NHS Trusts: Accountability

Mike Penning Excerpts

Tuesday 10th July 2018 Commons Chamber

[Sir Mike Penning (Hemel Hempstead) (Con)]

It is a privilege to have so long for this Adjournment debate on such an important subject. I know that when other colleagues realise that the debate has started, they will scamper to the Chamber. When I put down the title for this debate, I did not intend it to be a general debate, but when I have raised this issue in the House, many colleagues and those on the Front Bench have acknowledged it, particularly when I have raised it with the Leader of the House at business questions.

The NHS is not owned by politicians. It is not owned by doctors and nurses, and it certainly is not run by the bureaucrats in charge of the NHS. It is owned by the people. The people’s NHS was founded 70 years ago, which we are celebrating today. I would never advocate that we go back to the time when politicians and Ministers ran the NHS, but we are in a situation now where the bureaucrats who run the NHS have very little accountability. Time and again, my constituents say to me, “Why are they not listening to us? Why are they not listening to you, my MP? At the end of the day, you represent us in the House of Commons—you are there to represent our money.” That is the principle of our democracy today and has been the founding principle ever since we first elected people to this House over 900 years ago.

I find it amazing when we question the clinical commissioning group or one of the numerous trusts in my constituency. I never understand why, in a small county like mine, we have so many NHS trusts, acute trusts, mental health trusts and community trusts. The people do not understand it. They just see an NHS. They do not realise or want to know how many chief executives, finance directors or directors of nursing there are. They just want to be looked after by the NHS, which was the promise when the NHS was founded.

There are a couple of examples from my constituency that might resonate with colleagues around the House, as it may have happened in their constituencies as well. A few years ago in my constituency, we lost the NHS trust’s chief executive. The chief executive had been involved in the downgrading and closure of the acute hospital in my part of the world, and once he had done that, he decided to go to pastures new at very short notice. The then regional health authority seconded a new chief executive on what we thought was a temporary basis, but we noticed some time down the line that the role of chief executive of the West Hertfordshire Hospitals NHS Trust had not been advertised, and there did not appear to be anybody saying that we should have people applying for such a senior position in the trust.

The gentleman’s name was Jan Filochowski. I know Hansard will ask me to spell that name later, and I will attempt to help them as much as I can, but anybody in my part of the world will know who that gentleman is. I did not have any particular gripe with Jan. I completely disagreed with the running down that he continued to do, but I did have one specific gripe, as did the hospital action group in my part of the world. In particular, Mr Ron Glatter picked up the argument, and I fired off several really important questions to the NHS regional health authority: “Hold up a second, has this person got this job now? Has he been appointed, and if he has, when was it advertised, and when was he interviewed?”

Sometime down the line—hidden with lots of mirrors in lots of different parts of the NHS—it was revealed that the gentleman had got the job without it being advertised and without being interviewed for it. However, because he had been given a contract, it would have been too expensive to remove him and to start again from scratch. We eventually found out that his remuneration package was in excess of £300,000, which is well over twice what the Prime Minister of this country earns. I accept that someone does not become the Prime Minister to earn a lot of money—clearly, there are other reasons why someone becomes Prime Minister—but surely, within the NHS of all places, that sort of remuneration package is not only excessive, but actually sick. The money that person was earning! I am sure there are others who are earning close to that, perhaps more or perhaps slightly less.

[John Spellar (Warley) (Lab)]

Does it not get even worse, in that individuals who fail in such jobs are given pay-offs to get them out of the hospital, but in a fairly short space of time the magic circle again fits them up with an appointment in another hospital, where they again fail and again cost huge sums of money?

[Sir Mike Penning]

The right hon. Gentleman is absolutely right. The gentleman did not stay very long, but he caused carnage in our NHS trust and morale went through the floor. I am sure some of the books might have looked a bit better, but certainly acute care was really struggling. The gentleman left after two years, or something like that, and he went to Great Ormond Street Hospital as the chief executive. I am sure he went on a huge pay cut—no, I am being cynical: I doubt it. He has now retired.

On the right hon. Gentleman’s point, before that gentleman there was another chief executive involved in investing in our health, who went off under a cloud. I managed to get him summoned to the Health Committee, when I was a member of it, to find out the truth about what was happening with the closure programmes. The right hon. Gentleman is absolutely right because, a few years later, he appeared back in my constituency as the chief executive of the community trust. He then had the audacity to ask, “Can we put all that behind us, as this is a new job and a different project for me?” Yes, it goes full circle: just as the right hon. Gentleman said in the previous debate, it is jobs for the boys, and they come back round again.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Gentleman on securing this debate, in which he is highlighting a very specific issue. Does he not agree that there is a duty of care on Government-funded bodies, which quite clearly pay people from Government funds, to ensure that employees at every level are accountable to trusts? More must be done to inspire confidence in the NHS—this is quite clearly a confidence issue—as well as to provide transparency and clear accountability.

[Sir Mike Penning]

I could not agree more with the hon. Gentleman. We have discussed and debated this before, and this must be like “Groundhog Day” for the Minister. I should have thanked him earlier for bearing with me in what may be a much longer debate than he probably assumed when he saw it on the Order Paper.

It is important that there is proper due process when we employ people who work in the NHS, and in relation to salaries. I am sure that the Minister will now go away and check with the Treasury how this happened. My understanding was that such remuneration—and we are going back a couple of years—would not have been allowed even then. Trust in the NHS is vital. There are other examples, which I will produce, that will show that although the NHS is absolutely world renowned, there are errors in it that infuriate the people who it is supposed to be representing and looking after.

[Mr Jim Cunningham (Coventry South) (Lab)]

This is a timely debate. I agree with my right hon. Friend the Member for Warley (John Spellar): it seems to me that a game of musical chairs is going on. We see chief executives who leave under questionable circumstances get a job outside the NHS and then turn up at another trust somewhere else. There does not seem to be any accountability.

As politicians, we are often accused of being remote, but nobody is more remote than people at some of the trusts I have looked at. Someone trying to get information from them about their budgets and where the expenditure goes has a job on their hands. It is about time that how the Department is run is looked at; it gives directions to the rest of the chief executives in the country, even on appointments.

[Sir Mike Penning]

I agree almost completely; I would just say that sometimes these people do not even leave the NHS—they stay within the structure of the NHS, but just go to a different trust in a different part of the country. Then they just reappear again and again.

I have often wondered about something. A director of nursing should clearly have come up through the nursing ranks; I understand that. Clearly, also, clinicians have to be involved in the clinical side. But why does NHS management have to be completely incestuous in how it works? If someone started as a nurse or doctor, how on earth do they have the necessary qualifications to run a massive multi-million pound organisation? Yet that is how it seems to happen. It took a long time for Mr Ron Glatter to get the figures when he was challenged. When we eventually got them, it was like pulling teeth: was it a package or a salary? “This is personal information.” This is taxpayers’ money. One of the most difficult things is to find out exactly where the money is going.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

My right hon. Friend mentioned nurses, doctors and other clinicians taking on managerial roles. To what extent is that driven by a desire to reduce the number of managers in hospitals—to call them “nurse managers” and claim they are nurses when they are actually fulfilling a management role?

[Sir Mike Penning]

My hon. Friend brings great expertise to the debate, and I thank her for joining us. She is absolutely right. I declare an interest: my mother was a nurse in the days of “sister” and “matron”. Then there were nurse managers and other managers—all of a sudden, we went that way, but we seem to be coming back again. We can change the name on the Titanic, but it is still the Titanic: a manager is a manager, no matter what title we put on them.

It seems to me that we are not reducing the number of managers. I vividly remember that there were 11 primary care trusts in the Dacorum area of my constituency. Then the number reduced to two—one, actually, because there was only one director of finance. When we looked at the head count, the cost analysis, which should have massively reduced, it had actually gone up.

I want clinicians to be involved in the day-to-day care of my constituents, but I am not convinced that a GP should chair a clinical commissioning group, especially given that in most cases they do not seem to be full time in the role. What qualifications do they bring? I know that GP practices are much more business-orientated now than ever before, but they employ practice managers—the partners do not run things.

More recently, there has been an understandable concern in my constituency about the proposed closure of one of the facilities called Nascot Lawn; it is not in my constituency, but was playing a vital role in looking after the most vulnerable children in my community. Brilliantly, the families and loved ones came together to challenge the closure. They got the MPs on board and we were involved. I then scratched my head and said, “Hold on a second, I remember being told that Nascot Lawn was going to provide the respite care for my constituents when they closed a place called Woolmer Drive.” Woolmer Drive was a desperately needed respite centre where young people could go, and where their carers and loved ones could spend a bit of time. So not only did Woolmer Drive close, which meant that patients had to go to Nascot Lawn, but Nascot Lawn was closing. That was challenged, but there was very, very little consultation.

I will talk about consultations in quite a lot of depth. Frankly, most consultations are a sham. The decisions are made before they consult. They make the decision to close, put it in their budgetary regime and then consult. They then come out and say, “We’ve listened to the consultation and we are going to ignore you.” So what is the point of the consultation?

