The National Health Service

Eleanor Laing Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. We will begin with a time limit of seven minutes, but I would expect that to reduce as the day goes on.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. I am very sorry, but after the next speaker, the time limit will have to be reduced to five minutes. If Members who wait to the end are annoyed about that, they will have to speak to all those who intervened on the Minister and the Front-Bench spokespeople at the beginning of the debate; I do not blame the Minister or the Front-Bench spokespeople.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. We now have a five-minute time limit.

The National Health Service

Eleanor Laing Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

I inform the House that Mr Speaker has selected the amendment in the name of the official Opposition.

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[Jonathan Ashworth]

Let me deal with this point first.

The people of Leicester can see what is happening. Although the Secretary of State is putting money into Leicester Royal Infirmary, Leicester General Hospital in the constituency next door loses maternity services, loses the hydrotherapy pool, loses renal services, loses—[Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Remember that we were all going to try to be polite. The hon. Gentleman is talking about hospitals that people care about, and we must listen to him.

[Jonathan Ashworth]

It loses elective orthopaedics, loses urology, loses brain injury and neurological services, loses gynaecology, and loses podiatry.

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[Jonathan Ashworth]

Absolutely.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Let me say before the hon. Gentleman answers the intervention, that he has been very generous in taking interventions, and that is good for the debate, but I am sure he will bear in mind that he has been at the Dispatch Box for nearly half an hour, and I just say to him gently that that is all right with me, but he will incur the wrath of those who are waiting to speak later in the debate when they only get three minutes.

[Jonathan Ashworth]

Thank you for your guidance, Madam Deputy Speaker. You are absolutely right. I will not take any more interventions and I will move to wrap up.

My hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) is absolutely right that the compulsory competitive tendering provisions of that Act have forced through the privatisation of £9 billion-worth of contracts. Everything that was promised in the Act, from delivering on health inequalities to delivering more integrated care, has not come to fruition, which is why everybody understands that it needs to be repealed.

But there is another reason why the Act needs to be repealed: while it is on the statute book, it runs the risk of the NHS being sold off in a Trump trade deal. Under the World Trade Organisation, public services can only be excluded from trade deals where there is no competition with private providers or where they are not run for profit, but the enforced competitive tendering of contracts through the Lansley Act means private health providers already operate in competition with public NHS providers, and the so-called standstill ratchet clauses and the inter-state dispute mechanisms would mean a Trump trade deal would lock in the privatisation of our NHS ushered in by the Health and Social Care Act.

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[Mike Gapes (Ilford South) (IGC)]

I enjoy the knockabout that has been going on, but will the Secretary of State accept that the NHS reforms brought in by Andrew Lansley led to fragmentation, duplication and inefficiencies, which we are now trying to remedy by reconstructing and bringing groups together, as we are doing in north-east London, and that therefore there is merit in that part of the Opposition’s amendment?

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. If the Secretary of State answers the intervention, I will say to him what I said to the Opposition spokesman, which is that he has been generous in taking interventions but having been at the Dispatch Box for nearly half an hour, I hope he will be careful not to incur the wrath of Back Benchers who will have to wait until 7 o’clock to speak.

[Matt Hancock]

Yes, I am trying to take as many interventions as is reasonable. I feel as though I have been sitting down for most of the half hour that I have technically been speaking for—

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[Mr Sheerman]

On a point of order, Madam Deputy Speaker. The Secretary of State has made a serious allegation about my hon. Friend the Member for Leicester South. I have been in this House for a long time and I recall when PFI started under the John Major Government. [Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. That is a point of information, not a point of order. I will make no comment on it.

[Matt Hancock]

I will debate the hon. Gentleman’s involvement in PFI, which hamstrung the hospitals, every day of the week. Now, however, I wish to—

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[Geraint Davies (Swansea West) (Lab/Co-op)]

On a point of order, Madam Deputy Speaker. The Secretary of State has been talking now for nearly half an hour, yet he has not really referred to the amendment in respect of the relationship between public health and trade, particularly the ability of tribunals and companies to sue.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. That is not a point of order; it is a point of debate. I understand the hon. Gentleman’s frustration, so I will repeat what I said earlier: the Secretary of State has been, as was the Opposition spokesman, most dutiful in taking lots of interventions. I have allowed those interventions because I recognise that Members want to refer to particular hospitals and other things in their own constituencies. I allowed them, but I now encourage the Secretary of State to cease—

[Geraint Davies]

It is a point of order.

[Madam Deputy Speaker]

No, it is not a point of order if I say it is not a point of order.

I encourage the Secretary of State to make progress. I appreciate his generosity to his colleagues, but we will have to make some progress.

[Matt Hancock]

Quite right. I am voting for you, Madam Deputy Speaker.

On the point made by the hon. Member for Swansea West (Geraint Davies), to whom I will not give way—

Baby Loss Awareness Week

Eleanor Laing Excerpts

Tuesday 8th October 2019 Commons Chamber

[Anna Soubry (Broxtowe) (IGC)]

It is a real pleasure to follow the hon. Member for Brigg and Goole (Andrew Percy). My contribution to the debate will touch on a lot of what he said about the situation, which is undoubtedly true. It struck me again because of two constituents in particular who came to see me. I had my children at the Queen’s Medical Centre in Nottingham. My constituents went in there expecting, as most of us do when we go into hospital to give birth, that they would be taking their baby home after a safe delivery. Emily was their second child, and she died—she was a stillborn baby. That was at the end of 2013.

Until I met Richard and Michelle Daniels, I had not appreciated some of the issues we are talking about. When I gave birth to my babies, I had two wonderful deliveries, although they were very painful. However, I do not talk too much about the great pleasure, joy and magic I experienced in becoming a mother on those two occasions. I felt real shock when Richard and Michelle came to tell me that, although they got the most terrific care, love and support from the remarkable staff at the QMC when Emily was born dead, there was no facility at all, as the hon. Member for Brigg and Goole described.

