Coronavirus

Rupa Huq Excerpts

Tuesday 15th September 2020 Commons Chamber

[Matt Hancock]

We do have a standard for clinical masks, but for the widespread use of face coverings, we do not set a standard, because the evidence is that for the general public, using a face covering can make a big difference without drawing on the supply of clinical masks for personal protective equipment. Standards are set by the European Union that define what can be put into a hand sanitiser, but I am happy to work with my hon. Friend on the details if that needs to be strengthened.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

A world-beating app that is nowhere to be seen, the national R rate rocketing and local testing all but impossible—in Ealing, we would be lucky to get offered a test in Aberdeen—all bode ill for the start of the educational year. With press reports swirling around that there are hundreds of school outbreaks already, can the Secretary of State tell us exactly how many of those there are? Can he up the number of testing kits that schools are supplied with from 10 a piece? As universities go back, which means that people will be moving around bits of the country with different infection rates, can he ensure that everyone on campus gets a test, whether they have symptoms or not? We cannot let education be the next care homes crisis.

[Matt Hancock]

The hon. Lady raises important points. It is important to note that in Ealing, 462 people got a test yesterday, so tests are widely available in Ealing. The other issue she raises about ensuring that schools and universities have access to testing is important within the prioritisation. As she knows, we have sent tests to every school for use in exceptional circumstances when they need them. It is very important that those tests are used when people are symptomatic, rather than asymptomatic.

Covid-19

Rupa Huq Excerpts

Tuesday 1st September 2020 Commons Chamber

[Matt Hancock]

It is very good that we have been able to give funds to over 100 A&Es across the country so that they can expand, both to be able to cope with infection control procedures and to ensure that there is more space. I pay tribute to the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), who has driven through this programme along with the NHS. I am confident that this can be built in time for winter to ensure that we are ready by December.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

All of west London rejoiced when the Secretary of State axed the hated “Shaping a healthier future” programme, which was established by his predecessor. Will he now stave off the rumours circulating and confirm that the stopping of services at Ealing Hospital—that programme would have put an end to those services, as we know it—does not mean that the closure programme is coming in through the back door? There are a lot of rumours around. Will he start by restoring in full the CEPOD surgery and trauma services, so that we ward off the second spike that he and I do not want?

[Matt Hancock]

We have indeed stopped “Shaping a healthier future”, as it was called. We are continuing with the investment into primary healthcare services that was a part of that programme, but not with the rest of it. I am happy to arrange a meeting between the Minister for Health, my hon. Friend the Member for Charnwood, who is brilliant on this stuff, and the hon. Lady and other west London colleagues, to ensure that that commitment is kept to.

Covid-19

Rupa Huq Excerpts

Monday 16th March 2020 Commons Chamber

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

Among those who cannot work from home and who feel vulnerable are GPs. Will the Secretary of State heed the advice of the locum who came to see me, and sort out the inconsistencies whereby 111 has been diverting people to surgeries? Can he also do away with the box-ticking target culture that makes GPs terrified to perform a number of consultations in a certain length of time, and also get rid of the quality and outcomes framework appraisals, which are just unnecessary, and let doctors be doctors?

[Matt Hancock]

My message to everybody in the NHS is that they should do what they need to do to keep people safe in front of them. We are reducing a whole load of the bureaucracy that gets in the way —for instance, with measures from the Care Quality Commission—to ensure that people just do what is right in front of them. As the hon. Lady says, GPs cannot work from home. Some GP appointments do need to be face to face, but increasingly they can be over the phone or over Skype, and so they should be.

NHS: North-West London

Rupa Huq Excerpts

Wednesday 24th April 2019 Westminster Hall

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

Good news for a change from this Government, who have admitted that the crackpot “Shaping a healthier future” plan to cut the nine major hospitals in north-west London to five is not workable and has been killed off. It was always a David and Goliath battle.

I pay tribute to, on the one side, Ealing Save our NHS, which works shoulder to shoulder with Save our Hospitals Charing Cross and our two Labour councils, as my hon. Friend the Member for Hammersmith (Andy Slaughter) mentioned. They are people like Ollie, Eve, Arthur and Judy Breens, Aysha, Raj and Gill, who held protests and popped up at every carnival. They organised parties, lobbies and petitions, and distributed a quarter of a million leaflets, all of which were paid for out of rattling buckets and their own pockets.

On the other side, we had “Shaping a healthier future”, with its swanky offices in upmarket Marylebone. Tens of millions of pounds of NHS cash from the public purse was spent on private management consultants, who all mysteriously alleged that if they junked departments, A&Es and hundreds of beds, health outcomes would somehow improve. In the end, the figures did not work. Quelle surprise! They never worked.

As early as 2012, John Lister pointed out in his report that the whole thing was a pile of nonsense, as did reports from the two councils, which involved the forensic skills of Sir Michael Mansfield, QC. Even then, seven years into a five-year-long failing plan, local health bosses were still carrying on as if the emperor were fully clothed. There was a heavy-handed threat of legal action against me, because my 2017 general election leaflets pointed out that it did not work. That arrived days after my mother passed away at Ealing Hospital—I know every bit of the hospital, right down to the morgue.

Where next? These disastrous Frankenstein plans have seen the two A&Es nearest to Acton Central—Middlesex and Hammersmith—completely shut their doors. I congratulate the Minister on her appointment, and my question to her is: can we have them back, as well as the stroke unit, paediatrics, maternity services and A&E admissions for children at Ealing? All these things mean that the figures for type 1 A&E urgent visits are going through the roof. No more babies are to be born at Ealing. As a mum, I recently had to schlep out of the borough for a paediatric appointment at the West Middlesex Hospital, which is in the constituency of my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury).

As my hon. Friend the Member for Hammersmith said, we need a serious exercise in lessons learned from this whole sorry episode, rather than clinging on to defend the indefensible and denying that there are serious problems. Ealing Hospital remains perilously underfunded and in crisis. Staff morale has been sapped, as was pointed out, by all the uncertainty. We could go on and on about the Brexit effects—the EU nurses exiting in droves and the social care sector being hollowed out by this Government, who are obsessed with their £30,000 skills target.

The slaying of the beast that was “Shaping a healthier future,” which was always known locally as “Shafting a healthier future,” is not before time and has raised eyebrows, such is the cynicism of politics in our time. As we did at the Drayton Court Hotel in my constituency last week, let us eat, drink and be merry, because tomorrow there might be another election.

Early Parenthood: Supporting Fathers

Rupa Huq Excerpts

Wednesday 30th January 2019 Westminster Hall

[Tracey Crouch (Chatham and Aylesford) (Con)]

I beg to move,

That this House has considered supporting fathers in early parenthood.

As always, Mr Davies, it is a pleasure to serve under your chairmanship. I hope you will forgive me if I make any minor procedural errors; it has been a while since I have been on the Back Benches of the Westminster Hall Chamber, rather than closer to the wise counsel of the Chair.

