accept it. I respect them for doing that. Part of the problem was that in the early stages of the dispute, there was a lot of misinformation going around. There were a lot of doctors who thought, for example, that their salary was going to be cut by about a third. That was never on the table and never the Government’s intention. A lot of doctors thought that they were going to be asked to work longer hours. That, too, was the opposite of what we wanted to do. I am afraid that that created a very bitter atmosphere. I simply say that, in the end, the best way to restore morale is to support doctors in giving better care to their patients, and that is what the NHS transformation plan is all about and what we are working on.

[Sir Peter Bottomley (Worthing West) (Con)]

Around 10 years ago the mishandled introduction of MMC—modernising medical careers—and the medical training application service started some of the problems for junior doctors. I pay tribute to the BMA who, in the discussions up to May, helped to agree with NHS England employers changes to the proposed contract, which were to the benefit of doctors in training? I say to the Secretary of State and, through him, to the employers that I hope they will pay attention to the extra-contractual issues which are of concern to doctors, and that the BMA will catch up with the rest of us in saying that we rely on them and others in hospitals to give a good, safe service to patients. They need to work together with everybody else and we will support them in doing that.

[Mr Hunt]

I am absolutely prepared to give that assurance and I thank my hon. Friend for his comments. He is right. We can look at MTAS and such changes. We can go even further back and look at the introduction of the European working time directive—strange to bring that up in the current context—and the shift system, which sensibly reduced some of the crazy hours that junior doctors were being asked to work, but unfortunately at the same time got rid of the “old firm” system which gave junior doctors a sense of collegiality, meant that there was a consultant whom they knew and related to, and made their training a lot more rewarding and satisfying. That was disrupted when we introduced the shift system and the maximum hours limits. We need to think about—and we are doing some very important work on this—how we could recreate some of that sense of collegiality, which is particularly missing for junior doctors in the first two years of their training, before they have joined a specialty.

Land Registry

Peter Bottomley Excerpts

Thursday 30th June 2016 Commons Chamber

[Mr Lammy]

My hon. Friend is absolutely right. There is deep concern about a hike in fees and a profit motive distorting a public institution that we all value. I hope that the Minister will take that on board and give the House some comfort on that in the coming hours. I give way to the right hon. Gentleman.

[Sir Peter Bottomley (Worthing West) (Con)]

My wife is right hon., not me.

Were I not going to a Somme service in my constituency, I would try to take part at length in this debate. Is not the issue this? Whatever safeguards the Government want to build, commercialisation should be the Land Registry’s decision, not the decision of some commercial owner of the Land Registry. The issue is, therefore: can Government understand—I know that my hon. Friend the Member for Brighton, Kemptown (Simon Kirby), who is on the Front Bench, understands because I have written to him about it, as my Whip—that many of us here want the Land Registry to have the opportunity of creating innovative, value-creating enterprises? It should not be sold off for that to happen—it is not necessary.

[Mr Lammy]

The hon. Gentleman is demonstrating why he should be a Privy Counsellor and why he has been knighted. The Government should accept the cogent case being made by esteemed Members on the Government Benches. We are aware that there is a general sense that the Government are itching to privatise the Land Registry. Unlike with the 2014 consultation, this time around the status quo is not even being offered as an option. The wording of the consultation document is focused on how, not if, the Land Registry operation should be moved to the private sector. We know that the Government have commissioned bankers at Rothschild to size it up. We also know that potential buyers are linked to offshore tax havens. I am here today, alongside colleagues across the House, to make our opposition known and to call on the Government to think again.

Carers

Peter Bottomley Excerpts

Thursday 9th June 2016 Commons Chamber

[Mims Davies]

I absolutely agree with my hon. Friend. I shall go on to discuss the importance of young carers in a moment. More than 700,000 of the 6 million carers in this country are young carers who are taking on at a tender age all the burdens that I have described. This has an impact on their education and their opportunities. Our schools should show understanding and foster an environment in which young people can be carers. They should forge an appreciation of caring in our ageing society. Three in every four carers do not feel that their caring role is understood or valued by their community. It is incredible that we have so much more progress to make before we can live in a truly carer-friendly Britain. I believe that we are now at the start.

