Health Service Medical Supplies (Costs) Bill

Debate between Philip Dunne and Bob Stewart

Ping Pong: House of Commons
Wednesday 15th March 2017 Commons Chamber

[Mr Dunne]

My hon. Friend is right to point out that NICE is considering today in its board meeting thresholds for the introduction of new medicines. What I would not do, however, is share his concern that it will necessarily lead to delay in their take-up. In essence, it will provide NHS England with greater commercial flexibility to negotiate with drugs companies that propose to introduce a drug that may cost more than £20 million in a full year. It will give NHS England more time to negotiate a lower price with the pharma company. That should not, in and of itself, lead to either delay or less take-up.

I am aware of the concerns, expressed by my hon. Friend, other Members and some charities in a national newspaper today, about the joint NICE and NHS England consultation on the proposed changes to the appraisal and adoption of new technologies. There have been suggestions by Opposition Members that this is rationing of NICE-approved medicines. I assure the House that that is not the case. Patients will continue to have the right to NICE-recommended drugs, as enshrined in the NHS constitution. The proposals are intended to ensure that patients benefit from even faster access to the most cost-effective treatments, while addressing issues of affordability as well as effectiveness.

Let me be very clear: Lords amendment 3 would not impact on the proposals; the NHS will continue to fund a product approved by NICE, in line with NICE recommendations. I also remind Members that NICE and NHS England are making the changes to address concerns about the affordability of high-cost new drugs and other technologies that were raised by the Public Accounts Committee, which is chaired by the hon. Member for Hackney South and Shoreditch (Meg Hillier).

I have read the suggestion by the Opposition that the NICE and NHS England proposals would be contrary to our intent to increase the uptake of new medicines. As I said to my hon. Friend the Member for South West Wiltshire (Dr Murrison), that is false. In reality, last year saw spend on medicines grow more quickly than in any of the past 10 years, as we seek to secure rapid access to new medicines for patients.

Access to medicines is primarily dependent on clinicians’ choices about what is best for their patients. Clinicians need to be aware of new medicines and persuaded that they may be a better option for their individual patients, taking into account other conditions each patient may have and other medicines they are taking. We need to change the culture and behaviour of those clinicians who may be reluctant to use innovative medicines, and legislation is not the right way to effect behaviour change in the NHS.

[Bob Stewart (Beckenham) (Con)]

I want to ask a layman’s question: if NICE approves a drug, is the NHS necessarily required to buy it?

[Mr Dunne]

The short answer is yes, it is. That is set out in the NHS constitution. The measures considered by the NICE board today provide some additional flexibility for NHS England in its handling of negotiations with the drugs companies over the introduction of new technology.

Let me conclude on amendment 3 by saying that the Government strongly believe that it would have a negative impact on the Government’s ability to operate price controls, so I ask Members to disagree with it.

I will deal briefly with the other amendments. Lords amendments 1 and 2 and amendments 4 to 24 were made in the other place. They are all amendments that the Government brought forward, having worked constructively with parliamentarians on improving the Bill.

Amendments 1 and 2 relate to the remuneration for persons providing pharmaceutical services in England and Wales respectively. The amendments provide for new regulation-making powers in respect of special medicinal products. These are unlicensed medicines that can be manufactured or imported to meet a patient’s individual needs when no licensed product is available.

The unique nature of specials—the hon. Member for Central Ayrshire (Dr Whitford) mentioned them during our consideration in this place—and their manufacturing arrangements mean that we need to do more to ensure that the prices paid by the NHS represent value for money for all these products. These amendments would enable England and Wales to develop options that will secure improved value for money—for example, by using a quotes system that has been trialled in Scotland, but there are also other options. We will consult the community pharmacy representative body on how best to take this forward.

Amendments 4 to 7 introduce a consultation requirement on the Government with regards to medical supplies. Again, the hon. Member for Central Ayrshire helpfully pointed out that such a requirement was in place for medicines, but not for medical supplies. I thank her for engaging with me and my officials, which has helped to improve the Bill.

The Government have listened to concerns in the House of Lords and in this House about the Government’s power to control the prices of medical supplies. These amendments would ensure that the first order to control the price of any medical supply would be subject to the affirmative procedure, giving both Houses an opportunity to discuss that order.

Amendments 8 and 9 and 15 to 17 are amendments to the information powers in the Bill. Responding to concerns from industry about the potential burdens of the proposed information power, they introduce an additional hurdle for the Government to obtain information by requiring them to issue an information notice whenever they require companies to provide cost information related to individual products, which can be appealed by the company concerned.

