NHS Funding (York and North Yorkshire)

George Freeman Excerpts

Wednesday 7th January 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

Thank you, Mrs Riordan, for calling me to speak. It is a pleasure to serve under your chairmanship this afternoon.

I start by congratulating my hon. Friend the Member for York Outer (Julian Sturdy) on securing this debate, with the support of our hon. Friends the Members for Skipton and Ripon (Julian Smith), and for Malton (Miss McIntosh), and I congratulate them all on their contributions to the debate. I am very aware of the personal interest of my hon. Friend the Member for York Outer in health matters affecting his constituents, and of course his interest in NHS allocations, including this question of fairness for rural areas.

I will also take this opportunity to pay tribute to all the North Yorkshire MPs who have worked so hard together on this issue since 2010: my hon. Friends the Members for Selby and Ainsty (Nigel Adams), for Skipton and Ripon, for Thirsk and Malton, and for Harrogate and Knaresborough (Andrew Jones), the hon. Member for York Central (Sir Hugh Bayley), my right hon. Friend the Member for Richmond (Yorks) (Mr Hague), and my hon. Friend the Member for Scarborough and Whitby (Mr Goodwill). I know they have had one meeting, if not more, with the Secretary of State for Health, and as a group they have been an effective and forceful lobby on this important issue, which we in the Department of Health all take seriously.

Of course, the whole House will agree that good-quality patient care is something we all expect, regardless of which part of the country, or indeed which county, we live in. As my hon. Friend the Member for York Outer has signalled, the question is how we work within the overall NHS budget—I welcome his acknowledgement of the Government’s increasing that budget—to determine how funding for each area should be assessed and decided. He made the key point: that it must be done in a way that is fair to all citizens and patients, wherever and whoever they are, and that where someone lives should not in any way unreasonably distort their access to health care. It is the NHS—the national health service—and those initials should mean something.

My hon. Friend will be aware that I, too, come from a very rural constituency—Mid Norfolk—where many of the issues he has identified chime, including ambulance response times and the extra time that clinical staff and patients take to travel around. Of course, there are other issues and problems, which he has highlighted: hidden deprivation, ageing and elderly populations, and isolation and loneliness compounding conditions such as dementia, making it harder to set up initiatives such as dementia cafés.

Health funding is an issue I have taken an interest in for a long time. Years ago, I did some work in County Durham to unpack the index of local conditions and the standard assessments in local government spending. When we unpack those formulae, we discover that those used to allocate funding for deprivation are all inner-city indicators: they are all about high-rise blocks, the percentage of black and minority ethnic people, and density. They are all urban indicators, as if only urban areas really experience deprivation. So my hon. Friend is raising an important point, which goes to the heart of much of the way that Whitehall allocates funding.

I will say something about how allocations within the NHS are made under the arrangements we have put in place. As my hon. Friend is aware, NHS England is the independent organisation responsible for managing the budget and the day-to-day workings of the NHS. It supports clinical commissioning groups—the local groups of GPs and other health professionals who commission NHS services on behalf of their patients. To make sure that the taxpayer has a say in how that money is spent, the Government provide direction and strategic ambitions for the NHS through a document called “the mandate”. The current 2014-15 mandate was reviewed and updated in December. There are eight key areas, which are about making general improvements; the Government deliberately leave the NHS free to make decisions about how these objectives should be met. They are: helping people to live well for longer; managing ongoing physical and mental health conditions; helping people to recover from episodes of ill health or injury; making sure that people experience better care, and integrated care; providing safer care, with a greater emphasis on patient safety; promoting NHS innovation; supporting the NHS to play a broader role in society; and making better use of our health resources.

NHS England has been given £98.7 billion this year, rising to £101 billion in 2015-16, to achieve the objectives in the mandate. I welcome my hon. Friend’s support for the extra £2 billion that the Secretary of State recently announced. NHS England has the responsibility to ensure that that money is well spent.

The first thing to say on the financial aspect of the mandate is that we have protected NHS funding in this Parliament, as my hon. Friend acknowledged. In 2014-15, all CCGs received a funding increase matching inflation. Furthermore, like all CCGs in England, North Yorkshire CCGs will benefit from the £2 billion of additional funding announced in the autumn statement. As I say, those CCG allocations and the formula used to decide what they should be are the responsibility of NHS England. NHS England itself commissions some services directly, including all primary care, as well as making allocations to individual CCGs. So these allocations to CCGs, although they are crucial, are only one part of a broader picture. In making those allocations, NHS England relies on advice from the Advisory Committee on Resource Allocation. As my hon. Friend will be aware, ACRA provides advice on the share of available resources provided to each CCG, in order to support equal access for equal need, as specified in the mandate.

NHS England does not set income on an equal “cost per head” basis across the whole country. Instead, allocations follow an assessment of the expected need for health services in an area, and funds are distributed in line with that, which means that areas with a high health need, including rural areas, should receive more money per head. There have sometimes been suggestions that a single per capita payment should be made across all CCGs, but I am not sure that that would not in fact lead to further discrepancies. As my hon. Friend will be fully aware, the key question is what overall weighting should be given to a range of factors, including age, disability, rurality and disease prevalence. As he himself acknowledged, there is no simple answer that would please everyone; this process requires the making of difficult judgments.

Without knowing that background, it can sometimes be hard for people to understand what are misleadingly presented as huge anomalies in allocations to CCGs. In the Vale of York, the funding is £1,067 per head; in my constituency of Mid Norfolk, it is £1,050; and in central Manchester, an urban area with an urban CCG, it is £1,085. I appreciate that those small differences add up over large populations, but they are not huge variations. The objective is to ensure a consistent supply of health services across the country, with health funding following —as best the system can map it—health need. That is one of the reasons why the data steps that we are putting in place are so important to allow us to monitor disease and health need.

NHS England has reviewed the funding formula and made welcome changes that take into account three important factors in driving health care need: population growth, deprivation and the impact of an ageing population. That should go some way towards helping to address the points my hon. Friend made.

NHS England now believes, and tells us, that it has a funding formula that sets recurrent allocations to CCGs more accurately and fairly, which is what the formula is supposed to do. However, I welcome the scrutiny that my hon. Friend and other colleagues from North Yorkshire are rightly insisting that it be put under.

By reflecting changes in population around the country and better targeting of pockets of deprivation, the NHS should be able to offer the best services to patients where they need them. I know there is a perception in North Yorkshire that the area is relatively underfunded. However, the NHS in North Yorkshire has benefited from increased funding, and when the Vale of York CCG’s funding is compared to that of other CCGs across the country, it is evident that it is not a significant outlier in terms of either funding per head of population or the level of funding relative to the formula. I appreciate that those are average figures; my hon. Friend will know better than I do the specific details of his own constituency.

At a time of continued pressure on the public finances, the additional funding we have provided for the NHS underlines the priority that this Government place on it. It means that the NHS will continue to benefit from stable, real-terms increases in funding, which will allow us and NHS England to get those formulae more and more accurate. Next year, the recurrent allocations of all CCGs in North Yorkshire will grow by 1.94%, an increase of almost £17 million. I am delighted that these increases will ensure that CCGs, including those in North Yorkshire, can continue to meet ever-growing demands for services, while investing in new services.

As time is short, with my hon. Friend’s permission perhaps I could write to him on the specific points he raised about back pain and IVF.

[Miss McIntosh]

I have a very simple question. Obviously, we as Back Benchers scrutinise the Department of Health, but who scrutinises and monitors NHS England?

[George Freeman]

As Ministers, we are responsible and ultimately accountable to Parliament for that. However, I am conscious of the time, so perhaps I could pick that point up in a letter to my hon. Friend.

As I said, I welcome the attention my hon. Friend the Member for York Outer and other North Yorkshire MPs are bringing to this issue, and I hope I have signalled that I consider it a substantive concern. Citizens in this country, rural or urban, demand and expect a national health service—rightly so, because they have contributed to it—and they expect national access on a fair basis. The structure we have put in place is really about giving NHS England the clinical freedom to ensure that funding decisions are made on the right basis. No system will be perfect, but as Ministers we are absolutely committed to ensuring that the system we have is as accountable and transparent as possible, and to providing the security of funding to allow that process to be pursued.

I know from my own experience in County Durham and in my Norfolk constituency that these are important issues. It is about ensuring that our citizens in rural areas get equal access to health services. My hon. Friend the Member for York Outer and other colleagues are doing exactly the right thing in raising this issue. I will happily address in writing the points I have not had time to address this afternoon. I look forward to writing to colleagues with more detailed answers to the specific points they have raised.

Question put and agreed to.

Pharmaceutical Price Regulation Scheme

George Freeman Excerpts

Thursday 11th December 2014 Written Statements

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

I am announcing today the level of payment due from members of the pharmaceutical price regulation scheme (PPRS) in 2015 to keep health service spend on branded medicines within the levels agreed under the scheme. The PPRS payment percentage for 2015 will be 10.36%.

The PPRS is a voluntary scheme agreed between the Department of Health, acting on behalf of the UK Government and Northern Ireland, and the branded pharmaceutical industry, represented by the Association of the British Pharmaceutical Industry (ABPI), under sections 261 to 262 of the National Health Service Act 2006. The current PPRS commenced on 1 January 2014 and lasts for five years, ending on 31 December 2018.

The PPRS allows patients access to the medicines they need while maintaining affordability for the NHS and providing stability for industry in support of the Government’s innovation and growth agenda. There is an agreed, fixed limit on the vast majority of NHS spend on branded medicines with additional expenditure above this level paid for by the pharmaceutical companies. Spend will stay flat in 2014 and 2015. Annual growth will be limited to 1.8% in 2016, 1.8% in 2017 and 1.9% in 2018. Small companies with less than £5 million of sales a year to the health service are exempted.

In the interests of transparency we are publishing our estimates of aggregate PPRS payments in 2014-15 and 2015-16. It must be stressed that these are only estimates at this stage. The Department is committed to publishing outturn quarterly aggregate sales and payments data for the PPRS on an ongoing basis.

In England, PPRS payments are taken into account in the allocations to NHS England through the mandate. All the payments will go back into spending on improving patients’ health and care.

The Department has published a document setting out further details entitled “2014 Pharmaceutical Price Regulation Scheme: revised forecasts and profile of payment percentages”. Copies have been placed in the Library and are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Attachments can be viewed online at: http://www. parliament.uk/writtenstatements

Sickle Cell Anaemia

George Freeman Excerpts

Wednesday 10th December 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

It is a great pleasure to serve under your chairmanship, Mr Owen, and to respond to the right hon. Member for Wolverhampton South East (Mr McFadden), whom I congratulate on securing the debate. I hugely welcome the opportunity to discuss this issue.

Sickle cell anaemia is a really terrible condition and diagnosis for all those who are affected, but especially for our African and Afro-Caribbean communities. I want to start by acknowledging the work that the right hon. Gentleman has done for his constituency and his community, and I join him in paying tribute to the all-party parliamentary group on sickle cell and thalassaemia, chaired by the hon. Member for Hackney North and Stoke Newington (Ms Abbott). I also pay tribute to the Sickle Cell Society, the Wolverhampton sickle cell care and social activity centre and the patient groups. As with so many rare diseases, it is the advocacy of the few that in the end leads to changes in mainstream provision, and I am serious about paying tribute to that. The right hon. Member for Wolverhampton South East made a number of important points that I will try to deal with in detail. If I run out of time, perhaps he would allow me to follow them up in more detail in writing.

I stress that for those who have had a sickle cell diagnosis, it is a life-changing moment. All of us who are involved in policy making should not take our eyes off the personal suffering that patients—those with the diagnosis—and families and loved ones experience. Some 250,000 people in the UK carry the sickle cell trait, with about 15,000 affected by sickle cell anaemia, as the right hon. Gentleman knows. For those affected, it can mean a life of constant pain management, including, often, extensive periods of hospitalisation when the pain is bad, blood transfusion and red cell therapy, and tiredness, dizziness, palpitations, jaundice and gallstones. All those in combination mean that people are denied the quality of life that the rest of us take for granted.

