Blood Cancers

Peter Dowd Excerpts

Thursday 7th July 2016 Westminster Hall

[Jim Shannon]

It is always a pleasure to have the hon. Gentleman come along to a debate in support. He always does so, and his valuable contributions are always appreciated by us all. I wholeheartedly agree with him.

The way the system fails blood cancer patients can be illustrated via the case of ponatinib, a drug designed to treat chronic myeloid leukaemia patients who are resistant to or intolerant of other treatments. I will elaborate on this point later, for it is very important. I think that the hon. Gentleman has grasped that it is a vital issue as well. The drug is fully available to all CML patients in Scotland and Wales, but in the remainder of the United Kingdom it is provided on the NHS only to a small subset of patients who can benefit from it after NICE refused to appraise it because of the small patient population. One of the questions that we would like answered in this debate if possible—I am not sure whether the Minister is the right person to answer it, but I know that if he is not, he will certainly direct it to the right Department—is how we ensure that there is not a postcode lottery when it comes to the allocation and availability of cancer drugs.

[Peter Dowd (Bootle) (Lab)]

I thank the hon. Gentleman for securing the debate. Does he agree that parents—in my case, the parents of nine-year-old Charlie Fearns—are confused, distressed and dismayed that they are not provided with the medical intervention that they need to treat their child’s illness? Charlie needs chimeric antigen receptor T-cell therapy, but Mr and Mrs Fearns are having to find as much as £150,000-plus to fund the therapy themselves. Does the hon. Gentleman agree with me that that extra burden, in their circumstances, is far too onerous?

[Jim Shannon]

I thank the hon. Gentleman for his intervention and for that personal story. I think that that situation is a disgrace. Any of us in the House would wholeheartedly agree with him. There has to be a system that enables all the people of the United Kingdom of Great Britain and Northern Ireland to partake of, use and access these drugs. The example he gives shows just where the current system falls short. This debate gives us an opportunity to highlight that and to seek the solutions that he and his constituents want.

The situation with ponatinib has resulted in the equivalent of a postcode lottery in patient access across the UK, with some patients having to move to Scotland or Wales to undergo treatment. Why should they have to move? It is not fair that they should. It seems grossly unfair that they should have to either move or travel to the hospital. For these patients, the drug could be an alternative treatment to a stem cell transplant, and a last chance of survival.

The systems of appraisal used to assess blood cancer medicines need to be able to take into account the small patient numbers and the issues that that raises about the amount and maturity of data available, to ensure that all patients who need access to medicines do not miss out because of where they live.

Chronic lymphocytic leukaemia is the most common type of leukaemia, a cancer of the white blood cells. In leukaemia stem cells start to overproduce white blood cells that are not fully developed; in CLL, these are called lymphocytes. Figures from Macmillan and NICE estimate that some 2,700 to 3,200 people in the UK are diagnosed with CLL each year, with most cases occurring in people over 60 and very few in people under 40. Around two thirds of the diagnoses are made by chance through a routine blood test with doctors; people do not know they have it and all of a sudden they find out they do. The other third of diagnoses are made following visits to the doctor for CLL-related symptoms: enlargement of the lymph nodes, liver or spleen, anaemia, bruising or fever, drenching night sweats and/or weight loss of greater than 10%. Someone with any of those symptoms should see their doctor, and do so soon.

CLL is more prevalent in men, with recent studies showing that some of the risk of developing it is inherited from parents. One in 20 CLL patients has a relative with CLL or a very similar condition; however, CLL can and does affect anyone.

Meningitis B Vaccine

Peter Dowd Excerpts

Monday 25th April 2016 Westminster Hall

[Mark Durkan (Foyle) (SDLP)]

It is a pleasure to serve under your chairmanship, Mr Pritchard, and to follow the hon. Member for Faversham and Mid Kent (Helen Whately). She spoke so strongly on behalf of the Burdett family, whom she represents, and about the tragedy they have faced, and she also spoke to the wider issues raised by the petition following Faye’s death.

