Public Health: County Durham

Roberta Blackman-Woods Excerpts

Wednesday 12th June 2019 Westminster Hall

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

May I say what a pleasure it is to serve under your chairmanship, Mr Owen? I thank my right hon. Friend the Member for North Durham (Mr Jones) for bringing forward this important debate. In 2013, there was a general welcome for the transfer of public health funding to local government, because it meant that public health and addressing public health issues could be integrated into the council’s service delivery objectives to better promote public health objectives.

On transfer, the grant to County Durham was £44.5 million, based on an assessment of health needs in the county by professionals—albeit one heavily influenced by the Government’s austerity programme. It is therefore extremely alarming that the Government now plan to move to determining the county’s grant level not on need but according to a new formula, under the huge misnomer of the “fair funding review”—it is anything but. The public health grant to County Durham will be reduced by a massive 38% while resources are transferred to more affluent areas of the country that have much better health outcomes. That is clearly madness and cannot be right.

The public health team in County Durham has done a good job, despite facing the hugely complex health issues discussed in some detail by my right hon. Friend. The county has an industrial past of heavy industry that has left a huge legacy of negative health impacts on the local community. Despite that, and through use of the public health grant, public health professionals, to whom we all pay tribute this afternoon, have done much. They have reduced smoking prevalence and teenage conceptions, and they also provide excellent support for vulnerable families on health and wellbeing issues, including access to mental health services. Those positive changes will be very much put at risk by the massive reduction in funding. In fact, given the severity of the problems Durham faces, it should be given more funding, not less.

Public health professionals in Durham have to address not just the problems of our industrial legacy but high current levels of poverty, because proper regeneration of the county has not taken place as yet. For example, just one food bank said that it gave out 20,000 emergency food bank parcels in Durham last year. We are talking about massive levels of poverty. Almost a third of children in County Durham are being brought up in households affected by poverty. Increasingly, such households are those with parents in work, sometimes having to do multiple jobs just to make ends meet.

[Mr Kevan Jones]

Under the last Labour Government, my hon. Friend, along with my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), pioneered a free school meals initiative. Is she alarmed that, as I learned yesterday, the national school breakfast programme, which costs only £12 million nationally and affects quite a few schools—primary schools in particular—in her constituency, my constituency and other parts of County Durham, has still not had its funding guaranteed for next year?

[Dr Blackman-Woods]

My right hon. Friend makes an important point, which I am sure my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) and I will take up in the coming weeks. That is an indication of how little the Government seem to be concerned about the children growing up in poor households.

Let us look at the Durham situation. The starkest indicator is the seven-year healthy life expectancy gap between females in Durham, currently at 59, and those in Hertfordshire, where it is 66, and Surrey, where it is 68. That gives rise to the question of why the Government are transferring resources from County Durham to Surrey and Hertfordshire. I know the Minister is new to her post, but it would be helpful to get an explanation of why the Government think that is a good idea, because we have not had one so far. The appalling health inequality is compounded by overall life expectancy figures, which for women are 81 in Durham compared with 84 for Hertfordshire and Surrey. There is a similar gap for men.

Let us look at other measures. Suicide rates in County Durham were above the national average, with 20.6 deaths per 100,000 of the population for males. On mental health, the rate of young people admitted to hospital because of self-harm is significantly above the national average. On alcohol, 33.8% of people in County Durham drink more than the low-risk guidelines recommended, and 290 people died due to alcohol-related problems last year. There were also 12,500 hospital admissions and 108 road traffic accidents. That suggests a significant problem that needs to be addressed.

Furthermore, the percentage of mothers smoking at the time of delivery is above regional and national averages. As my hon. Friend the Member for Sedgefield (Phil Wilson) made clear, breastfeeding rates are low, yet we know that it provides the best nutrition that babies and young children can get. Seven out of 10 adults in County Durham are overweight or obese, significantly more than the national average, and cardiovascular mortality rates are also higher than the national average.

I could go on with endless statistics, but we are making the point that County Durham is an area with high levels of disadvantage and poverty. It is below the national average on almost every public health indicator imaginable, yet what are the Government doing? They are not giving additional funds to address those problems and ensure that our services continue to improve; they are threatening to take money away.

The workforce would be significantly affected by this measure. There would be a significant reduction in the number of visits that health professionals could make and the universal work on emotional wellbeing would be removed. Instead, only higher level and more targeted work would take place, although we know that misses most of the families and individuals who would benefit from services. Other prevention priorities, including visits and programmes trying to address problems around smoking at the time of delivery, breastfeeding, unintentional injuries and obesity, would also be reduced. The service would have to focus on safeguarding, which would increase inequalities, and issues would be missed.

I could go on and on. We have already seen a massive reduction in services. For example, my constituency has no Sure Start centres operating, which means there is nothing in place to bring together services that could support very vulnerable families. Can the Minister look at that issue as well?

