(5 years, 8 months ago)
Commons ChamberIt is something of a relief to speak on a subject that is not Brexit, and is not even vaguely Brexit-related, though if there were a people’s vote, South Western Railway would not survive in its franchise very long.
Let me relay a little history. The south western region, which is the Wessex part of the south of England and the south-western suburbs, which I represent, had a little over two decades of South West Trains, which was owned by the company Stagecoach. I do not think that they were regarded with enormous affection, but they provided a workmanlike service, and certainly nothing that could be described as disastrous. Since the change in the franchise, which was announced in August last year, there has been a rapid deterioration. That is the matter on which I wish to speak.
SWR, or South Western Railway, has joined Southern, Northern and Thameslink at the bottom of the league tables on almost every measure of performance. That is of concern to the people who use the eight stations in the area that I represent in Parliament. But it is not just me; many other MPs in south-west London are concerned. My right hon. Friend the Member for Kingston and Surbiton (Sir Edward Davey) has established an all-party group that is doing detailed work on the problem and will, I hope, produce a report to enliven this discussion. The concern goes much wider than my constituency.
It has been brought to my attention that the disabled access points on this line are not up to the standard expected by disabled charities and organisations. Does the right hon. Gentleman feel that the Minister should address the need for modern disabled access points that are technically updated and correct for those who are disabled?
That was not on my list of complaints, but I am sure we can add it.
The central concerns that people have are the following. First, there has been a marked deterioration in punctuality and reliability. The consumer group Transport Focus measures satisfaction with punctuality and reliability and it has sunk to 65%, which represents a 12% deterioration in the past year.
The second problem is the ability of the rail company to deal with major disruption. When there is somebody on the line or a points problem, we have been used to recovery within a reasonably short space of time. Now, the whole network is disabled for prolonged periods, due to the apparent inability of either Network Rail or South Western to deal with the problem.
The third problem is a strategy that I would call the concentration of misery. Whenever there is a serious disruption, the rail company has the choice of whether to spread it widely or concentrate it on one or two neglected branch lines. What is happening in practice is that some of the branch lines, including the so-called Shepperton line that runs through Fulwell and Hampton in my constituency, are particularly badly affected. The justification given to me by the company is that that affects fewer people, but the effect is that an already poor service becomes impossible. People are not able to get to work or to school and large numbers of cancellations take place. I had a message yesterday from a constituent who boarded a train and it was then announced that it would not stop at any of the announced stops, but would go straight to Waterloo. That kind of experience is commonplace.
There is then the issue of industrial action. I am reluctant to ascribe blame and I am sure that the rail unions have their share of responsibility, but for almost a quarter of a century we had virtually no industrial action in this part of London. It is now frequent and we have had eight major strikes since the change of franchise. Clearly there is a complete breakdown of communication between the employees and the employers.
Then there is the issue of the new timetable that we were promised. It is probably a source of relief that the company has not tried to put it into practice. We are still offered the old timetable, which the company finds extremely difficult to operate.
Last but not least, there is the promise of a 3% fare increase. That has led to probably the most serious and general complaint about the service: that it simply is not value for money. The surveys recently carried out by Transport Focus suggest that only 36% of passengers judge the service to be value for money, and I am sure that is deteriorating by the day.
(6 years, 3 months ago)
Commons ChamberI am grateful to have secured this Adjournment debate on a very specific issue that was originally raised with me by my constituent Liz Barron, who felt sufficiently strongly and sufficiently affected that she brought supporters from Walsall and Northampton to my Twickenham constituency. I then discovered that the health issue that concerns her affects some 50,000, and possibly 70,000, people across the country —an average of around 100 people per parliamentary constituency.
Those people suffer from a condition called hypothyroidism—an underactive thyroid—which leads to a variety of conditions, including chronic fatigue. There is a link to cardiac symptoms and diabetes, and in some cases to mental illness. For many of these people, the condition leads to the absence of a full life, and in some cases it leads to serious disability, leaving those affected on benefits and unable to live life to the full.
