Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 24th February 2015 Commons Chamber

[Mr Hunt]

I do not disagree with it, but I will tell the hon. Lady why we are missing that one target. Incidentally, we are hitting the seven other targets. We are treating and diagnosing so many more people, with 560,000 more diagnoses every year. That means that in this Parliament we are treating 700,000 more people than were treated in Labour’s last Parliament, saving 1,000 more lives a month. If the hon. Lady looks at some of the other things that Cancer Research UK says, she will see that it welcomes that strongly.

[Dr Sarah Wollaston (Totnes) (Con)]

7. What assessment he has made of the implications for his policies of Her Majesty’s Treasury’s costing of free social care at the end of life.

[The Minister of State, Department of Health (Norman Lamb)]

HM Treasury’s costing demonstrates the limitations of data available nationally in estimating the potential costs of providing free personal care at the end of life. That is why the Department of Health is undertaking further work with stakeholders to develop an evidence base to inform the next spending review.

[Dr Wollaston]

I thank the Minister for that reply. He will know that most people want to be able to remain at home at the end of their lives, surrounded by the people they love, and I pay tribute to all the carers, volunteers and health professionals, including Rowcroft’s hospice at home, who help to make that possible. Sadly, he will also know that often the situation can break down because of the sheer exhaustion of caring for a loved one at the end of their life. Will he commit that the Government will consider the quality of care as well as the costs when considering introducing free end-of-life social care?

[Norman Lamb]

I thank my hon. Friend for that question and join her in paying tribute to the work of so many people: volunteers, loved ones and the professionals working in the community. The whole emphasis should be on ensuring that we respect people’s choice about where they want to be and that they get the best possible care. Later this week, the independent review of choice at the end of life will be published and I hope that it will inform discussions. I am completely with her in trying to ensure that we can achieve this.

Child and Adolescent Mental Health Services

Sarah Wollaston Excerpts

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

First, let me caution against sanctimony. This is not a new issue: under the previous Labour Government, children did at times end up in adult wards. That is highly undesirable—everyone recognises that—and we must do everything we can to prevent it, but please do not try to claim that this is an entirely new problem. It is not. The Government have significantly increased the number of beds available, so significantly more are available now than there were in the last decade. The hon. Lady says that she sees increasing numbers of children held in police cells, but let us have some honesty and accuracy in this debate. The number of children who end up in police cells is falling, not increasing. The crisis care concordat, published last February, set a commitment to end the practice of children going into police cells. Indeed, we intend to legislate to ban it, but the numbers are lower than they were so she should not suggest that it is a growing problem—[Interruption.] She did suggest that.

The hon. Lady asked about my acting on the warning. That is exactly what we did. NHS England carried out a review of clinical judgment on the capacity required to meet children’s needs. As a result, there was a proposal for an increase of 50 beds nationally, focusing on the areas of the country where there was a significant problem, and the Government provided £7 million of additional funding to ensure that those beds were opened. Forty-six beds have opened. There is a temporary problem in Woking, where beds that were available are no longer accepting new admissions. That is a CQC issue. One thing that we have been absolutely steadfast on is that if standards are not being met, we should not continue to admit children to those wards.

The hon. Lady mentioned psychosis services, but this Government, for the first time ever, introduced a waiting time standard for early intervention in psychosis, which was widely welcomed by everyone in the mental health world. From this April, we start the process of introducing a standard. To start with, 50% of all youngsters who suffer a first episode of psychosis will be seen within two weeks and start their treatment within two weeks. That is an incredibly important advance.

The hon. Lady lectures the Government on mental health services, but perhaps she will consider why the Labour Government left out mental health when they introduced access and waiting time standards for all other health services. That dictates where the money goes and means that mental health loses out. This Government are correcting that mistake.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the extra beds committed to south Devon. The Minister will know that one of the most frequent points raised with the Health Committee in our recent CAMHS inquiry was the complete absence of accurate prevalence data on children and adolescents’ mental health needs and the services required to meet them. He will know that the prevalence data collection that used to happen every five years was cancelled in 2004. The Committee warmly welcomed the commitment to restart that survey. Will he update the House on exactly when that survey will start, whether the funds have been identified, and whether the scope of the prevalence data collection has been identified?

[Norman Lamb]

The hon. Lady is absolutely right. Unless we understand the prevalence of the problem, it is impossible to plan services effectively. I am delighted that we have secured the funding for an updated prevalence survey in 2015-16. It will be an expanded survey compared with the previous one. We want to cover as wide an age range as possible, to cover early years. That will give us the data, information and evidence we need, but I would then want us to do regular repeats to ensure that we maintain an understanding of prevalence.

NHS Major Incidents

Sarah Wollaston Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

In the right hon. Gentleman’s desperate desire to weaponise the NHS, I am afraid that Labour has sunk to new depths today. He said in the media this morning that the Government had put news management over patient safety. That is ironic coming from him, given that so many officials testified to Francis about the pressure they were put under not to come out with bad news when he was Health Secretary. Even the head of the Care Quality Commission was roasted because she wanted to publish details of the problems that were happening in the NHS under Labour and he did not want that to happen when he was Health Secretary. That news management stopped the moment he walked out the door, and those days are over.

