William Mead: 111 Helpline

Philippa Whitford Excerpts

Tuesday 26th January 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. There is so much in this report, but we must not let some very important recommendation slip under the carpet, and that is one of them. We have a commitment to a paperless NHS, which involves the proper sharing of electronic medical records across the system. We have also instructed clinical commissioning groups to integrate the commissioning of out-of-hours care with the commissioning of their 111 services to ensure that those are joined up. It is a big IT project, and we are making progress. Two thirds of A&E departments can now access GP medical records, but she is absolutely right to say that it is a priority.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Like others, I add my condolences to the family. It is hard to imagine anything worse for a family to face. Like many deaths in the NHS, it is always sad to look back and see that it was a catalogue of missed opportunities and errors. One thing I should like to pick up on is the fact that young children are very hard to assess. It is quite hard for a doctor to assess them when they are actually seeing them; they can be running round one minute and then keeling over half an hour later. It is particularly hard to pick up clues about their health over the phone. When NHS Direct services were started throughout the UK, they were based in local out-of-hours GP centres, which meant that the nurse could just pass the phone and say, “Can you come and chat, because I am not sure.” We had rules in our local one that if a young child was involved, they got a visit from our mobile service. Instead of such cases being put through call centres, I hope that the Secretary of State will agree in this review to have some dissemination back to a local system, so that these cases can be accelerated easily to a clinician.

[Mr Hunt]

I agree with the broad thrust of the hon. Lady’s remarks. Of course she speaks with the authority of an experienced clinician herself. In this case, the tragedy was that there was actually a doctor who spoke to the Mead family on the night before William died, and he did not spot the symptoms. It is not simply a question of access to a doctor, but ensuring that doctors have the training necessary. However, as she says, dealing with cases such as this can be very difficult. The doctor’s view on that occasion was that, because the child was sleeping peacefully, it was fine to leave him until morning when, tragically, it was too late. Other doctors would say that that is a mistake that could easily have been made by anyone, which is why the report is right to say that it is about not individual blame, but a better understanding of the risks of sepsis. She is right in what she says. As we are trying to join up the services that we offer to the public, it is a good principle to have one number that we dial when we need advice on a condition that is not life-threatening or a matter for a routine appointment with a GP, and 111 is an easy number to remember. However, we need to ensure that there is faster access to clinicians when that would count, and that those clinicians can see people’s medical records so that they can properly assess the situation.

Space Policy

Philippa Whitford Excerpts

Thursday 14th January 2016 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I beg to move,

That this House notes the scientific, cultural and technological opportunities arising from exploration of outer space and the significant contribution the space industry makes to the UK economy; further notes the increased public interest in space exploration resulting from Major Tim Peake’s mission to the International Space Station (ISS); welcomes the global co-operation that has led to the development of the ISS over the last forty years; takes note of the shortlist of airports and aerodromes that could host a UK spaceport published by the UK Government in March 2015; and calls on the Government to bring forward further advice and support for organisations considering developing such facilities so that they might be operational by the Government’s target date of 2018.

If hon. Members read the motion, they will see that it covers the incredible breadth and depth of the space industry and its amazing potential. I hope that that will be covered during the debate by Members from different parts of the United Kingdom. Some people are likely to stoop to using some fairly poor puns. At this point I would like to register the fact that I accept no responsibility for that. I lay the blame at the feet of the Prime Minister, who has stooped to using some pretty shocking puns at Question Time recently, something for which he needs to be penitent.

Some people who follow the media will be aware that our former First Minister, my right hon. Friend the Member for Gordon (Alex Salmond), has used as a travelling pseudonym the name of that famous captain of the USS Enterprise, but for a debate as important as this, I felt we should contact the real McCoy. I therefore have a message to the House of Commons from William Shatner:

“Space is one of the last known frontiers, mostly untouched by mankind and his politics. In opening a debate on this subject my hope is you take the tenets of Star Trek’s prime directive to universally and peacefully share in the exploration of it. I wish you all a wonderful debate. My best, Bill”.

As some people will have seen, we have also had a message on Twitter from George Takei—otherwise known as Mr Sulu—wishing us luck as we venture to the stars.

This is not a debate about fictional astronauts. We tried to get the debate on this day to honour a real astronaut, Major Tim Peake, who is currently in the international space station. We sought it today because tomorrow he will be making a spacewalk. Contrary to some slightly sloppy journalism, he is not actually the first British astronaut. That honour fell to Dr Helen Sharman from Yorkshire a quarter of a century ago, in 1991. I find it incredibly appropriate that, prior to that, she was a research chemist for Mars. [Laughter.] It’ll get worse.

However, Major Tim Peake is our first astronaut through an increased engagement with the European Space Agency. While Helen Sharman was on the Mir station, he is in the international space station, and tomorrow he will certainly be taking part in the very first British spacewalk. It will start, hopefully, at 11.30 GMT tomorrow morning. I would encourage all schools, children and youngsters of all ages to log on to principia.org or NASA TV on the internet, where it will be shown, as it truly is an historic moment. He has been tasked with changing regulators on the solar panels. As they are high-voltage regulators, the walk has to be carried out entirely on the dark side.

I am a member of the parliamentary space committee. We had the great opportunity to have a private tour of the “Cosmonauts” exhibition in the Science Museum, which I would recommend to anyone. The museum spent four years negotiating with Russia to bring incredible artefacts to this country—the space capsule of Tereshkova, uniforms of Gagarin and all sorts of pieces of hardware that even people in Russia did not know existed. What struck me as we went round the museum was the fact that, during points of incredible friction between Russia and the US and across the world, back channels always remained open. Co-operation always continued on the international space station. We have seen that in these few years of setting up the exhibition, during which we have had the Ukrainian crisis, Crimea and friction over Syria. If we can work so well together in space, it would be great if we could work a little bit better here on earth.

Any Members who were in the Chamber when I made my maiden speech will remember that I referred to Prestwick in my constituency as being on the shortlist for consideration as a space port. I remember that whenever I talked to anyone about that during the election, they would always just laugh, because in this country we think that space is for other people—the big boys: north America, Russia and maybe even China, but not us. That is something we have to change. We need to believe in what we can do, and I think Major Tim Peake’s mission will achieve that. We see the interest of school children and the Science Museum was packed on the day of the launch, and we had Members in this place watching it live on screen. We hope it will lead to an interest in STEM subjects—science, technology, engineering and maths—and an absolute belief in the space industry here in the United Kingdom.

The space industry is new, but the UK has a proud aviation history, which includes Rolls-Royce and supersonic flight. We need to take the next step and grasp that opportunity. The industry has changed over the past five years, and I applaud the decisions taken in 2010 that led to the formation of the UK Space Agency. It is now an industry with a turnover of £11.5 billion. It employs 35,000 people, three quarters of them in graduate jobs, and a third of its production is exports, but the vision of the Department for Business, Innovation and Skills is that it should grow to become a £40 billion industry. For that, we really need to take action.

If it was not a political decision, there should not really be any great doubt that the choice should be Prestwick. We already have almost everything that is needed. We have a runway that is touching 3 km. We are in a coastal position, to allow start-off over the sea. We have the northern air traffic control centre in our campus, which allows the planning of what will be some pretty clever management of airspace, and obviously we have relatively empty airspace. We are close to Glasgow University and Strathclyde technology catapults and we have, uniquely, an aerospace cluster on the airport campus. It contains BAE Systems, Spirit AeroSystems and many others, all of whom are interested in the idea of a space port.

Up the road from us is Clyde Space, which makes small CubeSats that are only a litre in size. Early communication satellites were weighed in tonnes and were the size of a double-decker bus, but the UK, through Surrey Satellite Technology, has led since the ’80s in producing satellites that are about the size of a fridge. That is a step change. It has been shown that if the cost of getting a satellite into space gets down to the tens of thousands, everyone is going to want one. We will have to look at regulating that, otherwise space will be full of junk, but it enables all sorts of possibilities. However, we do not have a domestic launch site. That is why the aim is to have a UK space port by 2018.

As well as all the physical attributes of Prestwick, 20 years of Met Office data show that, despite preconceptions, it has the clearest weather, compared with Newquay, which people would presume is the closest contender. Low cloud is suffered by Newquay 31% of the time and only 11% of the time at Prestwick. Less than 5 km visibility is suffered by Newquay 15% of the time and only 4% of the time at Prestwick. I live in Troon, which is next door, and I can vouch for the fact that we have a weird little weather system, locally known as the Prestwick hole. People can fly into it, drive into it or walk into it. They can be surrounded by thick cloud, but they will look up and see a large hole of pure blue sky. That is what has made Prestwick the clear weather airport for the United Kingdom for decades.

I call on the Minister to look not just at having one space port. I think this is an industry that will mushroom. We need to accept that all sorts of sectors will develop that we have not even thought about. It will diversify. This is a real industry. It is not about saying, “Beam me up, Scotty,” or fretting about the dilithium crystals that we see on the telly; it is a multi-billion pound industry. I call on the Minister to be imaginative, to be brave and to be boldly going where no Minister has gone before. [Hon. Members: “Ooh!”] Nearly done.