However, as the hon. Member for Strangford (Jim Shannon) pointed out, the worst aspect of all is a substantially reduced life expectancy. Even today, sickle cell sufferers will, on average, survive until their 40s or 50s. Even though that is a massive improvement on the position 40 years ago, when the average life expectancy was only 14 years of age, it is still a shock when the rest of us are expecting to live very much longer than that. We can only pay tribute to the bravery shown by the people who have to deal with all the problems that this condition brings. However, bravery and resilience are not enough; we need to look at the way in which we support and treat people and bring on innovative care pathways and medicines. That is why we are continuing to invest in improving services, especially blood, bone marrow and stem cell services, which are vital for the condition.

Let me say something about what we are doing. In England, NHS Blood and Transplant provides blood for transfusion services. There is targeted donor recruitment, extended donation testing, and supplements, through a national frozen blood bank suitable for the long-term storage of blood for those with rare conditions. NHSBT’s therapeutic apheresis services provide a range of services to patients through NHS trusts from its six units situated across England, in Bristol, Liverpool, Oxford, Sheffield, Manchester and Leeds. Those units undertake procedures that provide direct treatment to patients with a range of medical conditions, as well as collecting stem cells from both patients and donors. Therapeutic apheresis treatments and services provide both life-saving and life-enhancing treatments for patients referred in sickle cell crisis or for ongoing sickle cell management. NHSBT is working with commissioners further to improve access to automated red cell exchange for sickle cell patients as part of those services.

One option for patients is a stem cell transplant, which requires genetically matched stem cell units, either from bone marrow donated by an adult donor or through stem cells harvested from cord blood. In the past four years, the Government have provided an additional £12 million of new money to help with transplant services. The Department of Health, working in partnership with NHSBT and the Anthony Nolan charity, has overseen the delivery of improvements way above what we originally anticipated.

The achievements include the following. More than 60% of black, Asian and minority ethnic patients are able to find a well matched donor now, compared with 40% at the beginning of the Parliament, and 258 more UK patients received a potentially curative stem cell transplant in 2013-14 than in 2010-11. The process for stem cell provision has been significantly streamlined, with single access searching in both England and Wales. I am delighted to say that there are now 60,000 young donors on the so-called fit panel, whose volunteers are eight times more likely to have donated stem cells than other registry volunteers.

Increasing use of UK-sourced cord blood to meet the needs of UK patients is crucial. This year, more than 25% of cord blood transplants will use donations from UK donors, costing about half the price of imported units. That compares with 10% in 2010. The time taken to provide stem cells from adult donors has improved. The right hon. Member for Wolverhampton South East knows that that is a crucial issue. Samples for confirmatory HLA—human leukocyte antigen—typing are provided from more than 80% of donors within 15 days now, compared with 35% in 2010.

The NHS and its key delivery partners are committed to continuing service improvement—I will say more about that in a moment—in collaboration with patients and patient group representatives, which is crucial. In the NHS today, if a child is diagnosed with sickle cell anaemia, they will be referred to a care team in a specialist sickle cell centre. Those are specialist units usually based, as the right hon. Gentleman knows, in large hospitals and staffed by front-line health care professionals with a high level of expertise in treating people with sickle cell anaemia. A detailed treatment and care plan, which outlines future medical care, is now drawn up for each patient, and parents are given information and support to help them to manage their child’s condition.

Due to the complexity of sickle cell anaemia, multidisciplinary teams are now assembled. Typically, they include paediatricians, haematologists, clinical psychologists, social workers and specialist nurses. The purpose of the care plan is to avoid sickle cell crises and to provide adequate pain relief when a crisis does occur, as well as reducing the risk of serious complications developing, such as infections, stroke and other associated symptoms of sickle cell anaemia.

Clearly, we want to see improvements in health care services for all types of patients. The right hon. Gentleman made that point well. The Government have committed to specific strategic plans in key areas. One of those plans is “The UK Strategy for Rare Diseases”, which covers sickle cell anaemia. The strategy sets out a shared UK vision for all those affected by rare diseases. It is owned by each country in the UK and commits them to more than 50 commitments. The strategy focuses on five areas: empowering patients, identifying and preventing rare diseases, diagnosis and earlier intervention, the role of research and, most importantly of all, co-ordination of care. As I have said, people suffering from long-term conditions are resilient, but that resilience can easily be undermined by the constant to-ing and fro-ing that occurs when a patient’s care pathway is not properly managed.

[Mr McFadden]

I thank the Minister for outlining the nature of the specialist care teams that are in place. He is right, but the critical point made by the report from the peer review exercise was that although that approach worked well in some places, it did not work as well in others. The specialists whom he talked about—the specialist consultants and specialist nursing staff—were not always there in sufficient numbers, and there is still something of a lottery, some might say, or at least unacceptable variability in the quality of treatment and the understanding of the condition, depending on where the patient lives. I therefore want to press the Minister on the recommendations from the peer review exercise, which were all about making the best the norm. What will he and the Department do to ensure that those recommendations are followed through on in that way?

[George Freeman]

The right hon. Gentleman makes a good point. I have my eye on the clock, and I will deal with it.

I conclude my opening remarks by saying that it is no longer acceptable to make the patient fit the pathway. We need to fit the pathway around the nature and progression of the disease in patients. These patients in particular have to see a wide range of professionals, and we need to look at that model. The final thing that I want to mention in terms of our strategic response is the genome project. We are funding 100,000 full genome sequences, to be put together with phenotypic data, with cancer and rare diseases as the initial focus. I am confident that that will quickly start to unlock some insights into possible preventions and new treatments.

The right hon. Gentleman made a number of important points, and I want to acknowledge them. If I cannot deal with all of them now, I will come back to him in writing. He made points about the lack of understanding among GPs across the system; the need for better care pathways to try to reduce hospital admissions; the importance of data underpinning our understanding of good outcomes, best and worst practice and variability; and the important insights in the report. I want to come back to his two specific requests. I would be delighted to ask the various organisations involved to give me a progress report on where they have got to in implementing the various measures, and I will obviously share that with him; perhaps we will have an opportunity to debate it. I will also happily ask NHS England and the National Institute for Health and Care Excellence to look at the health economics of free prescriptions in terms of short-term costs unlocking longer-term savings. I cannot prejudge the outcome of that, but I will happily look into the issue.

In the three minutes left to me, I want to touch on a couple of the specific points that the right hon. Gentleman made. How do we promote understanding and get sickle cell disease higher up the agenda? The 100,000 genomes project also includes a substantial investment in training in rare diseases for clinicians across the NHS as we launch our genetic medicines service. NHSBT and the Anthony Nolan charity continue to promote donations of blood and stem cells, but there is also the issue of the training that goes with that. The Department of Health is working with those key delivery partners to see what more can be done to improve not only donation, but the understanding of the condition and the training across the system.

The right hon. Gentleman asked what measures were being put in place to support care for people with long-term conditions. Our aim is to make the NHS among the best in Europe at supporting people with long-term conditions such as sickle cell disease. In the past, we have not done as well in that area as we would have liked. Through the mandate, we have asked NHS England to make measurable, tangible progress and commitments to supporting people with ongoing health problems to live healthily and independently. The NHS outcomes framework contains a range of improvement areas, and I will happily ask it to give me a progress report on that work.

NHS England is tasked with responding to the UK rare diseases strategy. Earlier this year, as the right hon. Gentleman will be aware, it issued a statement of intent that sets out how it intends to play its part in delivering that strategy; and in the recent NHS England “Five Year Forward View”, it has set out various commitments on exploring specialist centres for rare diseases to improve the co-ordination of care for patients in line with the strategy. I understand that NHS England will be looking to those specialist providers to develop networks of services, integrating different organisations and services around patients. As I said, I will happily ask for a progress report and share it with the right hon. Gentleman. Possibly we will have a chance to debate that in a format similar to this.

I again pay tribute to the right hon. Gentleman’s leadership on this issue. I think that the advocacy of Members of Parliament and particularly those with high concentrations of patients who are especially heavily affected by this condition, along with that of patient groups and charities, will be seen in years to come to have played a major part in helping to drive new care pathways and the integration of research, medicine and care, so that patients who are suffering are given the support that they need.

Patient Safety and Medical Innovation

George Freeman Excerpts

Tuesday 9th December 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

I thank my hon. Friend the Member for Totnes (Dr Wollaston) for securing this Adjournment debate and giving the House, albeit only a few of us, the chance to debate what is, I agree, a very important issue that is the subject of live discussion in another place. I also thank my hon. Friend the Member for Cambridge (Dr Huppert) for his comments.

My hon. Friend the Member for Totnes is a tireless campaigner for good health care and good medicine, as Member of Parliament for Totnes, as a member of the medical profession, and as Chair of the Health Committee. I very much welcome her contribution. I will first deal with the points that she made, then set the scene and provide a little context about the Government’s view of this Bill, and then close with what I hope may be some reassurance about our commitment to patient safety.

My hon. Friend made a number of important points, which I repeat merely to signal that I have heard them loud and clear. She said that the Bill might risk creating a carte blanche, or open door, situation as an inadvertent side effect of unjustified and unsubstantiated claims. My hon. Friend the Member for Cambridge mentioned homeopathy and other non-evidence-based forms of medicine. My hon. Friend the Member for Totnes highlighted the danger of relying too heavily on the protection of a clinician merely seeking the endorsement of a fellow clinician. Implicit in her concern is the fact that most of us could probably find one person in life to support our own prejudices, however well intentioned.

My hon. Friend highlighted the risk of unethical approaches and the danger of back-door promotions, which none of us wants to see. On the danger of undermining public and patient trust in clinical trials, she knows that I am passionate about achieving precisely the opposite. We are very proud in this country that more and more of our patients are enrolling in clinical trials. The NHS is running a fabulously successful programme of promoting research medicine, and this year the numbers are up by 24% or 25%. That is good for patients, good for NHS research, and good for our life sciences sector.

My hon. Friend has highlighted the danger of accidental errors across the system today. We live with that risk, but I hear her point that it would be a disaster if the Bill inadvertently made errors more likely, rather than less. She also raised concerns about the Bill not promoting evidence-based medicine or requiring claims to be based on clear patient benefit. She made a specific point about the Cancer Act 1939, which I will follow up and deal with by letter, if I may.

Most concerning of all, my hon. Friend ran through a very long list of medical and health organisations that she described as being opposed to the Bill. I will look into that following the debate because—I will say more about this in a moment—we do not want the measure to be divisive or to alienate or undermine the consensus about the importance of good medical research in the UK and the NHS. I take that point seriously. My hon. Friend flagged up the letter from 100 oncologists that appeared in newspapers recently. Since that was published, there have been a number of discussions about—and, indeed, amendments tabled to—the Bill in the Lords. I want to have a look and make sure which, if any, of those concerns are extant as the Bill completes its passage through the Lords. I will say more about that in a moment.

My hon. Friend the Member for Cambridge endorsed those comments. I note in particular his comments about the importance of evidence-based medicine. As with so many issues that we deal with in this House, a good test is to ask: would I apply this to myself? Certainly, for myself and my family, I am a strong believer in evidence-based medicine. I am a believer in innovation as well, but my hon. Friend made an important point. I particularly enjoyed his mention of the politician’s syllogism: “We must do something; this is something; ergo, we should do it.” I assure him that that is not in any way the reason for the Government’s benign support for the Bill’s principles and the case it seeks to make to promote innovation. I align myself hugely with his comments about not wanting to open the door to quackery.

[Dr Wollaston]

Lord Saatchi has said that 20,000 people support his Bill, but if people are asked whether they are in favour of medical innovation, they are likely to answer yes, and if the same people are asked whether they are likely to support medical anecdotes, I think they are likely to say no. Sometimes the answer depends on the question being asked.

[George Freeman]

I am sure my hon. Friend is right. She makes an excellent point about the nature of the question having an impact on the answer one gets. I have repeated the concerns because they bear repetition and are important, and I want to signal that I am taking them seriously.

I want to set the scene in terms of the Government’s commitment to patient safety, the context in which innovative medicines are being developed, and the changes in the sector that are challenging some of the traditional methods of drug development. I will then address some of the specific points that my hon. Friends the Members for Totnes and for Cambridge have made and say something about the Government’s position on the Bill.

