Francis Report

Kevin Barron Excerpts

Wednesday 5th March 2014 Commons Chamber

[Kevin Barron (Rother Valley) (Lab)]

I reread the executive summary of the Francis report yesterday when I was on a train journey, and I decided that in today’s debate I would like to look at one of the most crucial aspects of his findings in respect of what happened at Mid Staffs.

On page 62, at paragraph 1.102, the summary states:

“The senior officials in the DH have accepted it has responsibility for the stewardship of the NHS and in that sense that it bears some responsibility for the failure of the healthcare system to detect and prevent the deficiencies at Mid Staffordshire sooner than it did. There is no doubt about the authenticity of their expressions of shock at the appalling story that has emerged from Mid Staffordshire. However, it is not possible to avoid the impression that it lacks a sufficient unifying theme and direction, with regard to patient safety, to move forward from this point in spite of the recent reforms put in place by the current Government.”

It goes on to say:

“Where there are perceived deficiencies, it is tempting to change the system rather than to analyse what needs to change, whether it be leadership, personnel, a definition of standards or, most importantly, culture. System or structural change is not only destabilising but it can be counterproductive in giving the appearance of addressing concerns rapidly while in fact doing nothing about the really difficult issues which will require long-term consistent management. While the DH asserted the importance of quality of care and patient safety in its documentation and its policies, it failed to recognise that the structural reorganisations imposed upon trusts, PCTs and SHAs implementing such policy have on occasion made such a focus very difficult in practice.”

It is my contention that we could probably say that of every reorganisation of the NHS, certainly in my three decades in politics.

The summary goes on to discuss the lessons learned and related key recommendations:

“The negative aspects of culture in the system were identified as including: a lack of openness to criticism; a lack of consideration for patients; defensiveness; looking inwards not outwards; secrecy; misplaced assumptions about the judgements and actions of others; an acceptance of poor standards; a failure to put the patient first in everything that is done.”

It goes on:

“It cannot be suggested that all these characteristics are present everywhere in the system all of the time, far from it, but their existence anywhere means that there is an insufficiently shared positive culture.”

Again, it is my contention that that sums up not just the past 30 years but perhaps the past 60 years of our national health service.

The summary goes on to say that achieving change

“does not require radical reorganisation but re-emphasis of what is truly important”.

All parties in the House should recognise that it is not the reorganisation but the re-emphasis of what is important that is significant. Paragraph 1.119 lists how that can be achieved:

“Emphasis on and commitment to common values throughout the system by all within it; readily accessible fundamental standards and means of compliance; no tolerance of non compliance and the rigorous policing of fundamental standards; openness, transparency and candour in all the system’s business; strong leadership in nursing and other professional values; strong support for leadership roles; a level playing field for accountability; information accessible and useable by all allowing effective comparison of performance by individuals, services and organisation.”

I was not surprised by any of that.

The right hon. Member for Sutton and Cheam (Paul Burstow) was a member of the Select Committee on Health in the previous Parliament between 2005 and 2010, and I had the privilege of chairing that Committee. In 2009 the Committee looked at patient safety in the NHS. We visited one of only four hospitals that were part of a patient safety project on how to look after patients inside hospitals, never mind outside. We looked at some of the major issues at the time, such as how different parts of the NHS interacted and their failure to communicate with one another properly. Much of the time they were working with different regulations, and occasionally the inspectorate was not sure what it was responsible for inspecting. This whole restructuring has been going on for a very long time, and it has been more confusing to people working inside.

I am pleased with how the Government have reacted to some of the Francis report’s main recommendations, but I take issue with them on one point. If we are to change the culture inside the NHS, we really need to look at the duty of candour. The Government have accepted the report’s recommendation on a duty of candour for organisations, but they have rejected the recommendation to extend that duty to individuals. I think that is fundamentally wrong.

I spent nine years as a lay member of the General Medical Council, which regulates doctors, and for the first few years I would sit on fitness-to-practise committees. I think that the only way we shall get change is if individuals have responsibility for the duty of candour, not just organisations. I believe that the Government have got that fundamentally wrong. If they really want to tackle the issues that led to the awful situation at Mid Staffs, they need that duty of candour to extend to individuals.

On the Government’s decision on the duty of candour, the Patients Association has stated:

“We question that if individuals are not already motivated by their own professional code, how will a duty on their employer encourage them to come forward?”

That is absolutely right. It continued:

“Without this fundamental change within the NHS, the Duty will just be providing lip service to the issue of patient safety and patients will struggle to see any real improvements.”

That is a big assumption, but on balance I agree. It is something that the Government, no matter who is in Richmond House, need to tackle throughout the NHS.

I have in my hand a copy of the Health Committee’s report on patient safety, which was published in July 2009. We looked at patient safety across the health care system and compared it with what was happening abroad. We visited New Zealand, which has a comparable health system—I accept that the country has only 4 million occupants, compared with our 60-odd million. We looked at why the culture here is the way it is, why people are not open and why they do not learn from mistakes that other health professionals have made. Often those mistakes are not reported because people fear they will get into trouble. We took evidence from the British Airline Pilots Association and learned that any mistake a pilot makes in an aeroplane is whizzed around the world so that other pilots understand it and learn the lessons immediately. That is not the case in our health service.

I want to mention two of the Committee’s findings from New Zealand. The first relates to investigating complaints. I do not think that leaving the duty of candour to organisations, as the Government suggest, will work well. New Zealand has a statutory body—I have mentioned it before in the House—called the Health and Disability Commissioner, which resolves complaints. People can go to the commissioner to request investigations, and they can do so anonymously if they do not want their colleagues to know about it. It is completely independent of the health care system. It works, and it has been working for many decades.

Another area we looked at in New Zealand—again, I accept that it is a very small country—was compensation and redress. I know from my experience of 30 years in Parliament that when people complain about something that happened to them in their local hospital that they are unhappy about, they are treated as if they are going to get into litigation and that it will cost a lot of money; immediately the barriers come up. That culture is not good for our health service, it is costing massive amounts of money for us as taxpayers, and it is certainly not good for the individual concerned. I do not know how many times I have been told that all the patient wanted was an admission that the hospital got it wrong and an apology; they did not necessarily want money. New Zealand has a redress system that some might call a no-fault liability system. Here, it would mean getting rid of lots of lawyers who make massive amounts of money and careers from public money for NHS litigation. Just those two areas hold back changing what is wrong in our system.

[Barbara Keeley]

I wonder whether my right hon. Friend has had similar cases to a difficult one that I had for months involving someone whose wife died in terrible circumstances at home. He was badly let down by the care she received and he wanted redress. He found that people were happy to have meetings with him and to talk to him, and were sympathetic and supportive, but whenever something was put in writing, it was absolutely dreadful. He was very offended and horrified by everything that was in writing, and that is the chilling effect of lawyers because they checked everything. It ruins the support that can be given after a difficult bereavement and when someone has a real case. Things can be said, but they cannot be written down.

[Kevin Barron]

I agree entirely. The system is defensive and people do not get a satisfactory response, but the lessons are not learned. Issues are not reported for fear of the consequences. The Minister is a doctor. He will know that if as a junior doctor he had seen a senior doctor doing something wrong and had gone public about it, it might have affected his career. Some young doctors’ careers have been affected. That is not good for the system, and it is certainly not good for patients.

I am a wholehearted supporter of the national health service and the way it is funded. There is none better in the world, and we can use it without question. It may be different in different parts of the country, but access to health care in this country is second to none in the world for the whole population as opposed to just those with money. Could it better? Yes, and what the Francis report said was a lesson for all of us, and for the national health service. We should change the culture, but we will not do that with reorganisation or by blaming one another in the Chamber for what is right or wrong. That just feeds the politics of the national health service. We must change the culture by putting the patient first, and after 60-odd years it is about time we did.

--- Later in debate ---

[Dr Poulter]

We are leading by example. As I outlined, the Secretary of State has accepted the TSA recommendation in full. A process is now under way involving NHS England and local commissioners. That was initiated last week. It is important that those conversations happen and that an update is brought forward in a timely manner. That is the right thing to do. It is not appropriate to rush decisions and processes because of a political agenda, rather than an agenda of benefiting the local patients and women concerned. I am concerned as a doctor and as a Minister that we must do the best thing by patients. Rushed decisions are not always the best thing for patients, because conversations need to happen between local commissioners and NHS England. I hope that the hon. Lady will be a little patient, because I am sure that the right decision will be made in due course.

There are three key areas in which the Government have taken forward the recommendations of the Francis inquiry: encouraging a culture of transparency and openness in the health care system; empowering front-line staff and encouraging good leadership in the NHS; and putting the patient at the heart of everything that the NHS does. As we have discussed, the patient was not at the heart of everything that was done at Mid Staffordshire for a period. That is why we have to learn the lessons and ensure, as best we can, that that cannot happen again.

On transparency and openness, it is important to highlight how we have already delivered on the recommendations of Robert Francis’s report. The CQC has appointed three chief inspectors for hospitals, social care and general practice who will ensure not only that the organisation is complying with the law, but that the culture of the organisation promotes the benefits of openness and transparency. Importantly, we now have clinically led inspections for the first time, which means that people who really understand what good care looks like will be in charge of the inspection process. That clinical leadership in the inspection process and at the heart of what the CQC does has to be of benefit to patients, and the Government are proud that we have delivered that.

We have also introduced a new statutory duty of candour on providers, which will come into force this year. It will ensure that patients are given the truth when things go wrong and that honesty and transparency are the norm in every organisation.

[Kevin Barron]

rose—

[Dr Poulter]

The right hon. Gentleman might wish to intervene in a moment, but first I will respond to his good points on the importance of the duty of candour. There is some disagreement between us, because he said that there should be a duty on individuals. He will be aware from his time at the General Medical Council that there is already a duty on professionals to act in the best interests of patients and raise any concerns about the quality of care. As a body, the GMC has learned lessons from Mid Staffordshire and reviewed its processes, but it is important to recognise that many front-line professionals at Mid Staffordshire tried to raise concerns. The culture at the trust was such that those in management positions did not always listen to them. If we want to support whistleblowers and people’s ability to speak out freely for the benefit of patients, that has to be done at organisational level. Health care professionals are already under a duty through their professional obligations, which I hope reassures the right hon. Gentleman.