I begin with two quick disclaimers. First, although my debate is about supporting fathers in early parenthood, I am extremely conscious that there is still much to do to combat inequality during maternity. I am an avid follower of Maternity Action and support many of its campaigns, some of which I know are making good progress. Secondly, this debate is not meant as a dismissal of the wonderful mums out there who are single or in same-sex couples. It is not about mums versus dads, nor am I pontificating only about married parents—not least because that would make me a hypocrite. I simply want to speak up for the many brilliant dads out there who, in an evolving society, are doing an incredible job of bringing up children. I want to highlight some of the real challenges that they too face.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

I am grateful to the hon. Lady for giving way so early in her speech. She is making a fantastic return to Westminster Hall from the dizzying heights; she is a principled person and we on the Opposition Benches all love her.

The hon. Lady mentions challenges. Is she aware of Dads House, which does all sorts of things to represent single dads? There are 400,000 single-parent families headed up by dads, which is 13.7% of all single-parent families. Dads House has its own food bank and does buddying, breakfast clubs and football—a sport that is close to the hon. Lady’s heart. Would she be interested in meeting members of the group? In fact, everyone in this House has a good opportunity to meet them, because after Prime Minister’s questions on 20 March they are coming to Speaker’s House for a reception with the all-party parliamentary group on single parent families—and all hon. Members are invited. The group does great work.

[Tracey Crouch]

I would love to come. Single parents play an incredibly important role, but for various reasons they are often maligned. Meeting single dads who are doing their very best, in whatever circumstances they find themselves bringing up their children, is an incredibly important part of that conversation. I would be delighted to come to the event on 20 March.

I want to address three points: perinatal support, loneliness in new dads, and shared parental leave. The first comes wholly under the Department of Health and Social Care; the second does partially; the third might not, but is important to the debate because it relates to the overall wellbeing of our children.

In December, the Centre for Social Justice published a really interesting report, “Testing Times: Supporting fathers during the perinatal period and early parenthood”. It looked in detail at written evidence submitted to the Select Committee on Health and Social Care inquiry into the first 1,000 days of life by the Fatherhood Institute, which described support for fathers as “toothless” and noted criticisms that within health services,

“well-meaning…father-inclusive policy-making…has been more ‘rhetoric than reality’”.

On the back of those comments, the CSJ did some additional polling. It found that seven in 10 new fathers

“were made to feel like a ‘spare part’”,

six in 10 said that they had

“had no conversations at all with a midwife about their role”,

and nearly half said that they had

“received little or no advice at all…on their role as a dad.”

However, it also found that

“more than 9 in 10 are present ‘at the scans and the birth’”

and that there is

“strong correlation between active father engagement and improved childhood outcomes.”

That is a recurring theme in a really interesting book on equal parenting co-authored by one of our own lobby journalists, James Millar. It includes several quotations from the 2015 UN-backed report, “State of the World’s Fathers”, about how engagement in the first year of a baby’s life is good for the dad as well as the baby. Substantial and high-quality father involvement can encourage a child’s positive social interaction and lead to higher cognitive development scores.

Oral Answers to Questions

Rupa Huq Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Caroline Dinenage]

I completely agree that technology can really help in this way. I recently visited Hampshire County Council, which is using a range of gadgets including a really simple one involving a light bulb that comes on when someone gets out of bed in the night to go for a pee. That is ingenious, and it is helping to prevent avoidable falls.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My constituent Holly Alliston has contacted me about the epipens that her two-year-old son, who has a severe nut allergy, relies on. There is a national shortage of them, and the Northfield Pharmacy has been emailed by NHS England to say that the situation is critical. What is the Minister doing about this? We hear about the possibility of troops having to distribute stockpiled medicines when we leave the EU, but this is hitting us now.

[Caroline Dinenage]

The hon. Lady is absolutely right to raise this matter. We are working closely with all the manufacturers of adrenaline auto-injectors to improve the supply situation as quickly as possible.

Surgical Mesh

Rupa Huq Excerpts

Thursday 19th April 2018 Commons Chamber

[Emma Hardy]

Part of the scandal is how many women were treated when they went back to their doctors. The fantastic work of groups such as Sling the Mesh has brought so many women together, and shown them that they are not alone and that many others have suffered.

The number of subsequent gynaecology out-patient appointments per 100 people having the mesh insertion procedure is 79. There are 43 out-patient appointments per 100 for rehabilitation, physiotherapy and occupational therapy. The figures show that the number of women having the procedure has fallen during the last nine years by 48%, which says an awful lot about what doctors think.

These women were injured. These women were ignored. These women are the victims of a scandal.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My hon. Friend is making a very powerful and moving speech. May I include testimony from my constituent, Adele Yemm, from Chiswick? There was a catalogue of errors with her case. She had only mild incontinence, and physiotherapy would have sorted it out. There were issues about consent—she was denied that. She had a full implant fitted. Does my hon. Friend agree that this is the biggest medical scandal since thalidomide?

[Emma Hardy]

I completely agree that this is an absolute scandal.

During the debate in October, I asked the Government to do four things: to commit to a full, retrospective and mandatory audit of all interventions and, if the data proves it necessary, a full public inquiry; to suspend prolapse and incontinence mesh operations while the audit is carried out; to bring forward the NICE guidelines for mesh in relation to stress-related urinary incontinence from 2019 to 2018; and to commit to raising awareness with doctors and patients alike.

In December, NICE issued new guidance, ruling that the evidence for the long-term effectiveness of the treatment for pelvic organ prolapse is

“inadequate in quality and quantity”.

The NHS is not compelled to act on these guidelines, but that would amount to a de facto ban.

In January, the Government caved in to demands for a national audit of surgical mesh, which reported on Tuesday. The audit is not perfect. For example, it looks only at NHS hospital figures and misses off private patients and out-patients; does not include men; does not include ventral rectopexy mesh sufferers; does not cover visits to GPs; and does not indicate how many times someone has to visit their GP before being referred for out-patient treatment. However, it seems broadly to agree with what we have been saying all along: that the Government’s claim that only 1% to 3% of women suffered serious complications is just not accurate.

--- Later in debate ---

[Dr Wollaston]

I do agree.

As I say, informed consent is essential, and that was lacking in very many cases. There are cavalier attitudes and assumptions that medical devices are somehow safer than medicines, but we know that that is simply not the case. We have to rigorously make sure that devices are all part of clinical trials, with long-term follow-up and tracking. Perhaps the Minister could update us on how we are getting on with the barcoding of devices, which clearly makes them over time. One of the tragedies is that many women are completely unaware that they have even had mesh inserted at all. That, again, has to be a lesson that we learn for the future about accurate documentation.

I hope that the Minister will comment on whether there are plans to introduce compensation for victims. As I said, many of the women I have met have had profound, life-changing injuries, and many are entitled to compensation.

[Dr Huq]

The hon. Lady mentions the physical injuries and physical pain, but does she agree that these women have also had great emotional pain and psychological suffering? Many are suicidal. The Minister would be well advised to introduce, within a future action plan, counselling services of some kind for these sufferers.

[Dr Wollaston]

I thank the hon. Lady for making that point. Yes, absolutely: the scars have been profound not only in physical terms but in the impact on how people feel about themselves. There is a great impact not only on them but on their families and their relationships.