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

More!

[Dr Whitford]

Oh, I am sure the Minister will have about two hours more.

Prestwick was Scotland’s first ever passenger airport and it was founded by Group Captain David McIntyre, the first man to fly over Everest. That is the kind of imagination and drive we need. I call on the Minister to please be imaginative and to support the industry across the entire UK so that it can live long and prosper.

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[Patrick Grady]

That is a fair point. It is important to recognise the huge achievement of all the astronauts of various heritages and from various parts of the United Kingdom. There is certainly no intention to play trumps.

[Dr Philippa Whitford]

Did not that gentleman change his nationality? He had dual nationality, and did not fly with the Union flag on his suit, as Helen Sharman did.

[Patrick Grady]

My hon. Friend was absolutely correct to pay tribute to Helen Sharman. I remember that as well. I was particularly young at the time, but I will leave Members to work that out for themselves, if they want to look up my biography.

The shuttle programme was a huge inspiration to many people. It is a very sad loss, but if its end several years ago was a low, we are now going through something of a renaissance. There have certainly been a number of highs recently, as I have mentioned. The fact that 15,000 people attended events to watch the launch of the Principia mission just before Christmas, including those of us in the Jubilee Room and later in Portcullis House, demonstrates how the international space station continues to serve as an inspiration.

Many of us who watched the amazing opening ceremony of the Glasgow Commonwealth Games will remember that, just when we thought it could not get any more exhilarating, a live broadcast was beamed down from the ISS. I was not at the ceremony, but with thousands of other people on Glasgow Green on that great day of celebration. There was a real coming together, with exactly the kind of inspiration that the hon. Member for Bracknell spoke about. It was humanity at its finest: people coming together from all over the world to take part in sporting endeavour and being supported by their fellow human beings hundreds of miles above the ground. It was particularly appropriate because, as we have heard and will continue to hear, Glasgow—and indeed Scotland—plays a significant role in the modern space industry and in space science.

In December 2015, my old university, Strathclyde, hosted the annual Canada-UK colloquium on the future of the space industry, which was attended by the Scottish Cabinet Secretary for Culture, Europe and External Affairs. Delegates visited two companies in the city, Clyde Space and Spire, which specialise in cube satellites technology and data. In the margins of that event, the First Minister strongly backed the calls that we have heard and will no doubt continue to hear for a spaceport to be located in Scotland. She pledged that the Scottish Government will do whatever they can to ensure that one of the bids is successful.

In my constituency, the University of Glasgow has one of the leading centres for space science and research in the UK, or indeed in the world. Space Glasgow brings together more than 20 academics from a range of disciplines to co-ordinate research, especially under the key themes of exploring and understanding space, mission analysis, risk and technology.

One recent achievement has been the university’s involvement in the launch of the European Space Agency’s LISA—laser interferometer space antenna—Pathfinder spacecraft. The launch in December marked the end of a decade of work for a team from the university’s institute for gravitational research, which helped to develop the craft’s sensitive optical bench. The bench is a hugely complex and important technology. It has a laser interferometer. [Interruption.] My hon. Friend the Member for Glasgow North West (Carol Monaghan) congratulates me on my pronunciation. It was developed, built and tested by the university’s team, and is capable of detecting changes in distance between test masses of as small as 10 picometres. It is an outstanding scientific achievement in its own right, and the images and knowledge that the Pathfinder will produce will no doubt help to inspire generations to come.

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[Jim Shannon]

Absolutely.

Ensuring that the space sector has a place in Northern Ireland and is aware of what we have to offer will go some way towards addressing the brain drain issue of too many of our young people emigrating. I would like to hear from the Minister how the space policy can better connect with Northern Ireland.

Northern Ireland has a proud history of air flight, although it is not linked directly to space policy. Henry George Ferguson, who was better known as Harry, a brother Orangeman, was a Northern Ireland engineer and inventor who was noted for his role in the development of the agricultural tractor. He was also the first Ulsterman and Irishman to build and fly his own aeroplane. The first ever airport in Northern Ireland was in my constituency of Strangford, in Newtownards, and was built in about 1910.

Northern Ireland has a fantastic aerospace industry with Magellan and Bombardier, which has been established for many years. I believe that there is a role for those aircraft companies to play in space policy and development. They can and should be part of it.

The space sector is fundamental to the future UK economy. I welcome the Government’s civil space strategy and the goal that the space sector will contribute £40 billion a year to the UK economy by 2030.

[Dr Philippa Whitford]

The point that I was trying to make in my opening speech was that the bid talks about a UK spaceport, whereas I think there will be different sectors. One sector that will come in the not-too-distant future is hyperbolic sub-orbital flight. Once we get past the Virgin Galactic model of a plane and a wee rocket, we will have the combination of jet and rocket engines, such as SABRE—the synergistic air-breathing rocket engine—which will go from standstill to orbit and back down. We will be able to fly to Japan in a short period of time. Different sites around the UK may therefore follow totally different routes. That should be enabled, not blocked.

[Jim Shannon]

I thank the hon. Lady for that significant and important intervention. She shows the vision that all of us in this House should have. There are no barriers to what we can do. Some of the things that are in “Star Trek” are not impossible, so let us look forward to those developments. I look forward to being able to travel from A to Z—from Belfast City to Heathrow—in a matter of seconds. If that is ever possible, we will be able to get here and back a couple of times and to do business at home and here, all in the same hour. Is that possible? I do not know, but I hope it will happen.

Thinking back on how space has been discovered, I am always mindful of the first time man stepped on the moon. It was one small step for man, one giant leap for mankind. For me, and I think for many others, that showed us the immensity and size of the universe that God created, and it focused our minds on God’s power and the fact that it was not for us as children, and that he is in total control of the universe.

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[Carol Monaghan]

Absolutely. It is really important that science fiction writers continue to write, because they often provide ideas and encouragement for creativity and development.

Satellites are also important in other areas. I have mentioned television; I could also mention communications, and weather and climate monitoring. It was satellites up in space that first photographed the issues with the polar ice cap, and we have now been able to compare the photographs that were taken 30 years ago with those that are being taken now, which are showing the real impacts on the ice cap.

[Dr Philippa Whitford]

The United Kingdom obviously has the potential to be part of a world network of satellites, in that the geostationaries are likely to be launched from America, the United Arab Emirates and Singapore, whereas Australia and the northern hemisphere will be launching satellites into polar and sun-synchronous orbits. Obviously, another blatant punt for Prestwick is that we are further north.

[Carol Monaghan]

I thank my hon. Friend for that intervention. Different areas can no doubt provide different services.

Possibly the most famous satellite is the Hubble space telescope. I have been asked why we should not simply view the stars from a dark area of the Earth, such as Chile or Hawaii. The answer is that the Earth’s atmosphere is a fluid. Let us try to imagine viewing images through water in a swimming pool. That gives us an idea of what it is like trying to view space from the surface of the Earth. Getting out of that fluid and putting the Hubble space telescope up there have enabled us to get images that would never have been considered possible in the past.

The third really important, and really exciting, aspect of space exploration is the possibility of living in different environments. It was thought for a long time that two things were required for life to exist: an oxygen-rich atmosphere and liquid water. However, we have now seen evidence, even on Earth, of life existing in extreme areas—for example, at very deep pressures in the ocean and in very cold parts of the world. That gives us real hope that there might be life in other places, even within our own solar system. It also gives us the opportunity to think of living further afield beyond the constraints of the surface of the Earth.

We have mentioned astronauts already. I have counted seven British-born astronauts, although I might have got that number wrong. Two of them are space tourists, and a number of them moved to the United States in order to pursue their careers, but what was really exciting about Helen Sharman and Major Tim Peake is that they were both living here in the UK. That gives our youngsters great hope.

We must not forget, however, that space travel is extremely dangerous, particularly during take-off and landing. The Challenger disaster in 1986, in which seven astronauts were killed as a result of faulty seals in the solid rocket boosters, is an example of that danger. In describing the dangers of re-entering the atmosphere, I shall refer again to the fluid I mentioned earlier. Let us imagine skimming stones on the surface of a lake. That is what it is like trying to get a spaceship back into the Earth’s atmosphere. It has to enter at a particular angle and at a particular speed. If it gets those things wrong, it will bounce off the atmosphere like a skimming stone. If the angle of entry is too steep, it will burn up very quickly. It is a very precise operation. We also remember the Columbia disaster in 2003.

When I was at the Science Museum just before Christmas with all those children, they cheered and shouted as the rocket was launched. I did not cheer and shout at that point, however, and the people in ground control at the European Space Agency also waited until the rocket had got into orbit proper before the celebrations really started. That is the point at which it is considered to have become a lot safer. We must pay tribute to the bravery of these astronauts. Theirs is a dangerous job, albeit a glamorous one.