The right hon. Gentleman has been in the House for many years and will remember that problems of people not being able to speak out freely in their organisations date back to the Bristol heart inquiry. Professor Kennedy, who oversaw that inquiry, noted that it was the cultural problem in that hospital provider that prevented people from speaking out. The problem was not that people were not prepared to speak out—they recognised their professional obligations; it was that there was a wish at a senior level not to recognise problems. That is what we need to tackle. We are now almost 15 years on from the Kennedy inquiry into Bristol—I was a law student at Bristol university at the time—and the NHS has perhaps not learned the lessons that it needs to. I am sure that putting a duty of candour on to NHS organisations will begin to get us where we need to be.

[Kevin Barron]

Will the Minister consider what I said about how an independent statutory commissioner could examine complaints about patients’ care, as happens in New Zealand? Will he get back to me about whether he thinks that is a good idea? The people who work in the institutions that he is talking about have no faith that anything can be changed.

[Dr Poulter]

I will talk about complaints a little later, but the right hon. Gentleman has made some important points. When we consider how to improve the delivery of care in our health service, it is important that we examine international comparisons. The system in New Zealand includes a different form of compensation, and perhaps that is partly why it has a more open culture—there could be many other factors. It is acknowledged much earlier in the process that something has gone wrong, and there is a genuine attempt to explain the situation to the family and say sorry. That is what good health care is all about.

No matter how good, well trained and dedicated staff are, things will sometimes go wrong in a health service. When they do, it is important that we are open and honest with patients and that we do our best to put things right if we can, or explain and apologise if we cannot. That is why we believe that the duty of candour needs to exist at organisational level. Of course, I am happy to write to the right hon. Gentleman, or meet him if he would like to talk through some of the issues that he raised today. He makes good points, and I know that he does so on a completely apolitical basis because he has the best interests of the health service at heart. We might disagree on other issues, but on this one it is worth having a meeting to discuss his views further.

Subject to the passage of the Care Bill, a new criminal offence will be introduced to penalise providers who give false or misleading information where that information is required to comply with statutory or other legal obligations. It means that those directors or other senior individuals, including managers, who consent to, connive in, or are negligent regarding an offence committed by the provider could be subject on conviction to unlimited fines or even custodial sentences. We must ensure that managers and those running the health and care service in a health care provider provide information in an honest and transparent way that is always in the best interests of patients.

Importantly, we are introducing through the Care Bill a single failure regime to ensure that failure is not only about the financial sustainability of the trust, but about whether a health care provider is providing good care, and the quality of that care. One problem in the past with the trust special administration regime has been that it is rarely used. When it is used, however, it is important to ensure that it is there to protect patients. Often in the past it was used only in a way that focused on financial failure. One important lesson to learn from Mid Staffs is that there should be a failure regime that also considers quality of care. Hospitals are not just about good accounts; they are primarily about delivering good care, which is why we need a single failure regime. My right hon. Friend the Secretary of State has been a tremendous advocate for the importance of quality of care in trust, and he should be commended for that. Thanks to him, we are now ensuring that we improve the TSA regime in that way.

Children and Families Bill

Kevin Barron Excerpts

Monday 10th February 2014 Commons Chamber

[Philip Davies]

I have said I am not going to give way. The hon. Gentleman can listen for once.

Moreover, this is totally and utterly unenforceable. What on earth are we doing saying to the police, whose resources are already stretched, that all of a sudden this should be a new priority for them to undertake? Have they got nothing better to do than go up as close as they can to a moving car to see whether there happens to be a small child in the back seat? Of course, this is not just about small children but all children. How on earth does the driver prove that the person in the back of the car is over 18 rather than under 18? What happens when the driver throws the cigarette away and the police have to try to prove whether they were smoking when they were pulled over? The whole thing is completely unenforceable. It is gesture politics of the worst kind, with Ministers and shadow Ministers trying to flex their health zealotry at all these health organisations and saying, “We’re tougher on these matters than the others.”

Standardised packaging—it is not plain packaging, as some people say—is also nonsense. In many cases, the standardised packaging is more colourful than the existing packaging, so this measure will not do anything for the people who say that all the colourful packaging encourages people to smoke. It is already the case that cigarettes cannot be displayed in large shops. What on earth is the point of having plain packaging for products that are already behind a counter and cannot even be seen? Again, the whole thing is complete nonsense.

All these arguments are arguments for banning smoking altogether. If people had the courage of their convictions and said, “We should ban smoking altogether”, I would at least have some respect for them, but they dare not say that that is what they want to do, even though we know it is their real agenda. While cigarettes are a legal product, brands should be free to use their own branding on the packs. Standardised packaging would simply be a triumph of the nanny state that would presumably soon be followed by plain packaging for alcohol, sweets, crisps, and all the foods that supposedly lead to obesity. Once we have gone down this road for one thing, why would we not have plain packaging for everything? We know, particularly given the current Ministers and shadow Ministers, that that is what it would quickly lead to.

I have tabled three amendments to Lords amendment 124 to try to make it more sensible. The Lords amendment states that the Secretary of State can make regulations if he believes that they

“may contribute at any time to reducing the risk of harm to…the health or welfare of”

children—I repeat, “may” contribute. This gives the Secretary of State the authority to make a decision on a whim just because he happens to think that it might make a difference. My first amendment would change “may” to “will” so that he would need to have some evidence for making a change rather than just doing it on a whim.

The second amendment relates to regulations. Under Lords amendment 124, the Government are saying that they can make lots of provisions and as long as some of them are capable of having a positive effect, that is fine. They can propose 10 ridiculous things and two sensible ones, and the regulations allow them to do it as long as some of them are sensible. My amendment says that “each” provision that they want to bring in should be capable of making a difference, not just the odd one or two in a whole series.

The Minister said that it would be a constraint on the Minister’s power to accept my amendments. Well, I make no apology for trying to constrain the Minister’s power. That is what the House of Commons is all about—trying to make sure that sensible decisions are taken based on evidence, not just on the latest whim of the nanny state brigade whom she has listened to. We are supposedly here to try to defend the freedoms of people in this country. This Government want to trample over every single one of those freedoms. It makes me wonder what is the difference between having Labour or this Government in charge. I expect no better from Labour, but I did expect an awful lot better from a supposedly Conservative-led Government.

[Kevin Barron (Rother Valley) (Lab)]

Listening to this debate, I could have heard the same things said in 2006 when the House came to a decision on smoking in public places. That is public health legislation which the Prime Minister says is good legislation, although he did not vote for it at the time. I hope that Members will bear that in mind.

I hope that Members will also bear in mind, as we always must when considering such legislation, that currently in the UK over 100,000 people a year die prematurely from smoking tobacco. I support the amendment, which will, I hope, further restrict the use of tobacco not just by young people but, in turn, by adults. As the Minister said, two thirds of people who start smoking are young when they do so, and it is addictive.

One of my points relates to what the Minister said about e-cigarettes not being sold to people under the age of 18. Some people argue that e-cigarettes are a gateway to tobacco use, but the organisation that I have worked with on this over many years—Action on Smoking and Health, which the hon. Member for Shipley (Philip Davies) clearly admires—says that there is no firm evidence for that at this stage; it is doing another survey this year. The important thing is that over 2 million people are using e-cigarettes, some of them so that they smoke less tobacco and some so that they smoke no tobacco. I agree with the Minister that we should view them as a medicinal product—as part of the family of nicotine replacement therapies. That should be our approach in stopping these awful deaths from smoking. VAT on nicotine replacement therapy products is currently 5%. If e-cigarettes were also licensed and charged at the same rate, that would benefit everybody.

I support what the Minister said about proxy purchasing. This has not yet been addressed and it should have been. Alcohol and tobacco are harmful, depending on how they are used, although alcohol is not as bad as tobacco.

We have debated standardised packaging many times in the House and heard the arguments about printers being affected, and so on. The hon. Member for Shipley said that standardised packages are very complicated, and of course they are. I hope that we will have better safeguards to stop people engaging in contraband activities. There is no way that this measure will do anything other than stop people advertising on cigarette packets the products that cause all these premature deaths.

I support the Government and the Opposition on banning smoking in cars with children. Enforcement is always an issue, and we accept that. When I first started driving, people had to have seat belts in cars but did not have to wear them, and only one person in four did so. When the law was changed, 90% of people started wearing them practically overnight. This is about changing habits. We could not have a worse situation than somebody in a confined space like a car smoking cigarettes when children are there.

Everybody said that the ban on smoking in public places would never be enforced. I was on the Health Committee when we had that debate and we went to Dublin to look at what had happened in Ireland. A guy there tried to get publicity by saying, “I’m going to be smoking in this pub tonight. Will you come down and get me?” However, there were very few problems with enforcement and the same is true of us now. We have not seen all the details, but, as far as I am concerned, the provision is a further step towards protecting young people and future generations from premature death as a result of ill health, and we should support that.

[Mr Charles Walker]

My concern about the Lords amendment is that we are in danger of criminalising otherwise very loving parents. We should guard against that. It would be appalling if people who have been good parents in every other way found themselves being criminalised as a result of smoking in a car when their children were present.

I hear the argument about seat belts and it is perfectly and entirely reasonable for the Government to set the terms of their use on the road. If the Government decide that someone who wants to drive on a road has to wear a seat belt, that is highly reasonable. I suggest that, if the Government really are determined to press ahead with banning smoking in cars, that is exactly what they should do: they should ban the consumption of alcohol in cars by any person of any age and ban smoking in cars by any person of any age. That would be a much more honest approach, because, as I have said, if we go down this road we will be criminalising hundreds of thousands of parents. Will a repeat offender—someone who has been penalised three or four times—have their children taken into care because they are deemed to be an abusive parent?

There is an enormous degree of hypocrisy in this House. I am pleased to say that I am a teetotal non-smoker. There are many people in this place who want to ban smoking because they think it is not done by very nice people, but they are much more relaxed about alcohol because of their own habits. If Members are genuinely concerned about the welfare of children, they need to realise that alcohol is the problem, not tobacco. Hundreds of thousands of children have their lives blighted by alcoholic parents and the problems associated with alcohol, yet we never talk about that in this House, because some Members think, “We, as nice people, drink.” I am extremely concerned about the direction of travel.

My final point—I know that others want to speak—is that we will drive another wedge between the police and those they are policing if we implement this provision. It is nonsense. We will expect the police to intervene and that will further widen the gap between them and those they are policing. That should be avoided and we should be very careful about widening that gap.

Mrs M. Barnes (NHS Treatment)

Kevin Barron Excerpts

Thursday 6th February 2014 Commons Chamber

[Kevin Barron (Rother Valley) (Lab)]

I thank Mr Speaker for allowing me to raise this subject in today’s Adjournment debate. I understand that he makes the decision on a Thursday afternoon.