It is true that there is nothing worse that could happen to any of us than to lose a child, but it must be even more heartbreaking to lose a child and then to be surrounded by people experiencing all the wonderful joy and celebration of a new birth and of having a new member of their family, but not to have somewhere to be able to say goodbye properly or to have quiet time. People also need the opportunity to bring in other members of the family so that they, too, can say goodbye. I was just blown away in my shock and horror when I heard that, in Nottingham, we had no such suite at all in the QMC or the City Hospital. That had been going on for many years, and one can only imagine how many people have suffered in that way, given all the touching speeches that hon. Members have made.

In early 2014, Richard and Michelle Daniels set up a charity called Forever Stars. They poured all their remarkable energy and dedication into making a great success of it, and they have raised over £400,000. Their first project was to install a serenity suite at the QMC—a place where a couple can go in the event of an unsuccessful delivery and the loss of a child. They can say goodbye properly, in the way that has been described, and siblings and other members of the family can come along. In due course, there was another serenity suite, at the City Hospital in Nottingham—again thanks to the Forever Stars charity that Richard and Michelle set up. That is now in operation.

By a remarkable coincidence, the hon. Members for Eddisbury (Antoinette Sandbach) and for Colchester (Will Quince) set up their all-party group in this place in 2015, and we had that first debate. I remember it distinctly. There were so many appalling stories that there was not a dry eye in this place, and that included your good self, Madam Deputy Speaker. All us were filled with a mixture of grief, horror and disbelief that so many people suffered baby loss with none of the proper facilities that they should have.

It is full credit to the Government of the time and to the former Secretary of State for Health, the right hon. Member for South West Surrey (Mr Hunt), that they did not mess about. They took up the campaign, and huge progress has undoubtedly been made. It is thanks to a lot of cross-party working and the considerable efforts of the former Secretary of State and his team, as well as those two hon. Members and others, that we have seen such marked progress.

The work of Forever Stars continues. As you can see, Madam Deputy Speaker, I am wearing pink and blue. That was not necessarily my first choice to put on this morning. It was a bit of a bet with Mr Richard Daniels that I would do it. However, I wanted to do it because Forever Stars is painting Nottingham, and indeed Broxtowe, pink and blue. Like so many other charities that have come out of so much tragedy and that are doing great work, Forever Stars is raising awareness, on top of the other work that it does. We have heard why that is so important.

I, too, join the calls in the report that the Baby Loss Awareness Alliance put out today—“Out of Sight, Out of Mind”—for specific work to be done to make sure we cater for grieving parents, siblings and other members of the family. I may one day be a grandparent, and it must be terrible for grandparents to see their own child and son-in-law or daughter-in-law suffer in the way that we know people do. We also know the effect these things have on siblings; we often forget them and how one explains things to them, and they often need support.

Forever Stars tells me that, in just the last 24 hours, it has had four calls from parents who have suffered a baby loss and who would very much like to be referred to the counselling or the psychological, and sometimes psychiatric, services that they desperately need. It is really important to ensure that those services are in place. I am told not only that 60% of parents surveyed want those services, but that nine out of 10 CCGs do not commission the talking therapies that the hon. Member for Ellesmere Port and Neston (Justin Madders) rightly spoke about.

Forever Stars continues in its great work and is now raising funds to create a serenity garden for parents in Nottingham. There will be a service every quarter when parents and, of course, other family members can go along to say goodbye again to a child or baby they have lost.

It is really important to recognise that this place does some terrific work when it comes together in this way. The APPG has done that terrific work on a cross-party basis. It is all too easy in the current political climate for people to criticise Parliament and set it up against the people, but that would be wrong in many ways. This is an example of why that is just not true, because this place can do genuinely great work that touches the lives of real people.

[Madam Deputy Speaker (Dame Eleanor Laing)]

The right hon. Lady is absolutely correct. When this House comes together and works properly, we do achieve what those who send us here expect us to achieve and hope that we will achieve. It is just such a pity that more people do not watch the proceedings on days like this instead of on days when the Chamber is crowded.

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[Jim Shannon]

I thank the right hon. Lady for that intervention.

Let me read those words again:

“I carried you for every second of your life—and I will love you for every second of mine…Let sweet Jesus hold you until mummy and daddy can hold you—you have just reached heaven before I do.”

[Madam Deputy Speaker (Dame Eleanor Laing)]

I thank the hon. Gentleman for his excellent speech. The whole Chamber agrees with every word that he has just said and appreciates the way in which he said them.

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[Ms Dorries]

What I will say to my hon. Friend in response is that, in the long-term plan, the NHS commits to

“improve access to and the quality of perinatal mental health care for mothers, their partners and children”.

We have committed in the long-term plan that an additional 24,000 women will have access to specialist perinatal mental health support, including more support for fathers and partners. That is part of the £2.3 billion investment in mental health that this Government recently announced. I will say it again: £2.3 billion. That is over half the annual prisons budget. Of course, some of that money has to be directed towards mothers in this situation.

My hon. Friend the Member for Banbury (Victoria Prentis) made an important point about infant mortality in other countries around the world. The Secretary of State for International Development announced a £600 million reproductive health supplies programme to help end preventable deaths of mothers, newborn babies and children in the developing world by 2030. It will give 20 million women and girls access to family planning, prevent 5 million unintended pregnancies each year up to 2025 and focus on the most vulnerable women, including FGM survivors. We are committed to working with Gavi, the Vaccines Alliance, to vaccinate a further 300 million children in the world’s poorest countries by 2025.

My hon. Friend also talked about making maternal mortality a never event. I am not sure that that will be an achievable objective, but NHS England is supporting the establishment of maternal medicine networks, which ensure that women with acute and chronic medical problems have timely access to special advice and care at all stages of their pregnancy.

The hon. Member for Ellesmere Port and Neston (Justin Madders) spoke about grief. Grief, for me, is the last taboo; it is the one thing that people still do not talk about. People still do not talk about how grief affects them, and I hope that some of the investment we are putting into mental health services and community services will help people to address grief.