[Rachel Maclean (Redditch) (Con)]

My right hon. Friend echoes our experience in Worcestershire. The Minister will know the deep concern my constituents have about Worcestershire Acute Hospitals NHS Trust. Exactly the same thing happened before I came to this place. Services were taken away from the hospital and people were told, “You’re being consulted.” All that happened was that services were removed. It was part of a plan, I understand that, but the idea that it was a consultation is really for the birds.

[Sir Mike Penning]

It is a tick-box exercise. Most of the time trusts cannot even get that right. In this particular case—I will come on to another case in a moment—we challenged it. We judicially reviewed it not once, but twice. But why should members of the public have to come together to raise money to judicially review such decisions? There is currently no other process with proper discussion and involvement of patients, which challenges the decisions we hear day in, day out.

[Mr Cunningham]

The right hon. Gentleman is being very gracious in giving way. We had a case involving two consultants. With one in particular, the case actually ended up in the courts. We have never been able to find out the cost of the litigation, but it was anywhere between £2 million and £4 million. On the one hand, the public has got to raise the money if they want to challenge something, but within the NHS itself, where resources are very scarce, a lot of money is wasted on litigation. This consultant was taken to task because he was a whistleblower. On the one hand they encourage whistleblowers, but if they do not like what the whistleblowers have to say they suspend them and eventually try to get rid of them through litigation.

[Sir Mike Penning]

I was coming on to that point, but let me meet it head on now. I speak to nurses and other frontline staff who look after my local patients, including some doctors, and they are petrified of telling their own MP what is going on in case of retribution. Perhaps the Minister will help me to get to the bottom of the number of gagging orders out there at the moment in my trust, whereby things have been settled and people have been gagged. The types of threats in the gagging orders that are put on them are very severe.

There was a consultation panel in my constituency about the future of health, and the people allowed on the panel had been gagged. These are members of the general public who have been told categorically not to talk to me. They are not to tell me what is going on in the NHS in my own local community. They will be thrown off the panel if they do, and it is worse for the staff who have gagging orders against them. This is very serious.

We see the amount of money the NHS uses in litigation, whereas our patients have to raise money themselves. The NHS seems to settle very easily when there are threats against it relating to malpractice or when something has gone wrong at the trivial end of things, but when things are really serious and deaths have taken place, down come the shutters. Nationally, we have seen what happens—it has happened recently in Gosport and in Staffordshire when I was a shadow Minister—unless the staff have 100% confidence that they can go to their MP or their line management and tell them what has been going on. Sometimes it can be quite trivial, but often it is very serious, and there is clearly retribution against them should they do so. That is something we need to sort out.

[Dr Caroline Johnson]

It is extremely important that all health professionals in hospitals are able to report any concerns that they have. I understand that there is to be a whistleblowing champion for each trust. What does my right hon. Friend know of those, and does he think they will help?

[Sir Mike Penning]

It is all well and good saying that there should be, perhaps in legislation, but unless people have the confidence that their career is not going to be curtailed, or unless they are close to retirement and are not going to put their pension at risk, they are not going to blow the whistle. What really upsets me is that although I was sent to this House to represent people and for them to be able to tell me, in confidence, anything that they needed to, so that between the two of us we could discuss how to take it forward—often without using their name, but if necessary we can—that is not happening. That really worries me an awful lot.

To go back to Nascot Lawn, we went to a judicial review. We have done that before in our part of the world. The judge sided with the patients, but all that happened—it was about process, of course—was that it went back to the CCG, which turned around and said, “We will consult slightly differently. We will address what the court said, and by the way, we are going to go ahead and do it.” It is a sham, and we should be honest about that in the House.

When we tried to prevent our acute hospital from being closed—I pay tribute to my community for that—we did everything in the world. We got a coffin on a trolley, and thousands of us pushed it from my A&E that was going to close to the nearest one at Watford hospital, which it was proposed people should go to, in order to show just how much passion there was. We managed to get the money together to go to judicial review—a lot of money; in excess of £60,000—and the judge said, “You have a moral case. You have an ethical case. I agree with you, but you don’t have a case in law because all the powers are with the trust and the PCT”, as it was then. I ask the Minister: how can it be right that people must be so concerned, not just in my constituency but elsewhere?

Lastly on this part of my speech, let me talk again about what happened when we lost our A&E. I have raised this in the House before, so the Minister knows what I am talking about. To go back a bit further, St Albans, Hemel Hempstead and Watford are covered by West Herts, and at one time all three had A&Es. We are a massively growing population. The largest town in Hertfordshire is Hemel, which will have a projected 20,000 new homes in the next 20 years. St Albans is expanding, and so is Watford. There was a consultation, but the public were ignored. The A&E was closed and made into an elective surgery facility in St Albans. The public promises to the people of St Albans were that Hemel’s A&E would look after them. It is not a particularly long ride—it is clearly not in St Albans town centre, but that was going to be that. However, a few years on, those responsible said, “Let’s shut Hemel’s A&E and move it to Watford, because that can look after West Herts,” so the promises went out the window. The public went mad in St Albans and in our area. They were all on the streets, and what did we get? An urgent care centre, some out-patient services and a fracture clinic. Really and truly, that is all that is left in Hemel.

[Rachel Maclean]

My right hon. Friend is generous in giving way a second time. Again, the parallels with Redditch are interesting. Does he agree that the problem for the public comes when they see that their town is growing and they feel that trusts have not planned for the future? That is exactly what we have in Redditch as well, because it is a new town and it is growing, and people do not understand how the future demand will be catered for in the trust’s plans.

[Sir Mike Penning]

That is absolutely what I hear every day in my constituency. I also hear, “What are you going to do about it, Mr MP? Get off your backside and do something about it!” I am doing everything I possibly can—I am meeting Secretaries of State and trusts—but what happens? I get ignored, because I have no powers at all; it is all in the hands of bureaucrats.

[Dr Caroline Johnson]

We have a similar situation in Grantham A&E, which serves my constituency. My hon. Friend the Member for Grantham and Stamford (Nick Boles) and I have been working to try to get Grantham A&E reopened around the clock since it was closed without consultation in August 2016.

[Sir Mike Penning]

If the A&E was closed without consultation, that is illegal. I think the Minister will confirm that it is illegal to make major changes to a community’s health provision without consultation.

Hemel Hempstead A&E closed after a bogus consultation, and everything moved to Watford. We were promised that it would all be okay, and that we would have a 24-hour urgent care centre manned by GPs. Let us go back to just before Christmas 2016. There had been chaos—and I mean chaos—at the acute admissions unit in Watford hospital, which has just recently come out of special measures. All the ambulances were getting held up in big bottlenecks at the A&E at Watford. The big, new, bright idea was that we would close the urgent care centre that had replaced the A&E in Hemel Hempstead, and that that would be okay.

I had a meeting with the chief executive of the trust, who told me, “Mike, we are only doing this on safety grounds, because we cannot get the GPs to cover the hours.” That was really surprising to me, because there is a GP drop-in centre in the next room—not across the other side of town or even in a different part of the complex, but in the next room. I was told, “That is a different contract. We can’t touch that, mate; it’s nothing to do with us.” The chief executive said to me, “Don’t worry, Mr Penning, we can’t close the 24-hour service, because we have not consulted. This is just a temporary, emergency measure.” She went on the local radio station—I did not ask her to do that—and reiterated exactly what she had told me. In fact, she went further and said that the centre would be closed for only a couple of months and that it would reopen, because it would be categorically illegal to change the hours without consultation.

Reducing the hours of an urgent care centre—which used to be an A&E—from 24 to 10 is a major thing. Eighteen months later, the trust consulted on a proposal to turn the 24-hour urgent care centre into an urgent treatment centre, which would shut at 10 pm. Perhaps the Minister can explain to the general public the real difference between an urgent care centre and an urgent treatment centre, because I struggled to do so. I know that there is a methodology within the Department, but all that Joe Bloggs, my constituents, saw was a downgrading.

By the time of the consultation, the centre had already been closed for 18 months, so what choice did we have? We could not rewind the clock 18 months. The trust misled us by saying that the measure was temporary. The chief executive promised me that to my face, and she repeated that promise on the local radio station. That commitment was not worth the paper it was written on—or rather the voice that spoke it. My constituents have suffered a massive loss of trust in brand NHS. Their trust has been decimated, because promise after promise has been broken.

Naturally, the vast majority of consultation responses —do not quote me on this, but I think it was about 80%—said that the centre had to be open 24 hours. Guess what, Madam Deputy Speaker? It is not. It has been renamed an urgent treatment centre, and it closes, allegedly, at 10 o’clock at night. Within the last few days, however, a very senior person in my constituency whom I trust implicitly saw someone collapse outside the centre at approximately 9.30 pm—half an hour before it was supposed to close—but the doors were locked. It was only because a member of the public opened them from the inside that the patient was seen. The doors were not opened by the NHS staff who were inside, even though they must have known that the patient was there. I hope and pray that she is okay.