I wish to discuss the treatment of a constituent of mine, Mrs Monica Barnes, who lives in the village of South Anston. I have been dealing with her over many years now, regarding different aspects of her health care, but my reason for wanting to speak today has to do with what has been recorded on her patient records at the Kiveton Park medical centre and the effect it may have had on her clinical treatment.

Mrs Barnes wrote to me on 5 July 2002. She said:

“Whenever I have attempted to obtain treatment some reference to litigation past or present has shown itself in my medical records and/or in letters of referral from the GP. This clearly shows there to be discrimination in my case. This time reference is made in the Patients Summary to the court case. See copy sent to me in very small print, enclosed.”

I have indeed got the patient’s summary. It is dated 18 January 2001. On the bottom, it says “await judges ruling”. My constituent contacted the Information Commissioner, and a letter was sent to the practice manager on 5 September 2002. It contained the patient’s summary and the court case entry. It said:

“In order for me to assess the practice’s compliance with the First Principle, I would be grateful if you could confirm whether individuals are made aware that personal data about them may be disclosed to other health professionals in the course of their care and treatment and the extent of such disclosures. In particular, could you please confirm whether such data as were disclosed in Mrs Barnes’ case are disclosed to other health professionals as a matter of routine, which of the conditions in the Schedules the practice is relying upon in order to make any such disclosure and whether individuals are made aware of the disclosure. Given that Mrs Barnes did not expect this, I would also welcome confirmation of these issues with regard to her case. If there is no legitimate basis for holding and disclosing the data in question when Mrs Barnes did not expect such processing, it is likely to be in contravention of the requirements of the First Principle.”

Mrs Barnes received a reply from the Information Commissioner on 6 March 2003. I have to say that the Information Commissioner had to write to the practice on 16 December to remind it of the letter it had been sent on 5 September 2002 about what was held on Mrs Barnes’s record.

Mrs Barnes received a reply from the Information Commissioner. It said:

“I understand that having considered its relevance to your patient summary records, the practice has removed the entry which states “court case”. (I have requested that the practice ensures that this does not appear elsewhere in your medical records).”

That was dated 6 March 2003. Presumably, my constituent would have been quite happy with such a positive reply. The letter went on to say:

“Consequently, on the balance of probabilities it does seem that the data in question is not relevant and is excessive for medical purposes. It is also our view that on the balance of probability it does seem that it was not necessary for the practice to disclose the details without your consent, when you did not expect this.”

That is a pretty firm statement that the Information Commissioner felt that it was wrong for the records to have been kept in such a way.

In the autumn of 2010, Mrs Barnes decided to join another practice in central Rotherham that had been built in the walk-in centre that had been opened. Her medical records were requested by the South Riding Health Services Support Agency, an organisation that I had never heard of in my 20-odd years as an MP, and they were sent on 3 November before being sent on to the new practice in Rotherham town centre. When Mrs Barnes visited her new doctor in November 2010, the practice had her medical records but on her next attendance her new GP said that he did not have them. Mrs Barnes told me that she was prompted to investigate their whereabouts.

In 2011, Mrs Barnes asked me to write to the chief executive of NHS Rotherham, who wrote back to me on 11 March saying that he had had the case investigated by his complaints officer who confirmed that the notes were sent on 3 November. The chief executive went on to say:

“However, I am informed that shortly after forwarding the medical records…the…practice received a letter from the Information Commissioners office advising them that the amendments were to be made to Mrs Barnes’…records. In order to comply with the Commissioners advice, the notes had to be retrieved from Mrs Barnes’ current GP via the SRHSSA. Whilst it is acknowledged that the Kiveton Park practice had Mrs Barnes’s medical records for several weeks, it is important to note that implementing the Commissioner’s advice was onerous.”

The chief executive wrote to me on the basis that the submission from the Information Commissioner had come in around November 2010, when my constituent was moving to another GP’s practice.

I then received a letter from NHS Rotherham on 1 June 2011, which accepted that the Information Commissioner’s advice was given in 2003 and not more recently, as mentioned in the chief executive’s letter. That was the reason for the retrieval of the records from her new GP, as it was felt “prudent” that the medical records should be reviewed for absolute accuracy. The two doctors concerned verified that the removal of information as advised by the Information Commissioner had been carried out.

Mrs Barnes referred her case to the ombudsman. She wrote to me in October 2011 setting out a number of instances in which she believed discrimination might have taken place and said in that letter:

“When I assessed my medical records at the Sheffield Northern Hospital in June 2011, I discovered that reference to court case etc, was still to be found in my patient summary.”

It seems clear to me that the advice of the Information Commissioner given in 2003 was not adhered to. The instruction was to remove that reference from her medical records in the practice and anywhere else it might appear.

I got involved with the Parliamentary and Health Service Ombudsman on Mrs Barnes’ behalf and corresponded with the office in December 2012. The ombudsman had earlier refused to investigate the case until the medical practice had the opportunity potentially to offer Mrs Barnes some compensation. That did not materialise, for whatever reason. My understanding was that the insurers might have wanted to consider the case and decide whether to take any action. In a letter to me in December 2012, the ombudsman asked Mrs Barnes for further clarification in three areas. The first was whether she had considered taking a legal remedy and why she might not have chosen to do so. The second was the level of compensation she hoped to recover. The letter said:

“The Ombudsman does not operate a tariff system and we are very much guided by what people hope to achieve. The levels of financial redress we may be able to recommend are modest when compared to sums that could be recovered by legal action and it is helpful for us to know whether we would be likely to meet the financial outcomes a complainant has expressed. This helps to ensure that they can be quickly directed to the most appropriate route to consider their concerns and helps to avoid complainants being dissatisfied at the outcomes we may be able to offer.”

The third point related to how Mrs Barnes felt that she had suffered damage as a result of the practice’s failings.

Mrs Barnes came back to me on this matter and we discussed in some detail how she should respond. In March 2013, I wrote to the assessor at the health service ombudsman saying that Mrs Barnes and I continued to be unhappy with the handling of her case. I reminded them that a letter I had received from them on 28 March 2012 stated that

“the Ombudsman will not normally consider a complaint unless the NHS organisation concerned has had a reasonable opportunity to resolve the complaint”.

I then went on to say that in relation to their letter dated 11 December, Mrs Barnes did not wish to go down the legal route because of the potentially high costs involved.

In relation to the ombudsman’s comment about the compensation that Mrs Barnes would wish to recover, as I have already pointed out, I said that

“she cannot risk going down the legal route because of the cost. Consequently, she feels the only route she has open to her is to go through the Ombudsman”.

I then said that I would appreciate it if they could be more specific about what level of financial redress they may be able to recommend if they were to settle the case for her. They told me that they had no tariff, which I quite understand.

On the third point, I reiterated that Mrs Barnes had previously provided them with information on how she felt about the damage suffered as a result of the practice’s failings. It was not just the one incident; there were many other incidents in the letter that I received from Mrs Barnes at the time.

Further correspondence took place between Mrs Barnes and the ombudsman, and in a letter to them, no doubt in her frustration, she said:

“I refuse to involve clinical negligence solicitors due to my having taken legal action against a particular hospital in the past with no outcome.”

Hence, presumably, the reference on her patient record. She went on to say:

“The only people who seem to benefit from litigation are the solicitors themselves. I refuse to further fill their pockets and barristers’ pockets with taxpayers’ money.”

That quote was used in a letter sent to me dated 18 June from the ombudsman’s office. Also in that letter it was stated:

“Mr and Mrs Barnes complaint correspondence referred to a number of other interactions with NHS Care that did not involve the practice since around 1990 and were not part of our considerations”.

That is an important point, and I agree with it. This complaint was about the issue of what was on Mrs Barnes’s medical record and how it may have been used by others if they had seen what was on that.

After further correspondence, I received a letter from the director at the ombudsman’s office in August 2013 after a review had taken place of the action/inaction of the ombudsman’s decision not to progress the complaint. That letter stated that when I wrote to the ombudsman on 24 June 2013 I had said that Mrs Barnes was unhappy with the decision because she did not have the money to take the case to court. It was said that Mrs Barnes had previously told the ombudsman that she was not prepared to put money into the pockets of solicitors and barristers, but not, so far as I can see, that she could not afford to take legal action.

The letter continued:

“However, while a person’s ability to pay legal costs is relevant in cases such as this, it cannot be the sole factor. Mrs Barnes is seeking damages for personal injury that she says she has sustained at the hands of a number of clinicians over more than 20 years and her claim arises from an action for which the law provides a specific remedy. In the circumstances we agree with our original decision that the matter is properly for the courts and is not one we should investigate.”

[Dr Julian Lewis (New Forest East) (Con)]

This is a very complicated case and I just want to be sure that I understand exactly what the ombudsman is recommending. My understanding is that the ombudsman is recommending that a lady who has had a lot of trouble because she once previously went down the legal route should, instead of pursuing a complaint about that with the ombudsman, go down the legal route all over again. Have I got that right, or am I missing something?

[Kevin Barron]

The hon. Gentleman is absolutely right. What gets me about the last two letters more than anything else is the fact that they are completely contradictory. The first states:

“Mr and Mrs Barnes’ complaint correspondence referred to a number of other interactions with NHS care that did not involve the Practice since around 1990 and were not part of our considerations”.

The last letter basically states, “No, we aren’t going to pursue any action at all. We’re not going to look at it.” It then states—I am sorry to repeat this, but I think that it is important—that

“Mrs Barnes is seeking damages for personal injury that she says she has sustained at the hands of a number of clinicians for more than 20 years”.

They are completely contradictory.

It seems to me that the parliamentary ombudsman, which is also taxpayer funded, has not only made contradictory statements, but handled Mrs Barnes’ case in a negative way. As we discussed when she and her husband visited my office, which they did on several occasions, this was not about what had or had not happened to her with the medical professional over the years; it was about what had been held on her personal records. In 2003 the Information Commissioner said that that was wrongly done and suggested it should be removed. We then found out that in 2010 the records were scooped back in again when they moved to another practice. I can only assume that the chief executive of NHS Rotherham did not know about the Information Commissioner’s decision at the time, because the second letter I received from the chief executive stated that it was more recent than he had been led to believe and that the records had been brought back from the new practice because they had just received information from the Information Commissioner that they had to change them.

I am deeply concerned about the situation. My constituent has effectively been railroaded into a situation she does not want to be in, and that she should not have to be in. Indeed, the British taxpayer has been railroaded into a situation that I do not think it should be in. My constituent said, not with my blessing—I give it my blessing now, though—that far too many people are forced into litigation in this country, at taxpayers’ expense, rather than following common sense by sitting down, looking at the problem and deciding what should be done sensibly, not feeding the law courts.