My hon. Friend the Member for Brigg and Goole (Andrew Percy) spoke about somebody who works in his office who has raised funds for the Cherished suite, and the right hon. Member for Broxtowe (Anna Soubry) spoke about the serenity suite. Over 50% of hospitals now have such suites, which are so important. I do not want to reiterate what anybody has said, but the fact that babies are born in a part of a hospital that is traditionally filled with joy is incredibly difficult. My hon. Friend the Member for Colchester has told me that it makes such a difference if people have somewhere to go and even to stay overnight with their baby, and where the family can go. Over 50% of hospitals in the UK have these suites, and I am going to ask that these suites are made available in the maternity areas at all the 40 new hospitals that are being built. [Hon. Members: “Hear, hear.”] I will ask; I will certainly push.

I want to continue with the points raised, and please pull me up if I miss anybody out. The hon. Member for Strangford (Jim Shannon) spoke so passionately—thank you. I know he has spoken in every baby loss debate we have had, and he has also spoken in the past about the important role that chaplains play in such situations. I would like to thank him for his incredible contribution. He asked about the pregnancy loss review. It is currently working with key partners to make recommendations to the Government about improving the care and support that women and families receive when experiencing a pre-24 week gestation baby loss. We are hoping the report will be published in due course and not too long from now.

I would like to speak about an area that I have particularly focused on, which is group B strep support. I have spoken about this many times, and I had my own Adjournment debate on it before I was a Minister. When I arrived in the Department, I set five key priorities, and this is No. 1 in the key priority areas because this in itself will prevent infant mortality. Group B strep is a leading cause of bacterial infection in newborn babies—just to put that on the record. I fully support the review that is taking place, and I hope that it has some further information so that we can make progress on this in, I hope, the not-too-distant future.

The hon. Member for Rotherham (Sarah Champion) spoke about hospices. I have Keech Hospice in my own constituency. I think hospices and their role is slightly outside the debate, bearing in mind the level of investment that we are putting into mental health services and counselling services. Somebody mentioned improving access to psychological therapies and the importance of talking therapies. I hope that any mother or family who needs mental health counselling as a result of baby loss will in future be able to access those services. I will write to her about the role of hospices in this particular area.

I appreciate the support from Members on both sides of the House in relation to the maternity safety ambition. I echo your words, Madam Deputy Speaker, about the tone of this House in such important debates. One of the most important things to come out of the debate today is the importance of learning for improvement and what we are beginning to learn through the perinatal mortality review tool and the Healthcare Safety Investigation Branch, which I have mentioned, that was introduced by the former Secretary of State.

I would like to remind Members that the NHS is still—and the NHS in the UK is still—the safest place in the world to have a baby: 0.7% of all births result in a stillbirth or a neonatal death. Having said that, on a day like today, 12 babies in England and 15 across the UK will be stillborn or die soon after birth, and many more families will lose a baby through miscarriage, ectopic pregnancy and other causes. We are, however, making progress: in 2015, the figure was 17 babies a day. Maternity and neonatal safety initiatives are beginning to improve outcomes, with most of the anticipated impacts still to be realised, as safety improvements are embedded in maternity and neonatal services and as we learn more from research and investigations about which babies die and why.

Finally, as we have discussed, the theme of Baby Loss Awareness Week 2019 is psychological support for those bereaved parents who need it. I understand that a working group is being convened to support the development of maternity outreach clinics that will integrate maternity reproductive health and psychological therapy for women experiencing mental health difficulties arising from and directly related to the maternity experience. I will undertake to ask this working group if it could consider extending the maternity experience to those who have lost a child in pregnancy, during labour and childbirth in the neonatal period.

I would like to finish by thanking all the midwives, doctors and healthcare support workers who do such a fantastic job in delivering more than 600,000 babies successfully every year and in helping the parents who, sadly, do not experience the happiness of a healthy baby.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Thank you. What an excellent, calm and constructive debate.

Question put and agreed to.

Resolved,

That this House has considered baby loss awareness week.

Women’s Mental Health

Eleanor Laing Excerpts

Thursday 3rd October 2019 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Before I call the next speaker, may I say to the hon. Lady that however difficult it might be, it is wonderful to hear the truth spoken in this place, especially in an atmosphere that for decades—indeed, until very recently—considered childbirth to be some form of weakness, rather than the process through which every human being arrives in this world. Speaking the truth, and dealing with matters as people deal with them in their everyday lives in the constituencies that we represent, is terribly important, and it marks a refreshing new attitude to the way we do business in the House of Commons.

Non-invasive Precision Cancer Therapies

Eleanor Laing Excerpts

Thursday 18th July 2019 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

I will try to manage without a formal time limit. If everybody takes around five minutes, everybody will have the opportunity to speak.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Hon. Members have done well on six minutes, but can we please now aim for five minutes? I am sure that people want to hear what the Minister has to say in response. There is no point in asking questions if there is no time for the Minister to answer.

[Kate Hollern (Blackburn) (Lab)]

I echo the comments of my hon. Friend the Member for Easington (Grahame Morris). There is not one Member in this House whose life has not been touched by cancer. My late partner, John, suffered from it and, sadly, lost his battle two years ago, despite excellent treatment from the Royal Blackburn Hospital. I know and sympathise with many constituents struggling through treatment. Major breakthroughs have been made in radiotherapy in the past 10 years, with modern advanced radiotherapy being more precise, curing more patients and producing fewer side effects to the point where patients can continue to work normally; but when comparing cancer services on a global scale, we see that only one quarter of people in the north-west believe that the NHS offers the best cancer care.

Like John, 47,000 men a year in Britain are found to have prostate cancer, and more than 11,500 a year die from the disease. Last October, the University of Birmingham published an article about a breakthrough in treatment. Previously, it was unclear whether there was any benefit to treating the prostate directly with radiotherapy if the cancer had already spread. The research helps to answer the question and has implications beyond prostate cancer. Clinical trials for the disease found that advanced radiotherapy boosted survival rates by 11% for men whose cancer had spread to nearby lymph nodes or bones. The result is likely to change the care given to around 3,000 men every year in England alone, and could benefit many more around the world.