On access to services, while we all welcome a tertiary service being set up for victims of urogynaecological mesh, there is concern about current waiting times for those who wish to have a referral to a tertiary centre, and about access to investigations, which need to be timely. When women come forward to report deeply personal and distressing experiences, it is important that they can be seen as rapidly as possible. I hope that the Minister will comment on that.

Charing Cross Hospital

Rupa Huq Excerpts

Wednesday 1st November 2017 Westminster Hall

[Andy Slaughter]

I am grateful for the clarity that my hon. Friend brings on that point. What is proposed is the loss of all consultant-led emergency services—type 1 A&E services. The site will therefore lose blue-light ambulances, emergency surgery and emergency consultant services. That is a very substantial change to the health facilities available.

The change came under the heading, “Shaping a healthier future”, which I am afraid my constituents regarded as a rather Orwellian title. That programme has now been subsumed within the sustainability and transformation partnership proposals, which are now nationwide, but essentially the meat of the proposal has not changed over that time. I do not deny—I look for points of agreement if I can—that some of the objectives are perfectly laudable, such as specialisation and the bringing together of expertise on a particular site, as has happened with stroke services, major trauma, renal services and so on, even within the three hospitals in the Imperial trust. That is to be commended. No one objects to improvement to primary, social and community care, which may in time lead to less pressure on acute services. If the consequence is not just better health outcomes but a saving for the public finances, we do not object. The problem, and the reason why there has been a breakdown of trust, is that the changes are being advanced before we know the consequences.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

Does my hon. Friend agree that the plans may be transformational, but they are certainly not sustainable, given that London is heading to a population of 10 million before long? It is projected that there will be 12,000 more people in his borough, Hammersmith and Fulham, between the last census and the next one in 2021. We were both at a meeting on Monday night, and he pointed out that the borough has a target of 20,000 new homes by 2035. Where are all those people meant to get treatment, given that we have lost A&E at Charing Cross and Hammersmith, and maternity and paediatrics at Ealing? Demographically, that is illiterate.

[Andy Slaughter]

My hon. Friend puts it very forensically. The difficulty is that however much the aspiration may be to relieve acute services, most independent analysis—whether from the King’s Fund or the Mansfield review, which specifically looked at west London—shows that that is not likely to happen in the foreseeable future. The precious little additional investment in primary and social care is barely keeping up with the pressure on those services. That is where the lack of confidence comes from. However pious and laudable the aspirations, what is hoped for is simply not happening in fact.

I welcome the announcement that nothing will happen in the current sustainability and transformation partnership period, which runs to 2020. That is an admission by the Government that the pressure on services is so great that one could not possibly think about the proposed downgradings at the moment, but that is simply to put off a wrong decision. It means that nothing can happen physically to the Charing Cross site, other than maintenance, until 2021. I have been told privately that it probably means a number of years beyond that, because the eastern part of north-west London, which includes the three Imperial hospitals, has now been put in the slow lane behind what is happening in the western half, so it is unlikely that any changes will happen before 2025. That is 13 years after the first proposals were put forward; that is a very long time in politics, but it is a very long time in the NHS as well.

I am looking for something of more substance from the Government. We have had virtually nothing in writing, or in terms of consultation or engagement with the public, since those announcements back in 2013. Substantial expertise in the community has sprung up in the vacuum that has been created by the health service simply not engaging—expertise through the hospitals movement, trade unions and local people generally. An independent survey conducted by a polling organisation recently showed that 90% of people in the west London area opposed the proposals—that has been borne out in every other survey that I have seen—and 82% think that they have not been involved properly in the decisions. I urge the Minister to listen to that, to turn over a page and to engage with the community on these matters.

Going back to the point made by my hon. Friend the Member for Ealing Central and Acton, last month the four-hour waiting time target was achieved only in 70% of cases for the two hospitals in Imperial. Figures are not disaggregated, so I cannot give them exactly for Charing Cross—only for St Mary’s and Charing Cross combined. That has been a regular pattern over the previous months and years, in particular since the closure of the A&E departments at the Central Middlesex and Hammersmith Hospitals.

The population is growing hugely—as are the health demands, because the area’s population is not only ageing, but mobile and diverse, and those are not on the whole people who do not need acute care. For many years Charing Cross has had good practice: people who arrive at that hospital and have something that can be dealt with by a nurse, a GP or an urgent care centre—in some way other than through consultant care—are simply filtered off, because all those services are available on site. This is not a case of unsuitable use; this is a case of growing demand, and lack of resources to deal with that demand.

I will sit down in a moment, because I want to give the Minister a proper opportunity to respond. I urge him not to read out the brief again because, with respect, I have heard it a number of times over the past five years. I genuinely wish to engage in reassessing what has happened. I welcomed the debate in the other place on 18 October, which was called by my friend Lord Dubs, a Hammersmith resident. More eloquently than I could, he too led a debate specifically on Charing Cross, in which a number of peers took part. The Minister there responded:

“there will be no reduction in A&E or acute capacity at Charing Cross Hospital unless and until a reduction in acute demand can be achieved”.—[Official Report, House of Lords, 18 October 2017; Vol. 785, c. 659.]

Those are very welcome words to have put on the record. I am sure that the Minister here will not resile from that today, but will there therefore be an assessment of whether the changes are likely to happen in the foreseeable future? If they are not going to happen for another four, eight or 12 years, or however long, I put it to him that the Government cannot persist in saying simply, “We will do this when the time is right.” That creates uncertainty, demoralisation among staff, and a motivation for management not to maintain or keep up services because they are in effect throwing good money into a building that they believe will not be there in the foreseeable future.

That is my first request to the Minister: that we have a proper assessment of whether those “Shaping a healthier future” proposals are still fit for purpose, as the Government believed in 2012—although I did not. My second request involves the land on the hospital site, because none of it has been designated as surplus land for redevelopment. I push the Minister to say what exactly is meant by that. In 2012 and 2013 we were told in terms that the land not used for health service purposes would be disposed of privately to subsidise the cost of building on the land that would remain within the health service. Will that not now happen, or is it simply that no formal proposals have yet been brought forward?

As I said, this has been a hospital site for well over a century, and the hospital has existed for two centuries. It would be a great pity if that were to change on my watch and the Minister’s, particularly when the hospital is needed most by people in my constituency and others who have used it throughout their life and their family’s lives.

--- Later in debate ---

[Dr Huq]

Is the Minister familiar with the King’s Fund analysis of the STP plans from February this year, which concluded that, despite all the warm words about the new models of care, they are driven more by financial imperatives than by clinicians?

[Mr Dunne]

I do not agree with that. The analysis at the time was of course of the preliminary drafts of the STP plans, before any assessment by NHS England or the Department of Health. The plans are evolving and becoming partnerships, and they will move at differing speeds in different parts of the country, depending on the quality of the work and the extent to which they meet the four tests for service change, namely that they should have support from GP commissioners; be based on clinical evidence; demonstrate public and patient engagement; and consider patient choice.