Eighty-five per cent. of sufferers, at the very least, are women. Hypothyroidism is very gender-specific. Underlying the issue is a policy failure by Government. I do not mean this particular Government—this is a long-standing problem going back at least 10 years under successive Governments. The problem is a paradoxical one that is rather different from what we normally see in health debates. Typically the argument in health debates is that something should be done but there is not enough money, whereas in this particular case far too much money has been spent on over-expensive drugs, leading to a correction in the form of severe rationing, which is now causing a great deal of hardship.
I have sought the right hon. Gentleman’s permission to intervene. Does he agree that lab tests are just one part of the diagnostic puzzle and that other steps have been taken to address the fact that between 40% and 50% of patients are either over-treated or under-treated, which massively affects their quality of life?
There is a lack of precision in this area, and there are questions both on the number of people affected and on the dosages required. I fully take the hon. Gentleman’s point.
We are predominantly dealing with the questions of cost and of physical availability, but let me develop the argument a little. It is estimated that one in 20 of the UK population have a thyroid condition of one kind or another. The figures vary considerably, and within that aggregate there are people who suffer from hyperthyroidism—an overactive thyroid—and the opposite, hypothyroidism, an underactive thyroid, and then there are people with thyroid cancer, who suffer considerably.
There is a standard treatment for hypothyroidism, and I will attempt to pronounce the drug’s name once—levothyroxine—before referring to it by its more common name of T4. The drug is broadly accepted to be fairly uncontroversial, at least in the UK. It has been seriously controversial in France, where the drug company Merck varied the composition, leading to considerable side effects. There were large-scale protests by hundreds of thousands of people in France, but there has been relatively little controversy about this particular drug in the UK.
What is controversial is where the standard T4 treatment does not work, or does not work adequately, for a fraction of hypothyroidism sufferers, estimated to be roughly 12%—the range goes from 5% to 20%. It has been established by tests over the years, and by successful treatment, that those people benefit from an additional drug, liothyronine, known as T3. We are talking about 50,000 people in this position and, as far as we can establish, only about 6,000 of them are getting the treatment they should have, which would substantially alleviate their condition.
The roots of this problem lie in the charging and costings for this drug. There is a monopoly supplier, Concordia, a company that was originally called Goldshield. The word “gold” was probably so obviously embarrassing, given the way it treated this as a goldmine, that it changed the name to Mercury Pharma, and it has subsequently been changed to Concordia. Some 10 years ago, this company originally produced a packet of these drugs for about £4.50, but the cost then increased to £258 for the same product, which is an escalation of about 6,000%. The NHS was originally spending some £600,000 a year on this drug, but I established through parliamentary questions that in the past three years it has spent successively £22 million, £33 million and £30 million. There has been an enormous increase in cost and an enormous burden to the health service as a result of the extraordinary pricing that this company has adopted. The consequence is that a large number of clinical commissioning groups have stopped supplying the drug and a large number of people no longer have access to it.
The Government, to their credit, have responded in the past year or so with two specific interventions, the first of which was referring the matter to the Competition and Markets Authority so that it could examine the abuse of pricing. The CMA has provisionally reported that the drug company has been seriously abusing the market and charging excessively. In addition, the Government have engaged in a consultation exercise on limiting the availability of the drug. There was a strong negative reaction and some 30,000 people petitioned the Government on those potential restrictions, but they have proceeded with guidance, at least in England, and the drug has been removed in many situations. The guidance is somewhat ambiguous but, in essence, it says that the drug should be made available only through secondary care—through hospitals. A user has to obtain a consultation with an endocrinologist in order to have the drug prescribed, and often this is difficult to secure. What are the consequences of that? In some 23 to 25 CCG areas in England the drug is no longer available on prescription, and 90% of CCGs have said that they wish to stop supplying it, so we have a postcode lottery.
