Vaccine Damage Payments Act

Tony Cunningham Excerpts

Tuesday 24th March 2015 Westminster Hall

[Mr Brown]

My hon. Friend is exactly right. Today, we are looking at—it is in the debate’s long title—reform of this legislation. As will become clear as I progress through my contribution, we really need to reach a decision on whether this is about reform or about ripping it up, throwing it in the bin and starting again, because we have moved on significantly since 1979.

As I was saying, reform could be a win-win, in that we could promote social justice and ensure an increase in the rate of vaccination that would benefit society. I believe that vaccine manufacturers are strongly in favour of such a change and are willing to contribute to a fund—and, I hope, to discussions.

It is unconscionable to relegate so many people who are disabled to a battle over causation, and for justice, and it undermines rates of uptake of vaccines not to have an effective system. The numbers of those seriously injured are low, so the total cost of full compensation would be affordable and would be self-financed through the increase in vaccination and the reduction in the burden of disease in society.

Towards the end of last year, I met two parents down here in London. They related to me the stories of their daughters, who had both had a reaction to the human papilloma virus vaccine. We dedicated the last meeting of the all-party group, on 14 January, to hearing from some young women who were able to attend, but mainly from the parents of several young women who had had a severe reaction to the HPV vaccine. I think that it is safe to say that the majority of those cases centred on those young women now finding themselves profoundly affected by what can only be described as symptoms similar to those of ME—myalgic encephalomyelitis—or chronic fatigue syndrome. All those girls had been fit and healthy, were doing well academically and had the social life that we would expect any teenager to have.

[Sir Tony Cunningham (Workington) (Lab)]

To emphasise just how serious the consequences are, I point out that Steve Hinks’s daughter, to whom my hon. Friend may be referring, is often asleep for 23 hours a day. That is how serious the consequences are.

[Mr Brown]

I thank my hon. Friend for his intervention. He is exactly right. It was absolutely astounding to hear the heartbreaking stories at our last meeting and to think that a young woman who had been fit and healthy now suddenly finds herself asleep for most of the day and has to be awakened on an ongoing basis to be fed. That is no quality of life at all. Something is seriously wrong. The worlds of these young women have been turned upside down. For some of them, to spend a few hours at school in a week is a major challenge. That issue could probably merit an Adjournment debate on its own. I am aware that the hon. Member for Reigate (Crispin Blunt) held a short debate on the topic back in May 2009. It is worth pointing out that there are serious concerns about the manner in which an individual’s allergic reaction to a vaccine is recorded—it might be better put as “not recorded” in many cases. Where there is an allergic reaction, it is only right that it is properly recorded, so that we can not only determine what is happening to the individual but get a broader perspective.

In October 2011, a proposal paper was produced by the vaccine victim support group—an unincorporated association with more than 300 members—and the all-party group for vaccine damaged people. They came together and were looking for reform of the Vaccine Damage Payments Act, which established in the UK a statutory no-fault system of a single lump sum payment from public funds for cases of proven serious permanent disablement resulting from vaccination. Most developed countries have established such systems. The scheme in this country is administered by the Department for Work and Pensions, with appeals being resolved within Her Majesty’s Courts and Tribunals Service. We are now 36 years on, and the system has continued, with relatively minor changes only.

The vaccine victim support group and the all-party group contend that reform of the system is highly desirable to deal with anomalies that now exist in the system, to reflect the changing landscape of today, to reassure the public about the safety and efficacy of vaccination, to reduce litigation and to promote and extend the uptake of vaccination to promote health and the elimination of disease. Both groups support the UK national vaccination programme and recognise that the benefits of vaccination outweigh the risks. Vaccines have significantly contributed to the elimination of disease, the increase in life expectancy and the improvement in public health.

Reform of the UK system of statutory vaccine injury compensation has the prospect of achieving important tangible benefits for the UK that mean that it would be irresponsible not to explore and effect reform through consultation with all relevant stakeholders, which include the pharmaceutical industry, the Department of Health immunisation team, the DWP and, via support groups, affected individuals.

The Act was brought into being by Parliament to put on a statutory footing a system of ex gratia awards of compensation for vaccine injury that had developed during the 1970s, largely as a result of whole-cell whooping cough and smallpox vaccine injury. The Department of Health had made a number of ex gratia awards to individuals who had suffered serious permanent disability as a result of catastrophic brain injury that they had suffered as infants shortly after DPT—diphtheria, pertussis and tetanus—vaccination.

The Government had commissioned Professor David Miller to conduct the national childhood encephalopathy study—NCES—a large-scale epidemiological study of incidents of brain injury and onset of seizure disorders following DPT vaccination. The study, published in May 1981, found a significant association between DPT vaccination and severe neurological injury and death.

The statutory scheme initially required an 80% and permanent level of disability to have been suffered, but later that threshold was reduced to 60%. Awards were initially £10,000. That was increased, in various changes, to £20,000, then £30,000 and then £40,000. The level of payment was largely based on the understanding that that was interim compensation pending the outcome of the litigation against the Wellcome Foundation.

In 1986, the United States enacted the National Childhood Vaccine Injury Act. That established a system of compensation in the US court of federal claims. Until four years ago, that had awarded compensatory damages in 2,806 cases, of which 1,266 involved the DPT vaccine, use of which ceased in 1996. That involved an outlay at that time of $2.2 billion. The fund to administer the scheme is established from a small tax on each dose of vaccine. That has proved relatively successful in the United States, and our all-party group has wondered for a long time why we do not in the UK, for every vaccine that is given, put into a fund a couple of pence. That is all it would take to deal with this issue. However, that has been rejected not only by this Government, but by the Labour Government in the 13 years for which they were in office. I think that we need to reconsider where we are.

In 1988, the court in Loveday v. Renton and the Wellcome Foundation dismissed the claimants’ claims. The judge found that the claimants had failed to establish causation to the required standard of proof. That was based on his findings of flaws in the data analysis of the NCES. Professor Miller and his NCES team subsequently published a follow-up study, in November 1993, which addressed the judge’s criticisms of the original study. The conclusions of the follow-up study were essentially the same as those originally: on rare occasions, the vaccine can cause severe neurological injury. Then in 2000 the Government decided that the initial awards should be “topped up” to the real-terms equivalent of £100,000.