In addition, NHS England introduced a new test from 1 April this year on the future use of beds, which is pertinent to the Charing Cross case. It requires commissioners to assure NHS England that any proposed reduction in the number of acute hospital beds is sustainable over the longer term and that key risks, such as staff levels, have been addressed.

The north-west London STP plan was published in November 2016. It confirmed that the “Shaping a healthier future” programme, to which the hon. Member for Hammersmith rightly referred and which was published in 2012, had set out the right plans to reshape health services across north-west London to respond to rapidly changing health and care needs. “Shaping a healthier future” forms a core part of the STP plan and I understand that the STP leadership intends to take that forward. There was a full public consultation in 2012 on the plans for a more integrated approach to care, whereby specialist services would be consolidated on fewer sites across north-west London to improve quality and efficiency, and routine and chronic care would be expanded to improve access, particularly in the community. It was proposed that Charing Cross would become a growing hub for integrated care in that services network. Following feedback from the public consultation, the proposals were refined to retain a wider range of services than was initially proposed on the Charing Cross site.

In October 2013, the Secretary of State for Health clearly set out, following the full public consultation, that both Charing Cross and Ealing Hospitals would retain A&E services, even if in a “different shape or size” from current arrangements, and that proposal remains. No final decisions have been made about the exact nature of services that are planned to continue at Charing Cross Hospital. It is certain that, even if changes are made, there will still be a thriving Charing Cross Hospital. There will be engagement with the public in due course on the detailed design and implementation of services on the site, which will include cancer, outpatients, diagnostics and 24/7 local A&E services.

As the hon. Member for Hammersmith quite rightly said, the STP is initially focusing on developing new models of care to reduce demand on acute services. I am grateful to him for welcoming the improvement of services in the community, so that it can be established that those services work before acute reconfiguration takes place through the proposal.

[Dr Huq]

The Minister is being generous in giving way. He pointed out that no final decisions have been taken, but can he not appreciate that that uncertainty creates a lack of morale among the staff? I had to visit Charing Cross very regularly for my late mother, who we lost during the election campaign, as her specialist Dr Perry was there. Staff morale is sapped: they are demoralised because they do not know what is going on.

[Mr Dunne]

I am very sorry to hear about the hon. Lady’s mother; she has my considerable sympathy and condolences. I will come to the issue of staff morale, which she is right to raise.

It is important that, whichever side we are on in this debate, we do what we can to ensure that the staff of all our NHS facilities—in this case Charing Cross Hospital— have confidence and clarity that they have good career prospects at that hospital. However we describe the challenges in our local NHS, we should not try to undermine the importance of those facilities to our local residents and, therefore, the importance of encouraging staff to continue to work there.

Agenda for Change: NHS Pay Restraint

Rupa Huq Excerpts

Monday 30th January 2017 Westminster Hall

[Catherine McKinnell]

The hon. Gentleman makes another valid point. I hope that the Minister is listening, because although we are focusing specifically today on pay restraint for Agenda for Change staff, there is a much wider issue for the Government to take on board. A variety of factors is affecting recruitment and retention of NHS staff. The axing of bursaries is just one significant factor that the Government should seriously examine, and reverse.

What has the pay restraint for Agenda for Change staff meant to individual nurses, midwives, paramedics, cleaners and other healthcare professionals since 2011? Depending on the measure of inflation used, it has resulted in a drop in real-terms earnings of up to 14%. To put that in context, the trade union Unison has calculated that it is equivalent to annual pay cuts of £2,288 for a cleaner, £4,846 for a nurse, £6,134 for a midwife and £8,364 for a clinical psychologist. Indeed, ahead of the 2017-18 NHS pay review process, Unison surveyed its members working in the NHS and received the following responses, which are a matter of deep concern: nearly two thirds felt worse off than they did 12 months ago; 49% had asked for financial support from family or a friend; 13% had used a debt advice service; 11% had pawned possessions; 11% had used a payday loan company; 15% had moved to a less expensive home or remortgaged their house; and just under one fifth took on paid work in addition to their main NHS job, 64% of whom did so because their NHS salary was not enough to meet their basic living costs. More than 80% said they had considered leaving the NHS in the past year.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My hon. Friend is making a powerful speech. Does she share the concerns of the London nurses at the lunchtime lobby today, who said that punitive London housing costs are making the situation even more acute? They feel that they are being forced out of the capital, which needs nurses, and that what is happening is almost social cleansing by the back door, pricing nurses out of our city.

[Catherine McKinnell]

Yes, I share those concerns, particularly about the significant shortage of nurses in London. The issue affects places throughout the country, but I fully appreciate the acuteness of the situation in London.

The findings that I have set out are mirrored in the most recent Royal College of Nursing employment survey of its members. It found that 30% had struggled to pay gas and electricity Bills, 14% had missed meals because of financial difficulties, 53% had been compelled to work extra hours to increase earnings, and 32% were working extra night and weekend shifts to help pay bills and meet everyday living expenses. The RCN stated:

“This corresponds with our year on year increase of 30%, over the past five years, on the number of our members seeking specialist money advice from our RCN Welfare Service. This contact from our members focuses predominantly on dealing with unmanageable consumer debt.”

It is shocking and depressing stuff. It is bad enough that the Government continually expect NHS staff, many of whom are at breaking point, to do more with less and treat more patients with fewer resources in what are usually physically and psychologically demanding roles, but to expect them to do so while they face such anxiety and stress over their own financial situation is completely unacceptable.

We do not need to take Unison or the RCN’s word for what is happening. I have received emails containing powerful testimony from NHS staff in my constituency. One explained:

“I have been qualified as a children’s staff nurse for 12 years and I reached the top of my pay scale four years ago. I have not had a pay rise since. 4-5 years ago I was in a comfortable position, I could afford the basics and if I wanted extras like holidays or treats I would just do overtime or extra shifts to afford these luxuries. However, due to the fact my pay against my cost of living has reduced by 14%, I now struggle to afford the basics and am having to do extra shifts just to be able to provide food and pay my bills… I am missing out on valuable time with my family as I have to work nearly every weekend in order to be able to get a wage that can cover our costs. It is now becoming such a stretch each month that I may have to leave nursing and find a job that pays me better... Working as a children’s nurse in a busy A&E unit is amazing and worthwhile, but it is very stressful. On a daily basis we deal with and see things that are devastating and can be difficult to switch off from. Our pay should reflect this.”

Another constituent challenged the claim made in the Government’s response to the e-petition:

“Average earnings for qualified nurses were £31,214 in the 12 months to June 2016”.

She described herself as an average nurse in her 40s with a partner and a child:

“I have been qualified and working in the NHS for 11 years. I don’t earn £31,214. The top of my band (band 5) is £28,464. So, I am paid about £14.50 an hour to clean up faeces, vomit, blood and other bodily fluids. To hold the hands of patients who are dying. To comfort the relatives of patients who are dying. To maintain complicated machinery/equipment that is keeping a person alive whilst watching the newly-qualified staff nurse who doesn’t feel confident and make sure they don’t do anything dangerous.”

