Oral Answers to Questions

Rehman Chishti Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

What a disgraceful comment. We do not need the Prime Minister to come before the House because I can tell the hon. Gentleman that Kettering hospital is safe, and that it is totally irresponsible scaremongering by the Labour party in the run-up to a by-election to suggest anything else.

[Rehman Chishti (Gillingham and Rainham) (Con)]

T4. Will the Secretary of State join me in welcoming the progress that has been made to reduce mixed-sex wards and improve patient privacy at Medway Maritime hospital in my constituency?

[Dr Poulter]

My hon. Friend is absolutely right to highlight the Government’s success in reducing mixed-sex wards not just in his hospital but throughout the NHS—we inherited a very different situation from the previous Government. Medway has been a pioneer in that area and my hon. Friend is right to commend the hospital and I put on record my thanks for all that it is doing.

Business of the House

Rehman Chishti Excerpts

Thursday 6th September 2012 Commons Chamber

[Mr Lansley]

I am surprised, and like the hon. Lady, I am obviously disappointed. I will of course ask whether my colleagues in the Home Office can respond to her on the issue.

[Rehman Chishti (Gillingham and Rainham) (Con)]

When I spoke recently to Bishop Michael Nazir-Ali, I was informed that there was persecution of Christian and minority communities in 130 out of 190 countries. May we have an urgent debate on tackling this growing problem?

NHS Risk Register

Rehman Chishti Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Andy Burnham]

One of my first acts as incoming Health Secretary was to commission Robert Francis QC to conduct an independent investigation into the events at Stafford on a local level. [Interruption.] Government Front Benchers are saying that it was not a public inquiry. They are right, but let me explain why. I did not commission a full public inquiry because, in my judgment, such an inquiry at that time, with all the glare and focus that it would bring to the hospital, would distract the hospital from its more immediate priority of making services safe as quickly as possible. I said to the chairman of the independent inquiry that if, at any time, he wanted to come back to me and ask for powers to compel witnesses, I would be well disposed towards receiving such requests. Given all the events that have taken place, to hear that the hospital is again having difficulties—that the A and E department is temporarily closed—gives me genuine cause for concern that the fundamental and far-reaching problems there have not been adequately addressed. That should concern us all.

I was talking about the risks identified by the NHS Northamptonshire and Milton Keynes risk register regarding the loss of capacity and problems in carrying out statutory functions resulting from the chaos caused by the Bill.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

Not for the moment.

The risk rating in that risk register was 16—extreme. Let me focus on the phrase, “statutory functions”, because it is important that the House fully appreciates what that involves. One of the statutory functions of the primary care trusts that have been wound down before new structures are in place is the safeguarding of children and vulnerable adults. What does the NHS London risk register say on this point? [Interruption.] Government Members do not want to listen. I am sorry if it is inconvenient for the Parliamentary Private Secretary, the hon. Member for Broxtowe (Anna Soubry), but she will listen. The risk register makes the chilling prediction that the huge loss of named or designated professionals from PCTs across London, and the subsequent damage to information sharing, may lead to “preventable harm to children”. That risk was rated at 20 pre-mitigation and 15 post mitigation.

It is not just NHS London that is saying this. Let me quote again from the NHS Northamptonshire and Milton Keynes risk register; this time I ask the House to listen very carefully. It warns of a

“failure to deliver statutory requirements which leads to the significant harm or fatalities of children and vulnerable adults”.

That was originally rated as an extreme risk and, even after mitigation measures, it is still rated as “very high” with the possible frequency of occurrence being “monthly”.

This is what the national health service is telling the Health Secretary and the Prime Minister about the potential effects of their reorganisation. It is appalling and shocking. They are taking unacceptable risks with children’s safety and people’s lives. If this is what the NHS has been telling Ministers for 20 months, since the White Paper was published, how can they possibly justify pressing on with this dangerous reorganisation? Has not what remained of any justification for carrying on just collapsed before us? If this is what is published in local risk registers, that prompts the question of what on earth they are trying to hide in the national assessment. The simple truth is that they cannot publish because if people knew the full facts, that would demolish any residual support that this reorganisation might have.

That brings me to my third point—the Government’s claim that it is safer to press on with reorganisation than to deliver GP commissioning through the existing legal structure of the NHS. The evidence that I have laid out comprehensively dismisses that argument. If the Government were to abandon the Bill and work with the existing legal structure of the NHS, that would bring immediate stability to the system and, as the British Medical Journal has calculated, save over £1 billion on the cost of reorganisation. The Government’s claim that it is safer to press on is rejected by the overwhelming majority of clinical and professional opinion in England. The royal colleges and other professional organisations have given careful consideration to the pros and cons of proceeding and abandoning. Some disruption comes with either course of action, but given the terrible mess that we are now in, those royal colleges have concluded, one by one, that the interests of patients are best served by working to stabilise the system through existing structures.