It had been suggested that anyone deemed to be vaccine damaged was carrying the SCN1A gene. That has been disproved by testing victims: they have all proved negative.

In 2010, the Legal Services Commission agreed in principle to fund a further review of the prospects of success of the surviving DPT claimants. Further litigation is therefore pending in that respect against the manufacturers and/or the Department of Health. The award now made for a successful application for vaccine damage payment is a single lump sum of £120,000. However, the majority of applicants—approximately 750 —have received only £78,000, because they received an initial payment of some £10,000. The payment is invariably made into a personal injury special needs trust, so that it is excluded, by statutory provision, from any assessment for means-tested benefits. That is done to ensure that it is received in addition to means-tested benefits such as incapacity benefit and disability living allowance, including components for care and mobility.

According to information supplied by the vaccine damage payments unit in 2011, a total of 931 awards had been made under the 1979 Act, of which 570 were related to the DPT vaccine. There were 89 applications to the unit in 2010 and 71 in 2011. One award was made in 2010, and no awards were made in 2011. So far, 3,983 applications have been rejected on medical grounds and 814 have been rejected for non-medical reasons—because the application was made either out of time or out of the scope of the scheme. The operation of the system has settled down, and after a flurry of historic awards in the early years, very few awards are now being made. The unit at one point consisted of two part-time members of staff. An appeal against the decision to refuse an award is made to the social security lower-tier tribunal, which is part of Her Majesty’s Courts and Tribunals Service.

The fact that surprisingly few awards are being made probably reflects the withdrawal of the DPT wholesale vaccine, the improvement in vaccine technology and the increased levels of safety and efficacy of vaccination. During the past few years, more vaccines, such as HPV and meningitis C, have been added to the national programme. It is likely that further vaccines—for example, varicella, H1N1, swine flu and hepatitis A and B—will be added in coming years. Many new types of vaccines are likely to become available in future years, because they are being developed to combat many sources of disease, such as malaria, candida, chlamydia, E. coli, genital herpes, hepatitis E, strep, rheumatoid arthritis, various cancers and numerous others.

There have been episodes of public concern about adverse reaction to vaccinations such as DPT in the 1970s, MMR in the late 1990s and early 2000s and, more recently, the HPV vaccine. Those episodes of concern have led to litigation, media sensationalism and public anxiety, and they have significantly reduced uptake of the vaccination, which has reduced the level of herd immunity on occasions and increased the incidence of outbreak of pandemic disease among unvaccinated populations. Those episodes of public concern caused anxiety and confusion to the public and resulted in considerable legal defence costs for pharmaceutical corporations and considerable cost to the UK legal aid purse. Litigation resolved few of the disputes, because hardly any cases reached trial. The public health programme was damaged by falling levels of vaccine uptake, and diseases in some cases were resurgent.

In 2003, uptake of the MMR vaccine fell to only 82%, largely as a result of Wakefield’s discredited autism theory. Even by the end of the MMR litigation, uptake had not fully recovered. In contrast, the United States achieves 98% vaccination uptake, possibly because all claims have to be brought in the federal courts under the vaccine programme rather than against a manufacturer. That shows that a proper safety net can boost the numbers of people who take part in a herd immunisation programme. Other countries have avoided the problem by enabling disputes over vaccine injury to be efficiently and proportionately resolved within a statutory compensation scheme, where individual cases can be thoroughly investigated and adjudicated. The lack of a fully comprehensive system for determining vaccine injury applications in the UK has contributed to the problems we face, so all stakeholders have an interest in reform.

The UK’s vaccine injury compensation scheme, as established in the 1979 Act, contains a number of serious anomalies. Not all vaccines are covered. Vaccines for swine flu, smallpox, hepatitis A and B, and yellow fever are not covered. A separate scheme for smallpox vaccine compensation had to be set up by the Department of Health for workers to encourage front-line health workers to participate in vaccination. The vaccine programme is no longer just for children, as it was initially. Many people in their professional careers need to be vaccinated, otherwise they cannot work.

The influenza vaccine is not covered. The safety net has holes in it, and the vaccine victim support group and the all-party group submit that the gaps should be addressed. We believe that everyone who is resident in the UK and is vaccinated should be able to have recourse to the compensation scheme in the event of a serious adverse effect. The current scheme is aimed mainly at compensating children, although adults are also, on rare occasions, covered. The coverage is therefore patchy and not comprehensive. Given the very small numbers involved, the scheme could easily cover children and all adults.

Children who die before the age of two are not covered. That exception is difficult to justify, because losing a child at 18 months is as tragic and devastating as losing a child six months later, at the age of two. That exception should be abolished. The 60% injury threshold is a real issue. An arbitrary distinction is made in the scheme for injuries that are still significant, but that amount to 59% or lower. The refusal of any compensation for someone with a 59% permanent disability cannot objectively be justified, bearing in mind the very small number of awards that are made. To qualify for criminal injury compensation, the minimum threshold value of injury is £1,000, and a similar level should apply in vaccine injury cases.

The current compensation award of £120,000, rather than compensatory damages, creates anomalies. A child with catastrophic injury resulting from clinical negligence in the administration of a vaccine—in other words, in breach of contra-indication—may receive £3 million. A child with a similar injury resulting from an adverse reaction to a vaccine would receive only one twenty-fifth of that compensation. That means that the burden of caring for the disabled person falls largely on their families. The current vaccine injury award amounts to the cost of care for a seriously disabled person for less than one year. That cannot properly be described as compensation; it is only a token.

West Cumberland Hospital

Tony Cunningham Excerpts

Monday 20th October 2014 Commons Chamber

[Sir Tony Cunningham (Workington) (Lab)]

West Cumberland hospital is used by thousands of my constituents who rely on the services it provides on a daily basis. The future of the hospital is an issue close to my heart and that of my hon. Friend the Member for Copeland (Mr Reed), whose constituency is next to mine. The hospital is based in his constituency, and with the prior agreement of the Minister, whom I thank, and of Mr Speaker, it is right for him to contribute to the debate.

Based in Whitehaven but relied on by people throughout west Cumbria, including tens of thousands of my constituents, the hospital is one of two sites that make up North Cumbria University Hospitals NHS Trust. The trust currently remains in special measures and in limbo over a delayed acquisition by Northumbria Healthcare NHS Foundation Trust. Reports by Sir Bruce Keogh, the Care Quality Commission and others have revealed serious problems with the trust, from a shortage of staff to governance and management issues. Through the hard work and commitment of clinical and non-clinical staff, improvements are being made—although slowly—and I add my personal and genuine thanks to all the staff who work so incredibly hard at West Cumberland hospital. However, the trust is still in special measures after more than a year.