Another constituent painted a very concerning picture about her financial situation. She recently qualified as a nurse—a year and four months ago. She is a single parent of three children, and commented:

“After studying hard for 3 years mixing university, placements and guided learning, I gained my degree only to find myself in more dire financial circumstances than I was as a student.

I live to a tight budget, I drive a car that is 16 years old, I don’t smoke or drink, and I rarely socialise with my friends unless it’s a special occasion. This month I was paid £1,450 after tax—from that £300 is childcare; £400 is rent; leaving £750 for the month covering gas, water, phone, food, insurance etc. I also receive £35 tax credits a week which covers my daughter’s bus fare to college and her lunch money.

I am a qualified professional and yet I would class myself as being on the breadline. I know there are others in greater need than I am; however I feel like I work hard and sacrifice my family time for nothing.”

Finally, a senior sister with 30 years’ experience in an acute trauma unit explained:

“After six years of pay restraint, I now see nurses struggling day to day to make ends meet. Those who have stayed are now planning to leave the NHS early and newly qualified nurses are unable to stay without reasonable remuneration.

I feel like I grieve every day for my profession now. We have an NHS workforce currently willing to work as hard as the service asks them, but this goodwill is now eroding faster than I have ever seen in all my years’ service.

I am retiring within a couple of years. This request comes not for me, but for those who come after me and who will be caring for me and my family in the future.”

It is clear that our NHS is facing a crisis, yet the people the Government entirely rely on to make the NHS work are being badly let down. Nobody would suggest for a minute that those working in the health service do it for the money. However, we have reached a situation in which nurses, midwives and other invaluable NHS staff are struggling to pay their bills or put food on the table, or are pawning their possessions or taking out high-interest loans just to get from one month to the next.

How can we expect people to continue to provide high-quality care to us and our loved ones in what are already increasingly challenging circumstances when they are also facing this level of stress and anxiety at home? I strongly urge the Government to look at this situation again and to take on board the concerns being raised not only by organisations such as Unison, the RCN and the RCM, but by NHS frontline staff who are saying loud and clear that this pay restraint simply cannot continue.

--- Later in debate ---

[Andy Burnham]

It is not only a false economy; it directly damages the quality of patient care. When people arrive on the ward who do not know the team or the environment and have to be told everything, it builds in confusion and delays because staff have to take them through things. It does not make sense to use private staffing agencies to the extent that they are being used in the NHS. The cost is exorbitant—that is No. 1—but it also damages morale, because it leads to staff in the permanent employ of the trust working on the ward alongside people who are being paid significantly more than them for the same shift, despite having just arrived on that ward. That does not build a sense of team on the ward; it builds a sense of resentment.

[Dr Huq]

My right hon. Friend makes a powerful point about the lack of continuity with agency staff coming in. He talks about recruitment and retention. The NHS traditionally has had a large overseas workforce. Does he agree that the £35,000 salary required to settle in the UK has not helped matters? Nurses normally start at £23,000. Our NHS would crumble without overseas workers. We have also heard that in the post-Brexit climate, people from overseas feel less welcomed by this nation. Does he have any comment on that?

[Andy Burnham]

My hon. Friend makes two important points. The first was on the effect that Home Office immigration rules could have had on the nursing profession. I think the former Home Secretary, now the Prime Minister, made some changes in that regard.

My hon. Friend is right that there is a much bigger context here: the post-referendum climate. The Government have been absolutely wrong not to guarantee the status of EU nationals currently working in our national health service. I have an example from my constituency of a Polish community nurse, who every day gets up early to go on her local round delivering insulin to vulnerable patients who are diabetic and housebound. One morning she heard a cry of, “Go home!”, out of one of the bedroom windows opposite. What does that make that nurse feel like, and is she likely to stay when we are in this prolonged period of uncertainty in which this growing hostility is felt to be around? There is a real risk here. We cannot simultaneously refuse to give clarity to those tens of thousands of nurses from other parts of Europe who are currently working in our NHS and run down the good will of nurses who are UK nationals. In the end, something will give, and it will be patient care, if we operate policies of that kind.

Alongside that, there is the attack on nurse training. We have seen cuts to nurse training places over a number of years, so there is a shortage of nurses coming through. Many places are being and have been forced to recruit from overseas. In those circumstances, with everything else that I have described, including the downward pressure on headline pay, how can it possibly make sense to scrap the nursing bursary? Will that not just be another factor that adds to the growing sense of crisis in the profession? Every single piece of support that is there to develop the nursing profession is systematically being stripped away.

We have seen years of that approach and are beginning to see the consequences in the national health service. Labour, of course, did not get everything perfect—I am not saying that—but I can say with some pride that when I was a Minister in the Department of Health, we brought through a major programme of investment in the nursing workforce, through Agenda for Change. It was the subject of hard discussions, but in the end it was agreed between the trade unions and the Government of the day. We did have in the Department of Health a social partnership forum, which brought together NHS Employers, trade unions and the Government to iron out problems relating to the nursing workforce. We did massively increase the numbers in the nursing profession. We did ensure that they were properly rewarded and had proper access to training. My worry is that we are seeing some of that break down.

In the immediate aftermath of the financial crash, it was acceptable, it seems to me, to ask the nursing profession to make a contribution to deficit reduction, but here we are, six years on, expecting people who are out there today, working flat out to keep an NHS in crisis going, to take pay cuts for the privilege of doing so. At some point, that strategy begins just to fall apart, and the NHS falls apart with it. I say to the Minister that we are not far from that point now.

--- Later in debate ---

[Justin Madders]

My hon. Friend has encapsulated the challenge we always face when a service is privatised. Most often the only way in which the savings promised by the private company can be delivered is by changes to staff terms and conditions. I also agree that the pay freeze affects not only nurses, but the whole of the Agenda for Change workforce. Today we are focusing in particular on some of the effects on nurses, because there are clear reasons why that position is unsustainable.

To return to some of the contributions we have heard today, my right hon. Friend the Member for Leigh described clearly the impact on a ward of having agency staff, and how that creates uncertainty and is not the most efficient way of working. There is also the manifest unfairness of having someone on the same ward, who is only there for that particular shift, earning significantly more than permanent members of staff. How demoralising must that be for those involved? He was right to say in conclusion that we cannot afford to lose the good will of the nursing profession further.

In common with many hon. Members who have spoken today, I pay tribute to everyone who works in the NHS and the health and social care sector, not only to doctors and nurses, but to other allied health professionals such as porters, healthcare assistants, cleaners, receptionists, care workers, paramedics and countless others. It is important to remember that behind every story about the crisis that our NHS has faced this winter are patients waiting too long for treatment, and hard-working public servants doing everything that they can to prevent a very difficult situation from getting worse.

The NHS is the biggest employer in the country—and one of the biggest in the world—and it depends on the tireless efforts of its staff to keep going and meet the challenges of rising demand and insufficient funding. Let us be clear: we cannot indefinitely keep asking them to do more for less. I would argue, as other hon. Members have, that only the good will of NHS workers has stopped the current crisis from turning into a catastrophe. I recently heard the staff who work in our NHS described as “shock absorbers”. That seemed to be a pretty good description of how they are taking and absorbing the relentless pressure and stress of being on the frontline of an underfunded health service. They can take that for only so long before something snaps, which is why it is so important that we fully explore these issues today.