I am conscious of the time, so I am going to shorten some of my points, but I still feel that they are important. Until now, it was thought that there was no point in treating the prostate itself if the cancer had already spread because it would be—I have heard those words—like shutting the stable door after the horse had bolted. However, the study proved the benefit of prostate radiotherapy for those men. Unlike many new drugs for cancer, radiotherapy is a simple and relatively cheap treatment that is readily available in most of the world. However, there are two main issues with access—the tariffs and the availability of modern radiotherapy machines.

As other Members have said, the current tariff disincentivises trusts from saving money because their income depends on the number of treatments. NHS research has shown that treating prostate cancer patients with 20 treatments, rather than 37, was better for patients and would save the NHS in excess of £20 million a year. I hope the Minister will let me and others know when the current situation will stop. When will NHS England allow trusts to use the radiotherapy equipment that they already have to move to even shorter periods of treatment? A period of five treatments has gradually been adopted around the world for large numbers of prostate cancer patients.

Preston is our nearest radiotherapy centre. It is a very short journey from Blackpool to Preston, but Preston is really struggling with workforce, funding and a shortage of oncologists. At least four of the seven machines there are in the second part of their life. There needs to be funding to provide, sustain and maintain the machines. In October 2016, NHS England announced a £130 million investment to spend on upgrading radiotherapy machines. It was welcome, but that money was merely the underspend from the drugs budget. Of the 260 machines in use, approximately 90 needed replacing by the end of 2017. We must ensure that the machines have a sustainable future.

Finally, I want to echo the asks in the “Manifesto for Radiotherapy” for a one-off £250 million investment and an estimated sustained additional £100 million a year to catch up and provide the advanced, modern radiotherapy and IT networks currently needed in the UK. Experts, charities, clinicians and patients are calling for urgent investment in radiotherapy services. Please, Minister, listen, and support the motion before the House.

[Madam Deputy Speaker (Dame Eleanor Laing)]

That was a very courageous speech by the hon. Lady, and I am only sorry that she had such a short time in which to make it.

Medical Cannabis under Prescription

Eleanor Laing Excerpts

Monday 20th May 2019 Commons Chamber

[Jeff Smith]

That is not an unusual case. There are lots of people who want to use medical cannabis and do not want to buy it from the street or go to Holland to import cannabis products, and they are frustrated.

I will wind up, because I have been speaking for longer than I intended. On the funding issue, there are cases of clinicians being willing to prescribe but being blocked by trusts or CCGs. What is the Minister’s understanding of how many cases there are where funding is the issue, rather than prescription? Even where clinicians are willing to prescribe and there is new thinking, CCGs do not have budget lines for some of these products, so the reluctance is understandable. I am interested to know whether the Minister has any information on that.

It might cost more for the NHS to supply more medical cannabis prescriptions, but we have to compare that with the reduction in other costs. The estimate is that opioid costs would be 25% lower, and there would be fewer hospital admissions. Professor Mike Barnes said in his evidence to the Select Committee that we could probably introduce medical cannabis in this country on the NHS at no net cost, when we take into account the reduced costs elsewhere.

Our system is clearly too restrictive. It is not working. We need creative thinking and flexibility from the Government, and we need them to look at the different types of evidence from around the world. There are people in this country who, if they were living in Holland, Australia or Canada, would be able to get on with their lives, get their cannabis products legally and not have the worries of the campaigners in our Gallery today about them or their children and relatives having to go through chronic pain or the episodes of epilepsy that we have seen in young patients over the last year.

We all want to make some progress and are desperately frustrated that we are not able to get anywhere. I refer the Minister to the evidence given by Professor Mike Barnes. We need to look at other types of evidence to inform ourselves of a way to deliver the products that our patients need into their hands.

[Madam Deputy Speaker (Dame Eleanor Laing)]

The hon. Gentleman made reference to the late Member for Newport West. The House will remember fondly that the late Paul Flynn raised this subject in the House persistently over many decades, and got very little support. I keep looking behind me, expecting to see him there in his usual place—

[Sir Mike Penning]

He’s watching you.

[Madam Deputy Speaker]

The right hon. Gentleman says Paul Flynn is watching us, and I have every confidence that he is. I say on behalf of the whole House that we remember him fondly.

Health

Eleanor Laing Excerpts

Tuesday 14th May 2019 Commons Chamber

[Nick Smith]

Will the Secretary of State give way?

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. The Secretary of State is not giving way, and we are running out of time.

[Matt Hancock]

Once again, a Conservative Government are expanding the NHS and planning for the future to ensure that it will always be there for us, with a record £33.9 billion investment and a focus on preventing ill health in the first place. I believe that, from the bottom of our hearts, we all know that we need to deliver.

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Before I call the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), I should give a gentle warning to colleagues. Obviously a great many people want to speak, and there is limited time, so there will be an initial speaking time limit of six minutes. I give that warning in advance so that speeches can be restructured.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. As I indicated earlier, there will be an immediate time limit of six minutes.

Integrated Care Regulations

Eleanor Laing Excerpts

Monday 18th March 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I beg to move,

That an humble Address be presented to Her Majesty, praying that the Amendments Relating to the Provision of Integrated Care Regulations 2019 (S.I. 2019, No. 248), dated 13 February 2019, a copy of which was laid before this House on 13 February, be annulled.

I am grateful that we have found time to debate this prayer motion in my name and the name of my right hon. Friend the Leader of the Opposition. For the Government to have attempted to make these changes without proper scrutiny is a huge discourtesy to the House. These changes are fundamental, with potentially far-reaching implications for the NHS, and they have aroused concern—[Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. It is not fair to the hon. Gentleman that people who have voted are now having conversations here. I would be grateful if people who wanted to talk about other things left the Chamber.

[Jonathan Ashworth]

The changes in the regulations have aroused considerable concern in the country, and proper parliamentary time should have been made available for a proper debate on them; they should not have been made through secondary legislation.