I pay tribute to the fantastic work done by the We Need West Cumberland Hospital group to raise public awareness. It organised a meeting recently to discuss services at the hospital, which was held in a sports stadium because no indoor facility was big enough to cater for the 4,000 local residents from Allerdale and Copeland who turned up to show support for their hospital.

My hon. Friend and I have worked closely with the group and will continue to do so. Its work has clearly shown the strength of feeling throughout west Cumbria, and the willingness of our communities to engage with the decision-making process when it comes to services at our local hospital. The crux of the issue is that the unwillingness of the hospital trust to engage with communities and local people has meant that all trust has broken down. People want a say in what their local health services do and should look like, yet the door is being shut—slammed in their faces. Because of that lack of openness from the trust, feelings of distrust have grown.

My hon. Friend has repeatedly said that the issues highlighted by Sir Bruce Keogh and the Care Quality Commission must not be used as an excuse to strip services away from west Cumbria, and particularly West Cumberland hospital. However, when decisions are made behind closed doors, that is exactly what the community, my hon. Friend and I fear is happening. Representatives of the trust were present at the recent public meeting, but they did not reassure the local people who attended one iota. Engagement has increased recently, but it feels a bit like reluctant engagement. That cannot, and must not, continue.

The nearest other hospital is more than 40 miles away from the West Cumberland hospital. The Cumberland infirmary in Carlisle faces many of the same problems, but stripping services from the hospital in Whitehaven to relocate them to Carlisle is in my view, and in the view of my hon. Friend, a recipe for absolute disaster. Taking ambulances out of service to transport patients in need of care more than 40 miles, a journey that takes at least one hour, creates unnecessary and unacceptable risks to patients. Brand-new facilities are about to open in Whitehaven at the West Cumberland hospital which will provide our constituents with a first-class hospital. Surely hospital services should be delivered in the hospital that has been purpose-built to provide them. I will repeat that so that there is no misunderstanding: surely hospital services should be delivered in the hospital that has been purpose-built to provide them.

The high degree of uncertainty surrounding services has been fostered by the lack of engagement from the trust. There seems to be uncertainty about particular services, especially consultant-led maternity services. The atmosphere in which any engagement has been conducted to date has led local residents to believe that the trust is hiding its intentions. If the services at the West Cumberland hospital are not under threat, why has the trust not made that clear? The fact that it has not suggests that the services could indeed be under threat. We cannot, and must not, allow a situation to develop where the lives of mothers and their unborn children are put in danger in the back of an ambulance on the long journey to Carlisle. It is difficult to do a caesarean section in the back of an ambulance.

I understand that members of staff from the trust were not allowed to attend the recent public meeting. That is also totally unacceptable. The trust needs to promote meaningful engagement, rather than shutting down reasonable debate. It is clear that many medical professionals within the trust have concerns about the how the trust is acting. This must change. There is deep concern within the medical community, and their views must be heard.

There is a great strength of feeling within our communities. People who use these services on a day-to-day basis, people who rely on these services when they get ill and the people who will use these services in the future deserve a say in how these services are provided. There is a willingness to engage by the people of west Cumbria. People want to see their services improved and strengthened, and they want to be part of that process. The trust’s lack of engagement cannot continue. It must be willing to engage with all the people of west Cumbria, staff and local residents alike, and the Government must ensure that this happens.

I have two final points for consideration. We keep being told that one reason for change is to create specialisms. For example, if a patient in west Cumbria has heart problems—perhaps they need a triple heart bypass—they may well need to go to a specialist unit such as the one in Middlesbrough. I, and the community, understand that, but perhaps the Minister could tell me what specialism is being planned for the new refurbished West Cumberland hospital, because it needs one.

Finally, my hon. Friend and I are to hold a meeting of interested bodies soon, including some not in the process, such as the university of Central Lancashire and Allerdale borough council, whose leader Alan Smith spoke to me this morning. Will the Minister encourage the relevant bodies to attend such a meeting so that we can provide the hospital that the people of west Cumbria deserve?

[Mr Jamie Reed (Copeland) (Lab)]

I would like to thank your office, Madam Deputy Speaker, and the office of Mr Speaker, for the advice with which they have provided me in the lead-up to today’s debate. That a Member of Parliament could have been prevented from speaking on an issue that relates directly to his constituency and constituents owing to the decision of an individual Minister, is too absurd to contemplate. That would have made a mockery of our democratic process at a time when there is a growing dislocation between the public and Parliament. This Chamber exists precisely for the purpose of holding power to account and if any Minister in any Government believes they can be exempted from that then they are badly wrong. That said, I am exceptionally grateful to the Minister for granting me permission to speak. I would also like to extend my thanks to my hon. Friend the Member for Workington (Sir Tony Cunningham) for securing this debate and congratulate him on his richly deserved knighthood over 12 months ago now—this is the first chance I have had to do so in public.

My hon. Friend and I have campaigned consistently on behalf of West Cumberland hospital in a fight that will continue for as long as it is necessary. The Government must not try to shut down the debate, especially given that patients, the public and medical professionals across west Cumbria require clear and open discussion and genuine public engagement regarding the future of our hospital—the first new hospital built after the establishment of the national health service.

We need the support of the Government in ensuring that such engagement takes place. The Government’s health reforms, of which I am a long-standing critic, were billed as devolving decisions about local health services to the communities relying on them, but in Cumbria, which the previous Health Secretary said should be the template for the whole of the country—consider that for a minute—engagement could not be any worse. In my constituency and that of my hon. Friend, the Minister will find tens of thousands of people willing to engage with the Government—and with the trust, for that matter—on the future of their services, but their voices are being deliberately ignored.

Before I continue, I must declare my interest in this topic. I was born at West Cumberland hospital; my four children were born there; my wife was born there; and over the past few years, it has saved my life not once, but twice—which I appreciate sounds careless. I am indebted to its staff for all they have done for me and countless others from my part of the world. The hospital has been one of the main focuses of my efforts since I was elected to this place, and it will remain so for as long as I am here.