As my hon. Friend the Member for Central Ayrshire (Dr Whitford) mentioned, Tim Peake is to do his spacewalk tomorrow. He will be outside the space station for more than six hours, which is no small task. It is highly technical and highly dangerous, and we wish him all the very best.

I have been pleased to hear so many Members talk about the importance of science, technology, engineering and maths and of getting girls involved in those STEM subjects However, to do that, we need teachers in place, and a serious policy of recruitment and retention of teachers. We need to think about how we will attract people from other areas into teaching.

A few years ago, I was lucky enough to meet a NASA astronaut, who was talking to a group of my school children. He was asked by one, “What do I need to study in order to become an astronaut?” His answer was great. He said, “It doesn’t matter. You must follow what you are passionate about—be that material science, engineering, physics, chemistry, biology or medicine. Follow what you are passionate about and then other things will follow.” That is an important message for our young people.

Finally, I ask the Minister to commit to the space industry not just financially, but in terms of advertising and ambition. As my hon. Friend the Member for Paisley and Renfrewshire North (Gavin Newlands) said, we must have the ambition and we must say to our young people, “This is for you and it is available to everybody.” On the back of Tim Peake’s mission, which has been so inspirational to watch, we really need to get the message out there that space is open for business. I now call on the Minister to make it so.

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[Dr Philippa Whitford]

We called this debate to celebrate Major Tim Peake’s spacewalk tomorrow, and obviously the incredible work he is doing to engage children and young people. Many Members have spoken about the need to engage girls, in particular. I do not think that there is really a clash between us on whether Tim Peake or Helen Sharman is the first British astronaut; they are people we should be promoting together. There is no friction between them. Indeed, she has given him her copy of Yuri Gagarin’s book to take there as a souvenir. Having spent 33 years in surgery, I know what it is like to be in a man’s world. I remember being told formally during my third year at medical school that women could not do surgery. We have come a long way.

We have heard from Members from all UK nations bidding for their site, which I think is absolutely right. We have also heard about the incredible breadth of the industry, and there are many things that we have not even thought about today. I am grateful to hear from the Minister that the structure and licensing will be looked at, because I think that is really important. I look forward to the day when our hubs are called not aerospace, but aero-space—aero, hyphen, space—and I expect that we will have multiple clusters and hubs. A time may even come when we need more than one space port; perhaps one for tourism and suborbital parabolic flights to Japan or north America, and one for getting satellites up—satellites that will end up being the size of a packed lunch.

I am grateful to all Members who have taken part in what has been a fascinating debate. We want to encourage our young people simply to aim for the stars.

Question put and agreed to.

Resolved,

That this House notes the scientific, cultural and technological opportunities arising from exploration of outer space and the significant contribution the space industry makes to the UK economy; further notes the increased public interest in space exploration resulting from Major Tim Peake’s mission to the International Space Station (ISS); welcomes the global co-operation that has led to the development of the ISS over the last forty years; takes note of the shortlist of airports and aerodromes that could host a UK spaceport published by the UK Government in March 2015; and calls on the Government to bring forward further advice and support for organisations considering developing such facilities so that they might be operational by the Government’s target date of 2018.

Hand Hygiene: NHS

Philippa Whitford Excerpts

Wednesday 13th January 2016 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Thank you for calling me, Sir Alan, in a debate that sounds simple but is important. The education centre in my hospital in Ayrshire is named after Sir Alexander Fleming, because the man who discovered penicillin was an Ayrshire lad. It may be that people have got complacent and think that the age of infections is done with. In earlier generations, children did wash their hands, but then people got too casual.

In Scotland, we began to be much more fixated on hand-washing in 2001, after some of the evidence about the impact of hospital-associated infections came out. In the early 2000s, our uniforms changed: white coats were banned, tops needed short sleeves and eventually we moved to no ties or jackets. We also began to have more audit in the system. We went through a painful experience between 2006 and 2007: a massive clostridium difficile outbreak in the Vale of Leven hospital in which 163 patients were affected and 34 died. Nicola Sturgeon, our First Minister, was the Cabinet Secretary for Health at the time, and she instantly set up a hospital-acquired infection taskforce when the problem became obvious. The whole approach accelerated.

We have several different organisations that are part of driving hand-washing, but it is about the culture. It is not a question of someone facing the threat of losing their job or being sanctioned; it is about getting people to see hand-washing as part of the rhythm of every contact. There is observation, as has been mentioned, and there are also ward champions. The observation is hidden, so no one knows it is happening. I must say, to my chagrin, that in every single audit of staff, doctors were the worst. That fact was published, to shame doctors by showing that we were the slowest to adopt the right practice. We also observe visitors, and there is alcohol gel as people come into wards. My office was on the ward, and it was easy to see physios, nurses, doctors and visitors interacting with the alcohol gel.

I pay tribute to the hon. Member for Morley and Outwood (Andrea Jenkyns) for setting up the APPG for patient safety, which I am part of, and the Handz campaign. In Scotland, we have the “Happy Birthday” hand-washing campaign, which has been running for some time. We already have that campaign in schools, but it is important to raise the issue.

To verify hand-washing, we have the Healthcare Environment Inspectorate, which turns up without anyone knowing it is coming. Its inspectors are down under the beds and poking around in the mattresses on the trolleys. They are observing staff and, believe me, if there is a dusty corner, they will find it. They also look at surfaces—is there a cracked surface or a rough bit of floor that could be difficult to clean? It is about not only hands but the cleanliness of the entire ward.

My hospital was lucky in that it never outsourced cleaning. We never had companies coming and going. We kept our ward maids. It was their patch, in which they took pride. The supervisor comes along, like your mother-in-law, wearing a white glove, to check exactly what everything looks like. They can be seen under the bed, in among the frame, cleaning every pick of it while chatting to the patient. Those are simple things, but we need to do them, because we are moving into what could be a post-antibiotic era. To think that we could lose something that we started using in 1942 after 80 years is absolutely terrifying, so we need to bring that culture back.

In the NHS, every single trust publishes its infection figures every quarter. The hon. Member for Amber Valley (Nigel Mills) mentioned all infections, and as a surgeon I have to admit that infections happen for all sorts of reasons. The reason why C. diff and MRSA are so important is that their root cause is the poor use—prolonged use—of antibiotics, which causes C. diff, and poor hospital hand hygiene, which causes MRSA.

Trusts’ infection rates are published every month and pinned up on the wards, so that visitors can see them. We also put out the reports of the Healthcare Environment Inspectorate. I have shown a critical report on one of our hospitals to the hon. Member for Morley and Outwood, to show how thorough and challenging the inspection is; there are no holds barred. That is what has to be done. There are also infections out in the community. The hon. Member for Bridgend (Mrs Moon) mentioned cytomegalovirus, which, again, can simply be reduced by hand-washing.

We in this place have to realise our part in all of this. We shake hands with hundreds of people. We go and eat our lunch, and I do not see people forming a queue at the ladies or gents to wash their hands. We should all have a bottle of alcohol gel in our bags. I am on the House’s medical panel, and I have put on the agenda that we should have exactly the same dispensers of alcohol gel used in hospitals outside our canteens. We need to set examples, whether that is by visiting local schools or simply by showing all the people we interact with.

The NHS has a responsibility for hand hygiene. We need to change the culture in the NHS, so that if a member of staff is near a patient and touching not only them but their environment, the member of staff washes their hands or uses alcohol gel before their next contact. We in this place also have a role in getting the message out into society.

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[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank my hon. Friend the Member for Amber Valley (Nigel Mills) for bringing this important matter to the notice of the House, and I thank hon. Members on both sides of the Chamber for their speeches and contributions.

Hand-washing is an interesting thing, is it not? For the majority of human history, from Pontius Pilate to Lady Macbeth, it was associated with a bad act. Hand-washing was what someone did after they had done something wrong. It was only through the transformation in clinical knowledge in the 19th century that the understanding of hand-washing and its criticality in reducing infection rates became commonplace, but it was a long fight. It is worth remembering that Ignaz Semmelweis, the man who made people understand that washing their hands in obstetric and maternity settings reduced the risk of infection, was so criticised by his colleagues that it drove him to insanity, and eventually to death in an asylum. This was a hard-won victory, and I utterly endorse the wise comments made by the hon. Member for Central Ayrshire (Dr Whitford): perhaps it is because it has become such a commonplace part of our modern understanding of hygiene that we have forgotten its central importance in reducing infection.

My hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) came to the Department of Health a few months ago and sat in on one of the Secretary of State’s Monday morning care meetings to discuss her Handz campaign and the fact that she wanted to set up an all-party parliamentary group on hand hygiene. I know that her personal testimony brought acuity to our understanding of why this is important. It is all too easy to see MRSA, E. coli and C. diff rates plotted on a chart and to forget that, actually, the result of those infections can lead to the tragic and completely unnecessary loss of life. However, even if it does not lead to that, it can often mean a very extended stay in hospital, with serious injury sometimes incurred as a result of infection.