The Opposition oppose the regulations and will seek to test the House’s opinion on them. We oppose the changes not because we are against integration. We have long called for greater integration of services to offer seamless care to patients, because the demands on the NHS are of a different nature from those of 71 years ago, when a Labour Government created the NHS with a tripartite structure. In those days, life expectancy was so much shorter, and infectious disease was the overwhelming medical challenge. In 2019, we are worlds away from the days when 30,000 hospital beds were set aside for the treatment of tuberculosis, or when wards were filled with row after row of iron lungs to treat those suffering from polio. Today, we are all living longer, with a variety of complex conditions, from diabetes to cardiovascular disease and chronic obstructive pulmonary disease—conditions that increase the risk of a poorer quality of life and mean a greater risk of premature death. Indeed, around 14.2 million people in England—nearly a quarter of all adults—have two or more conditions. More than half of hospital admissions and out-patient visits, and three quarters of primary care prescriptions, are for people living with two or more conditions.

The issue is not just ageing and frailty; poverty takes its toll. People in the most deprived areas of England can expect to have two or more health conditions at 61 years—10 years earlier than people in the least deprived areas. Health inequalities are widening, while advances in life expectancy are stalling. An ageing population, the increase in long-term conditions, and the increasing number of people with multiple health conditions means that we need to integrate services. Sometimes in these debates, when we talk of long-term conditions, we suggest that we are talking about a homo- geneous group, but it is quite the opposite. We could be talking of a 61-year-old man with renal failure and high blood pressure, or a 101-year-old woman with profound deafness and blindness. The way that such conditions affect quality of life, and the extent to which they are amenable to medical intervention, is likely to vary.

If health services are not better co-ordinated and not integrated, there is a greater risk to patient care through the poor co-ordination of medical care and increased time spent managing illness. The need to manage multiple medications may lead to poorer medication adherence, adverse drug events, and the aggravation of one condition by the symptoms or treatment of another. It can also mean damaging self-management regimes in which there are competing priorities, and a bewildering landscape for patients, who are often of an advanced age, with cognitive impairment and limited health literacy, so we support integration.

I have seen integration working on the ground. Just last week, I was in Bolton, where I visited the Winifred Kettle centre to see the model of integrated multi-agency work bring together mental health professionals, pharmacy, physio, occupational therapy and social workers. In Bury, I heard about how the local council’s chief executive doubles up as the chief executive of the clinical commissioning group. In Luton and Dunstable I saw with my own eyes that the hospital trust has various social care workers in its discharge unit, helping to avoid the indignity of huge numbers of elderly patients being trapped in hospital, ready for discharge but delayed for days on end, as happens too often. In Wolverhampton, a fascinating example is being developed: the hospital trust is taking on and employing GPs directly. In Wolverhampton, they call it vertical integration, although some might wish to go as far as to suggest that it is the nationalisation of general practice, something that not even Nye Bevan was able to achieve.

A Labour Government would move away from a competitive landscape of autonomous providers to one of area-based care delivered through integration, collaboration, partnership and planning. We will restore a universal, publicly provided and administered national health service. Locally, we envisage something akin to health and care boards, with a duty to provide health not only for those on a CCG list but for all residents. Nationally, the Secretary of State’s duty to provide care will be reinstated. We are consulting on these matters with patients, staff and wider stakeholders.

Mental Capacity (Amendment) Bill [Lords]

Eleanor Laing Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

It will be obvious that three people have indicated they wish to take part. I am sure that they will all limit their remarks not to a very small amount, but if they could be limited to six or seven minutes then everyone will get a chance to put their view.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

It is a pleasure to follow the hon. Member for Torbay (Kevin Foster).

It is my firm belief that the Bill is deeply flawed. Even with the concessions Ministers have made, and the forensic scrutiny and dogged determination of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and her Opposition Front-Bench team, as well as those in the other place, the Bill will do very little to help the crisis in our mental health services. Even at this late stage, I would add my name to those of my many colleagues and a plethora of stakeholder organisations urging Ministers to delay the Bill to allow proper deliberation and discussion. Why do I say that?

First, we cannot debate the Bill without a clear sense of the issues at stake. We are talking about the state’s right to remove liberty from a citizen without trial or the judgment of their peers. That goes to the very heart of habeas corpus and our most fundamental human rights. It concerns the very liberties that this Parliament has stood for centuries to defend. When Parliament has played fast and loose with our right to be free from arbitrary imprisonment, the consequences have brought shame upon us, so we must always think very carefully before passing laws that remove a person’s liberty, no matter how compelling we consider the reasons.

Secondly, we must never forget the history of the treatment of people with mental illness in this country. We have a sorry and shameful history of incarcerating people with mental illness, autism, dementia and other conditions. Often the incarceration was unnecessary and cruel, and motivated by malice not medicine. Women in particular could be locked up for so-called “hysteria” when husbands wanted them out of the way. We must tread very carefully.

Thirdly, there is the question of scrutiny of the Bill. We must act only after the deepest of thought and most widespread discussion and consultation. Unfortunately, the Bill has not been subject to the widest consultation and the deepest discussion. The discussion and suggestions that we made in Committee seem to have been largely ignored by the Government. We might have expected Ministers to have learned the lessons from the Health and Social Care Act 2012, which was imposed without consultation and then had to be delayed after its flaws were exposed. It then cost us hundreds of millions of pounds for an unnecessary raft of reckless reforms.

The Bill has been rushed and the consultation with stakeholders has been incomplete. You do not have to take my word for it, Madam Deputy Speaker. Just consider the remarkable open letter issued on Friday 8 February by so many of the organisations closest to the issue: the Voluntary Organisations Disability Group, Disability Rights UK, Foundation for People with Learning Disabilities, Action on Elder Abuse, Dementia Friends, Sense, the National Autistic Society, Royal Society for Blind Children and Mencap, just to mention a few—a very few—of the more than 100 local and national organisations across England and Wales who wrote to the Care Minister and the Parliamentary Under-Secretary of State, Baroness Blackwood.

What did this huge coalition of caring organisations come together to say? They raised “serious concerns” and “significant objections”. They called the Department for Health and Social Care’s consultation “piecemeal”. They talked about “serious conflicts of interest”. They highlighted the facts that impact assessments have been late and limited in coverage, and that there is a lack of clarity about how the system will be regulated with independent oversight. They concluded:

“We believe that the reforms in their current guise pose a threat to the human rights of those requiring the greatest support in life.”

A threat to human rights is a serious charge. When so many organisations are making it, surely Minsters must listen and not just plough on regardless?