As I have said, more than 6 million people in England provide unpaid care, with 1.3 million providing more than 50 hours a week. In my constituency, there are more than 10,000 unpaid carers. We have an army of carers quietly working away looking after their loved ones across this country, and they do it for humane reasons. We do not do enough to support and recognise them. Locally, the loss of respite has been a great cause for concern. Respite offers carers freedom and time to regroup, and a lack of it can be a great concern. Alternatively, the wrong type of respite might be offered or it might be poorly managed. I have heard about such experiences in my constituency surgery feedback.

I thank the volunteers in my constituency who support our carers. The One Community brings together many groups to support each other, including the Age Concern centre, Dementia Friends, the Alzheimer’s group and all the people who help carers by driving their loved ones to hospital or to the GP.

I also want to say thank you to everyone in my constituency who runs a lunch club or a social club, all of which provide important opportunities for social contact.

A recent Carers UK report highlighted the fact that many carers are struggling. Most of us will have to care for someone at some point in our lives, and we want to be able to do that. Three in every five people become a carer at some point. Members of this House and of the other place, and our staff, are carers too.

In leading this debate, I should declare an interest. I was a carer, although I did not realise it. I was a hidden carer. We are nothing if we do not bring our own experiences to bear in our work in the House. I was a “sandwich carer”—that is, someone with small children and older, ill parents. We became so friendly with the local ambulance service that we were on first name terms, and I thank them all for the kindness they showed me and my family. My dad was affected by an incident at work and was cared for by my mother for more than 25 years. That had a massive financial impact on me as I grew up and on our family. And when dad was gone, guess what, mum needed looking after too, because when you are looking after someone you often forget to look after yourself. People can go downhill quite quickly in those circumstances.

I found myself muddling along looking after small children, going to GP surgeries and getting mum up to London, where we struggled on the escalators and on the tube to get to vital hospital appointments. I did not realise that that was an ongoing role for me. I gave up my job and threw myself into it. I remember the phone calls. One came when I was about to go on air at a radio station just before 6 o’clock in the morning. Dad was unresponsive. There had been a problem with his insulin. Luckily, mum was awake because she was going to care for my children, covering for me while I was at work. She was caring for me, I was caring for her, and we were all caring for dad. When the phone rang, I had to drop everything and get there. For me, that was a snapshot of what people are doing day in, day out, and year in, year out. There is no break. If someone is lucky to get one, that is great, but it is still your watch even when they are not with you—are they in the right place?

A particular story that comes to mind was when my dad developed glaucoma as a result of the diabetes that was brought on by the head injury. He was given respite, but at that point he had not told people that he was losing his sight. He was in a respite centre and got lost going to the loo in the middle of the night. He got in the wrong lift and was wandering around a strange place. He was over 70, frightened and concerned though he was meant to be in a safe place. That story meant that no further respite was taken, meaning no further breaks.

I want to move on from my experiences, but please remember that all of us will be doing this. There are people in the House who do it already. I hope that we can recognise and understand the issue.

[Sir Peter Bottomley (Worthing West) (Con)]

Will my hon. Friend allow me to add that each of our offices has caseworkers to whom we should pay tribute for their dedication in trying to help carers and others? That is only one part of carers week, but it is one that should always be remembered. We are grateful to them.

[Mims Davies]

I absolutely agree with my hon. Friend. My caseworkers have been into the community, meeting constituents who are unable to come to surgeries or drop-ins. They have been to refuges to see women with difficult disability issues. They are prepared for anything and we would be nowhere without them.