It is not difficult to do that. PCT clusters could be maintained and the emerging clinical commissioning groups could simply take charge of the existing legal structure that is the residual PCT, and indeed any buildings and staff that they may still have. The painful truth is that delivering GP-led commissioning, which is where the Health Secretary began, could have been delivered without this Bill. Let me say to him again today that my offer still stands. If he drops the Bill, I will work with him to introduce GP-led commissioning using his emerging clinical commissioning groups.

However, that must be done in the right way. The local NHS risk registers raise concerns not only about reorganisation but about fundamental flaws in the policies that the Health Secretary wants to take forward. NHS Lincolnshire warns of a

“conflict of interest in CCG commissioning and provision: perceived or actual conflicts of interest arising from GPs as both providers and commissioners may impair the reputation of the CGG and, if not managed, may result in legal challenge.”

That has a moderate likelihood of happening but a consequence rated as catastrophic. A GP surgery in West Sussex has written to all its patients offering them

“private screening for heart and stroke risk”

from Health Screen First, for which, in return, the surgery receives a nominal fee from Health Screen First. In Haxby, GPs tried to restrict minor operations that are currently free on the NHS and at the same time launch their own private minor operations service, sending patients a price list. More broadly, stories are emerging around the country of plans by clinical commissioning groups to stop purchasing services from local hospitals, such as dermatology in Southwark and out-patients in south London. There are also plans to remove services from Stafford hospital, which we talked about earlier.

This unstable market in health care could have a very real effect on the viability and critical mass of essential hospital services, resulting in full or partial hospital closures. I have never heard of any plans from the Government to mitigate these risks other than the simple statement, “The market will decide.”

--- Later in debate ---

[Mr Lansley]

No, the risk register that the right hon. Gentleman is talking about relates to policy development, not an operational matter. It is a high-level risk register akin to others across Government that, if published, would be prejudicial to frank advice in policy development. [Interruption.] I am only repeating the position that he took when Secretary of State. Let me quote him:

“We have determined that the balance of public interest strongly favours withholding the information”.

I will take his advice and stick to my view: the release of the risk register does not serve the public interest, even if it might serve his political interest to make a song and dance about it. I have been clear about it, as has my noble Friend. The information on which any debate about the Bill should be conducted is already in the public domain.

[Rehman Chishti]

Will the Secretary of State clarify something? The point made by the shadow Secretary of State is complete nonsense. For him to give a commitment on something that might happen at a tribunal is bizarre, because the Secretary of State can use the rules under section 59 of the Freedom of Information Act to appeal to the High Court on a point of law. So he cannot give that commitment.

[Mr Lansley]

I bow to my hon. Friend on the procedures under the Freedom of Information Act. We have made it very clear that we are proceeding as the Act provides, as the Information Commissioner himself set out. I want to make it clear to the House that there is no information that it would be proper for the other place to have access to when considering the legislation, that it does not already have access to. The tribunal will be an opportunity not for politicians but for the likes of Lord O’Donnell, the former head of the home civil service, to set out clearly the process by which the free and frank expression of advice to Ministers in policy development needs to be protected under the Act.

I will tell the House about some of the risks that the NHS faced. It faced risks relating to the £67 billion private finance initiative repayment bill left to us by the right hon. Gentleman. He talks about hospitals being under threat, but we have had to offer exceptional financial support to seven hospitals to help them to back up their PFIs. Members might be interested to know that when I announced that decision on 3 February—just a fortnight or so ago—the shadow Secretary of State, who puts his view of these things on Twitter, wrote:

“I didn’t sign them off.”

He did not even use 140 characters. He managed it in even fewer. He said he didn’t sign them off—but oh yes, he did. What about Whiston hospital in St Helens and Knowsley? He signed that off. It is a pathetic attempt to escape responsibility for leaving the NHS in debt. [Interruption.] Oh, he is blaming his junior Minister now. It had nothing to do with him! When he refused to release the departmental risk register back in 2009, did he do that, or is he going to blame one of his junior Ministers? I have such excellent Ministers that I will never have to blame them for anything, but frankly I would never attempt to do so, and I hope they know that.

--- Later in debate ---

[Rehman Chishti (Gillingham and Rainham) (Con)]

It is a pleasure to follow the right hon. Member for Holborn and St Pancras (Frank Dobson), although given that the Order Paper reads,

“this House calls on the Government to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill”,

I wondered whether he was in the right debate. He spent most of his time not mentioning the Information Commissioner, although he mentioned risk in the last minute.