In addition, a lot of users have realised that they can get round these restrictions by going on the internet or travelling to Europe, because in many European countries the drug is available at cost. Remarkably, the NHS is paying some £9 per tablet, whereas in Germany it is available for 25p. People who have become aware of that can order it on the internet or go to Italy, Germany or Greece, where the drug is freely available. We are dealing with a combination of a postcode lottery, some well-off people able to pay the full market cost, and others who are using the drug unsupervised through internet purchases.
I shall round off what I want to say by posing questions on a series of issues to the Minister, the first of which relates to the history. We have had 10 years of a scandal that may well have cost the taxpayer some £200 million in overcharging, so I want to ask him whether he has any plans to retrieve that money. I established through parliamentary questions that the Government have been active in the High Court in cases of this kind and have recovered money for the taxpayer in previous cases of seriously abusive charging by companies. Do the Government have any plans to do the same in this case?
Why did it never occur to anybody in the NHS over the past 10 years to bring in these drugs from overseas? They are produced in Europe at standard quality, so there is no problem. Why is that not NHS policy? Perhaps I can recall a former Member of the House who was recently remembered because of his infamous “rivers of blood” speech: Mr Enoch Powell, who was once a highly respected Secretary of State for Health. One thing that he did in his period in office was to help the NHS to overcome issues of scarcity and cost by bringing in imported drugs in situations of this kind. There is a long precedent and I cannot understand why that option was not used on this occasion.
My second concern relates to current supply. Why are the Government not using the powers recently acquired through Parliament—in the Health Service Medical Supplies (Costs) Act 2017—under which they can force companies to cut their costs? That appears not to have happened in this case, and I am intrigued to know why. Two other companies have been licensed to break the monopoly; are they now producing the drugs, and at European-level costs? Are those drugs being made available to the NHS so that the problem can be resolved?
Finally, on the availability of the drugs to patients, will the Government introduce revised guidance to help a much larger number of patients to obtain prescriptions through their GP, as they did before, rather than having to go to a hospital? It is often not possible to get a consultation and, even if there is one, a prescription is difficult to obtain. Will the Government therefore issue revised guidance to help the large number of people who currently do not have access to the drug?
I conclude by quoting Sir Anthony Toft, a former physician to Her Majesty the Queen who was for many years president of the British Thyroid Association. He summarises the case from the point of view of an experienced professional:
“Experience of managing more patients with thyroid disease than most over a period of some 40 years is being trumped by inflexible guidelines; truly a remarkable state of affairs. Others hide behind guidelines to avoid the cost of prescribing liothyronine, which in the UK is exorbitantly priced by the sole supplier…when well-travelled patients can obtain supplies for a few euros in Italy and Greece and beyond.”
He strikes me as an authoritative and reliable source of advice. I do not know whether the Minister is aware, but 25 May—at the end of this week—is World Thyroid Day. He will make a lot of people very happy if they are able to celebrate that day with an advance in Government policy.
(9 years, 11 months ago)
Commons ChamberThe right hon. Gentleman is absolutely right. The Airbus factory in north Wales is an extraordinarily impressive part of British manufacturing. Most of us who have been there have been overwhelmed by the quality of its work. He is right that it is a European company and that it could not operate on any other basis than as a European network. Another key factor in its success has been the industrial strategy and the support that it receives through the aerospace growth partnership.
Northern Ireland is becoming a vital part of the United Kingdom’s business, trade and investment sector. It is showing clearly what it can do within the United Kingdom. Last week, Magellan Aerospace announced a £6-million investment and 47 new jobs in my constituency. Alongside that, there has been a £6.8 million investment in an advanced engineering and competitiveness centre for Northern Ireland, based in Belfast. Will the Secretary of State, in conjunction with the Northern Ireland Assembly and the Minister of Enterprise, Trade and Investment, Arlene Foster, develop innovative solutions in the advanced engineering sector, which are crucial to competitiveness and the growth of the British aerospace industry?