What do we want the Minister to do? The point was put forcefully by my right hon. Friend the Member for North Durham: we need a commitment from the Government to increasing public health funding in line with need; an extension to public health funding to be used in areas where the grant has been utilised effectively; and clarity on the timescale for decisions. We have already seen concern in County Durham about future funding, especially from the voluntary sector organisations that do much of the heavy lifting in terms of providing services to improve public health outcomes. The Government do not seem to be aware that funding for such organisations is often precarious and that they need some certainty from the Government to invest in staffing and services for the future.

The Government should certainly not be moving money from areas with the greatest health inequalities to those with the least health inequalities. They should be carrying out an impact assessment of any funding decision, so that we are really clear about what the impacts of that massive reduction of 38% in County Durham would lead to. As my right hon. and hon. Friends have said, this is an issue across north-east England. I look forward to hearing what the Minister will say to address this problem.

--- Later in debate ---

[Seema Kennedy]

No, I was repeating what the shadow Minister had said.

The recommended formula, which would create winners and losers in terms of overall levels of funding because of the disparity in historical spend compared with current need, has not been implemented because of the Government’s intention to extend the system of retained business rates. We continue to review the position, and future spending levels will be decided as part of the spending review, where we will review all available evidence.

I commend all local authorities on the efforts they are making to improve population health, as well as third-sector groups such as the children in Cleves Cross with their edible walkways. We continue to believe that local authorities are best placed to make decisions about the services that best meet the needs of their populations.

[Dr Blackman-Woods]

I am sure the Minister would accept that any formula that moves services from areas of relatively high need to areas of low need cannot be working properly. Does she also accept that it is simply not fair to push the onus to provide more services on to local authorities? As my right hon. Friend the Member for North Durham (Mr Jones) made clear, Durham County Council’s budget has been cut by 60% since 2010.

[Seema Kennedy]

I believe that local authorities and local communities are the right place for public health to be situated, because they best understand the needs of their communities.

Eurotunnel: Payment

Roberta Blackman-Woods Excerpts

Monday 4th March 2019 Commons Chamber

[Matt Hancock]

This is a cross-Government decision. The purpose of this settlement was to ensure the unhindered supply of medicines. I am the Health Secretary and it is my job to do everything that I can, in all circumstances, to ensure that there is that availability of medicines. I am sure that, whatever the Brexit scenario, the hon. Gentleman’s constituents who need medicines would rather that we made this settlement to ensure that we have the confidence that we can deliver that.

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

I have recently been to see the Secretary of State for Education to lobby him for desperately needed resources to rebuild schools in my constituency and I was told that there is no money. Can the Secretary of State tell me how incompetent I need to be to walk away with £33 million for my constituents?

Nursing: Higher Education Investment

Roberta Blackman-Woods Excerpts

Wednesday 21st November 2018 Westminster Hall

[Eleanor Smith]

My right hon. Friend covers a point about apprenticeships that I will address in my speech, because what we are saying is that it is one of the routes, but not the only route.

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

My hon. Friend is making an excellent speech on a topic that is important to us all. The Royal College of Nursing has made it very clear that the priority for the bulk of investment in nursing education must be the three-year undergraduate degree, because that is the fastest and safest route for growth at scale. Does she agree with that, and does she agree that we must not try to do nursing training on the cheap?

[Eleanor Smith]

Absolutely; I totally agree. I thank my hon. Friend for that intervention. We should not be doing the training on the cheap. I will try to address that point in my speech.

There is a huge risk that the long-term plan will be like previous plans and that Simon Stevens will not provide or fund a solution. He is spending money on services that cannot be staffed. He is creating new posts that cannot be filled, because trained and qualified registered nurses to fill those posts do not exist. I wonder whether the Prime Minister knows that nurses do not grow on trees, just as money does not. The five year forward view substantially failed to create nurses. In fact, during that time, the opposite happened: we lost thousands of nurses. I ask right hon. and hon. Members what on earth should be prioritised above growing the number of nurses.

Oral Answers to Questions

Roberta Blackman-Woods Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Caroline Dinenage]

My hon. Friend is absolutely right to mention this. Palliative care is crucial to the experience not only of patients but of their families and carers. He will be interested to know that we have a new indicator from 2018-19 to measure the proportion of people who have had three or more emergency admissions in their last 90 days of life, which will help us to assess how people can be better supported in the community, and to do that better.

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

24. Social care hubs could be part of the way forward for social care, but, in response to a recent survey of care providers in my constituency, 71% said that despite the best efforts of staff the quality of care had greatly diminished because of years of chronic underfunding. Does the Minister agree that we need a systemic change in social care funding, given that the extra money provided so far is a drop in the ocean and does not address levels of need?