I thank the hon. Member for Bath (Ben Howlett) for introducing the debate in the way he did, and I also thank the members of the Petitions Committee for the great service they provided to not only the House but the public by holding hearings in conjunction with the Health Committee. These petitions are a new way for Parliament to engage with the public on important issues, and I hope we will learn from this debate that there is also a new way for Members to engage with Ministers to deal with questions that are not always as easy to address as we might want them to be.

Over the past few years, ever since Bexsero was first licensed as a vaccine in Europe, I have tabled a number of early-day motions encouraging the Government and the Joint Committee on Vaccination and Immunisation to move more quickly. Like Meningitis Now and the original Meningitis UK “Beat it now” campaign, I wanted to ensure that we did not have to wait another five years, as we had to for the meningitis C vaccine, with all the accompanying loss of life and life-changing damage done to children in the meantime.

[Peter Dowd (Bootle) (Lab)]

I met Harmonie-Rose the other day, and what a beautiful little girl she is. I do not want to make inappropriate or spurious comparisons, but the swine flu vaccine cost £1 billion, which, despite the criticism, was money well spent. Does the hon. Gentleman agree that a vaccine catch-up programme would also be money well spent?

[Mark Durkan]

I believe that it would. I will come to that point shortly.

Many Government and Opposition MPs in the previous Parliament and this one have been aware of the issues and concerns involved. First, there was the issue of whether we would get the men B vaccine on to the immunisation schedule as soon as we should. Thankfully, steps were taken last spring, and it came on stream in the autumn. The decision that was made by the Department of Health here effectively became the predictive text for what happened in my devolved area, and I welcome the fact that the Health Minister in Northern Ireland followed suit. A similar issue has arisen here. If the Department responds to the evidence that the Petitions Committee and the Health Committee took, which was based on the issues that the petition raised, that will make a difference not only to NHS England, but to my devolved area.

Being based in Northern Ireland, I am conscious that the south of Ireland has taken the decision to follow the UK on the men B vaccine. It will take it up later this year, which may have an impact on the supply of the vaccine. That is why we need to ensure that, when we talk to Government Ministers here and the devolved Ministers, we also talk to the authorities in the south of Ireland. Between us, we have a very good instrument—the British-Irish Council—which brings together all the Administrations on these islands. They should collectively discuss these policy issues and challenges, and they should combine their muscle to improve their negotiating power with Glaxo on any price implications or sensitivities in relation to the drug.

We have been asked to address three main questions, and I hope that the Minister will do so. I know that some will sound like technocratic issues, and perhaps talking in those terms will make the Minister feel uncomfortable or insensitive. There are the issues that delayed the men B vaccine being put on the schedule in the first place and the issues that we face now, particularly the cost-effectiveness framework. As many hon. Members have said, the framework needs to be adjusted to take into account peace of mind factors and the lifelong impact on those who survive meningitis but suffer lasting damage and have difficulties with the economic and social costs that arise from that. The hon. Member for Bath addressed the issue of ensuring that there is a commitment to funding the adolescent intervention study. Rightly, he did not over-speculate about that, but we need to fully understand it and see what can come of it.

As the hon. Member for Bootle (Peter Dowd) said, there is the question of the under-fives catch-up. Most parents understand that that is a basic thing that should be done. People find it hard to believe that there is a significant case against it; they think it is just a question of how we manage and organise it. It is not enough to say, “If we reach the newborns, that will be enough.” The risk is significant.

Like the hon. Gentleman, I met Harmonie-Rose last week in Westminster Hall. I could not help but be conscious that I was talking to a beautiful, lovely child, and that perhaps, if the men B vaccine had been on stream earlier and in the immunisation schedule when it was licensed, she would not have had to use her great charm to lobby on this issue.

If we delay the under-fives catch-up, how many other people will be affected? How many other young, precious lives will be lost? How many families will be plunged into grief? How many young lives will be harmed? How many young people will lose limbs or suffer brain damage or facial disfiguration? We need a response and an intervention, which is why people have petitioned so strongly. The people who petitioned us want action, and I hope the Minister will address them in honest but hopeful terms.

Community Pharmacies

Peter Dowd Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Derek Thomas]

I thank the hon. Lady for that intervention. That is exactly why we are having this debate. I want the Government to examine the value of community pharmacists and to consider how they can do some of the work—in fact, a large part of the work—that would save money for NHS acute services.

