NHS Funding Bill

Debate between Steve Brine and Anne Marie Morris

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[Anne Marie Morris]

The hon. Lady makes a very good point—I think there are probably two points there. The first is what we should be measuring and when, and the second is about data and the privacy issue. The points are related, but separate. The first one, which is about measurement, is a point very well made. Certainly, the point at which my constituents are counted as being in the box and in need and being referred for mental health can be very far down the line from their first presentation. The figures will often not properly represent the number of people who are actually in need, so I think she is right that we need to be clear at what point we measure an individual coming into the system. I am not clear from what I have heard anecdotally that it is. Some clarity and perhaps an investigation into that would be very helpful. The hon. Lady’s point about privacy is a much broader issue, and I think it would be beyond the scope of this debate to look at it now. The point was well made, but it is a much bigger point for another day.

Through new clause 9, I am asking for an annual report that would show how mental health provision has improved. Such a report would state how we identified what we included in the mental health bucket that I mentioned; how we identified who is in need; how we measured whether that individual received an intervention, and whether any such intervention was timely; whether the individual’s condition has improved or got better; and how any improvement has been assessed, because that can be a very difficult question. I appreciate that for many individuals with mental health concerns, these are lifelong conditions. We would therefore not simply be measuring whether somebody is “cured”, but looking at the level of improvement and the extent to which the intervention has helped—or not helped—that particular individual. It is very complicated.

My new clause would require the Government to look specifically at how we are going to measure the extent to which we have been able to prevent mental health problems. Specifically, we need to start looking at the support we give in schools, to pregnant mothers and in many other situations. This provision would also require information on how we have diagnosed mental health problems. Too often in constituents’ cases, I find that it is only when a diagnosis is finally and formally made that there is any intervention or help. I have heard from a number of parents of young children and teenagers who have faced problems such as eating disorders and attempted suicide, but much to my concern and that of the parents, as no diagnosis has yet been made—because they cannot get an appointment and so on—the individual youngster who is self-harming is not yet considered to have a mental health problem. The consequence is that they do not get the support and assistance they need, so diagnosis is very important.

[Steve Brine (Winchester) (Con)]

I support what my hon. Friend is saying in her new clause about outputs. This is an issue that I tried to address—and failed, I readily admit—when I was the primary care Minister. She will be aware of the NCT’s Hidden Half campaign, which aims to improve the six-week postnatal check. Does she agree that there are opportunities for the NHS to make an intervention and assessment, but that those opportunities are currently missed? For example, we should be changing the GP contract so that when new mums go for the six-week check with their babies, they get a maternal mental health check at the same time. There are already opportunities, but we are missing them.

[Anne Marie Morris]

My hon. Friend makes an excellent point. Just like physical health checks, which are very much part of the standard GP system, mental health checks should equally be a part of the standard checks that take place when people present at surgeries. I entirely agree.

Health Technology Assessment Charges

Debate between Steve Brine and Anne Marie Morris

Tuesday 4th December 2018 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

Mr Speaker, you are remarkable for sitting here for all this time. I share the admiration for you, if not your football team after Sunday afternoon. Less said about that the better. I cannot even believe I have raised it. I know that you will have been there and will have enjoyed it. I just have to take my hat off to the 4-2 score. The return leg will come.

I am disappointed that only you, Mr Speaker, my Parliamentary Private Secretary, the Whip and my hon. Friend the Member for Newton Abbot (Anne Marie Morris), who introduced the debate, and I are here. An Adjournment debate without the hon. Member for Strangford (Jim Shannon) is a rare thing. I can only feel that he will come running in at any time.

I have been asked to reply to the debate on behalf of the Under-Secretary of State for Health, Lord O’Shaughnessy, who sits in the other place and has responsibility for this policy area. I take a keen interest in it, as he knows. My hon. Friend the Member for Newton Abbot has a keen interest in this matter, both on behalf of her constituents and in her capacity as chair of the all-party group on access to medicines and medical devices, which I know she chairs with aplomb.