I am now told that the doors are regularly locked at any time after 9 pm. That is disastrous for my constituents when they turn up there, but many of them simply do not trust the centre to be open at night. What is going on? Naturally enough, although sometimes inappropriately, they go to the A&E at Watford, which is causing it even more of a problem—but can we get anyone to listen? No, we cannot.

Watford General Hospital is in the middle of Watford, next to a football club about which a great many of my constituents are passionate, Watford FC. It used to be the home of Saracens, and I am passionate about them as well. The hospital was built in Victorian days, and the best way to describe it is “not fit for purpose”. The people of Watford will probably say, “Please do not run down the hospital, because it might be closed”, and I fully understand that, but the truth is that we all need a new hospital.

Although, as we heard earlier from my hon. Friend the Member for Redditch (Rachel Maclean) about her area, the population is growing massively, we are now supposed to listen to the management telling us what they are likely to provide. I have attended meetings with the Secretary of State and NHS Improvement about the applications from my local acute trust and clinical commissioning group, and it petrifies me that yet again they are not going to listen—I do not mean to me, or to the Minister, who knows that he has no powers and will be treated with the disrespect that I often receive; they just ignore us—but to the people whom they are supposed to be serving, and who pay their wages out of their taxes.

I am not a clinician, although I was a paramedic in the armed forces and I know a little bit, but surgeons, GPs and frontline senior nursing staff have been speaking to me privately. It is fundamentally wrong and dangerous to keep saying that Watford can cope with the ever-growing population of west Hertfordshire.

I have met representatives of NHS Improvement with a delegation from my hospital action group, led by the brilliant Betty Harris, with Edie Glatter and her team, Jan Maddern and others, and we have joined forces with a separate campaign from St Albans. We were promised that the NHS management, as they looked at the applications for healthcare regeneration in my part of the world, would ensure that the CCG and the acute trust had more than one option on the table, rather than just ploughing more money into the Victorian hospital. I know that there have been conversations about a greenfield site, which is owned by us because it is Crown Estate land. It is by the M1, close to the M25, between St Albans and Hemel Hempstead. It is perfect for an acute facility—the infrastructure could not be bettered—but I think we are being ignored again. I cannot prove that, but it is my gut feeling, and it is certainly the feeling of the thousands of people in my constituency.

I am a loyal member of the Conservative party. I was a Minister for seven years in seven Departments, and I was on the Front Bench in opposition for four and a half years. I have to ask myself why I am supporting a Government who are allowing my constituents to be ignored. The Minister must not take this personally, but the present situation is crazy. The Department of Health and Social Care—I was not in that Department, but I have been in many others—actually has very little control over what is going on out there in our wonderful NHS. We have inspections, my local hospital goes into special measures and then comes out of them, it gets into debt and then comes out of it. However, the truth in my part of the world is that if NHS management are not accountable to Ministers or to me as their MP—and, much more importantly, are not accountable to the people whom they are supposed to be looking after—we have a serious problem. If my constituents cannot come to me and express their concern about what is going on in the NHS, there is a serious problem with our democracy, and that is something that I cannot live with.

--- Later in debate ---

[Sir Mike Penning]

I must apologise to my colleague, the now Foreign Secretary, who was so generous with his time in seeing me. I hope that the new Health Secretary will not get so upset when I am banging on his door—perhaps as much as I was on the previous Health Secretary’s door.

[Stephen Barclay]

I am grateful to my right hon. Friend for recognising that in the House. I think that is widely shared across the NHS.

It is right that the Government are bringing forward the draft Bill to place the Healthcare Safety Investigation Branch on a legal footing. Indeed, trusts should disclose any pay settlements to NHS Improvement. Therefore, on the concern to which my right hon. Friend brought the House’s attention—whether whistleblowers have been gagged and, if so, whether that has been induced through financial payment—both those breach the Government’s guidelines and they would need to be reported to NHS Improvement. If he is able to share any specific allegations after this debate, I will be keen to explore them.

My right hon. Friend expressed concern that service changes are “all in the hands of bureaucrats” and I must take slight issue with that.

[Sir Mike Penning]

Only slight?

[Stephen Barclay]

Well, I must take issue with that point. First, my right hon. Friend is well aware that the Government have four tests that apply to service change that ensure the voice of patients is heard and in particular that service reconfigurations are clinically led and done at a local level. I draw attention to the work that Professor Tim Briggs and Professor Tim Evans are doing through the “Get it right first time” initiative, which is all about driving through change to service provision through the leadership of national clinicians working with local clinicians in order to get that service buy-in.

[Sir Mike Penning]

I do not want to take up too much more of the Minister’s time, but I am afraid that, in parts of the country, certainly in mine, the requirement to consult is simply being ignored. I have given the House a classic example in which an urgent care centre was closed at night with no consultation at all. It took 18 months for a bogus consultation to take place on whether it should close at night. The changes are there to be seen by everyone. I know that the Minister is telling me all this in good faith but, as he has heard from colleagues on both sides of the House, on the frontline, in the real world, people are ignoring the guidelines, which is surely illegal.

[Stephen Barclay]

I shall just unbundle two separate points from my right hon. Friend’s remarks. First, his point that these changes are all in the hands of the bureaucrats collides with the Government’s own position, which is that there are four tests. What he is drawing out is not whether the guidance is there as a protection but whether it is being implemented operationally, and that obviously needs to be looked at on a case-by-case basis. Secondly, he and I debated this issue in some detail in an Adjournment debate in March, when this specific point was explored more fully. The urgent care centre in question saw an average of seven patients between midnight and 8 am, and an average of four between 10 pm and midnight. So in the period between 10 pm and the centre reopening at 8 am, an average of 11 patients were being seen. I suspect that that is why, at local level, the change was made. I appreciate that it was initially done on patient safety grounds, with the consultation following, as we explored previously.

[Sir Mike Penning]

This is a hugely emotive issue. Yes, the excuse was that the centre was closing at night on grounds of patient safety because it could not get a GP there, but it does not take 18 months to turn round and say, “Oh, by the way, the numbers weren’t there in the first place and that’s why we had to close the centre.” That was the excuse 18 months after it had been closed at night times. Whether the numbers are right or not—they are hugely contested by my constituents—it cannot be acceptable that no consultation took place for 18 months.

[Stephen Barclay]

As I have said, we did explore these issues in some detail in March, and I absolutely respect the conviction with which my right hon. Friend is championing the interests of his constituents.

In the spirit of balance, I draw my right hon. Friend’s attention to the fact that a number of enhancements have also been made, including the introduction of a number of bookable appointments through NHS 111, which includes a clinical assessment service to ensure that patients’ needs are medically assessed; the addition of near patient testing for some conditions, reducing waiting times and reducing the need for patients to attend Watford Hospital; and an improved IT system meaning that medical staff will be able to access patient records if they give their consent. The clinical commissioning group also expects the service to expand to include a greater skill mix of other professionals such as pharmacists, emergency care practitioners and community nursing staff, and to provide access to mental health services. This is not a static situation. Some improvements have been made, but I absolutely take on board the concerns that my right hon. Friend has raised.

My right hon. Friend has raised concerns about the hiring of leadership positions, particularly two chief executive roles. He will be aware that this point was also raised by the hon. Member for Blackpool South (Gordon Marsden) in respect of the chair of Blackpool Victoria Hospital in an Adjournment debate only last week. I also note that the right hon. Member for Warley (John Spellar) and the hon. Member for Coventry South (Mr Cunningham) have raised similar issues. It is right that the views of constituency Members should be taken on board as part of any consultation, because Members of Parliament interact with a wide spectrum of their electorate and they are obviously well placed to feed into such consultations. As a Minister, that is something I take very seriously, and working on the cross-party basis, I am always keen to hear from colleagues when concerns arise.

That goes back to my right hon. Friend’s point about trust. Issues in terms of pay need to be balanced. On the one hand, we need to recognise the complexity of senior leadership roles. We are dealing with hospital trusts that often have budgets running into the hundreds of millions of pounds. These are senior, complex, challenging roles that need to attract talented individuals. At the same time, those salaries and that remuneration need to be balanced with the wider values of the NHS. There is a live discussion about what the right level of remuneration is to attract talent while not being out of step with the NHS values that both sides of the House recognise.

I turn now to my right hon. Friend’s point about the new hospital site and capital investment in the STP area. He will be aware that the same STP currently has a significant new build proposal at Harlow. My right hon. Friend the Member for Harlow (Robert Halfon) is assiduous in championing that proposal, and I met with the chief executive of that trust—

[Sir Mike Penning]

That is in Essex.

[Stephen Barclay]

It is in the same STP area.

[Sir Mike Penning]

My constituents will not know what STPs are. At the end of the day, the new site is in Essex, on the east Hertfordshire border, which is nowhere near my constituency. There is no tangible benefit when the debate is about a new hospital in west Hertfordshire.