Indeed, we will. I have had good discussions with Northern Ireland colleagues about the very successful advanced manufacturing sector. Bombardier has an expanding presence in Belfast, as the hon. Gentleman will know, and there are other parts of the aerospace supply chain that we are keen to develop in Northern Ireland.
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I am not sure why I am expected to apologise for a planning decision in the hon. Lady’s constituency that relates to an application made when the enterprise was under public ownership.
Does the Secretary of State agree that the loss of £750 million in one day warrants closer examination or an inquiry? At the time of the sale, he indicated that no jobs would be lost and that jobs would be retained. The suggestion in the press today, and from the unions, is that jobs will be lost. Will the Secretary of State say what discussions he has had with the new owners of Royal Mail and those in a position to indicate whether jobs will be retained?
Because we no longer own Royal Mail—we are a substantial minority shareholder—we do not dictate to it what its manpower policy should be. Many jobs were of course lost under public ownership. As I understand it, the proposal currently being put forward, and which is being contested by Unite, relates primarily to white collar executives rather than members of the Communication Workers Union, but that is a matter for them to resolve.
(10 years, 7 months ago)
Commons ChamberYes indeed. The all-age careers service that we have put in place is now generally acknowledged to be giving successful advice through the age range. On schools, we recognise that there is an issue to address on the career paths of the non-academic—the more vocationally trained. We shall shortly be issuing guidance to schools on how to access independent advice.
The aerospace industry has shown marked improvement in the past few months. Just last week, Magellan Aerospace in Belfast announced a new job contract through the Prime Minister, and jobs and opportunities were created. Is it now time for higher education and for industry, particularly aerospace, to work together to make sure that those jobs are taken by young people from universities and colleges at this time?
I am sure that the hon. Gentleman is absolutely right. I was in Belfast recently and met a combination of Northern Ireland universities and industry. They are working together and realise that a recovery is taking place, despite the problems of the traditional industries around Belfast. Such work requires the kind of collaboration he has described.
(10 years, 7 months ago)
Commons ChamberI thank my hon. Friend, who remembers such things from his time in the House, for his reminder. We have, I think, had four Select Committee reports under different Governments. The matter has been actively debated for something in the order of eight years, and we have moved quickly on it in comparison with what went before.
The failure of the pub companies to self-regulate underlines the need for an adjudicator, as does the fact that a number of pubs are closing. Does the Minister not feel that there is a sense of urgency in relation to bringing in legislation?
As I will say later—we have covered the matter in earlier debates—we did try to encourage self-regulation. We drew the conclusion that the action had not been adequate, which is why we moved on to proposals for statutory regulation on which we are now consulting. We have been down that road; we have tried that.
As I said earlier, there were more than 1,000 individual responses to the consultation. Many described very similar stories to the one that my hon. Friend has just mentioned.
May I move on, as the hon. Gentleman has intervened once already?
Just as this is not primarily an issue about the rate of closures, I think we would all agree that it is not fundamentally an issue of consumer choice. Otherwise, the competition authorities would have been engaged a long time ago. It has already been shown that the share of microbreweries has increased over the period for which many pubs have been under a great deal of stress. The number of breweries now tops 1,000, the highest figure since the 1930s.
The conclusion that I think we have all reached is that there are issues with the beer tie, but that is not the fundamental problem in itself. The Business, Innovation and Skills Committee argued that it does not want to see the tie model disappear. Under proper conditions, it is a business model that can be used and it has been around in various forms since the 18th century. The abuses are a different matter and are due in part to the lack of transparency in the relationship between the pub-owning companies and their tenants, which is what I want to turn to.
(10 years, 10 months ago)
Commons ChamberIt could be, but I know from my interaction with them that setting the minimum wage is a complicated enough issue in itself, but I will certainly bear the suggestion in mind.
I will enumerate a few more points and then take further interventions.