I have to tell the Minister that I am deeply disappointed that the Parliamentary and Health Service Ombudsman—I know that it is not directly a part of Government—can be run in that way and make those contradictory decisions. It seems to me that its decision is this: “We don’t have to do anything, so we’ll force her back to litigation if she does not want to go. That’s the end of the matter.” That cannot be correct, and I would like to know whether the Minister agrees.

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

I congratulate the right hon. Member for Rother Valley (Kevin Barron) on securing the debate and commend him for all the work he has done on behalf of his constituent, and for the work he did in the previous Parliament, before I was a Member, as Chair of the Health Committee. I know that he has a long and distinguished record of fighting on health issues in the House, for his constituents and more generally. I also congratulate him on his recent knighthood. I am sure that the House will echo those congratulations.

We can all agree that good-quality patient care is expected, regardless of which part of the country we live in, and that all patients should expect it. I pay tribute to the NHS staff in the right hon. Gentleman’s constituency for the work that they do.

I am sorry to hear about the difficulties that Mrs Barnes has experienced and that she is dissatisfied with the quality of the care she has received. It is never acceptable for a patient to receive anything less than the very best treatment and service from our NHS. However, I am sure that all hon. Members will appreciate that the provision of local health care services is a matter for the NHS locally and that the Department of Health and Ministers do not play a role in directly investigating individual localised health care complaints, which should, quite rightly, be investigated without political interference to ensure that there is no question of bias. There is an NHS complaints procedure to resolve concerns and to help local NHS organisations to learn from the experiences of their patients. On the anniversary of the Mid Staffordshire scandal and the Francis inquiry, it is right that we reflect on the fact that we have to learn from things that have gone wrong in our health service and make sure we put them right for the benefit of future patients.

I understand that, as the right hon. Gentleman outlines, Mrs Barnes has been pursuing this matter for many years and has made use of the NHS complaints system, up to and including the health service ombudsman, on a number of occasions. I also understand—this is an important point in the context of the ombudsman and other issues—that a number of the concerns that Mrs Barnes raises about her care relate to events involving non-NHS health care. I should make it clear that what I say relates to the NHS, and not to health care providers working outside the NHS with whom Mrs Barnes may have decided to undertake treatment.

It is relevant at this stage to say a few words about how the ombudsman system works.

[Kevin Barron]

I accept, to some extent, the Minister’s point about the wider issues, which were not a matter of referral to the ombudsman. However, a constituent might often go to the private sector needing to get things done because they are in pain, for example, and might then see a consultant they could also see under the NHS. Often the staff are the same people, and there is no great difference between the clinicians they meet. Does he agree with that?

[Dr Poulter]

The right hon. Gentleman is absolutely right. It is difficult, in terms of the care pathway, for any patient to draw these distinctions. However, the NHS complaints procedure relates to NHS care, and the ombudsman’s role is as a public sector ombudsman. That goes to the heart of some of the difficulties we are talking about.

If a complainant is dissatisfied with the outcome of their complaint locally, they have the right to take it to the health service ombudsman, whose office was set up under the Health Service Commissioners Act 1993. When complaints are escalated, it is important that they are investigated independently, free from the political process, to ensure that there is no question of bias. The health service ombudsman is completely independent of the Department of Health, the Government, and the NHS. It is therefore difficult for me to comment on the ombudsman’s decisions directly.

If a complainant is dissatisfied with the ombudsman’s decision, they may make use of her own complaints process. The recourse open to anyone after the ombudsman has made a final decision is to seek a judicial review. During the entire complaints process, we assume that patients would take legal advice whenever they think it necessary. That is in their best interests and, in some cases, it is often important that patients have advice from a completely independent source.

If, on the basis of the legal advice received, patients decide to commence legal action against the NHS, that is, of course, to be expected. The House will understand that I cannot comment on legal advice given to patients, including Mrs Barnes, as that is entirely a matter between the patient and her lawyer. Complaints about lawyers are not a matter for the Department of Health or the NHS, nor for this House to consider in this context. I am aware that Mrs Barnes has exhausted all the legal remedies open to her. Her case has been considered by a number of courts, including the Court of Appeal, and has on each occasion been rejected. It goes without saying that these matters will have been considered carefully by the various judges involved, and I should not and will not cast any doubt on their judgments.

[Dr Poulter]

My hon. Friend will be aware that patients have open access to their records and can request to see them, but it is not for a patient forcibly to remove relevant clinical information from them. I am not sure whether that was the case in these particular circumstances, but I hope to be able to reassure the right hon. Member for Rother Valley.

It is worth pointing out that, during the long line of litigation, in 2007 Mr Justice Simon said, following a hearing, that

“this is not a case of professional conspiracies by the medical or legal professions; it is a case where the balance of the evidence before the Court fell decisively and conclusively in favour of the defendant”,

meaning the NHS. There is a long history of legal rulings that make that point clearly. Indeed, I understand that the NHS Litigation Authority obtained cost orders in its favour for that case, although it was unable to recover its costs. I reassure the right hon. Gentleman, however, that I shall look into the issues he has raised about the ombudsman and the Information Commissioner and write to him about them.

[Kevin Barron]

I appreciate that. I know that there is some history to the case of Mrs Barnes, but in my humble view—I understand that the ombudsman and politicians should not get mixed up—this specific issue is not about what happened in the courts. It is about what did or did not happen at the request of the Information Commissioner. My reading of the situation is that it could have been managed and handled by the health service ombudsman and compensation could have been paid. In my view, the ombudsman sat back, possibly because of the history to which the Minister has just referred, and thought, “It’s got to go to litigation and that’s it.” When other avenues were closed off, the ombudsman’s office could have managed the situation, but it seems to me that it backed off, looked at the whole history of the case of Mrs Barnes and said that it had to go to litigation. I think that is unfair and that the ombudsman’s office could have handled things much better and smarter on behalf of my constituent.

[Dr Poulter]

I note what the right hon. Gentleman says. I have committed to looking further into the issue and to writing to him, and I hope that will reassure him further about the processes that have been followed in this case.

As I said at the outset, I am very sorry to hear that Mrs Barnes is unhappy at the care and treatment she has received from the NHS. I am also aware that, over the years, she has been seen and treated in a private capacity on a number of occasions, which, as we have discussed, complicates the issues, because it can make it difficult to establish whether the responsibility sits with the NHS—as part of either the ombudsman’s process or the NHS complaints procedure—or elsewhere. Her case has also been considered by the courts on a number of occasions and I have alluded to their conclusions.

I understand that Mrs Barnes made full use of the various NHS complaints processes, but remains dissatisfied, which we have discussed in detail today. Accordingly, she has involved the health ombudsman, but the outcome has not been as she would have wished.

As I have said—this is worth repeating—the ombudsman is independent of Ministers, the Department of Health and the Government. An option open to anyone dissatisfied with the ombudsman’s actions is judicial review, but it is not to be embarked on lightly and those considering doing so should ensure that they take legal advice.

I wish Mrs Barnes well and I appreciate the intentions of the right hon. Gentleman and his strong advocacy of her case.

Question put and agreed to.

NHS

Kevin Barron Excerpts

Wednesday 5th February 2014 Commons Chamber

[Mr Hunt]

I understand my hon. Friend’s frustration. This is the shadow Secretary of State who said that it was irresponsible to maintain the NHS budget at its current levels and who actually believes that it should be cut, and he has stuck to that position. It is not possible to make such investments by following the right hon. Gentleman’s advice.

The right hon. Gentleman talked a great deal about competition, and I am afraid that his comments about that also showed a wilful disregard for the facts. He raised two distinct issues, and he was right to do so, because they are important. The first relates to mergers. NHS hospitals often need to concentrate services for clinical and safety reasons, but the involvement of the Office of Fair Trading and the Competition Commission is not a result of the Health and Social Care Act 2012, as the right hon. Gentleman alleged. As he well knows, it is as a result of powers that they have under Labour’s Enterprise Act 2002. All my Front-Bench colleagues agree with me that we must ensure that when those powers are exercised, they are exercised in a way that is in the best interests of patients. For that reason, I have had useful discussions with both the Competition and Markets Authority—which is replacing the OFT and the Competition Commission—and Monitor about how their respective roles can be clarified.

[Kevin Barron (Rother Valley) (Lab)]

If the Secretary of State believes that, can he explain why the Health and Social Care Act contains a section stating that any mergers of NHS trusts must be referred to the Office of Fair Trading and the Competition Commission?

[Mr Hunt]

Yes, I can explain that. When drafting the Act, my predecessor wanted to ensure that investigations would not be carried out by both Monitor and the Competition Commission. [Interruption.] If Members wish me to answer the question, I will happily do so.

If we repealed the Health and Social Care Act—as the right hon. Gentleman has often argued should happen—the Competition Commission and the OFT, or the Competition and Markets Authority, would still have the power to stop mergers, under the Enterprise Act. The right hon. Gentleman should get his facts right before presenting his arguments.

Secondly, the Health and Social Care Act did not introduce new rules in relation to procurement. For all the efforts of the right hon. Member for Leigh to convince people otherwise, clinical commissioning groups observe the same procurement requirements as applied to primary care trusts. Labour may have made many mistakes in office, and the right hon. Gentleman may have shifted his own views dramatically to the left, but it will not do for him to try to seek cover for that by attaching blame to the Health and Social Care Act.

--- Later in debate ---

[Kevin Barron (Rother Valley) (Lab)]

First, I thank my right hon. Friend the Member for Leigh (Andy Burnham) for tabling the motion, because it gives us an opportunity to examine the whole issue of competition. Hon. Members will recall that I intervened on the Secretary of State on the subject of when competition came in to health care in this country, and he said that it had always been there. The hon. Member for Stafford (Jeremy Lefroy) and the right hon. Member for Sutton and Cheam (Paul Burstow) will recall, as they served on the Committee for the Health and Social Care Bill, that when I intervened on the right hon. Member for Chelmsford (Mr Burns), a Minister at the time, to ask what the Competition Commission and the Office of Fair Trading had got to do with the mergers of NHS trusts, he did not answer me. I asked that question during a clause stand part debate and he did not know that the question was coming. It was not part of an amendment and it was not flagged up to the advisers as being something likely to happen. I raised it on several occasions in that Committee and on the Floor of the House during an Opposition day when he was winding up, and he did not answer me then either.