I want to focus on the argument over the risk register. I support the Secretary of State’s decision to challenge the Information Commissioner’s decision ordering the release of the Department of Health risk register. It is important to consider the procedure followed by the commissioner in determining whether it was the right decision to make. The Secretary of State’s decision to challenge the commissioner’s ruling is, procedurally, absolutely correct. The procedures set out in the Freedom of Information Act, as amended—[Interruption.] It is important to set the tone and background.

[Andy Burnham]

It’s not a court.

[Rehman Chishti]

The shadow Secretary of State does not understand the legislation. That is why he is making these assumptions. Section 35(1) makes it clear that:

“Information held by a government department…is exempt information if it relates to…the formulation or development of government policy”.

[Interruption.] Opposition Members do not like what they are hearing, but I hope that they will show the same common courtesy that I have shown them in the past. Section 35(1) makes it clear that the procedures applied by the Secretary of State were in line with the Freedom of Information Act, which was enacted by the previous Labour Government. Under that procedure and statute, he is entirely within his rights, using the correct procedure, to apply section 57 to appeal the ruling to the tribunal. That is absolutely right and proper.

It is important to say that we have the right—[Interruption.] I will come to the point on which the shadow Secretary of State keeps interrupting me—I am sure that he is not doing so to put me off making the point that he does not want to hear. Under the procedure in section 57, the Secretary of State can challenge a decision. It is important in our system—whether the criminal justice or the civil system—to have checks and balances on decisions that are made, whether by the Information Commissioner or by judges. If the shadow Secretary of State is now saying that the Information Commissioner’s ruling should be final, with no right of appeal, he should have said that when the Freedom of Information Act was being passed. However, he did not do so, and there is a right of appeal, where cases go to the tribunal. Even beyond that though, he asked earlier whether the Secretary of State could give us an assurance that he would not challenge the decision of the tribunal. Being realistic, how can the Secretary of State give that guarantee? The right hon. Gentleman knows, and I know, that the Secretary of State does not know what the judgment of the tribunal will be. He also knows that the rules that his Government passed, in section 59 of the Act, enable a referral to the High Court where there might be a wrong point of law.

[Andy Burnham]

Briefly, does the hon. Gentleman not accept that there is a big difference between the Secretary of State being within his rights and his being right not to publish? We accept that he is within his rights, but is he right? The precedent was set by the previous Government. We published a risk register after receiving a ruling from the Information Commissioner. That is the precedent.

[Rehman Chishti]

I am grateful to the shadow Secretary of State for that point, to which I shall return. In my view, the Secretary of State is absolutely right to use that discretion. The shadow Secretary of State knows the Department of Health well because he has been there, but I should point out to him that a spokesman for the Department of Health said:

“We have never previously published our risk registers as we consider them to be internal management documents. We believe that their publication would risk seriously damaging the quality of advice given to Ministers and any subsequent decision-making”.

I would say to the shadow Secretary of State—[Interruption.] He asked the question; I would be grateful if he listened to the answer. The reason why I say that the Secretary of State is within his powers and is right to do what he did is that never before have any Government or Secretary of State released that information. Being a sensible, considerate and fair man—which the Secretary of State is—he is right to challenge the decision, because that information has never been released before, as stated by the spokesmen for the Department of Health and made clear on page 2 of the information pack provided by the Library.

I also want to refer the shadow Secretary of State to another point. He has previously used the exemptions in section 36. Either we have exemptions or we do not, but the current exemptions, whether in section 36 or section 35, were put in place by the previous Government. If they did not want those exemptions—if they had said that everything should be in the public domain—they should have made that clear. I remind the Opposition of the saying “What’s good for the goose is good for the gander”. The fact is that you applied similar provisions, whether in section 35 or section 36, to withhold information. If you were able to do that in the public interest, then this Government, applying the same procedures and the same rules, can do so too. There is simply no point having legislation, in the form of the Freedom of Information Act, and now suddenly, when you are in opposition, you move the goalposts. In my view, that is totally and utterly unacceptable. It is also important to note that the Department of Health—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. May I gently remind the hon. Gentleman that I am not responsible? He keeps saying “you”, and I assure him that I will not and do not want to take responsibility for the NHS.

[Rehman Chishti]

I am grateful, Mr Deputy Speaker, and I am sorry to put the previous Government’s legacy on you.

Moving on, it is important to bear in mind the previous Secretary of State’s decisions in 2008, to which I referred earlier. However, it was not just him who acted in that way; the Secretary of State for Health before him, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), made similar decisions, under section 36 of the Act. In view of the procedure provided under the Freedom of Information Act and the similar decision taken by previous Labour Health Secretaries on public interest grounds, I feel that the Secretary of State is absolutely right to challenge the current Information Commissioner’s ruling.