I am well aware that there is a need to secure better value for money in areas of the NHS. Over the weekend, I met four community pharmacists and they all talked of the opportunities to make savings that they have identified. They are willing and able to see more patients. Pharmacists give free, over-the-counter advice to thousands of people every day, promoting self-care and diverting patients from GP and urgent care services. However, it is estimated that £2 billion-worth of GP consultations a year are still being taken by patients with symptoms that pharmacists could treat.

Pharmacists want to have a greater role in prescribing drugs, so as to reduce waste. Last year in Cornwall alone, £2 million-worth of unused drugs were returned to community pharmacists to be destroyed. Pharmacists are best placed to reduce this waste. They want to do more to support people with mental illnesses; they are keen to provide continued care of people with diabetes and other long-term conditions; and my local community pharmacists want to work with the Department of Health to improve services, engage in health and social care integration, reduce drug waste and improve access to records, in order to support the giving of prescriptions.

[Peter Dowd (Bootle) (Lab)]

On that point, does the hon. Gentleman agree that what is needed is a joint, co-ordinated approach to planning investment and implementing change, in partnership with national and community pharmacy bodies, rather than pushing things through at a great pace?

[Derek Thomas]

I thank the hon. Gentleman for that intervention. In my experience so far of looking at this subject, I have found that those in the pharmacist community do not feel that they have been properly consulted or engaged with. Pharmacists believe that they have many of the solutions that the Government wish to see.

Before I conclude, I will read one final letter that I received on Monday from a GP in my constituency. Dr Rebecca Osbourne writes:

“As you will no doubt be aware, General Practice is facing a crisis with too few GPs managing an ever-growing demand. Demand for appointments outstrips availability of doctors and allied surgery staff, and patient needs are increasingly complex with an ageing population with multi-morbidity.

A good Pharmacist helps to take some of the pressure off a local surgery—offering advice about self-limiting conditions, and prescribing over the counter medications for presentations that do not need to be taken as ‘on the day’ appointments with a GP; patients who are on complex medications can receive education and advice from their pharmacist regarding their regime, including the importance of compliance, which can further reduce the burden elsewhere in the system; vulnerable patients, whether elderly or experiencing mental ill-health, have an extra professional keeping watch over them, and a pharmacist may be better placed than a GP”—

it was a GP who wrote this—

“to see a trend developing or a change that requires further attention.”

Swine Flu Vaccination: Compensation

Peter Dowd Excerpts

Tuesday 12th January 2016 Westminster Hall

[Stephen Twigg]

I am grateful to the hon. Gentleman for making that point. While the focus of my remarks has been on the compensation period, there is clearly a related issue with the attitude of the DWP on the severity of disability. I concur with the important point that he raised on behalf of his constituent. A number of other families in other constituencies around the country are also affected, and I welcome the colleagues from all parties who are in the Chamber for this debate.

It is worth reiterating the point that the hon. Gentleman just made: the Government have accepted that there is a causal link between the vaccine and narcolepsy. Since 2014, the Department of Health has had responsibility for the 1979 Act, which is a welcome change. Bringing the Department of Health into the process should ensure that responsibility for the legislation is controlled by health professionals, rather than benefits officials. That shift of responsibility can be a good thing for constituents like mine who have outstanding compensation claims. I am asking the Department for Health to extend the compensation scheme to make it possible for all citizens who have life-changing conditions as a result of vaccines to claim compensation. That is not only important for the individual families suffering as a consequence of adverse reactions; it is crucial to ensuring public confidence in the vaccination system.

[Peter Dowd (Bootle) (Lab)]

Does my hon. Friend agree that the quality of life of people who have been affected or damaged by the vaccine is dreadful and quite deplorable? We should be doing something as soon as we can to sort that out.

[Stephen Twigg]

I thank my hon. Friend for making that point. He is absolutely right. In preparing for today, I was struck that some of the aspects of this subject are technical in character. It has been a little like going back to school and doing biology again in learning some of the terminology. What lies at the heart of the debate, however, is the lives of children and their families. I raised this issue on behalf of my constituent because I want to ensure that he and his family have the quality of life that any family should have the right to expect.