[Caroline Dinenage]

The hon. Lady is right. We know that the adult social care system is under pressure, which is why we are setting out a more sustainable future in the Green Paper which will be published later this year. It is, however, important to point out that more than 83% of adult social care providers are rated good or outstanding, and that, thanks to a range of Government actions, County Durham has received an additional £37 million for adult social care in 2018-19 and was allocated £2,822,376 in the recent winter funding announcement.

Social Care Funding

Roberta Blackman-Woods Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

In terms of quality in Buckinghamshire and Birmingham, we look at the CQC reports right across the system, and we are not finding a geographic variation based on those sorts of statistics. That is just the fact of the matter.

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

I have heard nothing from the Minister to demonstrate that he understands the severity of the situation facing social care. Last week, the Local Government Association met a cross-party of group of MPs. It said that local government needs £1.3 billion to stabilise social care, and pointed out that that money cannot be raised by a council tax increase, especially because that raises the least money in the areas with the highest need.

[David Mowat]

In terms of council tax increases, this is not about the local government settlement that has already been announced. The additional better care fund will start to deliver more money from next April, and will deliver more money after that. During the course of this Parliament, there will be a 5% increase, in real terms, in money spent on adult social care.

Clinical Commissioning: North Durham

Roberta Blackman-Woods Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

I beg to move,

That this House has considered changes in clinical commissioning group commissioning practices for GP referrals in North Durham.

I asked for this debate as a result of a development that affects many in my constituency and other constituencies covered by the North Durham clinical commissioning group. I was made aware of it not by the clinical commissioning group but by “BBC Look North”, which received a tip-off from a GP about an upcoming change to the way GPs refer patients to a specialist. The change made by North Durham CCG fundamentally alters the way in which a GP refers a patient to a specialist.

It was always the case that if a GP saw a patient and considered that their health condition needed further investigation, they would be able to refer that patient directly to a specialist. The scheme introduced by North Durham CCG adds an additional layer of referral: if a GP wants to refer a patient, they must send a letter and medical records explaining why to a private health company called About Health, which will decide whether a patient should be referred to a specialist. That means that, in effect, a private company that has never seen the patient can overrule the decision of the patient’s GP to refer them to a specialist in a hospital. Conditions that would be referred under the new system include cardiology, gynaecology, dermatology and gastroenterology. Suspected cancer cases would be excluded from the system, although many cancers are detected when patients present with other health issues.

The decision to implement the scheme was taken following a year-long trial carried out by North Tyneside CCG. We do not yet know the clinical outcomes of the patients involved in that trial, but North Durham decided to roll out the scheme even without that information. North Durham CCG’s decision to adopt the new practice for referrals was also made without proper consultation of local residents or patients. Many patients were not even informed that confidential information about their health status was being shared with a private company. My hon. Friend the Member for North Durham (Mr Jones) and I had a meeting with the clinical commissioning group in September, only weeks before it introduced the new scheme, and yet it made no mention of the scheme whatever.

[Liz McInnes (Heywood and Middleton) (Lab)]

I am listening to the debate with astonishment. General practitioners, by their very name, are generalists, are highly trained and should be aware of the signs and symptoms of diseases and know who to refer patients to, but the intervention of a private company has been inserted as a barrier to patients getting specialist treatment. I cannot believe what I am hearing. I am sure my hon. Friend shares my surprise.

[Dr Blackman-Woods]

My hon. Friend makes an excellent point. Indeed, I was shocked and surprised. In fact, when “BBC Look North” presented me with the information, my immediate reaction was of huge concern for my constituents. I did an interview for “BBC Look North” and was then contacted by other news outlets. As a result of those interviews, I was contacted by many of my constituents, some of whom had already been adversely affected by the new referral system, and by GPs who said they were being forced to jump through hoops or to refer their patients unnecessarily to physiotherapy services when they knew that treatment would not help before they could refer to a specialist in a hospital.

I was also contacted by a GP in the area covered by North Tyneside CCG who said that he had referred a patient to a specialist for a skin condition but the referral was overruled by the new scheme, which is called the referral management system. The skin condition turned out to be cancer, but that was not discovered until months further down the line, which meant that far more radical surgery was required than would have been the case if the patient had been seen by a specialist when the GP first referred them.

I therefore have a number of serious concerns about the referral system and the way in which the decision to implement it was made. My first concern is the possible negative impact on the health of my constituents and other people who live in areas affected by the new patient referral management schemes. I am concerned because whether a referral to a specialist goes ahead or not could have a long-term impact on the health of the patient or even result in something more serious, especially if decisions are overturned by About Health. A patient might not receive the treatment they need early enough.