The overall story of infection caused by poor hand-washing has been good over the last decade. Rates of MRSA, MSSA, C. diff and E. coli have all come down— very considerably in some circumstances—but, as the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), rightly noted, we have plateaued in almost all of those, and worryingly so. In fact, in the case of MRSA, there has been a worrying, albeit slight, increase in rates in hospitals. That has now been consistent enough to constitute a trend.

We have to be clear that, from the Government’s perspective, we are still not entirely sure in each case why the reductions have not continued. To some extent, it is clear that an increasing role is played by community infection and community onset, or expression, of infection. We do not yet have a full understanding of the relationship between community settings and hospitals, and the chief medical officer is working very hard to try and understand it. Therefore, this is a pressing moment, not least because of the problems of antimicrobial resistance, which the hon. Member for Central Ayrshire mentioned, and which is why we have to be particularly vigilant.

Overall, the one thing that will guarantee that we do not make more progress is if I make a central directive from Richmond House and then ensure compliance through a massive, bureaucratic reporting mechanism. The only point on which I differed from anyone in their observations was when the shadow Minister, in his generally very wise comments, talked about the relationship to staff retention. That was because, although general infection control should be part of how teams work, it should be part of the personal, professional responsibility of a clinician, no matter where they work—whether in the community or between hospitals as a bank nurse or clinician—to take infection control very seriously.

How do we improve matters? How do we make sure that, as in so much of the NHS—to copy Bevan’s words, which I do not tire of using—we are “universalising the best” and lifting poor performers, of which there are several, up to the best standards in the country, some of which can be found with our neighbours in Scotland?

[Dr Philippa Whitford]

I have not worked in a hospital in England, but the poster campaign that the hon. Member for Morley and Outwood (Andrea Jenkyns) referred to involved massive posters that were in the lifts and targeted at visitors, porters, nurses and doctors. The five points of contact were above every sink and in every room. If we are trying to change a culture, I wonder whether the first thing is actually just to try to get the campaign out there among staff and visitors.

[Ben Gummer]

I take the hon. Lady’s point, and I agree that we have to re-educate the public that we have not won the battle and that we have to re-engage. I will take her comments to the chief medical officer and talk to her about what more we can do to re-engage the public in the debate on hospital-acquired infections.

NHS Bursary

Philippa Whitford Excerpts

Monday 11th January 2016 Westminster Hall

[Paul Scully]

I am a new Back-Bench MP so I was not around then, but I know that Martin Lewis was on a Committee at some point afterwards to determine relationships, but I will take advice on that.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

May I just clarify that figure of paying £5 a month, which is £60 a year? At £60 a year, that loan would never ever come close to being repaid over 30 years—over a whole working life.

[Paul Scully]

That is on a band 5 salary. I would expect nurses to increase that. The point of the student loans system is that it is a finite time period of 30 years.

--- Later in debate ---

[Paul Scully]

I will just complete my comments regarding student loans in general, but then I will come directly to the hon. Lady’s point because it is one of the issues particular to nurses that I mentioned a little while ago. Student loans in general do not go on credit files, so the only way that a loan, credit card or mortgage company will know if someone has a student loan is if they ask for it. Obviously, for bigger loans, they tend to ask. Student debt is not accounted for by mortgage lenders in terms of the total amount owed, although they will look at the affordability of the loan and at an applicant’s outgoings. When tuition fees and student loans were first introduced, the Council of Mortgage Lenders confirmed that lenders would not use that or add that total debt to the amount owed when they considered mortgages.

[Dr Whitford]

Is it not the case that the Financial Conduct Authority has announced that the size of someone’s student loan will affect their ability to get a mortgage and will be taken into account?

[Paul Scully]

Well, I think a lot of it is down to affordability. [Interruption.] No, there is a big difference. Someone might have an amount of £50,000 or something like that, for example, but it is about the repayment. Whether someone is paying £5 or £50 a month, that is the figure that lenders will look at to work out whether they can afford to repay the loan. As I said right at the beginning, that top line figure is not the crucial one. The crucial one is actually the amount that someone will pay out of their salary each and every month.

Looking at the current case and at positions that are particular to nurses, we have talked about the fact some people going into the nursing profession may already have a degree and are doing a second one. There are mature students. The average age of those applying to study is about 28 or 29. I believe I have covered my take on people’s concerns about the diversity of the workforce changing.

Under the current rules, people cannot usually access the student loans system if they have already done a degree to the same level. The view of the Council of Deans of Health is that the Government should make those courses exempt from that rule. I will be interested to hear what the Minister says about whether that is the case. If it is, in the new system, people would be able to access student loans if they wanted to—that would be an equivalent or lower qualification exemption. As repayment amounts are based on salary and not on the total loan, the amount repaid would be the same whether someone has one or two loans. Effectively, that makes it a graduate contribution, not a traditional loan. The system is slightly different from a graduate tax, which was discussed a few years ago, because it is finite—it finishes after 30 years, and a graduate tax, as we might have had under other suggestions, would have carried on going past a graduate’s retirement. As I said to the hon. Member for Hampstead and Kilburn (Tulip Siddiq), the introduction of tuition fees and loans for other degree courses has not led to a drop in applications and has not affected the diversity of applicants.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Thank you, Mr Evans, and it is an honour to take part in such an important debate.

There is no question but that England requires more nurses. The ratio is 5.8 nurses per 1,000 patients, the lowest in the UK, and yet NHS England cannot fill nursing posts. It is bringing nurses in from overseas and using agency nurses, so that number needs to be expanded. The approach taken is the idea of simply removing the cap, but the challenge is how enough placements will be found. As the hon. Member for Heywood and Middleton (Liz McInnes) said, how will that be funded when Health Education England is facing a massive cut? Furthermore, it is not simply a matter of funding the placements; they require the contribution of nurses and other staff on the wards who are already really busy. It is not something that can be dreamt up in an office in Westminster and happen by magic.

There is also the issue of whether, at the end of training, that unlimited number of nurses will all find jobs in our NHS. It is likely that they will not. We will therefore have wasted not just their money in the tuition fees they will pay for the cost of their training, but money invested by the Government in their training. That is short-sighted, because the Government will lose control of workforce planning, which is key, and with only 5.8 nurses per 1,000 patients, clearly that has not worked too well up to now.

There is an argument for re-expanding nurse places, which were at their height in 2004 when we had nearly 25,000 places and reached a low in 2012-13 of 17,500. At the moment, they have just crept above 20,000, but that does not even bring us back to the figures seen in 2001-02. We clearly need more places, but the idea that nursing students should take on the burden is ridiculous.

Hon. Members in the Chamber will know of my interest: I have been a doctor for 33 and a half years. If there had not been free tuition—and grants back in 1977—I could not possibly have become a doctor, let alone gone on to study surgery and work as a breast surgeon for all of those years. England is already losing out on students who have talent but not the opportunity to follow any degree, and medical degrees in particular. Now we are talking about nurses and allied health professionals—as Members have said, allied health professionals are included in that important group.

Some Members have asked about an impact assessment. We have not heard about one and it is clear that there been absolutely no consultation. The Royal College of Nursing reported that there was no consultation with it: I should have thought that that is where one would start.

We need to look at the bursary. As the hon. Member for Lewes (Maria Caulfield) explained, it is not exactly generous: £1,000 is guaranteed. Above that, it is means-tested and it reaches the dizzy heights of £3,091 only for people in London. That is not a lot of money. As my hon. Friend the Member for Paisley and Renfrewshire North (Gavin Newlands) mentioned, the bursary in Scotland is £6,578, which is all non-means-tested and non-repayable, because we consider it absolutely crucial to invest in the people we need to run our health service.

The biggest kick for students will be having to pay tuition fees, which are currently £9,000 a year: we do not know what they will reach in the future. That instant debt of 27 grand will certainly put people off. Even if I had been told at the age of 18 that I did not have to pay back the loan until afterwards, the idea that someone with no support in the world, as was the case at the time, would be signing on the dotted line to take on what was almost a small mortgage would be hard. People are not going to do that.

The idea that people will not be put off is naive. It will put off the 50% of nursing students who are postgraduates and mature students, and it will put off people from poor socioeconomic backgrounds. It will reduce diversity. We have talked about the need for Parliament to reflect our population, and it is crucial too that nurses and doctors reflect the population that they serve. That will change, because becoming a nurse will be an expensive business.

We need to think about why we moved from the old days of the enrolled nurse and the registered nurse: those were the nurses I used to work with. I have to say that, from the number of stripes on their hat, I knew exactly what experience they had and exactly what they could do. Many of us thought, “Why are we suddenly doing degrees?” but when we look at where our NHS is now, we see the whole point of that, because nurses are now leaders in the NHS and the vision of the future NHS workforce is of nurses leading independent teams, being out in primary care, triaging patients and diagnosing and treating on their own. The idea of the nurse as handmaiden has thankfully long been laid to rest.

The same applies to allied health professionals. About 30% of the patients who come to primary care have a musculoskeletal problem and part of the vision of improving primary care is to allow patients access to a physiotherapist—an expert on their problem—if they have a sore back, hip or knee.