On such an important issue, it is absolutely right to say that in the interest of fairness and transparency, the matter should be looked at by a higher authority. If a point of law is at stake, I would say that section 59 should be used to refer the matter to the High Court. The debate has touched on the excellent work going on—whether in respect of the cancer drugs fund or the reduction of viruses in hospitals—so I endorse the view of my constituent, Mr Thomas, sitting in the Public Gallery, who says that the Government are doing an excellent job.

Melanoma

Rehman Chishti Excerpts

Wednesday 18th January 2012 Westminster Hall

[Pauline Latham (Mid Derbyshire) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hood, and I am grateful to Mr Speaker for selecting this important topic for debate. According to the British Journal of Cancer, the incidence of the most serious form of skin cancer, melanoma, is expected to rise by 52% in both men and women by 2030. One of the many tragic aspects of advanced melanoma is that, compared with other cancers, it disproportionally affects younger people. Indeed, more than a third of all cases of melanoma affect people who are under the age of 55. With such a high incidence, combined with the aggressive nature of melanoma, treatment options are very important.

I want to draw attention to the new and innovative drug, ipilimumab, also known under the trade name of Yervoy. Ipilimumab works in a new and unique way through a form of immunotherapy. It encourages the immune system to produce more cancer-killing cells. The drug is significant, and it has not been available to patients before.

In July last year, ipilimumab was launched in the UK with a licence approved by the European Medicines Agency. This is the first major advance for treatment of this cancer in 30 years. However, to the disappointment of patients and stakeholders, the National Institute for Health and Clinical Excellence announced on 14 October that it would not be recommending ipilimumab for the treatment of advanced melanoma on the NHS. I was profoundly disappointed to discover that the chief executive of NICE, Andrew Dillon, had deemed that this treatment was not

“a cost effective use of NHS resources.”

In response to that news, I held a stakeholder investigation in the Houses of Parliament and invited patients, carers, clinicians, charities—they included the patient support group, Factor 50, and the Karen Clifford Skin Cancer charity, also known as Skcin—and parliamentarians to come together and discuss their personal concerns about the negative preliminary guidance that was given by NICE.

[Rehman Chishti (Gillingham and Rainham) (Con)]

My hon. Friend mentioned that this disease affects younger people to a greater extent. One of my constituents, who is young and has young children, needs the drug Yervoy, which is expensive. Does she agree that we need to do everything that we can to ensure that those young children can see their mother for a longer period and that her last days are not lost days?

[Pauline Latham]

I completely agree with my hon. Friend, and I will come on to some cases in a moment. It is a very important point.

As well as coming together to share our concerns, the meeting was held to create a report that was submitted to NICE in response to the appraisal consultation document, in anticipation that it would be considered ahead of the NICE technology appraisal meeting, which took place on 16 November. We have had no response so far.

When holding the meeting on advanced melanoma, I was given the opportunity to hear first hand from melanoma patients, who are desperate to receive the drug. Melanoma often strikes at the younger end of the population. More than a third of all cases of melanoma occur in people below the age of 55, and it is the second most common form of cancer in the UK for those aged between 15 and 34. What those statistics on advanced melanoma in the younger population do not show is that many people in that age group will have children and so will face a very aggressive cancer, alongside the knowledge that they face leaving behind their children and family.

The patients whom I met at the meeting all echoed a simple and profound point: they are desperate to stay alive, so that they can be with their children, husbands, wives, partners and families. Given that treatment options for the disease have not advanced for three decades, how can it be fair not to release the drug for use by those patients who could have more time with their families? One young patient—a lady aged only 30—said at the meeting:

“I need to live. I have to live for my children. I just want a few more years so that my boys will remember me.”

Richard Clifford, the founder and trustee of the Karen Clifford Skin Cancer charity—Skcin—said at the meeting that

“median overall survival time after diagnosis is six to nine months. This is tragic because people have little time to prepare themselves and their loved ones for what is inevitably going to occur.”

I could not agree more with his sentiments. There is clearly an unmet need in the treatments available, and I believe that ipilimumab has a place in today’s treatment options, which are already scarce for cases of malignant melanoma. An experienced oncologist from Leeds who has used ipilimumab echoed that view at the meeting:

“It is the first drug that can help people live longer or make them more likely to be active for a meaningful period of time.”

I add a personal plea for help: my brother died from a malignant melanoma 11 years ago this month at the age of 54, one week after his birthday, leaving his wife and two teenage children. I know how debilitating this form of cancer is and how quickly it can spread. Apart from radical surgery, he had very few options in terms of the drugs on offer. As a result of Michael’s illness and death, I see my GP regularly, and I have had several pre-cancerous areas removed before they had the chance to progress to malignancy.