As confirmed by NHS England this morning, this was an operational decision; it was nothing to do with Ministers. This was the local NHS doing its best to get good guidelines out in a tough winter. [Interruption.] It is a local decision. The right hon. Gentleman is the man who talks—he did not deliver this in office—a lot about integration. It is absolutely right that a local hospital should talk to the rest of the local NHS to check about the impact of any decision it makes on major incidents, to make sure that patients are treated safely—is he now saying to this House that local hospitals should not talk to the rest of the NHS? That is what these guidelines say. This was a period when we had 16 major incidents, but that number has gone right down because performance on accident and emergency is significantly—[Interruption.] This is the underlying point, because the reason we have fewer major incidents is that A and E performance has got better. This is the week when we discovered that public satisfaction with the NHS jumped five points last year. This is the week when NHS unions have put patients first by suspending their strike, and Labour focuses not on patients, but on politics. On patients, he did not want to talk about the Welsh ambulance service publishing its worst ever figures, although the Labour leader says that we should be looking at what is going on in Wales.

Let us be clear: where Labour runs the NHS we have double the number of people waiting at A and E; double the number of people waiting too long for ambulances; and 10 times the number of people waiting for their operations. We have seen Labour today in Wales and Labour before covering up around Mid Staffs, ignoring patients and weaponising the NHS for political advantage—has the right hon. Gentleman not proved today that Labour is still not fit to run the NHS?

[Dr Sarah Wollaston (Totnes) (Con)]

Our hard-working NHS staff and, more importantly, patients need to have absolute confidence that the Secretary of State will never lean on operational decision making in these circumstances and will always allow that decision making to take place at the appropriate local level, backed, if necessary, by national guidance.

[Mr Hunt]

My hon. Friend is absolutely right to say that. It is why many people in the NHS will be so astonished to hear the shadow Secretary of State, who presided over a culture where precisely that kind of leaning from on high happened, making it difficult for people to make those local operational decisions in the interests of patients, now trying to make a political point. This was a local decision and it was confirmed today that Ministers had no involvement in it, and Labour should stop trying to score political points.

NHS (Government Spending)

Sarah Wollaston Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie]

Labour Members are absolutely committed to saving the national health service from the fate that would befall it should the hon. Gentleman’s party have a further five years in office. We will absolutely not apologise for fighting tooth and nail to do what we can about, for instance, the staffing crisis that the NHS also faces.

[Dr Sarah Wollaston (Totnes) (Con)]

rose—

[Chris Leslie]

Before I give way to the hon. Lady, I shall tell her what is happening with staffing in the NHS. The NHS is now spending a further £500 million a year on agency nurses. Six thousand nurses who were trained in the UK have left the country and gone elsewhere, and 4,000 nurses are coming from overseas to try to back-fill some of those places. We are spending a fortune, day after day—far more than we ought to be—on these more expensive agency nursing staff. I know that as Chair of the Health Committee, the hon. Lady has a view on agency nursing within the NHS. Is she really content with the situation?

[Dr Wollaston]

I will write to the hon. Gentleman on that point, which is very important, but I wanted to respond to his question to my hon. Friend the Member for Dover (Charlie Elphicke) about why we dropped Labour’s policy of 48-hour access. I will tell him why, as a former GP who was there at the time: it was because patients could not get advance appointments. It caused enormous distortion of clinical priorities, and it was absolutely right that it was dropped, as called for by the profession. It was a ridiculous policy and it is absolutely right that it has been dropped.

[Chris Leslie]

The hon. Lady should know that there were provisions for advance appointments in the system that we had. Given that we have these pressures, with GPs being totally overstretched and having more and more people to deal with, and the shrinking number of GPs per head of population, she should not be surprised that we are in this situation. We have to do more to recruit and train more GPs. That is part of the way in which we would save the NHS from the situation that it is facing.

When all these different factors are combined with the high levels of winter flu and the growing population, we have an NHS in crisis—but there is an alternative. Yes, we have to repeal the competition-driven Tory changes, but we also have to deliver a sustained increase in resources and a fund designed urgently to alleviate the pressures. That is why, as shadow Chief Secretary, I want to take the time to talk about our £2.5 billion fund.

National Health Service

Sarah Wollaston Excerpts

Wednesday 21st January 2015 Commons Chamber

[Andy Burnham]

I give way to the Chair of the Health Committee.

[Dr Sarah Wollaston (Totnes) (Con)]

I thank the right hon. Gentleman for giving way. I am concerned. Does he understand the difference between a pilot and an experiment? Does he not think it is right that the Secretary of State should listen to clinically led advice about how we might improve ambulance waiting times, rather than just roll out changes without a pilot, not an experiment?

[Andy Burnham]

I do not think there is a massive difference between a pilot and an experiment. My objection is that that is being introduced in winter—and a difficult winter at that—in the most troubled ambulance service. I am not against a pilot, but it should be conducted at a quieter time of year. I should have thought that bringing it in now would strike the hon. Lady, with her long experience of the NHS, as more than a slightly risky thing to do.

I need to hear today the Secretary of State’s plan. What is his plan to bring standards in ambulance services and A and E back up to where they should be? If he waits much longer to tell us, people will conclude that he simply does not have one. The simple truth is that our hospitals are full and operating way beyond safe bed occupancy levels. It is a system that is visibly creaking at the seams.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

I think we need to look at the emergency medicine contracts. One thing said by the College of Emergency Medicine—I have a lot of sympathy with this view—is that emergency doctors want not more money, but the right to the same holidays that other doctors get. It is the time off that is important to them. They have to work 24/7 and they get extremely tired; they want some compensation for that in being able to spend extra time with their families. We are getting more people into emergency medicine, but we should look at anything we can do to make it better.

[Dr Sarah Wollaston (Totnes) (Con)]

NHS staff are working extraordinarily hard to deal with not only the extra demands, but the increased complexity of patient cases in all parts of the urgent care system. Will the Secretary of State set out what more can be done to make sure that people access the right part of the system and that all parts of the system work together?