Podiatrists provide care to an increasing number of diabetics. People are probably not aware that the life expectancy of someone with a severe diabetic ulcer is poor, ranking above only lung cancer and pancreatic cancer. That is a real threat to patients, so we need podiatrists who can check feet and treat ulcers at an early point. There are only 3,000 podiatrists for the whole of England, yet student numbers have been reduced from 361 to 326.

We are reducing the numbers of the very people we envisage needing in future—it is like the right hand and left hand are not talking to each other and do not know what the other is doing. As we say in Scotland, two grey cells and they are in a huff; they are not talking to each other. That needs to change. We need to look at the NHS as a whole and the people we expect to provide care in future.

As I mentioned, we have a reasonable bursary in Scotland. I would not say that our students are living the high life on £6,500 a year but, like our other students, they do not pay tuition fees. The hon. Member for Lewes cited a figure for graduates earning £100,000 more, but we must remember that that is over an entire working lifetime, so that is £2,500 a year, which is not a huge amount, and that is reduced by their debt. If students are graduating with £50,000 or £60,000 of debt from their study and living costs and so on, those extra earnings shrink to almost nothing. We will gradually reach the point at which people who might have considered being nursery nurses or primary school teachers or contributing to society in another way that is not well remunerated will not feel able to take on that debt.

We need to look at what we will need in future. We require physios and radiographers, who they will provide the wraparound care for our ageing population, out in the community, leading their teams and working on their own. I call on the Minister to follow the Scottish example and invest in people. That is the key.

Sadly, what we have seen recently—certainly in my short time in the House—is the debt created by the bankers towards the end of the previous decade became sovereign debt, which is now becoming individual debt. All the time in the main Chamber we hear how we cannot leave public debt to future generations, but we are putting it on future generations as individuals. We need to recognise that. People struggle to get a house, they struggle to get education and they struggle to get a job. We need to change that. In this instance, our return is a coherent, diverse, broad NHS staff made up of people who are committed to what they do. I call on the Minister to answer the many challenges raised today and to say how he will invest in the future workforce that will look after the people of England.

--- Later in debate ---

[Ben Gummer]

The numbers do relate to full-time students. I concede that, in the case of part-time students, there have been, for a longer period than the time since 2011, problems in maintaining a rise consistent with that across the population. The Chancellor has accepted that fact, which is why he devoted specific attention and funds in the spending review to supporting part-time mature students. However, in this case we are talking about a nursing degree that is, for the vast majority, a full-time one. For the majority of nurses—I believe the figures are not quite those given by the hon. Member for Central Ayrshire, although I do not have them to hand—their degree is a normal undergraduate degree, taken before maturity. For all those people, I want the same benefits that have been provided across the rest of the university sector. The hon. Member for Sheffield Central was a Member in the previous Parliament, as was the hon. Member for Lewisham East, and they made exactly the same claims then as they do now about a reduction in opportunity, a reduction in number of applicants and a reduction in all the areas where we want universities to perform. I am afraid they have been proved wrong and the Government have been proved right, and that is why it is important that we extend those benefits to nursing.

I will address in terms the process by which we have come to this decision, about which the hon. Member for Ilford North raised some detailed questions, and our intention for the wider reform of training routes into nursing. It is important that hon. Members should see the changes that we are making to university training as part of a wider reform enabling us to increase both numbers and the quality of courses, as well as improving the student experience for nurses entering nurse registration by whatever route. The policy has been worked through in considerable detail in the Department of Health. There has been consultation with leading nursing professionals. The Department of Health is advised by a number of chief nurses. All were consulted and involved in working up policy in this area, which is entirely how it should be.

We have been very open about the fact that we want a full and detailed consultation about how the proposals should be implemented. We want that to be thorough and to involve everyone, whether they oppose or are in favour of the changes, so that we get the detail right. While I will maintain that the overall policy direction is correct for the reasons I have given, it is important to make sure we implement the detail correctly. If we do not get it right, it could have a perverse impact. If we do, this could be an important moment for the nursing profession, because we will be able to do something that previous Governments have not been able to do. Even in the wildest spending realms of the imaginations of some colleagues of the hon. Member for Lewisham East, it would not be possible to commit the resources to expand the training places that the route we have decided on will make possible.

The Opposition must answer a central point when they set out their opposition to the proposal. The fact is that we want to give more training places to people who want to become nurses. Last year, there were 57,000 applicants for 20,000 places. We want to expand the number of places so that people get the chance to become a nurse, but within the current spending envelope—even if we were to increase it more significantly than we propose to over the next five years, and certainly far more significantly than the Opposition propose—it is not possible to do that.

[Dr Whitford]

Does the Minister not accept, on the basis of invest to save, that if agency nurses are costing the NHS £2 billion, such an investment in future nursing would, in actual fact, save money in the long term?

[Ben Gummer]

I agree with the hon. Lady that one key thing we have to do is ensure we have a permanent workforce and do not depend across the service on agency and locum nurses and doctors. However, part of that is ensuring we have the workforce numbers trained to be able to fill places. In the past, we have failed to predict workforce numbers with any accuracy, which is something all Governments are guilty of.

No matter what happened to training places, the changes required across the service because of the impact of Mid Staffs on our understanding of safe staffing ratios has meant an increase in the requirement for nurses. At the moment, in the very short term, that requirement has to be plugged by agency and locum nurses, but we want to replace them with a full-time permanent staff that is sustainable. I hope the Opposition are able to bring an alternative view—I would be interested to hear it—but if we are to increase the number of training places, we have, simply put, to be able to afford to do so. The surest way of expanding places is to repeat exactly what we did for all other university degrees back in 2011, which has seen a massive expansion in training places.

The other point that the hon. Member for Lewisham East and her colleagues must address if they wish to oppose this reform is how they would afford not only the expansion in training places, but the maintenance support for nurses going through training. I completely agree with the hon. Member for Central Ayrshire and my hon. Friend the Member for Lewes (Maria Caulfield): the current bursary funding is not generous. It is certainly not sufficient for many, especially those with caring duties, to maintain themselves, but how can we find the increase while ensuring we expand places at the same time?

Through reforming bursaries, we are ensuring that we can increase the cash amount by 25%—something that, again, could not be funded out of the existing envelope, even though we are increasing NHS spending more than any other major party promised at the last election. We are therefore able to provide the support that people going through nurse training are rightly asking for.

--- Later in debate ---

[Ben Gummer]

I will write to the hon. Lady with year-by-year figures, where available—pass rates change every year. The nursing training course is one of the most over-subscribed of all undergraduate courses. Compared with other undergraduate courses, whatever metric we use, it is a significantly over-subscribed course. We know that a significant number will not receive a place on a course, even though they have met the criteria.

[Dr Whitford]

If the cap is completely removed, the Government will lose any ability to plan a workforce for the future. If all 47,000 applicants are given a place, what will happen when they come out at the other end? There will not be the placements to train them, and there will certainly not be the jobs. Is this just a way of having a flood of cannon fodder nurses, so that their pay can be frozen?

[Ben Gummer]

The hon. Lady mentioned in her speech, as did the hon. Member for Ilford North, the need by some trusts to recruit from abroad and to use locum and agency nurses. I hope she will understand therefore the internal logic of our argument: even at the moment, we are not able to fill places from the domestic supply of nursing graduates. It is precisely our wish to expand that supply. Planning the workforce will, in large part, be controlled through the placements that Health Education England buys from universities on behalf of the taxpayer and the NHS.

Several hon. Members raised the issue of clinical placements, on which we are now in deep discussions with Universities UK. The hon. Member for Ilford North raised that issue, as did my hon. Friend the Member for Lewes. I urge them both to look at the example of the University of Central Lancashire, and its relationship with Central Manchester University Hospitals NHS Foundation Trust and Bolton NHS Foundation Trust. They are delivering innovative and exciting ways of providing new placements outside the scope of the existing placement scheme, even without any Government support or change in the rules.

There is an appetite for delivering additional clinical placements, and we will see how that progresses in our discussions with Universities UK. All the while, it is important to point out that the Nursing and Midwifery Council has to register nurses at the end and ensure that the degrees are satisfactory. All of this will have to abide by the NMC’s recommendation that the placements are up to scratch, so we are constrained, quite rightly, in anything we might want to do by what it decides in that regard.

[Ben Gummer]

In the course of taking interventions, I am skipping around the points that hon. Members have raised, which I want to address. The hon. Lady is right that the University of Central Lancashire has worked up a really good course, which is partly about job security at the end of it. It is exactly the kind of scheme we are looking at to improve attrition rates, which were another point that my hon. Friend the Member for Lewes raised. We have to do better to help nurses complete their courses, and again, that metric has improved across the rest of the university sector since 2012. I hope that in freeing up nurse training a little through our reforms, we will be able to provide better incentives for foundation trusts and NHS trusts to have an end-to-end training offer for student nurses—if not modelling the one that the University of Central Lancashire has brought in, then a variant on it.