I am also concerned about the financial impact of the decision. I understand that the NHS is under considerable financial pressure, but I doubt whether the scheme will end up saving money in the long run. That is because, as I just set out, in many cases where referrals are rejected the problem does not go away and patients return to their GP or even go to A&E with far more serious problems, which take up more of the NHS’ time and resources. About Health, the private company deciding on referrals, will be paid a basic fee and an additional £10 for each referral letter, which in itself will incur a significant cost. I am therefore not at all sure that the scheme is cost-effective.

My final concern is about the lack of public consultation and information on the decision to implement the scheme. Last October, the Secretary of State for Health announced plans to rate CCGs to make

“the most patient-focused NHS culture ever”,

which would be

“much more accountable to their local population than previously.”

The decision made by North Durham CCG to change completely the way in which GPs can refer a patient to a specialist without any consultation flies in the face of CCGs being accountable to the local population. How are people supposed to hold a CCG to account if they are not aware of changes that are being made?

The North Durham patient reference group meets monthly in Durham city to discuss patients’ points of view and give feedback to the CCG about proposals and issues. The group, which is drawn from members of each GP practice forum across Durham, was informed of the new referral scheme only as it was about to be introduced, and it was not given any opportunity to give feedback on proposals. Despite meeting monthly, members of the group had not even heard about the plans before they were presented with them and told that they were to be introduced imminently.

Similarly, members of patient forums at local GP practices were informed of the decision, rather than consulted on it. I am told that patient forums and the North Durham patient reference group were concerned and opposed the immediate implementation of the proposals, but North Durham CCG decided to go ahead and implement the new scheme immediately in any case.

This is a really important point for the Minister. If a patient goes on to the CCG’s website, what they see does not tell them that their details will be given to a private company; they are simply told that a referral system is in place and that referrals are to “consultants” or “specialist GPs”. I think many patients would conclude from that wording that their medical information is to be sent to a specialist at a local hospital rather than to a private company.

I have written to the CCGs in the north-east to invite them to meet me and other members of the northern group of MPs to discuss this issue. It has been extremely difficult to get them to come to a meeting with us or indeed to get any information from them at all. I have some questions, which I will put quickly, to give my hon. Friend the Member for North Durham time to speak. Does the Minister know of any other clinical commissioning groups in the UK that have implemented a patient referral management service? Does he think that it is acceptable that no consultation was carried out? Will the practice be repeated by other CCGs across the UK—particularly ones ranked as in special measures? How can About Health, or other private companies, be held accountable if decisions result in negative outcomes for the health of patients? Does the Minister agree that the referral system is acceptable at all?

[Geraint Davies (in the Chair)]

Both the Minister and the Member who moved the debate have agreed that Kevan Jones and Julie Cooper may speak, on the understanding that they will speak for under five minutes and two minutes respectively.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship today, Mr Davies. I, too, congratulate the hon. Member for City of Durham (Dr Blackman-Woods) on obtaining the debate, and I congratulate the other hon. Members who spoke too. It is good to have a chance to discuss the matter and weigh up the pros and cons of what is being done.

The context is the CCG in the hon. Lady’s area, which consists of 31 GP practices. It has been rated as a good CCG by the Care Quality Commission. Its treatment referral time is above the national standard, at 92% within 18 weeks. I want to talk first about the policy area, and then about the specifics of the decision to employ About Health in North Tyneside and North Durham.

The first thing to say about the policy is that referral management is not a new area. In 2007, something like 70% of primary care trusts had a type of referral management system in place. The intention is fairly clear: when a GP is making a referral, it will be absolutely obvious in many cases that it needs to happen. In many other cases it will be clear that a referral is not needed. There will also, frankly, be a grey area in the middle—that will happen in any profession.

[Dr Blackman-Woods]

Will the Minister focus on this specific referral system, under which, we understand, all referrals to specialists from GP practices in the CCG area are subject to private company screening and there is also a target to send back at least 50% of all referrals made?

[David Mowat]

I was explaining the purpose of the policy and the fact that this referral mechanism was used widely in 2007. A King’s Fund report from 2010 sets out the pros and cons of using referral management—I suggest the hon. Lady reads it.

These things are not new. They are a mechanism by which a consultant, or a GP with a specialist interest in the area of what is being referred—there are six areas of referral in this CCG, as the hon. Lady said—has two to three days to either accept that the referral goes on to the secondary system, or to contact the GP and have a discussion about what the best alternative pathway might be. There is an appeals process if the GP does not agree with that decision.

The hon. Lady asked where else such referral management was being done across the NHS in England. It was introduced in 2007, as I said, and it is being done very commonly. It is being done in Bromley, Cambridge, Peterborough, Imperial in London, and Southampton. I saw a similar system in Tower Hamlets to the one working in her area—indeed, the GP was very proud of the way they reacted, with an email referral system, when there was every possibility of things not going ahead.

This is not rationing. It is completely wrong to say that. It was brought in by the CCG, which is GP-led. If the GPs in the CCG do not agree with it, they have the mechanism to replace the chairman of the CCG.