Today’s debate will allow us to realise that caring will only increase in importance. With an ageing population and advances in medical science, we are seeing a steady increase in those who need care and those who are willing and able to provide it. Since 2001, the carer population has grown by a staggering 16.5%. There is a strong economic case for doing more for our carers. The economic value of the contribution made by 6 million carers is £132 billion a year, which is nearly equal to the UK’s total health spend.

As the number of young carers grows to over 700,000, perhaps we need a national day to recognise them and to highlight and support what they do. They look after family members who are physically ill, mentally ill, disabled or perhaps even misusing substances. These young children miss out on many normal childhood experiences that they should be taking part in. Young carers can sometimes be isolated and bullied owing to the pressures they face at home.

Junior Doctors Contracts

Peter Bottomley Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

What is devastating to the morale of junior doctors is when they are represented by an organisation that constantly feeds them misinformation about the contents of the new contract. First, the BMA told them that it was going to mean that their pay was cut. Then it told them that they were going to be asked to work longer hours. In fact, the reverse is true on both those things. The way that we raise morale among the very important junior doctor workforce is by the BMA saying that it is prepared to take a constructive approach to sensible negotiations, not refuse to budge, as we saw in February.

[Sir Peter Bottomley (Worthing West) (Con)]

It is important to be both rational and reasonable. It is reasonable for registrars to be earning, on average, £53,000 a year and, when fully established, more than £100,000. It is rational for junior doctors’ leaders to accept that rostering should be a matter of discussion, as there is a right and a wrong level. The remaining issue is some of the premium pay for Saturdays. It seems that it would be a good idea if those behind the BMA negotiators came out into the open and explained in detail to my patients and the patients of the 649 other MPs, or the MPs in England anyway, what the issue is that is stopping it calling off the strikes, getting people back to talks and making agreements.

[Mr Hunt]

As ever, my hon. Friend is absolutely right. When I have spoken to junior doctors who are protesting, they have not wanted to bring up issues in the new contract, as much of it is very good for them. I am talking about the fact that they cannot be asked to work six consecutive nights, which they can be at the moment; the fact that they cannot be asked to work more than six long days in a row, which they can be currently; and the fact that the maximum hours that they can be asked to work is going down from 91 to 72. There are many things that are good in this new contract, which is why the sensible and rational thing for them to do is to sit down and discuss it with the Government and not to set their face against it at any cost.

Junior Doctors Contracts

Peter Bottomley Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

We do face many challenges; the right hon. Gentleman is absolutely right to say that we need to focus on those, and so the sooner we resolve this dispute with the BMA, the better. I simply say to him that if we were to carry on negotiations that were clearly not going anywhere at all, this dispute would go on for even longer. We have been trying to resolve these issues for a very, very long time, and in the end one has to decide if one is going to do what it takes to move forward.

[Sir Peter Bottomley (Worthing West) (Con)]

Mr Speaker, if every one of the 650 MPs came to you and said that one of their constituents was dying unnecessarily every five weeks—that is the lower estimated number of excess deaths; it would be once every two weeks at the higher estimated number—I would hope that you would grant this kind of debate every day until we had a system that was safer for patients and junior doctors, and until we brought into the open the nameless characters behind the BMA negotiators. They refuse to come out into the open and argue their case on its merits, and to say why they will not discuss Saturday pay.

[Mr Hunt]

My hon. Friend is absolutely right. Part of the hallmark of this Government’s approach to the NHS has to be honesty about where we have too many avoidable deaths, and where there is the weekend effect for people admitted to hospital at the weekends. We have a big responsibility in that regard. The reason why we discharge that responsibility is that we believe in the NHS. We want the NHS to be the safest, highest-quality system in the world. Just as this Government have pioneered reforms that have dramatically improved the quality of state education, so too we need equal reforms in the NHS. That is why it is absolutely right to say that we have to focus on these things and debate them in this House. We should not automatically say that there is someone who must be blamed when we are dealing with these difficult situations. Unfortunately, one of the things that has led to feelings running high in this dispute has been the sense of blame being tossed around, when what the Government want to do is try to solve the problem.