The Government’s response to the Mid Staffordshire NHS Foundation Trust public inquiry, led by Sir Robert Francis, “Hard Truths: The Journey to Putting Patients First”, demonstrated beyond any doubt, I hope, the Government’s absolute commitment to creating a new culture of openness, compassion and accountability and a renewed focus on patient safety right at the heart of the NHS.

The truth is that the NHS is one of the safest health care systems in the world. I am delighted to report that, in the recent Commonwealth Fund report comparing the US health care system with those of 11 other nations, the UK came top. However, there is always scope to improve health care standards universally and to reduce avoidable harm further. That is why the Secretary of State set the ambition this June, at the launch of the Sign up to Safety campaign, to reduce avoidable harm by half and save 6,000 lives over the next three years.

We have put patient safety right at the heart of the Government’s agenda for health. For that reason, I am delighted that the Government are actively supporting the Bill on patient safety sponsored by my hon. Friend the Member for Stafford (Jeremy Lefroy). The Bill has several important provisions on the use of data to drive safety across the system and to ensure transparency and accountability in health outcomes.

Why do we need to look at mechanisms for promoting innovation? My hon. Friend the Member for Totnes was kind enough to signal her awareness that the Government—particularly me, as the first Minister for life sciences—have taken an active role in trying to promote it. The reason is that we face a challenge in the field of drug discovery and development, as well as in medical technology generally. There is a challenge and an opportunity.

The challenge is that the more we know about disease, genetics and data—the datasets at our disposal in the NHS, and the history of drug reactions and the way in which patients respond to diseases differently—the more we realise that patients respond to the same disease or the same drug in different ways, and that those ways can often be predicted. These insights are beginning to change the way in which drugs are developed.

Increasingly, we do not need the one-size-fits-all, blockbuster drugs that we have traditionally expected the industry to bring us after long, slow, protracted and increasingly expensive clinical trials and randomised, double-blind trials. Of course, those trials have a strong part to play in our system, but the more we know about the nature of disease and the extraordinary breakthroughs that our biomedical and life sciences sector is making, the more the agenda shifts to designing around patients, as well as around tissues, data and genomics. That is why the Government are so committed to shifting our policy landscape to support the extraordinary role that our NHS can play globally. It is a uniquely well positioned, integrated national health care system, with extraordinary leadership in genomics and informatics, which the Government are actively supporting.

My hon. Friend made the point that the randomised, double-blind trial has given medicine great service in the 20th century, and I agree. As we move further into the 21st century and see the transformational power of new technologies, it is equally true that the system of expecting the industry to go away and spend 10 to 15 years, and an average of £1.5 billion, to develop a new drug—many of them fail in late-stage clinical trials, because of some toxic side effect in one patient or a few small number of patients—is leading to a crisis in the industry and in the pipeline for new drugs and new treatments, and to patients increasingly suffering because we cannot give them innovative medicines.

Part of the agenda for this Government and all western Governments is to look at how to accelerate the way in which our health systems support research and to bring innovative medicines, as well as devices, diagnostics and other innovations, to benefit patients more quickly.

[Jim Shannon (Strangford) (DUP)]

I apologise for not being in the Chamber at the beginning of the debate, Madam Deputy Speaker, but I did not realise that the business had moved on so fast. In the university in Belfast, we have developed some great partnerships in relation to finding new drugs. Nearby Belfast city hospital works together in partnership with the university to address the issue of innovation for new drugs and to address how best to utilise them and make them available. I know that the Minister is aware of that, but does he recognise that such a partnership—with Queen’s university, financed by big business, alongside the NHS in the form of Belfast city hospital—is a precedent for how to innovate?

[George Freeman]

The hon. Gentleman makes an important point. I want to take this opportunity to pay tribute to the work being done in that cluster at Queen’s. I am delighted to say that I will be coming in the new year to support it and to show, as the UK Minister, that there are great clusters in Scotland, Northern Ireland and Wales. I very much look forward to that visit.

The truth is that the landscape is changing. Part of the challenge that we all face is to find ways to accelerate earlier access to innovative treatments for patients, and earlier access for those developing innovative drugs, devices and diagnostics to our health system, so that we can more quickly design innovations that are more targeted and personalised. We are seeing the first genuinely personalised cancer therapies and drugs that, in the unfortunate event that one is diagnosed with cancer, can be designed around one’s genetic profile. I was at a seminar on that development this morning. It is changing the landscape of drug development. We are keen to ensure that we benefit from it in the UK and that we use every mechanism in the NHS to support it.

[Dr Wollaston]

Does the Minister accept that a doctor who uses such innovative treatments within the NHS is protected under existing law and that we do not need new legislation to make them available to patients?

--- Later in debate ---

[George Freeman]

I will happily come on to the existing law and the protections within it.

Three weeks ago, I announced a major review of the landscape of innovative medicines development, which will involve a review of NICE and the Medicines and Healthcare Products Regulatory Agency. It will look closely at how we can develop a new landscape for the quicker development of innovation with patients in the NHS.

I reassure the House that the Government are committed in all this work to putting patient safety first and developing a landscape of evidence-based medicine. I have listened carefully to the concerns of my hon. Friends the Members for Totnes and for Cambridge. I reassure them that I and the Government take their concerns very seriously.

Lord Saatchi has identified the threat of litigation as a potential barrier to innovation. The purpose of his Bill is to set out a series of steps and a clearer legal framework that will make it less likely for doctors to be put off reasonable innovation because of the rather circular defence that the best treatment is one that is already well established. The intention of the Bill is to tackle the risk that the fear of clinical negligence could undermine the commitment of doctors to embracing innovation in the system. It does not claim to be a panacea or silver bullet to solve all our innovation challenges, but to be one measure in the broader landscape.

In Committee in the House of Lords, the Government supported Lord Saatchi’s amendments to the Bill, which added an objective test of responsibility to the doctor’s decision to innovate. The amendments exclude any doctors who act irresponsibly from enjoying the protections of the Bill.

The amended Bill provides a number of other safeguards for patients, including the requirement for doctors to take full account, in a responsible way, of the views of other appropriately qualified clinicians. My hon. Friend the Member for Totnes argues that that does not go far enough. I would be interested to hear the views of Members of the upper House who are more qualified than I am when they debate Third reading at the end of the week. The package of amendments is intended to ensure that there is expert peer review of any doctor’s proposal. Furthermore, it ensures that the doctor must act responsibly in taking account of that review, thereby applying an objective standard to their conduct. In addition, the Bill requires any doctor to consider the risks and benefits associated with the proposed treatment, alternative treatments and doing nothing. That provides a further safeguard.

Let me be clear that we do not want the Bill to prevent patients from taking doctors to court when there is a good reason to do so. Doctors who follow the steps set out in the Bill or the steps required in normal practice should be able to demonstrate more easily that they have acted responsibly, because they will have considered the necessary steps in advance of any innovation. However, by invoking the freedom to innovate that is set out in the Bill, one does not in any way avoid the scrutiny of the courts. Doctors will still have to justify their actions if any case is brought against them, just as they do now.

[Dr Huppert]

At the beginning of the Minister’s comments, he said that he and the Government were keen to ensure that this would not be a divisive issue, and that they would not progress with it if it became one. He now sounds like he is being very supportive of the Bill. Will he provide an assurance that if the Bill continues to have the vast weight of medical and legal expertise against it, whether that is expressed in the House of Lords or by the organisations that my hon. Friend the Member for Totnes mentioned, he will ensure that the Government do not back it?

[George Freeman]

I am merely trying to set out a balanced review of the arguments. In closing my speech, I will give an assurance that I hope will satisfy my hon. Friend on that point.

On protection, under existing common law and in the Bill doctors must show that they have acted responsibly. They cannot simply go through the motions and seek advice from an inappropriate source as that would not be “responsible”, which is the key test in the Bill and common law. Even if doctors follow the steps in the Bill when deciding to adopt an innovative treatment, they might still carry it out negligently and be subject to a negligence claim in the same way. When something goes wrong it is right that patients are free to seek compensation, and that will continue to be the case. The Government do not want any undermining of protection for patients against clinical negligence.

My hon. Friend the Member for Totnes made a point about the Bill not requiring doctors to seek the prior agreement of an appropriately qualified doctor, and instead being required only to take account of their views. I would not want the Bill to give a carte blanche to quackery or non-evidence based medicine. The Bill requires a doctor to take full account of the views of at least one appropriately qualified doctor, just as any responsible doctor would be expected to do, and they would not be able to ignore certain views or give them minimal weight by just “noting” them unless there were reasonable grounds for doing so. All doctors will be bound by the core and primary duty of responsibility and care to their patients. If the Bill were to require the explicit agreement of another doctor to innovate—that is one suggestion made in the other place—we are worried that that would open the possibility of a new negligence action against the countersigning doctor and lead to more confusion. We would not be able to give the countersigning doctor any certainty about their legal position, and they would not be able to rely on provisions in the Bill.

My hon. Friend made a point about undermining confidence in clinical trials. Although the Bill has raised awareness of innovation in medical treatment, it does not confer additional rights on patients to demand innovative treatment. It will still be for the doctor to decide the most appropriate course of treatment in discussion with their patient and using their best professional clinical judgment. Nothing in the Bill allows doctors to bypass any processes or requirements set by their trust when undertaking innovative treatments in the NHS, which includes ensuring that the commissioner would fund the treatment if it is to be provided within the service.

Individual innovation is important but no substitute for medical research and testing the efficacy of new treatments in a systematic way. A large part of my work is about ensuring that we use all of our £1 billion a year for the National Institute for Health Research infrastructure in the NHS, to ensure—as the Prime Minister set out in his speech when launching our life science strategy—that every willing patient is a research patient and every hospital a research hospital, and that we learn from evidence that we develop daily in our interaction with patients. Lord Saatchi and Ministers are determined that doctors should learn from innovative medicine as we go along, and a large part of the NIHR and our data programme is about ensuring that we pick up and track innovations and outcomes more accurately across the system.

[Dr Wollaston]

Does the Minister accept that that cannot happen under the Bill, and that those things will remain a series of unlinking anecdotes? In medical science and for the safety of patients no one will be able to track whether there were unintended consequences or benefits, and it will not advance the cause of medical innovation whatsoever.

[George Freeman]

I would be interested to see the Bill once it has completed its passage through another place and ensure that it contains adequate provision for evidence-based medicine, and that, by encouraging innovation, we are not in any way encouraging medicine that is not supported by the best evidence available.

My hon. Friend spoke about consultation. The Department of Health carried out a full consultation on the issues raised in the Bill, which ran from February to April this year. It was delighted to receive 170 responses to that consultation, making clear a range of opinions. Responses came from a range of audiences, professional bodies, patients and clinicians. Four regional public consultation events were also held. Lord Saatchi attended those events and it was in no small part thanks to his involvement that a number of changes were made to strengthen the oversight mechanisms in the Bill. At every stage, the Department of Health has engaged with Lord Saatchi to develop amendments to align the policy of the Bill with the legal and expert clinical advice we have taken, including from Sir Bruce Keogh.

[Dr Huppert]

The Minister is being very generous, although we do appear to have quite a lot of time. He talked about 170 responses. How many were supportive of the Bill and how many were not?

[George Freeman]

I do not have that information at my fingertips, but I will happily look into it and come back to my hon. Friend if I may.

Crucially, following the Committee stage, Lord Saatchi and the Government have continued to engage with peers and key stakeholders. Let me take this opportunity, on the question of the Government’s support, to reiterate that this is a private Member’s Bill. This is not a Government Bill. We are very supportive of the Bill’s aims and intent to promote a culture and regulatory framework that is supportive of innovation within the NHS, but it is equally important that we do not in any way damage or undermine public or patient confidence in research in this country and in the NHS. I stress that the Bill has not been given Government time. We are supportive of its principles, but it is very important that when it leaves the House of Lords, where it will have been subject to extensive scrutiny by very eminent medical and legal opinion, it comes to us in a format, even if not every single point is unanimously supported, that has the very strong support of our most senior lawyers and medics.