[Stephen Barclay]

I beg to differ from my right hon. Friend on that, because this gets to the crux of the issue. The NHS must evolve. It has to move with technology and with the skills mix. Alongside the significant funding injection that the Prime Minister announced at the Royal Free Hospital, the NHS must also deliver productivity. At the specialist level, such as oncology or neuroscience, we often have populations of 3 million that need to be treated. Look at the footprint of the Christie NHS Foundation Trust, for example.

If we look at the other end, we need to deliver more care in the home and not have acute trusts soaking up so much investment. We need dynamic reconfigurations without acute trusts being the sole focus of our attention. We need service changes but—this goes to the core of my right hon. Friend’s remarks—they must be taken forward with clinical leadership and in a way that delivers trust.

I am happy to continue to engage with my right hon. Friend’s specific allegations on a case-by-case basis.

 Orkambi and Cystic Fibrosis

Mike Penning Excerpts

Monday 19th March 2018 Westminster Hall

[Sir Mike Penning (Hemel Hempstead) (Con)]

It is a pleasure to take part in this debate. Like everybody in this room, I have constituents who suffer from this terrible genetic disease. We live in a society where sometimes those who shout loudest get heard more, but interestingly, it is not possible for those who suffer from this terrible disease and their families and loved-ones to have orchestrated the petition. Members of the general public who have no contact with someone who has CF have signed it and decided that the process is fundamentally unfair. Like the hon. Member for Dudley South—

[Ian Austin]

North.

[Sir Mike Penning]

My apologies—don’t forget I am a southerner.

The hon. Member for Dudley North (Ian Austin) and I had a good meeting at the roundtable. All of us learned things. For colleagues who were not there, there are some good notes to come around.

We thought we would not have a decision by tonight from NHS England on the Vertex proposals—it usually takes much longer—so I was very disappointed when I saw not only what NHS England put out, but the press release from Vertex. As the hon. Gentleman said, it is not so much because the Department, NICE or the companies are bad—our constituents could not have any of their drugs without the R&D done by those companies. NICE is not capable, under its guidelines, of properly analysing the benefits of the drug, or the other drugs coming down the line. The Republic of Ireland must have sat in exactly the same position that we are now in. It had difficult negotiations with Vertex about a plan for not just one or two drugs, but the drugs coming down the line.

Let us not beat about the bush: this drug is not a cure. It helps some people. At the end of the day, they will either have a transplant or their lungs will give way. It is wonderful that we will have an opt-out transplant system. People are dying in this country today because the organs are being wasted. Lung transplants are vitally important. We should all campaign in our constituencies to give people the confidence to tell their loved-ones what they want done with their organs, rather than just relying on the legislation. At the end of the day, to help people today and future sufferers of this terrible disease—we know they are coming, because it is genetically in the system—we need not only drugs that slow it down and stop the lungs filling with fluid, but to get a cure. I hope we get to that position in my lifetime. Those of us who have been in the House for some time will remember taking the Human Fertilisation and Embryology Act 2008 through. It was very controversial when we started using that sort of technology, research and work, but I am pleased that we passed that Act because many people are around today who have better lives and who, without us using that technology, would have been very worried.

As my hon. Friend the Member for Sutton and Cheam (Paul Scully) said, this is not about individuals. When an individual gets CF, the whole family and all their loved ones get it. If the family is not there, what happens? The NHS and social services. Several colleagues have asked about the overall cost. If we do not give people these drugs—not just this one, but the others coming down the pipeline—the cost to the NHS is greater. If we take away the moral and ethical position that we have something that will improve and extend someone’s life and look just at what NICE looks at—the cost implications—it is plainly obvious that we need to have a better system for NICE to assess the costs.

My hon. Friend called it “physiotherapy”, but someone who suffers with CF has to have a pummelling. People have to do an amazing thing to their loved ones to get the fluid out their lungs and to stop them drowning internally. Instead of saying that drug companies are bad and NICE is good, we need to bang some heads. Frankly, the only people within Government who will do that are the Ministers. That was said to me time and again when I was a Minister. Time and again I tried, and time and again I got pushed back, but I kept going.

It is obvious—to echo what I said at the start of my comments—that those who shout the loudest should not always win. In this case, we need to shout for them. That is what we were sent here for, and that is what we should do today.

Hemel Hempstead Urgent Care Centre

Mike Penning Excerpts

Tuesday 13th March 2018 Commons Chamber

[Sir Mike Penning (Hemel Hempstead) (Con)]

First, may I say what a privilege it is to have secured this Adjournment debate this evening, and how proud I am of my constituents who for so many years have been fighting the changes and particularly the cuts to healthcare in the Dacorum area where my constituency sits? In particular, I thank Edie and Ron Glatter and the Dacorum Hospital Action Group and its fantastic chair Betty Harris, who is very poorly; they have been fighting this campaign for many years. I also pay tribute to the fantastic work our local BBC radio station, BBC Three Counties, has done over the years, in particular that of the excellent journalist and reporter Justin Dealey; without his work, this debate would probably not have taken place.

For the national health service to carry on being the world-class service it is today, the public, our constituents, need to have faith not only in the fantastic doctors, nurses and porters and those who run the frontline services, but in the management of our hospitals and health provision. I am sorry to say, however, that the trust and feeling of commitment we need from our health service management in our part of the world are not just broken, but have completely failed.

I will not go into the history because tonight I want to talk about the urgent care centre, but the history of what has been happening to out-of-hours and urgent care, including A&E, in my constituency has been going on for many years. The previous Labour Administration decided to close the A&E and all acute services at the Hemel hospital after they had already been closed at the St Albans hospital, with all services moved into a Victorian hospital next to a football ground in Watford. We will not dwell on that tonight, however, but will come back to it on another evening.

As part of the sop to my community, we were given an urgent care centre—24/7, seven days a week, throughout the day and night—and next to it a walk-in GP centre. I was therefore surprised when Ms Fisher, chief executive of the West Hertfordshire Hospitals Trust, phoned me just before Christmas to say that, sadly, the urgent care centre would have to temporarily close on safety grounds at night. I was shocked by that, not least because the A&E in Watford struggles greatly, so the more people we can encourage to use other NHS facilities instead, the better. I said, “This is happening over Christmas which is one of the busy times,” and was told, “Don’t worry, Mr Penning, it’s only a temporary thing and we’ll have it open again just after Christmas.” They then put out a press release headed “Temporary overnight closure of Hemel Hempstead Urgent Care Centre”. Interestingly, that press release is still on their website today. I actually printed it off before I came into the Chamber this evening. As I go through my comments, Members will realise just how false that statement was.

One of my constituents then contacted Three Counties Radio, and Justin Dealey, its excellent reporter—

--- Later in debate ---

[Sir Mike Penning]

Thank you, Mr Speaker. I have even longer to pontificate, which is great news.

Justin Dealey acquired an interview with the said Ms Fisher, the chief executive of West Hertfordshire Hospitals NHS Trust. It was quite a long interview, in which Ms Fisher indicated:

“This is a short-term measure which is us acting in the interest of patient safety because, for the next few weeks over the festive period, we are unable to secure GP cover.”

I think most people would understand that, but not if they knew that the GPs were working in the room next door. But that is a separate issue. Justin went on to suggest that surely Ms Fisher understood that local constituents would have real concerns, and asked her whether she would be concerned if she lived in the area. She said:

“I completely understand their concerns, but what I want to reassure the residents of Hemel is that if there were to be any permanent change it would be our absolute intention to include people fully”

in that decision. She went on to say that

“legally we would be obliged to consult for a permanent change of that nature.”

That press release was issued not before Christmas this year but in December 2016. We have had no night provision at all in Hemel since then. Everybody has to go for urgent treatment to Watford A&E. Alternatively, they have to dial 111, which is an excellent service, but after they have been triaged they apparently get sent to Watford A&E. Watford has just come out of special measures, and I praise the work that has been done at the hospital but there is still a lot more to be done.

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Gentleman for giving way. I sought his permission to intervene on him beforehand. He is outlining very well the issue with the Hemel Hempstead urgent care centre. Does he agree that, although there is immense staffing pressure, closing or scaling back on urgent care units and minor injury units only adds to the pressure on A&Es? There must be more investment in these mid-level centres if we are to prevent the A&Es from crumbling under the weight of the work they have to do.

[Sir Mike Penning]

I clearly agree with my hon. Friend. It was kind of him to come and tell me that he wanted to intervene on me on behalf of other parts of the country that are facing similar pressures.