Contaminated Blood

Peter Bottomley Excerpts

Tuesday 12th April 2016 Commons Chamber

[Dr Monaghan]

I would absolutely support that suggestion. I would also note that many victims in England now face cuts of up to £7,000 a year, together with cumulative losses from the freezing of six annual payments to patients of £15,000 a year, time-limited support for partners and spouses after patients’ deaths, and the ending of help for the children and parents of those affected. Moreover, victims will no longer have access to grants for support with such things as mobility issues and modifications to property; nor will they have access to free expert advice.

The Haemophilia Society, which campaigns on behalf of victims of this scandal, has said that it has deep concerns about the proposals for England. It compared the proposals for England to those in Scotland, saying:

“These concerns are compounded by the fact that similar proposals in Scotland offer more generous payments to its affected community. There is a risk that, if both sets of proposals are accepted (as they currently stand), affected people in England will receive much lower incomes that those in Scotland.”

The Scottish Government have already provided £32 million over the last 10 years to the current UK-wide schemes, so they are already committed to support those infected in Scotland. Nevertheless, on 18 March this year, the Scottish Government announced a substantial package of increased financial support for those affected by infected NHS blood and blood products in Scotland, amounting to an additional £20 million over the next three years alone. The new Scottish scheme will see annual payments for those with HIV and advanced hep C nearly double from £15,000 to £27,000 a year, and those affected with both HIV and hep C will have their annual payments increase from £30,000 to £37,000.

[Sir Peter Bottomley (Worthing West) (Con)]

This is a pure inquiry. Would it have been open to the Scottish authorities to say that the increased levels of compensation would be available to all those affected within Scotland rather than on the basis of where people had acquired the infection?

[Dr Monaghan]

I do not think that would be possible because it would be an admission of liability, and these are ex gratia schemes with no liability in response to the payment.

In addition to the measures I have explained so far, a new support and assistance grant scheme will be established in Scotland to administer and provide more flexible grants to cover additional needs. Scottish Government funding for this scheme will increase from £300,000 to £1 million a year. In real terms, the new arrangements will mean additional financial support is available for all categories of infected people and their dependants in Scotland. In Scotland, we are clear that this is not the end of the process and that there will be ongoing work with patient groups on this matter.

In overwhelming contrast to the Scottish Government, the UK Government are proposing to cut funding for victims of this scandal, leaving vulnerable people thousands of pounds a year worse off. It is extremely disappointing that the UK Government do not think it important to support those who were infected in England, and it is clear that the proposed cuts demonstrate that the UK Government’s priorities lie with austerity, not with the victims of this terrible scandal. It is time for the UK Government to support those whose lives have been ruined by this unprecedented scandal. For people such as Julie, anything less literally heaps insult on injury.

--- Later in debate ---

[Sir Peter Bottomley (Worthing West) (Con)]

It was 1958 when Dr Garrott Allen at Stanford started discovering the risks of contamination in blood. Over the next 20 to 30 years, he spent his time trying to persuade people that commercial blood companies probably knew early on—they certainly knew later on—that one in seven of those from whom they were taking donations was at high risk of contamination. It was not until 1991 that Crown immunity was lifted from the blood products laboratory. If people look at the taintedblood.info website, they will see the chronology, which is pretty accurate and very useful.

That does not solve the problem faced by the Government, Members of Parliament and those affected. I propose that, while the national health service should be treating people, responsibility for dealing with the compensation and trying to make up for the costs to those affected should be taken away from the Department of Health and held jointly by the Cabinet Office and the Treasury. I think that that is the only way of solving the problem of Scotland having to determine where those affected got the infection, rather than their actual situation and where they live. If we are going to have a national approach that not only recognises the autonomy of the Scottish Parliament and the Scottish health service but treats people fairly, we have to find a way of getting the non-health aspects away from the Department of Health. I ask the Government to consider whether there is any way of doing that effectively.