The incredible determination, professionalism and compassion that we see from staff comes against the backdrop of six years of pay restraint. Salary increases for NHS staff have either been frozen or capped at a level far below the rate of inflation. According to Unison, between 2010 and 2016 that represented a cut of more than £4.3 billion from NHS staff salaries, or a loss of between 12% and 19% in actual value since 2010. The Royal College of Nursing believes that since 2011 there has been a real-terms drop in earnings of 14% for its members. With Treasury forecasts indicating that the cost of living will go up by more than 3% every year between 2018 and 2020, it is not difficult to see how the current policy on pay restraint is unsustainable.

The policy is already beginning to have a huge personal impact on some of those affected. Registration fees have gone up by more than a third in two years, and we know well that wages have not kept pace with the cost of living. As we have heard, particularly from my hon. Friend the Member for Newcastle upon Tyne North, staff surveys from the RCN and Unison found that nearly two thirds of staff feel worse off financially than they did a year ago. Forty-nine per cent. had asked for financial support from a family or friend, 13% had used a debt advice service and 11% had used a payday loan company. About a third of nurses are struggling to pay their gas and electricity bills, 53% are working extra hours just to pay their everyday bills and 11% had pawned possessions. The Cavell Nurses’ Trust also found that 20% of nurses had skipped a meal in the last year due to money worries. Those are not abstract figures; they represent real people.

There was a lobby of Parliament today, and I am sure that some hon. Members in the Chamber went to hear at first hand from nurses how they are struggling. I met a nurse from the west midlands who works three days a week because of her caring responsibilities. She told me that she is living below the poverty line. Are we not ashamed that someone caring for our most vulnerable has to live like that? Are we really comfortable with a situation in which the people we are asking to care for our loved ones are having to pawn their possessions in order to make ends meet? In one of the richest countries in the world, can any of us accept the sight of nurses going to food banks?

Nowhere is the problem more acute than in our capital city. The Nursing Times reported that 40% of nurses who currently live in London say that the cost of housing means they will be forced to leave the capital in the next five years. Of course that challenge is not unique to the health service, but vacancy rates in the London area are among the highest in the country, with at least 10,000 nursing vacancies. How long will it be before we reach a tipping point from which there will be no recovery?

The impact is not just on nurses in their daily lives outside work, but on their working environment. NHS staff surveys paint a picture that cannot be ignored. The 2015 survey for England found that 48% of those surveyed stated that a lack of staff was impinging on their ability to do their job, and only 43% felt able to manage all the conflicting demands on their time. The warning signs are there for us all to see.

Analysis of NHS England data by the Health Service Journal found that 96% of NHS hospital trusts in England had fewer nurses covering day shifts in October than they had planned, and 85% did not have the desired numbers working at night. In 2013, the regulator Monitor, now part of NHS Improvement, warned about the potential impact of continuing pay restraint, stating in a report:

“Capping wages for longer to keep costs down would be self-defeating for the sector in the long term as it would make recruiting and retaining good quality professionals increasingly difficult.”

We had that very clear warning four years ago, but we have not heeded it.

The evidence that we have heard today and on previous occasions has proved that that prophecy was correct. The Public Accounts Committee reported that the number of nurses leaving their jobs increased from 6.8% in 2010-11 to 9.2% in 2014-15. Simon Stevens gave evidence to that Committee in 2014, stating that pay restraint would not be an “indefinitely repeatable strategy”, yet that is exactly what the Government propose to do.

Pay restraint, along with a cut to the number of nurse training places in 2010, led to a situation in which the amount of money that the NHS spent on agency staff soared by £800 million in a single year to £3.3 billion in 2014-15. Although considerable steps have been taken to bear down on the figure since then, the situation only developed because of poor and short-term decisions made by the Government, and it remains the case that we still spend far too much public money on agency staff because the NHS has been unable to recruit and retain enough of its own. If we had maintained the levels set by the last Labour Government, we would have had 8,000 more nurses trained during the last Parliament.

Recent figures have revealed that the agency staff cap has been breached almost 2.7 million times in its first nine months of operation. That is a clear example of the impact of the recruitment and retention crisis on all areas of the NHS and how the current workforce balance is completely out of kilter. The use of agency staff is meant to be a temporary measure in times of particular demand and stress for the workforce, not a permanent feature. The fact that these incidences have run into the millions in less than a year should be a huge concern to the Government and a clear warning that the stability and continuity that we all want to see in our workforce is a long way from being achieved. The Government urgently need to address the situation in which hospitals seem unable to provide safe levels of care without relying permanently on agency staff.

The dependency on agency staff has made the case for a pay increase as strong as it has ever been. That is the view not only of the Royal College of Nursing, but of those that look at the impact of skills shortages on the wider economy. In March 2016 the Migration Advisory Committee found that many nurses are moving to agency work or leaving the profession altogether. The fact that the Government have had to put nurses on the skills shortages list should have been the point at which they realised that their pay restraint policy had reached the end of the road. Instead, they have ploughed on regardless, treating the symptoms rather than the cause.

In that regard, the disastrous policy of having tuition fees for student nurses will almost certainly make the position worse, not better. The Royal College of Nursing warned at the time that the policy could act as a disincentive for students from some backgrounds—particularly mature students and those on lower incomes—and early indications are that applications to study are down by at least 20%. If that turns out to be an accurate reflection of the position, the pressure on existing staff can only increase.

[Dr Huq]

At the weekend, on the doorstep, I met my constituent Dr Linda Burke, who is pro vice-chancellor for health and education at Greenwich University. She is really worried, because her university’s figures look like they are down by between 20% and 30%—UCAS will have final figures for late applications. She says that that is serious because it will directly reduce the number of nurses for the NHS. We should be thinking about our future workforce. Does my hon. Friend have anything to say about that?

[Justin Madders]

I am glad to hear that my hon. Friend is out on the doorstep on a Saturday morning, but sorry that the news she was given is so concerning. It is not, however, a surprise. This is something that just about everyone interested in the matter warned the Government of and, as she says, we will find out in the next month or so what the final figures are. If they are of the order that we are hearing about, the Government will have the opportunity seriously to reconsider the policy. Today, when I attended the lobby, I heard some student nurses saying that they are finding it difficult to get staff mentors, because senior staff are exhausted. They do not blame those staff for that; they understand the intolerable pressure, because they too see it for themselves.

The change to student fees will add an extra penalty on those training from this year onwards, due to the Government’s decision to freeze the student loan repayment threshold at £21,000. That means that all future nurses will face a real-terms pay cut. According to Unison, based on current salaries, the average nurse, midwife or allied health professional will lose more than £900 per year to meeting their debt repayments. In practical terms, for a nurse on band 5, that means a salary cut approaching 5%. It is abundantly clear that that will make staff retention harder, not easier; there is a clear link between pay and retention levels.