I do not wish to repeat what my hon. Friend said, but I want to echo my support for the We Need West Cumberland Hospital campaign group. These are local people exercised by what is happening to their national health service. They have created a group with passion and purpose, and it is time for decision makers to sit up and take notice of them—that means the Government as well as the trusts in question. The group exists only because the local health economy is in turmoil and because its members, like everyone else, are being purposely shut out of decisions relating to their hospital, as service decisions are made and increasingly removed by stealth.

As my hon. Friend pointed out, just a few weeks ago this group of concerned people organised a public meeting to discuss the future of services at West Cumberland hospital. About 4,000 people attended on a dark Monday evening at the recreation ground in Whitehaven. Had we held it on a summer weekend, only a few weeks earlier, more than 10,000 people—easily—would have attended.

My constituents are deeply concerned. The lack of engagement from the North Cumbria trust and other decision makers has fostered a feeling of toxic distrust. This simply is not conducive to establishing faith or trust, or to building the local services my constituents, the people of west Cumbria and the whole of the Cumbrian health economy need. I implore the Minister to intervene to stop this behaviour and ensure that an effective framework of meaningful public engagement is put in place before it is too late. I hope he can write to the North Cumbria trust to ensure this takes place.

Consultation is one thing, but meaningful engagement is another thing altogether. Rather than simply being consulted on a plan designed by the trust behind closed doors, it would be much more beneficial to have public involvement in what the plan should look like before it is consulted on. Surely that would make for a much easier, expedited consultation and a much easier, effective implementation. We did that locally prior to 2010 and we should do so again. I hope the Minister will address that point directly.

I want to address the concerns expressed about the services provided by West Cumberland hospital. The vacuum left by the lack of engagement from the trust means that local people are understandably worried about what their services will look like in the coming years, and the ability of the trust to engage with local people has been clearly and demonstrably worsened by the recent reorganisation of the NHS. However, the acquisition of North Cumbria by the Northumbria trust is also proving to be a significant problem. I hope the Minister will pay careful attention to this point. The acquisition cannot proceed unless both Monitor and the Care Quality Commission are satisfied that the trust is both financially and clinically sustainable.

The acquisition was meant to provide certainty and stability, yet years later the process has provided neither. In fact, the uncertainty is only worsening matters. There are justifiable fears that financial sustainability will be achieved by reducing, and only by reducing, the amount of services provided at the West Cumberland hospital, under the guise of “clinical sustainability”. Will the Minister agree today to stop any further progress of the acquisition of North Cumbria by Northumbria unless a comprehensive public consultation on the future of services provided by the West Cumberland hospital is undertaken prior to an acquisition? The people of west and north Cumbria need the Government’s help with that, which is the least the Government could do.

We have already seen some services move from the West Cumberland hospital to the Cumberland infirmary at Carlisle, itself a hospital in serious difficulty. People are worried that more services will follow and they are especially worried about consultant-led maternity services being transferred from West Cumberland to Carlisle.

[Sir Tony Cunningham]

The journey between West Cumberland and Carlisle is 40 miles, but some people have to go to Newcastle—for example, for chemotherapy. Just think of the anguish when children have to have chemotherapy as far away as Newcastle, which is almost 100 miles away.

[Mr Reed]

My hon. Friend makes an absolutely pivotal point. This is about not just the effectiveness and efficacy of the clinical solutions provided by the NHS; it is about the patient experience and the best outcomes for patients, and not just those 40 miles from Carlisle and further afield. The 40-mile point is Whitehaven, but it is actually much further south than that: it is Egremont, Cleator Moor, Seascale, Wasdale, Eskdale and so on. It is the people there who, perhaps more than others, are disadvantaged by these moves.

Childbirth is one of the biggest moments in any parent’s life, but the elation and happiness that surrounds a new family at this time can all too often turn to stress, worry and fear. Any complications can have a catastrophic effect—I have seen this recently with close friends. If there are complications during a labour, it is just not feasible for an expectant mother—particularly one in difficulty—to be transferred 40 miles from Whitehaven and further afield south, on a journey that, as my hon. Friend said, takes well over an hour at the best of times and considerably longer in heavy traffic. On occasion, the roads will become impassable in bad weather. In fact, only this year, after a visit to my constituency, a Minister wrote to one of his colleagues, a Minister in the Department for Transport, pointing out the inadequacy of the A595, bemoaning the state of the road infrastructure. If the roads are not good enough for visiting Ministers, they are certainly not good enough to be transporting patients at the time of their greatest need.

The truth is that a one-hour journey for a mother in labour means more than 90 minutes, bed to bed. That is indefensible. Also, studies have shown that an increase in straight-line ambulance journey distances is associated with an increased risk of death and that an increase of 10 km in straight-line distance is associated with an absolute increase of around 1% in mortality. Consider that for a moment. The centralisation of some services from the West Cumberland hospital in Whitehaven to Carlisle will increase the mortality risk for west Cumbrians much further afield than Whitehaven.

Between 2007 and 2008, the local primary care trust, as it then was, undertook a consultation on local services, to which it received 140,000 responses. As a result, the people of west Cumbria were told that they would receive a new hospital, built on the site of the West Cumberland hospital. The new hospital would retain services, including consultant-led maternity services, and also develop specialisms not catered for at Carlisle. The deal struck was also set to provide newly built cottage hospitals in Millom, Keswick and Maryport, to complement the existing new one built in my hon. Friend’s constituency in Workington.

When the Government took office in 2010, they scrapped the funding for the new hospital, as they did for all other existing new build hospital projects. It is only through perseverance, hard work and a lot of lobbying by me, my hon. Friend and others that the Prime Minister acquiesced and returned some of the money, for which we are very grateful indeed. However, the full funding was not returned and funds had to be found elsewhere. The Minister will know that to this day I am still consistently making the case—through the trust development authority, NHS England and other bodies—for extra funding. Now that the new hospital site is almost completed, it is only right that the other promises that were made are honoured.

Consultant-led maternity services cannot be removed from the West Cumberland hospital, and the Government must surely intervene to ensure that this does not happen. Before the election, the then Leader of the Opposition and now Prime Minister promised a “bare-knuckle fight” to stop maternity services moving, yet that fight has never appeared. Around the country, people wonder whether it will ever appear. However, can the Minister confirm that there is set to be a nationwide maternity services review? Will he explain when that will begin and end?