I want to close by highlighting the fact that the Bill has generated substantial interest, both in Parliament and outside. In many ways, if those concerns can be reflected in high-quality scrutiny and the tabling of amendments, we should be able to demonstrate that democracy works and end up with a Bill that both achieves the aims of Lord Saatchi and reassures those with concerns. I want to be clear that, as the Bill completes its passage in the House of Lords, I hope it returns to this House in a form that the vast majority of medical opinion and respectable bodies in the medical field feel able to support. It is not our intention to have a Bill that undermines public or patient trust in research medicine.

We cannot legislate for best practice; we can only legislate to support our front-line clinicians to do what they believe is best for their patients. At the heart of that is a sacrosanct duty of care that all clinicians share, and which the Bill does not in any way weaken or undermine. That duty is to do what is best for patients.

I want to close with some supportive quotes the Bill has received from a number of important people, lest the House should form the view that it is unanimously opposed, which is not the case. Dame Sally Davies, the chief medical officer, has said:

“I am confident that, with the amendments made in Committee stage, the Bill is safe for patients and has the potential to encourage responsible innovation.”

Sir Bruce Keogh, at NHS England, said:

“Encouraging innovation in medicine and protecting patients are both of vital importance. That is why I am pleased that amendments have been devised to address concerns about patient safety.”

Sir Michael Rawlins, president of the Royal Society of Medicine, said that the Bill will allow responsible innovation and treatment:

“I believe the use of the provisions in the draft Medical Innovation Bill will benefit patients, especially those with rarer diseases, and the furtherance of medical science.”

A letter to The Telegraph from 40 leading medical professionals, including David Walker, professor of paediatric oncology at Nottingham university, and Riccardo Audisio, the president of the Association of Cancer Surgery, said the Bill

“legally protects doctors who try out innovative new techniques or drugs on patients when all else has failed. This Bill will protect the patient and nurture the innovator. It will encourage safe medical advancement, while at the same time deterring the maverick, thereby recalibrating the culture of defensive medicine. Finally, it will work with evidence-based medicine and provide new data that will inspire and support new research.”

I hope very much that that is the case and that when the Bill leaves the House of Lords, the vast majority of qualified senior opinion in this field is able to agree with it. It is absolutely our intention to support the Bill’s noble intent to promote medical innovation, but equally our intention is to not undermine in any way the Government’s commitment to patient safety or the duty of care that all clinicians share and owe to their patients.

Question put and agreed to.

Branded Medicines (NHS)

George Freeman Excerpts

Thursday 4th December 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

It is a pleasure to respond to this debate and to follow the hon. Member for Copeland (Mr Reed) and my right hon. Friend the Member for South Cambridgeshire (Mr Lansley). It is a shame that there are not more Members present, because I know that the debate has been warmly welcomed across the House. I congratulate the Backbench Business Committee on granting it and my right hon. Friend on securing it.

I would like to take this opportunity to pay tribute to my right hon. Friend for all his work in this field, both as the Member for South Cambridgeshire—I do not think there is a constituency that more represents this cluster—and as the former Secretary of State for Health, because he led many of the initiatives that he spoke about so eloquently this afternoon. He is as well placed as anybody to describe the evolution of policy in that space, and it is my great privilege, as the first Minister for life sciences, to inherit that baton of leadership.

I also want to acknowledge the very helpful comments and questions from my hon. Friend the Member for North Herefordshire (Bill Wiggin) on whether there is more of an opportunity for the NHS to become more of a partner in the development of novel medicines. He is absolutely right, and I will come to that in a moment. He also raised the question of off-label drugs, as did the hon. Member for Copeland, and I will also address that shortly. The hon. Gentleman also requested an update on progress in this field and some detail on the review of innovative medicines that I announced two weeks ago. I am grateful for his support for that and for his recognition of NICE’s work on value-based assessment.

My right hon. Friend the Member for South Cambridgeshire set out eloquently, and incredibly helpfully for the House, the challenge we face and the evolution of policy in this area. He talked fluently about the challenge facing the Government, and indeed all mature western democracies, with an ageing population, a demographic time bomb and the rise of chronic diseases. As the Chancellor reminded us in yesterday’s autumn statement, we inherited a very serious structural deficit in the public finances and huge pressure on our budgets. We have to balance the requirement to spend our drugs budget as effectively as we can for patient benefit, but in a way that supports our leadership in medical research for the benefit of patients. That goes to the heart of my mission as the new Minister for life sciences: how do we embrace science, research and innovation so that we spend every health pound more effectively? It is about embracing precision medicines, cutting out waste and ensuring that we deliver maximum health benefit for patients through our health budget, but in a way that attracts inward investment to our economy to equip us better to pay for the modern medicines that we will all need.

My right hon. Friend highlighted that NICE has led the world in health economics on the 20th century model, which is really based on an averaging of health economic benefits, as he explained, and that is under increasing pressure from some of the breakthroughs in science that are bringing us a new generation of stratified and personalised—in some cases, literally—medicines, which do not fit well with the model of averaged, whole-population health economic assessments.

My right hon. Friend made the point fluently that it is ironic that we are a leading centre for research, but unless we also become a leading centre for adopting these new medicines, we will struggle to retain that. We set that out very clearly three years ago in the life sciences strategy. The Prime Minister was very clear about that. We do not believe that we can rest on our laurels simply as a 20th economy with a strong pharmaceutical footprint; in the 21st century we have to use all our resources, including our NHS, to accelerate the discovery of new medicines and their adoption into the system.

[Mr Jamie Reed]

I wish the Minister every success in that mission and offer the fulsome support of the Opposition in ensuring its success, but does he agree—I do not wish to divert him too much—that critical to that success is that Britain remains in the European Union?

--- Later in debate ---

[George Freeman]

I thank the hon. Gentleman for that warm support for this mission. We are ambitious for this country in life sciences research, and ambitious for Europe too. One of the things I am exercised by is the danger of the European Union putting in place a regulatory framework that does not support 21st-century leadership in regenerative medicine, in stem cells, and in the use of data. In the new year, I will lead a delegation to the European Commission to highlight the fact that this new landscape requires a new regulatory framework. I very much hope that we can persuade the European Union to embrace that so that Britain can lead in a Europe that leads in a global sector.

My right hon. Friend talked about institutional and cultural barriers to rapid adoption of new medicines and the need for a new system. I strongly agree with the tenor of his thinking. It must be a system in which we put patients right at the heart of the assessment of need and in which clinicians are empowered and supported to make decisions based on what their patient needs. The new model of 21st-century research and medicine is about accelerating a much more patient-centred model of research, not just so that we design drugs around patients and their genetics and data, but so that the patient voice is stronger in the allocation of resources. That is a challenging but important agenda that we need to embrace.

My right hon. Friend reminded us that this formed a lot of the thinking behind the original concept of value-based pricing and the need for us to move towards a new mechanism for reimbursing innovations on the basis of the impact that they have in populations. I strongly support all that. He highlighted the cancer drugs fund—a really important measure that seeks to make sure that, in cancer, the therapeutic area that has most challenged the traditional method of health economics, we do not allow patients to suffer from lack of access given the increasing stratification of new drugs that do not fit well with the NICE model. I pay tribute to his leadership on this. I am very proud that we have managed to increase the funding of the cancer drugs fund at a very difficult time for the public finances, with another £160 million this year bringing the total to £280 million. More than 60,000 patients have benefited from that.

My right hon. Friend is right, however, to signal that the cancer drugs fund is, in essence, a stop-gap mechanism to make sure that we are able to update the systems, protocols and procedures within NICE for adopting and procuring innovative medicines. We do not intend to have a specific fund for every therapeutic area or, indeed, additional assessment measures within NHS England on top of those already faced by the industry through NICE. It is crucial that we use this window of opportunity to put in place the new system to adapt NICE’s mechanisms and procedures to the new landscape. That is precisely what the review that I announced a couple of weeks ago is about.

My right hon. Friend made a number of comments about the pharmaceutical price regulation scheme. His overall message that price should reflect the value of new medicines and that we should, as far as we can, pay on results, paying a premium to innovations that have particularly high impacts and patient benefits. I suggest that that should apply equally to med tech as to pharmaceuticals. That is part of what was originally conceived of in the value-based pricing proposals that he brought forward. I agree with all that, and I think it is the direction of travel. In a moment, I will explain how the review and the work we are pursuing in the Department of Health is intended to pick up that thinking and drive it forward.

I welcome my right hon. Friend’s reference to the importance of new methodologies. I have discussed this with NICE. He will not be surprised to hear, as it is an organisation that is constantly looking to update its procedures, that it is actively looking at these challenges and welcomed my review as creating a forum for it to share things with industry and charities. I particularly welcomed his mentioning the role of charities. Increasingly, we will see charities as sponsors of drugs alongside big pharma and small companies. As he said, the system is very heavily geared around big pharma as the main developer of new drugs, but that is increasingly not the case. We need a policy and reimbursement landscape that reflects the needs of not-for-profit and smaller company sponsors.

Clinical validation of whether an innovative drug or device is going to work in patients is key, and I know that that is the most valuable moment of all for organisations, because I used to work with them. We should not forget that there is also value in the developers of an innovation being told that it will not work in patients. The “slow no” is the death knell for so many innovative companies and charities. We should look to embrace a model in which we can add value by helping the developers of innovations not to pursue those that will not work well and to target those that can be channelled towards those patients who will benefit most.

I hear loud and clear my right hon. Friend’s call for us to urge NICE to develop a more value-based assessment and to explore all mechanisms in the PPRS for innovative medicines. I am very happy to agree with those two things and take up the challenge to support them. I agree with my right hon. Friend’s analysis that we have a window of opportunity in which it is important that we set out a new framework so that, beyond the cancer drugs fund, NICE is able to provide a holistic, comprehensive model for assessing the new range of medicines that come on stream, and that we do not have to set up additional funds for different types of medicines with additional burdens of assessment both within and outside NICE. That is precisely what the review I have announced is about and I will deal with some of those specific points.

My right hon. Friend made an excellent speech that captured and set the scene and the challenge we face. I will summarise in my own words the problem. We are moving from a 20th-century model of drug discovery and pharmaceutical innovation whereby typically a new drug takes 10 to 15 years to come to market and costs $1 billion to $1.5 billion. It follows a linear process that starts with deep university biological research and then, if we are lucky, it gets spun out into a company or licensed and sent to industry. If we are lucky, it will then get financed through various stages and taken through phases 1, 2, 3 and 4 of trials, with hugely costly international studies. Then it is approved as safe by the Medicines and Healthcare products Regulatory Agency or the European Agency for the Evaluation of Medicinal Products. Then it is approved by NICE as being of suitable cost-benefit for recommended use in the NHS, and then it has to be taken up by clinicians in the service.

The truth is that that model is not working well enough for anyone, but most importantly, as my right hon. Friend has pointed out, it is not working for patients. It is coming under pressure for a series of reasons, partly because the industry is struggling with the time cost of a 10 to 15-year development pipeline, leaving it with innovations it needs premium pricing for to justify the huge sunk costs at a time when we are facing a demographic time bomb. Given the rising cost of disease, we need to get maximum value out of every pound. We cannot afford to pay premium prices for every new innovation, so we need a new model.

The great challenge that that represents is also a great opportunity for this country, because the new model will be about designing innovations around particular patient groups. Yesterday, we believed that what we thought were blockbuster diseases required blockbuster drugs, but today, the more we know about disease, patient data and genomics, the more we know that certain patients respond to the same disease—and, indeed, the same drug—in different ways. If we can use that insight with industrial partners, a new generation of treatments can be designed around patient groups and introduced to them dramatically earlier, which is a completely new value proposition, principally for patients, but also for the NHS. That will allow us to become something of a partner in innovation and unlock the basis of a new model of reimbursement.

I do not pretend that that is easy, or we would be able to do it overnight. We will certainly not be able to do it by Christmas, by the election or even within a year or two. It might involve a 10-year programme of deep and long-term change, but we are definitely committed to embracing it and to laying a policy foundation for it.

I want to say something about the PPRS, because it plays a very important role in this landscape. We negotiated and agreed this important deal with the industry. It contains mechanisms for supporting innovative medicines, not least the exclusion for small companies—those with a turnover of less than £5 million—and the exclusion of new medicines brought on stream from January this year. The review we have announced—

Health and Social Care (Safety and Quality) Bill: Money

George Freeman Excerpts

Tuesday 25th November 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

I beg to move,

That, for the purposes of any Act resulting from the Health and Social Care (Safety and Quality) Bill, it is expedient to authorise the payment out of money provided by Parliament of any increase attributable to the Act in the sums payable under any other Act out of money so provided.