There is a lot of exciting thinking out there in universities, foundation trusts and NHS trusts about how we can implement the reforms to make nurse training better, expand the number of places and solve their workforce problems. My job is to release that thinking. I cannot do it within the straitjacket of the existing system, but I can through the reforms I am able to make.

[Dr Whitford]

Is the pilot in Lancashire that has been described not an argument for better manpower and workforce planning, rather than for simply throwing things open to the winds, which is what is proposed?

[Ben Gummer]

I was merely making the point that there is a lot of exciting thinking out there, outside the workforce planning that we are doing. Through our reforms, I hope to be able to encourage more of that. I know that there is some very innovative thinking in my part of the country. People want to get on with it in the NHS and university sectors, but at the moment they cannot, because of the constraints on how nurses are trained and recruited.

I turn to the issues raised by my hon. Friend the Member for Sutton and Cheam, who introduced the debate on the petition. He asked four specific questions. One was on specialist courses, and the shadow Minister repeated that point. Some specialist courses have suffered shortages for many years. For several years, the Higher Education Funding Council for England has been dealing with the wider attribution of training funds and university tuition funds across the sector, and it will take on responsibility for making sure that very small and specialist courses are properly funded and promoted. In liberating the universities sector a little, I hope that we will be able to excite interest in some of the more specialist courses, which have been suffering for several years, and better match foundation trusts’ workforce requirements with universities’ ability to deliver.

My hon. Friend asked whether foundation trusts will be able to pay back loans as an inducement. I do not know whether that will be possible for foundation trusts specifically, but they are free to offer pay premiums to aid their recruitment—they have been able to do so for many years. I imagine that will continue.

My hon. Friend asked about the number of placements and the financing of them. That will be determined by the consultation and in discussions with Universities UK. He also asked about the arrangement for placement expenses, and I have heard his point. I know it is a unique problem that is specific to student nurses—although to some extent, it also applies to student teachers—and again, we want to look at that in detail in the consultation to ensure that we get the implementation right. That is why it is not just a matter of pure detail; it is about how the policy works as implemented.

The hon. Member for Ilford North raised a number of points in addition to the ones he raised in his Adjournment debate. I apologise for not having answered all of them previously; I had a short time and he raised a huge number, with his usual eloquence. However, I hope I can answer some of his specific points on this occasion.

The hon. Gentleman asked about the problems of recruiting into community-based settings. There is a shortage in that specialty, which has traditionally suffered from problems in recruiting. I am well aware, just as he is, of the need to improve recruitment into community settings and primary care settings if we are to get the proper integration of primary and secondary care, and more importantly, of social care and the NHS. That is one of the key challenges facing us in the years ahead. Health Education England has a scheme under way called “Transforming nursing for community and primary care”, which it launched just over a year ago, precisely to incentivise nursing applicants into that specialty. Again, I hope that universities will respond positively, as they have in the case of other courses, so that they step up to the workforce demands placed on them as a result of the reforms that we are making.

The hon. Gentleman asked what the amount of debt to be written off was. The long-term loan subsidy—he will understand the phraseology—remains at 30%. That is the figure that the Treasury has set. As a consequence of that and because of, as he put it, reliable reports from newspapers, which he imputed to be fact, he asked whether there would be an increase in student fees above inflation. I can say to him that there are no plans at all to increase student tuition fees above inflation.

The hon. Gentleman asked whether I would be willing to meet those who disagree with my point of view and that of the Government on this matter. I would, of course, and I have done already. I would be delighted to meet anyone whom he wishes to bring to me, including the demonstrators he mentioned.

The hon. Gentleman began his speech, however, by talking about a burden of debt. It is important for all of us here to remember that the loan is an attachment against earnings, which is time-limited and limited according to the ability to earn, so it is not like debt such as a mortgage. We made the same argument back in 2011 and 2012, and it is important that we use language correctly in this place. We saw an uptake in university courses after the 2012 reforms. Once prospective students understood how the financing worked, how they would pay back the tuition fees and that it was not a debt that would saddle them in the same way that a mortgage or hire purchase agreement might, as was suggested at the time, university applications increased significantly. We all have an interest in this place in making sure that the number of people going into nursing increases. It is important, therefore, that even if we disagree with the policy, we do not misrepresent it.

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 5th January 2016 Commons Chamber

[George Freeman]

I pay tribute to the right hon. Gentleman. He is a Norfolk colleague and as Minister did a lot of work in this area. He raises an important point that as a society we need to think profoundly about how we integrate health and social care. As I say, the Government have made a £3.5 billion commitment from the new precept and the better care fund is a significant commitment, but he is right—we will have to go further. Through the devolution programme and the integration programme, we will have to develop more powers so that local health leaders and care council leaders can better integrate services to reduce unnecessary pressure.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

In Scotland, A&E performance is published weekly, but since June that in England has been published only every month and now after a six-week delay. Since that time, the performance in Scotland has risen and 96% of people were seen within four hours in Christmas week, which is a huge challenge, whereas the last data published for England were for October and show a figure below 90%. Do the Minister and the Secretary of State accept that to improve performance we need to return to more timeous and frequent analysis and publication?

[George Freeman]

I share the hon. Lady’s interest in data and in proper information. We need to be a little careful about Scottish figures. Over winter, England publishes three times more A&E performance measures than Scotland every week. We publish quality rankings on hospitals, care homes and GP surgeries, which Scotland does not. What we do not hear about in Scotland is A&E closures, A&E diverts, emergency admissions, general and acute beds—I could go on. It is dangerous to compare data that were not prepared on the same basis, but I share the hon. Lady’s enthusiasm, as does the Secretary of State, for information.

[Dr Whitford]

I am aware that the renewed strike call from junior doctors has actually been called in order to meet the new rules created by the Government’s own union laws and that negotiations are ongoing. To avoid an impact on hospital waiting times, what will the Secretary of State bring to the negotiating table to try to reassure junior doctors?

[George Freeman]

I am delighted to be able to announce—the hon. Lady might already have heard this—that the Secretary of State has appointed Sir David Dalton from Salford Royal to lead on that. I repeat the offer that the Secretary of State made this morning: we are very close to an agreement, so the right approach is not to strike, but to come to the table and reach it.

Conception to Age 2: The First 1001 Days

Philippa Whitford Excerpts

Thursday 17th December 2015 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

One other area we need to consider is malnutrition and micro-malnutrition. Regardless of obesity or weight, we are seeing a more malnourished diet in this country from poor quality food and reliance on food bank food. Work done has shown low levels of iodine, which increases cretinism, and low levels of folate, in girls in their late teens, which means that, as they enter the child-bearing age, they are at high risk of having children who have major disabilities.

[Bill Esterson]

I am glad the hon. Lady managed to get that point on the record. That is an incredibly important part of the picture of the damage done to brain development. I want to concentrate my remarks on the damage from alcohol and the inquiry report that the all-party group has just published, but I am grateful to her. Her point is very complementary to my remarks.

My hon. Friend the Member for Nottingham North made a powerful point on the potential of early intervention—he said it could be the biggest deficit reduction scheme of all and mentioned the figure of £17 billion. That is an important point when it comes to foetal alcohol spectrum disorders. In Canada and the US, they use the term “million dollar baby”. It refers to the lifetime costs of the damage done by alcohol during pregnancy. The hon. Member for Congleton and others have mentioned many of those costs, whether it is the inability to engage socially or hold down a job. Many end up in the criminal justice system and many of us care for children and young adults who were damaged by alcohol during pregnancy. All of these things have huge economic and social costs. It is incredibly important that we take those points on board, whether on alcohol harm or other forms of damage and deprivation caused during pregnancy and in the early years.

The all-party group took evidence from a great many experts: Martin Clarke of the Adolescent and Children’s Trust; the consultant psychiatrist and nationally renowned expert on FASD, Dr Raja Mukherjee; Sir Al Ainsley Green, now President of the British Medical Association; SABMiller from the drinks industry; the British Pregnancy Advisory Service; Public Health Research; a midwife; and parents and carers, as well as young adults living with foetal alcohol spectrum disorders. We heard heartrending examples of damage done, difficulties faced and the life-limiting effects of alcohol during pregnancy.

I want to pay tribute to and thank the Foetal Alcohol Spectrum Disorder Trust for the secretariat support, and other organisations such as the National Organisation for Foetal Alcohol Syndrome, which has for many years attempted to improve the education of professionals in health, education and other sectors on what is needed to prevent the disorder and to support people who care for children and young adults; and Mencap, which advises GPs.

There have been some puzzling changes over the past 20 or 30 years, something the hon. Lady touched on. In the 1970s, alcohol consumption in the UK was one of the lowest in the western world. From that low base, however, there has been a steady increase. There is a remarkably strong correlation between the increase in alcohol consumption and the increase in the incidence of mental health problems, attention deficit hyperactivity disorder, autism, Asperger’s, and many different kinds of learning and physical disabilities. The remarkably close correlation suggests causality. Brain damage is not reversible and is clearly significant. As the hon. Lady said, the World Health Organisation estimates that 1% of people born today are affected by FASD. Even at 1%, that is 7,000 children born every year. That is 7,000 too many.