Defence Expenditure (NATO Target) Bill

Debate between Philip Dunne and Bob Stewart

Friday 23rd October 2015 Commons Chamber

[Bob Stewart]

Cyprus is not an overseas territory, but the sovereign base areas in that country are part of the United Kingdom. People have now started to arrive in those areas by ship. May I tempt my hon. Friend to tell the House what the Ministry of Defence and the Foreign and Commonwealth Office are going to do about that? Are we perhaps going to put more ship capability out there? The ship that is now at RAF Akrotiri is old and very tired.

[Mr Dunne]

I thank my hon. Friend for giving me the opportunity to explain what we know thus far about the arrival by boat yesterday of migrants on the shore of RAF Akrotiri. I understand that 114 migrants arrived and have been accommodated overnight within the sovereign air base, where military personnel have provided them with food, water and bedding. There are 67 men, 19 women and 28 children, and they are being assessed by medical personnel. I am sure everyone will welcome the fact that they have already been found to be fit and well. We are grateful to the Republic of Cyprus for agreeing to process all asylum claims through its system. That process began yesterday morning and will be continued as rapidly as possible. Further details will be provided when appropriate. The nationalities of those in the group will be confirmed only as they are processed by Republic of Cyprus officials, but we believe them to be a mix of Syrian, Palestinian and Lebanese nationals.

I cannot give my hon. Friend any specific information on what naval intervention took place. I do not believe that the operations of HMS Richmond or HMS Enterprise were affected by the arrival of those people in Cyprus, but I will confirm that to him in writing.

[Bob Stewart]

There is a very small patrol vessel at the mole at RAF Akrotiri, but it does not go out very often and it has a very small crew.

[Mr Dunne]

I am grateful to my hon. Friend for informing the House of those facts, based on his deep experience of our capabilities.

My hon. Friend the Member for Eddisbury (Antoinette Sandbach) is already proving to be a doughty champion for Cheshire, my neighbouring county. I am always pleased to see people standing up for Cheshire. She has also given tremendous support to the armed forces since arriving in the House. I applaud her for that and support her efforts. She drew attention to the contribution that defence makes to the prosperity of the nation, which I touched on earlier. She is absolutely right about the skills that defence is able to provide to our people. We are the largest employer of young people coming out of college or school into an engineering trade. We are also the largest provider of apprenticeship programmes in the country and the largest provider of skilled employees back into the civilian workforce, once military careers come to an end. We therefore play an enormous role, which needs to be more widely acknowledged, in helping to upskill our nation.

My hon. Friend the Member for North West Norfolk (Mr Bellingham) explained the significance to defence of RAF Marham in Norfolk, as the home of the Tornado squadron, including 31 Squadron, with which, as we discovered, his father served. RAF Marham will become the home of the squadron for the new F-25B joint strike fighter, Lightning II, when it is stood up. He spoke powerfully of the role of international development aid as a pump primer for trade to help recipient countries to emerge into self-sufficiency.

I would like to dwell for a moment on the mutually supportive role that humanitarian aid spending can play to help to keep this country and its citizens secure. With the present conflicts in the middle and near east, the United Kingdom is able to use the aid budget, through DFID, to provide vital humanitarian assistance. As hon. Friends are aware, refugees from the Syrian civil war have received £1.1 billion from the United Kingdom. We are the largest donor outside of the US to those suffering from this appalling civil war, and in Yemen we are the fourth largest donor, which is not quite so well known, following the US and regional donors. We have pledged £75 million to humanitarian relief stemming from the civil war in that country. There is therefore a vital role for us to play as a nation, and the pledge to contribute 0.7% of GNI—which I will come to later and which is used to help refugees in those places—helps us as a nation to remain more secure, so in my mind there is a clear linkage between these two pledges.

My hon. Friend the Member for Gainsborough spoke movingly of the role of defence in our midst, especially in his county of Lincolnshire. RAF Scampton is of course the home of the Red Arrows, who play such a vital role in promoting the air force and will, I believe, play a part in welcoming the Prime Minister of India on his visit, which will be exciting to watch. Lincolnshire is also, as he told us, home to RAF Coningsby, one of the three operating bases for combat jets across the UK, and RAF Waddington, the operating base for our ISTAR—information, surveillance, target acquisition and reconnaissance—assets, or at least it will be again, once its runway has been resurfaced, which is under way at the moment.

As a former Chairman of the Public Accounts Committee, my hon. Friend spoke knowledgeably about the risks to good government of ring-fencing, as we have discussed. He also raised the problem of target setting, with the attendant risk of skewing procurement, not least given the challenges, which I am grateful to him for acknowledging, that exist in managing such a significant procurement programme as we have in defence.