I believe that the local CCG in Cumbria wants to commission the consultant-led maternity services at the West Cumberland hospital, but that the North Cumbria trust does not wish to do so. I have submitted a series of freedom of information requests to the trust, seeking its internal proposals for removing consultant-led services; to date, I have received no response. Can the Minister help in that regard? Can he impress on the trust the urgency of the matter and the need for full candour? I hope he will be able to do so in writing.

Report after report by Sir Bruce Keogh and by the Care Quality Commission has shown that there are real issues, as my hon. Friend said, that need to be addressed not only in north Cumbria, but right across the Cumbrian health economy. Staff shortages are having a major impact on the services—not just the type but the quality—that can be delivered. Will the Minister commit himself today to investigate the recruitment practices of the North Cumbria trust? Will he commit himself to assist with recruitment, with financial incentives for potential new staff? This is critical. I am inundated with complaints from staff about the poor quality of recruitment advertising, cancelled interviews for applicants and much more. As a result, we have one of the highest locum spends in the whole country. The Minister will be only too aware of the effect on the trust’s ability to provide, in some cases, even the most basic front-line services.

In the people of west Cumbria, this Government—any Government—the trust and the regulators will find a willing partner for constructive discussions about what services should and could look like. They have been through these issues year after year; they are well versed in them and up to speed with the realities of modern clinical practice—and commissioning decision making, too.

More than that, however, with the brand new hospital being built, we should be able to develop a new model of health care for health economies such as Cumbria’s that is exciting, attractive and sustainable. We should be able to attract top-class medical professionals to our hospitals, and we should be able to support them. As Bruce Keogh points out, there is excellence at the North Cumbria trust. These issues are genuinely—we can say this without exaggeration—matters of life and death.

I have asked the Minister a series of questions. There will doubtless be many more, and if he cannot answer them today—I again express my gratitude for being allowed to speak in this debate—I hope he will answer them in writing. In addition, I hope he will agree to meet a delegation of hospital campaigners—from my constituency and that of my hon. Friend—in the Department of Health as soon as possible. Most of all, I hope he will listen to the clear voice of the people of west Cumbria. We need the West Cumberland hospital and the services it provides, and we will fight to the finish to secure the hospital services we deserve and the hospital we were promised. Future generations of west Cumbrians deserve nothing less.

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

I congratulate the hon. Member for Workington (Sir Tony Cunningham) on securing this evening’s debate, and I commend him for his interest in local health matters affecting his constituents, and for his clear advocacy of the needs of local patients.

We all understand that the configuration of local health services is an important issue for many Members—and for many of our constituents—particularly those who represent the more rural parts of the country such as Cumbria. We all agree that patients should receive high-quality care, regardless of where they live.

These are challenging times for the West Cumberland hospital. There have been difficult decisions to face up to, following the Keogh review, and the hospital has been put on special measures, following concerns about some aspects of patient care. I will say a little more later about that and about the importance of patient and public engagement in all decisions affecting the reconfiguration of local health care services.

First, I want to provide hon. Members with some reassurance about the future of local health services. It is important to note that for the first time in more than 50 years significant investment is being made under this Government in health care facilities in west Cumbria. The West Cumberland hospital is being redeveloped at a cost of £95 million, with this Government providing £70 million of that funding. The improved hospital will offer high-quality services and facilities fit for the 21st century, including significant local elective surgical services for the benefit of local patients.

The local doctors in the Cumbria clinical commissioning group are committed to keeping West Cumberland hospital clinically and financially viable, with the majority of Whitehaven patients continuing to access services, including A and E, at that hospital. I would also like to reassure the hon. Gentleman that it is the local doctors and nurses who run the clinical commissioning group—not me or anyone in Whitehall—who will make the decisions about health care in Whitehaven and Cumbria.

Before I move on to the specifics of the issues raised by the hon. Gentleman, it is worth noting the long-running issues at North Cumbria University Hospitals NHS Trust and the progress that has been made towards addressing them. Because of a history of high mortality rates—which means that more people were dying at the trust than should have been the case—the trust was placed into special measures in July 2013 as a result of Sir Bruce Keogh’s review. The trust is now working towards a merger with Northumbria Healthcare NHS Foundation Trust, which will further ensure that it can offer safe, high quality and sustainable patient services.

The trust has continued to work hard to tackle its long-running problems with recruitment of medical staff. It has recently implemented a nurse practitioner work force model to replace trainee doctors, who are currently not being placed at the trust due to long-standing difficulties in ensuring the necessary levels of senior medical training support. A recent positive development is that the trust has increased its consultant medical staff by 17%, as well as introducing a new nursing structure, which is helping to ensure safe nurse staffing levels on every ward.

[Sir Tony Cunningham]

Why does the Minister think there is such a shortage of doctors?

[Dr Poulter]

This has been a long-standing shortage; the trust has not been an attractive place for junior doctors to work for many years—probably for the past decade. However, the trust is now looking at ways in which it can better incentivise doctors to work there. That is an important step forward. If we want junior doctors to return to the trust—given that they have been removed from it because they were not getting the high-quality training they needed in order to become consultants—we must ensure that we incentivise the recruitment of more senior doctors to the trust. The hospital is now looking much more seriously at that than it has done in the past.

As I just outlined, recent measures have resulted in the consultant medical staff being increased by 17%, which is a positive step forward. Measures are also being put in place to ensure that nurse practitioners will be better used, where appropriate, to treat patients. The trust can be proud and pleased with the progress that it is making in that respect. An important aspect of looking after patients is to ensure that there is a full rota of junior doctors on site, and I am sure that if the progress in increasing the amount of consultant cover is maintained, that will become available again in the future.

On performance, the trust has put in place a recovery plan to meet waiting time targets from the end of 2014. It is currently working to reduce its backlog of patients who have been waiting for more than 18 weeks from referral to treatment, and it has received additional funding to support that. As hon. Members have pointed out, however, the trust has been financially challenged for some time. Last year, it reported a deficit of £27.1 million. The Department of Health provided significant financial support to the trust in 2013-14, as it has in previous years. The trust received £11.5 million from the Department, alongside support from the trust development authority and the clinical commissioning group, and £6.3 million in private finance initiative funding support. As we have discussed, however, that position is not sustainable in the long term. That is why further discussions about foundation trust status are being held.