I was about to say that extending the compensation scheme is important not only as a matter of compassion and decency for the families concerned, but to ensure public confidence in the system of vaccination. There is barely a one in a million chance that people will react badly to a vaccine, so if it was certain that, were that to happen, there would be compensation, that would not only be right for the affected families but increase confidence in vaccination.

In conclusion, I am aware that the Department of Health has for some time been in discussions with the lawyer representing Lucas. I thank the Department for listening to my constituents’ concerns, but, on behalf of Lucas and his family, I urge the Minister to do everything she can to ensure that those discussions are brought to a successful conclusion.

--- Later in debate ---

[Peter Dowd]

GlaxoSmithKline was indemnified because there was an issue of risk—that is the whole point. Why are the Government not as quick to effectively indemnify the victims of this vaccine?

[Jane Ellison]

Perhaps it would be easier if I wrote to the hon. Gentleman after the debate to clarify that point.

As I have said, it appears from the timing that the constituent of the hon. Member for Liverpool, West Derby received the vaccine during the 2010-11 flu season. The 1979 Act did not cover seasonal flu vaccination at that time as it was not part of the routine childhood immunisation programme. Influenza was added to the Act as a specified disease in February 2015, but the order stipulated that the vaccination against influenza must have been administered after 1 September 2013, when flu vaccination became part of the routine childhood immunisation programme. Unfortunately, that will not assist the hon. Gentleman’s constituent. I am afraid that it is not possible to accept a claim outside the conditions laid down in the Act. I recognise that that aspect of the scheme has produced an unfortunate result in this case, but we must work within the confines of the law. The Act has been in place for many years on the basis of disease rather than vaccine, and the Government currently have no plans to change how the scheme is run.

Of course, I have sympathy for the case that the hon. Gentleman has made on behalf of his constituent, and I recognise the frustration and disappointment that his constituent and his family will feel at my response. This is a complex topic, with no quick or easy answers, as successive Governments have found. I stress, though, that the VDPS is only one part of the wide range of support and help available to severely disabled people in the UK. Other examples include the disability living allowance, which provides an important non-contributory, non-means-tested and tax-free cash contribution towards the disability-related extra costs for severely disabled children. I encourage the hon. Gentleman’s constituents to consider what other entitlements might be available. I know that the hon. Gentleman will continue to offer Lucas and his family every support in that regard.

Question put and agreed to.

Mental Health

Peter Dowd Excerpts

Wednesday 9th December 2015 Commons Chamber

[Peter Dowd (Bootle) (Lab)]

Thank you, Madam Deputy Speaker.

“There they stand, isolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside—the asylums which our forefathers built with such immense solidity to express the notions of their day.”

Who would want to go back to that description of the old county asylums by Enoch Powell, the then Minister of Health, in a speech in 1961?

The proposals will set the country on a path of integrated community services for people with mental health issues, with an emphasis on the hospital as the place of last resort. No one doubts the complexity of the issue, but there is a real danger we will have a system that does not do one thing or the other. On the one hand, mental health hospitals are struggling to cope with demand for in-patient beds; on the other hand, community services are also straining to cope. There is a symbiotic relationship that feeds off the gradual inability of the other to cope with demand, despite the best efforts of the staff in those services, such as my colleagues in the 5 Boroughs Partnership NHS Foundation Trust, the staff of Mersey Care NHS Trust in my area, and charity and local authority workers.

What would happen if we did not have carers? We need to give them more support—concrete support—not warm words. I am not pointing the finger at the Government. We have gone beyond that. We genuinely have to get down to the issue. However, they are the Government, and they have a significant responsibility to get to grips with this burgeoning and growing crisis. I hope that the Minister has the vision to do so.