[Mr Hunt]

As a former GP, my hon. Friend understands this issue better than most. For me, the single most important thing for patients with the most complex needs, particularly for vulnerable older people, is having a system where the buck stops with a doctor. Someone must be accountable for ensuring that such people get the right care wrapped around them. We have brought back named GPs for all over-75s this year as a first step, but there is much more to do.

A and E (Major Incidents)

Sarah Wollaston Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

First, let me thank the right hon. Gentleman for this opportunity once again to go through the plans that we have in place to support the NHS and to reiterate the gratitude of the whole House to NHS staff for what they are doing under huge pressure at the moment. Let me start by telling him where I agree with him. I agree that what happens in the social care system is closely linked to what happens in the NHS. That is why, from June last year, meetings have been happening in 140 local authority areas between the local NHS and local authorities to work out how best to plan for winter. The result of that planning process, which is funded by £700 million of Government support, is extra doctors, extra nurses, extra beds and new plans in every area. I am absolutely satisfied that that money is making a difference. Every day in our A and E departments, 2,500 more people are being seen within four hours than was the case four years ago when the right hon. Gentleman was Health Secretary. The local structures worked last year, and they are working now. Now is the time to get behind them and to support the local NHS.

In a letter that the right hon. Gentleman wrote to me yesterday, he talked about Government failure. This is not the time to play politics—[Interruption.] Perhaps Opposition Members will listen to this. The head of NHS England, Simon Stevens, a former Labour special adviser, said yesterday

“the NHS, the Department of Health and local clinicians have done everything that could reasonably be expected”

to put in place plans over the last weeks. If the right hon. Gentleman will not listen to that, perhaps he will listen to Rob Webster, who runs the NHS Confederation, a representative body of all NHS organisations. He says that we should be grateful for the huge effort NHS staff have put in over the past few weeks and that it is not the time to play political football.

The right hon. Gentleman talked about ambulances, where we are putting in £50 million of support this winter, and some changes proposed by the Association of Ambulance Chief Executives, which he was informed about three months earlier than they came to public light. This is what the AACE said:

“We have been surprised by some of the reaction today given that over the last three months the principles of what we are proposing…have been shared with Labour…and we have received no negative feedback”.

What did the right hon. Gentleman say? He said it was a panic decision to relax 999 standards. There was no panic, no decision, no relaxation of 999 standards; I did what any Health Secretary should do: I simply asked for clinical advice on what would be best for patients. He chose to frighten the public, to scaremonger for party political purpose. Is it not time the Labour party, for once, thought about the impact on patients of the kind of things it is saying in the press?

The right hon. Gentleman then talked, and the Leader of the Opposition has talked, about the causes of these challenges being the reforms this Government introduced in this Parliament. Let me say to him that the one part of the UK that introduced these reforms, England, happens to have the best A and E performance and the one part of the UK that has most set its face against these forms, Labour-run Wales, has one of the worst performances. If he wants to do something about A and E pressures, instead of trying to make political capital in England, he should be getting Labour to turn things round in the one place it does run the health service—Wales. He should be backing this Government’s support for the NHS in a difficult period that has meant more doctors, more nurses, more people being seen quickly, more operations, long-term support and a plan for our NHS; it should not be politics and scaremongering ahead of an election.

[Dr Sarah Wollaston (Totnes) (Con)]

May I join the Secretary of State in warmly thanking NHS staff, who are stepping up to meet the extraordinary increase in demand for their care and expertise? Will he reassure the House that in meeting this extraordinary, complex challenge, they will not be made to chase targets, as we know that that was distorting clinical priorities in Mid Staffs, and that clinical staff should always feel absolutely confident that they have his support to place clinical priorities first and foremost?

[Mr Hunt]

My hon. Friend is absolutely right about that, and it is very important. Targets matter, but not targets at any cost. It is worth remembering that, over the four years we were seeing the tragedy unfold in Mid Staffs, it was meeting its A and E target the majority of the time. So it is very important that patient safety is the priority. That is why we have to support NHS trusts when they have major incidents and why we have to make it clear that, although targets matter, trusts need to be sensible and proportionate in their efforts to meet those standards.

UK Ebola Preparedness

Sarah Wollaston Excerpts

Monday 5th January 2015 Commons Chamber

[Mr Hunt]

May I first thank the right hon. Gentleman for the constructive tone of his comments and the official Opposition’s willingness to work closely with us on this very important issue? Let me cover some of the important points that he made.

The right hon. Gentleman is right that the disease is continuing to progress in those countries. We now have a total of 7,905 reported deaths, and there are 20,206 reported cases, which is likely to be an underestimate. There are some early—I stress, early—signs that the rate at which the disease is reproducing itself is beginning to fall to about the level where it is stabilising. However, those are early signs, and the truth is that we still need to do a huge amount of work to bring the disease under control.

We think that it is absolutely vital to proceed as quickly as possible with the vaccine that the right hon. Gentleman mentioned, and I can tell him that we currently have three vaccines in the first phase of clinical trials. We have made some changes to speed up the process by which they can be used in the field, and DFID has put in £1.34 million to establish a joint research fund with the Wellcome Trust, so we are making progress on that front.

It has been impossible to get supplies of ZMapp—the drug given to the other Ebola patient treated in the UK, Will Pooley—because it is grown using genetically modified tobacco plants, so there is a time constraint. Clinically, we do not yet know whether it was significant in Will Pooley’s recovery. We have tried other experimental treatments on Pauline Cafferkey, including using some of the plasma from Will Pooley, and we hope that will have an effect.