This was not about money. Normally, when our constituents come to talk to us, especially about the health service, it is about money. They tell us that they are really concerned that there is not enough money to provide the services, but on this occasion we were told that this was nothing to do with money. It was to do with the contractual problem with the GPs. We kept on asking what was going to happen, and then—completely out of the blue and still without consultation—we were told that the Government had said that there should be no more urgent care centres and that they should become urgent treatment centres instead. I was repeatedly told that it was the Government saying that this should be done. I asked whether the Government had said that the centre should not be open 24/7. I was told no, but that we had to move to being an urgent treatment centre. In the past couple of weeks, the unit has changed from being an urgent care centre to being an urgent treatment centre. Interestingly enough, that means that paramedics and nurse practitioners are running the facility, and in many cases—without being rude to our GPs—they have more skills than a basic GP. I have to declare an interest, in that I was a military paramedic, so I am slightly biased about these things.

Was there a consultation before that decision was made, not just to close the UCC but to change to a UTC? No, there was not, even though it is a legal requirement to have one. We are now in a consultation, however. I could not believe it when I first heard this, but I have now heard from several constituents that in the actual meetings that took place—not when people were writing in—when different plans and options were being put to my constituents, a member of the clinical commissioning group staff was at the table trying to convince the public what sort of option they should go for. If we are going to consult the public, surely we should trust them and then have the confidence to listen to them.

What I find really fascinating about what is happening in my part of the world is that people from nowhere near my constituency—from the other side of Watford—are being consulted. They would never come to my facility in a million years—unless they just happen to be in the area—but they apparently have the same rights in this consultation as my constituents, who are again losing facilities hand over fist. Those other views are being taken into consideration because they happen to be part of the trust area. My constituents just scratch their heads and say, “This is illogical.” This facility, even though it is part of the NHS and anybody could come to it, is obviously being used by the largest town in Hertfordshire and the other towns and villages within Dacorum. However, I have no problem with the people of St Albans being consulted over this, because they are clearly part of the process.

Trust has been severely damaged. A highly paid chief executive of an NHS trust went on the radio—telling an MP is one thing, but going public is another—and tells listeners, “This is temporary. Please do not worry; it will all be okay. By the way, if I did actually change the service, that would be illegal because I have not consulted.” Frankly, when they then did not consult—the UCC is quite clearly never going to open again—that breaks the trust.

I have raised the accountability issue in the House before. It is absolutely right that my good friend the Minister on the Front Bench does not make decisions about what A&Es and UCCs are open and how many beds there should be. Those are quite clearly clinical decisions that should be based on knowledge and demand in the area—that is not what happened when our A&E was closed—but we seem to have moved from one extreme to another. I am told that if we want to challenge the consultation, the only way is to put the decision to judicial review based on the consultation. We tried that when the A&E was closed and we got a judicial review. The judge was generous and said, “You have a moral case, but you probably don’t have a clinical case. You don’t have a case in law, because the consultation was done.” However, if the consultation was a complete sham or did not take place at all, where do we go?

I have asked Ministers, I have tabled questions and I have been to see the Secretary of State. At the end of the day, who are these people accountable to? I know that we can go to the health committees at the local council, but they do not have the powers to say that an individual or a trust has brought the NHS into disrepute, and yet that is what has happened here. Nobody was twisting the chief executive’s arm to go on the radio and say what she said. We all listened to it—I got a transcript the following morning—and I sat with Justin and said, “Well, that’s it, Justin. We’re okay.” I was not at all happy about the facility being closed over the 2016 Christmas period, but at least we knew that GPs were going to be recruited and that we were going to get there.

However, the exact opposite has happened. We are not getting the GPs back, and now the facility being open 24 hours a day is only one of the options. I know that the Minister’s notes will say how many people used to go to it at night and so on, but half the problem was that it was never properly promoted. There are access issues at the A&E because so many people are turning up and being triaged when a huge percentage of them do not need to be at an A&E but somewhere else within the NHS. I would argue that they should be at a UCC or UTC or that a GP should come out to them, but that is a separate issue because hardly any GPs make home visits in my constituency.

I know exactly how things work, because I was a Minister for a while and know about the advice that comes down from the trust and the clinical commissioning group, which will say things that are different from what I have said. However, I can honestly say that if there is one issue in my constituency that absolutely unites every political persuasion on my patch, it is the acute health provision in my constituency. We pushed a coffin on a hospital trolley all the way from Hemel Hempstead Hospital to Watford, to indicate that lives would be lost. We had debate after debate with the ambulance service, which said, “Don’t worry, we can get the ambulances there on time.” It probably could, if it rushed them through on a blue light in the middle of the night—if an ambulance was available. Because of the previous Administration’s botching of the regionalisation of the ambulance service, there are often not that many ambulances available, even though the ambulance depot is on my patch.

People do not want to clog up A&E; they want to have the confidence that there is somewhere safe that they and their kids can go for treatment. We have no idea what the conclusion of this retrospective consultation will be. We have no faith that even if the conclusions are in agreement with what we want, we will actually get it. Not all my constituents agree with me, but in a treatment centre I would rather have a highly qualified paramedic nurse practitioner than—I have to choose my words carefully here—an ordinary GP, simply because the paramedic nurse practitioner has so much experience in that area. That is where the modernisation of the health service has been so brilliant. But after telling me that the decision was not about money, it is, frankly, disgusting to sit people down at consultation meetings and try to convince them that it would be better if the centre was not open 24 hours a day.

I hope that the Minister understands how passionate we are about the matter. My constituency is 17 minutes from London and it shares a boundary with yours, Mr Speaker. People in the top part of my constituency all go to Luton and Dunstable—quite rightly so; it is an excellent facility—and those in the bottom part of my constituency, or anyone who comes off the M1 and the M25, end up going to Watford for their acute care.

I want Watford General Hospital to succeed. I think the location of the site is completely ludicrous, and we need a new general hospital for the growing population in our part of the world. I know that you have pressures on housing, Mr Speaker, as we have. But I want the houses, because I want people to have somewhere to live—so many families are struggling at the moment—and if we are to build those houses, we need facilities, such as schools and everything else. When my constituents go to bed at night, they need to know that the urgent care centre is open in case something happens; and that if they cannot cope, we can blue-light them to Watford or to Luton and Dunstable.

I have tried for weeks and weeks to get this Adjournment debate. My hon. Friend the Minister is lucky, because I had been asking for a 60-minute debate in Westminster Hall. We may yet end up there, but that will depend a lot on what he says from the Dispatch Box.

[The Minister for Health (Stephen Barclay)]

I will do my best to address the issues raised by my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) in order to pre-empt the further debate to which he alludes. I congratulate him on securing this debate. I commend him for his continuing and passionate campaign on behalf of his constituents, and for his expertise on health issues, which he has brought once again to the House.

I reiterate the fundamental principle for all service change in the NHS: it should be based on clear evidence that it will deliver better outcomes for patients. That is the framework that is applied. I understand that my right hon. Friend is concerned about the changes proposed in his constituency. He will appreciate, not least as a former Minister, that I cannot say anything that would prejudice the outcome of the ongoing consultation, but he has spoken powerfully about his concerns in the House tonight.

I am sure that my right hon. Friend agrees that any decision should be driven by what is best for the constituency clinically, by what is best for the health service in the area, and by what is of most benefit to the greatest number of people in the area. I shall briefly set out some of the background, as I understand it, to the issues that inform the consultation. As he mentioned, in December 2016, the urgent care centre was temporarily closed overnight because of concerns about patient safety as a result of problems with staffing the GP overnight shifts. The CCG’s advice was that the urgent need to address patient safety issues did not allow time for consultation about that temporary change. I appreciate the concern that he raised about the manner in which that decision was taken.

The local NHS has worked hard to manage the consequences of the decision. I understand from the CCG that the volume of overnight patients at the centre was relatively low, and that the impact that has been felt at Watford General Hospital, notwithstanding the other challenges it faces, has been of the order of one or two patients per night, usually those with relatively minor injuries. As my right hon. Friend will be aware, emergency cases have been sent to Watford since the closure of Hemel Hempstead’s A&E in 2009—he referred to the protest involving a coffin about that decision, which was taken under the previous Labour Government. On provision in the early hours of the morning, he will also be aware that journey times then will be shorter than they would be at the times when the urgent care centres are open.

[Sir Mike Penning]

Let me go back a fraction. If the decision has to be based on clinical advice—I understand the principle—what is the point of consulting the public, who are not clinically trained? We have to consult them, because that is what the law says, so is the law wrong for saying we should consult people who are not clinically trained? If the decision has already been made, what is the point?

[Stephen Barclay]

The public consultation is to inform the discussion with clinicians. If such a decision were taken by Ministers—my right hon. Friend alluded to this in his remarks—it would likewise be informed by public consultation. That is part of running a transparent and open process.

The CCG is now consulting the public on future opening hours, following a broader urgent care strategy review. The consultation seeks views on three options: retaining the current temporary hours; increasing the temporary hours by two hours at the end of the day; or re-opening on a 24-hour basis. As it runs until 28 March, I know that my right hon Friend and his constituents will wish to share their views as part of the process.