NHS (Charitable Trusts Etc.) Bill

Peter Dowd Excerpts

Friday 6th November 2015 Commons Chamber

[Mr Rees-Mogg]

That is an interesting point, but probably, no, I would not agree. Such an extension should happen in highly exceptional circumstances, rather than made a general rule, because copyright law needs to be simple and fair. If it were used to advance particular charities, it would give an option on copyright that was ultimately extendable to a charity of the donor’s choice and we might end up with strange, effectively, avoidance measures to pass money through generations and extensions that had not been intended in the legislation. The length of copyright is already quite long beyond the author’s death, and that provides plenty of charitable donations in the normal course of events. Although I believe in rigour in what one believes politically and in trying to follow logic through to its end, the fact that “Peter Pan” is such an exceptional play and Great Ormond Street is such an exceptional hospital shows that there should be exceptions that make the system fundamentally more human. Therefore, I am in favour of such an extension as a one-off, but I would not welcome it as a general rule.

I have one question for the Minister, however, on the Transatlantic Trade and Investment Partnership. The trade agreement with the United States will look particularly at matters that relate to intellectual copyright. It might be important specifically to exclude “Peter Pan”—along with the French, who are excluding all their dodgy films, but that is slightly by the bye—because I can envisage a Hollywood studio making a film of “Peter Pan” and finding that it had to pay royalties in the United Kingdom but nowhere else, and that might conceivably fall foul of TTIP. I do not want to raise absurd difficulties for TTIP, which is a good scheme and is enormously welcome, but this is such an exception not just to our laws of copyright but to the normal international laws of copyright that it would be a pity if the system were not robust and could not continue. It may not be disastrous, because American film-makers are good, decent, noble people, and it is hard to think that they would be so mean-minded and damage their reputation, which is probably more to the point—[Interruption.] The hon. Member for Bootle (Peter Dowd) needs to shout a bit louder—I cannot hear his sedentary interruptions, but they sound fascinating, and I wish he would share them with the House. I am happy to give way if he wishes to intervene. American film-makers would not want to damage their reputation by being aggressive on “Peter Pan”.

[Peter Dowd (Bootle) (Lab)]

Does the hon. Gentleman agree that he is damaging his reputation talking this nonsense?

[Mr Rees-Mogg]

If I were talking nonsense, Madam Deputy Speaker would rule me out of order under Standing Orders that refer to a speech being both tedious and repetitious. I do not think that I am being either of those, nor wandering—

Off-patent Drugs Bill

Peter Dowd Excerpts

Friday 6th November 2015 Commons Chamber

[Paul Flynn (Newport West) (Lab)]

rose—

[Peter Dowd (Bootle) (Lab)]

rose—

[Alistair Burt]

I will deal with these two interventions, and then, if colleagues do not mind, I will have to make progress.

[Alistair Burt]

I have known the hon. Gentleman for a long time, and that last bit was rather unworthy of him. I have not seen anything from the ABPI, but having picked up this measure from my colleague, the Under-Secretary of State for Life Sciences, dealt with the evidence, as I have seen it, and had conversations with officials, I am perfectly convinced.

[Peter Dowd]

I have been sent here by my constituents, and the Minister said on his website, in response to a constituent regarding the Assisted Dying (No. 2) Bill:

“I believe that human life is intrinsically valuable and sacrosanct.”

I respect that view, but does he not agree that having rejected that Bill just a few weeks ago, this House has a responsibility, through this Bill, to facilitate, without reticence, access to medicines that would give practical and humane effect to the will of this House for those who have a terminal illness or for the prevention of that terminal illness?

[Alistair Burt]

Yes, of course. Why would a Government not wish to do that? I quite understand the hon. Gentleman’s point. I am trying to explain that that is exactly what happens now, and that to suggest otherwise carries a degree of risk.

Cities and Local Government Devolution [Lords] Bill

Peter Dowd Excerpts

Wednesday 21st October 2015 Commons Chamber

[John Mann]

The Minister will clarify whether, legally, people can have a say, but I am sure that there are ways in which a say can be created to ensure that there is popular consent. There are ways in which we could choose to do that. I am not talking about my own informal consultations, which are pretty huge. It would be interesting to get the Minister’s take on that. Those are key points.