--- Later in debate ---

[David Mowat]

I have given way a lot; I want to make some progress.

That is also of benefit to GPs, because they can quickly validate decisions on the best pathway for those grey areas that may or may not require a referral with a consultant who knows more than them about that particular discipline. Of course, it is of benefit to the providers because it takes away something like 20% of unnecessary outpatient appointments. Indeed, one of the providers for the scheme in North Tyneside has asked for it to be extended to an additional discipline, because they feel that some of the referrals they receive are unnecessary and that the referral management system—in the way we have been doing it in the NHS for the past decade—is a mechanism for preventing that.

[Dr Blackman-Woods]

The only information that North Tyneside CCG has put into the public domain is how much money it has saved through this system. It has not made an assessment of clinical outcomes for patients at all.

[David Mowat]

I am going to talk about the About Health situation and the people who have been awarded the contract in North Durham. It is a one-year pilot that builds on the one-year scheme in North Tyneside. I think it started last month; it covers six disciplines and it does not cover urgent referrals, in particular cancer. All the national requirements for referral-to-treatment times still count in exactly the same way. The local CCG performed a risk analysis before it decided to take the scheme forward and build on what happened in North Tyneside, and the scheme is monitored.

I have been told that a very important feature is that there is a clear GP appeals process. If they are not happy with a decision that has been taken, that process can happen very quickly.

Community Pharmacies

Roberta Blackman-Woods Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

Let me begin by thanking Greg Burke of County Durham & Darlington local pharmaceutical committee for his valiant efforts in bringing the issue of cuts in community pharmacies to my attention. I also thank him for arranging my visit to Bowburn pharmacy, where I met Phyllis Whitburn, Nigel Nimmo, Len Britten and Hieu Truong Van. The visit reinforced my view that community pharmacies are vital to our communities, and especially to those in the ex-mining villages in my constituency, where they often provide a lifeline. The Minister has said that many pharmacies are within a 10-minute walk of two or more others, but that is simply not the case in many parts of my constituency.

I had hoped that all the lobbying that took place earlier this year, led by my hon. Friend the Member for Barnsley East (Michael Dugher), would remind the Government of the excellent services that community pharmacies offer and how much money they ultimately save the NHS, and that that might persuade them to abandon the cuts agenda. It was therefore with great sadness that I listened to the Minister’s statement on 20 October, in which he outlined the cuts. No rationale for them was presented, and it seems odd that the Government have instigated them without waiting for the outcome of either the King’s Fund review or the Royal Pharmaceutical Society’s review of community pharmacy services.

Let me also draw the Minister’s attention to the large body of research on community pharmacies that has been carried out by Durham University. It has established that they are very well placed to address health inequalities, that they are most prevalent and most used in the most disadvantaged areas, and, indeed, that 100% of people in most deprived areas could have access to one. It is very odd that the Government are cutting services that benefit those areas. The same point has also been made by the Local Government Association, the Pharmacists’ Defence Association and others. According to the LGA, the closure of community pharmacies could leave many isolated and vulnerable residents struggling to gain access to pharmacies, particularly in deprived and rural areas. The LGA has also drawn attention to the knock-on effect on local government services, which are suffering cuts as well.

The Minister ought to take up some of the points made in the PDA briefing that was sent to all of us before the debate. The Government should be thinking about regulating the wholesale margins, reviewing the margins of some of the larger companies, and reviewing the way in which community pharmacies and the pharmaceutical wholesale industry are organised. They should not be making these cuts in community pharmacy services.

Land Registry

Roberta Blackman-Woods Excerpts

Thursday 30th June 2016 Commons Chamber

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

I thank my right hon. Friend the Member for Tottenham (Mr Lammy) for securing this debate. It is a pleasure to follow the hon. Member for Colchester (Will Quince), who made a powerful speech.

It is completely clear to me that privatisation is not the way forward for the Land Registry. Privatisation will damage the Land Registry’s reputation for independence. It could cause job losses in my constituency and elsewhere and, ultimately, cost the public money. The UK’s Land Registry is a model of good practice around the world. It gives advice to other countries about how to set up and run land registry services in an independent and impartial way. Its expertise is welcomed by many other countries.

Privatisation could seriously damage confidence in the Land Registry’s independence. As we have heard, the former Chief Land Registrar and chief executive of the Land Registry, John Manthorpe, has said:

“The Registry’s independence from commercial or specialised interests is essential to the trust and reliance placed on its activities. It would not be possible for actual or perceived impartiality to be maintained or public confidence sustained, if a private”

company

“were to assume responsibility for the…maintenance of a public register.”

