Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 1st April 2014 Commons Chamber

[Norman Lamb]

That is precisely what I am seeking to do, but we have to address what I have often described as an institutional bias against mental health in the NHS. For example, when the previous Labour Government introduced a maximum waiting time of 18 weeks, inexplicably, they left out mental health again. What possible justification can there be for that? We are ending that and ensuring that when commissioners determine where funding goes they will have to take into account waiting time standards in mental health for the first time.

[Dr Sarah Wollaston (Totnes) (Con)]

I am proud to be a patron of Cool Recovery, a mental health charity in my constituency that provides vital support and information for sufferers and their families. Will the Minister confirm that as we welcome Simon Stevens to his new role, he will not only discuss how parity of esteem is reflected in the overall funding share but make sure that some of that funding can go to the charities that provide that parity?

[Norman Lamb]

I will absolutely discuss parity of esteem with Simon Stevens when I meet him very soon and I will ensure that the case for third sector organisations is taken into account, as they play an incredibly important role. I was delighted, incidentally, to be down in the south-west at the signing of the crisis care concordat to ensure that people who are suffering a mental health crisis are treated in the same way as people who are suffering a physical health crisis.

Minimum Practice Income Guarantee

Sarah Wollaston Excerpts

Wednesday 26th March 2014 Westminster Hall

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a huge pleasure to serve under your chairmanship, Sir Roger. I am extremely grateful for the opportunity to raise the problems caused by the removal of the minimum practice income guarantee. The removal of the minimum practice income guarantee is not the sole cause of the crisis facing some of England’s rural surgeries, but it has unveiled the failure over several decades to provide a sustainable basis for funding GP surgeries in rural communities. The coming crisis, which could have the unintended consequence of closing dozens of rural surgeries, will be immensely costly to our communities and to the taxpayer. Taking intelligent, targeted and swift action to prevent those closures will be extraordinarily cheap by comparison.

Over the past few months, I have been working with our communities in and around Hawkshead and Coniston in my constituency, whose surgeries are undoubtedly at risk. Last August, 500 local people filled the school hall at John Ruskin school in Coniston at a public meeting. Five hundred people is an impressive turnout in any community, but when we realise that the total number of patients listed at Coniston is just 900, we see how important the issue is. Those 500 people turned up because they know that it would be impossible for them reasonably to access another surgery, given how remote and isolated they are. My job today is to convince the Minister—I hope it will not take much doing—that my constituents are right and he should take action to help them. Let us be clear: unless a specific decision is taken to provide new and additional support for small rural surgeries, there will be a series of surgery closures that will be hugely damaging to our communities, harmful to patient safety, costly to the taxpayer and utterly embarrassing for Government.

In my constituency, two practices stand out as being in need of immediate aid from NHS England and the Department of Health: Coniston and Hawkshead, two communities in the central Lake district, which are about as remote as one can get in England. Both communities have a GP surgery, and both surgeries are at risk because of unsustainable funding. If you would care to have a look at your Ordnance Survey map of the Lake district, Sir Roger, you will see that if either of those surgeries were to close, the next nearest surgery would be on the other side of at least one lake, not to mention a couple of mountain ranges.

Across the country, there will, of course, be some small practices that should amalgamate with others, predominantly in urban areas where access and sparsity are not such an issue. The number of small rural GP surgeries, such as Coniston and Hawkshead, which are facing up to falling off the funding cliff is relatively small. At the last count, there were 36 in the whole country. Therefore, although intervention is vital, it is manageable and affordable. It is not a big problem to solve if we do it now, but it will become an enormous problem if it is not tackled. The evidence is clear that for that to happen, there will need to be strong and unmistakeable political leadership. In other words, Ministers must state unequivocally that they want NHS England to protect small, strategically vital GP surgeries, and that they expect a formal fund to be set up to make that happen—a small strategic surgeries fund—just as our Government have successfully done to protect small, strategically important schools in rural areas. It will cost little, but it will save a lot.

A couple of weeks ago, controversially, our Government fought to permit the Secretary of State to have the right to intervene in local trust matters when there is a patient safety issue. They were right to do so, because elected Governments should involve themselves to ensure that strategic priorities are met. Here is one such example. It is strategically vital that people in rural areas across the country, including Coniston and Hawkshead, have the same rights to access health care as anyone else.

[Dr Sarah Wollaston (Totnes) (Con)]

As somebody who has worked in a small rural community, where there are high levels of deprivation in an area of relative affluence, the difficulty is that many people cannot access transport to get to services in other locations. I agree with my hon. Friend that we must prioritise access in small rural communities and recognise the problems of rural poverty.

[Tim Farron]

I am grateful to my hon. Friend for making that strong and good point. What counts as poverty in rural areas is often very different from what counts as poverty in urban areas. It is poverty in terms not only of income but of access to services. The average age of my constituents is 10 years higher than the average age of the UK population, so isolation and lack of access to private transport, never mind public transport, make it physically impossible to access another service. That is why we need to intervene.

I have had many conversations with NHS England, our local area teams and the clinical commissioning group. In the nicest possible way, there is a sense that they are all seeking a lead from the top. They are all good people, but they seek direction from the top. To be fair, NHS England has identified some 90 GP surgeries as outliers—practices that will lose more than £3 a patient—and a further 200 or so that will lose more than £2 a patient. However, that process of identifying outliers does not tell us which practices will be sustainable and which will not. Crucially, although outliers have been identified, no resource has been identified to help to protect them. That is why the Government must take a lead and make it clear that surgeries such as Hawkshead and Coniston must be protected, and that funding must be set aside to ensure that they not only survive but thrive. I am concerned that many of the discussions and the media attention have focused around the minimum practice income guarantee when we should focus more directly on funding sustainable general practice in remote rural areas.

In south Lakeland there are vast differences in minimum practice income guarantee payments per patient. Coniston gets approximately £25 a patient, Hawkshead gets less than £1 a patient and Ambleside gets around £15 a patient. By comparison, Slaidburn in Lancashire receives £110 a patient, even though the Slaidburn practice is the same size as the one in Hawkshead. The proposed changes from April will begin to remove those differences. Arguably it is correct to do so, but it is not correct simply to leave it at that.

The process of removing the minimum practice income guarantee and redistributing the funds per capita is a staggeringly blunt instrument. It is the ultimate one-size-fits-all policy, which treats small rural practices the same as large urban ones. It is on a par with making the casual assumption that the local village shop will have the same business model as Tesco. Smaller practices do not have the economies of scale that larger practices do; for example, the core practice management costs are the same whether the practice has 1,000 patients or 5,000.

NHS England’s argument is that, because smaller surgeries are inefficient, they should merge with neighbouring practices to increase efficiency. That works in urban areas, where there are often multiple GP practices operating close together. In that case, it is safe and sensible to consider sharing resources more efficiently. In remote rural areas, however, it is not possible to achieve those savings without sacrificing patient safety. It is not possible physically to merge with a neighbouring practice if it is on the other side of a lake. Merging, say, Coniston and Hawkshead with a larger, more distant surgery in Ambleside or Ulverston will not change the fact that health care still needs to be provided in the heart of those communities.

The only way to get savings is by closing a surgery or downgrading the service significantly in one or more of the villages and asking the patients to travel to another one for their main GP service. That would, in fact, result in no savings at all. Consider the increased cost to the ambulance service, to the A and E units nearby—not that they are particularly nearby, by the way—and to social care that would be triggered by the removal of GP services from the heart of our community. The human costs of closure are immeasurable, but the financial costs are measurable. It would be extreme foolishness to let our surgeries close by accident.

NHS England suggests that the policy does not impact on large numbers of rural practices, and that a greater number of urban practices will lose out. It is correct: there are not a large number of rural surgeries at risk. However, the analysis ignores the fact that, for the rural surgeries, an alternative to the current service provision is simply not available. Patients cannot simply move to the neighbouring practice down the road, because there is no “down the road”.

The changes come on the back of an already diminishing level of income in general practice for small rural surgeries. Hawkshead’s 2013-14 income from the GP contract is down 5% on 2012-13, and that has absolutely nothing to do with the removal of the minimum practice income guarantee. We should therefore be careful not to allow the removal of the minimum practice income guarantee to mask the much wider problem of a lack of sustainable funding streams for a relatively small and very manageable number of rural surgeries.

NHS England states that the removal of the minimum practice income guarantee will be phased gradually over seven years, but only so much can be squeezed out of an ever-reducing funding stream. The core running costs of the premises cannot be cut, so all that is left to cut is staff. If the staff consists of barely a handful of committed professionals, all that is left to do is close.

Hawkshead is already at 50% of the national staffing average, which reflects its historical low level minimum practice income guarantee funding compared with similar practices. At the same time, the surgery has the highest patient satisfaction levels in the country. It is officially the best surgery in England, but, as things stand, its only options are to reduce service provision to a level that would never be tolerated in an urban area, or to close. I am sure that the Minister will agree that such unacceptable choices mean that we must intervene.

Unlike Coniston practice, Hawkshead will gain by a small amount through the proposed changes. However, it will be by only about £1,000 a year, when the historical funding shortfall is about £35,000 to £40,000. Coniston’s income will decline significantly—by around £25,000 to £30,000 a year—and, to put it mildly, both surgeries will be at severe risk.

The minimum practice income guarantee should be removed or phased out. That is not challenged by those of us in rural communities. The wide disparities between surgeries with significant minimum practice income guarantee grants and those that, like Hawkshead, get pretty much nothing, makes the case for us. Nevertheless, the removal of the minimum practice income guarantee provides an opportunity to ensure that, in the wider context of a fairer and more efficient funding model, there should also be an element in the formula that does what the minimum practice income guarantee was originally intended to do, only more efficiently, more effectively and less expensively.