I will, if I may, pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy) for his tireless work on this Bill, particularly for his championing of the cause of information sharing, which sits right at the heart of the Government’s commitment to transparency in health care.

Question put and agreed to.

Oral Answers to Questions

George Freeman Excerpts

Tuesday 25th November 2014 Commons Chamber

[Norman Baker (Lewes) (LD)]

5. What recent assessment he has made of the potential medicinal benefits of cannabis.

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

Cannabis is classified as a class B drug under the Misuse of Drugs Act 1971, as my right hon. Friend knows. To sell cannabis or preparations made from it as a medicinal product would necessitate obtaining a licence from the Medicines and Healthcare products Regulatory Agency. Cannabis in its raw form is not authorised as a medicinal product in the UK. However, certain cannabis extracts are contained in Sativex spray, which is the only medicine produced from the cannabis plant that is approved for use as a medicinal product in the UK. It is licensed for use in treating spasticity in multiple sclerosis and was approved in June 2010.

[Norman Baker]

Over the last year or so, I have met a number of credible people from all walks of life and with a range of medical conditions who have told me that the only substance that helps their medical condition is cannabis. However, they cannot secure it through the NHS and they risk getting a criminal record if they try to obtain it for themselves. Will the Minister look at the much wider availability of cannabis for medicinal purposes in other countries and try to find a way to help those in need in our country?

[George Freeman]

As a former Home Office Minister, the right hon. Gentleman will be aware of the difficulties of getting this policy right. I do not believe that anyone in the House thinks that we ought to allow the prescription of a controlled substance willy-nilly without good evidence. I should like to draw his attention to this evidence from Cancer Research UK, which states:

“At the moment, there simply isn’t enough evidence to prove that cannabinoids—whether natural or synthetic—work to treat cancer in patients, although research is ongoing. And there’s certainly no evidence that ‘street’ cannabis can treat cancer.”

We continue to keep this matter under close observation, and there is good evidence of science being done by companies and by the National Institute for Health Research.

[Ian Austin (Dudley North) (Lab)]

Has the Minister assessed whether the use of cannabis can result in paranoid and deluded behaviour, leading people to believe, for example, that it is possible in this country to mount a huge conspiracy to pervert the course of justice involving the police, the ambulance services, the security services, the Government of the day and the media, and to pretend that someone who had killed themselves had actually been murdered?

[George Freeman]

The hon. Gentleman makes an interesting parliamentary point, but my responsibilities cover only the licensing of cannabis for medicinal purposes.

[Mark Pritchard (The Wrekin) (Con)]

Cannabis no doubt has some limited medicinal benefits for some illnesses, but will the Minister put it on record that it is not the Government’s intention further to liberalise any licensing of cannabis, especially in the light of the Institute of Psychiatry’s empirical evidence that abuse of the substance can lead to severe mental illness?

[George Freeman]

My hon. Friend makes an important point, and I am happy to give him that undertaking. We have to be careful to maintain a distinction between recognising the damaging effects of the recreational use of cannabis and the specific medicinal benefits of some of its derivatives, when tested and proven, in medicinal products. We intend to make that distinction very clear.

[David T. C. Davies (Monmouth) (Con)]

6. How many patients have received treatment through the cancer drugs fund since the inception of that fund.

--- Later in debate ---

[Andrew Stephenson (Pendle) (Con)]

8. What steps his Department is taking to accelerate access to innovative medicine and health care technology in the NHS.

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

Accelerating access for patients to innovative medicines and health care technology is central to my mission as the UK’s first Minister for life sciences. Breakthroughs in genetics and the use of data are unlocking a new era of precision medicines, earlier diagnosis and remote monitoring, which can dramatically improve patient outcomes, and the efficiency of our health service. That is why I announced last week a major review of the role of the regulators, the Medicines and Healthcare Products Regulatory Agency and the National Institute for Health and Care Excellence, in accelerating innovation in the NHS.

[Andrew Stephenson]

I know that the Secretary of State has already visited Airedale general hospital to see its telemedicine service. Earlier this month, I visited Marsden Grange care home in Nelson to look at the service from a patient’s perspective. The service is reducing pressure on the ambulance service, local GPs, A and E departments, and, crucially, improving patients’ experiences. How can we ensure that telemedicine is much more widely used?

[George Freeman]

My hon. Friend makes an excellent point. As with Airedale, the Marsden Grange care home initiative shows that we can improve patients’ outcomes, deliver more health for the same amount of money and make our system much more efficient. That is why we so strongly support telemedicine, why NHS England has undertaken a rapid review of the 3 million lives programme and why, last week, we launched our review to accelerate the adoption of innovative med-tech and e-health technologies into the NHS.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

What is the good of innovation if we do not use it? For the 1 million people who suffer from atrial fibrillation, the three new NICE-approved drugs are a life saver; they make life worth living. But only about 6.5% to 7% of people have been prescribed the new drugs, as they are being blocked by clinical commissioning groups and GPs. What will the Minister do about that?

[George Freeman]

The hon. Gentleman is right to raise the matter. We have all seen it coming in recent years. Extraordinary advances in science are developing a huge range of new products, which our system is having to adjust to cope with, and that is precisely why I launched the review last week with NICE and the MHRA. We must look at these transformational technologies that bring new opportunities to our services and at how we can design a system that is better able to target innovations to the patients who need them.

[Mark Menzies (Fylde) (Con)]

18. Dementia is an abhorrent disease that affects thousands of people across the UK, and a significant number in my constituency of Fylde. With that in mind, what steps is the Minister taking to ensure that dementia sufferers have access not only to the most innovative medicine but to the most advanced early diagnosis?

[George Freeman]

My hon. Friend makes an important point. Dementia is one of those diseases where the loved ones and the carers of patients often suffer every bit as much as the patients. That is why, under the Prime Minister’s leadership, we have launched the G8 dementia summit to bring together the world to tackle the disease. We have launched a dementia strategy. Diagnosis rates in Britain have gone from 42% to 55% in two years. We have launched a new dementia service and doubled research spending. We will have 250,000 staff trained by next March, and, from April, we will be investing £3.8 billion into the Better Care fund. It is an important disease that deserves our priority.

[Lilian Greenwood (Nottingham South) (Lab)]

The Ear Foundation recently published a report that estimates that the real cost of adult hearing loss is at least £30 billion a year. I hope that the Minister has read it. What is he doing to ensure that adults who could benefit from improved hearing technologies, including cochlear implants, do so, and when does he plan to publish the action plan on hearing loss that has long been promised?

[George Freeman]

I am not aware of the veracity of the £30 billion figure, but I will happily look at it, and I happily undertake to look at the progress of the report and the work that the hon. Lady raised.

[Mr Adrian Sanders (Torbay) (LD)]

20. It is a well-established fact that type 1 diabetics who have insulin pumps are much more able to control their condition than those who do not, yet the take-up of insulin pumps in the UK compared with Europe and America is pitiful. What is the Department doing to increase the commissioning of insulin pumps? In the long run, the costs go down with better control.

[George Freeman]

My hon. Friend raises a important example of an innovation that, despite costing a little extra at the beginning, saves substantially downstream. One of the challenges in our national health service is tackling a series of ways in which the system is not well geared to incentivising such innovations. NHS England recently set out its five-year forward view, which has, for the first time, a strong commitment to tackling such issues, and we are working with it to see what we can do to remove barriers and promote incentives for earlier adoption.

[Mr Russell Brown (Dumfries and Galloway) (Lab)]

What steps are being taken to ensure that emerging treatments for Duchenne muscular dystrophy that receive conditional approval are available through the early access to medicines scheme as early as possible?

[George Freeman]

I was delighted, when we launched the early access to medicines scheme earlier this year, to see the very strong support that we got from the Duchenne dystrophy group. Dystrophy is one of those terrible diseases that desperately need the fast-tracking of new medicines. As I said, last week we launched a major review of our landscape for the earlier adoption of innovative medicines in the NHS, so that patients in the most severe clinical need can take part in cutting-edge research and we get drugs to patients more quickly.

[Mark Durkan (Foyle) (SDLP)]

9. What recent representations he has received on access to off-patent drugs; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

The hon. Gentleman will be aware of the debate in the House two weeks ago in which I gave a very full statement of the Government’s position on off-patent and off-label drugs. We want to promote their wider use, but we do not believe that the Bill presented to the House is the right mechanism for achieving that.

[Mark Durkan]

Will the Minister borrow from the approach taken with the Medical Innovation Bill, and commit to consulting on whether the Government should support, or how they might pursue, the key purposes of the Off-patent Drugs Bill?

[George Freeman]

As I said in the debate, we absolutely support the Bill’s intention, which is to promote the greater use of off-label and off-patent drugs, but that must remain a decision for clinicians exercising their judgment about what is best for their patients. We do not think it right that the Government should be put in the position of effectively sponsoring new drug licence applications to the Medicines and Healthcare Products Regulatory Agency. I have convened a round table working group with all the stakeholders to try to look at how we can maximise information to clinicians to promote the use of off-label and off-patent drugs.

[Mr David Crausby (Bolton North East) (Lab)]

10. How many (a) NHS trusts and (b) foundation trusts are forecasting a deficit.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

I pay tribute to my hon. Friend for his tireless campaigning on the issue of cancer drugs. I can assure him that the cancer drugs fund now administered by NHS England continues to fund effective cancer drugs which have been not been recommended by the National Institute for Health and Care Excellence. Over 60,000 patients in England have benefited from the fund since October 2010. That is why we announced a £160 million boost to the fund earlier this year.

[Eric Ollerenshaw]

Will my hon. Friend look again at the CDF’s proposal to delist 42 cancer drugs, including Abraxane, which was put on the list only nine months ago and is the first new drug in nearly 40 years to produce an extension of life for pancreatic cancer patients?

[George Freeman]

I am grateful to my hon. Friend for his notice. I have spoken to NICE. It is appraising the use of Abraxane for pancreatic cancer and has not yet published its final guidance. It would not be appropriate for me to intervene at this point. Obviously, we respect NICE’s clinical independence. Abraxane is available through the CDF for patients meeting specific clinical criteria. I understand that the NHS England’s CDF panel plans to reassess the inclusion of Abraxane in the national list, but no decisions have yet been made.

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to follow the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw). Everyone in every part of the United Kingdom wants to improve access to cancer medicines. When the Prime Minister launched the cancer drugs fund in the home of Clive Stone, he promised to get

“more drugs to people more quickly”.

Mr Stone recently criticised proposals to remove a number of drugs from the fund, writing in his local newspaper that

“People are going to die, there is no doubt about it. Why don’t people keep their promises?”

Additionally, the Breakthrough Breast Cancer campaign has said that it is

“deeply concerned that several very effective breast cancer drugs appear on the list of drugs at risk of delisting”.

We all know someone affected by cancer in some way. What does the Secretary of State have to say to those patients relying on those drugs that are being removed from the fund?

[George Freeman]

The first thing I would say is that we have given an undertaking that any patients currently on drugs will not have the drug removed. Secondly, we are dealing with some very difficult issues. We have had extraordinary breakthroughs in the progress and rate of development of new cancer drugs, and we need to have a system for ensuring that the cost-benefits—the health economics—are done properly. NICE leads the world in making these difficult clinical judgments and we support its independence in doing so, but we need to ensure that we are not turning this issue into a political football. I notice that the shadow Health Secretary said that this was good politics but not good policy. It is really important that we ensure that when we set a benchmark on this debate we are guided by what is best for patients.

--- Later in debate ---

[Greg Mulholland (Leeds North West) (LD)]

My constituent, six-year-old Sam Brown, is one of 100 people with the rare disease Morquio. His family live in a state of anxiety because they do not know whether the drug Vimizim will be approved for further use on 15 December. Will a Minister please meet me and Katy and Simon, Sam’s parents, to give Sam the Christmas present he needs and to keep Sam smiling?