As others have said, the consultation paper from the Government seems to show a lack of understanding of what actually happens with the register. The Government talk about the register as though it were a static document that is produced once and for all and can be handed over to somebody else, but it is very much a live document, as transactions are constantly added and updated. That means that there is enormous potential for a conflict of interest emerging from a private company running the register when information that might be placed on it could change on an hourly or daily basis. The Government’s consultation paper showed no acknowledgement of conflicts of interest that could arise or how they would be dealt with.

The Competition and Markets Authority has also raised concerns about privatisation, particularly that a private company running the Land Registry as a monopoly could weaken competition by making it harder to access the information it holds. As we have heard, an exemption from the Freedom of Information Act could mean that the sort of information found in the Panama papers would not be available for public scrutiny, which would be a great loss. The Government must seriously consider whether it is sensible to change a model that has a sound international reputation and a lot of trust, and that works so well and has real independence.

It is abundantly clear that there is no public demand for privatising the Land Registry. When privatisation was last suggested in 2014, the public consultation showed that 91% respondents disagreed with the idea that the services could be better delivered outside government. The hundreds of emails I have received from constituents opposing the Land Registry’s privatisation in just the past few weeks suggest to me that public opinion has not changed since 2014. I will quote just a few of my constituents who have written to me about this so that we can all hear how concerned they are. One wrote:

“The Land Registry is a self-financing public service which doesn’t cost the taxpayer a penny to run—so why is the government considering selling it off to companies with links to offshore tax havens?”

Another said:

“Experts from all backgrounds have been calling the government’s plans to sell the Land Registry short-sighted. The government’s own watchdog warned that it would threaten competition, and an expert from the World Bank said it would increase corruption.”

Another said:

“This government seems to be hell-bent on disposing of everything which we value, not to mention that

the Land Registry

“is actually a net contributor to the treasury.”

It is not only constituents who are concerned. Institutions from the Law Society, to the Public and Commercial Services Union, the Open Data Institute, the Co-Operative Group and very many small and large businesses have expressed their unease at the idea of privatising the Land Registry. That is for a whole variety of reasons that we have heard today: the registry has strong public confidence; there is ease of access; and it is trustworthy. Why are the Government so keen to go against the opinion of the public and experts? The Government’s decision again to raise the idea of privatisation, just two short years after they were forced to withdraw proposals in the face of massive opposition and a broad alliance of interests is, quite frankly, baffling.

Will the Government provide reassurances to my constituents working in the Land Registry office in Durham who fear that their jobs could be lost in the event of privatisation? The Land Registry is a major employer in Durham, providing hundreds of skilled jobs. Employees are understandably very concerned that privatisation could lead to job losses or even a full closure of the Durham office, which has existed for over 50 years. As this has been the only Land Registry office in the whole of the north-east since the closure of the York office some years ago, I would be concerned about not only my constituents’ jobs, but the impact that such a closure might have on the north-east’s economy.

When the privatisation of the Land Registry was last discussed in 2014, it was estimated that the Land Registry in Durham contributed £10 million per year to the local economy; I very much doubt whether that sum would have reduced in the past two years. Given the instability of our economy in the wake of the pro-Brexit vote, I would be extremely concerned by the prospect of further damage to the north-east’s economy.

The privatisation of the Land Registry would be bad not just for my constituents but for the public as a whole. The revenue brought in through the Land Registry each year would be lost. As a recent report from the New Economics Foundation made clear, in the long term, the sale of the Land Registry would result in a significant loss of income to the Treasury. In 19 of the past 20 years, the Land Registry has produced a surplus. It paid £120 million into the public purse last year. It is clear that the decision to review proposals to privatise the Land Registry is being driven by the Treasury’s desire to bring in revenue in the short term without looking at the long-term negative impact that that would have on public finances. The estimated £1.2 billion that could be raised from the sale will not stretch very far into the future.

In 2014, the Land Registry expanded to include services relating to local land charges. I said at the time that I thought the Government were doing that in order to fatten the registry up for privatisation, and it seems I might have been right. Once again, the Government are pushing for privatisation, so I think my fears were not misplaced. The Government’s responsibility must be the long-term health of the economy, and it is clear that the money that can be raised from privatisation will not offset the long-term costs of having no revenue from the Land Registry.

This Government have failed before to get the best deal for taxpayers when privatising services, most recently in the case of Royal Mail, in which shares were tragically undersold at the cost of millions of pounds to the taxpayer. How can we be confident that the Government will get the best deal for the British public with the privatisation of the Land Registry? Without them being able to guarantee a good deal, would it not be better, for that reason alone, to keep the Land Registry in public ownership? We have been through many of the other reasons why privatisation should not happen.

I end by quoting the words of another of my constituents who wrote to me about this issue:

“The Land Registry is working well, it’s not broken—there’s no need to fix it. In fact, it’s successful, profitable and part of a vital data infrastructure that our country needs.”

I completely agree with my constituent and ask the Government to drop any idea they might have about privatising the Land Registry.