There is a saying in the disability rights movement: no decisions about us without us. When I served as a trustee of the Alzheimer’s & Dementia Support Services and as a Mencap Society committee member, that was a principle we held dear, yet those in their place on the Treasury Bench are not listening. To be clear with the House, we have a serious problem that needs fixing. We have vulnerable people waiting for months, families at the end of their tethers and mental health and care professionals feeling frustrated, and that is why the system is broken.

--- Later in debate ---

[Chris Bryant]

I was expecting my hon. Friend the Member for Stockton North (Alex Cunningham) to go on a bit longer, but now that I have the Floor, let me say this.

There is quite a bit of consensus, certainly among Labour Members, that there are elements of the Bill with which we are not happy, and I am sure that we will vote on those in a few moments. What the Minister said earlier makes me hopeful that she will do her level best to ensure that the way in which the needs of people with acquired brain injuries can be met will be clearly laid out in the code of conduct. As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, some of the issues are very specific to them; they are different from those affecting other people in the same category.

The deprivation of liberty is one of the most important issues that Parliament ever has to consider. We all accept that, and it was referred to by both the Minister and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley). I hope that we manage to get the code of conduct right, at the right time, and that the process we use ensures that as many as possible of the users, patients, carers and organisations that are involved in this matter on a daily basis have a real opportunity to feel that they can own that code. I think that that is the point at which the Minister might manage to assuage some of our concerns, although some Labour concerns are extremely strong.

As I told the Minister yesterday, I do not intend to press my amendment to a vote. She is smiling now. I therefore beg to ask leave to withdraw the amendment.

Question put and agreed to.

Amendment, by leave, withdrawn.

[Madam Deputy Speaker (Dame Eleanor Laing)]

With the leave of the House, I propose to put Government amendments 5 to 37 together.

Schedule 1

SCHEDULE TO BE INSERTED AS SCHEDULE AA1 TO THE MENTAL CAPACITY ACT 2005

Amendments made: 5, page 8, line 6, leave out from “Wales,” to end of line 10 and insert

“the person registered, or required to be registered, under Chapter 2 of Part 1 of the Regulation and Inspection of Social Care (Wales) Act 2016 (anaw 2) in respect of the provision of a care home service, in the care home;”.

This amendment amends the definition of “care home manager”, in Wales, so it will be the person who is the registered service provider. This mirrors the approach taken for England.

Amendment 6, page 8, line 13, at end insert—

““Education, Health and Care plan” means a plan within the meaning of section 37(2) of the Children and Families Act 2014;”

This amendment is consequential on Amendment 22.

Amendment 7, page 8, leave out line 16

This amendment is consequential on Amendment 13.

Amendment 8, page 8, line 17, at end insert—

““independent hospital” has the meaning given by paragraph 5;”

This amendment is consequential on Amendment 13.

Amendment 9, page 8, line 27, at end insert—

““NHS hospital” has the meaning given by paragraph 5;”

This amendment is consequential on Amendment 13.

Amendment 10, page 8, line 46, leave out “Hospital” and insert “NHS hospital and independent hospital”.

This amendment is consequential on Amendment 13.

Amendment 11, page 8, leave out line 47.

This amendment is consequential on Amendment 13.

Amendment 12, page 9, line 15, after “6” insert “(1)”.

This amendment is consequential on Amendment 18.

Amendment 13, page 9, line 16, leave out “a” and insert “an NHS”.

This amendment amends paragraph 6(a) so that where arrangements are carried out mainly in an independent hospital the responsible body for those arrangements will not be the hospital manager.

Amendment 14, page 9, line 17, at end insert—

(aa) if the arrangements are carried out mainly in an independent hospital in England, the responsible local authority determined in accordance with paragraph 8A;

(ab) if the arrangements are carried out mainly in an independent hospital in Wales, the Local Health Board for the area in which the hospital is situated;”

This amendment makes provision for who the responsible body will be for cases where arrangements are carried out mainly in an independent hospital in England or Wales.

Amendment 15, page 9, line 18, leave out “paragraph (a) does not apply” and insert “none of paragraphs (a) to (ab) applies”.

This amendment is consequential on Amendment 14.

Amendment 16, page 9, line 27, leave out “neither paragraph (a) nor paragraph (b)” and insert “none of paragraphs (a) to (b)”.

This amendment is consequential on Amendment 14.

Amendment 17, page 9, line 28, leave out “(see paragraph 9)” and insert

“determined in accordance with paragraph 9”.

This amendment is consequential on Amendment 14.

Amendment 18, page 9, line 28, at end insert—

‘(2) If an independent hospital is situated in the areas of two or more Local Health Boards, it is to be regarded for the purposes of sub-paragraph (1)(ab) as situated in whichever of the areas the greater (or greatest) part of the hospital is situated.”

This amendment provides that, for the purpose of determining who is the responsible body, if a hospital is situated in the areas of two or more Local Health Boards, it should be regarded as situated in whichever of the areas the greater (or greatest) part of the hospital is situated.

Amendment 19, page 9, line 29, after “manager” insert

“, in relation to an NHS hospital,”.

This amendment is consequential on Amendment 13.

Amendment 20, page 9, line 45, at end insert—

(ca) if the hospital is vested in a Local Health Board, that Board.”

This amendment makes provision that the hospital manager for an NHS hospital vested in a Local Health Board will be that Board.

Amendment 21, page 9, line 46, leave out from beginning to end of line 12 on page 10

This amendment is consequential on Amendment 13.

Amendment 22, page 10, line 20, at end insert—

8A (1) In paragraph 6(1)(aa), “responsible local authority”, in relation to a cared-for person aged 18 or over, means—

(a) if there is an Education, Health and Care plan for the cared-for person, the local authority responsible for maintaining that plan;

(b) if paragraph (a) does not apply and the cared-for person has needs for care and support which are being met under Part 1 of the Care Act 2014, the local authority meeting those needs;

(c) in any other case, the local authority determined in accordance with sub-paragraph (4).