For anyone new to this subject, there is a widely shared video of the effect of a small drop of alcohol on an embryo, which is compared with an embryo that does not experience the ingestion of a small drop of alcohol. The difference is stark. For two hours, the embryo stops moving altogether. We can only wonder at the damage done at that very early stage of pregnancy. International evidence suggests that the damage is done in the early days and weeks in particular.

As the hon. Lady said, the advice is far from clear. On the one hand, people are told not to drink. That seems clear. From the evidence heard by the all-party group, that is the right advice. However, the advice also says that if a woman chooses to drink, she should drink only one or two units. The advice appears inconsistent and contradictory. We took evidence from health professionals, the vast majority of whom do not appear to be aware of the real level of risk and danger. They do not appear to be passing on advice to women planning to conceive or who are pregnant. That is why our inquiry recommended it be made clear that the best thing for mother and baby is for the mother not to drink at all.

I hope that the Minister—I am sure he will—and all who are interested will read the report and carefully consider its recommendations. It is only an initial report—we plan to continue our work—and I hope that he or one of his colleagues will come to one of our meetings to discuss this matter in greater detail. As my hon. Friend the Member for Nottingham North said, early intervention gives us a fantastic opportunity not only to improve the life chances of many people but to save a lot of money. When it comes to the damage done by alcohol during pregnancy, the 7,000 figure, which, from the evidence we received, might well be on the low side, suggests that there is a huge opportunity. I hope that, as a result of the work we have done and the fine work of those Members responsible for today’s report, progress can be made and that the Minister will agree to commission the prevalence study, so that we can start to reduce the number of children damaged every year in this country.

Tobacco Control Strategy

Philippa Whitford Excerpts

Thursday 17th December 2015 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The hon. Member for Harrow East (Bob Blackman) gave us a comprehensive summary of the situation, so I will bring us back to a few key points that we need to think about. What are the issues? They are not just the obvious things that people care about, or see mentioned in adverts, such as lung cancer; there is hardly a part of the body that is not affected by smoking. There are many problems that people are not aware of, such as stomach ulcers and bladder cancer. There are also the obvious ones, such as strokes, heart attacks, peripheral vascular disease and dementia—14% of Alzheimer’s is caused by smoking. Amputation is commonly due to peripheral vascular disease. Those are things that put people in a dependent situation and often result in them being in care homes. Not only does that have a direct cost for the NHS, but huge costs in our care world will become an increasing burden.

We have had quite a lot of success, but as was mentioned, 18.7% of people in England smoke. Unfortunately, while there has been a considerable drop in Scotland, the figure there is 20%. We started with the worst heart attack rates, and we still have 10,000 people in Scotland dying from heart disease every year. That number is almost equivalent to the population of Troon, where I live. That is a considerable number of lives lost every year. In England, the figure is 100,000. In addition to the question of the number of people who die, there is the painful journey to dying, and the amount of debilitation and suffering for the person and their family.

We have had success: in March 2006, Scotland was the first United Kingdom country to go for the smoking ban, so next year’s 10-year anniversary is approaching. I expect that there will be a re-evaluation of the ban’s success. We had a 17% drop in admissions for heart attack in the first year. That is a bigger effect than anyone expected. We saw an 18% drop in admissions for acute childhood asthma. Myocardial infarctions had been dropping slowly by 3% a year in the previous decade, but the rate accelerated to 17%. Childhood asthma admissions had been increasing by 5% a year until the smoking ban; there has been a 40% drop in smoking exposure for 11-year-olds. And so it goes on. We saw a much bigger impact in the first year than we could have hoped for. There has been success, and that has been UK-wide. It has all been done separately, but we were very much moving in the same direction.

We think of the debates that we have had here with the Minister with responsibility for public health on other issues, such as obesity. The whole public health agenda involves us taking radical action. It is interesting to hear about the earlier debates on banning sponsorship and banning smoking in public places, and how hard those things were to do, but look at what we and the NHS have recouped from that. We need to look at that going forward.

The impact of the cuts and changes to Public Health England has been covered in great detail. It is right that a lot of public health measures are integrated in local authorities, because they can bring about a more people-centred approach to such things as active transport, and the control of how tobacco is sold and how things are sold near schools. This is about looking at the whole person, because public health cannot always just be campaigns looking at one bit at a time. We need to challenge our whole lifestyle, and local authorities are in the best position to do that.

Unfortunately, Public Health England faced a significant cut of more than 6%, or £200 million, and it has been earmarked for significant ongoing cuts. That is a real problem. We have heard about the cuts to smoking cessation, including Manchester stopping all specialist services, and it being on a charitable or basically ad hoc basis in other places, and that just is not good enough. We need to think about how we go forward, and the lives being lost, the suffering being caused and the burden on the NHS.

In the five-year forward view, a shortfall of £30 billion was identified. Some £22 billion of that is expected to be found by the NHS. When Simon Stevens was in front of the Health Committee, on which I sit, he identified that the NHS was expecting about £5 billion to be saved through prevention, but at exactly the same time, we are talking about cutting public health funding. If that prevention does not come about, that £5 billion saving will not happen and the NHS will hit a brick wall. It is important that we look at all that local authorities do, including to prevent tobacco being sold to under-age people, and to prevent the smuggling of cigarettes and the selling of illicit cigarettes—the whole environment that people are facing.

The hon. Member for Harrow East mentioned the experience in New York, and the stalling of the drop there. That is already being seen here, with the slight increase in the prevalence of smokers, the decrease in quit attempts and the decrease in success. One of the biggest successes is an almost halving of young smokers starting. While the main drive of smoking cessation is helping people to stop, it is important that we do not create future generations who are in the same boat as ours. If we had listened to Wanless 12 years ago and got serious about public health then, we would be in a better place. He said that there would be a sudden surge of preventable and multimorbid diseases hitting the NHS, and that is exactly what we are living through.

It is timely that the debate in the Chamber is about the 1,001 critical days of pregnancy and the first two years of life. We need to invest in our children to try to have healthier, more successful generations in the future. We see odd patterns, such as the connection between smoking and people who end up in prison, and between smoking and those who have mental health problems. There has not been enough research to enable us to say that that is causal, but the fact that mental health patients smoke one third of all tobacco consumed does prompt the question: which one is the chicken, and which the egg? We need to think about our future generations; we need to ensure that pregnant women stop smoking—and do not start again as soon as the child is there, thereby exposing those young children to cigarette smoke. A lot of work has been done on smoking in cars. There has been a big campaign in our neck of the woods to try to get people to go outside the home and not smoke in the presence of children.

We have had a huge amount of success on this issue, due to the work of successive Governments who have ploughed forward, but we cannot afford to take our foot off the gas. We owe it to adults, to those who are approaching the age at which they might take up smoking, to the young, and to those not yet born to aspire to a future generation that is not burdened with the crippling diseases related to smoking. I saw this as a breast surgeon. People ask, “Why do people from deprived areas have poor success from cancer treatment?” Quite simply, I would meet someone aged 70 with breast cancer who had begun to collect morbid diseases from the age of 50. I could see straight away that they would not survive chemotherapy, and might not survive surgery. Treatment for a disease that is not related to smoking is therefore completely inhibited by their underlying disease. Smoking affects every part of people’s bodies. It affects the NHS and our society. We need to ensure that the smoking control policy we have at the moment is quickly replaced by one that is just as determined.

Victims of Contaminated Blood: Support

Philippa Whitford Excerpts

Wednesday 16th December 2015 Commons Chamber

[Jane Ellison]

That point is well made and very much on my mind. When I can say more about the shape of our proposed reformed scheme, I hope my hon. Friend will see that we have tried to respond to her concerns and those of many other right. hon. and hon. Members.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The Penrose inquiry was held in Scotland—there has not been a UK inquiry—and, in response, the Prime Minister made his statement about the £25 million transitional payment. These people are awaiting a final settlement and compensation for what the NHS did to them, but their suffering goes on. We were told that the transitional payment would be made this financial year to help people get to that settlement. The consultation is on the final arrangement, but we need some action now and people need access to the new hep C drugs. The Scottish Government have written about support for fuel payments, but we need the transitional money now. It should not be kicked into the long grass.

[Jane Ellison]

This certainly has not been kicked into the long grass. As I have told the House, it is my intention to consult in January. I have said before, but it is worth repeating, that although we are working to establish a fair resolution, liability has not been established in the majority of cases, so it is not appropriate to talk about compensation payments, particularly on the scale that some campaigners and colleagues envisage. I have been open about that for many months. The hon. Lady is right to make the point about treatments, and all those things will be considered. I can confirm to the House that, although the £25 million was allocated to be spent in this financial year, it will be carried forward. The money that the Prime Minister announced in March was to support the transition of the scheme, which we envisaged beginning next spring, following the consultation. The money will support that, and it will be carried forward.