--- Later in debate ---

[Paul Burstow]

In England, one of the opportunities coming up as a result of the Health and Social Care Bill is the transfer of public health responsibilities to local authorities. Alongside the authorities’ other responsibilities for environmental health and trading standards, that brings both enforcement and education opportunities, which will be very important in making the existing regulations even more effective.

Earlier diagnosis is central to the strategy the Government have laid out, because if we catch more cancers earlier they will become more treatable. The SunSmart campaign has a website that provides information about how to spot the symptoms of the disease, and during 2011 it received more than 11,000 visits per month on average, peaking in June, surprisingly, with more than 21,000 visits. With a programme grant from the Department of Health, Cancer Research UK and the British Association of Dermatologists are working together on a toolkit to provide practical online support and training to help GPs with pattern recognition for skin lesions. The toolkit will be piloted early this year, before a planned national roll-out, building on the evidence base.

That leads me on to treatment. Once skin cancer is diagnosed, access to appropriate treatment, delivered to a high standard, is critical. Increasing access to cancer treatments is a goal that all Members who have contributed, or are listening, to the debate share. I pay tribute to my hon. Friend the Member for Mid Derbyshire for her campaigning work on behalf of a number of her constituents and other people, and I would like to set out the current situation in relation to ipilimumab. I am struggling with the pronunciation of that word, and I apologise; I do not in any way wish to denigrate the issue. It is really important to explain where we are, because the drug is being appraised by NICE for use in the treatment of stage 3 and stage 4 malignant melanoma. NICE has a rather difficult job, and my hon. Friend has fairly described the challenge it faces in coming to its judgments. NICE’s role is to provide the NHS with robust, evidence-based guidance on whether a drug should be available, on clinical and cost-effectiveness grounds. I would like to reassure my hon. Friend that NICE recognises that its work has genuine consequences and has an impact on individuals’ lives. It makes a great effort to ensure that clinicians, patients, and anyone with an interest is involved in its work. I will forward my hon. Friend’s speech to NICE and ensure that it sees it.

NICE published its draft guidance on both the clinical and cost-effectiveness of ipilimumab last October. My hon. Friend has explained that the document does not recommend the use of the drug by the NHS, and she has described, in no uncertain terms, the dismay and disappointment that she and others feel on behalf of the families and the sufferers. However, NICE has not yet finalised its guidance to the NHS, and I am sure that Members will appreciate that, because NICE is an independent body, it would not be appropriate for me to dictate to or direct it. What I can tell Members—I hope this will be at least a glimmer of light—is that Bristol-Myers Squibb, the manufacturer of the drug, has proposed a patient access scheme, and the Department has agreed that NICE can consider it. I understand that NICE will now ask its appraisal committee to consider the scheme as part of its reconsideration of the drug.

Until NICE publishes its final guidance, PCTs are responsible for making funds available on the basis of individual needs in their local populations. There is no excuse at this point for PCTs not to do that, and patients have a right under the NHS constitution to expect local decisions about the funding of medicines and treatments to be made rationally, following proper consideration of all the evidence. In addition, where a treatment is not normally funded, PCTs are required to have processes in place to consider exceptional funding requests if a doctor feels that a particular patient’s exceptional clinical circumstances would warrant such funding. To help PCTs make these difficult decisions, the Department has issued a set of core principles that should govern them.

That is the current regime, and when this Government came into office they decided to go further, as part of their coalition programme. We are delivering on a promise in our programme for Government to create a cancer drugs fund. In the first year of the fund we have provided £50 million, and from 2010 through to the end of the fund there will be £600 million. I will say a bit more later about what happens after the fund ends.

[Rehman Chishti]

It is great to hear the Minister saying that we are looking to ensure that people can get new drugs, such as Yervoy. Does he agree that we must also ensure that PCTs, local authorities and the voluntary sector provide excellent palliative care to the terminally ill?

[Paul Burstow]

My hon. Friend makes a very important point. He will know that we received the recommendations of the palliative care review last year, and we are looking forward to making announcements on it in the near future.

The cancer drugs fund means that clinicians in England are now able to prescribe cancer drugs from which they feel patients would benefit, without restrictions simply on cost grounds. That goes back to the absolutely correct point made earlier by my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) about adding years, months and days to a person’s life, and ensuring that those days are not lost.

Up until last November, 10,000 cancer patients had benefited from the cancer drugs fund and clinical recommendations, with a number of them receiving ipilimumab through the fund. Strategic health authority regional clinical panels are using their clinical judgment. I understand the concern raised by my hon. Friend the Member for Mid Derbyshire about variation, but we are assured that there is consistency between areas, and if there is any evidence to the contrary, I urge her to share it with the Department so that we can pursue that.