Other critical challenges remain. Most significantly, some services at West Cumberland hospital remain fragile due to difficulties recruiting specialists and consultants and to the current heavy reliance on locums. However, I hope that that issue will be addressed in the near future if the trust can continue to recruit more consultants.

The Care Quality Commission inspection report published in July 2014 rated the safety of acute medical and outpatients services at the West Cumberland hospital “inadequate”. That reflects the difficulties that the hospital has faced for many years, and continues to face, in recruiting adequate staff to run some of its services safely and effectively. However, the trust has made significant progress in addressing the many challenges it faces. The CQC inspection acknowledged that, giving it an overall rating of “good” for providing a caring service to patients.

Another CQC inspection is expected to take place in early 2015, and I understand that the trust is working hard to make improvements ahead of that. For example, the outpatients service has greatly improved the availability of patient notes, an issue highlighted at the previous inspection. As I understand it, patients’ notes were not available when they came for an appointment. That is not helpful in providing an understanding of their previous history, which disadvantages the staff who are looking after the patient and trying to provide the best possible care. The trust has taken that issue on board and I understand that it is making good progress to address it.

The trust has made significant progress in other respects, most notably, and perhaps most importantly, in reducing high mortality rates. That means that patients in Cumbria who would have died had these changes not been introduced are alive today. Having been one of the highest in the country, the trust’s mortality rates are now within national confidence limits, and the trust and its staff must be commended for that turnaround. Further progress has also been made in, for instance, the meeting of the four-hour A and E standard, the implementation of a new patient experience programme, and a reduction in clostridium difficile infection rates. However, changes must continue to be made to secure a sustainable future, and to enable the trust to keep building on the good progress that it has made so far. It is important for the local NHS to be supported in that work to secure safe, high-quality patient care.

Hospital Mortality Rates

Tony Cunningham Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

My hon. Friend knows that the Labour party refused 81 requests for a public inquiry into what happened at Mid Staffs—I repeat: 81 requests. He also knows that if it was not for that public inquiry, we would not be here now. That is the biggest lesson to learn about the benefits of a public inquiry, and that is why transparency matters. I hope he is also pleased that we will be having a debate on the Francis report in Government time later this year.

[Sir Tony Cunningham (Workington) (Lab)]

If the teams going into Cumbria recommend increased staffing and resources, will the Secretary of State fund that?

[Mr Hunt]

If the issues are around staffing, we will sort those out. If the issues are around leadership, we will sort those out. If the issues are around clinical practice, we will sort that out. My commitment to the House is that we will do what it takes to sort out these failing hospitals.

Health Services (North-West)

Tony Cunningham Excerpts

Thursday 11th July 2013 Commons Chamber

[Mr Hunt]

This decision is about Trafford general hospital’s A and E services. What we are considering in this decision is whether the other hospitals can absorb the extra patients who will come to them as a result. We think that the neighbouring A and Es will initially have to absorb only about 25 patients in total. It is not a decision about the future of other A and Es.

[Sir Tony Cunningham (Workington) (Lab)]

The new service in Cumbria will have to be managed, and part of the problem in Cumbria is poor management, yet we have been waiting for two and a half years for Northumbria Healthcare NHS Foundation Trust to take over in Cumbria. When will we see that acquisition?

[Mr Hunt]

I am keen to resolve that issue as soon as possible. Indeed, I think that it is really important, given what we heard this morning from NHS England about the big challenges facing the NHS, that we try to take these difficult decisions much more quickly than normally happens. When we have paralysis and decisions being put on hold, that creates uncertainty and the worries that the hon. Member for Stretford and Urmston (Kate Green) talked about, so I want to ensure that we decide these things as quickly as possible.

Manufacturing

Tony Cunningham Excerpts

Thursday 24th November 2011 Commons Chamber

[Mr Sheerman]

I agree absolutely, and was going to mention that. I was also going to mention the Aldridge Foundation and Rod Aldridge, who founded Capita. He puts a great deal of money into education and is absolutely obsessed with finding entrepreneurs and giving them a chance to become successful.

We must ensure that there is reward for the risk of being an entrepreneur. We have to be open about the fact that that is what we want to reward. No one on either side of the House should fail to realise that. I do not mind seeing entrepreneurs getting super salaries. I have a great deal of sympathy with some aspects of the 99% campaign, but I do not mind people earning a great deal of money and being rewarded if they are entrepreneurs who produce jobs and wealth. I am worried when people in pretty safe and comfortable jobs, who are never going to risk anything, get millions of pounds a year. That is what I do not like.

On skills and training, the STEM subjects are neglected in our country, and we need more young people to stay with science, technology, engineering and mathematics longer.

[Tony Cunningham (Workington) (Lab)]

Many engineering entrepreneurs, past and present, started out as apprentices, so does my hon. Friend agree that if we put more energy, resources, money and time into apprenticeships we might see more entrepreneurs?

[Mr Sheerman]

I absolutely agree, and I will come on to that issue.

The slight disagreement between me and the Secretary of State for Education has occurred because I believe that young people who are not very academic but quite good at practical subjects will lose out on an opportunity if we remove design and technology as an option, focus on the more rarefied academic subjects and push the more hands-on subjects to one side.

After the Tomlinson report we lost diplomas, and that was the fault of the Blair Government, but the role of our universities is one thing that we can say is brilliant. If it was not for our universities, I would despair. They are increasingly working with entrepreneurs and the manufacturing hinterland, and that must be rewarded. We need more links between universities and further education colleges, of which there are about 450 in this country, and they really need to work much more closely, so that they turn out the young people that local industry needs. We should not pretend that all apprenticeships are three-year courses in engineering, because they are not; the average length of an apprenticeship is one year to 15 months, but they are not good enough; they are not proper apprenticeships.

On design, anybody who wants to know or who cares about the creative industries should look at Sir George Cox’s review of them and their relationship with enterprise, innovation and manufacturing. If we were to ask him, “What is the one thing that could transform this country’s manufacturing success and wealth creation?” he would tell us, “It’s the supply chain and how this country and its Departments procure. At the very heart of making a great change, it’s procurement that will do it.”

I could have covered other things today, but I finish on this point. In this country, we are still pussyfooting around competition. I have grown up to be a free trader, with the belief that we are a trading nation and should not have any barriers to trade, but I am changing my mind. I do not believe that this country, at this moment in time, with the imbalance in exports and imports between ourselves and Germany and China, can possibly accept the situation for much longer. Something pretty dramatic has to be done, especially when research increasingly shows that China, that wonderful, not very democratic industrial nation that is growing very fast every year, conducts a form of economic warfare against any area where it feels there is competition.