Moving on to how people should be treated, I have received a message from someone on behalf of the nearly 200 co-infected people and the 2,220 mono-infected hep C stage 1 victims. Here are some words directly:

“Now about the way they are blackmailing us over the drugs!

I and every other Haemophiliac have never paid for our Factor VIII, I have never paid for any of my HIV anti viral drugs, and my other prescription charges are covered by a pre payment certificate, my blood tests, ultrasounds scan, Fibroscans, and all my appointments are covered by the NHS? So why would they even consider asking us if we think the money should come out of the additional £100 Million they have offered as financial help?”

The answer to that is that it should not. By the way, to those for whom the proposals on which the Government are consulting would lead to a reduction in income, the Government certainly should say that they need to be red-circled—that their money will remain the way it is—and no one should have their money reduced as a result of the changes. We are trying to extend help to people, not to reduce it.

I turn to another quote:

“Co-infected Haemophiliacs need a voice in the debate, we are so few left, dealing with two virus as you know has increased complications. We need to be respected and remembered as are the Scottish Haemophiliacs in the midst of all the mono Hep C victims.

Being co-infected with HIV/AIDS and Hepatitis C is the equivalent of 2nd stage Hepatitis C, but at the top end where someone has received a liver transplant, has a limited life expectancy and has to take medication every day for the rest of their lives or die, but the co-infected also has the additional problems of having the illnesses both these viruses can cause—even to the point doctors cannot tell which virus is causing the problem. On top of this we have the life-long secrecy and stigma attached to HIV/AIDS virus.”

It seems to me that we have got to say to Government that they may be trying more now than Governments have tried before, but it is not appropriate for Department of Health Ministers to have to balance this against other treatments. It must come out of the Department of Health so that the money can go properly to those who have suffered because we made mistakes and the American blood companies made mistakes. We need to recognise that. I am not talking about liability; I am trying to deal with what should happen now.

As it happens, the first person in my family to take an AIDS test was my mother, who had a serious operation and received lots of blood. The second was my wife, who received eight units of blood in 1975 when the issue started to come out. I have my blood tested for HIV/AIDS and hep every 10 weeks as a blood donor. I only wish that we had remembered what Richard Titmuss said in his book about giving blood, “The Gift Relationship”. We do it for free, and we do not know who is going to benefit. The people who benefit do not know where the blood comes from, but at least it comes from people who have been tested to make sure that it is safe for our blood to be passed on.

Points of Order

Peter Bottomley Excerpts

Tuesday 12th April 2016 Commons Chamber

[Mr Peter Bone (Wellingborough) (Con)]

On a point of order, Mr Speaker. We have just had questions to the Secretary of State for Foreign and Commonwealth Affairs. We had an excellent team of Ministers here, but we did not have the Secretary of State. The Minister for Europe made the point that the Secretary of State was on the last leg of an overseas visit. I thought it was a convention of this House that Parliament came first and that Secretaries of State should be here for questions unless an emergency took them away from the House—clearly this trip was planned. Will you give guidance to the House on whether Secretaries of State should be on overseas trips when questions to their Department are scheduled?

[Sir Peter Bottomley (Worthing West) (Con)]

Further to that point of order, Mr Speaker. Things may have changed since I was paying attention to this—it is 25 years since I was a Minister—but in my day, a Minister for the Government spoke with the same authority no matter what rank of Minister they were.

[Mr Speaker]

Certainly the team communicate with the House as a team. That is undeniable. This is not within the power of the Chair. The Secretary of State did courteously write to me to notify me that he would be absent. My sense is that he is not likely to be absent on anything like a regular basis. If that were to happen, it would be strongly deprecated not just by the Chair but by Members across the House. Let us hope it does not happen again. If there are no further points of order, perhaps we can move on to the ten-minute rule motion.