The review by Save the Children is being conducted in conjunction with Public Health England staff in Sierra Leone, and I hope that it will report in the next few days. We are obviously keen for them to report as quickly as possible, but we do not want to put them under pressure not to do a thorough report. I am satisfied with current protective arrangements on the basis of our clinical evidence, but as we saw with the screening arrangements, with a disease such as Ebola we must constantly keep an open mind about the best ways of dealing with things, and we will look carefully at what Save the Children recommends. I am satisfied with the protections in place for NHS workers in the UK on the basis of advice from the chief medical officer, and we will obviously also look at what happened in the US. At the moment we do not believe that the personal protective equipment suits have been breached, but we must keep an open mind and see what other evidence comes forward.

On the screening procedure, our clinical protocols were followed when Pauline Cafferkey arrived, but organisationally I do not think that it was as smooth as it needed to be. There were a lot of people to deal with, and because it was over the Christmas period we probably did not have as many people to do that as we needed, which meant that those coming for screening needed to wait longer than we would have liked. However, on the basis of revised protocols, and to ensure that we do not repeat this situation—nine more volunteers are coming back this Sunday and 60 more the following Sunday—the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), and the chief medical officer have been to inspect what is happening, to ensure that we learn the necessary lessons. Other volunteers have said that they think the screening procedure is working smoothly. This was a relatively isolated incident, but we must learn the lessons.

On expanding screening to other airports, I will look into whether Glasgow airport was informed and let the right hon. Gentleman know, but we have obviously learned from this event the importance of close working with the Scottish Government, and that has worked very well.

Finally, the right hon. Gentleman mentioned the active monitoring of people who come back, and I think that we have the best system. We are not only actively monitoring those who have been tested for having contracted the disease, but actively monitoring anyone in the high-risk groups. Of the 2,495 people who have been screened since we set up the process, 54 have been identified as having had direct contact with Ebola patients and as being in the high-risk group, and we have an enhanced monitoring process for them. Everyone else is informed exactly what to do if they develop feverish symptoms, which is what happened with Pauline Cafferkey.

I again thank the right hon. Gentleman for his constructive approach to this issue.

[Dr Sarah Wollaston (Totnes) (Con)]

I join the Secretary of State in paying tribute to Pauline Cafferkey and all NHS volunteers, aid workers, staff at DFID and Public Health England for the work they are doing to keep us safe in the UK by fighting Ebola on the front line in west Africa at great personal risk. I also thank him for updating the House so succinctly on the improvements to the screening protocols, so that everyone will be screened if they have symptoms, not just a temperature. Will he update the House on the vaccines and say whether there has been any progress on the provision of rapid screening for Ebola? Will he reassure us that he will not follow the knee-jerk response that we have heard calls for from some quarters, which is to quarantine all NHS staff, because of the unintended consequences of such an approach?

[Mr Hunt]

I thank my hon. Friend for her constructive comments and I agree with what she has said on this issue. Some 678 health care workers have contracted Ebola since the outbreak of the disease, and of those nearly 400 have died, the vast majority African. That shows how incredibly brave front-line workers are, and perhaps the fact that—tragically—we have someone in this country who has contracted Ebola is a good way of reminding ourselves that many hundreds of other people have already been in this situation. They are all incredibly brave. We are proceeding as quickly as we can with the possibility of having a much speedier Ebola test, which would obviously be helpful for the screening process.

I agree with my hon. Friend that we do not want a knee-jerk response on quarantining people who come back. The contribution of NHS volunteers and health care workers from western countries in fighting the disease in Sierra Leone, Guinea and Liberia is critical. Some 1,500 people from the NHS have volunteered, but they volunteer on the basis that we will follow proper clinical protocols, meaning quarantining people when it is clinically necessary to do so, but not doing so when it is not necessary. If we are to keep their confidence, we must be proportionate in our response.

Patient Safety and Medical Innovation

Sarah Wollaston Excerpts

Tuesday 9th December 2014 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

Like books, one should never judge a Bill by its cover. Later this week, the Medical Innovation Bill reaches Report stage in the House of Lords, but I would like to demonstrate that it is fundamentally flawed in its premise, it is unnecessary, it removes essential protections for patients, and it increases the risks of their exposure to maverick doctors. I believe it will undermine not only patient safety but medical innovation and so will have precisely the opposite effect to that intended.

Under current law, a doctor is negligent if he or she acts in a way which no responsible body of medical opinion would support, or which is irrational or illogical—the so-called Bolam test, as refined in the case of Bolitho. The Bill would rewrite the law on clinical negligence and a doctor whose decision to treat would not be supported by any responsible body of medical opinion, or was illogical or irrational, would be able to call on a new Saatchi defence if they fulfilled the procedural requirements of the Bill. That is important: the Bill’s protection of doctors applies if the procedural requirements are met. The Bill states:

“For the purposes of taking a responsible decision to depart from the existing range of accepted medical treatments for a condition, the doctor must…obtain the views of one or more appropriately qualified doctors in relation to the proposed treatment”.

There is no requirement for the second doctor to have seen the patient or even read their notes, and no requirement for them to be independent. They could be working at the same private clinic. It is of little reassurance that the treating doctor must

“take full account of the views”

of the second doctor if the second doctor is in collusion with the first in that treatment, which may be unreasonable.

If the Bill is passed, we will put patient safety at risk and we will no doubt have to return to amend the legislation subsequently. Let me quote from a letter forwarded to me by a constituent who had met a visitor to my constituency who managed to convince him utterly that this individual’s company had found a cure—a miraculous treatment—for cancer, but was being obstructed by a vast conspiracy in the medical community. In the letter, David Noakes, who describes himself as the chief executive of a biotechnology company, refers to a compound he calls GcMAF, which he describes as

“a human protein, present in 5 billion healthy people, that removes a number of diseases, including terminal stage 4 cancer. It has no side effects.”