It was good to welcome my hon. Friend the Member for Congleton (Fiona Bruce) to a defence debate. She acknowledged that she is not an habitual attender, unlike many of the other colleagues who have participated in the debate, and it was refreshing to hear a different approach. She emphasised how the military can and does support humanitarian efforts, often on a cross-government basis, to help other nations in distress. She referenced Sierra Leone and Nepal—I will have something else to say about Sierra Leone in a few minutes. I would like to draw her attention to the role that the military was able to play in bringing relief to the people of the Bahamas earlier this month, when a just-under hurricane strength storm ripped across the islands, causing mudslides and wreaking havoc. As it happens, I was the Minister on duty on the day and was able to authorise the Royal Fleet Auxiliary vessel Lyme Bay to go to the assistance of the people of the Bahamas. It was there for a few days and provided invaluable help to the people of those islands.

My hon. Friend the Member for Torbay (Kevin Foster) started by enlightening the House about his formative—may I say existential?—relationship with the Royal Navy. He welcomed our plans to develop new capabilities for our armed forces, but cautioned us on the importance of avoiding waste and poor decision making in improving our procurement processes. As he has an interest in this, I hope he will take the opportunity to look at what we are doing in our equipment plan, which was published yesterday, and will appreciate what the National Audit Office said—which was little short of praise—for the progress made thus far. We are acutely aware that we cannot rest on our laurels. It is important to continue to bear down on inefficiency.

Avro Vulcan XH558

Debate between Philip Dunne and Bob Stewart

Tuesday 21st July 2015 Westminster Hall

[The Minister for Defence Procurement (Mr Philip Dunne)]

Sir David, I am sure you will join me in congratulating my hon. Friend the Member for Aldershot (Sir Gerald Howarth) on securing this debate and on paying such a moving tribute to this magnificent aircraft, which, as we can all tell from the tone of his remarks, he holds in very high regard indeed.

My hon. Friend also told us how he originally became a trustee of the Vulcan to the Sky Trust; I suspect that on the back of that public explanation, he may be invited to become a trustee of several other aviation charities in the future. He has been a doughty advocate for the trust. I share his respect and admiration for the dedicated enthusiasts, many of whom he named, whose tireless efforts returned this iconic aircraft to flying condition so that another generation might witness it in the skies over the UK. I met several of those volunteers at the royal international air tattoo last year, and was impressed by their dedication and commitment to this remarkable aircraft, which I enjoyed seeing again, albeit static, at RIAT this year.

The Avro Vulcan was introduced into service with the RAF in 1957. As we heard, 134 were produced for the Royal Air Force by Avro at its Woodford aerodrome site near Macclesfield between 1956 and 1965. It was designed as a long-range bomber capable of reaching targets far into the then Soviet Union. On its introduction, it represented the cutting edge of aviation and was a step change in technology from its wartime predecessors. It was a clear, iconic demonstration of the quality and vision of British engineering. The last operational Vulcan squadron disbanded in 1984, but the Vulcan continued with the RAF in a display role until it finally left service in 1993.

The Vulcan bomber was a stalwart of the so-called V-force, which comprised Vulcan, Victor and Valiant aircraft. The V-force provided Britain’s strategic nuclear deterrent during the dark days of the early cold war. The RAF’s Vulcan fleet was held in a state of continuous readiness to respond to any nuclear threat from potential aggressors. It required continuous training and dedication to maintain aircraft and aircrew at a constant state of peak readiness.

[Bob Stewart]

I want to challenge my very good friend the Member for Aldershot slightly on one point. My hon. Friend stated that there was only one operational attack by a Vulcan on the Falklands; as the Minister just outlined, the Vulcan fleet was operational from about 1957 to ’69, flying in the cold war on operations, defending our freedom and our right to exist. I should like to point that out. I slightly disagree on that small point.

[Mr Dunne]

My hon. Friend is right to emphasise the role played by Vulcan crews during the cold war, but of course my hon. Friend the Member for Aldershot is also correct in saying that the aircraft was only ever used once in a strike capacity, during the Falklands war. I will mention that in a moment.

The state of high readiness continued for many years, until the nuclear role of Vulcan bombers was replaced in 1969 by the Royal Navy’s fleet of Polaris and later Trident submarines. It is precisely because of the deterrent capability that it provided to our country that the Vulcan was never called on to use its nuclear capability in anger against the Warsaw pact. I am sure that my hon. Friend the Member for Aldershot agrees that that is precisely why the Government remain committed to the provision of a continuous at-sea deterrent today.