Let us look at the way in which the Chinese seek raw materials, resources, minerals and rare earths. An expert from a university told me yesterday, “If you want to know who’s going to move into Afghanistan in 2015, it will be the Chinese, because Afghanistan has more of the rare earths that China wants than anywhere else.” The Chinese will be there in 2015, as they already are in Africa and throughout the world, and they are also manipulating currencies and targeting specific industries in a way that we have only just begun to comprehend.

So there is economic warfare, and it is about time that the Treasury, with other Ministries, was conscious of this: manufacturing matters in this country. We need skills and entrepreneurs, but we have to have fair competition with competing nations.

--- Later in debate ---

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

I have taken part in a number of debates on this matter over the years, including as a Minister in the previous Government and as an Opposition spokesman after the election. Such debates often follow a similar pattern. Labour Members talk about the great wave of industrial closures that happened in the 1980s. We had a flavour of that a minute or two ago. Government Members are tempted to say that manufacturing declined as a proportion of GDP under the Labour Government. It all gets a bit familiar. Whatever the rights and wrongs of those arguments, they are united by two things. First, they tend to look in the rear-view mirror. Secondly, they take little account of the huge wave of globalisation and the enormous technological advances of the past 20 years.

Nobody can underestimate the importance to every developed economy, including ours, of the opening up of China as the factory of the world. To try to pin that on any single Government is to miss the point. No country is immune from its effects. Whatever product one makes, the chances are that it takes fewer people to make it today than it would have taken 20 years ago. It takes fewer people and fewer person hours to make a car today than it did 20 years ago. It is therefore not surprising that the number of people employed in these activities has declined.

It is good that this debate is focused on the future of manufacturing. We should avoid the rear-view mirror stuff that sometimes characterises these debates if we can. Any honest debate about the future of manufacturing has to begin by acknowledging the power and reach of globalisation and the power of technology, rather than pressing the rewind button or taking us on a nostalgic tour of the past.

[Tony Cunningham]

There is a company in my constituency called New Balance, which is the only running shoe manufacturer in the United Kingdom. It sells its running shoes to China. It does that because of the quality of the product. Is that not the way to compete?

[Mr McFadden]

That is a good example. I know that my hon. Friend is a keen runner. In my more conscientious days, I have also done some running. New Balance is an excellent product. He shows that globalisation is a two-way street, not a one-way street.

The emphasis on the past that sometimes characterises these debates can lead to an over-pessimistic discussion about decline and loss. Let us be honest: we make less than we used to, as is clearly shown by the figures. However, I also believe that we make more than we think and more than we sometimes give ourselves credit for. The point made by my hon. Friend the Member for Workington (Tony Cunningham) shows that, and there are other examples. We still make about 1.5 million cars a year, most of them for export. We have heard news today that Toyota has again chosen the UK as the base for a new model, which I understand will create up to 1,500 jobs. We also have a hugely successful pharmaceutical industry with a strong balance of trade surplus.

Although we had a debate earlier about British aerospace that centred on the loss of jobs, that sector as a whole is strong and is an important earner for us. Only this week, Goodrich, a company in the constituency of my hon. Friend the Member for Wolverhampton North East (Emma Reynolds), won a contract to maintain landing gear systems for the United States air force. That company has already taken on 200 people this year, and it aims to keep hiring in the period to come.

Health Care (West Cumbria)

Tony Cunningham Excerpts

Wednesday 16th March 2011 Westminster Hall

[Tony Cunningham (Workington) (Lab)]

The Minister mentioned community hospitals. There is one in my constituency at Cockermouth, and for a considerable period the authorities have been promising to rebuild it. After the terrible flooding in 2009, parts of the hospital are in portakabins. We are desperate for the new hospital. The funding and the planning permission are in place, yet we are still waiting for a decision. Will the Minister please look into that situation—she does not have to do it now—because the people of Cockermouth are desperate to get their new hospital?

[Anne Milton]

I thank the hon. Gentleman for his remarks. It is frustrating for local people when they are waiting for decisions to be made. General elections come along, disrupt things and, sadly, slow down the process even more. I can understand his constituents’ frustration. Later in my remarks, I will address how we can move forward.

The hon. Member for Copeland was right to make the point that local NHS organisations are precious not just for the services that they provide, but for the employment and economic support that they bring to the area. I note, in particular, his work with the west Cumbria strategic forum and the development of the energy coast master plan for west Cumbria. The development of local NHS services plays an important role in that.

The hon. Gentleman will also know that in west Cumbria, as in other parts of the country, the NHS is under tremendous financial pressure. Indeed, he alluded to that. We are where we are; we have inherited a substantial deficit. Both parties acknowledge the fact that we face some serious economic challenges, and we are determined to find £20 billion in efficiency savings so that we can then reinvest in quality care, and the need to do that is real and urgent. Such pressures would have existed whoever was in government. The fact that we have protected NHS budgets is an important step in ensuring that the challenges facing the NHS are slightly less than those facing other areas. None the less, the upshot is that every NHS trust in the country will have to make tough choices to put health care on a sustainable footing, and that is what is happening in west Cumbria.

I understand that the North Cumbria University Hospitals NHS Trust has struggled financially for a number of years. Clearly, there are some unresolved issues that people are now keen to sort out. Like the country as a whole, the trust is on a journey to restore balance to its finances, and we need to consider how we get better value for money. When I visit hospitals and trusts, it is interesting to see how substantial amounts of money have been taken out of costs by small changes in the way services are delivered. Although this is a challenge, it is also an opportunity, and I am impressed with the innovation that people are demonstrating.

As the hon. Gentleman is aware, the trust concluded in February 2011 that it would not be in a financially viable position for achieving independent foundation trust status by the 2014 deadline. It has made the difficult choice to pursue an arrangement with an existing foundation trust, through merger or acquisition, to ensure its ability to deliver high quality services in the future. The trust reached that decision for a number of reasons, including reduced contract income as more health care is provided outside acute settings, historical debts, costs associated with the private finance initiative scheme, to which the hon. Gentleman alluded, and ongoing requirements to meet cost saving targets.