He attaches a couple of scientific-y looking papers, which have no bearing on proving its clinical effectiveness. Mr Noakes continues:

“It’s always difficult to get feedback, but we have hundreds of superb results. In Guernsey, we treat over 100 people and…have 50 successes including 10 excellent cancer results. We have perfect feedback in our German and Swiss clinics, where our 7 doctors reduce tumours at the rate of 25% a week”.

He says that he cannot do it in the UK

“because the law is so destructive.”

Here is the bit that really worries me. Mr Noakes states:

“But we state that if you have terminal stage 4…cancer, have not had chemotherapy, and you do the”

so-called

“GcMAF protocol, you have an 80% chance of being cancer free in a year.”

In other words, what the company is specifically saying to people is that they can look forward to that result if they do not have chemotherapy—it is actively encouraging people not to have evidence-based treatment and promising that it has a cure for cancer.

Mr Noakes says that

“The pharmaceutical industry is not interested in”

this treatment, because there is no profit in it—

“it is too cheap, and can’t be patented”.

He says:

“The chemo lobby is so powerful it has changed British law so that doctors are only allowed to prescribe the poison of chemo for cancer when there are…better treatments.”

He adds, specifically:

“Lord Maurice Saatchi is trying to get that law changed with his Medical Innovation bill, but against so powerful a lobby”—

and so on. In other words, for this individual and the seven doctors to whom he refers, the Bill would be carte blanche. They see it as a Bill that would provide them with protections. The Bill specifically refers to medical practitioners and doctors as the people who can take this forward—not homeopaths or unregistered doctors. He says that he has seven doctors in his company. If one of those seven consulted another doctor in the clinic, it is highly likely that they would agree that this was an eminently sensible treatment.

[Dr Julian Huppert (Cambridge) (LD)]

I thank my hon. Friend for giving way and for securing this debate on an important subject. It is a shame that more people are not in the Chamber to discuss it. There are some very real concerns. Does she agree that people who are terminally ill may be desperate for treatment, and that simply makes them prey to people who may be unethical, who may be trying to push the envelope, and who may be doing things that would harm them but that sound quite good?

[Dr Wollaston]

I agree with my hon. Friend. In my constituency a medically qualified individual attempted to set up a cancer conference. It had to be pointed out that under the Cancer Act 1939 it is not legal to advertise cures for cancer. The Bill would allow people to circumvent the Cancer Act. How easy is it to get a reference to a miracle treatment planted into a magazine article, for example? This is the real danger here. While the Cancer Act protects people against blatant advertising, it does not provide protection against the back-door advertising that we already see. What is to stop individuals who are absolutely desperate—as my hon. Friend has said—going to doctors with articles saying, “This is a cure. I want you to refer me to this clinic.”

[Dr Huppert]

I will try to resist the temptation to intervene too often. Does my hon. Friend agree that this is not just about cancer? We have already had homeopathic doctors, who may practise medicine as well as homeopathy, claiming that they have powerful treatments for Ebola that the World Health Organisation will not let them work on. The Bill would open the door for all sorts of quacks who will do serious harm in the name of medical innovation.

--- Later in debate ---

[Dr Wollaston]

I agree. I thank my hon. Friend for making the point that this is not just about cancer treatment but about a wide range of surgical treatments and therapies for any number of conditions.

If the Bill is about reducing medical litigation so that doctors are free to undertake innovative treatments, why do those who are involved in medical litigation say that there is no need for it? The Medical Defence Union, the Medical Protection Society, even the NHS Litigation Authority, are clear that the law, with the Bolam and Bolitho tests, is well established. They feel that the Bill could increase uncertainty. The MPS briefing says:

“Fundamentally, current law allows doctors acting responsibly to innovate, and this Bill is unnecessary. The time has come for the debate to shift towards improving education about the present law, rather than confusing the law through a new piece of legislation.”

That is another point that is worth bearing in mind.

Far from promoting medical innovation, the Bill could undermine recruitment to genuine clinical trials. If someone had been persuaded by the likes of the doctors in the letter that I read out that there was a miraculous treatment for their terminal cancer, why would they wish to be enrolled in a clinical trial and be part of a randomised trial? If they could circumvent that and go along to a private clinic, why would they do that? Medical research does not just answer the question about whether a treatment works; it also helps answer the question whether a therapy or procedure has serious side effects. The history of medicine is littered with good intentions and innovations that seemed like a good idea but turned out to have disastrous side effects. I think, for example, of the use of 100% oxygen for premature babies, which led to blindness, or the use of steroids after head injury, which might have seemed like a good idea at the time but led to many, many deaths until it was realised that it was a dangerous innovation. There is an assumption that all innovation must be good innovation, but much innovation can be dangerous.

The randomised double-blind trial has been one of the greatest advances in medical science and has provided enormous protection for people. I look back at my time in medicine. Fairly soon after I qualified in 1986, I was a junior doctor on the Hedley Atkins breast unit. The newly appointed consultant is now Professor Sir Mike Richards, who is one of the country’s foremost and respected experts in cancer, formerly the cancer czar. He does not think the Bill will protect patients. We need to listen to the opinion of those who have serious concerns about such Bills. When I was working on that cancer unit in the 1980s, very many of the patients who did not survive at the time would survive today going to the same unit with similar conditions. That is because we now know what the best treatments are. We know that not from a series of unlinked anecdotal treatments, but because of former patients who were enrolled in clinical trials.