A small strategic surgeries fund could cover the additional cost per patient of keeping the core expenses covered. As a basic need, Coniston must keep its current funding, and Hawkshead must rise to a similar level in order to sustain service provision. NHS England will argue that it has reverted responsibility for the decision-making process to local area teams. However, there is no ring-fenced funding to deal with the problem, so local area teams are limited in what they can do. Our local area team has given its support to ongoing service provision in Hawkshead and Coniston, and I am extremely grateful for that, but so far no additional funding has been identified to support the practices.

The Minister will know that strategic small surgery funds have been established in Scotland and Wales. They are ring-fenced at the centre to ensure that no surgery that needs to remain open is closed by accident. Rural communities in England suffer from poor funding in social care, secondary care and primary care. Far too often, people in areas such as Cumbria are forced to put up with services funded at a fraction of what is required in order to provide care equivalent to that on offer in urban areas.

It is understandable that civil servants in Whitehall and officials in NHS England should come up with funding mechanisms that, in the first instance, overlook the fact that it simply costs more money to provide equivalent care to rural communities. It may even be understandable that officials might be ignorant of the desperate social needs in rural communities caused by poverty, ageing populations and isolation. However, once those problems are made clear, it is not acceptable to shrug them off. Once we have brought them to national attention, it is imperative that we see action.

In summary, I want to make five quick points. First, a small number of small, rural surgeries in England are at risk, partly as a result of the removal of the minimum practice income guarantee. Secondly, Coniston and Hawkshead are two such surgeries, and there is no alternative to having a surgery in either of those communities that is either sensible or safe. Thirdly, rural communities have as much right to decent health care as anyone else. Fourthly, it will cost relatively little to come up with a strategic fund to protect those few dozen surgeries. Fifthly, such a fund will be created only if the Department of Health and NHS England agree that it must be, and then make it so.

My constituents deserve access to good local GP services as much as anyone in London, Birmingham or Manchester. Unless we tackle the problem I have outlined, my constituents will be put at unacceptable risk. On behalf of the people of south Lakeland, and all other rural communities, I ask for the Minister’s help in setting up a small strategic surgeries fund so that we can remove that risk.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve under your chairmanship again, Sir Roger. I congratulate my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) on securing this debate, which is pertinent to many constituencies in England. Indeed, it is pertinent to my own constituency in Suffolk. Later in the debate, I hope to reassure him by giving good local examples from Suffolk of how the joint working he has described can be very effective. The issue is not just money, but improving the quality and availability of care for patients.

We all recognise the importance of local GP practices, particularly in rural communities such as those in my hon. Friend’s constituency. I would like to reassure him that the Government believe that high-quality local services can be maintained. I will not rehearse all the background to the 2004 GP contract negotiations, which we know changed the way that GP practices were funded, but it is worth drawing out a couple of points. Rather than receiving a series of fees and allowances, since 2004, GP practices have been paid based on a formula to take account of need and work load. Practices can also earn money by participating in the quality and outcomes framework—commonly known as QOF—or offering enhanced services.

To smooth the transition to the new system, a minimum practice income guarantee was introduced and used to top up practices’ core funding to match their basic income levels before the 2004 contract was introduced. We must also remember that many GP practices are of course small businesses in their own right. They value and enjoy the flexibility that the GP contract implicitly recognises, and that can bring great benefits to patients. In a moment I will talk a little more about the minimum practice income guarantee and the changes under the recent GP contracts, which from now on will be negotiated by NHS England, as my hon. Friend outlined.

It is worth talking a little about rural practices and highlighting some of the measures in place to support them—it is important to get that on the record. We recognise the fact that rural practices, in areas such as Hawkshead and Coniston in my hon. Friend’s constituency, play a vital role for their local communities. We also recognise the rurality and the often sparsely scattered populations that such GP practices look after. Both the Government and NHS England intend high-quality local services to be supported and maintained.

My hon. Friend will be aware that the funding formula for general practice already includes an allowance for rurality, and there is also provision for the costs of temporary residents. That can be a particular issue during the summer months with the arrival of tourists in the Lake district. The funding formula already includes additional support for rural areas and places with a more transient population because of tourism, or for the seasonal population fluctuations in more agricultural constituencies where there is a high reliance on temporary, summertime or seasonal labour.

Rural GPs may also be able to increase their income in other ways. For example, dispensing practices tend to be in rural areas, although not exclusively. That is potentially another way to provide additional income for a practice, as well as important support for the community, which can have closer-to-home access to prescribed medications and drugs.

I understand that NHS England is working with local GPs through the Cumbria clinical commissioning group to decide how to maintain accessible, responsive, high-quality primary medical services—my hon. Friend alluded to that in his speech. For example, NHS England can help practices to work more closely together. It is looking at doing that by sharing IT and other back-office support in order to improve care and practice efficiency. NHS England is also ensuring that, through practice patient participation groups and local healthwatch services, patients are being kept fully informed and are able to contribute to discussions.

I would like to talk briefly about the phasing out of the minimum practice income guarantee, which last year we announced would begin this April. As my hon. Friend outlined—I was pleased that he supported this—we consider that the payments are no longer equitable, because under the system, two surgeries in the same area serving similar populations could be paid different amounts per patient they serve. That is inequitable and does not make sense.

The payments of the MPIG will be phased out not simply overnight, but over seven years. The overall intention is for the funding for GP practices to be properly matched to the number of patients they serve and the health service needs of those patients.

Funding will also continue to take into account the unavoidable costs of providing services in rural areas. The issue is not one that affects only rural practices, as both rural and non-rural practices receive MPIG payments.

[Dr Wollaston]

Regarding the point about funding following the number of patients, the Minister will be aware that there is now greater flexibility for patients to register. Relatively young, mobile patients may choose to be registered near their place of work; indeed, they should have that flexibility. However, that is an additional income drain on small and sparsely located practices. Is the Minister aware of that?

[Dr Poulter]

Absolutely. I alluded to that point in some of my earlier comments. We know that there is the tourist trade, which is an important part of the local economy in the constituency of my hon. Friend the Member for Westmorland and Lonsdale. Recognition of that factor is built into the funding formula for GP practices. People moving locally to work somewhere is already taken into account as part of the formula, which will benefit the funding of some of the local practices in my hon. Friend’s constituency. I hope that is a helpful clarification of the point about people moving from one location to another.

[Dr Wollaston]

Does the Minister accept that not all sparsely populated areas will see that offset by incoming tourists? Many areas of the country will not see that offset benefit.

[Dr Poulter]

Absolutely. As I have outlined, other parts of the formula recognises rural areas; they are already recognised in GP funding allocation. Therefore, on both counts, additional support is available for areas such as those described by my hon. Friend the Member for Westmorland and Lonsdale in his constituency, and indeed those in Totnes and in my own constituency. Rurality is already factored into GP contracts and funding for GP practices and health care.

What will happen with the money that is recycled and released from the MPIG is an important point. The money released by phasing out the MPIG will be reinvested into the basic payments made to all general medical services practices, which are based on the number of patients and key determinants of practice work load, such as the age and health needs of patients and the unavoidable costs of rurality.

Another factor that we all recognise—I know it is a factor in Totnes and, I believe, in Westmorland and Lonsdale—is that many older people choose to live in rural areas. Older people once used to retire to seaside towns, but they are increasingly retiring to predominantly rural areas. The changes and the freeing up of cash from the MPIG will benefit all practices. In the health care funding formula—not necessarily the GP funding formula, but how clinical commissioning groups allocations are allocated—there is a strong weighting for age which will bring broad benefit to rural areas, particularly those that have a high proportion of older people.

NHS England has been undertaking specific analysis of the withdrawal of the MPIG. Inevitably, a small number of practices will find themselves in more difficult circumstances. NHS England has been considering the small number of significant outlier practices, as my hon. Friend the Member for Westmorland and Lonsdale mentioned, for which alternative arrangements may need to be made to ensure that appropriate services are maintained for local patients. We appreciate that that is a matter of concern for some practices, and my hon. Friend has outlined concerns in his own constituency. That is why we have decided to take seven years to implement the change to the MPIG funding. Phasing in the changes over that period will allow the minority of practices that lose funding to adjust gradually to the reduction in payments.

NHS England has been looking carefully at how its area teams can support the practices that are most affected. It has invited practices that believe they will have problems as a result of the phasing out of the MPIG to raise that concern with their area team. In a small number of cases where there are exceptional underlying factors that necessitate additional funding, NHS England has asked its area teams to agree different arrangements to ensure that appropriate services for patients continue to be available. That includes looking at how services are funded.

Importantly, NHS England has suggested that practices with small list sizes could look at collaborating with other practices, for example through federating, networking or merging with nearby practices, to provide more cost-effective and better services for patients, a point I will come to in a moment. Practices can also identify other ways they could improve cost-efficiency, such as reviewing staffing structures, and they can review commissioning or contracting options.

Care Bill [Lords]

Sarah Wollaston Excerpts

Tuesday 11th March 2014 Commons Chamber

[Mr Speaker]

I remind the House that with this we are discussing the following:

Amendment (a) to Government new clause 34, in subsection (3), after ‘of’, insert ‘improving’.

Amendment (b) to Government new clause 34, in subsection (3), after ‘adult social care’, insert

‘; and if it has satisfied itself that the recipient is competent to handle the data in compliance with all statutory duties and to respect and promote the privacy of recipients of health services and adult social care.”.’.

New clause 25—Misuse of data provided by the Health and Social Care Information Centre: offence—

‘(1) A person or entity commits an offence if they misuse, or negligently allow the misuse of information they have requested and received from the Health and Social Care Information Centre.

(2) “Misuse” means—

(a) using information in a way that violates the agreement with the Health and Social Care Information Centre;

(b) using information in a way that does not violate the agreement with the Health and Social Care Information Centre, but that gives rise to use that is outside the agreed limits of use; or

(c) using information supplied by the Health and Social Care Information Centre in such a way as to allow or enable individual patients to be identified by a third party.

(3) A person who is guilty of an offence under subsection (1) is liable—

(a) on summary conviction, to an unlimited fine;

(b) on conviction on indictment, to imprisonment for not more than two years or a fine, or both.