--- Later in debate ---

[Bill Esterson]

Yes, I rather thought the hon. Gentleman might say that— [Interruption.] The Minister correctly points out that was an opportunity for mischief that could not possibly be missed.

My hon. Friend the Member for Llanelli (Nia Griffith) made an excellent speech. She talked about the petition containing 300,000 names that was handed in to the Department for Business, Innovation and Skills. I was there with her on the day, as were a number of our hon. Friends. She rightly asked what on earth we are doing here just two years after the last attempt at a privatisation, at which time very clear and widespread opposition to it was demonstrated.

[Dr Blackman-Woods]

Does my hon. Friend agree that when many of us, with a whole range of organisations and unions, including the PCS, turned up at the Department, it would have been really helpful if the Minister had come out to meet some of the people who wished to hand over that huge petition? [Interruption.]

[Bill Esterson]

The Minister, from a sedentary position, points out that that would not have been him. Perhaps we can take that as him agreeing that the Minister responsible should have been there to meet us all on that day. He can choose whether to respond to that point when he replies to the debate shortly.

The hon. Member for Telford (Lucy Allan) made a point about the importance of the Land Registry’s success to her constituency. That is true for each and every one of us in every constituency in the country.

The Land Registry has existed for 150 years. Currently it does not cost the taxpayer a penny. It makes a significant profit and delivered a surplus in 19 of the past 20 years. A one-off fee from its sell-off is no strategy for deficit reduction, as Conservative Members have acknowledged. It would allow for only a one-off reduction of debt. This is not an economically coherent approach to Government finances. Worse, it is cynical to pretend to taxpayers that the proposal constitutes the responsible management of the economy. I am afraid that, driven by the Treasury and the Chancellor, privatisation is exactly what the Government appear to be trying to do.

The consequences of selling off the Land Registry are far wider and more dangerous than losing a profitable public sector enterprise. Having a trusted impartial register of land underpins our economy. I do not need to repeat to Members the uncertainty and danger that has been caused by the Brexit decision that was taken a week ago. We have seen that uncertainty in the markets and it is spreading to the real economy, with job losses already announced. That uncertainty applies right across our economy, as well as to the role the Land Registry plays.

Any house that families or companies buy or sell relies on the Land Registry granting and transferring title deeds. It is the only proof of title or ownership recognised by law for £3 trillion of UK property. By virtue of it, every property sale, purchase, repossession and mortgage in the UK is carried out transparently and in confidence by the seller, buyer and lender. The Land Registry’s independence is fundamental to the trust that homeowners, mortgage lenders and solicitors place in it. How could that trust remain if the very basis of that trust—the knowledge that the Land Registry is utterly impartial—is removed? How could the Government maintain that its impartiality will remain if it is taken over by private interests?

Let us look at the potential buyers who are showing an interest. Of the private investment firms reported last month by The Times to be interested in running the Land Registry, all have links to offshore tax havens. That makes a mockery of the Government’s claims of being serious about clamping down on tax avoidance and tax evasion. Canadian pension company OMERS, American private equity firms Advent International and Hellman & Friedman, and General Atlantic each have links to such jurisdictions, not least the Cayman Islands. When the Minister responds, will he tell us if he agrees that the Land Registry’s absolute transparency and independence from private interest is fundamental to the trust placed in it by homeowners and mortgage lenders? Does he also agree that this trust would be fundamentally undermined if such firms took over? That is what people up and down the country can see happening.

Junior Doctors’ Contract Negotiations

Roberta Blackman-Woods Excerpts

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

That is a question I am increasingly asking of those in the BMA’s leadership. They have agreed with Sir David Dalton that the remaining issue is about pay. Having said for several months that it was not about pay, they have now, in the end, come clean and said that it is about pay. That is what we are dealing with: pay rates for plain time and for Saturdays, where they wish for preferred rates over nurses and other “Agenda for Change” staff.

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

Junior doctors in my constituency are only very reluctantly taking action on Wednesday. They are supported by many of my constituents, who think that it is simply a disgrace that junior doctors are being forced to take industrial action because the Government are simply failing to address the legitimate concerns raised by the BMA. I heard the Minister say that his door is open, but what he is actually going to do to settle the dispute, and does he think it helps to denigrate the BMA in the Chamber this afternoon?

[Ben Gummer]

The hon. Lady says the junior doctors in her constituency had legitimate concerns. They did. Every single one has now been answered in the negotiations between Sir David Dalton and his predecessors apart from one, and that is the one the BMA refuses to open negotiations on, despite having promised to do so in November last year. Yes, our door remains open, but the BMA has first to agree to talk to us, which it is again refusing to do.