The main thrust of my hon. Friend’s remarks was about the charging process the NICE has proposed, but let me reiterate to the House that the Government are committed to ensuring that patients can benefit from rapid, consistent access to effective new treatments. It is always important to say that in these debates. NICE plays a key role in this aim, through its technology appraisal and highly specialised technologies programmes. Through both programmes, NICE produces authoritative evidence-based guidance on whether drugs and other treatments should be funded by our NHS. Where NICE recommends a treatment as value for money, the NHS is required to make funding available, so that the treatment can be provided when it is clinically appropriate for a patient. That is reflected in the NHS constitution as a right to NICE-approved treatments, as it should be. Since it was established, NICE has recommended around 80% of the drugs that it has assessed. Many thousands of our constituents have benefited from access to effective new treatments as a direct result of its guidance.

Over almost 20 years, NICE has gained a firm reputation as a world leader in its field, and I was pleased to hear my hon. Friend talk about us wanting more NICE. When I travel around—at the G20 last month, for instance—and talk to fellow Ministers, they are always respectful about and look with some envy at what NICE achieves as an organisation. If we did not have it, we would have to invent it, so it is crucial that the methods and processes for making recommendations continue to evolve and develop to meet new challenges. I totally take my hon. Friend’s point about the NICE methodology review next year. These issues will be talked about within that process, of course.

My hon. Friend talked at length about charging. We think it extremely important that we have a system such as NICE in place to ensure that the NHS spends its money—public money, our constituents’ money—in the most effective way possible. It is critical that NICE’s work operates on a sustainable footing in a way that enables it to continue to be responsive to developments in the all-important—I completely agree with what my hon. Friend said—life sciences sector.

To date, NICE’s technology appraisal and highly specialised technology programmes have been funded through the resources that it receives from Government. However, in common with all Government bodies, it is right that NICE considers how to operate with maximum efficiency, as well as who stands to benefit from the services that it provides. My hon. Friend is absolutely right to talk about the robustness of how it spends money and looking at efficiencies across the board. As she rightly points out, that is why it will be doing its methodology review and why it does that regularly. It is also essential for us that NICE continues to be able to respond to continuous change in the global life sciences market—it is a global market, of course—whether with the ever-growing movement towards personalised medicine or an increasing number of medical devices and digital products.

For that reason, the Government and NICE believe that the most appropriate and sustainable method for NICE’s appraisal programmes in future is for NICE to charge the companies that benefit directly from its recommendations. This is not without comment and controversy, as we have heard this evening, but it also has support. To this end, the Government carried out a public consultation between 10 August and 14 September on proposed changes to regulations that would enable NICE to charge companies for the cost of making technology appraisal and HST recommendations. The consultation followed extensive engagement by NICE with the life sciences industry on a possible charging model. During that engagement, NICE heard clearly from companies that it would be important to ensure that there was some mechanism for minimising the impact of charges on small companies—my hon. Friend rightly referred to that—wanting the NHS to invest in their innovative and effective new products.

The Government are committed to ensuring that there is appropriate support for small businesses—I do not know whether my hon. Friend saw my speech before the debate, but she seemed to know a lot of what was in it—and she is right that this was reflected in the Government’s recent consultation that proposed a small discount for small companies and provision for small companies to pay by instalments. That was in there, too. We are especially keen in the response to pitch this right as we move from the consultation to the Government response. That is probably as much as I can say about that, but I repeat: we are keen to pitch that right for small companies and have listened to responses, including from my hon. Friend, to that consultation. It also gave a clear commitment to reviewing the charging mechanisms over time to ensure that they are fit for purpose and respond to developments in the life sciences sector.

We received 78 responses to the consultation from a range of audiences, including the life sciences sector, the NHS, patient groups and professional groups, as well as my hon. Friend through the all-party group. A range of issues were raised in response to the consultation, such as NICE’s impartiality and the impact on drugs for rare diseases, as well as potential impacts on small companies. I was over the road at the Britain Against Cancer conference today talking, for instance, to Cancer52, which represents people with rarer cancers, so that is very important to me as the cancer Minister.