I do understand the criticism made by my right hon. Friend’s constituents that the overnight closure has been dragging on for too long and that a final decision needs to be made as soon as possible. The views gathered during the current consultation will inform the CCG’s decisions about the future opening hours for Hemel Hempstead UTC, as well as about the contract for West Herts medical centre. I further understand that the CCG has commissioned an independent research company to review and analyse all the comments received, and the feedback will be compiled into a summary report. That will be presented to the Herts Valleys CCG board meeting, in public, on 26 April, when a decision on both issues will be made.

Turning to the issue of the treatment centre’s status, on 1 December 2017, Hemel Hempstead UCC changed to a UTC, as part of national measures introduced by NHS England. I understand from the CCG that this was a change of name, not of service. The CCG therefore did not carry out a further consultation on the establishment of the UTC as it did not feel that that represented a significant change in service. I understand that no services have been withdrawn from the UTC, but there have been a number of enhancements, including: the introduction of a number of bookable appointments through NHS 111; the addition of near patient testing for some conditions, reducing waiting times and reducing the need for patients to attend Watford General Hospital for some tests; and an improved IT system, meaning that medical staff will be able to access patients’ records if they give consent. The CCG also expects services to expand to include other professionals, such as pharmacists, emergency care practitioners, those providing access to mental health services and community nursing staff.

That also dovetails with some important changes in planned care locally. I understand from the CCG that improvements in the treatment of musculoskeletal disease mean that the single point of access triage at Hemel can direct people on to community physio, where that meets their needs. That is good for the individual patient and also ensures that capacity in the acute settings is able to concentrate on those with more complex needs.

[Sir Mike Penning]

The Minister has just told the House that there has been a complete change in how physiotherapy is provided—it was provided at the hospital and is now provided elsewhere. There was no consultation on that, although I understand that there was a requirement to do so, because this involved a complete change of service in respect of where people go and so on. The point I am trying to make is: when there is no consultation, what do we do? Do we just sit back and say, “Okay”? Some kind of measure has to be taken when consultation continually gets ignored or does not happen at all.

[Stephen Barclay]

The distinction that was being drawn was in respect of services that have been removed, on which my right hon. Friend is right that there is a legal requirement for a consultation. He has expressed to the House his concerns about the process by which that temporary decision on patient safety was taken. The point I was making was that the services that have been brought to the area are bringing a benefit to the local community. I would have thought that they would be welcomed. Indeed, from April, many patients with diabetes in the area will no longer need to travel to Watford to be seen by a consultant, because the consultants will be coming to them by working in the community. Again, that is good for patients and for the system as a whole. It is part of the way in which these systems evolve: some services come closer to the community, while others, as under the decision taken by the Labour Government in 2009, are rationalised into Watford A&E.

I understand my right hon. Friend’s frustration that in his view the local CCG seems out of touch with popular opinion. Given the way in which he champions the community that he represents, I know that he is not out of touch with popular opinion—he always speaks in a well-informed way about his constituents’ needs, and I would expect that to be represented in the consultation responses that the CCG receives. The CCG is accountable to NHS England for fulfilling its functions. It is also a member of the health and wellbeing board, at which local authorities and other partners can challenge how it has been fulfilling its functions. The CCG’s activities are subject to scrutiny by local authorities and to supervision by NHS England. If NHS England believes that the CCG is failing to discharge its functions, it has the power to intervene and issue directions, or to replace the accountable officer.

It is worth reiterating that all proposed service changes should meet the four tests for service change. They should have support from GP commissioners; be based on clinical evidence; demonstrate public and patient engagement; and consider patient choice. It is right that such matters are addressed locally, where local healthcare needs are best understood, rather than in Whitehall. I think my right hon. Friend recognised the point about Ministers not making clinical-led decisions. For those reasons, I am sure that he will appreciate that I am not able to offer the House an opinion on the merits of the proposals, but of course we recognise that changes to health services inspire passionate debate, as they should, from all quarters, as we have seen this evening.

There is no standard approach on what an urgent care centre should offer. The offer varies between different urgent care centres, depending on the services required locally. Urgent care centres can treat a range of injuries, including sprains, strains and broken bones.

[Sir Mike Penning]

I want to help the Minister. The urgent care centre is gone. We do not have an urgent care centre; it is now an urgent treatment centre. This is something that confuses my constituents as well. I was trying to make two points. First, it is not just about the clinical commissioning group on its own. The decision to close over Christmas in 2016 was made by West Hertfordshire Hospitals NHS Trust, and it cannot escape blame, because it was the trust’s chief executive who made that decision and went on and acted. Secondly, it is also about the lack of knowledge and understanding of the community. We have had a churn of people coming through and running the services. They seem to come and go and come and go, never understanding or empathising with the constituency.

[Stephen Barclay]

Before my right hon. Friend’s intervention, I was just coming to the urgent treatment centre, because there is obviously a distinction. Urgent treatment centres are about standardising the range of options and simplifying the system so that patients know where to go and have clarity about which services are on offer. My right hon. Friend made the point about how we direct footfall and constituents into services at the right point to reduce the demand on the A&E at Watford by simplifying what the UTC does, what it offers and how that is understood by constituents.

Patients and the public will be able to access urgent treatment centres that are open for 12 hours a day, and that are GP-led and staffed by a range of clinicians with access to simple diagnostics. They will have a consistent route to access urgent appointments offered within four hours and booked through NHS 111, ambulance services and general practice. A walk-in access option will also be retained. They will increasingly be able to access routine and same-day appointments, and out-of-hours general practice for both urgent and routine appointments at the same facility where geographically appropriate. UTCs are also part of a locally integrated urgent and emergency care service working in conjunction with the ambulance service, NHS 111, local GPs, hospital A&E services and other local providers.

In conclusion, these are important issues, and decisions should not be taken lightly. The location of services is a difficult and often controversial issue, and my right hon. Friend is to be commended for his campaign and the points that he has made on behalf of his constituents.

[Sir Mike Penning]

It is not often that we get more time to speak in this place, so while I have the Minister at the Dispatch Box, can he answer this very simple question: what recourse is there for me, as the MP, and for my constituents when we are misled—I know that I have privilege, but I am using the word “misled”—by a senior NHS management team about what is going to happen to the urgent care service? I am talking about when what the team says turns out to be completely untrue. What recourse is there so that we can start to rebuild some trust in my constituency?

[Stephen Barclay]

As my right hon. Friend knows, it would be inappropriate for a Minister to comment on a specific allegation such as that from the Dispatch Box. I cannot comment on this specific consultation, which is under way as we speak. The point that has come out of this debate is that the decision of December 2016 was taken on patient safety grounds, owing to a difficulty in recruiting GPs at that time. A consultation is now under way, and it is for my right hon. Friend’s constituents to make their case as part of that consultation.

The people affected by these changes need to be involved in the decision; that is what the consultation will seek to achieve. Our starting point for discussing service change is that there will be no changes to the services that people currently receive without proper public consultation. I therefore urge my right hon. Friend and his constituents to make their voices heard as part of that consultation in the usual way.

Question put and agreed to.

Medicines and Medical Devices Safety Review

Mike Penning Excerpts

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

I do not accept that there is a contradiction. We have to be open to the science and we have to be led by the science at every stage, and if there is new scientific evidence, we must absolutely take that on board. We must also always be led by patients in what we do, and that is exactly what I am announcing.

[Sir Mike Penning (Hemel Hempstead) (Con)]

It was a pleasure to lead the debate in the House when we secured time from the Backbench Business Committee to discuss this. I really appreciate the tone adopted by the Secretary of State, and by the Prime Minister when I asked her earlier if there was good news. May I also pay tribute to the Minister, my hon. Friend the Member for Winchester (Steve Brine), who is sitting next to my right hon. Friend the Secretary of State, for the work that he did, because I gave him really quite a hard time during the debate?

However, there will be huge disappointment among the Primodos campaign team. The idea of being led by the science from the expert working group is fascinating, because it refused to allow some science to come forward as it had not been peer-reviewed, but then accepted a load of other evidence from the drug companies. On this review going back to the Department of Health and Social Care, it is implicated in this, in that these drugs were given out by GPs in surgeries without prescription, so that will give no confidence at all. I therefore think that the Baroness will have both hands tied behind her back when doing her work.

[Mr Hunt]

I commend my right hon. Friend’s campaigning, but I am afraid I have to disagree with him. This is an important step forward; we are absolutely going to be led by the science—we have to be led by the science—and we are giving Baroness Cumberlege full rein to look at what the expert working group did, and to challenge it if she thinks fit.

Hospital Car Parking Charges

Mike Penning Excerpts

Thursday 1st February 2018 Commons Chamber

[Sir Mike Penning (Hemel Hempstead) (Con)]

Thank you for calling me to speak, Madam Deputy Speaker. This takes me back a long way, to 2006, when you were a Health Minister and I shadowed you for some four years. The issue of car parking charges was around at that time, and successive Governments have talked about addressing it. This is a regressive tax. It is a tax on everybody, because everybody needs the NHS—that is why it is there. It is even more regressive for NHS staff, who are taxed even more just to go to work their difficult shift patterns. That is completely unacceptable.