We have now got the answer, and it came in November. My right hon. Friend mentioned what the then outgoing NHS chief executive said to the Health Committee last November. Commenting on the new rules, he said:

“I think we’ve got a problem, which may need legislative change.”

Of course, that is absolutely right, because we had legislative change when the Health and Social Care Act 2012 came in—that is the truth. It changed statute: it meant that the OFT and the Competition Commission can interfere in health care. That is what it did and that is what it was meant to do. That is what the Opposition questioned and voted against at the time—that is the truth.

My right hon. Friend talked about the cost of all this in terms of the Freedom of Information Act and the millions of pounds spent on external competition lawyers. My local Rotherham hospital has spent tens of thousands of pounds on London lawyers, and for what? There is no prospect of a merger or anything else. This money is seeping out of the local health pot, just so that advice about competition law can be got from lawyers based in London. This is real: if people want to do anything, they are going to have to take legal advice about doing it. That is the truth.

I have to say to my right hon. Friend the shadow Health Secretary that he may have an ally in the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb). I am told that he said last week:

“I have a problem with OFT being involved in all these procurement issues…I think that’s got to change. In my view it should be scrapped in the future.”

I wait to see how he is going to address these things—if he did indeed say that—when he winds up this debate. If he did say it, I agree with him, as would many others out there.

I wish to make a couple of other points, one of which is about what happened in Bournemouth and Poole, where a merger was blocked by the Competition Commission last autumn. When it was blocked, the chief executives of the Bournemouth and the Poole hospital trusts said in a joint statement that they were “deeply disappointed” by the decision. They said:

“The benefits of merger, which included increased access to consultant care and new patient facilities, will now be much more difficult to deliver, which is disappointing for both our patients and staff.”

They went on to say:

“We recognise that the Competition Commission has a statutory role to perform”—

my argument is that it never had such a role before a change in the law—

“and specific criteria which it must use to assess benefits, but we believe that the outcome of the process is fundamentally wrong. The assessment of the merger was always weighted to put competition ahead of benefits to patients, and we do not believe the NHS is best served in this way.”

The Government amendment to our motion today states that

“clinicians are in the best position to make judgements about the most appropriate care for their patients.”

That is not the case in Bournemouth and Poole. The Competition Commission has decided, against clinicians’ wishes, to stop the merger going ahead. That is the truth, and that is how we should read the amendment. It is false in what it says. It then goes on to say that it

“notes that the rules on tendering are no different to the rules that apply to primary care trusts.”

That is not true. The rules changed when the Health and Social Care Act was passed. That is why competition and changes in the health service are matters for lawyers now. [Interruption.] The hon. Member for Bournemouth East (Mr Ellwood) might represent one of the hospitals, but his hospital and his local clinicians stopped the merger because the Competition Commission said that it was wrong. This is about competition law, and not about providing patient services.

[Mr Tobias Ellwood (Bournemouth East) (Con)]

This came in in 2002.

[Kevin Barron]

Let me touch briefly on the matter that is in today’s press. The Secretary of State said that we had to keep people out of A and E; he is absolutely right. If I made an addition to our motion today, it would have been around the issue of alcohol. Alcohol is a major problem in accident and emergency departments throughout the land. It used to be an issue on Friday and Saturday nights, but now it is an issue seven nights a week in cities. Not that long ago, the Prime Minister said that the Government were considering putting a minimum price on a unit of alcohol to reduce binge drinking and to improve public health. Today we had an announcement from the Minister for Crime Prevention, the hon. Member for Lewes (Norman Baker)—not from the Department of Health—that the Government are to ban the sale of cheap alcohol in England and Wales because they want to cut back on alcohol-related crime. People who work daily with the problems of alcohol and alcoholism have expressed views on the matter. The Alcohol Health Alliance, which includes the medical royal colleges, said that the impact of the ban on selling at below duty plus VAT would be negligible. It will affect about 1.3% of sales.

Eric Appleby, the chief executive of Alcohol Concern, said:

“The idea that banning below-cost sales will help tackle our problem with alcohol is laughable, it’s confusing and close to impossible to implement. On top of this, reports show it would have an impact on just 1% of alcohol products sold in shops and supermarkets leaving untouched most of those drinks that are so blatantly targeted at young people. The government is wasting time when international evidence shows that minimum unit pricing is what we need to save lives and cut crime.”

I could go on, but suffice it to say that the Government have completely dumped the idea that alcohol is a threat to the public health of this country. The measure will not stop people bingeing. It will not stop alcohol-fuelled people turning up at A and E. The truth is that some 50% of people who turn up at A and E get no treatment at all. We should be looking at the societal effects that are driving people into A and E departments—whether it is closure of walk-in centres or the fact that too many people are falling down because they have had too much to drink and believe that they have a right to block up A and Es and potentially slow down treatment for those who are facing an emergency. The Government are ducking the issues related to alcohol and are ducking the problems in A and E departments up and down the land. It is about time they showed some courage and did something positive. Alcohol is a public health issue, not a crime issue.

--- Later in debate ---

[Paul Burstow]

That is absolutely right. For example, in continuing health care there is often a great deal of contestability that leads to discharge delays, but they are NHS-caused delays. I am not saying that the NHS should be blamed any more than social services, but I want some honesty about how the figures are presented as they do not bear close scrutiny in the argument made by the right hon. Member for Leigh. His solution is simplistic, too. It is good to have a debate about competition policy—I remember Labour Ministers trumpeting the introduction of the first competition policies in the NHS and the establishment of the competition and collaboration committee in the Department of Health. Labour established those policies.

Monitor’s role is to protect the interests of patients—that is what it says in the Health and Social Care Act 2012—not to promote competition. The idea that we can solve the problem by sweeping away Monitor opens the doors to competition red in tooth and claw. Of course, the Competition Act 1998, the EU’s competition legislation and procurement law would still apply without any of the fetters, barriers or protections that Monitor can and should be providing in its role as the regulator of competition in the NHS.

[Kevin Barron]

It is interesting that the right hon. Gentleman says that, because he knows from his time on the Health Committee that European competition law is not used in any health care system across the European Union.

[Paul Burstow]

The problem is that EU competition law was brought into our law through the 1998 Act. That was what opened this particular box, and by bringing Monitor into the picture and giving it the mission of protecting the interests of patients, we put that issue back in its box—and the right hon. Member for Leigh would sweep that away.

Hospices (Children and Young People)

Kevin Barron Excerpts

Wednesday 18th December 2013 Westminster Hall

[Mr Kevin Barron (Rother Valley) (Lab)]

I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this debate. I will try to keep my contribution as short as possible as other hon. Members want to speak. First, I think it right and proper to say a few words about Bluebell Wood children’s hospice in North Anston in my constituency. It is in 6.5 acres of land that was regenerated after closure of the local coal mine, and has its own exclusive access road. Its highly specialised care team look after children with a vast range of complex medical needs and support the whole family on their life journey, offering short respite breaks, day care provision, community support, crisis intervention and end-of-life treatment and care.

Families often come to Bluebell Wood hospice exhausted after caring for a child with a life-limiting condition requiring 24-hour, seven days a week care. It is there to help, and offers respite care to the whole family and gives them the opportunity to spend quality time together knowing their child is in safe hands. It gives families the chance to recharge their batteries and to come and go as they wish. It is a relaxed, fun and happy place to be, where brothers, sisters, mums and dads can enjoy the fun and games. Its motto is “living with love and laughter”.

The hospice provides eight beautifully appointed bedrooms for children and young people as well as accommodation for families. It also has two end-of-life suites, “Primrose” and “Forget-Me-Not”, which are self-contained accommodation suites where parents can stay after their child has passed away. The deceased child can stay in a special adjoining room to be close to them. They can stay until the funeral, giving family and friends the opportunity to visit at any time. The staff are also on hand to help the family with any funeral arrangements if necessary.

The hospice boasts a music room, messy play room, sensory room, cinema room, soft play area, teenage room and Jacuzzi. It is surrounded by beautiful and tranquil gardens, including a dragonfly remembrance garden, which was built by Alan Titchmarsh and was featured on his ITV programme, “Love Your Garden”. It offers care and support for children and young people with a shortened life expectancy, both in their own homes and at the hospice. There are only 43 children’s hospices in the country and Bluebell Wood cares for more than 170 children from south Yorkshire, north Derbyshire, north Nottinghamshire and parts of north Lincolnshire.

Fundraising for the hospice started in 1998 after the death of an 11-year old boy, Richard Cooper, who had a rare degenerative disease and longed for care and support outside a hospital environment. The charity was established, and community support to build a children’s hospice in south Yorkshire was quickly forthcoming. After a lot of fundraising and working with families in the community for two years, Bluebell Wood children’s hospice proudly opened its doors to children with life-limiting conditions on 19 September 2008.

[Fabian Hamilton]

I would like to pay my own tribute to Bluebell Wood, as well as Martin House, both of which I know. Does my right hon. Friend agree that one of the best ways in which all hon. Members here can help to support the hospice movement—as he and the hon. Member for Pudsey (Stuart Andrew) have done—is to come and support the all-party group on hospice and palliative care, which meets regularly in this place, at least every three months, and brings together professionals from hospices all over the country? Will he please endorse the request to attend those meetings and support the all-party group?

[Mr Barron]

I am a member of the all-party group—indeed, I am an advocate of all-party groups—and I believe that bringing together professional people from the hospice movement leads to advancement and educates us about what is happening out there in the real world.

Bluebell Wood has 90 employees, including the care team and administrative staff, and currently more than 350 active volunteers. The hospice and I are extremely proud of them. It would not be the place it is today without them. They work on reception and in the kitchen, they help with the housekeeping and administration, they dig the gardens, paint rooms and help in the shops, to name but a few tasks they carry out. The hospice has eight shops in the surrounding region which raise funds. They are based throughout south Yorkshire, and there is also one over in Derbyshire, in Bakewell. I want to point out to the Minister that it costs more than £3 million for Bluebell Wood.

[Mr Nigel Dodds (Belfast North) (DUP)]

I join in congratulating the hon. Member for Pudsey (Stuart Andrew) on securing this important debate. Would the right hon. Member for Rother Valley (Mr Barron) allow me to offer my thanks and support, on behalf of my constituents, to the Northern Ireland children’s hospice, which looks after 600 life-limited children and young people, and to the volunteers and staff there? The recent announcement by the Minister of Health in Northern Ireland to allocate £2.3 million towards the hospice movement, including the adult hospice in my constituency, has proved an enormous boost to all those involved in looking after the terminally ill in Northern Ireland.