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

I would be delighted to meet my hon. Friend and his constituents to review that very important issue.

[Mark Reckless (Rochester and Strood) (UKIP)]

Last month one patient waited 35 hours in Medway’s A and E, and in the past year 10 patients have waited more than 24 hours. I was grateful to the Secretary of State for taking up my invitation to visit the hospital. What progress has been made specifically on turning around the A and E department?

Innovative Medicines and Med-tech Review

George Freeman Excerpts

Thursday 20th November 2014 Written Statements

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

I am today announcing an external review of the pathways for the development, assessment, and adoption of innovative medicines and medical technology.

Technological advances including digital diagnostics, cell therapy, genomics and stratified medicines are fundamentally changing the health care landscape and the way in which these advances are developed and utilised. These advances have real potential to transform prevention and treatment, improving patient outcomes. Yet they are increasingly challenging traditional systems of regulation, assessment and adoption, the subject of growing public and professional debate.

The innovative medicines and medical technology review will consider how our health care and regulatory systems can best respond and adapt to this new landscape of innovation. We are strongly placed to do this: our £1 billion National Institute for Health Research programme provides a platform for testing and evaluating medical innovations, and we have internationally—renowned expertise in evidence—based assessments of the health economics of drugs and devices.

The review will consider how to speed up access for NHS patients to cost-effective new diagnostics, medicines and devices. It will focus on innovative types of product: in particular, drugs based on stratified medicine, new diagnostics, and digital health technologies. It will examine the pathway from “first in human” trials, through licensing and health technology appraisal, to commissioning, reimbursement and clinical practice. It will set out both short and long-term options for action by Government and relevant bodies—including the National Institute for Health and Care Excellence, Medicines and Healthcare Products Regulatory Agency and NHS England.

We expect the review to recognise the public spending environment in which the NHS operates, and the overriding need to ensure value for money. It will respect the parameters of the 2014 pharmaceutical price regulation scheme for branded medicines, and take account of the existing statutory responsibilities of NHS bodies and the European legislative frameworks for the regulation and procurement of medicines and medical technologies. It will start early in 2015 following the appointment of an independent organisation to lead the work, and report back in the summer.

Health Services (Halifax)

George Freeman Excerpts

Thursday 20th November 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

I congratulate the hon. Member for Halifax (Mrs Riordan) on securing this debate. I know that this is an issue of concern to her and to my hon. Friend the Member for Calder Valley (Craig Whittaker), as well as to a number of other Members locally. The issues around proposed changes to health services in Calderdale and Huddersfield have been debated in this House before.

Of course, the configuration of health services is an important issue for many Members and their constituents. We all agree that patients should receive the best and safest care possible. I know these issues are of keen interest locally, with Members from across the political parties taking a close interest in the changes. People always worry about any change in the NHS, because it is such a loved and respected institution. However, it is not right to play on these anxieties. Change is necessary to ensure that the NHS can offer modern, high-quality care fit for the 21st century.

It is slightly disappointing that the hon. Lady has adopted such a partisan approach. In the period running up to an election, NHS reform is not well served by party politics, and I note the hon. Lady’s refusal to accept interventions from my hon. Friend the Member for Calder Valley. I think we need to hear from people on both sides of the House. I have taken the trouble this week to talk to staff and doctors at the front line locally who are leading the work on this issue, to hear from them what they are planning and what they hope to achieve. I hope that hon. Members, including the hon. Lady, take the time to do the same; I know they would appreciate it.

Let me say a few words about our general approach to reconfiguration before touching on the specifics of the case. The Government are clear that the design of front-line health services, including A and E, must be a matter for the local NHS. It is local clinicians—not me or anyone in Whitehall—who will make decisions about health care in Halifax. That is how it should be. The NHS has a responsibility to ensure that people have access to the best and safest health care possible, and to plan for the future to ensure that safe and sustainable services are available to all patients now and in generations to come.

Reconfiguration is about modernising the delivery of care and facilities to improve patient outcomes, to develop services closer to home and, most importantly, to save lives and improve patient safety. That is why we must allow the local NHS continually to challenge the status quo and look for the best way of serving patients. All these service changes are being led by clinicians and are based on a clear, robust clinical case for change that delivers better outcomes for patients.

The health economy across Calderdale and Huddersfield is working to develop a shared vision for the future provision of high-quality, sustainable services. This work is necessary to respond to the challenges facing the local health economy. As in many areas, the NHS in Calderdale and Huddersfield needs to adapt to an ageing population, increased prevalence of long-term and lifestyle-related illnesses, the needs and aspirations of patients and increased pressure on our public finances. The truth is that local services are currently fragmented, with some duplication and inconsistency of outcomes. There is a need to reduce preventable hospital admissions and enable and support people to live in their own homes for as long as possible. I welcome the fact that the local NHS is looking into how community and in-hospital services can be provided to deliver the best outcomes for local patients.

[Craig Whittaker]

The Minister will recall that the hon. Member for Halifax (Mrs Riordan) did not say whether she had read the strategic review of our area’s health authority, but if she had, she would have seen that it contains no proposals to close the Halifax A and E. Can the Minister confirm that?

[George Freeman]

My hon. Friend has made an excellent point. I think it important to be guided by what the local professionals—clinicians and NHS staff—are saying. I have spoken to them this week, and I can indeed confirm that there are no plans to close the A and E at present. A clinically led consultation is taking place, quite properly, and before the local NHS leadership recommends any decisions, they will be the subject of public consultation with local people.

[Mrs Riordan]

I can tell the hon. Member for Calder Valley (Craig Whittaker) that I have read the strategic review. Let me also make it clear that when the consultation began, the acute trust recommended the closure of the Halifax A and E.

[George Freeman]

As I have said, the local NHS leadership is looking at all the issues on behalf of the patients whom they are there to serve. My point is merely that playing party politics is not helpful. We need to be guided by the local clinical experts. It is important for the NHS to engage widely on the future provision of health services, and it has done that over the last three years. Thousands of local people have given their views on what matters most to them, and that feedback is shaping thinking locally.

Local clinical commissioning groups are focusing on the phased delivery of improvements in community services ahead of any changes in hospital services. Our health system is evolving to adapt to the new landscape of modern medicine, and I think it is in the interests of our patients to encourage that, provided that it is led by clinical decision making. Local commissioners recognise the need for change in hospital services, and I suspect that, as a user, the hon. Lady would recognise that as well. The local NHS believes that the way in which services are currently organised in Halifax does not deliver the safest, most effective and most efficient support to meet patients’ needs. Patients rightly expect that when they see the initials “NHS”, they can expect the very best service that is available, and when they do not receive that service, it is incumbent on the system to adapt so that they do.

The trust is affected by shortages in middle-grade doctors and the high use of locums in A and E, which has an impact on the safety of patient care, and difficulties are involved in providing senior consultant cover overnight and seven days a week. Those are classic problems, which often affect smaller hospitals. We need to ensure that we are delivering the very best care to our patients.

There is often a need for inter-hospital transfers owing to the lack of co-location of first-class services on both sites. The co-location of emergency and acute medical and surgical expertise can result in significant improvements in survival and recovery outcomes, most notably for stroke and cardiac patients. Those who are most seriously ill, with life-threatening conditions, have a much greater chance of survival if they are treated by an experienced medical team that is available 24/7.

It is right for the local NHS to address those challenges to ensure that it can continue to deliver safe, sustainable, high-quality services. Heaven forbid that the hon. Lady should fall ill and require any of those services, but I am sure that, were that to happen, she would want to receive the very best care, and that if that were available in Huddersfield, she would want to be treated in the best possible place. To that end, Calderdale and Huddersfield NHS Foundation Trust has considered a number of options for the future delivery of services, one of which involves one hospital delivering planned care and the other delivering unplanned care. At this stage, no proposals have been ruled in or out. Preferences have been expressed in regard to how services can best be delivered, but no decisions have been made, and I can confirm that there are no formal proposals for changes in hospital services.

In August, the local CCGs decided to delay public consultation on hospital services. While they are signed up to the need for change, they have chosen first to focus on the delivery of improvements in community services in order to build confidence in the changes and demonstrate to local people the benefits they are confident they will deliver. That seems to me entirely appropriate. The CCGs are following a process of change. They understand the need to take people with them, and to build confidence in the changes that they propose. It is incumbent on all Members to encourage and support our NHS leadership locally in building that public confidence in the services.

Change can be difficult to explain to patients, particularly the most vulnerable and elderly patients whose focus is, rightly, on the immediate availability of care. Patients’ reasonable anxieties are often exacerbated by speculation in the media about potential changes and their possible local impact. Services are sometimes described as closing when in fact they are simply being provided in a neighbouring facility or changing for the better in response to advances in treatment.

I know that local people care deeply about the future of their local health services and will want to be involved in decisions about the future of their local hospitals. This is, and should be, a locally led process. Local people should continue to make their views known to those developing proposals for the future of local services, as they have done throughout the engagement process. I also want to encourage them to listen to the reasoning behind any proposals from local NHS clinicians and management for any service changes. I encourage the hon. Lady to work with the local NHS as it further develops its proposals. I know that the CCGs have met hon. Members and are happy to continue to do so.

When talking about potential changes to hospital services, it is important to remember that it is the services, the people and the co-ordination—not the bricks and mortar—that really matter in getting people the right care at the right time. The flexibility and co-ordination of services are just as important as how they are geographically configured. In supporting our local NHS we often end up supporting the current institution—the building in its present location and configuration—but we need to allow the service to evolve and allow our local clinicians and NHS leadership to develop the best possible provision for the people it is designed to serve.

The NHS is one of the great institutions in the world; it is one of this country’s great legacies. Ensuring that it is sustainable and that it serves the best interests of patients sometimes means taking tough decisions. Freezing a service in aspic out of love for it will not allow the NHS to develop and maintain its leadership in the provision of 21st century health care. These decisions are made only when representatives of the local NHS, working in collaboration with local people and local authorities, are convinced that what they are proposing is absolutely in the best interests of their patients.

I make no apology for the fact that it is this Government who have taken these decisions out of the hands of the politicians and the mandarins in Whitehall and put them into the hands of local clinicians and local NHS managers who have the interests of local patients at heart and who are driving those decisions in their interests. It is important that the NHS in Calderdale and Huddersfield develops solutions that will allow it to provide high quality, safe, effective and sustainable services to local people for generations to come.

[Craig Whittaker]

I recall when the Labour Government took the acute services from Halifax and sent them to Kirklees in 2005. I campaigned strongly against that at the time, but I was wrong because it appears that we now have a greater life-saving institution locally. Can the Minister tell me whether there is any evidence around the country that having specialists in one place, rather than having them split between several sites, does in fact save lives?

[George Freeman]

My hon. Friend makes an important point. There is a huge amount of evidence—which the Department is keen to publish and disseminate in order to inform the debate—that in many areas, particularly in relation to respiratory and cardiac conditions and to diabetes, the centralisation of services in specialist centres drives up clinical outcomes, improves patient safety and prevents avoidable death. Patients have a right to expect us to put in place a framework that allows the NHS to evolve. We need to find ways of ensuring that those services that are best provided locally—community-based services—are provided in that way, and that those requiring increased specialisation in centres of excellence and expertise that operate 24/7 are also available. That is what the local NHS leadership is endeavouring to do, and we should support them in that because it is in the interests of the patients, whose NHS this is.

Question put and agreed to.

Health and Social Care (Safety and Quality) Bill

George Freeman Excerpts

Friday 7th November 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

I am delighted that this important Bill appears to have cross-party support. I strongly support it, as do the Government, and I pay tribute to the tireless commitment shown by my hon. Friend the Member for Stafford (Jeremy Lefroy) to the cause of public safety. I think that I speak for the whole House—although many Members are not present this morning—when I say that he has commanded all our respect in campaigning so tirelessly, with such good grace and diligence, and with cross-party support to ensure that the lessons of the appalling tragedy at Mid-Staffs are properly learned. He has demonstrated the integrity of that work again today, which is reflected in the degree of support for the Bill.