Can we have some assurance that, over time, these measures will not lead to more elected representatives? If people are honest, they understand that if we have a two-tier scenario linked in with unitaries, either the districts or the counties will inevitably go at some stage, and probably sooner rather than later. That is bound to happen. Some may say that that is a good thing. As I have said, I have argued for unitaries before, but it is important that councillors understand that that is what is happening. Similarly, it must be clear that we will be able to choose, and the Derbyshire districts will be able to choose, where we will go. I am sure that the Government want that. They say that it is a brilliant idea, so they must want us to be part of it. It is really how we do that with guarantees. It would be useful to have that on the record.

[Peter Dowd (Bootle) (Lab)]

As a former leader of a council and a member of a combined authority and local enterprise partnership, I welcome the thrust of the Bill. There is no question about that. I said in a previous debate that the train is going out of the station—the cat is out of the bag, to mix metaphors. Whichever description we use, this is the reality.

I do not deny that the governance structure in local regions is important, but whatever that structure is we must move the debate on. Local government has changed over centuries. In the 19th century, it changed to reflect the industrial revolution. It changed at the beginning of the last century and at the end to reflect the patterns of population, demography, business and so on. It has changed over time. London changed in the early ’60s, we changed again in the 1970s and it is now time to change once more. People might have concerns, but that is life. It has to move on.

My hon. Friend the Member for Bassetlaw (John Mann) made a point about having too many councillors, but I am pretty agnostic on that. The United States have significantly more councillors proportionately than we do, and they get on okay, and the same applies to the French. It is part of the heart of a community that there might be lots of councillors. I am not arguing for that, but I do not think that it is a reason for not going ahead with changes.

I support the comments made by my hon. Friend the Member for Nottingham North (Mr Allen) about the principle. There will be changes to local government and devolution in the coming years, and we might as well recognise that while we are in this transition and get on board with the constitutional convention. That does not stop things happening now, but we really need to get on with it, and I ask the Government to consider that seriously.

I also support what my hon. Friend the Member for Sheffield South East (Mr Betts) said. He referred to some of the specifics. It seems remarkable that a mayor would not have the borrowing powers he described. I hope that is just a mistake—a lacuna in the legislation—that will be put right. It is important that the detail is picked up.

There is a danger that this debate will get a bit too esoteric. Do I think that devolution will be good for my city region of Liverpool? Yes, it will. Why? This is not unique to us, but we have a thriving visitor economy. For many years, that has been our direction of travel and Liverpool is now the fourth most popular city in England for national and international visitors. That could link into the point made by my hon. Friend the Member for Bassetlaw about hotel taxes and the ability, if that many people are coming into the city from abroad, to use that revenue if we so wish. I am not saying that we should, but we should have that flexibility if we want it. The visitors are coming to my city, not to anybody else’s, and that is important.

At the moment, the visitor economy brings in £3.8 billion and 40,000 jobs, and it is a major growth sector. Do I think that the city region would manage that, grow it and progress it better? Yes, I do. There is no question about that. If we wait for Whitehall to help us, we will be waiting until the cows come home, and I mean no disrespect to Whitehall.

[Mr Graham Allen]

My hon. Friend reminds me that Thomas Jefferson once said that were people to wait for Washington to tell them when to reap and when to sow, they would soon go hungry. The same probably applies if we wait for Whitehall to figure out how to do some of these things. Will my hon. Friend also comment on local government borrowing and social investment bonds? In America, there is a multi-trillion dollar local government capital market. People borrow, they return, they use their liquidity and they stash money overnight. That would be a fantastic source of revenue that is currently denied to local government.

[Peter Dowd]

My hon. Friend is spot on in in identifying some of the mechanisms that can be used to help local economies. For example, low carbon investment accounts for 1,400 businesses in our area and is a major growth sector. Among the organisations that invest in our area is Copenhagen city council. Why cannot we as a city council or a local authority invest in our area in that way? Devolution will eventually enable us to do that. The low carbon industry is one of our priorities and brings a huge amount of money into the local economy. We want to grow that area, and we could do that best ourselves.