The accusation sometimes made is, “Aren’t clinical trials just experimenting on people?” Far from it. There seems to be a benefit for everyone taking part in a clinical trial, even those who are not receiving a treatment that turns out to be more effective. If the Bill is passed and undermines enrolment in clinical trials, we will be doing a grave disservice to medical innovation, and it will be to our great shame to have done so. I would like the Minister to address that point when he responds.

That is a fundamental flaw in the Bill. There is also a fundamental flaw in the premise that separate anecdotal treatments can progress medical research. Interestingly, clause 1(5) states:

“Nothing in this section permits a doctor to carry out treatment for the purposes of research”.

In other words, it specifically precludes the treatments being linked in any way, so we will learn nothing from these treatments. Lord Saatchi’s premise is that his Bill will advance medical knowledge, but there is no evidence that it will advance medical knowledge an inch because we will not be able to answer that fundamental question about whether there are unintended harms from the treatments or any long-term benefits.

Where will the evidence be of benefit from those “innovative treatments”? Will the Minister look carefully at that, and be clear in responding? The list of bodies opposed to the Medical Innovation Bill is very long—the Academy for Healthcare Science, the Academy of Medical Royal Colleges, the Academy of Medical Sciences, the Medical Research Council, the Wellcome Trust, Action Against Medical Accidents, the Association of Medical Research Charities, the Association of Personal Injury Lawyers, the British Medical Association, the British Pharmacological Society, Cancer Research UK, the Good Thinking Society, Healthwatch, the Medical Protection Society, the Medical Defence Union, the Motor Neurone Disease Association, the National Institute for Health and Care Excellence, the NHS Health Research Authority and the NHS Litigation Authority.

Richard Francis QC, one of our most respected national authorities on patient safety, opposes the legislation. I think that we ought to reflect carefully on his words:

“If there is misunderstanding then it should be corrected by guidance, not by legislation which exposes vulnerable patients to unjustified risk and deprives them of remedies when mistreated by those who have no acceptable justification for what they have done.”

Those are very serious words indeed. The legislation is also opposed by the Royal College of General Practitioners, the Royal College of Physicians, the Royal College of Psychiatrists and the Royal College of Radiologists. That is an important list.

There is a powerful lobby in favour of this legislation that purports that those who oppose it are somehow dinosaurs.

I urge the Minister to read the letter from 100 leading oncologists that was published in The Times on 13 November, which states:

“We devote our professional lives to treating patients with cancer and advancing research that contributes to finding more effective treatments for cancer. We neither want nor need Lord Saatchi’s bill. We do not believe that it will help our patients or future patients. We are dismayed that the bill is being promoted as offering hope to patients and their families when it will not make any meaningful difference to progress in treating cancer.

The law of medical negligence does not hinder our work or prevent innovation. There have been significant advances across all the modalities of cancer treatment over recent decades. There was no call for this change in the law from the medical profession. The current law already allows us to use off label drugs and to try new treatments when they are in patients’ best interests.

We are concerned that rather than promoting responsible scientific innovation in the treatment of cancer, the Medical Innovation Bill will actually encourage irresponsible experimentation producing nothing more than anecdotal ‘evidence’, at the potential expense of causing serious harm and suffering to patients, their families and carers. Innovation is best carried out within the discipline of controlled clinical trials, not by individual doctors acting on a whim.”

I think that sums it up well.

Were we to title the Bill correctly, it would be called the medical anecdote Bill. We should be saying that it makes provision in relation to anecdotal treatments in medical treatment. If we titled it correctly, there would be no question whatsoever of its having Government support. I urge the Minister in the strongest terms please not to give the Bill Government backing. To do so, I think, would be to our great shame. We would undoubtedly have to return to amend it. It would put patients at risk, and it would put recruitment to clinical trials and genuine innovation at risk.

I look forward to hearing the Minister’s response and about the many good things the Government have done to promote genuine innovation. I will not detain the House by offering that list now, because I know the Minister has done more than anyone I can think of in the House to promote true medical innovation. I therefore hope he will recognise that the Bill would do quite the opposite, and ensure that it does not progress.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

I thank my hon. Friend the Member for Totnes (Dr Wollaston) for securing this Adjournment debate and giving the House, albeit only a few of us, the chance to debate what is, I agree, a very important issue that is the subject of live discussion in another place. I also thank my hon. Friend the Member for Cambridge (Dr Huppert) for his comments.

My hon. Friend the Member for Totnes is a tireless campaigner for good health care and good medicine, as Member of Parliament for Totnes, as a member of the medical profession, and as Chair of the Health Committee. I very much welcome her contribution. I will first deal with the points that she made, then set the scene and provide a little context about the Government’s view of this Bill, and then close with what I hope may be some reassurance about our commitment to patient safety.

My hon. Friend made a number of important points, which I repeat merely to signal that I have heard them loud and clear. She said that the Bill might risk creating a carte blanche, or open door, situation as an inadvertent side effect of unjustified and unsubstantiated claims. My hon. Friend the Member for Cambridge mentioned homeopathy and other non-evidence-based forms of medicine. My hon. Friend the Member for Totnes highlighted the danger of relying too heavily on the protection of a clinician merely seeking the endorsement of a fellow clinician. Implicit in her concern is the fact that most of us could probably find one person in life to support our own prejudices, however well intentioned.

My hon. Friend highlighted the risk of unethical approaches and the danger of back-door promotions, which none of us wants to see. On the danger of undermining public and patient trust in clinical trials, she knows that I am passionate about achieving precisely the opposite. We are very proud in this country that more and more of our patients are enrolling in clinical trials. The NHS is running a fabulously successful programme of promoting research medicine, and this year the numbers are up by 24% or 25%. That is good for patients, good for NHS research, and good for our life sciences sector.