(4) An entity who is guilty of an offence under subsection (1)—

(a) is liable to an unlimited fine; and

(b) must disclose the conviction on all future applications to access data from the Health and Social Care Information Centre.’.

Government amendment 8.

Amendment 29, in clause 116, page 100, line 29, after ‘Authority’, insert

‘and the Secretary of State’.

Government amendments 17, 18, 15 and 16.

[Dr Sarah Wollaston (Totnes) (Con)]

I love medical data. They have undoubtedly saved my life and the lives of almost everybody in the House. Medical data, particularly big data, allow us to identify which drugs and procedures work and which do not work. They enable us to pick up the rare side effects of medications that have recently been released on to the market before they can wreak the kind of havoc that we have seen in the past. They enable us to identify which are the good hospitals and which are the failing hospitals. They allow us to identify which clinicians need serious retraining and from which clinicians the public need protection.

I would argue that evidence-based medicine is one of the greatest advances of our age. Evidence-based medicine works a lot better if we have access to big data. I state for the record that I do not intend to opt out. I hope that the Government will use the six months that we have to mount a clear campaign to the public that sets out just what the possibilities are.

I also feel that some of the concerns about releasing big data to pharmaceutical companies are misplaced. We need our pharmaceutical companies to be able to access those data, and there is a virtuous circle. We know that if we attract more research to the UK, not only will that benefit our universities, it will create more employment.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

My honourable colleague from the Health Committee mentions pharmaceutical companies. Does she feel it is appropriate—we touched on this in the first part of the debate—that insurance companies have access to hospital data? As I said yesterday, BT now has access to our hospital patient data on the cloud systems in the United States. Does she think that those uses are concerning, and what should we do about them?

[Dr Wollaston]

That is absolutely correct and I will come to those points later in my remarks. The public did not expect to see their records uploaded to insurance companies, specifically where that resulted in higher premiums for many people.

We have a virtuous circle of improving access to data for our universities and creating high-quality jobs within the industry. If we can attract research to this country, and it is carried out among the UK population, the results from that research will be more relevant to the British population. Also, less research will be carried out in circumstances that are ethically questionable or with oversight that may not be up to the standards we expect in this country, or that sometimes exploits people in developing countries and where we cannot be sure of the accuracy and reporting of that research.

This is a virtuous circle, but I am afraid it has unfortunately been broken by the oversight and some of the arrangements that have taken place in NHS England and the Health and Social Care Information Centre. It is frankly beyond me that nobody has assumed responsibility for destroying the trust in what should have been the most exciting advance that would have benefited countless hundreds of thousands of people, not only now but in the future.

On the six-month delay, I call on the Minister to set out clearly how we will campaign to inform the public of the benefits of the proposal, but also of the risks. We have seen a rather patronising approach that has assumed the public will not notice or care about those small risks, but they are there and we must set out clearly what they are and how they will be addressed and minimised. There is much more we can do to minimise those small risks.

Of course we need transparency about past errors; the performance of NHS England and the Health and Social Care Information Centre in the Health Committee was disappointing. I am glad that on its website, NHS England has now clarified that Sir Nick Partridge, former chief executive of the Terrence Higgins Trust, will conduct an audit of all previous data releases by the NHS information centre—the predecessor body. We are also expecting the release on 2 April of all the data released by the current body. I understand that that will set out the legal basis for those releases, but also their purpose, and that goes to the heart of my amendment.

We must have clear penalties for breach, not only in the provisions in the Bill, but across the whole NHS and social care sector. The Minister will know that in practice, if somebody wants to snoop on someone’s personal medical data, there are far easier ways to do it. He will also know that the penalties are derisory. In a well-publicised case in December 2013, a finance manager at a general practice had been deliberately snooping on the records of thousands of patients within the practice, and focusing—rather disturbingly—on one young woman he had gone to school with and her family. Those were repeated breaches of her and her family’s privacy in a really toxic way. That individual was fined only £996. The public need to be clear that there will be severe penalties not only for individuals who deliberately breach privacy, but for companies. A fine of £996 for an insurance company or a large body is laughable.

[Mr Jamie Reed (Copeland) (Lab)]

The hon. Lady makes an excellent case. The maximum fine for an individual breaching the data clause in the situation she describes is £5,000. Does she agree that that is not adequate?

--- Later in debate ---

[Dr Wollaston]

I thank the shadow Minister for making the point that £5,000 is woefully inadequate. The financial penalties—significant ones on a sliding scale commensurate with the wealth of the individuals or organisations concerned—should be set out, but I believe that people should go to prison for such data breaches. Organisations should be clearly held accountable. It should be made clear to them that, should such breaches occur, requests from them will not be looked on favourably. There should be a clear penalty. Currently, those penalties simply do not exist.

How do we explain to the public the small risks and how we will address them? One significant risk has not been covered: the powers of NHS England to direct the Health and Social Care Information Centre to collect information when it is considered “necessary or expedient”. That could include full identifiable, confidential data. Will the Minister address one point on that? I have been told that NHS England has, in meetings with senior researchers, discussed the fact that, in the next releases of care data, it plans to include free text. Free text takes us into an altogether different area, so will the Minister give categorical reassurances on it? I support the principle of a default opt-in, but might not support it if the data included free text. Free text is deeply and intensely personal data and is not coded, and the public need specific reassurances on it.

[Paul Burstow (Sutton and Cheam) (LD)]

Given that the intention, as I understand it, is to create wholly anonymised data, surely the use of that contextual information creates the possibility of re-linking to an individual’s identity. The hon. Lady is right to make that point, and I hope the Minister can reassure us, but surely that is a step too far.

[Dr Wollaston]

I agree with my right hon. Friend. Free text takes us into a different territory. People say things in free text to their doctor knowing that it will not appear in a coded form.

There are other ways in which we can improve reassurance for the public. Perhaps we could pseudonymise data before they leave the practice, which would introduce another important layer of protection. That suggestion has been made to the Minister on a number of occasions.

[Barbara Keeley]

The hon. Lady was in the Chamber yesterday when I talked about the cloud systems using NHS patient data launched in the States. What disturbed me about that was that the commercial companies involved said that the data—our patient data that they were using—included clinical data, demographics, education and income. That provided a context, and the companies could link episodes throughout a patient’s life. People would be disturbed if they understood that companies charging for usage in another country had linked their data in that way and had almost a lifetime’s coverage of people’s medical records.

[Dr Wollaston]

Linking primary and secondary care data is so important, but the purpose to which it is put is at the heart of the matter. To whom are the data released? If data are uploaded to Google—27 CDs of our database—and leave the premises, we have no control over them. We could not apply in the States the controls and sanctions I have described. It is simply not good enough to be reassured that the data will not be handled by Google staff. What is to stop them accessing the data when they have gone offshore? The hon. Lady is right to make that important point.

My amendments are about improving the situation in two ways, the first of which is on the purpose of the information. Will the Minister consider adding the word “improving”? He might be concerned that, if the wording is “improving health and adult social care”, the Bill could restrict open research. I do not agree. He will know that improving the care of patients is fundamentally the purpose of research. The amendment would therefore not restrict open research. The amendment would put beyond doubt the fact that the fundamental purpose of releasing data to, for example, insurance companies or Genomics UK, is improving care. People would see that the data release is not for a fundamentally commercial purpose to benefit a commercial organisation without a necessary link to improving care for people in the UK. Those questions should be asked at every stage of the process.

It was reassuring yesterday to hear the Minister clarify that insurance companies will be specifically excluded. However, there is no reassurance in the existing wording in respect of other organisations, including, for example, the Department for Work and Pensions. We can see how the case could be made that disseminating information to the Department for Work and Pensions is for the purposes of

“the provision of health care or adult social care”

or “the promotion of health”, which is the existing wording of new clause 34. As he knows, the longer somebody is off work with, say, lower back pain, the less likely it is that they will ever return to work. The Department for Work and Pensions could argue that disseminating information is all about improving care, but in fact, the fundamental purpose might be altogether different. If the principle in the Bill is that information dissemination is clearly about “improving” care, it would focus people’s minds on the underlying purposes when they make appraisals about whether their information should be given out. That could happen without disadvantaging primary medical research access to the information—the principle of improving care would clearly be at stake. I hope the Minister considers adding the word “improving” to the Bill.

My amendment (b) would mean that there is a reassurance in the Bill on how the data are handled by the person receiving them. We have the reassurance of the confidentiality advisory group, but including a responsibility and a duty in the Bill not just for those giving out the information but for those receiving it would be helpful. I ask anyone following this debate to hold their fire and not to be distracted by those who are rather jumping on the bandwagon on this issue and seeking to undermine the fundamental principles behind care.data. Those principles are important and we could save countless hundreds of thousands of lives in the future by having good access to medical data. But it simply will not do to gloss over the very real concerns that have been expressed. We will see the same problems arising six months down the line unless those very real concerns are addressed. To those who are following the debate, I say, “Do not opt out.” Let us give the Government, NHS England and the Health and Social Care Information Centre the opportunity to address those real concerns and to put them beyond doubt. I will not opt out and I hope that others will join me.

--- Later in debate ---

[Barbara Keeley]

Indeed it is. There is a question about why CCGs have to have identifiable patient data, and there is a lot of concern about that, which my hon. Friend is right to raise.

We expressed our concerns, but they have been compounded by reports of use of data unknown to the public. The Minister was unwilling to answer the point I wanted to put to him earlier in the debate about how the HSCIC will treat organisations such as BUPA, which are insurance providers as well as providers of health and care. I hope that he will answer that question when he winds up the debate. BUPA is one example, but there are other companies that have multiple functions—some of them are straightforwardly commercial and others involve health and social care—and there is scope for confusion if those firms apply for and obtain access to the data.