It would not be appropriate for me to pre-empt the Government’s response to the consultation, and I do not intend to do that this morning, but I can assure the House that the Government have been carefully considering all the issues raised and agree that any charging mechanism must include appropriate support for the small companies, while protecting the impartiality and benefit of NICE’s work to patients and, as my hon. Friend rightly says, the global nature of this business and the great opportunities in this sector from Brexit.

We will publish our response to the consultation very shortly. The Under-Secretary of State for Health, Lord O’Shaughnessy, has invited my hon. Friend to meet to go through these proposals in detail and discuss her response to the consultation. As chance would have it, I understand that the appointment went in the diary today—just before today’s debate. Who would have thought it? That is happening this Thursday.

[Anne Marie Morris]

Would it be right to say that the consultation assumed there would be a charging mechanism and that it was not about whether but about how?

--- Later in debate ---

[Steve Brine]

Yes, the consultation was about how, but we are listening very carefully to the “how”.

As my hon. Friend said, Members have expressed concern that the introduction of the charging mechanism will make us a less attractive country in which to invest. We are committed to ensuring that the UK is an attractive environment for the life sciences sector. Sir John Bell’s life sciences industrial strategy published last year set out the sector’s vision for how we will do that, and we fully support the strategy’s vision. We have committed £500 million of Government money, and that has been backed by significant investment from 25 different organisations across the sector. Strong progress has been made on that sector deal, therefore, and one year on we are working with partners to agree the second sector deal with the new measures to secure our lead in the areas of global opportunity.

[Anne Marie Morris]

I thank the Minister for answering my last intervention so honestly. Given that the last consultation was not about the “whether” but about the “how”, may I ask if there was ever a consultation on whether this was the most appropriate way to ensure better value and more money for NICE to develop more medicines more efficiently?

[Steve Brine]

Not to the best of my knowledge, but this will of course continue through the NICE review process next year, and I have no doubt that my hon. Friend will be able to discuss this at great length with Lord O’Shaughnessy on Thursday.

I stress that the Government share the views that we have heard today about the vital importance of NICE’s work and about protecting the UK’s place in this important sector, which a lot of people work in and which—more importantly—a lot of patients rely on. That is why we want to ensure that NICE can continue to develop its recommendations with the same authority, transparency and impartiality that have been the backbone of what is a world-leading organisation with a world-class reputation.

Question put and agreed to.

Winter Flooding (Preparation)

Debate between Steve Brine and Anne Marie Morris

Wednesday 19th November 2014 Westminster Hall

[Steve Brine]

I have already mentioned the Isle of Wight fire brigade, and generally speaking, the Hampshire fire and rescue service were incredible. I have heard from many colleagues around the country about the work they did. I had the mobile number of the chief fire officer and I was constantly talking to him. At one point, I remember being out in the village of Littleton in my constituency; I called them and within two hours, they came out and helped pump out some people who were in real trouble. So yes, they were incredible.

On the statutory duty, my honest answer is that I am not sure, but I am well aware of the debate. I am more than open to it, and fire officers have talked to me about the issue in my part of the world. I thank the hon. Gentleman for his contribution.

The tale of central Winchester last winter is a winter’s tale with a happy ending. That was in no small part down to the effectiveness of Gold control, which is based in Netley in southern Hampshire, backed up by Silver control in Winchester at the Guildhall, under the leadership of Simon Eden, the chief executive, and Rob Humby, the leader of the city council. That is the sort of command and control system that I am sure Members will recognise from their areas, designed to co-ordinate cross-agency working. It was a recommendation of the Pitt review following the floods of 2007 and it is key now to our planning for next winter if needed. It worked, and to visit it, as I did on a number of occasions back in February, and see city officers working alongside the Army, county colleagues and fire and rescue colleagues was very reassuring indeed.