I have raised this issue many times before. Members might remember that I used to be a firefighter. Firefighters do not pay to park in the yard at the fire station. Our excellent police do not pay to park their cars. The ambulance service is part of the NHS in my constituency, and its staff do not pay, either. They drive to work and they go to the pound to pick up their ambulance. So why should other emergency workers be charged in this way? It is fundamentally wrong.

This issue has gone back and forth across the Floor of the House, no matter which colour Government we have. Contracts have been signed, by previous Governments and by ours, that have locked us into hugely expensive agreements, particularly the private finance initiatives. We need to do something about that, and I will say more about it in a moment.

[Bob Stewart]

It seems to me that there should be staff car parks. There should be a set-up in which staff have separate parking arrangements so that they do not block public parking spaces. They should also have guaranteed slots, so that they are not late for their shifts.

[Sir Mike Penning]

That happens in some parts of the world. For example, that is what they do at the Luton and Dunstable University Hospital NHS Foundation Trust, which looks after part of my constituency. I went there the other day to visit someone who was in palliative care. I did not know how long I was going to be seeing them, or whether I would see them again. The fantastic news is that they are now at home, being looked after by the hospice movement, of which I have been a member for 40 years. That is what the hospice movement is very much for.

Interestingly, I parked and paid in what I thought was a public car park, but I was in the staff car park. So, when I went to try to get out, the barrier would not go up. I pressed the button to talk to someone, and they said, “You’ve parked illegally.” I said, “How have I parked illegally? I’ve got a ticket.” Fortunately, they had no idea who I was, because they probably would have just lifted the barrier to get the MP out of there as fast as possible, which is normally what happens when we visit our hospitals, isn’t it—everything is brilliant, rosy and shiny and everything is great. I said to the person, “No. If you’re going to fine me, fine me. I’ll see you in court, because I have paid in an NHS public car park that you have designated.” They eventually just said, “Oh, go away.” I have been waiting for the fine to come through—it probably will now—and I will see them in court, but the charging is morally wrong.

The situation is even more difficult for patients. The previous debate was about babies and parenting. Babies come out when they want to, usually, not when we want them to, and not based on how much time is left on a car parking ticket. That is what happens, and yet people are getting fined every day because they have outstayed their time in the car park. How can that be right?

A Member who could not be in the Chamber today because they had to attend another meeting, asked me to mention volunteer drivers. What would we do without them? They are fantastic, but they have to pay to park in some hospital car parks before they take patients home, which they do as volunteers because the patient ambulance service is struggling so much. In some parts of the country—I know that it is happening in my area—people are actually asking for patient transport because the car parking facilities are so bad. They are putting more of a burden on patient transport because they cannot find a parking space and they are petrified of being late for their appointment. If they are late for their appointment owing to patient transport, that is okay, but if they cannot find a parking space, they hear, “Oh, you’re a bad person.” We have heard that people are parking outside hospital car parks. Blue badge holders are being charged to park in a car park when they can park for free on the road, so that is what they do. We know that is happening, and it is really very wrong.

I know that the Minister is a good man, and an honourable man, but when he stands up to reply he will almost certainly say that parking is devolved to NHS trusts, and that it is for them to decide how they run their facilities. But for those of us who are Members of Parliament, NHS trusts are completely unaccountable. We can moan about this, but they will not listen in the slightest. They will be looking at whether they can get away with it and how much they can raise.

This is not just about money; it is about space. We have heard that if car parks do not charge, they will be full of people from the town centre. When the acute facility at the excellent Hemel Hempstead Hospital was closed, it was moved to the middle of Watford town centre, next to a football stadium. Apparently Watford play there, and a lot of my constituents will be very upset when they hear about me being derogatory about Watford, but they have a huge number of fans. I went to Watford General Hospital on a Saturday morning to visit a constituent, a good friend of mine, and I parked and paid. When I came out, there was a group of parking people around who clearly wanted to give me a ticket. I had paid in the football bit that is designated for use by Watford football club when they are playing at home. What has that got to do with going to see and look after someone at an NHS hospital, or go to that hospital?

Unfortunately, the parking attendants did recognise me, and they were very apologetic, but I do not think that is right. What would have happened if they had not known who I was? The ticket was coming. How on earth can we have a full acute hospital in the middle of a town as big as Watford, next to a football stadium, and then call that a modern NHS hospital? The parking facilities there for staff and patients are frankly almost non-existent, not least because tons of it has been carved off for the football club. I want Watford to be very successful, but what I want in our part of the world is a brand-new hospital, with proper parking facilities, on a greenfield site away from the town centre, so that we do not have any concerns about whether people will park there all day in order to go shopping. At the moment, though, I do not have that.

There is the acute hospital in Watford, which struggles—it has just come out of special measures and I wish it well—and Hemel Hempstead Hospital, which is basically a clinic these days. We have out-patients; we have a few intermediate wards. They charge the staff, and patients with out-patient appointments, to park there. The car park is empty. Hardly anybody parks there because there is nothing on the site any more, but the hospital still insists on charging. That pushes the patients outside, so there is restricted parking outside, which is also an issue. It is cheaper to park in the council car park in the town centre and walk 400 yards up the hill than to park in a car park that is empty because there are so few facilities at the hospital.

This problem has to be sorted out from central Government, and the central Government guidelines have to be enforceable. I was a Minister for many years: Departments can issue as many notices as they like, but nothing will happen if they do not come out with the stick. Could the money be raised in other ways? Could there be savings in the NHS? As we have heard, the amount of money being raised, compared with the overall pot, is peanuts. One of the more recent chief executives of my very small acute trust was on a package of over £300,000 a year. If we want to save money instantly, let us take a look at the salaries of the really top people in the NHS and let us look after the people at the bottom—we certainly should not charge them to park when they go to work.

--- Later in debate ---

[Tracy Brabin (Batley and Spen) (Lab/Co-op)]

It is a pleasure to follow my hon. Friend the Member for Slough (Mr Dhesi), and I congratulate the right hon. Member for Harlow (Robert Halfon) on his extremely powerful speech and on raising this important issue.

I want to start with an experience that our family recently went through. My daughter started to show signs of acute appendicitis. As any family could imagine, we quickly bundled our daughter, who was in agony, into the car and drove to the hospital—it was not a very calm journey. I am sure that many Members will have had a similar experience. We were panicking and scrambling around for change so that we could park the car, then taking turns to pop out every few hours to move the car or top up the ticket. That was obviously a one-off and bearable, but for many a trip to the hospital is sadly not a one-off experience, and they are forced to take several trips a week because of chronic illness. They are people going through the worst of times, and the cynical approach of charging them to park is unacceptable. It is not anyone’s choice to be ill, and they should not be exploited.

New figures show that the money raked in from NHS car parks in England run by private firms has increased to £500,000 every day. The £175 million that was made from hospital car parking charges in 2016-17 is equivalent to only 0.001% of the total health spend, but still, ruthless private car parking firms pocket most of it. It cannot be fair that worried family members who visit their loved ones can end up with eye-watering fines if they arrive late back to their cars. As my hon. Friend the Member for Heywood and Middleton (Liz McInnes) said, it cannot be fair that NHS staff who have parking charges deducted from their wages are fined for parking in the wrong bay when they cannot find a space in the correct bay.

Some may recommend that regular hospital visitors use public transport, but in my constituency, Batley and Spen, the bus that used to connect Birstall with our local hospital has been cancelled, as have local bus services in many smaller communities. That has forced more people to use a car and thereby incur parking costs. My local hospital, Dewsbury and District Hospital, charges after 20 minutes, so people get 20 minutes for free. There is a reduction for blue badge holders, but they still have to pay. There is a stress-inducing pay-on-exit system, and it is quite complicated to get car parking concessions approved by hospital staff on the day. It is not an ideal situation.

[Sir Mike Penning]

Does the hon. Lady agree that in the 21st century, means-testing at the point of delivery, which is what we are talking about here, is morally unacceptable in an NHS of which we should be and are proud?

--- Later in debate ---

[Julie Cooper]

I thank the right hon. Gentleman for that comment.

I am grateful to Members on both sides of the House because it seems that there is much agreement on the matter. It is heartening to hear Members mentioning—and fully understanding—its impact on patients, visitors, carers and NHS staff. My hon. Friend the Member for Great Grimsby (Melanie Onn) mentioned the effect on the greater transportation system.

The hon. Members for Telford (Lucy Allan) and for Cleethorpes (Martin Vickers), and my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) made powerful speeches, as did my hon. Friend the Member for Colne Valley (Thelma Walker), who accused the system of profiteering. My hon. Friend the Member for Heywood and Middleton (Liz McInnes) made an important point on behalf of staff. The right hon. Member for Hemel Hempstead (Sir Mike Penning) referred to the burden of having to pay to go to work. My hon. Friends the Members for Batley and Spen (Tracy Brabin) and for Enfield, Southgate (Bambos Charalambous) mentioned personal family issues when people are taken away from a sick family member’s bed to replenish parking meters.