Oral Hormone Pregnancy Tests

Roberta Blackman-Woods Excerpts

Thursday 23rd October 2014 Commons Chamber

[Roberta Blackman-Woods (City of Durham) (Lab)]

I congratulate my hon. Friend the Member for Bolton South East (Yasmin Qureshi) on securing this important debate and thank the Backbench Business Committee for granting it. I would like to thank, too, my hon. Friends for setting up the all-party group, which has been so helpful in supporting campaigners on this issue.

In common with my hon. Friend the Member for Coventry North West (Mr Robinson) and the hon. Member for Enfield North (Nick de Bois), I have come to this issue via my constituents, and I shall talk in greater detail about the experience of Mr and Mrs Chapman in a few moments. When they came to see me at a surgery a few months ago, I approached the issue, as have most hon. Members, with a certain degree of incredulity that a situation such as that experienced by that family could have gone on for so long without any action being taken, particularly without any serious examination of why so many babies were born with serious deformities between 1953 and 1975 or of the relation between those deformities and the hormone pregnancy drug that so many of the women had taken.

We know that the most common abnormalities identified include neural tube defects, cleft lip and palate, limb reduction defects, general cardiovascular defects as well as many more. It is believed that 1.5 million women took primodos and the effect of the drug much depended on the stage of pregnancy, but in addition to many women having children with defects, it is thought that in many more women the drug caused miscarriage.

In a written parliamentary answer in the previous Parliament, the number of those affected in the longer term by primodos was assessed at about 3,500. Most campaigners think that that figure is too low and that the real figure is much higher. We know that the drug company simply discontinued primodos and never looked back, but the victims, their parents and their wider families continue to live not only with the birth defects, but with uncertainty over what has caused them. Mothers are unable to forget the guilt for using the drug. Their children, now grown up, continue to look for answers as to why they were born with abnormalities. It is up to us in the House today to try to ensure that those people get the answers they have been seeking for many decades.

We know from sales statistics that many thousands of women used primodos as a pregnancy test between 1970 and 1977 even though it was not licensed for use in that way. We know that there was a huge delay in putting information into the public domain about the possible dangers of using the drug; indeed, information did not appear in the public realm until eight years after the first reports indicated possible dangers. That seems to be an extraordinary delay and, again, one for which no real explanation has been given.

Similarly, and despite the weight of evidence, regulators did not warn doctors and patients about the possible dangers of using the drug until much later than in other countries. Authorities in Sweden, Finland, Germany, USA, Australia, Ireland and Holland issued warnings on the drug as early as 1970 to 1975. That was many years before any warning was issued in the UK, despite the fact that the Committee on Safety of Medicines was the first medical authority to know of the hazard, as other Members have said. We know that some doctors continued to prescribe the drug to pregnant women even after official warnings from the Committee on Safety of Medicines had been given. We need some answers as to why doctors kept on prescribing the drug even when it was known that there were some dangerous consequences of using it.

We also need to ask why the medical community and indeed the committee that was licensing medicine did not take on board much earlier information, especially in the academic medical community, about the potential harm that could be caused by taking the drug. As early as 1967, as Dr Isabel Gal discovered, there were warnings that primodos potentially caused spinal congenital malformations in newborns. The Medical Research Council picked up on that the next year and said that it could be another thalidomide story. Yet no real action was taken to remove the drug until 1978. Some explanation for that delay would be very helpful.

We know that the drug companies and the MHRA are now saying that it is very difficult, given the passage of time, to do anything about this dreadful situation. We have to reject that notion very strongly. There are data available. They may not be in the public domain at the moment, but those data need to be examined and that is the purpose of the motion. The issue needs to be examined very carefully to provide some answers and to see whether a causal link can be confirmed. If not, other answers must be given to the people who have for many years considered primodos to have been the cause of the birth defects they experienced.

I will try to stick to the 10-minute ruling on speech length, so finally I will talk about the case of Mr and Mrs Chapman. I have their full permission to talk about their situation. It is truly heart-wrenching. Their daughter, Margaret, was prescribed primodos—two tablets were the instructions—simply to confirm a pregnancy. It was not her first pregnancy. She was surprised that she was being given medication to assess whether she was pregnant, and queried it, but the doctor said there would be no side effects, so she trusted the doctor and took the tablets. After her baby was born in March 1975, she noticed that her baby was blue, called the midwife and the baby was rushed to Newcastle general hospital. The baby was diagnosed as having a deformed heart and they were told she would probably not live very long. She was given emergency surgery in a specialist heart unit and, despite dedicated nursing at home by her mother and wider family, lived only for 18 months. That dreadful situation has stayed with that family for many years. It is heart-wrenching, and they desperately want some answers.

My hon. Friend the Member for Coventry North West said that these families desperately need closure. I agree, and I hope we make a decision today to set up an independent panel, and to have all the relevant documentation put in the public domain. These families have been extraordinarily patient—we must pay tribute to how they have kept campaigning year after year, despite not really being listened to—and I hope today we listen to them and start the process that will perhaps give them some answers.