The revelations we have already had show that HSCIC does not have accountability, transparency or sufficient control over releases of patient data. In our Committee inquiry, it was put to HSCIC and to NHS England that one of the ways being recommended to ensure that escapes of patient data did not happen, and to allay the fears and concerns we have expressed, was for HSCIC to run on the basis that it kept the database intact and did not download datasets outside the information centre. What it did was take in research queries and ran them. That would be much safer and that is what is done on secure systems in other places. A mechanism has been suggested and I hope it is being considered.

I appreciate the comments made by my colleague, the hon. Member for Totnes about not opting out, but a recent survey of 400 GPs found that 40% intend to opt out of the scheme because of a lack of confidence in how the data will be shared.

[Dr Wollaston]

Does the hon. Lady agree that we have an opportunity, in the next six months, to provide reassurance on some of these real concerns? Does she share my hope that GPs will change their position and that we should be doing everything we can, as opinion-formers, to encourage them to do so?

[Barbara Keeley]

I would like to think so, but I am not going to hold my breath. I think I am a lot more pessimistic than the hon. Lady. Indeed, we know that some GPs have been so alarmed that they want to opt their patients out of the scheme. They should be able to do that without penalty. It is up to Ministers, NHS England and HSCIC to rebuild that confidence, but they are not doing so at the moment. They seem to see what is going wrong as a communication or public relations problem. It is not a communication or PR problem; it is a very serious problem with regard to the integrity of what they are doing, and a lack of transparency and accountability. We cannot say that enough times.

--- Later in debate ---

[Jim Shannon]

Earlier I referred to Macmillan and to Cancer Research UK who, even today, are not convinced. We make these points on behalf of our constituents and the groups that lobby us.

[Dr Wollaston]

Does the hon. Gentleman agree with many commentators, including the British Medical Association, that it would help if the remit of the confidentiality advisory group could be extended from currently just looking at patient-identifiable data to looking at pseudonymised data or potentially identifiable data? That would give further reassurance that there is more oversight so that we do not see the kind of instances that many people are expressing concerns about.

[Jim Shannon]

The hon. Lady is right that the amendments would go a long way to addressing that issue. I hope that the Government take that on board.

In response to the fears expressed by many, several amendments were tabled to clarify the circumstances in which the Health and Social Care Information Centre will be able to release data. We need further clarification of the provisions concerning the dissemination of information, which suggest that the information centre may disseminate it only if it considers that doing so would be for the purposes of the provision of health care and adult social care. Clarification is needed for those charities that have contacted many of us in the Chamber. Cancer Research UK, among other worthy causes, would like reassurance that access to data for research is included on the

“provision of health care and adult social care”

and that access to research data will not be restricted on the basis of the amendment. That is the reason I support the proposals.

Cancer Research UK has said that it particularly welcomes the Government’s inclusion of proposals that would give the Health Research Authority the ability to accept guidance on how the governance of particular research should be handled by the NHS trusts and their duty to adhere to it. These proposals were added following calls from Cancer Research UK and the medical research sector, and were supported by many parliamentarians during the pre-legislative scrutiny of the Bill of which I, with others, was a part.

Governance continues to be the primary barrier to conducting research in the NHS. A single trial can take place across multiple trusts, so obtaining governance approvals from each participating trust, which may have different approval criteria and often duplicate checks, can cause significant delays. New clause 25 would put in the Bill the firmness, accountability and legislative control that is necessary to ensure that the leakage, for want of a better word, of information does not take place. It is important that we do that.

In conclusion, statistics indicate that by 2020 one in two people will get cancer. We had a debate in Westminster Hall this morning on cancer care; it was passionate and well thought out by many Members with personal experience of cancer in their families and their constituencies. The enormity of cancer and what it will do to society is why we have a responsibility in the House to ensure that we help. The need for research and new treatments for cancer is greater now than ever. We must ensure that while protecting people from the unsafe or mercenary use of personal information, we are not hampering the fantastic work done by these charities to discover more about cancer and to help more people win their personal battle. I support these amendments and I ask the House to do the same.

[Sarah Newton]

It is a great honour to follow the hon. Member for Strangford (Jim Shannon), who touched on an incredibly important point: we must not forget the people whose lives have already been transformed by research organisations’ access to data to find cures and prevention for diseases such as cancer. There cannot be anyone in the House who has not been touched by cancer, personally or within their families. It is incumbent on us all to do everything we can to create the right ecosystem and regulatory environment to enable research that will have a life-saving and transformative effect for people.

[Dr Wollaston]

Does my hon. Friend agree that early diagnosis is one the keys to improving cancer outcomes? By linking GP records to hospital records we can identify which practices were not referring early enough and help to improve that practice.

[Sarah Newton]

That is a very important point. Without the sharing of data, such patterns would not occur and we would have the much-talked-about postcode lottery whereby someone’s ability to get timed referrals and access to the best quality care depends on where they live and who their GP is.

I have the great pleasure and privilege of serving on the Science and Technology Committee. We have recently undertaken an inquiry into the regulatory framework for research into all sorts of diseases, including cancer. A very important finding of the inquiry was the essential role of sharing data. It is incredibly important that we come up with the right structures and protections to enable people, and GPs, to have confidence to enable the sharing of that data.

We should be very proud—we in the Chamber must not forget—of the fact that the UK leads the way in many areas of medical research; our universities, our trusts and our foundations are world leaders in what they do. That is very important in terms of our universities’ standing and important to a lot of high-quality jobs in our economy, not only for the benefit of citizens here but people all over the world. We must to do all in our power to maintain a system that enables money to be invested in research at our universities.

--- Later in debate ---

[Mr Dorrell]

I am not going to comment on whether the free text data should or should not be part of the system, or on whether the safeguards are adequate. However, I agree with the hon. Lady absolutely that the one sure way of undermining public confidence in safeguards is to change those safeguards every five minutes according to whichever witness we are listening to.

[Dr Wollaston]

My right hon. Friend made the point that the programme is for the benefit of patients. Does he agree that it would reassure people if we made it crystal clear that it was about improving care and not about systems?

[Mr Dorrell]

My hon. Friend is right, as she always is on these issues. This is about improving the care that is delivered to patients.

Getting away from the debate about data, I want to make my final point. We are repeatedly told that the system is too fragmented and has not taken advantage of the opportunities created by the proper gathering and manipulation of data—as other sectors of the economy have done—in order to reshape services around the needs of consumers. That is the opportunity that the proper handling of data provides, and it is hugely in the interests of patients that we ensure that we take that opportunity. We must take it, but we must do so with proper safeguards.

--- Later in debate ---

[Dr Poulter]

As the hon. Gentleman will be aware, under the 2012 Act, NHS England has responsibility for much of the operational day-to-day performance of the NHS, and NHS England has accepted responsibility for the fact that it did not communicate some of the information about care.data in the best way. But I hope that by referring the House to the safeguards we have in the 2012 Act and the additional safeguards we are putting in place through our Government amendments, we can reassure hon. Members that data will be used for the benefit of the health and care system, and for the promotion of health.

I wish now to deal with some of the good points raised in the debate and I hope to bring further reassurance to hon. Members. My hon. Friend the Member for Totnes (Dr Wollaston) rightly asked about an issue that came up recently in the Health Committee: whether data would be allowed to be passed on to the Department for Work and Pensions. The overriding purpose of any release to the DWP could not conceivably be the provision of health care or adult social care in England or the promotion of health so, no, that could not happen under the 2012 Act or under the provisions we have introduced today.

My hon. Friend also raised issues relating to the HSCIC and free text. As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, it was outlined in the Health Committee evidence sessions that the use of free text had been examined and had, in effect, been ruled out—I hope that my recollection is correct on that. To give further reassurance, may I say that the HSCIC made it clear that the General Practice Extraction Service that we have in place to support the extraction of the data from those GP systems for care.data has taken great care to ensure that we extract only the coded information in those records, not the free text notes, which patients may well have shared during consultations with their GPs? In addition, a number of explicit conditions were excluded from those extractions, including issues relating to HIV/AIDS; sexually transmitted infections; termination of pregnancy; in vitro fertilisation treatment; complaints; convictions; imprisonment; and abuse by others. Clear safeguards and reassurances have been established on those issues, and I hope that reassures my hon. Friend further.

[Dr Wollaston]

Will the Minister confirm that there is no way that free text will be uploaded, either now or in the future?

[Dr Poulter]

As things stand at the moment, free text is not going to be used. That is the reassurance given by the HSCIC; it clearly does not envisage that text being used and it has given reassurances on that. That is reassuring for me and I hope it is reassuring to my hon. Friend. There are those additional safeguards in place, particularly for vulnerable patient groups, to make sure that more personal data about convictions, imprisonment and abuse by others will not be collected by the information centre.

--- Later in debate ---

[Mr Speaker]

Order. I was going to call the hon. Member for Totnes (Dr Wollaston), as she had applied to speak in the Third Reading debate, but if she does not wish to speak, I will call the right hon. Member for Charnwood (Mr Dorrell) instead. Does the hon. Lady wish to catch my eye?

[Dr Wollaston]

indicated assent.

[Mr Speaker]

I call Dr Sarah Wollaston.

[Dr Wollaston]

Thank you, Mr Speaker.

I congratulate the Secretary of State on this groundbreaking Bill. It is disappointing that there has been such a curmudgeonly response to it. Some important concessions and improvements to the Bill have been made during its passage through the House, and it has been a great pleasure to serve on it throughout the entire process, starting with the Committee on the draft Bill. At every stage, the Government have listened to the concerns and made improvements.

There is just one small element that I would like to draw to the Secretary of State’s attention. There has been a step change on the issue of open data. For the first time, there has been recognition of the need not only to publish data but to disseminate the findings of the research involved. That has been an important concession in relation to part 3 of the Bill. We have also heard today about the improvements to the clauses on care.data, and I would like to ask anyone following the debate on that subject to bear in mind that their health, and the health of their children and families, will be improved if we see a commitment to improving access to health data. Let us keep that in focus. We must ensure that we listen to the very real concerns that are being expressed, but please do not opt out of care.data. Let us move forward with this exciting project and with the commitment to research that we have seen throughout the passage of the Bill.