As we have just discussed, Vulcans did see action during the 1982 Falklands conflict. At that time, the Vulcan was already a 25-year veteran, approaching the end of its service life. There was no expectation that it would shortly be thrust into a critical role in the Falklands war. In the Black Buck raids, RAF Vulcan aircraft flying from Ascension Island carried out what were then the longest-distance bombing raids in history, covering a return distance of some 7,700 nautical miles. A total of five successful raids were made by Vulcan aircraft against the airfield and Argentinean radar installations at Port Stanley. A Vulcan bomber cratered the runway at Port Stanley and denied Argentinean fast jets a base from which to attack the taskforce. It also sent a clear strategic message to Argentina that Britain would take any necessary steps to defend its sovereign territory and protect the islanders’ right to determine who governed them—a policy that this Government still hold dear today. The House will be interested to know that Vulcan XM607, which completed the first of the Black Buck raids, is preserved at RAF Waddington, is much prized and can be seen by members of the public from the Waddington aircraft viewing enclosure.

The Black Buck raids were a testament to the courage of the men who flew all the aircraft involved and to those who supported them. I know that my hon. Friend will share my admiration for the Handley Page Victor tanker crews that assisted with the raids: a remarkable relay of some 12 tanker aircraft that ensured that the Vulcan was refuelled in mid-air five times per mission. That is a remarkable example of improvisation, professionalism, airmanship and military logistics.

Vulcan XH558 made its maiden flight in May 1960 and has flown more hours than any other Vulcan. It first served with 230 Operational Conversion Unit, providing training for pilots new to the Vulcan type, before transferring to front-line service with the Waddington wing. In 1973 it transferred to the maritime radar reconnaissance role and in 1982 was converted for use as a refuelling tanker. It finished its RAF career with the Vulcan display flight before making its final RAF flight in 1993.

Retiring from the RAF after many years of sterling service, the Vulcan was taken into private ownership, as we heard, thanks to the work of the Vulcan to the Sky Trust. It was returned to flying condition in 2007, since when it has been seen at many air shows across the UK. Although the preservation of the aircraft is not a core defence requirement, the RAF has in the past assisted where it could with this project to restore and maintain Vulcan XH558. It seconded a number of skilled RAF engineers to the restoration project and provided hangar space, notably at RAF Lyneham.

As I said, I saw the aircraft on the ground at RAF Fairford on Friday. Although it was static, it was the air platform subject to the greatest intensity of interest at the show. I saw the video of it flying in formation with the Red Arrows on Sunday, which must have been an utterly thrilling sight for the thousands of spectators present. I cannot think of a more fitting way for the RAF to mark its affection for this fine aircraft, with two icons of British aviation flying side by side. Even more appropriately, the Vulcan was once based at RAF Scampton in Lincolnshire, now home to the Red Arrows—evidence, if any was needed, of the great heritage of the RAF and the comforting ebb and flow of the past giving way to the future.

The MOD takes its commitment to the aviation heritage of this nation very seriously and is proud to do so. It is RAF heritage strategy, where possible, to preserve one of every aircraft type in the national collection at the RAF Museum. In the financial year that ended in April ’14, the MOD donated just over £9 million pounds in grant in aid to the RAF Museum, which preserves many of the nation’s finest military aircraft, including two Avro Vulcans, which can be viewed by all who visit the RAF Museum sites at Hendon or at Cosford, just outside my constituency in Shropshire—a good visit for all. The Imperial War Museum, which received a £21 million grant from the Department for Culture, Media and Sport last year, also has a Vulcan aircraft at its site at Duxford.

Many will share my hon. Friend’s disappointment that the Vulcan will not continue to fly and that we will not be able to spot it in the skies of the nation that it served and protected so diligently. But as we have also heard, it is encouraging to learn that the Vulcan will continue to play a pivotal role in the future, just it has in our past, albeit in a heritage capacity.

I was delighted to hear my hon. Friend mention the plans for the XH558 to be a living centrepiece for a Vulcan Aviation Academy and Heritage Centre at Robin Hood airport, near Doncaster, providing inspirational opportunities for the next generation to learn about aviation and help prepare them for future jobs in the aviation world. I am sure the House will welcome this admirable initiative, and I wish the project the very best.

I congratulate my good friend the Member for Aldershot on his fine championship of the Vulcan through his work on the trust. I also congratulate him on securing this debate and on giving us this opportunity to highlight the role that the Royal Air Force has played in serving this nation so well, using various aircraft types for close to 100 years.

Question put and agreed to.