[Mr Barron]

The right hon. Gentleman makes his case very well. As I was saying, Bluebell Wood costs £3 million a year. I notice that my hon. Friend the Member for Rotherham (Sarah Champion) is in the Chamber today; she was the chief executive at Bluebell Wood hospice until what I think I could call her “elevation” to become the hon. Member for Rotherham just over 12 months ago—I see that she is not too sure about that phrase. Bluebell Wood costs £3 million a year and as we know, adult hospices in England receive an average of about 34% of their funding from Government. Children’s hospices typically receive much less Government funding—somewhere in the region of 15% of their running costs—although some get next to nothing, and I have to say that Bluebell Wood falls into that category. It receives 5% of its funding from Government and, were it not for the volunteers, the rest of it would not be there at all. It certainly would not be in the shape that it is now, providing that vital service, not only in the hospice itself, but at home.

In the summer of 2010, the Government set up a review of palliative care funding and in July 2011, they published a report, which I recognise stated that there is

“a stunning lack of good data…for palliative care in England.”

I know that finding a tariff, finding out the right costs and what should be paid is very difficult, but the national health service is, far too often, taking decisions without evidence. I see a need for that evidence to be collected.

Pilot sites were offered in November 2011, and I do not know how many sites were set up in March 2012. Can the Minister say when those pilots are likely to have enough good data that we are able to take real decisions about how the NHS, although it should not take over hospices such as Bluebell Wood, should perhaps contribute a bit more to the vital care that those children, young adults and families receive in hospices?

Pharmacies and the NHS

Kevin Barron Excerpts

Wednesday 20th November 2013 Westminster Hall

[Mr Kevin Barron (Rother Valley) (Lab)]

I congratulate the hon. Member for Ipswich (Ben Gummer) on applying for and securing the debate at this opportune time. He will know that the change from primary care trusts to clinical commissioning groups means that there is indeed scrutiny in local communities of the worth of local pharmacists and of what they have been doing over many years.

I should put it on record that I chair the all-party group on pharmacy. The group receives financial support from the Company Chemists Association, the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee and the Royal Pharmaceutical Society. The lobbyists Luther Pendragon provide the group with administrative assistance. I have no personal interest in the group, other than chairing it, but I thought I should put those details on record.

Community pharmacy sits at the heart of our communities, and pharmacists are trusted, professional and competent partners in supporting individual, family and community health. An estimated 1.6 million people visit a pharmacy each day, of whom 1.2 million do so for health reasons, making pharmacists the most accessible health care professionals.

I was not really surprised to hear the hon. Gentleman say that pharmacists were not mentioned in the information he got from Southwark. Pharmacists tend to be a little add-on, and we had an example last week, with the publication of the report on A and E, which said that pharmacists might be able to help with some of the issues it raised.

Like GPs, dentists and optometrists, community pharmacies are private organisations contracted to provide NHS services to the public on behalf of NHS England. However, that is not really understood by the public. A 2011 survey by Pharmacy Voice found that 88% of people regarded GP practices as public bodies, when the vast majority are, of course, private businesses. However, only 32% of people regarded pharmacies as public bodies, which is extraordinary, given their impact on our communities.

More than 90% of the average community pharmacist’s turnover comes from the NHS. That is a higher percentage than for GPs in some parts of the country, and even some NHS hospitals do not get that much of their income from the NHS. Pharmacies often provide advice to patients free of charge, with one in seven community pharmacy consultations not resulting in a sale.

The hon. Gentleman said that we do not use pharmacies in the way people do abroad. Many years ago, when my children were quite young, and we were on holiday in places such as Spain or Portugal, the pharmacist was the first health professional people were asked to go to but, sadly, that is not the case in this country. The pharmacist was there with powers to help.

Community pharmacists are the face of the NHS in communities and on the high street, having more engagement with the public than other health care professionals. Some 99% of the population, including even those living in the most deprived areas, can get to a pharmacy by car within 20 minutes, and 96% can get to one by walking or by public transport. Pharmacists can reduce A and E waiting times by dealing with people with common conditions. The hon. Member for Plymouth—

[Oliver Colvile]

Plymouth, Sutton and Devonport.

[Mr Barron]

I am sure Hansard will put that right anyway—I could have said “somewhere in the south”. The hon. Gentleman mentioned the all-party group, and we had a session on pharmacies easing the burden of emergency care. We had several witnesses, one of whom—Paula Wilkinson—was the chief pharmacist at Mid Essex Clinical Commissioning Group. She showed us a publication that the CCG was sending round mid-Essex called “Why wait to see your doctor or nurse? See your pharmacist first!” It is part of the health care on the high street initiative that the CCG is running, and she focused the majority of her comments on that initiative, which she said nudged—that is very much Government-speak—people towards using the pharmacy first. Like another witness, she focused on the expanded role that pharmacies could play in serving patients with minor ailments.

Paula said—this is quite interesting, and I would be interested in the Minister’s comments—that for people on low incomes, prescriptions often provided a way of gaining free access to medicines that are otherwise available over the counter without a prescription. She said that meant that patients on low incomes were perversely incentivised to attend their GP or an A and E service to get prescriptions. She believed consideration should be given to providing some free medicines without prescription to those on low incomes. Clearly, if a patient has been on a medicine for a long time, that would not be that challenging, and a professional such as a pharmacist could extend the period without having to go through any rigmarole and clogging up the rest of the system.

The A and E report that came out last week showed that 40% of people who attend A and E have nothing whatever done to them, which is an extraordinary statistic. Indeed, 50% of people who are blue-lighted—an ambulance or paramedic goes out to them—are not admitted to hospital. We need to look at certain issues in primary care services and, to some extent, in the acute sector if we are to deal with such people.

Community pharmacy provides a common ailments service—we call it a minor ailments service in Rotherham —in 10% of England, and people are encouraged to go to the community pharmacy as part of that. A nationally commissioned service would reduce pressure on GP surgeries and, subsequently, on A and E. Recent reports suggest that 56 million to 57 million visits a year could be managed by pharmacists, freeing up GPs to manage more complex cases, and I agree.

Pharmacists support people with long-term conditions to manage their symptoms, improving access to care for people in the most deprived areas and increasing capacity to treat patients out of hours and in the community. The Minister will be well aware of this, but about 75% of NHS expenditure goes on people with long-term conditions. This winter, quite a lot of them are likely to end up going to A and E and clogging up the system because they have, for whatever reason—they may be forgetful as a result of other problems, such as dementia—not adhered to their drugs regime at home. Managing such people in the community using professionals such as GPs, nurses and pharmacists is a better way of caring for such people. We have few systems to deal with these things, although the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) will no doubt tell us what is going on in his constituency with healthy living pharmacies, so I will not go into that. These are, however, major issues, and the strengths of pharmacists should be used a bit more.

I mentioned the question of medicines adherence. Under the present general pharmacy contract, it is pharmacists’ duty—and they are paid for this—to take in unused medicines. It is extraordinary that every year medicines costing hundreds of millions of pounds are prescribed and then are unused, for whatever reason. It is a difficult situation. The 2010 report by the York health economics consortium and the school of pharmacy at the university of London suggested that up to £500 million could be generated in England in just five therapeutic areas—asthma, diabetes, raised blood pressure, vascular disease and the care of people with schizophrenia—if medicines were used optimally. Those are all long-term conditions on which taxpayers’ money is spent. The report rightly said that sub-optimal use of medicines and waste undermine the £12 billion investment in medicines by the NHS.

Pharmacists do quite a lot of work which, although it is contracted to the NHS, is not always laid out nationally or used by local health partnerships. The hon. Member for Ipswich pointed out that pharmacists were not included in the publication that he cited. A medicines use review is a review of a patient’s medicines—prescribed and non-prescribed—to promote adherence and to support the optimal use of medicines; 2.8 million MURs were provided by community pharmacies in England in 2012-13. Since 2011, pharmacies have offered a new medicine service to provide additional support to patients who are starting to take certain medicines for long-term conditions. An evaluation of the effectiveness of the NMS is due soon, and more than 640,000 people starting to take new medicines have benefited. That is adherence —making sure that people do as their prescription sets out.

The York and London review, which is entitled “Evaluation of the Scale, Causes and Costs of Waste Medicines”, goes into the question in great depth, and clearly the problem will never be eliminated altogether. Nevertheless it is clear that in this country people sit and write out prescriptions and people take them away and effectively put them on the shelf. The patient might use the medicine for a couple of days. Perhaps they do not like the side-effects, and indeed that is unavoidable on occasion. However, some medicines are stored in bathroom cabinets, and when they are emptied the medicines are taken back to the pharmacist or thrown away, which costs the nation hundreds of millions of pounds. We must question whether some of those medicines, given that they are not used, should be prescribed in the first place. However, that is a wider issue for health professionals, not me.

More than 57 million GP consultations a year involve minor ailments. If we rolled out the scheme that currently covers about 10% of England, we could greatly reduce pressure on those services, and GPs could get on with more important things. The patients could be moved to pharmacies, and more than £812 million of GP capacity could be freed for other things.

In 2009-10, 140,000 people chose their community pharmacy to set a quit date and 62,000 had successfully quit smoking by the fourth week, which was a 13% increase on the previous year. Pharmacists give support in a wide variety of public health roles, including flu vaccinations, international normalised ratio-testing clinics—monitoring and adjusting the dose of the blood-thinning medicine warfarin—and asthma clinics.

There has been much debate in Parliament about changes in the Health and Social Care Act 2012. The Minister was on the Committee that considered the measure. Two things were writ large in that Act. First, we have now put into statute the need to reduce health inequalities—but they are not reducing. Everyone is living longer, but in terms of social class things are still going downwards. Pharmacists could work on reducing health inequalities in areas where there is known deprivation. That should be a major aim. Secondly, the Minister will remember the emphasis on population health. In view of the statistics that I have read out, I think pharmacy has a major role to play in improving population health.

Public health problems were very bad 150 years ago, and they involved the environment—bad housing, bad sanitation and bad water. The public health issues that this century will suffer from will be to do with individual lifestyles. I read out some statistics about smoking cessation and pharmacies, and I believe that community pharmacists are the gatekeepers to the national health service. Far more people visit them than any other part of the NHS and they have a major role to play. The sooner we alter the current mode of contact and move away from the situation where pharmacists get the bulk of their money just churning out prescriptions to one where they cover wider issues within communities and look after the health of the population, the better we shall be.

--- Later in debate ---

[Steve Baker]

My hon. Friend is right. In the 21st century, we should be waking up to the opportunities to use technology to drive down costs and drive up service. People are so busy today, so why can they not have consultations in their offices with Skype, and why can pharmacists not prescribe to offices with Skype? The solution to these problems is for the Government to abolish whatever rules and controls they can and wherever they can, and to liberalise when abolition is not possible.