(2) If more than one local authority is meeting the needs of a cared-for person for care and support under Part 1 of the Care Act 2014 the responsible local authority is the local authority for the area in which the cared-for person is ordinarily resident for the purposes of that Part of that Act.

(3) In paragraph 6(1)(aa), “responsible local authority”, in relation to a cared-for person aged 16 or 17, means—

(a) if there is an Education, Health and Care plan for the cared-for person, the local authority responsible for maintaining that plan;

(b) if paragraph (a) does not apply and the cared-for person is being provided with accommodation under section 20 of the Children Act 1989, the local authority providing that accommodation;

(c) if neither paragraph (a) nor paragraph (b) applies and the cared-for person is subject to a care order under section 31 of the Children Act 1989 or an interim care order under section 38 of that Act, and a local authority in England is responsible under the order for the care of the cared-for person, that local authority;

(d) if none of paragraphs (a) to (c) applies, the local authority determined in accordance with sub-paragraph (4).

(4) In the cases mentioned in sub-paragraphs (1)(c) and (3)(d), the “responsible local authority” is the local authority for the area in which the independent hospital mentioned in paragraph 6(1)(aa) is situated.

(5) If an independent hospital is situated in the areas of two or more local authorities, it is to be regarded for the purposes of sub-paragraph (4) as situated in whichever of the areas the greater (or greatest) part of the hospital is situated.”

This amendment makes provision as to who the responsible body will be in cases where arrangements are carried out mainly in an independent hospital in England.

Amendment 23, page 11, leave out lines 45 to 47.

This amendment is consequential on Amendment 22.

Amendment 24, page 12, line 19, at end insert—

12A (1) The following must publish information about authorisation of arrangements under this Schedule—

(a) the hospital manager of each NHS hospital;

(b) each clinical commissioning group;

(c) each Local Health Board;

(d) each local authority.

(2) The information must include information on the following matters in particular—

(a) the effect of an authorisation;

(b) the process for authorising arrangements, including making or carrying out—

(i) assessments and determinations required under paragraphs 18 and 19;

(ii) consultation under paragraph 20;

(iii) a pre-authorisation review (see paragraphs 21 to 23);

(c) the circumstances in which an independent mental capacity advocate should be appointed under paragraph 39 or 40;

(d) the role of a person within paragraph 39(5) (an “appropriate person”) in relation to a cared-for person and the effect of there being an appropriate person;

(e) the circumstances in which a pre-authorisation review is to be carried out by an Approved Mental Capacity Professional under paragraph 21;

(f) the right to make an application to the court to exercise its jurisdiction under section 21ZA;

(g) reviews under paragraph 35, including—

(i) when a review will be carried out;

(ii) the rights to request a review;

(iii) the circumstances in which a referral may or will be made to an Approved Mental Capacity Professional.

(3) The information must be accessible to, and appropriate to the needs of, cared-for persons and appropriate persons.

12B (1) Where arrangements are proposed, the responsible body must as soon as practicable take such steps as are practicable to ensure that—

(a) the cared-for person, and

(b) any appropriate person in relation to the cared-for person,

understands the matters mentioned in sub-paragraph (3).

(2) If, subsequently, at any time while the arrangements are being proposed the responsible body becomes satisfied under paragraph 39(5) that a person is an appropriate person in relation to the cared-for person, the responsible body must, as soon as practicable, take such steps as are practicable to ensure that the appropriate person understands the matters mentioned in sub-paragraph (3).

(3) Those matters are—

(a) the nature of the arrangements, and

(b) the matters mentioned in paragraph 12A(2) as they apply in relation to the cared-for person’s case.

(4) If it is not appropriate to take steps to ensure that the cared-for person or any appropriate person understands a particular matter then, to that extent, the duties in sub-paragraphs (1) and (2) do not apply.

(5) In this paragraph “appropriate person”, in relation to a cared-for person, means a person within paragraph 39(5).”

This amendment inserts new paragraphs 12A and 12B of the new Schedule AA1 to require responsible bodies to publish information about authorisation of arrangements under the Schedule and to take steps at the outset of the authorisation process to ensure that cared-for persons and appropriate persons understand the process.

Amendment 25, page 12, line 32, after “practicable” insert

“and appropriate, having regard to the steps taken under paragraph 12B and the length of time since they were taken,”.

This amendment amends the duty in paragraph 13(2) of the new Schedule AA1 for a responsible body to take steps, as soon as arrangements are authorised, to ensure that cared-for persons and appropriate persons understand matters relating to the authorisation, to reflect the fact the body may have already have done that very recently under new paragraph 12B (inserted by Amendment 24).

Amendment 26, page 12, line 33, leave out from “any” to “understands” in line 34 and insert “appropriate person”.

This amendment amends the duty in paragraph 13(2) so that the duty to ensure that cared-for persons and appropriate persons understand matters relating to an authorisation does not also apply to independent mental capacity advocates (who can be expected to understand those matters) in line with the new duty in paragraph 12B (inserted by Amendment 24).

Amendment 27, page 12, line 34, leave out from “understands” to end of line 5 on page 13 and insert

“the matters mentioned in paragraph 12A(2)(a), (c), (d), (f) and (g) as they apply in relation to the cared-for person’s case”.

This amendment aligns the description of matters that must be explained to the cared-for person and any appropriate person with the list of matters in new paragraph 12A (inserted by Amendment 24).

Amendment 28, page 14, line 46, at end insert—

‘(1A) The person who makes the determination need not be the same as the person who carries out the assessment.”

This amendment makes it clear that a determination need not be made by the same person who carries out an assessment. A person could, for example, make a determination based on an assessment carried out previously by a different person (paragraph 18(6) of the new Schedule AA1 allows for this).

Amendment 29, page 14, leave out lines 47 and 48 and insert—

‘(2) The appropriate authority may by regulations make provision for requirements which must be met by a person—

(a) making a determination, or

(b) carrying out an assessment,

under this paragraph.

(2A) Regulations under sub-paragraph (2) may make different provision—

(a) for determinations and assessments, and

(b) for determinations and assessments required under sub-paragraph (1)(a) and determinations and assessments required under sub-paragraph (1)(b).”