Let me begin by echoing the support that my hon. Friend expressed for Julie Bailey, my hon. Friend the Member for Stone (Sir William Cash) and Ken Lownds, all of whom have done a huge amount of work behind the schemes in support of the Bill and the wider cause of patient safety. My hon. Friend spoke extremely powerfully about the 4,000 unavoidable deaths and the many thousands more unavoidable incidents of harm. Such incidents will, of course, be avoidable if we are better equipped to track, monitor and collect data in the way that is proposed in the Bill, and to develop the culture of transparency and accountability for which it provides.

My hon. Friend spoke about the concept of zero avoidable harm, which sits at the heart of the Bill, and spoke particularly powerfully about the culture of health and safety. In the aviation and nuclear industries, as we heard from the hon. Member for Copeland (Mr Reed), it is a culture that involves actively looking out for near misses, and actively welcoming the reporting of problems by staff members from top to bottom of an organisation as soon as they have been identified, that has enabled those industries to develop such exemplary health and safety records. One of the great lessons that emerges, loud and clear, from the Francis report is the need for a change of culture.

My hon. Friend referred to the science of safety and the elimination of variability from the system, and to the good work that is being done in this country, not least as a result of the Francis report. That is another example of an area in which the NHS is leading in global medicine. He also spoke of the importance of integrating information and data. His account of the journey made by his constituent Janet Powell as she helped to escort her mother across the health and care landscape will have resonated with many Members. It certainly resonated with me, because over the last 18 months I have been in a similar position, supporting my own mother through a journey from primary care to hospital care to community care in Norfolk. As many Members and many millions of carers outside will know from experience, it is often the carers, parents and loved ones of patients who are carrying the best information about the patient through the system. That information is often too slow and does not keep up with the patient on their journey.

My hon. Friend spoke very powerfully about the risk-averse attitude to sharing information. That is a problem, and the Government are committed to trying to tackle it. That is another reason why we are supporting this Bill. Key to that, as my hon. Friend touched on, are the recommendations of Dame Fiona Caldicott, and I am delighted that she has agreed to take a lead role and to accept the invitation of the Secretary of State to look at the safeguards we need to be putting in place across the whole of the NHS and Department of Health care and data provisions. That will help provide a strong degree of reassurance to both Members in the House and people outside that patient concerns about confidentiality are being met.

My hon. Friend also spoke very powerfully about his support for health care professionals, and I would like to put on record my support for his comments about the NHS staff who are in Africa on the front line of the fight against Ebola. We owe them all a huge debt of gratitude.

We also heard from a number of other Members who spoke very powerfully. My hon. Friend the Member for Bury North (Mr Nuttall) was kind enough to congratulate me on my role in managing to get the data-sharing measures included in this Bill. They were raised before this House in my ten-minute rule Bill, which fell, but I am delighted to see those measures picked up in this Bill.

My hon. Friend also spoke very powerfully about the NHS as a bedrock of British society, and I could not agree more. He made some interesting points, too, about the difference between the science of health care and the human and compassionate and cultural side of health care, which this Bill goes right to the heart of. That has always been a great strength of the NHS, which in its founding charter is a scientific and research-led organisation, and which has always put compassionate care at the very top of its mission.

My hon. Friend the Member for Congleton (Fiona Bruce) spoke very powerfully and again paid tribute to both the NHS and its staff. She also spoke about the importance of transparency and of there being public confidence in the data confidentiality aspects of this Bill and more generally across the health care system.

I was pleased by the tone and spirit of the speech of the hon. Member for Copeland and to hear that there is cross-party support for this Bill. Although parliamentary time is short in this Session, I think that with that support this Bill has every chance of reaching the statute book.

I was particularly pleased to hear the hon. Gentleman’s powerful—and personal—support for the importance of data sharing in 21st-century health care. He rightly highlighted Salford as a beacon of what can be achieved, and that stands as a tribute to the NHS in the north-west, which is leading the way in the use of informatics and medical data for both research and treatment.

The hon. Gentleman also spoke powerfully about his personal experience as a diabetic patient, and about his reliance now on data as a patient and his active embrace of telehealth and the use of smartphones. He also spoke very powerfully about how that is allowing him to have better control of his condition. Patient empowerment, through data and electronic health records and putting in place a landscape so that patient medical information flows with the patient and reflects the patient journey across the system, is key to both this Bill and the Government’s wider proposals for building the integration of health and care and a 21st-century model of the NHS in which health care moves from being something done to patients when the system is able to do it to a system in which active health citizens are empowered and enabled and encouraged to take more responsibility for their health care so they can drive through the system in the way that suits them.

We might not have a packed House here on this Friday morning, but we have certainly packed in the arguments. We have heard a lot of high-quality contributions. I want to talk about the thinking behind the Bill and answer some of the key questions that have been raised.

The need to maintain minimum levels of quality much more consistently was put into sharp focus by the landmark public inquiry report, published in February 2013, on the terrible, shocking and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust. I think everyone in the House would accept that the subsequent Francis report shook the health system to its core. Francis’s call for a fundamental culture change across the entire health and social care system that would put patients first at all times still resonates loudly in this Chamber and throughout the health and care debate.

Sir Robert Francis QC, the chair of the inquiry, made a compelling call for action across six core themes: culture; compassionate care; leadership; standards; information; and openness, transparency and candour. That is a checklist that all of us who are involved in health care need to keep close at hand. The inquiry represented a watershed in our thinking on safe and better care. That in turn is driving a culture change across the NHS as we resolve never again to allow the system to fail patients and service users in the shocking way that it did.

The Government published their response to Robert Francis’s public inquiry on 19 November 2013. That response, “Hard Truths: The Journey to Putting Patients First”, demonstrates the Government’s commitment to creating a culture of openness, with greater accountability and a relentless focus on safety in an NHS that puts compassion at its heart. In response to the events at Mid Staffs, to Robert Francis’s recommendations and to Don Berwick’s excellent review of improving patient safety, the Government have already introduced a number of measures to improve safety. First, a new statutory of candour on providers will help to ensure that patients are given the truth when things go wrong and that honesty and transparency are the norm in every organisation. This new duty will be overseen by the Care Quality Commission. It will come into force for all NHS bodies soon and for other registered providers by April 2015. We expect staff to reflect the duty in their everyday activity.

An organisation is made up of its staff, and providers will be expected to implement the new duty through staff across their organisation. Training and education of staff will also support the establishment of an open culture. The General Medical Council, the Nursing and Midwifery Council and the other professional regulators will introduce a new explicit and consistent professional duty of candour, making clear a requirement to be open, whether the incident is serious or not.

Secondly, the Secretary of State announced in March a new Sign Up to Safety campaign, a platform on which all NHS organisations and patients can share, learn and improve ideas for reducing harm and saving lives. It was launched in June, and health care leaders have been invited to set out what their organisations will do to strengthen patient safety, including by producing a safety improvement plan. Sign Up to Safety aims to achieve much more than just the numbers of NHS organisations joining; it is about motivating participants actively to get involved. The campaign will go beyond institutions and seek to sign up as many individual NHS staff as possible, and everyone who chooses to join will commit to the new patient safety ambition.

In order to realise the Berwick report’s vision of the NHS as an organisation devoted to continual learning and improvement, NHS England and NHS Improving Quality have established a new national patient safety collaborative programme. This will spread best practice, build skills and capabilities in patient safety and improvement science, and focus on actions that can make the biggest difference to patients in every part of the country. The safety collaboratives will be supported systematically to tackle the leading causes of harm to patients. The programme will include establishing a patient safety improvement fellowship scheme to develop 5,000 fellows in a national faculty within five years.

We are absolutely committed to changing the culture of patient safety through investment in leadership. NHS England is now working with The Health Foundation to help develop proposals for a safety fellowship initiative. The NHS is on a transparency journey, through the NHS Choices patient safety section, to become completely open and transparent. More information about our local health services is now more publicly available than ever before. As well as using the information to drive improvements, it is vital that a patient or member of the public can easily find and understand what it says about their local health services.

In June, NHS Choices began publishing new and existing information in a new safety section, complementing the wealth of information available about our hospitals and wards. It specifically provides information on: nurse staffing levels, including at ward level; infection control and cleanliness; CQC national standards; whether the unit is recommended by staff to their relatives and friends; patients assessed for risk of blood clots; the response to patient safety alerts; and open and honest reporting. The NHS is one of the safest health care systems in the world but there is always scope to improve health care standards universally and reduce avoidable harm further. That is why the Secretary of State for Health set the ambition to reduce avoidable harm by half and save 6,000 lives over the next three years.

As well as the devastating effect that health harms can have upon patients, service users and, as hon. Members have mentioned, their carers and families, a recent report by Frontier Economics has estimated that poor care could be costing the NHS up to £2.5 billion every year. That is why the Government have thrown their full support behind this important Bill, which will do much to improve the safety of patients.

[Jeremy Lefroy]

I am grateful to the Minister for the argument he is developing. Does he agree that the Bill is vital for staff? They do not want to be involved in instances of avoidable harm; it preys on their minds and can blight their careers. If the institutions to which they belong are not seeking to avoid harm, it is often the professionals, rather than the institution, who carry the can, and that is not right.

[George Freeman]

As ever, my hon. Friend makes an incredibly powerful point. An institution is only as strong as the staff within it, and when an institution is not taking seriously an issue that the staff confront as a daily reality, it puts them in an impossible position. He rightly says that by changing the culture of the institution, NHS staff will be able to do their jobs more easily and with more confidence, safe in the knowledge that when they raise issues that may be of concern, whether or not there is in fact a risk, they will be welcomed and supported. That culture change is vital if we are going to turn things around in the way that we are committed to doing.

There are three key sets of provisions in the Bill: the ones that will mandate patient safety as a key requirement of CQC registration; the provisions ensuring the integration of data across the health and care pathway; and the provisions dealing with the regulation of professional standards. They represent real and significant steps to support and develop patient safety in the NHS, and we are delighted to support them. Let me deal with each of the three in turn.

On the CQC requirements to include safety, clause 1 is central to the Bill’s focus on safety and quality, and, in particular, the elimination of the avoidable harm that flows from the provision of poor care in health and adult social care services. Safety is paramount and must be the focus of care providers at all times. The experience at Mid Staffs underlines the importance of that and of what can happen when providers put other priorities before safety. The CQC’s role in protecting patients is vital, and safety and the avoidance of harm are key elements of the CQC’s regulation of providers, in two key ways. First, monitoring registered providers against safety requirements and taking enforcement action when the requirements are not met is central to the CQC’s objective to protect and promote the health, safety and welfare of people who use services.

[Jeremy Lefroy]

Does the Minister also agree that the Bill’s provisions, in seeking to get that focus right to the top and make it the responsibility of the Secretary of State, ensure that, right here in this House, patient safety is of the essence?

[George Freeman]

My hon. Friend makes another important point about the role of leadership in the culture change that we are seeking to drive. I believe all hon. Members would acknowledge the Secretary of State’s personal commitment to this crusade for patient safety, and it is symptomatic of the level of leadership that is required. If the leader—the accountable senior executive—in every trust and organisation in the NHS makes clear their personal commitment to this agenda, it helps to change the culture and to create the conditions in which the reporting of patient safety issues and concerns is welcomed and encouraged.

Safety is also a critical component of the CQC’s new inspection regime and one of the five key questions the chief inspectors ask when rating the quality of services. Currently, it is at the Secretary of State’s discretion as to whether registration requirements should cover safety of care. Clause 1 removes that discretion and instead places a duty on the Secretary of State to impose registration requirements about safety of care. We welcome that duty, because it absolutely fits with the Government’s wider commitment to putting patient safety right at the heart of our health and care system. The duty will cover all providers registered with the CQC across health and, importantly, adult social care, and will help ensure that no avoidable harm will come to patients and service users when they are being provided with a regulated service. It is important to say at this point that the duty will not place an obligation on the Secretary of State to ensure that care or treatment is risk-free—no Secretary of State could ever give that undertaking. Health care provision is of its nature a risky business and can be so. Chemotherapy, for example, saves lives but can have significant side effects. A test of reasonableness must be applied in assessing whether harm is avoidable. The registration requirements that are before Parliament do cover safety and will allow the CQC to take action against poor providers in a way that has not been possible up to now. The Government therefore welcome the clause, which reinforces what the regulations are seeking to achieve and will ensure that the key message of safety and harm reduction runs consistently through the CQC regulation, and across the system as a whole, for years to come.