My hon. Friend has highlighted the danger of accidental errors across the system today. We live with that risk, but I hear her point that it would be a disaster if the Bill inadvertently made errors more likely, rather than less. She also raised concerns about the Bill not promoting evidence-based medicine or requiring claims to be based on clear patient benefit. She made a specific point about the Cancer Act 1939, which I will follow up and deal with by letter, if I may.

Most concerning of all, my hon. Friend ran through a very long list of medical and health organisations that she described as being opposed to the Bill. I will look into that following the debate because—I will say more about this in a moment—we do not want the measure to be divisive or to alienate or undermine the consensus about the importance of good medical research in the UK and the NHS. I take that point seriously. My hon. Friend flagged up the letter from 100 oncologists that appeared in newspapers recently. Since that was published, there have been a number of discussions about—and, indeed, amendments tabled to—the Bill in the Lords. I want to have a look and make sure which, if any, of those concerns are extant as the Bill completes its passage through the Lords. I will say more about that in a moment.

My hon. Friend the Member for Cambridge endorsed those comments. I note in particular his comments about the importance of evidence-based medicine. As with so many issues that we deal with in this House, a good test is to ask: would I apply this to myself? Certainly, for myself and my family, I am a strong believer in evidence-based medicine. I am a believer in innovation as well, but my hon. Friend made an important point. I particularly enjoyed his mention of the politician’s syllogism: “We must do something; this is something; ergo, we should do it.” I assure him that that is not in any way the reason for the Government’s benign support for the Bill’s principles and the case it seeks to make to promote innovation. I align myself hugely with his comments about not wanting to open the door to quackery.

[Dr Wollaston]

Lord Saatchi has said that 20,000 people support his Bill, but if people are asked whether they are in favour of medical innovation, they are likely to answer yes, and if the same people are asked whether they are likely to support medical anecdotes, I think they are likely to say no. Sometimes the answer depends on the question being asked.

[George Freeman]

I am sure my hon. Friend is right. She makes an excellent point about the nature of the question having an impact on the answer one gets. I have repeated the concerns because they bear repetition and are important, and I want to signal that I am taking them seriously.

I want to set the scene in terms of the Government’s commitment to patient safety, the context in which innovative medicines are being developed, and the changes in the sector that are challenging some of the traditional methods of drug development. I will then address some of the specific points that my hon. Friends the Members for Totnes and for Cambridge have made and say something about the Government’s position on the Bill.

The Government’s response to the Mid Staffordshire NHS Foundation Trust public inquiry, led by Sir Robert Francis, “Hard Truths: The Journey to Putting Patients First”, demonstrated beyond any doubt, I hope, the Government’s absolute commitment to creating a new culture of openness, compassion and accountability and a renewed focus on patient safety right at the heart of the NHS.

The truth is that the NHS is one of the safest health care systems in the world. I am delighted to report that, in the recent Commonwealth Fund report comparing the US health care system with those of 11 other nations, the UK came top. However, there is always scope to improve health care standards universally and to reduce avoidable harm further. That is why the Secretary of State set the ambition this June, at the launch of the Sign up to Safety campaign, to reduce avoidable harm by half and save 6,000 lives over the next three years.

We have put patient safety right at the heart of the Government’s agenda for health. For that reason, I am delighted that the Government are actively supporting the Bill on patient safety sponsored by my hon. Friend the Member for Stafford (Jeremy Lefroy). The Bill has several important provisions on the use of data to drive safety across the system and to ensure transparency and accountability in health outcomes.

Why do we need to look at mechanisms for promoting innovation? My hon. Friend the Member for Totnes was kind enough to signal her awareness that the Government—particularly me, as the first Minister for life sciences—have taken an active role in trying to promote it. The reason is that we face a challenge in the field of drug discovery and development, as well as in medical technology generally. There is a challenge and an opportunity.

The challenge is that the more we know about disease, genetics and data—the datasets at our disposal in the NHS, and the history of drug reactions and the way in which patients respond to diseases differently—the more we realise that patients respond to the same disease or the same drug in different ways, and that those ways can often be predicted. These insights are beginning to change the way in which drugs are developed.

Increasingly, we do not need the one-size-fits-all, blockbuster drugs that we have traditionally expected the industry to bring us after long, slow, protracted and increasingly expensive clinical trials and randomised, double-blind trials. Of course, those trials have a strong part to play in our system, but the more we know about the nature of disease and the extraordinary breakthroughs that our biomedical and life sciences sector is making, the more the agenda shifts to designing around patients, as well as around tissues, data and genomics. That is why the Government are so committed to shifting our policy landscape to support the extraordinary role that our NHS can play globally. It is a uniquely well positioned, integrated national health care system, with extraordinary leadership in genomics and informatics, which the Government are actively supporting.

My hon. Friend made the point that the randomised, double-blind trial has given medicine great service in the 20th century, and I agree. As we move further into the 21st century and see the transformational power of new technologies, it is equally true that the system of expecting the industry to go away and spend 10 to 15 years, and an average of £1.5 billion, to develop a new drug—many of them fail in late-stage clinical trials, because of some toxic side effect in one patient or a few small number of patients—is leading to a crisis in the industry and in the pipeline for new drugs and new treatments, and to patients increasingly suffering because we cannot give them innovative medicines.

Part of the agenda for this Government and all western Governments is to look at how to accelerate the way in which our health systems support research and to bring innovative medicines, as well as devices, diagnostics and other innovations, to benefit patients more quickly.