On the cancer drugs fund in Wales, the devolved Administration have to make their own judgment about how to prioritise NHS spending, and in contrast to the UK Administration they have decided to reduce spending on the NHS.

My hon. Friend also asked about the future arrangements when the cancer drugs fund finishes. We want to find a way for patients who benefit from drugs provided through the fund to continue to do so, at a cost that represents value to the NHS and to our wider society. We are considering whether it would be sensible, after the fund comes to an end in 2014, to assess some of the drugs, including the one we are debating, under the new value-based pricing arrangements. A final decision has not yet been made on that, but I will certainly write to my hon. Friend as we get to a conclusion.

My hon. Friend drew attention to the potential wider costs of cancers such as melanoma. As we develop our value-based pricing system, it is important that we ensure that those wider costs are taken into account. We want a more systematic and transparent way of working, so that interested parties, including pharmaceutical companies, charities, Members of Parliament and the general public, are clear in advance about what factors can be taken into account and what supporting evidence will be needed.

I thank my hon. Friend for raising this issue. I hope that a glimmer of hope is provided by a new scheme that could allow NICE to re-appraise the drug and come to a different conclusion. We will now wait to see how NICE proceeds. It is absolutely right to use parliamentary opportunities such as this to raise awareness. It is by raising awareness that we will save lives, which is the bottom line.

Care of the Dying

Rehman Chishti Excerpts

Tuesday 17th January 2012 Westminster Hall

[Robert Halfon (Harlow) (Con)]

I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing this debate. I have known him as a good friend for nearly 30 years and his values have remained the same over that time.

I welcome this debate because I feel that we need to move the focus of the discussion away from assisted dying and towards quality of life. I became involved with this issue not by accident but through involvement with my local hospice, St Clare. It is one of the most wonderful community organisations with which I have ever had the privilege to be involved, both as a parliamentary candidate in Harlow for many years, and as its MP. St Clare is dedicated to promoting quality of life and care, and it has taught me much about the important role of palliative care and how it needs our support.

I should like to make several brief points, the first of which concerns equity of funding. St Clare hospice in Harlow receives 24% of its funding from the local primary care trust, although other nearby hospices in other PCTs, such as Farleigh hospice or St Francis hospice, receive around 40% of their funding from the PCTs. I welcome the figure of 40% and do not deride it, but it is important to have greater equity of funding. There is also a cliff-edge issue: 70% of charitable hospices have agreements with their local PCT that last for just one year. We need longer-term agreements, so that hospices can plan ahead.

Although we often talk about the big society, the hospice movement existed before that was even mentioned. It has pioneered the big society for many years, and 157 charitable hospices in the United Kingdom receive the bulk of their funding from private and community sources. More than 100,000 people donate their time to local hospices. St Clare hospice has 500 volunteers, and on one occasion, I was pleased to work there as a receptionist. Given what the Government are trying to accomplish in many parts of the public sector, hospices deserve more recognition for their role as part of the big society. They are models of how charitable institutions can raise extra funds, invest in services and train the community, without resources coming simply from higher taxes.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I support everything that has been said so far about doing whatever we can to preserve life. Funding has been mentioned, as have the community and voluntary sectors. Medway contains the Wisdom hospice, where £539,000 is raised annually by the voluntary and charitable sectors. That is a great example of how communities want to preserve and support palliative care.

[Robert Halfon]

My hon. Friend makes a good point that is exactly right; his constituency is lucky to have him serving it so well.

I want to highlight bereavement counselling services. St Clare offers such a service, and about 40% of families that become involved with it receive bereavement counselling. That is a huge extra cost for something that the hospice does not have to provide but nevertheless offers as an extra service. Hospices receive little recognition for their work on bereavement care, and a UK study has shown that such care is often overlooked. In 2010, more than half of hospital maternity units still lacked dedicated bereavement support, thus leading families to turn to their local hospices. In 2007, an Oxford university survey of bereavement care in 10 Marie Curie hospices around the country showed that, although there are some great services, such care is patchy or non-existent in other areas. That is why hospices such as St Clare that go above and beyond the call of duty in the bereavement services that they offer deserve recognition and extra financial support.

To conclude, I should like to comment on the remarks made by my hon. Friend the Member for Hexham (Guy Opperman) who is no longer in his place. I have huge respect for him, but he mentioned choice in death. The problem with assisted dying and the move towards euthanasia is that people will be pressured into making choices. That is why I am passionately against any move towards assisted dying.