Nobody is suggesting for a minute that anyone who goes into nursing is motivated by money, but when someone who has just finished yet another draining shift, going above and beyond the call of duty time and again, finds that they do not have enough cash in the bank to feed themselves and their family, and when each year their wages buy them less and less, they could be forgiven for thinking, “Is it all worth it?” It is morally wrong for the Government to put our nurses in that position, and it makes no sense economically either.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

Mr Evans, I am grateful to you for calling me to wind up the debate. It is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) on taking up the petition and giving a well-constructed speech, with which many people listening to the debate—not just Members from her party, but those outside—will feel considerable sympathy. I express similar sentiments towards the hon. Member for Ellesmere Port and Neston (Justin Madders). Although I do not agree with his prescription, I thought that he conducted himself in a thoroughly considered way, as usual. It is a pleasure to be shadowed by him, as well as by the hon. Member for Central Ayrshire (Dr Whitford), who as usual made a constructive contribution.

[Sir Roger Gale in the Chair]

First, I should say that we are all rightly proud of our national health service and the staff who work incredibly hard day and night for the benefit of patients. They undoubtedly deserve a cost of living increase, but we must recognise that the financial and quality challenge facing the NHS is unprecedented. These are not normal times. I deny the allegation that Agenda for Change staff are undervalued, as the right hon. Member for Leigh (Andy Burnham) indicated in his speech, which was knowledgeable, given his previous role as Health Secretary. Staff at all levels in the NHS do a fantastic job, and it is vital that we in Government and the leaders of the NHS recognise that staff morale is important to maintaining staff commitment to services.

In my experience of making visits across the NHS, hard-working staff put patients first every single day of the week. They do so because caring for sick and vulnerable people is as much a vocation for them as it is a job. I know that pay restraint is challenging, but when I speak to staff, they tell me that they want to know that the right number of staff will be working alongside them in the hospital or community setting. The Government have listened. Contrary to some of the contributions made by hon. Members, staff numbers have increased significantly across most grades since May 2010. We have recruited almost 11,800 more doctors. More than 13,300 more nurses are working on our wards today than in May 2010—the overall number of nurses working for the NHS is at an all-time high. There are over 2,100 more midwives, and more than 6,300 currently in training, as well as over 1,500 more health visitors and over 2,400 more paramedics.

The allegation that people are leaving the NHS in droves is simply not borne out by the facts. The most recent workforce statistics were published last week, covering the period ending October 2016, and they showed that a record number of full-time equivalents were working in our NHS.

[Dr Huq]

The Minister is giving figures for the current workforce, but does he have any for the future workforce? I mentioned my constituent, Dr Linda Burke, of nursing and education studies at the University of Greenwich. She is worried that due to the cut in nursing bursaries, the number of applications is falling, possibly by as much as 30%. The RCN itself has said:

“We have consistently raised concerns to the Government… Despite 100 years of nursing knowledge and expertise, our advice fell on deaf ears.”

The RCN is effectively saying, “We told you so.” Will he remark on that?

[Mr Dunne]

I can say to the hon. Lady that there are 51,000 nurses in training today—I cannot tell her whether that is a record number, but it is a very significant number. There are 1,600 paramedics in training, which I believe is a record number. She and one or two other hon. Members have given anecdotes today about applications for new courses starting in the autumn, but I cannot tell her what the figures will be, because I have not yet seen any numbers published by UCAS. I think that they are due in the coming days, so we will have to see.

Breast Cancer Drugs

Rupa Huq Excerpts

Thursday 26th January 2017 Commons Chamber

[Siobhain McDonagh]

I agree with the right hon. Gentleman. I am sure that he knows more about this process than I do. It clearly makes sense to consider these unique, unusual first-tier drugs in the light of that reconsideration.

I hope that we will hear the stories of the many women whose lives, having been affected by secondary breast cancer, have been enriched by Kadcyla. The drug Kadcyla matters so much to all these women for one simple reason: it works. It is effective. It has already been available on the NHS for more than two years and, compared with other treatments, its side effects are limited. Today, it is nothing short of a tragedy to know that countless women who thought that Kadcyla would be the next treatment they would receive for their breast cancer are having their lives shortened before their eyes.

I ask Members to imagine this: they are living with breast cancer; there is no cure, but there is something that could give them extra time with the people they love—the people who depend on them. It could be a year, five years or even longer. If they needed the drug today, the NHS would give it to them, but if they needed it in a few months’ time, they may have lost their chance.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My hon. Friend is making a very powerful speech. May I congratulate her on securing this debate, and say how proud I am to be a co-signatory? The phenomenon of there being drugs in the pipeline that would make a vital difference to patients, but which are being held up by conflict between NICE and pharmaceutical companies over pricing or value for money, applies not only to breast cancer but to other cancers, too. My constituent David Innes is one of 20,000 sufferers of chronic lymphocytic leukaemia. He was diagnosed in 2009, when he was 39. He was in Parliament earlier this week, making the same argument, and saying that both parties need to end the logjam and come up with a deal to ensure the availability of these drugs. They need to put patients first. Life is too short not to do so.

[Siobhain McDonagh]

I completely agree with my hon. Friend. I wish her constituent, David, all the best.

How can we withdraw a drug from the NHS that is working, especially when we are offering nothing in its place? It seems senseless to me, and it is truly devastating to those for whom it really matters. Of course, as my hon. Friend says, Kadcyla is just one drug that we need to look at. What will happen with other key breast cancer drugs now and in the future? I wish to consider just two more examples. Perjeta is currently available through the cancer drugs fund, but unlike Kadcyla it has not yet been re-appraised, although it will be soon. Perjeta is used for HER2 positive secondary breast cancer patients. In many ways it is even more effective than Kadcyla, as it enables women to live for an additional six months without their breast cancer progressing, and can extend life by an additional six months or more. However, because it is administered with two other drugs—Herceptin and Docetaxel—it would not be considered cost-effective under NICE standards even if the drug manufacturer gave it away for free.

The other drug is Palbociclib, which is used on women with hormone receptor positive and HER2 negative breast cancer. It is a new drug, which is being assessed for the first time by NICE. It is extremely effective and enables women to live for at least an additional 10 months without their breast cancer progressing. However, because women are living longer, robust overall survival data are not yet available. Perversely, that will count against it in the NICE appraisal. Overall survival data are given greater weight than progression-free survival in NICE appraisals, despite the fact that the outcome is the same—a longer, more enriched life.

We are seeing effective treatment after effective treatment being rejected or facing rejection by NICE. I want to know this: is it really right that we have a health service that plans to take away those lifelines? How is the decision to take away these life-extending drugs beneficial for people living with cancer, or for any of us who might one day need access to them? Who makes these decisions, and how can we be sure that they are the right ones?

We have a drug appraisal process, which is certainly valuable and necessary, but I question the factors that constitute that process. It is too easy to assume that the experts must automatically be right. The process is: numbers in, formula used, and then a yes or no answer. Let us not forget that we are talking about people’s lives. The lives of those affected and those for whom this decision is all too real are in the hands of a formula—the NICE appraisal process—and yet this life-changing formula has had little examination for many years. How many of us actually understand what factors are taken into account in these life-or-death decisions? The drug Palbociclib is proving so effective that, at present, it only has data on how long people are living without their breast cancer progressing.