[Mr Barron]

The majority of patented goods that the national health service buys are a recognition not just of cost, but of the pharmaceutical industry’s worth to the British economy—including exports, manufacturing base and so on. We export around £7 billion of pharmaceutical goods a year. Might a free market endanger that?

[Steve Baker]

We may be in danger of straying into philosophically deep water about what free markets do and do not do. Clearly, because of the moral imperatives of health care, we cannot have an unimpeded market. We have made political decisions to ensure that no one goes without health care. That has consequences, and we should accept them.

The way to deploy scarce resources in the service of the public is to allow the price system, as well as profit and loss, to run as freely as possible. When we talk about something’s worth, price is too often ascribed to things that are not subject to market transactions. Only through exchange can it be established how people value things. I do not want to go on for too long, so I will leave that to another debate, perhaps the one on the Budget.

I want to encourage the Government to liberalise and to look more closely at what can be done to enable pharmacists to set up wherever they need to in order to serve the public best.

Mid Staffordshire NHS Foundation Trust

Kevin Barron Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. These problems of high mortality rates date back very many years, and nothing, or too little, was done to sort them out. We must therefore make sure that we have a system where that cannot happen. Concealing poor care does not protect the reputation of the NHS, because in the end it gets out and destroys public confidence. I hope his constituents will feel that today’s announcements will create a new culture of openness and transparency that gives them confidence, so that if these awful things were ever to happen again—we hope they do not—we would find out quickly and action would be taken.

[Mr Kevin Barron (Rother Valley) (Lab)]

Having spent nine years as a lay member of the General Medical Council and five years chairing the Health Committee, I have heard little this afternoon that is likely to change the culture inside the national health service. May I refer the Secretary of State to the report on patient safety that the Committee produced in the previous Parliament? We considered the idea of having a statutory ombudsman to whom people could complain and who would have the power to investigate, even anonymously, instead of this situation in which doctors, particularly young doctors working in hospitals, dare not complain about what senior doctors are doing because of the attack on their career structure. We really must get some independence into this. We can have good words, we can talk about candour, and we can wish a lot of things, but changing the culture of the NHS is not done by statements or by legislation in this House; it is done by working inside the NHS. I am afraid that at the moment the system works against changing the culture owing to career structures and everything else. We need some independence in all this so that people can really learn how to change. New Zealand would be a good example to look at.

[Mr Hunt]

All I can say to the right hon. Gentleman is that Robert Francis himself stated this morning that we have announced a comprehensive collection of measures that

“will contribute greatly towards a new culture”

in the NHS. He is persuaded that this will make a very big difference.

Independence is a vital part of this change, so what are we doing to create it? For the first time, we will have an independent chief inspector of hospitals who goes anywhere he likes in the system to try to root out poor care. That person will be the nation’s whistleblower-in-chief, and their job will be to find out about these things inside hospitals. We are creating a culture in which it is in the interests of hospitals and doctors to be open and transparent, and that is another significant change. I do not want to underestimate the scale of the challenge we face, but I think most people would say that in the past 12 months we have seen one of the most fundamental attempts to change the culture of the NHS in its 65-year history.

Urgent and Emergency Care Review

Kevin Barron Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

My right hon. Friend is absolutely right about that. We do need parity of esteem between mental and physical health. The situation puts particular pressure on A and E departments, including the one closest to this House, at St Thomas’s hospital, where people said that the biggest single worry they have and the biggest single thing that makes it difficult for them to meet their targets is the lack of quick access to psychiatric services. We are looking at this matter and he is right to highlight it.

[Mr Kevin Barron (Rother Valley) (Lab)]

The Minister said that changes taking place in urgent and emergency care are done locally for local need. What does he think of the following statement made by Sir David Nicholson last week before the Select Committee on Health? He said:

“We are bogged down in a morass of competition law…we have competition lawyers all over the place telling us what to do, which is causing enormous difficulty.”

Does the Secretary of State not agree that the Government were warned about that when they brought in the Health and Social Care Act 2012? They were told that competition law was going to create chaos in the NHS, and it is doing exactly that.

[Mr Hunt]

I think the right hon. Gentleman will find that some of the competition law powers that are being used and are causing Sir David worry were actually from the Enterprise Act 2002, which we are now looking at to see whether we can sort it out.

Tobacco Packaging

Kevin Barron Excerpts

Thursday 7th November 2013 Commons Chamber

[Mr Evans]

That is exactly what is going to happen, and I think one hon. Member intervened to say that that is part of the evidence from Australia. A lot of people like brands, such as Benson & Hedges or Regal, but others will go for the own-brand—whatever is cheaper. If it is £1 cheaper than the more expensive brands, that is what they will go for. Some people, I swear, will smoke the dust off the floor if it is sold at £1 cheaper than a branded pack. The point my hon. Friend raises therefore has got to be looked at as a possibly unintended consequence of bringing in standardised packaging.

I visited Clitheroe grammar school a few months ago and the issue of why the Government have delayed introducing standardised packaging was mentioned. I thought about it for a while and then I said to the pupil concerned, “Right: how much cannabis and ecstasy is consumed in the UK?” The pupil said, “Oh, quite a lot,” to which I said, “I think you’re probably right. Do us a favour: describe to me the packaging on cannabis or ecstasy.”

I ask Members to think about that for a second. What is the packaging for cannabis or ecstasy? There is no packaging. They come in foil or see-through bags, or in an envelope, perhaps. Clearly, people are not buying these products because of the packaging, standardised or otherwise. They buy them because they want them. That is a strong counter-argument to the proposal to get rid of branding.

[Mr Kevin Barron (Rother Valley) (Lab)]

Surely the answer to the question is that if those things were legal, health warnings would be on them, and quite right, too.

[Mr Evans]

Certainly there is no health warning on cannabis and ecstasy, and we know they kill a lot of people.

--- Later in debate ---

[Mr Kevin Barron (Rother Valley) (Lab)]

I congratulate the hon. Member for Harrow East (Bob Blackman) on securing this important debate. Like him, I am an officer of the all-party group on smoking and health, and I also believe that tobacco control transcends the usual party differences. In my years in the House, that has certainly been the case for anti-tobacco policy.

Members will know that back in 2006 the previous Labour Government conceded a free vote on ending smoking in enclosed public places. The vote was won by a majority of more than 200, which showed that the proposal had strong support. The Government might want to find a similar means of getting themselves out of their awkward position, as they have been accused of being in bed with the tobacco industry because they have blocked the introduction of standardised packaging. The Children and Families Bill, which is now in Committee in the other place, might present such an opportunity.

The hon. Member for Harrow East rightly drew our attention to the fact that most smokers start their lethal addiction when they are children and that, for many years, the tobacco industry has advertised and marketed its products to make them as attractive to young people as possible. We all know that eight out of 10 smokers start by the age of 19 and that more than 207,000 11 to 15-year-olds become smokers each year. One in two of them, if they remain smokers, will die a premature death. In this country, in the region of 100,000 premature deaths a year are caused by the habit of smoking.

I am sorry that the hon. Member for Ribble Valley (Mr Evans) is no longer in the Chamber. He made the argument that the 12 million smokers in this country were all adults. Of course, most of them are adults—that is absolutely true—but at what age did they start smoking? Statistics on the number of people who start smoking at the age of 21 are insignificant. I started smoking years before I could legally buy cigarettes. I was smoking at the age of 12, and I stopped at the age of 24. The vast majority of people I was at secondary school with smoked. We were just trying to emulate other people. I also came from a poor, working-class family, and in theory there was not the money to buy cigarettes, but we used to find it. I say to the hon. Member for Hornchurch and Upminster (Dame Angela Watkinson) that if we look at the incidence of smoking now, social classes 4 and 5 have the majority of smokers and of premature deaths.

The importance of packaging is well understood by the tobacco companies. They dodge the existing health warnings and packaging requirements with great skill and ingenuity. I draw the attention of the House to the packaging of Benson & Hedges Silver Slide. Benson & Hedges in this country is owned by Japan Tobacco International, one of the big four international companies. People slide the cigarettes out of the pack, so it is not the standard packaging that was around when I was smoking back in the 1950s and 1960s. The outside of the Silver Slide package looks pretty normal but, unlike most packs, it is opened by pressing the side opening where it says “Push and Slide”, which exposes a tray containing the cigarettes. Printed on the tray are the words:

“I owe my success to having listened respectfully to the very best advice, and then going away and doing the exact opposite”,

which is a quote from G. K. Chesterton. The initials B&H are highlighted for a little extra brand identity on the slide. I suggest that the design has the obvious purpose of reinforcing a key tobacco industry marketing message that has been used with success for many years, particularly to recruit young people to smoke and to discourage quitters. That message is pretty simple—smoking is cool and an act of rebellion, and it is adult and transgressive. The hon. Member for Harrow East rightly pointed out that that marketing strategy is set out clearly in the internal documents that were published as a result of the US master settlement agreement with the industry.

[Alex Cunningham]

Is my right hon. Friend aware of the advertising in America for Vogue cigarettes, which says:

“The Vogue cigarette style was based on 1950s couture. The cigarettes that are preferred by women from across the world. Their lengthened appearance is an attribute of their femininity”?

Does he think that that is another example of the industry aiming to glamorise smoking?

--- Later in debate ---

[Mr Barron]

It is indeed. The packages themselves are there to attract young women. I have an empty packet in my office that demonstrates exactly that. The idea that packaging is not used to sell products or advertise them effectively is nonsense. The Silver Slide design is intended deliberately to undercut the health warnings that the law now requires on each packet.

The hon. Member for Ribble Valley talked about adverts and bill posters, and said that he could only understand the part at the bottom. When I introduced a private Member’s Bill in 1994 to get rid of tobacco advertising and promotion, it was pretty clear that most of the adverts on billboards were not understood by some people. They were deliberately designed for the inquiring mind. There would be a picture of a piece of silk with a cut halfway down the middle. The advert did not say Silk Cut cigarettes; it did not have to. However, who are the ones with inquiring minds? They are young people. Tobacco companies did that deliberately for many years, and the G. K. Chesterton quote is to get young people to say that they can take this on, and that they are not bothered about what people say.

In Australia, it has been decided that there should be no branding on tobacco packaging other than the product name shown in a standard font, size and colour. No other trade marks, logos, colour schemes and graphics are permitted. Colours and graphics have been selling cigarettes in this country for decades. In Australia, cigarette packs should not carry attractive designs and should therefore come in standard shape, size and colours, and the colours should be as unattractive as possible. There should be prominent health warnings front and back, in pictures as well as writing, and there should be a phone number and web address on every pack to help smokers to access quit services.