[George Freeman]

The hon. Gentleman makes an important point. I want to take this opportunity to pay tribute to the work being done in that cluster at Queen’s. I am delighted to say that I will be coming in the new year to support it and to show, as the UK Minister, that there are great clusters in Scotland, Northern Ireland and Wales. I very much look forward to that visit.

The truth is that the landscape is changing. Part of the challenge that we all face is to find ways to accelerate earlier access to innovative treatments for patients, and earlier access for those developing innovative drugs, devices and diagnostics to our health system, so that we can more quickly design innovations that are more targeted and personalised. We are seeing the first genuinely personalised cancer therapies and drugs that, in the unfortunate event that one is diagnosed with cancer, can be designed around one’s genetic profile. I was at a seminar on that development this morning. It is changing the landscape of drug development. We are keen to ensure that we benefit from it in the UK and that we use every mechanism in the NHS to support it.

[Dr Wollaston]

Does the Minister accept that a doctor who uses such innovative treatments within the NHS is protected under existing law and that we do not need new legislation to make them available to patients?

--- Later in debate ---

[George Freeman]

I am merely trying to set out a balanced review of the arguments. In closing my speech, I will give an assurance that I hope will satisfy my hon. Friend on that point.

On protection, under existing common law and in the Bill doctors must show that they have acted responsibly. They cannot simply go through the motions and seek advice from an inappropriate source as that would not be “responsible”, which is the key test in the Bill and common law. Even if doctors follow the steps in the Bill when deciding to adopt an innovative treatment, they might still carry it out negligently and be subject to a negligence claim in the same way. When something goes wrong it is right that patients are free to seek compensation, and that will continue to be the case. The Government do not want any undermining of protection for patients against clinical negligence.

My hon. Friend the Member for Totnes made a point about the Bill not requiring doctors to seek the prior agreement of an appropriately qualified doctor, and instead being required only to take account of their views. I would not want the Bill to give a carte blanche to quackery or non-evidence based medicine. The Bill requires a doctor to take full account of the views of at least one appropriately qualified doctor, just as any responsible doctor would be expected to do, and they would not be able to ignore certain views or give them minimal weight by just “noting” them unless there were reasonable grounds for doing so. All doctors will be bound by the core and primary duty of responsibility and care to their patients. If the Bill were to require the explicit agreement of another doctor to innovate—that is one suggestion made in the other place—we are worried that that would open the possibility of a new negligence action against the countersigning doctor and lead to more confusion. We would not be able to give the countersigning doctor any certainty about their legal position, and they would not be able to rely on provisions in the Bill.

My hon. Friend made a point about undermining confidence in clinical trials. Although the Bill has raised awareness of innovation in medical treatment, it does not confer additional rights on patients to demand innovative treatment. It will still be for the doctor to decide the most appropriate course of treatment in discussion with their patient and using their best professional clinical judgment. Nothing in the Bill allows doctors to bypass any processes or requirements set by their trust when undertaking innovative treatments in the NHS, which includes ensuring that the commissioner would fund the treatment if it is to be provided within the service.

Individual innovation is important but no substitute for medical research and testing the efficacy of new treatments in a systematic way. A large part of my work is about ensuring that we use all of our £1 billion a year for the National Institute for Health Research infrastructure in the NHS, to ensure—as the Prime Minister set out in his speech when launching our life science strategy—that every willing patient is a research patient and every hospital a research hospital, and that we learn from evidence that we develop daily in our interaction with patients. Lord Saatchi and Ministers are determined that doctors should learn from innovative medicine as we go along, and a large part of the NIHR and our data programme is about ensuring that we pick up and track innovations and outcomes more accurately across the system.

[Dr Wollaston]

Does the Minister accept that that cannot happen under the Bill, and that those things will remain a series of unlinking anecdotes? In medical science and for the safety of patients no one will be able to track whether there were unintended consequences or benefits, and it will not advance the cause of medical innovation whatsoever.

[George Freeman]

I would be interested to see the Bill once it has completed its passage through another place and ensure that it contains adequate provision for evidence-based medicine, and that, by encouraging innovation, we are not in any way encouraging medicine that is not supported by the best evidence available.

My hon. Friend spoke about consultation. The Department of Health carried out a full consultation on the issues raised in the Bill, which ran from February to April this year. It was delighted to receive 170 responses to that consultation, making clear a range of opinions. Responses came from a range of audiences, professional bodies, patients and clinicians. Four regional public consultation events were also held. Lord Saatchi attended those events and it was in no small part thanks to his involvement that a number of changes were made to strengthen the oversight mechanisms in the Bill. At every stage, the Department of Health has engaged with Lord Saatchi to develop amendments to align the policy of the Bill with the legal and expert clinical advice we have taken, including from Sir Bruce Keogh.

NHS (Five Year Forward View)

Sarah Wollaston Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Speaker]

The Secretary of State confirms that he is not making any allegation of personal dishonesty against any individual. Enough: we are grateful. We will leave it there for now.

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the statement. The extra funds for the NHS constitute a clear endorsement of Simon Stevens’s excellent “Five Year Forward View”. I particularly welcome the announcement of multi-year budgets and investment in patients’ ability to control their own records. Will the Secretary of State confirm that the process of creating paperless NHS hospitals will move seamlessly from primary to secondary care, and will be controlled by patients themselves?

[Mr Hunt]

The commitment to a paperless NHS is not a commitment to the creation of paperless hospitals by 2018; it is a commitment to the creation of a paperless NHS so that, with patients’ consent, information can flow seamlessly between different parts of the system. The interface between primary care and secondary care, and social care, is a very important part of that process.