--- Later in debate ---

[Nick Thomas-Symonds (Torfaen) (Lab)]

I begin by thanking the Backbench Business Committee for selecting this very important topic for debate this afternoon. I pay tribute to my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) for the passionate but very thoughtful way in which she introduced the debate. I endorse everything that she said. On the drug Kadcyla, she said, quite pithily, that, first, it works and, secondly, it has far fewer side effects than many other cancer drugs. I was also very proud to have backed the “43p a day” campaign that she mentioned.

I declare an interest as the chair of the all-party group on off-patent drugs and should also say that one of my first actions as a Member of this House in 2015 was to become a breast cancer ambassador. I was very proud to do that, as the person who inspired me to come into politics, my grandmother, died of the disease some years ago.

I was lucky enough in my early months in this House to be drawn in the ballot for a private Member’s Bill. I introduced the Off-patent Drugs Bill, and although it was talked out in quite controversial circumstances on 6 November 2015, I was none the less pleased after that to work on a cross-party basis to achieve legislative progress. I pay tribute to the hon. Members for Central Ayrshire (Dr Whitford), for Bury St Edmunds (Jo Churchill) and for Daventry (Chris Heaton-Harris), and to the former Minister for Life Sciences, the hon. Member for Mid Norfolk (George Freeman), for the work that was done in those months to make legislative changes which were incorporated in the Access to Medical Treatments (Innovation) Bill, which received Royal Assent in March last year.

I want to come to the pledges that were made on 29 January 2016 and how things have moved forward since. I say to the Minister that in setting out a number of questions about this matter, I do not necessarily expect them all to be answered in detail in her closing remarks. If there are aspects that she feels she cannot answer in detail, I would be grateful if she wrote to me about them after the debate.

On 29 January 2016, I and others in the House tabled a package of amendments to the Access to Medical Treatments (Innovation) Bill. Some were substantial and went into the Bill. Others were probing amendments designed to extract the promises that I have talked about. The then Minister for Life Sciences said:

“Broadly, the intention of the package of amendments is to introduce off-label repurposed medicines in the Bill, and to put it four square at the heart of the agenda.”

That is precisely what we sought to do that day. He added:

“I wholeheartedly supported the intention of his Bill and its predecessor, but not the mechanism. We now have a mechanism that will work”—

we had spoken that day about the mechanism.

One of the amendments requested an action plan, but the Minister decided he did not want that on the face of the Bill. However, he said:

“let me set out my commitment and that of the Government to pursuing this agenda with time and rigour.” —[Official Report, 29 January 2016; Vol. 605, c. 543.]

[Dr Huq]

I remember very well my hon. Friend’s Bill and the shameful way it was talked out by the professional filibusterers on the Government Benches. However, does he not agree that any action plan needs to look at these things in the round? It should look at the poor post-diagnosis support and information that patients get across other types of cancer, not just breast cancer. It should also look at the limited availability of the effective drugs we have talked about, which do not have side effects, and at the fact that drugs have been de-listed from the Cancer Drugs Fund.

[Nick Thomas-Symonds]

I certainly agree that the pathway has to be comprehensive, and I will come back to it in a moment.

In addition that day, the then Minister for Life Sciences said he would

“explore mechanisms for ensuring NICE can look at evidence and develop evidence-based guidance on off-label medicines, so that doctors are aware of which drugs are being used in an off-label indication…NICE is now looking at ways to collect evidence on repurposed medicines.”

He spoke about the “British National Formulary”, and I am pleased about the progress that has been made on it, which I will come back to in a moment.

We proposed—this would have applied to NHS England—that there should be a new system of national commissioning for repurposed drugs. Again, our amendment was not accepted, but this pledge was given:

“The NHS is hungry to look at all options for promoting off-label and repurposed drug use.” —[Official Report, 29 January 2016; Vol. 605, c. 544-45.]

I hope that that pledge can be repeated by the Minister at the Dispatch Box today. There was also a commitment to consult all relevant stakeholders. Again, I would hope that that is fairly uncontroversial and can be repeated.

Let me come now to where we have got to. When I intervened on my hon. Friend the Member for Mitcham and Morden, I quoted the worrying statistic about bisphosphonates, which really do provide a case in point. They are used to treat osteoporosis, but they are very effective in their secondary form—the repurposed form—where someone has primary breast cancer, and they certainly help to prevent that from spreading to the bone. The statistic that only 24% of clinicians are prescribing bisphosphonates is very worrying, and it does need to be addressed, because there should be no barrier in the system to their being far more widely prescribed than they are.

Let me come to the working group. I understand that it will conclude at the end of next month. I am very grateful for the fact that I will be meeting officials from the Pharmacy and Medicines Directorate in the next few weeks to discuss this issue. However, if there is to be a pathway, I would appreciate it if the Minister was prepared to share it with me in draft form before that meeting, so that comments could be made on it, particularly going back to the pledges made last year.

The “British National Formulary” has begun work. Indeed, I looked up bisphosphonates specifically on BNF Online before I came to the debate. What makes the 24% statistic even more worrying is that BNF Online says:

“The use of bisphosphonates in patients with metastatic breast cancer may reduce pain and prevent skeletal complications of bone metastases.”

That is there already—it is in the prescriber’s bible, if you like—so the Minister really should focus on why it is not filtering through the system in the way that it should.

In addition, there is a pilot licensing scheme that brings together medical research charities and generics manufacturers to license off-patent drugs for their new purposes. If the Minister could comment on whether she is looking for that to become a fully fledged scheme, that would be helpful.

The scheme is an interesting development, because my Bill, in its original form, would actually have put a duty on the Secretary of State for Health to seek licences for drugs in their new indications, and that was the bone of contention between me and the then Minister, who thought that it was too onerous for the Secretary of State to have that duty.

Looking back at that debate, I think the other interesting thing is that a point was made about the EU’s licensing scheme. It was said that any changes could run a coach and horses through that scheme, but given that we will not be members of the European Union by the end of this Parliament, I would be interested to hear how the Minister thinks the end of the Brexit process will affect this issue. If the European licensing scheme was seen by the Minister at the time as posing something of a problem, perhaps she can tell us if she will consider whether the pilot licensing scheme can now become fully fledged and how she sees things developing here in the UK without the European scheme.

I appreciate that I have put a lot of points to the Minister. As I said, I am perfectly happy for her to write to me about them. However, we should not forget the difference that this off-patent drugs agenda can make to people’s lives. Those who face this disease show incredible bravery. For example, we have my hon. Friend the Member for Bristol West (Thangam Debbonaire) in the Chamber with us, and Bonnie Fox, a constituent of the hon. Member for Croydon South (Chris Philp), is in the Public Gallery. We in this House, as legislators, owe a duty to all who suffer from this terrible disease to take all possible steps to make what are extraordinarily cheap drugs as readily available throughout our country as possible.