Care Bill [Lords]

Sarah Wollaston Excerpts

Monday 10th March 2014 Commons Chamber

[Barbara Keeley]

In introducing new clause 3, the right hon. Member for Sutton and Cheam (Paul Burstow) said how he felt that the NHS institutionally must change to identify and support carers. Of course I agree with that. My hon. Friend the Member for Leicester West (Liz Kendall) introduced new clauses 19, 20 and 21. She mentioned my private Member’s Bill, which I feel is having its last outing today in these new clauses; it proposed measures on the identification of carers. I want to touch on how long these issues have been around.

Eleven years ago, I completed a project on identifying and providing support for carers and co-wrote a report on that. The report made recommendations to Government, NHS bodies, GPs and their teams on how important it was to identify and support carers. That project mapped 36 primary care support initiatives for carers run by the Princess Royal Trust for Carers. We are talking about a long time ago. We felt that the role of carers, including their contribution to the work of the NHS, had generally been under-recognised and under-valued.

Through the 1990s, to the point where I wrote that report, we had carers assessments following the excellent Carers (Recognition and Services) Act 1995, introduced by Malcolm Wicks. That was strengthened by the Carers and Disabled Children Act 2000, which enhanced the carer’s right to an assessment. We even had in 1999 standard 6 of the national service framework for mental health, which said:

“all individuals who provide regular and substantive care for a person on the Care Programme Approach should have an assessment of their caring, physical and mental health needs, repeated on at least an annual basis”.

Even at that point, the Department of Health said that the implementation of the carers’ right to an assessment four years in was

“patchy. Assessments are not always carried out. Some carers are offered very sensitive practical and emotional support. But others receive very little, or no help”.

Fast-forward 15 years to the Care Bill, and carers are still in a similar situation. The identification of carers and referring them to sources of advice and support is still not happening on an adequate scale, and we have had all that legislation and good practice. Carers UK has told us that two thirds of carers that it surveyed said that, although their GP knew they had caring responsibilities, their GP did not give them any extra help. We have heard examples of what that can mean.

Carers week is in June, and we look forward to that. We know that in that week we meet carers at events. There is a common theme: they tell us repeatedly they are not getting advice and information to help them care. They can be carers of people with cancer, carers for people with terminal illness, carers of people with Parkinson’s or of people with dementia. Does the Minister want to start changing that for carers week this year? Does he want to go along to carers week events and have carers start to say to him, “I have been identified by my GP and my GP does recognise my caring role”? I hope he does, because I have heard so many people say how much it would have meant to them and what a difference it would have made to their caring if their GP had recognised it.

Even for conditions such as Parkinson’s, only one in 10 carers has been offered an assessment. These are people who are caring very often more than 50 hours a week, and, as a disease such as Parkinson’s progresses, up to 24 hours a day. They and the people caring for somebody who has had a stroke or who has dementia are the people who really need advice, support and breaks. These are the reasons we must support new clauses 3, 19, 20 and 21.

The Care Bill puts great emphasis on carers assessments rather than on the identification of carers, and I introduced a private Member’s Bill on that in September 2012. The clauses in that Bill, which we see again today, would have ensured that NHS bodies had procedures in place to identify carers and to promote their health and well-being and ensure they receive information and advice. I believe the key reason in identifying carers should be because we have a concern for their health, particularly those with the heaviest caring commitments. That is one in five of all carers, and that is more than 1 million people, which is just too many.

Those caring for more than 50 hours a week are twice as likely to suffer ill health, particularly those caring for a person with dementia or stroke. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) has just talked to us meaningfully and movingly about the impact of that caring role on her family. We want early identification and support for those carers so they can maintain their health and manage and sustain their caring role. I agree with my right hon. Friend that they should be fast-tracked for appointments. As hopefully we move towards integration and, beyond that, whole-person care, local authorities cannot be expected to act alone to identify and support carers.

As has been touched on in this debate, we also have to face the fact that the number of people receiving social care services is shrinking. In Salford this year, because of budget cuts, 1,000 people are going to lose their eligibility for social care services and 400 people who would have become eligible for care will not become eligible. The unpaid carers in those families will be taking on that substantial burden, yet, sadly, the GPs and doctors around them will not identify them, will not help them, will not make sure they get advice and support.

This Care Bill is the place to make the change, and I say to the Minister let us not wait another 15 years to make the change and place such a requirement on health bodies—and schools, universities, colleges and further education colleges in the case of young and student carers. Let them just have policies in place to identify carers and to provide support for them.

[Dr Sarah Wollaston (Totnes) (Con)]

I would like to speak briefly to new clauses 1, 26 and 9. I hope new clause 1 on the adult safeguarding access orders would rarely ever be necessary because, as the Minister knows, the vast majority of carers are out there day in, day out, night after night providing dedicated care, often at the expense of their own health. There is a tiny minority of people, however—and I am afraid I have met some of them—who are coercive, controlling and manipulative, particularly if there is money at stake. At the moment there is no right of entry even if other relatives or neighbours and friends have raised concerns, and even if clinicians have concerns. Of course in most cases a negotiation can take place and access can be gained, but very often that access is only with a rather controlling person in the room as well, and it can be very difficult to make a full assessment of capacity under those circumstances, as I am sure the Minister is aware. There are people who are at risk. We know that 29 local authorities have identified that there have been vulnerable adults for whom they have been unable to gain access.

New clause 1 is about stating that there needs to be a final backstop in circumstances where it is clear that the safeguarding of a vulnerable adult at risk is paramount. I know there are those who say we already have right of access under the Police and Criminal Evidence Act 1984, but unfortunately the bar is set too high and there is uncertainty about the ability to gain access. New clause 1 sets out very clearly the thresholds, and also the safeguards, because this is not about riding roughshod over individuals who do not wish to have a social worker entering their home. Instead it is about setting out the rights of an individual who may be under the control of a coercive third party. We need to have greater clarity and I hope the Minister will consider this new clause. Having a final backstop works well in Scotland; it is very rarely used but we need to have it in place as a final resort.

--- Later in debate ---

[Mr David Burrowes (Enfield, Southgate) (Con)]

I, too, have had experience of being in a police station, as a duty solicitor in my case, and therefore have seen for myself that the very last place these most vulnerable of people should be is a police station. Given that the Government have made commitments—indeed, financial commitments—on a diversion service, to ensure that the principle of diverting these vulnerable people is recognised, surely the next step is to support the principle of my hon. Friend’s new clause?

[Dr Wollaston]

I thank my hon. Friend for those comments and I welcome the mental health crisis care concordat, and what is being done to emphasise that prevention is by far the best way forward, but even with those prevention measures in place I think we would all accept there will still be circumstances where people will reach crisis, and unfortunately a police station is absolutely the last place anyone, let alone a child, would wish to be in crisis. In Devon and Cornwall alone, 27 children last year were taken to police cells for long periods of time. On three occasions those children were as young as 12 and 13. That is simply unacceptable. One of the reasons it is likely to continue is that there is no penalty currently for the NHS in continuing to use such facilities. It does not have to pick up any of the financial tab. That is putting enormous pressure on our police forces. They do not wish this to happen, of course. If we cannot at least have this sunset clause, which I think is eminently sensible, I hope the Minister will consider making sure that the NHS has to pay to use the police cells, and that there is a significant financial penalty, because that would be a driver. That would make it financially much more sensible for the NHS to put in place measures for these vulnerable people—who often have been found by the police at the point where they are about to take their own lives. It cannot be acceptable for this situation to continue.

Moreover, the variation in such use of police cells is extraordinary. There are some areas where that is not used at all and others where it is very heavily relied on. I hope the Minister will say in his response that he is prepared to consider a sunset clause, or at least a financial penalty, so we see drivers in place and we continue to move away from such a practice. However, I absolutely recognise the point made by my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) that prevention is far better, and I know all areas are working towards that and that the Minister fully supports it.

New clause 9 is an extraordinary measure that is widely welcomed because of the principles to which the right hon. Member for Salford and Eccles (Hazel Blears) referred about well-being and prevention. These are at the heart of the Bill and everybody welcomes them. However, I think the Minister recognises that there could be unintended consequences if we were to introduce many new statutory obligations without their being funded fully. As he will know, we have two tests—a needs test and a means test—for people to pass in accessing social care, and 88% of needs tests are now set at a substantial level, which has been quite a considerable change. There is also the means test, which stands at £23,250. On many occasions as a GP, I remember coming across the absolute shock encountered by people when they realised that they would get no help whatever.

The change under the Bill will be extraordinarily welcome, although we should be under no doubt about the burdens that it will place on local authorities, in particular in my area. Devon has the third oldest demographic in the country, but funding of local authorities for health care does not have sufficient emphasis on the age structure of the population. There will be great impact on Torbay and on other areas in Devon, such as my constituency.

New clause 9 is a sensible measure about how we plan for the future and make an appraisal of whether we are fulfilling the important provisions in the Bill, ensuring that we have sufficient resources directed towards prevention and well-being. I hope that the Minister will see the new clause as helpful and as one that will assist us in planning for the future.

[John McDonnell (Hayes and Harlington) (Lab)]

I will speak to the amendments in my name. I share the view of the right hon. Member for Banbury (Sir Tony Baldry) that we should not have nodded the programme motion through blithely. Many of my constituents have contacted me about the Bill, because care in my area is on the edge of crisis, with the new threshold rolling it back for many people. That is why I support new clause 11; people need their human rights to be ensured in the Bill. New clause 2 is important, because we have a Children’s Commissioner and we need a commissioner for the elderly and other care services, so that there is someone to speak out for people. I support new clauses 7 and 9, because I agree that introducing legislation without funding is meaningless. We place local authorities in an impossible position, as they struggle to provide the services.