There are 100,000 premature deaths a year from tobacco smoking in this country. If those deaths had been caused by anything else in the 30 years that I have been in Parliament, this House would have been sitting 24 hours a day, seven days a week, until we could find a way to stop it. It is no good the Government saying that they will wait. We know what tobacco marketing has been like for decades. We have stopped most of it, and we should stop this advertising at the point of use as well.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

In an area such as Salford, 1,000 young people—the figure was 1,100 in Barnsley—will start to smoke this year. If I am called to make a speech, I will talk about that. Ten months, a year or 18 months of delay will cause 1,000 or 1,500 young people in an area such as mine to start smoking, and that is a tragedy.

[Mr Barron]

And another 207,000 nationally will start this habit a year.

One might ask why people buy a packet of cigarettes when it has a warning on it, but this is an addiction. All sorts of addictions sadly roll over common sense, and tobacco is no different. Stopping young people starting is crucial, and that is working. Smoking rates for young children are diminishing now, as are rates for adults, partly as a result of taxation and partly because we are stopping tobacco companies promoting cigarettes.

There are no figures to show that counterfeiting is more likely with plain packaging. Earlier this year, the Japanese company came to the House and told us that there would be more counterfeiting, but there is no evidence of that. It showed us—I have one in my pocket —a counterfeit packet. It looks like any other Benson & Hedges packet, so counterfeiting happens now. Standard packaging could include features to protect against counterfeiting, and it is for the House to regulate to introduce them. Hon. Members should not use the arguments that have been sold by the tobacco companies year after year. When it was found that tobacco related to massive numbers of deaths, the companies were still questioning that decades after the event—they still do now. They use this House to do it on occasions and, I have to say, it is wrong. When there are 100,000 premature deaths a year, we as legislators have some responsibility to alleviate the problem. I know that smoking is addictive and it is difficult for people to stop.

[Dame Angela Watkinson]

Does the right hon. Gentleman agree that no young child can become addicted to cigarettes unless their parents provide them with the money to buy them?

[Mr Barron]

My father used to provide me with cigarettes; the only thing was that he did not know about it. I used to go in his packet of Woodbines and take one out, and he did not count them very often. That was how I started smoking on the street at a very early age. If we put the price up, of course it will reduce the consumption of cigarettes, but we need to stop young people starting.

--- Later in debate ---

[Guto Bebb]

The hon. Lady completely misrepresents my view. I said clearly at the outset that the temptation for young people is much enhanced if the product is affordable, and I think she fully understood my point.

It is important to recognise the problem of illicit and smuggled products because evidence—yes, to be tested and argued about—has been presented to suggest that plain packaging will actually make it easier for these products to be made available. I am fully aware that there are arguments on both sides. However, what is being said in this debate is, in effect, that the Government’s decision to wait to look at the evidence from Australia somehow indicates that they are in league with the tobacco companies. I find that quite distasteful.

I genuinely approach this debate from the point of view that I would like the number of people who smoke to be reduced—to nothing, I hope. I have never smoked, and if any of my children smoked I would be absolutely furious. Indeed, I lost my father to lung cancer at the young age of 63. My children never saw their grandfather simply because of his smoking. If the evidence was clear that plain packaging would be the answer, I would be supportive. I find it very odd that Members are saying that looking at the evidence is somehow condemning people to die. That is emotional and unacceptable language.

When Populus recently surveyed a number of police officers about whether they thought that plain packaging would be helpful, 86% of them clearly stated that they thought it would make it easier for illicit tobacco products to be supplied and that those products would be targeted at young people who could afford them. Sixty-eight per cent. of the police officers thought that plain packaging would lead to an increase in the size of the black economy in relation to tobacco products. A full 62% thought that an increase in cheap tobacco products would result in an increase in the use of tobacco products by children. Those are very interesting and important findings from a poll of police officers. Are their views correct? We need to look at the evidence and consider very carefully whether it supports them.

[Mr Barron]

The latest figures from HMRC, at a mid-point estimate, show that the market share of illicit cigarettes has fallen from 15% in 2006-07 to 9% in 2010-11. There is no evidence that this is not going the right way; it is enforcement that we lack.

[Guto Bebb]

The right hon. Gentleman should perhaps read the report by the Public Accounts Committee, which presented evidence that there has been an uplift since 2010-11. I thought that the whole point of this Chamber was to debate on the basis of the facts, and that we liked evidence to be up to date. If he wants to quote evidence from 2010-11, that is absolutely fine, but I refer him to the PAC report, which has updated figures. It is interesting that he would probably be very supportive of today’s PAC report on universal credit, but when the facts do not suit him he seems to ignore them.

The key thing we need to remember is that time and again this place has legislated in haste. There is a significant question mark over both sides of the debate. What the Government have said is very simple: let us see the evidence and consider it. If the evidence from Australia and other countries that decide to go down this route proves that there has been a reduction in the use of tobacco products, a reduction in illicit tobacco being taken into the country, a fall in the availability of illicit products, and a fall in the number of smuggled products, it would be worth taking the issue extremely seriously and moving to legislate. However, the argument advanced by some hon. Members is about their prejudice rather than the facts. We should congratulate the Government on being willing to wait and legislate correctly rather than acting in haste and possibly contributing to and supporting the behaviour of people who are making tobacco products available to young people not at £7.50 or £8 but at £2.50 or less.

We should consider very carefully what is tempting young people to take up smoking. I am very clearly of the view that the temptation is not necessarily branding but more likely to be price. Labour Members might like to have a good feeling about doing something in this place to help young people, but they should do it on the basis of facts, not their ill-informed opinions.

--- Later in debate ---

[Jake Berry]

I guess that the reason why people wear seat belts is that it is a criminal offence not to do so. If the hon. Gentleman is suggesting that smoking in cars should be made a criminal offence, that just reinforces my point about the desire of certain people on the other side of the debate to ban smoking. If that is what people want, we should have an active debate about it and give people who smoke legitimately an opportunity to have their say.

During this Parliament alone, the Government have increased NHS funding by £12 billion, given people access to the cancer drug fund and protected public spending with regard to local authority public health budgets. That is good progress and I am proud to be part of a Government delivering it. Limits on the display of tobacco products have also recently been introduced in larger stores. Anyone who has been to a supermarket recently will have seen the white signs that slide backwards and forwards to disguise tobacco products, and they will be introduced in smaller retailers in 2015. I support that and think it is a good thing.

The ban on vending machines in pubs is particularly good. I started smoking by buying cigarettes by the men’s loo in a pub in Liverpool, where I was brought up. It is the easiest way to buy cigarettes under age, so I am delighted with and support the ban. The way in which the Government have continued to increase the tax on cigarettes has also been good. I think that making them more expensive discourages people from taking up smoking. I support all that action, but such action must be based on benefits.

[Mr Barron]

I started on my anti-tobacco crusade 20 years ago this year when I promoted a private Member’s Bill. In all that time, the only person I have heard say that if tobacco was discovered now it would be banned was the then Conservative Secretary of State for Health, who now sits in the other place. As far as I know, it has never been part of the anti-tobacco campaign in this country to say that we want to ban people from smoking. What we want to do is prevent them from starting and save lives.

[Jake Berry]

I think it is right to say that if tobacco was discovered today it probably would be banned. I also think that if alcohol was discovered today it probably would be banned. That does not mean that we should seek to do so.

I am very pleased with the progress the Government have made. The evidence shows that we have reduced to a record low the number of people who smoke, but there are still things left on the to-do list. First and foremost, we need to look at the evidence from Australia. If it demonstrates that plain packaging has reduced the amount that people smoke, we should take it up and I would not oppose it. I do not accept, however, that that has yet been proven. Part of being in this House, in government or in opposition is to have an evidence-based debate about outcomes. I do not think that we have the evidence or that the outcome will be a reduction in the amount that people smoke. We also do not yet know the impact of disguising packages in supermarkets, which may have the effect we seek without increasing the regulation on the tobacco industry.

We need much more rigorous enforcement against under-age sales. It is illegal to buy cigarettes under the age of 18. People under that age can have consensual sex and they can go to Afghanistan to fight in the Army, and the Opposition and the Liberal Democrats think that they should have the right to vote, but they are not allowed to buy cigarettes. We should have much more rigorous enforcement of the existing laws against selling cigarettes to under-18s, rather than rush to introduce new laws on plain packaging and banning smoking in cars.

--- Later in debate ---

[Mr Barron]

If the other place legislated to introduce standardised packaging, we would be able to have a vote in this Chamber. May we have a free vote, just as the current Prime Minister argued for a free vote on smoking in public places?

[Jane Ellison]

The Government are following discussions in another place closely. Beyond that, I am not able to comment in this debate, but we are well aware of those discussions and Ministers are participating in them.

Australia introduced standardised packaging in December 2012, and New Zealand and the Republic of Ireland have committed to do that. In addition, other academic studies are emerging about the effects of that policy.

The UK has a long and respected tobacco control tradition internationally, although at times in this debate it has been possible to miss that point. Under successive Governments the UK’s record has been good, and we will continue to implement our existing plan to reduce smoking rates while keeping the policy of standardised packaging under active review. The tobacco control plan for England sets out national ambitions to reduce smoking prevalence among adults, young people and pregnant mothers. As the plan makes clear, to be effective, tobacco control needs comprehensive action on a range of fronts.

I will talk a little more about this in the context of devolved powers of public health to local government, but there is a slight danger that by focusing only on one aspect of tobacco control, we forget that there are other—and indeed more—things that we could do. Even if it was possible to say today that we would do this tomorrow, we would still be debating how we could effectively control tobacco and stop children taking up smoking. As various hon. Members have said, including the right hon. Member for Rother Valley (Mr Barron), this is an ongoing battle to protect children’s health.

Accident and Emergency Departments

Kevin Barron Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

We have not heard any kind of policy from the Opposition today, or any suggestion as to what they would do differently. We have presented to the House a package of short-term and long-term measures, designed to address the immediate and the underlying challenges. It is a very comprehensive package, but it is going to be a very tough winter and I would urge all responsible politicians from all parties to row in behind the package, which I think will make a very big difference on the front line.

[Mr Kevin Barron (Rother Valley) (Lab)]

If the 2004 GP contract was to blame for the current crisis in A and E, could the Secretary of State explain why, in 2009-10, over 98% of patients were seen within four hours?