Clauses 2 and 3 deal with the key changes requiring a common identifier and imposing the duty to inform other health care professionals along the care pathway. Far too often in the health care system, patients lead and their information follows and, particularly as patients migrate between primary, hospital and community care, they and often their loved ones are left driving the patient journey without access to the necessary information. Too often, the health care professionals do not have access to the very latest information on the treatment that their patient has received in another part of our health and care system. That is why we welcome the clauses.

Clauses 2 and 3 concern the sharing of information by providers and commissioners to support people’s direct care and treatment, as an essential part of the delivery of safe, effective and high-quality care. The sharing of timely, accurate and relevant information facilitates the provision of integrated care and treatment tailored to people’s needs and wishes, yet we know that that sharing does not always happen as it should. Anxiety about information governance and data protection can stifle the sharing of information between staff and organisations working together to care for an individual. Clauses 2 and 3 will require that providers and commissioners of publicly funded health and adult social care share the information which is so essential to the delivery of safe and high-quality care. That will relate only to the way in which information is shared by organisations directly involved in an individual’s direct care.

Clause 2 places a duty on providers and commissioners, within scope, to record and use consistent identifiers in people’s health and care records and correspondence. There is a requirement to include the identifier when sharing information with other organisations directly involved in that individual’s care. Clause 3—

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. May I say to the Minister that he does not need to explain the whole Bill; the promoter has already done that. The Government have said that they support the Bill, so I am at a bit of a loss as to why the Minister does not appear to be giving us any new information, but is reiterating what has already been said. Perhaps he could clarify some things a bit more, but we do not need a commentary on every clause.

[George Freeman]

I completely understand, Madam Deputy Speaker, and I do not intend to give you a commentary on every line of the Bill; that happens in Committee. However, given that the Government are supporting this private Member’s Bill, I thought it was important that, as part of our wider commitment, I set out why and on what basis we are supporting it, and give some guidance to the House on where in Committee there may be differences and where and why the Government are taking the view that they are. None the less, I will heed your comments and ensure that I keep my remarks at an appropriate high level.

[Madam Deputy Speaker]

Order. I absolutely agree with the Minister. We would be interested to hear any qualifications from the Government and where they were, as that would give the House time to consider what will be occurring in Committee. I look forward to hearing him say that.

[George Freeman]

It is important to recognise that clauses 2 and 3 relate only to how information is shared by organisations involved in an individual’s direct care. My hon. Friend made the point that this Bill is solely focused on the needs of the patient; it is not in any way about the Government or the NHS seeking to collect information for any other purpose other than to ensure that patient care is first and foremost in the system.

Clause 3 places an express duty on direct care providers and commissioners of publicly funded health and adult social care. When providing care to an individual, organisations within scope would be required to ensure that the relevant information is shared with staff within their organisation, and also within other organisations along the care pathway, where it is in the individual’s best interests. That duty would apply only if it directly facilitated the individual’s care and if it was in his or her best interest. That will not only support the delivery of safe, effective and integrated care, but improve people’s experience of their care and support, sparing them the frustration of having to tell their story over and over again as they move along the care pathway.

Simply sharing is not enough. To realise fully the benefits of sharing information, it is vital that the information shared is accurate, relevant and timely. In order to provide safe and high quality care, especially where it is urgent or where multiple care teams are involved, information needs to follow the person, so that professionals can access the right information at the right time. Using a consistent identifier is essential to that aim, as it ensures that the information being shared relates to the right individual.

A number of people have asked about the common identifier. Clause 2 places a duty on the Secretary of State to make regulations that will specify the consistent identifier to be used. It is the intention of the Government that the prescribed identifier should be the NHS number.

The universal use of the NHS number is a long-standing priority of the Department. Ensuring that records include a person’s NHS number, especially when they move between providers on their care pathway, is vital to the safety and quality of care. A number of Members asked about our view of the appropriate identifier. We believe that consistent use of the NHS number will facilitate the co-ordination of care, reduce errors and support the integration of records.

Ensuring a reliable and seamless transfer of information is all the more vital when the patient is a vulnerable person. That vulnerable person could be an elderly patient with dementia and many complex needs, for whom large institutions can be difficult to navigate at the best of times. I must stress that these duties are strictly limited to sharing for direct care purposes, with only those organisations directly involved in the provision of care, and only where it is in the patient’s interests.

Let me be clear: this will not permit or require sharing of information for any other purpose. The duty would not apply where there were good reasons for it not to apply. Such reasons could include: when an individual objects to his or her information being shared, or to his or her NHS number being used; where the individual would be likely to object; or when an individual receives, or may receive, services, such as sexual health services, anonymously.

[Jeremy Lefroy]

Should this Bill command the support of this House on Second Reading, does the Minister agree that one thing we would need to consider in Committee is this real issue of the mixing up of personal information and patient information within records? How best that can be addressed will require quite a lot of discussion.

[George Freeman]

My hon. Friend makes an excellent point. As he is aware, there are a number of initiatives on data across the health and care system, which is why the Secretary of State has appointed Dame Fiona Caldicott to advise the Government and to look at the pilots that NHS England is currently running on the care.data programme. It is important that the data provisions of this Bill and the confidentiality provisions and guarantees are closely examined in Committee and that there is no confusion over the purposes for which the data provisions are being used, which are solely to do with patient safety.

Clause 4 creates a power for the Secretary of State to make regulations to exclude certain persons or their functions that would take them outside the scope of the new duties for continuity of information. The Government intend to make regulations that will exclude providers and commissioners of children’s social care and providers and commissioners of children’s health care within the Department for Education’s purview. Those exclusions will include local authorities and other organisations exercising educational functions and children’s social service functions, children’s homes and residential family centres, fostering and adoption support agencies and certain schools, nurseries and educational institutions. I am delighted to tell the House that the Department of Health and the Department for Education are working together to support information sharing and use of the NHS number, where appropriate, by those organisations.

The use of patient data can arouse significant public concern and controversy and lead to highly charged debates. The public rightly expect to see their data held securely and used only for their benefit. That sits full square at the heart of these proposals, which is why NHS England has taken back the care.data proposals to review, revise and pilot, and why we have appointed Dame Fiona Caldicott. The information-sharing provisions of this Bill are solely concerned with the sharing of information between health and care providers where it is in an individual’s direct care interests.

To summarise, the consistent patient identifier and information-sharing provisions will support three key things: better informed care decisions, leading to care and treatment being better tailored to people’s needs and preferences, and better health and care outcomes; safer care, with a reduced likelihood of errors, adverse events and sub-optimal care stemming from a lack of information;, and improved experience of care, with individuals being called upon less often to repeat their story, and having increased confidence that the person caring for them has all the information that they need.

Let me turn now to the third and final section of the Bill, which deals with the regulation for the Professional Standards Authority and the professional regulator. We welcome these clauses, which will bring in a consistent objective for the PSA and for the regulators of certain health and care professionals, including dentists, nurses, midwives and opticians.

That will ensure that public protection is at the heart of what the regulators do. This measure is about not changing what the PSA or the professional regulators do in relation to professional regulation, but ensuring a coherent, strategic approach by them in the performance of their functions. Patients and the public need to understand the role and purpose of the organisations that regulate our health professionals in order to have confidence in what the regulators do. Having clear and consistent objectives is vital to that.

Let me touch now on the automatic erasure provisions, which my hon. Friend said had been withdrawn. The intent of the policy is to enable the regulators automatically to erase from a professional register individuals tried and convicted of certain serious crimes. However, it would be necessary to amend the existing statutory framework for each of the regulators properly to achieve the policy and would result in a Bill that is much longer and more complex than is usually acceptable for a private Member’s Bill. In the light of that, and given the complexity of the drafting required to achieve the policy, we took the position that automatic erasure should not be taken forward.

Automatic erasure was one of the areas considered by the Law Commission in its review of the regulation of health professionals. The Government remain committed to legislating on this important issue at the earliest opportunity. We have explored all other possible legislative options for taking forward issues arising from that piece of work and therefore propose to take forward automatic erasure in a future parliamentary Session alongside other measures in response to the Law Commission’s review. The long title of the Bill, which sets its scope, specifically mentions the intention to provide for automatic erasure, but I believe that my hon. Friend the Member for Stafford has indicated his intention to table an amendment in Committee to remove that from the long title.

When I talk to people about the Bill, I am asked one or two key questions, which I believe those watching the debate will want to hear us answer, and which the hon. Member for Copeland has asked me to deal with. The first is, “Are my medical records already shared with others involved in my care?” Unfortunately, the sharing of information about one’s care is not as widespread in the system as it needs to be. Those who use the NHS the most often are often those who have the most to remember. It can be very frustrating for health professionals, and too often that lack of information is involved in the misdiagnosis and the mistakes that my hon. Friend the Member for Stafford spoke of.

The second question that we are often asked is, “Don’t these regulators already put patient safety at the heart of everything they do?” The CQC and the professional regulators are all there primarily to protect us. The measures in the Bill are not a reflection of any failure in that respect. However, these organisations are given legitimacy through legislation; their remit and ability to act are defined in law, and it is important, we believe, that their legislative basis is explicit about their respective roles and duties in public safety. It is not our intention that the Bill, if it becomes law, should result in a dramatic change to the way in which the regulators operate on a day-to-day basis. We know that they are already focused on patient safety. The Bill enshrines that focus and ensures that those organisations are never hindered in their important work.

The Bill is a big step forward. I urge hon. Members from both sides of the House to support it.

Later in the year, we shall publish a comprehensive update on achievements to date and the progress towards Sir Robert Francis’s vision of a system delivering safe, compassionate care.

The events at Mid Staffs were a shocking reminder of the systemic failings in patient safety and care that occur when the culture and practice of healthcare institutions cease to prioritise the human, the compassionate and the cultural aspects of health care. I am delighted to support the Bill, which fits very well with the Secretary of State’s crusade for accountability, transparency and patient safety. It complements the measures that we are putting in place, as a Government, to support patient empowerment, to integrate health and care, and to meet the need for seamless information that follows patients, rather than patients so often traversing the care pathway without that information to hand.

There are two other questions that I was—

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. With respect to the Minister, I spoke to him nearly 15 minutes ago with regard to his comments on the Bill. He has now been speaking for 37 minutes to tell us how much the Government agree with the Bill. There are other Bills to be debated this morning. I tried asking the Minister very nicely and gently. Now I am saying to the Minister directly that it is not his job to use up time in the House. Could he please conclude what are the major points on the Bill?

[George Freeman]

Thank you, Madam Deputy Speaker. I have concluded my prepared remarks. I just want to deal, if I may, with the questions that were asked of me in the House.

[Madam Deputy Speaker (Dame Dawn Primarolo)]

With respect to the Minister, he should have integrated those into his remarks on the Bill, because I presume he was listening to the comments of the other speakers. He has now been speaking for nearly as long as the rest of the debate, and this is not really acceptable, Minister, given that there are other Bills to be debated this morning, and that this Bill seems to have the wholehearted support of the Department. The word succinct must be in the Minister’s mind, which means brief, and I will interrupt him again if he is not.

[George Freeman]

Thank you for that clarification, Madam Deputy Speaker. In that case, perhaps it would be appropriate for me to list the questions now and then deal with them by writing to Members.

There were important questions about the Law Commission, some of which I have addressed, but I will write more fully. The hon. Member for Copeland asked me about the duty of candour dropped under pressure from professionals. If he is happy, I will drop him a line on that. The hon. Gentleman also asked about the care.data issue. I think I have dealt with that in my comments, but he should feel free to contact me if there are any omissions. There were important comments about the BMA, Madam Deputy Speaker, which I am taking your guidance to mean I should not address. Its briefing arrived on my desk this morning, and obviously I will look at it very carefully and write to Members with our position on the concerns that it has raised, although I note that its report also seems to have a lot of support for the intent of the Bill.

Lastly, there was a question about making data sharing much more consistent. I want to confirm that the Department of Health is working with our partners, and will produce guidance to support compliance across the system.

On that basis, Madam Deputy Speaker, following your guidance, I express again our support for this important measure and resume my seat.