There are other reasons why my city region will benefit from devolution. We want more manufacturing. The Government have said that they want to move into manufacturing because that helps with exports. In our area advanced manufacturing is worth £3.2 billion and accounts for 50,000 jobs and 3,000 businesses. Again, we need to grow that as part of our strategy, which may well fit in with the Government’s agenda. It may not, but that is a matter for us. We are working closely with businesses through the LEP and outside the LEP to continue to develop that sector.

The creative and digital sector is important. Merseyside had a long history of creativity. I am not saying that other places do not have that, but for decades we have had the benefit of the creativity that we have brought on, and we want to continue to bring it on. Why not? That will be best done from within Merseyside. The sector is worth £878 million, and accounts for 3,500 businesses and almost 19,000 jobs. We are best placed to grow that. The life sciences and health sector is huge and worth £1.7 billion, with the potential to grow even more.

I gave those examples of our priorities—the visitor economy, advanced manufacturing and so on—because many of those have been pushed from within our area. We want the structure, the capability, and the devolution of powers and resources to enable us to push them further.

This may be a radical proposal and it may be slightly party political. The Conservatives have made major cuts in our local government budget in Merseyside and other areas, and that will continue. If that happens, so be it, although I do not agree with it. But I would rather have devolved budgets and resources even at a lesser amount if we can determine how to use them, because our priorities may not be the priorities of the Government. One of the good things that the Government did was to lift much of the ring-fencing which had become endemic over the past 10 or 15 years.

If, with devolution, comes the resource—appropriately equitable, possibly over a transition period—all the better. Colleagues in my neck of the woods and I welcome devolution. We want to be able to push the agenda on for our area and we think we are best placed to do that. Importantly, we would be accountable for that at a local level, and that is the key.

[Mr Steve Reed]

This group of amendments deals with the functions of combined authorities and their funding. I shall try to cover the whole range and also speak to our amendment.

The Minister said that he and the Government are listening to these debates and making changes as a result. It is disappointing, therefore, that they have not brought any significant changes to the Committee in relation to this group, after the debates and decisions that were taken in the Lords, and the debate on Second Reading, on introducing stronger financial powers. Areas are being given new powers, which is absolutely welcome, but the truth is that they will lack the resources they need to use them fully.

Local government has proven itself to be more efficient than national Government, as hon. Members have testified, but Whitehall still will not let go. That is why I tabled amendment 58, which would introduce multi-year financial settlements. That would offer city regions financial stability and allow them to have long-term planning, which currently is not on offer under the financial settlement or the funding of local enterprise partnerships. Without long-term funding arrangements, they cannot plan sensibly for the long term.

The Government must commit to providing devolved regions with the resources they need so that they are not being set up to fail. The regional development agencies, which LEPs replaced, were able to make single three-year funding arrangements. LEPs are in many respects better, but they have access to a smaller budget, and there are far too many small ring-fenced grants, which constrains their ability to take the big, long-term, strategic decisions in the way they need to. We must ensure that combined authorities do not suffer the same problems.

Amendment 58 would therefore make provision for multi-year funding agreements, which would give combined authorities the resources and time they need to build financial stability and allow them to best protect themselves against unfair funding settlements of the kind we have seen central Government deliver since 2010, which I fear we are going to see again when the Chancellor makes his pre-Budget statement to the House in a few weeks’ time. This is an important issue, and I believe that the success or otherwise of devolution depends on it, so we will seek to push that amendment to a vote.

A number of other amendments are aimed at increasing financial stability. We are particularly interested in the Government’s view of those. I urge the Minister, in the Secretary of State’s absence, to respond to them so that we do not have to bring them back on Report. In particular, amendment 60, tabled by my hon. Friend the Member for Sheffield South East (Mr Betts), seeks further powers to allow mayors to borrow. New clause 14, tabled by my hon. Friend the Member for Nottingham North (Mr Allen), would allow local areas more discretion over the setting of council tax bands.

New clauses 10 and 11, tabled by my hon. Friend the Member for Harrow West (Mr Thomas), seek further devolution to London. I think he is quite right to point out that the devolution journey in London has not ended, because the capital is seeking further powers. His points about devolving housing to London are certainly worth further exploration. However, it is worrying that the Housing and Planning Bill contains more than 30 centralising measures, taking powers away from the localities and putting them in the hands of Ministers here in Whitehall, which runs completely contrary to everything we have heard from Ministers this afternoon about their devolution intentions.