Exclusivity is a serious issue. The second point, which I think one or two Labour Members have been trying to make, is that there are cases where the simple lack of predictability is damaging for families trying to manage their personal finances responsibly, especially those who are employed on a regular basis for a long period of time and are then, in the jargon, zeroed down. A problem would flow from that. Then there are people who are on zero-hours contracts for many years and for whom it becomes a way of life. There may be good sectoral reasons for it, but in some cases it is a way of keeping them out of regular employment with the various obligations that are attached to it. In our gathering of evidence, we have encountered two specific instances. There are people who sign up to a zero-hours contract in good faith, because it gives them and the employer flexibility, but they then take advantage of their right to reject work and are discarded because they are allegedly inflexible, defeating the whole purpose of the contract in the first place. We found that other people were indeed pressurised into taking zero-hours contracts against their better judgment and against their preference. All those things happen, and they must be weighed against the undoubted advantages that some individuals and some industries gain from having the option to make such arrangements.
At a time of economic squeeze, when those who tender or apply for contracts find that their prices must be lower, they are forced to apply the minimum wage and to restrict working hours, and that has an impact on those who are on zero-hours contracts. Does the Secretary of State feel that the Government have a duty to ensure that the tender process gives workers rights, whether it takes place at Government level, at council level or at regional level?
The hon. Gentleman is right to view the matter in that broader context. Several Members, including the hon. Member for Streatham, have already given the example of domiciliary visits in the care sector. I have encountered cases in my constituency involving people whose working conditions are very poor, who are on zero-hours contracts, whose pay is very low, and for whom there is no chance of progression. When we dig into such cases, as I did on one occasion, we may discover that the companies concerned are not profit-making companies but charities, and that the real cause of the problem is the very poor price at which they took the contract. The origin of the problem therefore lies in local government. The zero-hours contracts and, indeed, the minimum wage issues are symptoms rather than causes.
Let me list some of the matters that we will be considering in the consultation, and explain how we will approach them. It is important for us not to close down options. First, there is the issue of exclusivity. We could do nothing, and rely on existing law; we could ban it; or we could provide effective information and guidance requiring employers to justify it. A number of legal interventions are possible.
Secondly, we must consider the cases of people who are employed on zero-hours contracts for very long periods when they do not choose to be. Should we introduce a system requiring employers to offer permanent employment at some stage?
Thirdly—and probably most important—there is the issue of transparency. We can argue in favour of fairness, and we can also argue that, for the economic purposes of a flexible labour market, if rational people know what they are doing, that is a considerable improvement. The problem that we have discovered, and to which many Members have already referred, is that when people accept a job offer they are often not clear about the obligations and limitations that are involved. Should we introduce a code of conduct requiring proper transparency and information? Should it be voluntary, should it be a Leveson-style code with statutory underpinning, or should it be controlled by a stronger sanction-based body? We have a range of options, and we will view them with an open mind and act accordingly.
(11 years, 1 month ago)
Commons ChamberOf course, we need prudent, responsible lending, but I subscribe to the view, which I hear frequently around the country, that many SMEs find it difficult to access finance from the banks and that we cannot just let the situation remain as it is. That is why we are in the process of establishing the business bank, which is currently marketing £300 million. There is substantial interest in investing in that project.
In the last period of time, it has been quite understandable that there have been problems with getting loans from banks, but another problem has been with small and medium-sized businesses being paid in time. It has been suggested that some £30 billion is outstanding in payments from big business to small business. What steps are being taken by the Secretary of State to help small business get moneys paid on time by big business?
My colleague the Minister of State has launched an initiative to ensure rapid settlement, particularly down the supply chain. We name the big companies that do not settle their debts properly in that way. We also have a programme of supply chain financing, the advanced manufacturing supply chain initiative, which will help the settlements to which the hon. Gentleman refers.
For the record, I am a Democratic Unionist, not an Ulster Unionist. In an earlier response, the Minister said that he was not sure what 73% of shop workers were after. What they were saying was that they were concerned about legislative change being made permanent for the future. The issue they were worried about was changing Sunday trading for ever.
If that was the worry, we have dealt with it effectively, making it absolutely clear that this is a one-off, temporary and very specific change.