Care (Older People)

Rehman Chishti Excerpts

Tuesday 6th September 2011 Westminster Hall

[Tracey Crouch]

I am suggesting that we need to look at various ways to fund care in future. I believe that a market exists for this type of care insurance. There are people who can afford to take out such insurance, but they do not necessarily know that there are products out there that could prevent them from having to fall back on the state. For example, they could afford to take out a premium. It may be a hefty premium at the outset, but it could prevent them from draining all the assets from their home and then relying on state funding for residential care. Such insurance policies are certainly an option that we should look at, and indeed Dilnot himself looks at the financial services sector as one that could relieve some of the burden on state funding.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I congratulate my hon. Friend on securing this debate. With regard to the use of resources, we have looked at taxation but we must also look at Medway council, which is the local authority that she and I share and which was rated “excellent” in its use of resources by the Department of Health. Rather than increasing taxation, local authorities have a key obligation to ensure that resources for the elderly are available and are funded. For example, in Medway there is free swimming for the over-60s, concessionary bus fares start at 9 am rather than 9.30 am, and home library services are available for the elderly, so this issue is not simply about increasing taxation; it is about making better use of resources. Medway has done so and it is rated “excellent” by the Department.

[Tracey Crouch]

Indeed. This issue is about using resources wisely. However, it is very well discussing how resources are used now, but the problem lies in the future. At the moment, one in six people are over 65, but by 2050 one in four people will be over 65, and resources will only be able to stretch so far.

We spend a lot of time—rightly so—talking about financial education for young people, but I am enormously sympathetic to the suggestion that we should consider providing free financial health checks for people in their 50s and early 60s, possibly funded by using unclaimed assets in banks and insurance companies, and possibly delivered by financial advisers, charities or through the new money advice service. The provision of good quality care is an emotive matter for all involved. Standards of care, and indeed of care homes, differ dramatically, not just across the country but across constituencies. I recently visited Amherst Court in Chatham, a purpose-built Avante Care and Support home that supports residents with dementia. I was really impressed with what it offered and could tell that a lot of thought had gone into the building and the care provision. Such quality, however, has to be paid for, and unfortunately not all residential homes offer the same standards. When homes close, sometimes because the buildings are no longer fit for purpose, there can be uncertainty for residents and their families. It is that postcode lottery of care that we need to mitigate as best we can through the consideration of our long-term care requirements, which is why one policy that we need to get absolutely right for the benefit of our elders is the one on building more homes.

We have a massive housing shortage in the UK, but it is the older generation who have the least choice as to where they live. If they decide to downsize from their family home, they find that there are few bungalows or smaller houses being built. There are not many purpose-built retirement complexes, whether flats or houses, and any new development with social housing rarely, in my view, considers the needs of the elderly.

--- Later in debate ---

[Alison McGovern (Wirral South) (Lab)]

I congratulate all hon. Members who have spoken so far, especially the hon. Member for Chatham and Aylesford (Tracey Crouch). I feel sure that her grandmother would be incredibly proud of her today. Her contribution was important and she made many points that I wholeheartedly support.

I want to follow on from the comments of the hon. Member for Newton Abbot (Anne Marie Morris), who articulated part of the problem very well. Although we have focused on Dilnot, the review and funding, I argue alongside her that we cannot talk about money without talking about what people get for that money. What people are prepared to pay surely depends on the quality of care that they are going to get.

[Rehman Chishti]

The hon. Lady makes a point about resources. A crucial issue linked to resources is that of the principle and presumption of early intervention and prevention in improving the quality of care for the elderly.

[Alison McGovern]

I agree. In a moment, I will talk about some of the problems that local authorities are currently facing. They have had bigger cuts than any part of Government in Whitehall. Although I wholeheartedly agree with what the hon. Gentleman said, it is a challenge to all of us to support local authorities in that prevention role.

The hon. Member for Newton Abbot rightly made the point that quality matters above all else. Some of the examples given by her and others were compelling in terms of the moral requirement on us all to stand up for the dignity of older people. I firmly believe that, when we hear examples such as the one just given, we know what is happening is wrong. I have heard examples from my constituents: for example, older people are told that a “breakfast” visit to get them up can take place any time between 6 am and 11.30 am, regardless of their personal preference. That is not good enough and is an offence to somebody who prior to needing care was independent and perfectly capable of looking after themselves. We all know that instinctively.

The question is: how do we get from where we are to where we would like to be? I want briefly to make two points on the subject. First, I shall mention enforcement and some of the professional development issues. Leading on from that, I shall talk about the market for care provision and why there is an interesting and difficult problem that the Government will have to tackle regarding the market for providing care. I agree with many of the points made by the hon. Member for Newton Abbot about some of the anomalies surrounding enforcement. I repeat that local authorities are having to struggle with the fact that, if they were a Government Department, they would be experiencing the biggest cuts in Whitehall. That makes the job of having responsibility for the care of older people, which is a fixed cost, very difficult.