With regard to the work force, we need to ensure pay and adequate training, so that we fully professionalise the work force. In my area, we have a high turnover of care workers, which leads to distressing results. In one case, an elderly lady was burgled and on the next day a new carer came in, but she thought that she was being burgled all over again, because she did not recognise the person. That is the instability in the industry at the moment. That is why I support new clauses 17 and 18.

On the amendments in my name, new clause 31 is generated by one of my constituents called Jonathan Kay, who asked me to get the matter dealt with in the Bill. For many years, Jonathan has been funded by the local authority to employ a personal assistant to enable him to carry out his day-to-day tasks—he is a disabled person—but he has experienced serious problems with personal assistants in the past, even suffering abuse on more than one occasion. When employing personal assistants, Jonathan has found assessing the suitability of candidates extremely difficult, and he has not been able to obtain reliable recommendations from any public body, despite using public funds to employ them.

Part 3 of the Bill provides that the training and education —but no qualifications—of carers will be undertaken by Health Education England. The purpose of my new clause is for Health Education England to allow scope for the local education and training boards to do such work and to compile, publish and maintain a register of all persons who provide regulated social care for individuals under arrangements made by or paid for by a public authority. That would allow people such as Jonathan to access a list of trained professionals whom they can employ with confidence, we hope, in future.

With amendment 26, I am simply seeking to install into the Bill a provision on the right to live independently, as recommended by the Joint Committee on Human Rights, but dismissed by the Government. The Government might well have been concerned about the legal actions that were taking place with regard to the independent living fund, but the Committee’s report made its disappointment very clear that the Government had not taken the opportunity of the Bill to be explicit about their support for the convention on the rights of people with disabilities and article 19—“Living independently and being included in the community”—being a human right. It should therefore be included in the Bill. The Government have given assurances that the general direction of the Bill might achieve the same ends, but that is not good enough in that it does not enforce the rights in law.

My amendment 21 covers the same ground as new clause 15, so I will not dwell on it in any depth, but I will give an example. Whether with our parents or in our community, we all know about the uncertainty of charges for residential care. They cause real concern and anxiety among families. Yes, the ability of local authorities to negotiate rates influences the overall market, but that is why there is a need for some form of indicative price. A care funding calculator is used to set the care of people with learning difficulties, and that model has worked and saved public funds. We should at least be considering in the Bill that sort of process for care overall.

My proposals in amendment 20 would

“require the local authority, when carrying out the assessment, to capture an individual’s main and other disabling conditions”.

A whole group of organisations, including the Parkinson’s Disease Society, Sue Ryder, the Motor Neurone Disease Association, the Multiple Sclerosis Society, the Epilepsy Society, the Neurological Alliance and the Alzheimer’s Society, have all campaigned for this simple change in the assessment process, which merely requires local authorities to collect and record information about an individual’s main and other disabling conditions when they are conducting their social care assessments and arranging care packages. Why is that important? It is important for local authorities to be aware of the different conditions in their community, so that they can plan long-term services, but it is also important for us to be aware of the information nationally, so that care services and our investment can be planned in the long term. Taking that into account seems to be a minor amendment.

Amendment 22, which I also tabled, was proposed by the Royal National Institute of Blind People and lobbied for by a number of my constituents. In clause 76, the duty is placed on the local authority to establish

“a register of sight-impaired and severely sight-impaired adults who are ordinarily resident in its area.”

The existing provision relates only to adults and does not include children. My amendment simply ensures that the local authority is required to collect information on both adults and children. The reason for this is that, under the Children Act 1989, there is a requirement on local authorities to collect information with regard to blind and partially sighted children, but 20% of local authorities admitted failing to meet that legal requirement. Furthermore, 20% of local authorities have no register; three councils include just 1% of disabled children known to the authority on the registers; one in four authorities have whole registers with fewer than 2% of disabled children known to the council; and almost six in 10 councils include 10% or fewer of the disabled children. The RNIB therefore emphasises that in clause 76 we should place on local authorities a duty, when collecting information, to include children ordinarily resident in their area. Again it is the same mechanism; it is about the planning of services to ensure that they are properly invested in over the long term.

Overall, I welcome the Bill, but I fear that it will disappoint many as a result of the failure to address some of the considerable issues with regard to funding, rewards to the work force and professional training, and the appropriateness of the cap on costs.

Patient Medical Records

Sarah Wollaston Excerpts

Tuesday 4th March 2014 Westminster Hall

[Mr Roger Godsiff (Birmingham, Hall Green) (Lab)]

It is always a great pleasure to serve under your chairmanship, Mr Weir, and I welcome the opportunity to make a contribution to today’s debate on how our health service can use patient data to improve health care.

Using data collected by the NHS to improve patient care sounds like a wonderful idea and it should be something that we can all support. However, almost nobody in the country, apart from NHS England, the Department of Health and companies with a commercial interest in the area, support what has been proposed. The scheme, which had the chance to bring about huge benefits for patients, has suffered from a complete failure to listen to either patients or doctors. The bottom line is that people simply do not want their medical data to be sold to the private sector or used for profit-making activities, and no amount of awareness raising or leafleting will change that.

I want to ensure that we have a consent-based model for using patient data that patients are happy with and have confidence in. Patients’ opinions should be used to inform the way in which care.data works and not trampled over in the hurry to extract data. Patients matter, but we have heard no apology to all those who were not properly informed about care.data and whose confidential data would have been extracted without their knowledge if there had not been this hastily arranged delay. Why, I ask, have we had no apology to the in-patients who did not receive the leaflet, those with learning difficulties or visual impairments who could not read or understand it, and those whose first language is not English, or to the elderly, sick and infirm, who could not get to their GPs to discuss the scheme?

[Dr Sarah Wollaston (Totnes) (Con)]

I fully support the principles behind care.data, but I think we need balance here. Does the hon. Gentleman accept that no patients were informed at all about the fact that their hospital episode statistics data were being released under the previous Administration, and they had no opportunity either to opt in or opt out?

[Mr Godsiff]

I certainly accept that, and I know that the hon. Lady has already raised that with the Government. I think the Government gave an answer, then had to apologise for the answer they gave and had to correct it.

[Dr Wollaston]

I was referring to the Labour Government.

[Mr Godsiff]

Well, there is not a Labour Minister responding at this time; there is a Minister from the Department of Health, which is peopled by members of the coalition Government.

Let me make it clear: this is not an argument between people who are in favour of research and those who are against it. Of course, we all want to facilitate life-saving medical research, but I want to do so without damaging patient confidentiality or public confidence in the NHS. We now have another chance to get this right, and we have six months in which to do that.

--- Later in debate ---

[Dr Poulter]

I am not going to give way because of the time. I have not said anything controversial; I am just reiterating the fact that a lot of the issues that have arisen today were discussed at great length during scrutiny of that Bill. The hon. Gentleman will recall that as he made many interventions and speeches in Committee.

We need to highlight the importance of this issue. We must ensure that we have the right data and the right processes in the NHS to inform good care. It is about ensuring that we have the data to improve research, to drive better integration and, in the wake of the Mid Staffs scandal and the Francis inquiry, to ensure transparency in protecting patient confidentiality and in the quality of care provided by health care providers so that we can ensure that high quality care is provided throughout the NHS and that its quality is properly scrutinised. We must learn from examples of good care, and where, by comparison and other standards, care is not good it should be transparently exposed.

There are important research benefits, too. We know that if we want to combat disease, address some of the challenges that we face in the health system and improve our knowledge of diseases from cancer to heart disease, we need to have the right information. We have to ensure that we collect data and information to improve patient care, which is the heart of everything we are talking about today. As long as we do that—I believe that we have the right safeguards in place through the 2012 Act and through the further clarifications and reassurances provided by the amendments to the Care Bill that have been tabled for next week—we are in the right place to deliver improved transparency and care quality while ensuring that we protect patient confidentiality, in which we all believe.

[Dr Wollaston]

I am passionate about the principles of care, data, and I will not be opting out because of the benefits that the Minister and many others have outlined. He mentions the Francis report, and one of its fundamental principles was that people should be open and transparent about past errors and take account of genuine concerns. I am concerned that what we are hearing from the Health & Social Care Information Centre is very defensive. There is a complete refusal to be transparent about errors; it is blaming everything on a previous body. Many members of those two bodies are the same, so for us to proceed with confidence those legitimate concerns must be addressed.

[Dr Poulter]

My hon. Friend makes an important point. It is also important to highlight that sections 263 to 265 of the 2012 Act put much stronger safeguards in place. Those sections state that processes must be in place in the Health & Social Care Information Centre to ensure confidentiality and to ensure that data are always handled in the right way. The body is responsible for ensuring that those processes are kept up to date and that there are accountability frameworks for those processes. That important step forward was not in place for the previous body.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 25th February 2014 Commons Chamber

[Mr Hunt]

It is a pleasure—I think for the first time—to take a question from someone who might be one of my constituents in Godalming. However, I do not agree with the hon. Gentleman that the process has been shambolic. The programme has been in place for 25 years, so it is important to understand that this big public debate is happening because this Government did something that the previous Government did not do: we said that if we are going to use anonymised data for the benefit of scientific discovery in the NHS, people should have the right to opt out. We introduced that right and sent a leaflet to every house in the country, and it is important that we have the debate—[Interruption.] The right hon. Member for Leigh (Andy Burnham) complains, but he did not want to give people the right to opt out when he was Health Secretary.

[Dr Sarah Wollaston (Totnes) (Con)]

The Secretary of State will be aware of the report in The Daily Telegraph setting out how hospital episode statistics data were sold to insurance companies, which were able to match that information with credit ratings data. Nothing will undermine this valuable project more than a belief that data will be sold to insurance companies, so will he set out the way in which he will investigate how that sale was allowed to happen and categorically reassure the House that there will be no sale of care data to insurance companies?