The most visible example of that was one very bleak afternoon in February in Winchester, when those of us who had been heaving sandbags for longer than we would care to remember were more than a little relieved when Silver control sent some incredible guys and girls from HMS Collingwood to help us. Something tells me that they had the shoulders for it more than I do, and they were very welcome.

I said at the outset that I wanted to explain the wider socio-economic impact that flooding can have in a constituency such as mine. That is why I shall focus on what happened in a number of the villages that I represent. In places such as Kings Worthy, Headbourne Worthy, Littleton, Hursley and Sutton Scotney, flooding from groundwater, not the river, is the main flood risk management issue. The impact of groundwater flooding on individual communities such as those is severe and long-lasting in terms of the duration of flooding and recovery. My constituents living in Lovedon lane and Springvale road in Kings Worthy, as well as Chris and Sharron Bruty, who, with Ross Brimfield, run the King Charles pub—they were incredibly helpful to me and many other residents—would recognise that problem, as it was in their lives, and almost in their pub, for a month or more.

Residents just up the road in Headbourne Worthy, whose parish council chairman in a meeting with me just last week described his village as the “plughole for the valley”—he meant it in the nicest possible way—had weeks of deep water creeping closer to their homes and the ancient St Swithun’s church. The road through the village was closed, at their request, because of the bow waves—that became a hashtag last winter—caused by inconsiderate drivers flying through the floodwaters.

[Anne Marie Morris (Newton Abbot) (Con)]

I am very interested in what my hon. Friend has to say, and he is absolutely right to raise the issues that arise in villages. Does he agree that this is one of the challenges? The Environment Agency does a good job with the major schemes, and that is reasonably well funded. However, when we get to the smaller schemes, we find that the local authorities are simply not funded and therefore the prevention—there are many things that you can do in fields with help from farmers—is not done, because the money simply is not there. One protection and prevention measure this year could be to put the funding in those local authorities—particularly the rural authorities, which are so dreadfully underfunded.

[Steve Brine]

My hon. Friend is a visionary and a futurist. Bear with me—“bear with”, as someone recently said.

I was touching on Headbourne Worthy. The Good Life Farm Shop lost thousands of pounds of business because of the road closure. That is part of the wider socio-economic impact that I mentioned. My constituents in the village of Littleton, another place where my team and I shifted thousands of sandbags, took that to a whole new level, as one end of the village was the ungrateful recipient of thousands of tonnes of water flowing off groundwater-saturated farmland at the other. One thing that I have learned this year is that water is ruthless and will find its way, no matter what or who is in its way, to the lowest common point. I saw that happen to devastating effect.

Meanwhile, villagers at the other end of my constituency, in Hursley, saw rising groundwater levels fill cellars and infiltrate sewerage systems, with the resulting outpouring down the picture-postcard streets. The villagers do not look on that as their village’s finest hour and I would not want to see it again.

What do all these communities, including Sutton Scotney in the north of my constituency, where there are still constituents out of their homes, have in common? As I said, their flooding was the result of groundwater—levels just overspilled. The problem that they all share is that the cost-benefit ratio for flood alleviation schemes—this issue was alluded to by my hon. Friend the Member for Newton Abbot (Anne Marie Morris)—under the national funding formula does not favour them or, I am sure, many of the villages that colleagues represent, because of the low number of properties that are actually physically flooded.

The difficulty is being able easily to quantify impacts such as the road closures that I mentioned, disruption to local businesses, such as the Good Life Farm Shop and the King Charles pub, deliveries to those businesses and to homes, welfare services, social care, education—I mentioned St Bede’s school—and normal life in general. Our experience in Winchester points to the need for the cost-benefit analysis for flood alleviation schemes to be articulated in a very different way.

We know that the national funding formula, the so-called flood defence grant in aid programme, will never touch us, but we want to build something that is complementary to it, not in place of it, which properly recognises the value of multiple small-scale local measures to deliver community flood resilience.