Having trained as a nurse and worked in the NHS for 25 years, including as a district nurse, I am acutely aware that although our focus is always on acute care the majority of health care is delivered outside acute settings. It is the tension and the co-operation between those two elements of health care that we must now finally get right. The trust must address the issues that I have just mentioned. In particular, it must identify and agree an affordable clinical model that will deliver sustainable high-quality services. It is no good going for short-term gains. We need the process to be sustainable and lasting.

The hon. Gentleman will know that, back in 2007, the NHS in Cumbria set out its plan to reduce unnecessary hospital admissions by looking after people closer to their homes, which is where they want to be. The closer to home programme supported the development of community-based services and the redevelopment of acute facilities to meet local needs. In support of that programme in Cumbria, there is the redevelopment of West Cumberland hospital, which will deliver acute services with support from a wider range of community services.

Following recommendations by the national clinical advisory team last year, I understand that the north Cumbria health economy is now working to develop an affordable clinical strategy, covering primary, secondary and acute hospital services. I understand that the strategy will be published this summer. I suspect that it cannot come soon enough for the hon. Gentleman and many others in the area. In many ways, the strategy will build on the closer to home programme by considering how local health care services can be delivered more affordably, while keeping service quality at the very highest level, which is critical. As part of that process, it is true that the review group is looking at what will happen to acute services at West Cumberland hospital.

During his tour of hospitals in Cumbria last year, my right hon. Friend the Secretary of State for Health acknowledged the importance of West Cumberland hospital to the local people. That view is shared by all of us and it is being taken into account by the Department of Health, the North West strategic health authority and the NHS in Cumbria, which is working on the full business case for the redevelopment of the hospital. That business case will need to reflect the clinical strategy. It is very important that these decisions are driven by clinical need and that they meet the needs of local people.

[Anne Milton]

Yes. I thank the hon. Gentleman for that intervention. He is absolutely right to tie up the facts. As politicians, we tend to use the word “sustainable” in a rather flippant way, but what he has just said is what “sustainability” should be about. It should take account of the changing needs of the area; we should be building services not for the next five years but for the next 10, 20 or 30 years.

Tension between acute services and community services has always existed, as has tension between acute services and specialist services. If I think back to my own time in the NHS 30 or 40 years ago—I am very old and it was a long time ago—I recall that regional centres for neurosurgery were being developed. Specialist services need to be provided in specialist centres. Local people want to know that they can go to their local hospital for the majority of things that are wrong with them. That is important. There needs to be a clinical driver in the process, to ensure that people get the quality of care that they need. However, one also needs to take account of people’s wants and desires, and they want care on their doorstep.

The hon. Gentleman raised a number of issues. I recommend that he attends the debate that is happening elsewhere in the House today if he wants a fuller discussion of NHS services. He wanted a number of guarantees from me, so he wanted a number of guarantees from the centre and yet in the same breath he talked about “top-down” and “centrally imposed” diktats. Again, that is one of the key issues, because the centre is never very good at making local decisions. What matters locally is that changes and discussions have the support of clinicians, and ideally are led by clinicians. Those changes and discussions must also have the confidence of local people. That confidence is possibly what has suffered in the past.

The hon. Gentleman talked a little about GP commissioning, GP fundholding and “any other willing provider”. He asked what “any other willing provider” means. I suggest that he goes back to his own party to ask that question, because using “any other willing provider” was at one point its policy. I feel very strongly that the reforms in the NHS will bring decisions about commissioning and getting care right for people absolutely where they should be: with the GPs who know and understand their local communities. It is extremely important that GPs’ inputs and commissioning skills are used to the fullest.

I am told that the national clinical advisory team is reviewing the draft strategy and that a final version will be put to the strategic health authority in the months ahead. In addition, the full business case for West Cumberland hospital, together with the business cases for development of community services, will need to be considered alongside the final clinical strategy. I know that the delay is frustrating, but it is absolutely vital if the decisions are to be made. I or my ministerial colleagues will be very happy to have a meeting with the hon. Member for Copeland. In fact, it might be useful if a meeting was set up with a number of MPs from the area, to thrash out some of the more difficult issues when we have slightly more time to do so.

The process must be clinically led and choices must be made on clinical grounds. The primary care trust must also be satisfied that proposals are properly costed and can deliver sustainable solutions and a sustainable model of care for Cumbria. However, I emphasise that no final decisions have yet been made.

This is an important period in the story of the NHS. An ageing population, rising demand and increasing costs are combining to make it a uniquely challenging time. It is always challenging to deliver health care, with rising expectations and rising demands. That means that all parts of the country must look critically at how they can make the best use of resources to deliver effective health care, in whatever setting it can be most effectively delivered. It also means more care being provided in the home and in the community. I think most people see that development as a positive step, and there must be support for it. The difficulty is that realising cost savings ultimately means changing hospital services as demand changes. However, the NHS actually has a good history and a good record on evolving and changing to meet changes in demand and patient choice.

[Tony Cunningham]

I quite agree with the Minister, and we understand why there need to be more services in the community. However, the point that I was trying to make in my earlier intervention is that we are desperately in need of a new community hospital in Cockermouth. If we are to have acute services at the West Cumberland hospital, we need up-to-date modern community hospitals that can do the sort of work that she is talking about. Will she at least undertake to look personally into why there is such a delay in the development of the community hospital in Cockermouth?

[Anne Milton]

Yes. I thank the hon. Gentleman for that intervention and I understand completely his passion on the subject. It is terribly frustrating to wait for something and I will ensure that we come back to him specifically on that point, because the hospital has been delayed for too long.

[Tony Cunningham]

I thank the Minister.

[Anne Milton]

Our ministerial doors are open, so I urge Members to set up a meeting to thrash out some of the issues that we have discussed today. Obviously, no final decisions have been made yet and we are waiting for reviews to be completed, so that all the relevant information is on the table. However, it is terribly important that local politicians feel confidence in the process, which must always be led by clinical needs, and feel that they can bring the public with them.

It is not an easy time in west Cumbria. Change is not easy and we are in a difficult financial climate. However, change requires proper scrutiny and this debate has been an opportunity for some of that scrutiny. As I have said, change also requires public engagement. I hope—indeed, I am sure—that the hon. Member for Copeland and his colleagues in the area will play their part in making change happen and ensuring that there is public engagement with it.