[Mr Hunt]

My hon. Friend is absolutely right to raise that issue and I am happy to give that assurance. That incident is one of the reasons why we set up the Health and Social Care Information Centre through the Health and Social Care Act 2012, in the teeth of opposition from the Labour party. Following the establishment of the centre, the guidelines in place mean that such a thing could not happen. She is also right that it is important that we reassure the public because, let us not forget, it was this important programme that identified the link between thalidomide and birth defects, that identified that there was no link between MMR and autism, and that helped to identify the link between smoking and cancer, so it is vital that we get this right.

Care Bill [Lords]

Sarah Wollaston Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

I could not agree more. I would guess that disabled people listening to the debate today will be very worried about what they are hearing. The change will restrict support for them, and it is a false economy. If they cannot go out to work, how on earth does that help them or, indeed, anybody? The change will have an impact on disabled people, with some losing their support.

I was going on to make the point that disabled people and older people are already paying much more for care as a result of changes in recent years. As research by my hon. Friend the Member for Leicester West (Liz Kendall) has shown, they are paying almost £740 more a year for vital home case services compared with 2010, up on average by almost £50 a month. That is a hidden cost of living crisis, because who sees that older people have to pay more out of their bank accounts? It goes unnoticed by the media and large parts of society, but the most vulnerable people in society are bearing the brunt.

[Dr Sarah Wollaston (Totnes) (Con)]

I am glad that the right hon. Gentleman has mentioned older people. Does he accept that although health inequalities are very important in setting funding formulas, age is one of the greatest predictors for establishing need? It is absolutely vital to include such factors as age and rurality in deciding funding formulas, and it is precisely to remove the politicisation of such decisions that we are handing them over to another body.

[Andy Burnham]

The hon. Lady must have misunderstood me. I am not saying that age is unimportant; I am saying that age is important, but so is need. In my view, those two must have equal weighting in the system, as they do at the moment. As I understand it, the proposal is to deprioritise need or deprivation as part of the funding formula, which will have the effect of removing funding from communities in which the expectancy for a healthy life is already shortest. I do not believe that that is defensible, and I would be surprised if she found that it was.

[Dr Wollaston]

Will the right hon. Gentleman give way?

[Andy Burnham]

I shall do so once more, but then I must make some progress.

[Dr Wollaston]

The right hon. Gentleman is being generous in giving way. The point is that we are discussing the Care Bill and how need relating to age is the single greatest predictor of someone’s need. I accept that health inequality is a very important factor, but the formula currently does not take enough note of age-based need and multiple long-term conditions.

[Andy Burnham]

I am not sure that I agree with the hon. Lady. Some older people in my constituency probably do not have as good a quality of life in later life as some in her area, because there are ex-miners with chronic obstructive pulmonary disease and other things, who have very extensive needs caused by the dangers they were exposed to during their working life, and that places a burden on our health service. Of course, people are more likely to be living with chronic disease in more deprived areas, and both those things have to be recognised in the funding formula. If the change goes ahead, it will cause great volatility and move a lot of money around the system, but it will not allow areas such as the one I represent to invest in the home-based, high-quality, integrated services that the Secretary of State said he wanted.

To return to the costs of care charged by councils, let us call the hikes in charges what they are—stealthy dementia taxes that seek out the most vulnerable people in our society. The more vulnerable someone is and the greater their need, the more they pay. People who are paying more for care under the current Government and often receiving a worse service will not be convinced by the Secretary of State’s claims for his Bill today. It will feel like a con, and that feeling will only intensify when people understand more about the proposed cap.

Although we welcome the principle of a cap, this one is not what it seems. It is set at £72,000, despite Dilnot warning that a cap above £50,000 would not provide adequate protection for people with low incomes and low wealth. The Health Secretary has repeatedly said that people will not have to pay more than £72,000 for care.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Sefton Central (Bill Esterson), who speaks so compellingly about his family’s experiences and sets out the case for why we must get social care right.

I welcome the Bill. It was a pleasure to serve on the Joint Committee on the Draft Care and Support Bill and I think the legislation has been greatly improved by its passage through that Committee and through the House of Lords. It establishes that we need a social care system that works around the needs of individuals, as well as the well-being principle and the vital prevention principle set out so compellingly by the hon. Member for Sefton Central. The Bill also consolidates a confusing patchwork of legislation that I remember coming up against in my time in the NHS. People were not sure what their eligibility was, and they could move from one part of the country to another and find that they no longer qualified in the way that they used to.

There are many things to welcome in the Bill. The hon. Member for Lewisham East (Heidi Alexander) compellingly set out the effect of losing everything in the ghastly lottery of eligibility. Setting a cap on costs and raising the threshold from that paltry £23,250 to £100,000 is very welcome. So too is the focus on better information, advice and advocacy, and the assessment and better support for carers. My hon. Friend the Member for South Swindon (Mr Buckland) made some important points about child carers and the transition from children’s services to adult services.

There is a huge amount to welcome in the Bill and I could talk for 10 minutes on why all these aspects are important. Unfortunately, we also need to focus on the challenges. The predominant challenge is demographic. Nationally 2.2% of the population are over 85, but in my constituency we got there 31 years ago. By 2020-21 2.9% of the population will be over 85, but for Torbay that figure will be 4.9%. That represents an enormous demographic challenge. We were discussing with the right hon. Member for Leigh (Andy Burnham) the reasons why age is so important in assessing need. Because of their demographics, places such as Torbay and wider south Devon face additional challenges with rurality, which means that they are under pressure like never before. Although I fully understand that we must take into account deprivation and health inequalities, unless we take sufficient account of age and need in assessing the formulae, the system will collapse.

I should point out that Torbay is not only nationally renowned but internationally renowned. As a member of the Health Committee, when we visited Copenhagen and Sweden, I ended up being shown slides of Torbay—how Torbay organises health and social care. If we look at the challenges facing Torbay, we see that it was those demographic and financial challenges that were the driver for looking at how health and social care could be better integrated and—I refer to the experience of the hon. Member for Sefton Central—how avoidable admissions could be reduced. Enormous progress has been made. Waiting times for occupational therapy have been reduced from two weeks to two days, for physiotherapy from eight weeks to 48 hours, and for urgent equipment to help keep people at home from four weeks to four hours. As a result, Torbay has the lowest hospital admission rate for elderly vulnerable people in the whole of the south-west.

[Norman Lamb]

I am grateful to my hon. Friend for giving way. Does she share with me the excitement at the plan for Torbay as a pioneer to bring mental health back into primary care, properly to integrate that part of patient care? We have seen in other places that this can do an enormous amount to prevent a deterioration of health.

[Dr Wollaston]

Absolutely. I welcome the fact that Torbay will be part of one of the integrated care pilots, and particularly that focus on mental health, as my hon. Friend says.

Services in Torbay have been transformed through the use of care co-ordinators, so that only one phone call is necessary. There has been transformational work in sharing information and records and in rapid response to a crisis and putting prevention in place. The challenge that Torbay now faces is financial. Unfortunately, the elastic can stretch only so far before it snaps. Torbay’s funding is set to fall from £71.2 million this financial year to £63.6 million in 2014-15. Those cuts are in addition to the demographic challenges, the challenging situation in relation to children’s services, and the fact that we know that across the country 2015 is set to be a crunch year for NHS funding.

I welcome the £3.8 billion transfer for better care. We heard in the draft Bill Committee and in the Select Committee how such joint funding arrangements are the best driver to integration. A formula for integration cannot be dictated. What works for central London or central Manchester will be very different from what works in south Devon and in rural areas, but the fund will force people to work better together in a way that fits their area. That is very welcome.

[Bill Esterson]

Would the hon. Lady advocate a single service, and has she any thoughts on how that would operate? I am interested to hear her views.

[Dr Wollaston]

Indeed. It operates very well already in Torbay, but it cannot be dictated centrally. We need to get the hurdles out of the way, allow people to work together locally and facilitate that. We heard on the draft Bill Committee that joint funding streams were the best way to move that forward.

Unfortunately, in Torbay in the crunch year 2015 we will see the funding drop below 90% of projected expenditure. At that point, rather than driving further integration, it will cause systems to start to fall apart because people need to protect their own silos. That is a real danger. As the Bill proceeds to Committee, I hope we look very carefully at the effect of the funding gap and make sure that we are not setting a system up to fail. One of the problems with the Bill is that it sets up many new statutory responsibilities. Councils will have to fund care accounts, which will undoubtedly be complex, bureaucratic and subject to challenge. Councils will have responsibilities for carers’ assessments. There will be increasing numbers of eligible people as the thresholds and caps change. We will see safeguarding adults boards, more rights to information and advocacy, and for many, deferred payments, if they have not already been making those.

Once we create these additional statutory responsibilities, there will be less money to go around for the very things that are at heart of the well-being and prevention principle. That is what concerns me. Would it not be a tragedy if we set up carers’ assessments but there was no funding left for services to respond to needs? Voluntary organisations in my community can function incredibly efficiently on very little money. They do not need to be fully funded, but they need some funding. If that money dries up, I worry about how we will move forward with a genuine well-being and prevention principle.

I want the Bill to succeed. In the remaining minutes I shall touch on those aspects that I think are, sadly, still missing, which were recommended by the draft Bill Committee. One is how we calculate care costs according to their actual cost, not the cost to the council. For a person living in their own accommodation, it sometimes costs a great deal more to access support than it would cost a council to provide it. We need to look at that again.

There is a small but important area relating to powers of entry in exceptional circumstances for those who are subject to abuse in their own home. It would be wrong for us to ignore that possibility. Although the overwhelming majority of carers of course do a wonderful job in challenging circumstances, there are occasions, sadly, when people can be at risk from those who love them. Very often that is as a result of the intensely challenging circumstances that carers face. We need to reserve a power of entry in exceptional circumstances where there are very serious concerns about individuals who may be vulnerable and unable to communicate easily.