My hon. Friend the Member for Harrow West also referred to fiscal devolution. We certainly need to see that, but it must sit alongside a fair equalisation mechanism, with incentives for areas so that they can benefit by expanding their economic potential, including the ability to invest in housing, infrastructure and those things that will increase the opportunity for jobs and prosperity.

The Government have tabled a number of minor amendments relating to the functions of police and crime commissioners, particularly amendments 23, 24 and 25 to schedule 2. There have been a number of media reports about devolving fire service functions to PCCs, but the Bill gives those functions to mayors. Can the Minister assure the House that fire services will not be politicised in the hands of mayors, a move that the Local Government Association says there is “no pressing need for” at this stage?

We support the principle of subsidiarity—an ugly word for a beautiful concept, as my hon. Friend the Member for Nottingham North reminded us in relation to his new clause 2—which states that decisions should be taken as close to citizens as possible. That is a very important principle that central Government repeatedly fail to understand.

On my hon. Friend’s points about a constitutional convention, he has been constrained to keep within the scope of this Bill by talking about a local convention. However, we believe that we do need a model for engaging civic society in the whole country—citizens, not just politicians—in seeking a new constitutional settlement that will shift powers not just from Whitehall to town hall but to communities, neighbourhoods, service users and all citizens to get power out of this place and into the hands of people who can really make a difference once they have access to it.

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The National Health Service Act 2006 enables NHS England to delegate and share responsibility for certain health functions, such as the commissioning of GP services with local clinical commissioning groups. It also allows CCGs to work together to improve the exercise of their functions and provides for the Secretary of State to involve local authorities and NHS bodies in the commissioning of public health functions.

[Peter Dowd]

I do not think anyone could disagree with the concept of maintaining standards, but when the Minister talks about what NHS England will be allowed or permitted to do, he needs to go further. The concept of subsidiarity is relevant. Powers should be devolved down, subject to standards, or there should be an onus, almost by default, on transferring responsibilities downwards rather than allowing bodies to pick and choose what they think should be devolved.

[Alistair Burt]

The order by which powers will be devolved will be subject to parliamentary approval. The safeguard is that the Secretary of State will have the power, as Parliament requests and demands, to put limitations on and conditions into that order. The reason there is no template for which powers must go downwards is that each area will probably have something different. The Bill provides a permissive opportunity for NHS powers to be devolved, but the powers to be devolved will depend on what each devolved administration is looking for. This part of the Bill sets out the ability of the Secretary of State and the NHS to achieve that, and the safeguard applies in respect of national qualities and standards and the regulatory process. The decision on which bits will be devolved down will be made by the Secretary of State and the NHS in consultation with the local areas that want the extra powers. I hope that helps the hon. Gentleman.

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[Peter Dowd]

I would press for further clarity. I understand what the Minister says. The point I am trying to make is that if a local area says, “We think we are best able to provide particular services and responsibilities in a particular way” and NHS England, for example, says that it is not prepared to relinquish those responsibilities, we need a means of mediating that clearly and unambiguously. The assumption should be that the powers will go down to the local area if it wants them—subject to standards.

[Alistair Burt]

I take the hon. Gentleman’s point. I am not sure, however, that we can be more prescriptive on the face of the Bill. The hon. Gentleman is describing the process by which an area says, “We think that, in addition to the functions already devolved, other things need to be devolved to help local health services work together”, but it is difficult to envisage the circumstances in which NHS England would say, “Well, no you can’t”. At the moment, most are working collectively in any case, so this is a matter for local decision making and agreement between the parties involved. I do not think we can say more than that directly in the Bill at this stage. The whole process of devolution will fall into disrepair if there is continual conflict between an area that says, “Look, we think we can do this”, and a central authority that says, “No, you can’t, there’s no point in that given the process we are going through”. The provision of safeguards is about ensuring that NHS England can be confident of devolving powers, because ultimately the regulatory powers and the safeguards should ensure that patients and constituents are protected by national standards remaining the same. That is how I envisage it working.