ACCESS TO MEDICAL TREATMENTS (INNOVATION) BILL

Philippa Whitford Excerpts

Wednesday 16th December 2015 Public Bill Committees

[George Freeman]

I do not. I am politely winding my way round to saying that. However, the reasons are important. It is not that I object to amendments at all—I hope the Bill will be heavily amended in Committee to reach that nirvana of all the parties—but, because the clause is important and helps to clarify the Bill’s intention, I suggest that the amendments should not be pressed. However, we might work on a package of amendments on Report that tackle giving clinicians access to information about innovative medicines and the important points made by the hon. Gentleman.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

My concern about the Bill is that it seems to create a parallel system for something that we already have. We already have clear structures around litigation, defence and informed consent, which the Bill seems to bypass. If a doctor finds one other doctor who agrees with them, they can do what they like to somebody—they can go out and clip their privet hedge and give it to them: they are at the end of life and desperate, so they will try anything. That is really concerning.

The database would create a second information system that is not just about people reporting something. Someone might go to it in desperation, read about privet hedges and try that. That creates a separate system from the research system that has been developed over many years.

When I was a young doctor—sadly that was quite a long time ago—there was a paternalistic approach, in which the patient did exactly what the doctor told them. The thing is, when people are at the end of life or suffering from something for which we do not have an easy treatment, they are incredibly vulnerable, so we have a duty to protect them.

Part of the problem with the Bill is that it would create separate systems. Why should a doctor go through the entire system of pre-clinical research phases 1, 2 and 3, getting permission and getting things passed when, whatever their idea is, they can talk some wee lady into it and give it to them without any cover? That is quite frightening and would undermine our trials process.

There are things that could be improved. I agree with the Minister that some institutions have become rigid and defensive, thinking, “We don’t want you using that for anything else.” Out of the Bill we could get, as the Minister said, a database that talks about research that is going on that we could collaborate in, and what the findings and trial results are. Busy, front-line clinicians are often unaware of trials. In Scotland, we have the Scottish Breast Cancer Trials Group so that we flag up trials to people. There could be merit in that, but the idea that putting on a database something that I do to a patient, just randomly, somehow gives it credence is actually quite frightening.

We have Bolam. We have a system and a definition of negligence and litigation. Creating these two parallels undermines the patient. How can they give informed consent if we are talking about something that has no work-up, no safety profile and no phase 1 trials? How do we ensure that we are not encouraging people to do that across the country? There are things that could be done with the Bill but, as it stands, I have grave concerns, as many other doctors do.

[The Chair]

Before I call the Bill’s promoter, I have allowed quite a lot of latitude but it is important in Committee to focus specifically on the amendments that we are deliberating, which the hon. Lady did without referring to them. That is the way forward and that is our system.

--- Later in debate ---

[George Freeman]

I thank and pay tribute to the hon. Member for Torfaen for his persistence and patience in working with all parties on this matter. Similar to the Bill we are discussing, his Bill touched on an ambition shared by colleagues across the House to promote greater off-label use of medicines. I have encouraged him and my hon. Friend the Member for Daventry has welcomed his commitment to try to work through this Bill to see whether we might be able to tackle some of the same objectives, which is an ambition I strongly support.

In this Bill, my hon. Friend the Member for Daventry has repositioned a much stronger focus on the database being a registry not for capturing innovations that medics might or might not think are reasonable to record, but for the provision of information to clinicians on licensed, unlicensed and off-label uses for innovative medicines that are currently being developed. That represents a powerful opportunity for us to strike a blow for getting clinicians access to drugs that are in development, in trials or in an early access to medicine scheme and to off-label drugs currently in use of which clinicians might be unaware.

I dream of the day when a clinician can talk to a patient, click on their electronic medical records to see their history, click on available treatments for patients of that profile and see, at the click of a mouse, what clinicians around the country are doing, including the numbers. That could then be used to help intelligent prescribing, using their best clinical judgment and their knowledge of the patient. There is an interesting opportunity for us to do something here.

Let me turn to the amendments. Amendment 7 seeks to make it explicit in the Bill that “treatments” includes access to off-patent drugs. I actually support that ambition. Lawyers at the Department of Health will tell me that it is otiose—a legal term meaning that it is not strictly necessary—but, as a pure democrat, I think that it would be helpful if we could find a way to make it clear that that is specifically what we want to achieve. I can list the reasons why a lawyer might say it is not a good use of legislation because it is already covered by the existing definition, which it is. I think it would be helpful to send a message that we explicitly want the database to promote off-label use. As the Minister responsible, I would happily take instruction in whatever mechanism from the House to go away and come back with a proposal on it.

Amendment 8 seeks to provide for the establishment of an arm’s length body to assist those seeking regulatory approval for off-patent drugs in a new indication. As the hon. Member for Torfaen is aware, we have talked about that at length. Although I understand the thinking behind it, I do not accept it. For those colleagues who have not been following this debate closely, the thinking is broadly that because an off-label indication does not have an applicant company with a patent and a commercial interest, there is nobody to promote its case, and to put together the data package, lobby for it and advocate for it through the system, and to ask NICE to look at it. Word has got round that, because of that absence of a commercial interest, those uses are not being properly looked into, and that if it had a licence clinicians would use those off-label indications.

I understand it, but I think that the logic is profoundly flawed for two or three reasons. First, the evidence is that even where off-label indications are well evidenced and even recommended by NICE, in which case there is clearly no barrier, uptake is patchy and in some places slow. That is not because of the absence of recommendations and data. In the example of the use of Tamoxifen as a preventative treatment for cancer, in fact, patients and clinicians decide not to use it, in many cases because of the side effects or because women prefer to have surgery. It is not due to the lack of a licence; it is because it is an off-label use and has different impacts on different patients, and patients always want to reserve the right. It is the same with the use of bisphosphonates. There are off-label treatments that are well evidenced and well supported and recommended by NICE. It is not about the absence of a licence.

Most profoundly, I worry that if we expected all off-label uses to have a licence we would inadvertently create a situation in which those off-label uses that did not have a licence would suddenly become questionable. I totally understand that is not the intention of the hon. Member for Torfaen. We might actually undermine our objective and end up in a situation in which we have to license every single off-label use in order to keep it legitimate, which would be the complete opposite of what my hon. Friend the Member for Daventry wants to achieve. I will come later to why the Secretary of State and I do not want to become the licensors of medicines.

[Dr Whitford]

I accept the Minister’s point about Tamoxifen. There are certainly other reasons why patients do not take it. As we move into an era of more and more non-medical prescribers—nurses and professions allied to medicine—those people are going to be a lot less comfortable prescribing unlicensed drugs that are not in the “British National Formulary”. Those people are made to sign a liability form and they are simply not going to do that. We are moving patients out into the community. The idea that they will come to a specialist every eight weeks for a prescription is not practical.

Southern Health NHS Foundation Trust

Philippa Whitford Excerpts

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

I will do that, and I am very grateful to my hon. Friend for giving me the opportunity to do so. We see this situation all too often. There was a story in the Sunday newspapers about a family being shut out of a very important decision about the unexpected death of a baby. It is incredibly important to involve families, even more so in the case of people with mental health problems or learning disabilities. The family may be the best possible advocates for someone’s needs.

We need to change the assumption that things will become more difficult if we involve families. More often than not, something like litigation will melt away if the family is involved properly from the outset of a problem. It is when families feel that the door is being slammed in their face that they think they have to resort to the courts, which is in no one’s interests.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I echo what the Secretary of State said about family involvement, which should be routine in investigating an adverse event. It definitely takes the heat out of the situation.

There are two issues here. One is the shocking difference between 30% of adult deaths being investigated, and just 1% of deaths of people with learning disabilities, and Connor represents the human face of that, which is frightening. The second issue is about individual trusts being left to decide what and how much they investigate, and what they produce, because a much more systematic consideration of the data is required. NHS England publishes annual mortality figures. Strikingly, 16 trusts that were identified with higher than expected mortality levels also had higher than expected mortality the year before, yet it appears that no action was taken. The benchmark appears to be “average”, but if we have poor performance, that average is lower. We should set our aspirations higher than that.

[Mr Hunt]

The hon. Lady is absolutely right. The 30% figure was for people with mental health conditions, not for all adults, but I question why we are investigating only 30%—the highest figure at Southern Health NHS Trust—of unexpected deaths. These were not just deaths; they were unexpected deaths, and it is the duty of medical directors in every trust to satisfy themselves that they have thought about every unexpected death. We must reflect on these serious matters.

The hon. Lady is right about the need to systematise processes when there is an unexpected death, so that we do not have a big variation between trusts. The exercise that Sir Bruce Keogh is doing, going around all the trusts, is about trying to establish a standardised way of understanding when a death is or is not preventable. The hon. Lady has been a practising clinician, so I am sure she will understand that at the heart of this issue is the need to get the culture right. Clinicians should not feel that a trust will take the easy route and blame it all on them, rather than trying to understand the system-wide problems that may have caused a clinician to make a mistake in an individual instance, and that is what we must think about.