NHS Reorganisation

Rehman Chishti Excerpts

Wednesday 16th March 2011 Commons Chamber

[John Healey]

Nobody can doubt our commitment to the NHS, and to both investment and reform, during our 13 years in office—often in the face of opposition from trade unions. Of course there is room for efficiencies, and there are ways to get much better value for money out of the NHS but, as the Select Committee on Health has said, the reforms will make it harder, not easier, to meet that challenge.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Has the shadow Health Secretary seen the consultation responses to the White Paper, which show widespread support for the reforms?

[John Healey]

The hon. Gentleman needs to read some of the material for himself, rather than just reading the briefings provided by his Whips and his Front-Bench team. Some of the 52 organisations that this Government and the Health Secretary claim supported the Bill have written to me saying that far from supporting the principles of the Bill, they have “grave concerns” about the White Paper; that was said by the Patients Association. The Chartered Society of Physiotherapy has said:

“We have been very clear that we have grave concerns about the scope and speed of the structural changes proposed”.

Diabetes UK, Cancer Research UK, the Royal College of Speech and Language Therapists and others do not take kindly to being misrepresented by Ministers as supporting this Bill when they have such grave concerns.

Oral Answers to Questions

Rehman Chishti Excerpts

Tuesday 8th March 2011 Commons Chamber

[Jessica Lee (Erewash) (Con)]

13. What steps he is taking to improve NHS cancer services.

[Rehman Chishti (Gillingham and Rainham) (Con)]

14. What steps he is taking to improve NHS cancer services.

[Steve Baker (Wycombe) (Con)]

17. What steps he is taking to improve NHS cancer services.

--- Later in debate ---

[Paul Burstow]

First, I will take the opportunity to pay that tribute to the excellent and hard work of clinicians in providing invaluable support to people affected by cancer. My hon. Friend is also right to refer to the importance of respite care for families. As part of the end-of-life strategy that the Government are taking forward, we are looking to improve palliative care services and inquiring into the possibility of a per-patient funding mechanism to cover the costs of these services.

[Rehman Chishti]

Given the Minister’s commitment to improving patient experience, and the significant learnings from the national cancer patient survey, will he ensure that from now on the survey will be conducted annually?

[Paul Burstow]

My hon. Friend is right to draw attention to that survey, which has produced invaluable data. More than 65,000 patients took part in the 2010 survey, and it is proving to be an invaluable tool in enabling trusts and commissioners to identify areas where there is scope for improvement locally. The cancer strategy that we published in January commits us to repeating such a patient experience survey, and we are exploring the options at the moment.

Oral Answers to Questions

Rehman Chishti Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Paul Burstow]

I am grateful for the question. The answer, of course, is yes, we are determined to maintain these targets because we believe they make a difference.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Will the Minister ensure that patients who currently do not have access to a clinical nurse specialist will have such access? Research suggests that it considerably improves experiences and outputs.

[Paul Burstow]

The hon. Gentleman is right that we need to ensure that we invest in cancer specialists, and in the past six months the coalition Government have set out a number of steps that we will take, and are taking now, to improve cancer survival rates and cancer services. Raising awareness of signs and symptoms, new screening methods for bowel cancer and improving the number of specialist staff are just some of the things into which the Government have already started putting additional resources, in order to make a difference.

Rarer Cancers

Rehman Chishti Excerpts

Wednesday 27th October 2010 Westminster Hall

[Rehman Chishti (Gillingham and Rainham) (Con)]

It is a pleasure to speak under your chairmanship, Mr Robertson. I thank and congratulate the hon. Member for Manchester, Withington (Mr Leech) on securing this debate on such an important and sensitive issue. Applying the basic principle that brevity is a virtue, not a vice, I shall keep my submission short. I place on the record my thanks to organisations such as Macmillan Cancer Support, which have been very helpful in providing information for me to consider and base my submission on.

My first point is that representations have been made to me that people who suffer from rarer forms of cancer should be given priority in the Government’s proposals for the new drugs fund, on the basis that they are the ones who are the most disadvantaged by the current NICE drug appraisal system.

Secondly, the services available through the clinical nurse specialist system are very unlikely to be given to people with rarer forms of cancer. I urge the Minister to consider extending that system and ensuring that people with rarer forms of cancer have access to it. That is especially important because new research shows that clinical nurse specialists save the NHS money by co-ordinating services more effectively, along with significantly improving the patient experience and outcomes.

Thirdly, I seek an assurance from the Minister that the full maximum of the money allocated in the coalition agreement to the cancer drugs fund will be available. It is vital that we ensure that people who need those drugs get them at the earliest opportunity.