Another issue is free social care at the end of life. We know that 73% of people would like to be able to die at home. In my experience working as a GP in rural areas, where that broke down for most people was as a result of a lack of social care, and the challenge of caring for somebody right at the end of their life, when they may, for example, be doubly incontinent. Until people are in that situation, they may not understand how incredibly demanding it is to have to be with someone 24 hours a day, trying to stay awake and provide the intensive support they need. Allowing everybody to access free social care in those terrible final days would be a very important step forward.

Finally, the duty of candour we have introduced for foundation trusts is welcome, but I think that it should be extended to social care.

[Norman Lamb]

It will be.

[Dr Wollaston]

I thank the Minister for that clarification. Also, an offence of wilful neglect already exists with regard to adults who lack capacity, but I would like the Minister to consider extending it with regard to those who have capacity.

We heard earlier about reconfiguration. We need to streamline reconfiguration processes. It is not right that the NHS’s valuable resources should be spent on long, drawn-out and expensive legal challenges. We know that in many cases we need to reconfigure in people’s best interests. Let us take out the party politics and get it right. Let us ensure that people have the right care and that we face the financial challenges in the NHS in a mature fashion.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 26th November 2013 Commons Chamber

[Dr Poulter]

My right hon. Friend raises important issues. I should like to pay tribute to the work that he did in expanding children’s talking therapies and IAPT—improving access to psychological therapies—services to make better provision for mental health support. He is right to highlight, as the CMO did, the fact that we do not have enough data on children’s mental health. That has been a historical problem, and we are looking at ways to improve the data so that we can use them to improve health outcomes in mental as well as physical health.

[Dr Sarah Wollaston (Totnes) (Con)]

In Devon and Cornwall since the beginning of this year there have been three occasions when children as young as 12 and 13 with acute mental illness have been detained in police cells instead of an appropriate place of safety, and 25 occasions when children of 17 and under have been so detained. Will the Minister meet me to discuss how we can end this appalling situation and make sure that all children who are detained under section 136 are seen in an appropriate location?

[Dr Poulter]

My hon. Friend is right to highlight this problem, which is unacceptable. My hon. Friend the Minister of State is looking into it. A lot of anecdotal evidence is stacking up that this practice is happening. We do not find it acceptable, and I or my hon. Friend will be happy to meet her to discuss the matter further and ensure that it is stopped.

Mid Staffordshire NHS Foundation Trust

Sarah Wollaston Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

As the hon. Lady knows, we are going through a process at the moment and the trust special administrator is drawing up detailed plans, so it is premature to say what will happen, but we will of course keep the House well informed and there will be plenty of opportunities for her to question me, or anyone else she wants to question, about any decisions that are eventually made.

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the Secretary of State’s statement, which will help health professionals to get on with their jobs and improve openness and transparency across the NHS. I particularly welcome his recognition of the important role played by the 1.3 million health care assistants across health and social care. In implementing the vetting and barring scheme, will he ensure that individuals looking after people at home or in outside institutions can access that list to ensure that they have health care assistants who comply with the fundamental standards?

[Mr Hunt]

That is a very good point. I will take it away and look at whether that will be possible, because there is a powerful logic behind making that happen. As my hon. Friend has mentioned health care assistants, I would like to highlight the brilliant work they do, along with so many NHS staff. It has been a very challenging year for them to read about these examples of poor care, which are as shocking to them as they are to us. I agree that now is the time to get behind the people on the front line, who really want to change the culture for the better.

Tobacco Packaging

Sarah Wollaston Excerpts

Thursday 7th November 2013 Commons Chamber

[Bob Blackman]

The issue for us is that we want to remove the last aspects of advertising that are available to the tobacco industry. At the moment, there is still an attractive promotional aspect of tobacco, which is the packaging. We want all tobacco packs to be uniform, including the colour of the pack, and to allow the promotion of strong anti-smoking and pro-health messages. Evidence is emerging from Australia, but other parts of the globe are going ahead with standardisation of packaging, including Ireland.

[Dr Sarah Wollaston (Totnes) (Con)]

My hon. Friend is making a powerful point. Does he agree that use of the term “standard packaging” or “plain packaging” is a misnomer? We should be calling it “stark-staring truth packaging”. What it means is that we are handing someone a packet with a picture of gangrene. It is actually a crystal ball, and it counteracts the very powerful subliminal messages and the last legal form of tobacco marketing in this country.

[Bob Blackman]

The fact is that smoking is a lethal addiction. We know that. It is the one product in service in the world where, if used in the way it is intended, will lead directly to poor health and possibly death. Across England, 80,000 people a year die from smoking-related diseases. There are more premature deaths from smoking than from obesity, alcohol, illegal drug use and AIDS put together. It is the biggest single killer. In the long run, if we can get a fall of just one percentage point in smoking prevalence rates, we could save 1,800 lives per year. Who would not wish to save 1,800 lives per year? There cannot be an effective public health policy unless tobacco control is at its heart.

--- Later in debate ---

[Alex Cunningham]

I will congratulate any Government who are making the right decision on plain packaging.

I am aware that some Members fear that a fall in demand for tobacco will cost many of their constituents their jobs. I know that they will stand up and speak for the industry, but they will also be speaking for their constituents. I hope that the prospect of improved health, a smaller burden on the national health service and the protection of children will make them think again. I also hope that today’s debate will focus not on the cynical speculation that surrounds the drivers of tobacco policy and the influence that the tobacco lobbyists are able to exert, but on the decidedly positive effects that standardised packaging could bring, and the harm that is likely to result if the Government continue to insist on dragging their feet.

Reducing the prevalence of tobacco use is a key public health priority. None of us needs reminding of the consequences of smoking, which remains the leading cause of preventable mortality in the UK. Half the number of lifetime smokers will die from smoking-related diseases, which means that there may be 100,000 preventable deaths each year. One in five adults continues to smoke, and many people continue to take up the habit, including 573 children aged between 11 and 15 each and every day.

[Dr Wollaston]

Does it not strike the hon. Gentleman as strange that the Government claim to be delaying the introduction of standardised packaging because they want to wait for more evidence, but at the same time are virtually rushing into regulation to make e-cigarettes a medicinal product, although there is mounting evidence that, if anything, they could cause harm?

[Alex Cunningham]

I agree that we also need to look into the issues surrounding the smoking of electronic cigarettes.

The Government should be acting on this matter. The evidence has already been presented to the House today. It is unquestionable that we need to take action now, and save children and young people from an addictive habit that will devastate their lives.

As I have said many times before, while I disagreed with the former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley), about a number of issues, I believe that the best thing he ever said was that he wanted the tobacco industry to have “no business” in the UK. I hope that the new Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), shares that goal, and will pursue it with the vigour that it deserves. I welcome her recent assertion that

“Stopping children and young people smoking is a priority for us all”.

However, actions speak louder than words.

Since the Government’s consultation closed 15 months ago, Australia has become the first country to introduce standardised packaging for tobacco products. That is already changing attitudes. Our own Government’s inaction in failing to enact measures similar to those in Australia poses a major threat to tobacco control. However, I was pleased to hear the new Under-Secretary of State tell the House during Health questions last month that

“new information ... not just from this country but from around the world… is under very active consideration.” —[Official Report, 22 October 2013; Vol. 569, c. 132.]

I should welcome her confirmation of the timetable for the completion of that consideration and the making of a definitive decision.

I have no doubt that standardised packaging for tobacco products is necessary to quell demand. Smoking is an addiction that begins in childhood, and tobacco packaging is designed to be attractive, catching the eye of young people in particular. I am aware of the damage that this horrible habit is doing to people in my constituency, young and old alike, many of whom live in some of the most deprived wards in the country. We need to take active steps to reduce the incidence of smoking, and to implement measures to prevent future uptake. The decision to delay progress with standard packaging will needlessly condemn hundreds of thousands more to a life of addiction because some think it “cool” to smoke. Plain packaging fits the bill. Not only is there a real need for it, but it is a solution that is wanted and workable.

It is worth noting that, during a Westminster Hall debate in September, the former Under-Secretary of State for Public Health, the hon. Member for Broxtowe (Anna Soubry), recounted her own experiences of tobacco addiction and its horrendous consequences. Fortunately, she was able to kick the habit. It is significant that she recalled the “power of the packet”, and spoke openly of choosing a particular brand of cigarette for her first pack

“because they were green, gorgeous and a symbol of glamour.”—[Official Report, 3 September 2013; Vol. 567, c. 23WH.]

Indeed, she made a superb case for standardised packaging as a means of preventing future uptake. I hope that that, along with evidence provided by fellow Members today, will remind the Health Secretary of the strong supporting evidence, and persuade him to delay no more. Perhaps he will even go so far as to do the right thing and give Members the right to vote on the issue, thus allowing the will of Parliament to be implemented.

The United Kingdom has previously taken a leading role in this regard, certainly in Europe. It has some of the most comprehensive tobacco control policies in the world, not least the tobacco control plan, which led to the introduction of smoke-free public places and the banning of displays on retail premises. It is clear that the current Government have recognised, at least to some degree, the raft of negative consequences that can arise from ready access to branded packaging, yet Ministers remain adamant that the evidence we have is not substantial enough, and continue to insist that non-legislative solutions are better suited to the task in hand.

There is already a wealth of evidence that standardised packaging works, and new evidence is being published all the time. A systematic review of 37 peer-reviewed studies, carried out by the university of Stirling for the Department of Health, found standard packaging to be less attractive while also improving the effectiveness of health warnings, thereby reducing smoking uptake among young people. The review also found that standardised packs were perceived as having less “clutter” to detract from the all-important health warnings, with the monotony and sincerity of the packaging serving to enhance their seriousness and believability. Since then at least 12 additional studies have been published, and the growing body of research consistently reports that standardised packaging would reduce the appeal of tobacco products and increase the effectiveness of health warnings.

Lest there be any doubt, let me add that the evidence from Australia confirms those findings. Not only do those who smoke cigarettes from standardised packs perceive their cigarettes to be of a lower quality than those from branded packs, but there is a demonstrated tendency to perceive cigarettes as less satisfying.