This amendment provides power to make regulations setting out requirements which must be met for a person to make a determination or carry out an assessment. The requirements will relate to matters such as knowledge and experience. Different requirements may be set out for a person making a determination than a person carrying out an assessment.

Amendment 30, page 15, line 12, after “the” insert “determination or”.

This amendment is consequential on Amendment 29.

Amendment 31, page 15, line 14, after “the” insert “determination or”.

This amendment is consequential on Amendment 29.

Amendment 32, page 15, line 16, leave out “The” and insert “An”.

This amendment is to make it clear that the assessment being referred to is an assessment on which a determination under the paragraph is made.

Amendment 33, page 15, line 32, leave out “made on an assessment” and insert

“by a person, who meets requirements prescribed by regulations made by the appropriate authority, made on an assessment by that person”.

This amendment is to make it clear that a determination required under paragraph 19 of the new Schedule AA1 must be made by the same person who carries out the assessment on which that determination is based and that person must meet requirements set out in regulations.

Amendment 34, page 15, leave out lines 38 to 44.

This amendment is consequential on Amendment 33.

Amendment 35, page 15, line 46, leave out from “16,” to “by” in line 1 on page 16 and insert

“a determination may not be made”.

This amendment is consequential on Amendment 33.

Amendment 36, page 16, line 7, leave out “assessment” and insert “determination”.

This amendment is consequential on Amendment 33.

Amendment 37, page 16, line 9, leave out “assessment” and insert “determination”.—(Caroline Dinenage.)

This amendment is consequential on Amendment 33.

Amendment proposed: 49, page 16, line 12, leave out from “out” to the end of line 16, and insert “by the responsible body.”—(Barbara Keeley.)

This amendment would require the responsible body to carry out the consultation in all cases.

Question put, That the amendment be made.

--- Later in debate ---

[The First Deputy Chairman of Ways and Means (Dame Eleanor Laing)]

As the knife has fallen, there can be no debate in the Legislative Grand Committee. I remind hon. Members that, if there is a Division on the consent motion, only Members representing constituencies in England and Wales may vote.

Resolved,

That the Committee consents to the Mental Capacity (Amendment) Bill [Lords] as amended in the Public Bill Committee and on Report.—(Caroline Dinenage.)

The occupant of the Chair left the Chair to report the decision of the Committee (Standing Order No. 83M(6)).

The Speaker resumed the Chair; decision reported.

Third Reading

Appropriate ME Treatment

Eleanor Laing Excerpts

Thursday 24th January 2019 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am terribly sorry but it is obvious that a lot of people wish to speak. We have very little time, and I am sure the House wishes the Minister to have time to answer the many important points raised, so I must reduce the time limit to three minutes.

--- Later in debate ---

[Kelvin Hopkins (Luton North) (Ind)]

First, may I add my support to the motion as set out on the Order Paper and congratulate the hon. Member for Glasgow North West (Carol Monaghan) on leading the way in securing this debate and also on her excellent speech.

I spoke in a previous Westminster Hall debate and later put down written questions on ME on the basis suggested by Dr Ian Gibson, whom longer-standing Members may remember as the Labour Member for Norwich and a distinguished medical scientist in his own right. Ian was incensed by the use of graded exercise therapy. He said that it was less than useless and actually damaging to sufferers as well as causing them pain and raising false optimism that such therapies would work. Given that ME causes extreme fatigue, suggesting more exercise seems to me about as sensible as asking frostbite sufferers to walk about in snow. The other suggested treatment, cognitive behavioural therapy, helped to underpin the myth that ME is a psychological problem, not a physical condition. Neither of those supposed therapies should have been given credence and efforts should have been focused long ago on discovering the real causes of ME and on undertaking proper and thorough research to develop effective treatments.

I first became aware of ME more than 25 years ago when two of my young relatives were found to be suffering from the condition. The fact that I was not aware of ME until then is itself extraordinary given that some 25,000 children are estimated to be suffering from the condition. That is more than 38 children, on average, for every one of our constituencies.

I later became informed of sufferers in my own constituency and recall one man in particular who suffered constant pain and had to lie in a darkened room because he could not bear the light. Such symptoms are well known, but, of course, like so many illnesses, the severity of symptoms can vary greatly. MS, for example, can advance rapidly, or can remain fairly mild and stable for many years. Such variations do not invalidate the condition.

I have mentioned children with ME, but if all adults were included, the figure reaches 250,000, or nearly 400 per constituency; it really is that serious. The impact on the lives of those constituents is enormous, but the cost to society and to the economy is over £3.3 billion a year—an enormous sum. Therefore, finding causes and discovering effective treatments are vital. Funding research must be a priority, first, to reduce the level of suffering, but also to reduce the wider social and economic costs. Research into ME represents just 0.02% of all grants given to funding agencies—just one 500th of the total, a pathetic amount.

In conclusion, I hope that we are now putting behind us all the myths and misdiagnoses related to ME. It is a physical condition and it is causing untold suffering. Recent research has looked very promising, and has pointed to possible causes of ME. One factor in particular has recently received publicity—the overactive immune system in many sufferers. It seems that we are starting to move in the right direction. We must congratulate the scientific and medical researchers who have done, and who are doing, so much valuable work towards finding solutions to the scourge of ME and alleviating the suffering that it causes.

I hope that Ministers and other hon. Members will take note of the reports in “Breakthrough”, the journal of ME research—

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. I call Mr Stephen Pound.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. I have to reduce the time limit to two minutes, or else every Member will not get a chance to speak.

--- Later in debate ---

[Madam Deputy Speaker (Dame Eleanor Laing)]

The hon. Lady clearly appreciates that that is not a point of order, but she has corrected the record and, as she says, I am sure that Hansard will bear her out.

Just before we adjourn the House, I am afraid that once again I have to inform the House of a further correction to the number of votes for Members for English constituencies in the Division on Lords amendment 36 to the Tenant Fees Bill yesterday. There was a technical hitch at that time, and the figures were announced as: Ayes 261, Noes 194. The figures should have been: Ayes 263, Noes 194. The result is unaffected, but the record has been put straight.