No one likes to pay to park, but to pay to park at a hospital really does add insult to injury. We are not talking about a luxury experience, a shopping trip or a fun night out; we are talking about paying to visit a hospital. People are not queuing up to go to the hospital café, as the hon. Member for Telford pointed out. No one goes to hospital because they want to. People go because they are sick. They go for treatment, for surgery, for chemotherapy and for kidney dialysis, and they go to visit loved ones. In short, hospitals are not destinations of choice: people go because they must. I am quite shocked that it is free to park at Trafford shopping centre yet I must pay to park at my local hospital.

During the past three years, I have spent hours and hours visiting my mother in hospital. I have often gone backwards and forwards two or three times a day, juggling hospital visiting around work and other commitments. I have to say that it has all been very distressing. As I leave the hospital each night worried, wondering what tomorrow will bring, the last thing I want to do is to stand outside in the cold queuing to pay for my parking. This burden is, of course, in addition to the actual cost.

Some hospital car parks demand payment in advance, as we have heard. This brings its own set of problems, because patients and visitors have to judge how long each hospital visit will last, and then often have to leave the ward or treatment room to feed the ever-hungry parking machine. Of course, running to and fro between the car park and the hospital is impossible for someone hooked up to a dialysis machine. Many dialysis patients suffer with multiple conditions and are unable to work, so paying to park three times a week for dialysis sessions that each last four to five hours is a real financial burden for them and their carers.

Paula in my constituency relies on the weekly £62.70 carer’s allowance she has received since she was forced to give up work to provide round-the-clock care for her husband, who suffered a severe stroke. He has been in hospital for the past month. She has visited every day, often staying for two to three hours to support and comfort him. This costs her more than £20 a week. By the time she has paid for her petrol, half her carer’s allowance is gone.

We have a national health service that was set up to be free at the point of delivery. It was established in 1948 to make healthcare a right for all, but that is not what is happening. Even though hospital car parking is free in Scotland and Wales, here in England, hospital users are forced to pay often extortionate rates, with charges varying from £1.50 an hour to £4 an hour. We are charging the chronically ill, the terminally ill, and their carers and visitors. More than half of all people over 76 have conditions that require regular hospital appointments, and hospital car parking charges are an extra burden for them and their families. The Alzheimer’s Society reports that patients with dementia stay five to seven times longer in hospital than other patients aged over 65. Hospitals can be frightening places for people with that condition. They rely on family and carers visiting them to give support. Parking charges are an extra burden that these families could well do without.

The Patients Association has commented:

“For patients, parking charges amount to an extra charge for being ill…Hospital appointments are often delayed or last longer than expected, so even if you pay for parking you could end up being fined if your ticket runs out. Visiting a hospital can be stressful enough without the added concern of whether you need to top up the parking.”

Macmillan Cancer Support says:

“The core principle of the NHS is to provide free healthcare for all at the point of access. But sadly some cancer patients in England are paying extortionate hospital car parking charges in order to access treatment for a life-threatening illness.”

Bliss, the charity for babies born prematurely or sick, says in its “It’s not a game: the very real costs of having a premature or sick baby” report that these charges can contribute to the financial burden that many families face when their babies need neonatal care.

In the midst of all this misery, the average hospital trust is making £1 million of profit from car parking charges, and several hospitals the length and breadth of the country report profits of over £3 million. Last year, NHS hospitals made a record £174 million from charging patients, visitors and staff. In addition, 40 trusts report additional income from parking fines.

Some people point out that public transport is an option that avoids parking charges. Public transport provision has been reduced in response to funding cuts, but even where it exists, there are many for whom it is not an option. Some patients are too unwell or too frail to travel on a bus. Others, including cancer patients attending for chemotherapy, have reduced immunity and must avoid contact with the general public.

[Sir Mike Penning]

The hon. Lady is making a compelling case, as have most Members. Public transport has its place for out-patients and so on, where it is available, but imagine someone going into labour and saying, “Can I wait for the No. 2 bus, please?” This is farcical. We need car parks to be there for people when they need them, rather than being a cash cow.

[Julie Cooper]

I entirely agree and thank the right hon. Gentleman for his intervention.

Patients and carers are often balancing work and other commitments, and have tight time schedules that preclude public transport. I have spoken to the parents of a terminally ill child who left their child’s bedside only to tend to the needs of their other children. They do not have time to wait for a bus.

No discussion of hospital car parking charges would be complete without a consideration of their impact on NHS staff, which Members have spoken about eloquently. These staff pay to go to work and are still not even guaranteed a space. That can lead to them being late for the beginning of their shift. Some hospital staff whose shift overruns because they are tending to patients’ needs face fines for overstaying their parking time. That is clearly no way to treat our health professionals. It is no wonder we face a crisis in recruitment and retention.

Government action to date has been limited to a series of recommendations on hospital car parking. Currently the Government recommend that hospital car parking charges should not be applied to blue badge holders, carers, visitors of relatives who are gravely ill, and patients who have frequent out-patient appointments. In reality, those recommendations count for very little. In fact, the trend is to increase car parking charges and to reduce the number of those who are exempt. Many hospital trusts have even begun to charge blue badge holders.

It is not good enough for the Government to abdicate responsibility. This is a matter of principle. Scandalously, Conservative Members have previously argued in the Chamber that the NHS needs the income from parking charges. I have no doubt that the NHS needs this revenue, as it is common knowledge that the service has been starved of funding since 2010, but is it right that we fund our health service by taxing the sick?

Labour Members will have none of this. I am proud that the next Labour Government will ensure that our NHS is properly funded and will abolish car parking charges at all hospitals. To pay for that, we will increase the premium tax on all private health insurance policies. Crucially, no hospital will lose funding as a result of our policy.

In 2015, I asked the Government via a private Member’s Bill to exempt carers from hospital car parking charges. At the time, that relatively modest proposal was met with derision from Government Members. My attempt to remove this financial burden was dismissed as a worthy aim, but not worthy enough for the Government to support. Indeed, Conservative Members went to great lengths to talk the Bill out.

Times, I hope, have changed. Today I am asking, along with the right hon. Member for Harlow, that the Government remove all car parking charges at NHS hospitals. Today we ask the Government to do the decent thing by removing this tax on the sick and taking action to ensure that we truly have an NHS that is free at the point of access.

--- Later in debate ---

[Stephen Barclay]

With respect to my right hon. Friend, it is a statement of fact, as confirmed by my officials—I am very happy to correspond with him further about it—that 67% of NHS sites do not charge. If one wants to get into the definition of a hospital, it actually covers more than acute services. I do not want to get distracted by that point. The one I was seeking to make is to recognise that this issue is particularly concentrated on acute hospitals, and that is the issue before us.

The hon. Member for Great Grimsby recognised that there is considerable room for flexibility within trusts. One of the key issues in this debate is the distinction between charges covering the maintenance of car parks, and how a reduction in charges may lead to a reduction in the number of spaces and the quality of the facilities—we heard, for example, about the state of the car parks in north Manchester—and those involving profiteering, with charges going beyond of the cost of maintenance. The hon. Lady is concerned about that, and the interplay with the current guidance. The hon. Member for Colne Valley (Thelma Walker) also mentioned that when she highlighted the distinction between the charges at her hospital and those of the local authority, and raised the issue of transparency.

The right hon. Member for Kingston and Surbiton (Sir Edward Davey) expressed concerns about transparency in relation to blue badge holders. They are not means-tested, so an affluent blue badge holder could be spared a charge while a less affluent visitor to a hospital is charged. Transparency about how the guidance is applied is therefore a factor, as has been recognised.

[Sir Mike Penning]

May I push the Minister a little bit on blue badge holders? Quite rightly, blue badge holders are not means-tested. The key is their ability to access services. It does not matter how much they have in the bank. If they need to go to a hospital and they have a blue badge, surely spaces should be free and as close to the point of entry as possible.

[Stephen Barclay]

Absolutely. As my right hon. Friend will be aware, the guidance speaks to that. My hon. Friend the Member for Cleethorpes (Martin Vickers) mentioned the 64 pages of guidance. I am very happy to take away and look at why there are 64 pages of it. Blue badges are part of the conversation that my right hon. Friend the Member for Harlow began in 2014.

--- Later in debate ---

[Stephen Barclay]

Of course, but equally the hon. Lady must recognise that the fact that charges are still being applied under PFI agreements put in place by a previous Government in 2008 signals that there are often complexities, in terms of what can be done when different factors apply. As my hon. Friend the Member for Solihull highlighted, there are factors relating to displacement. That is why trusts have local discretion, but as the House has discussed today, we need to understand the transparency around that and how it is applied.

[Sir Mike Penning]

Will the Minister give way? He is being very generous.

[Stephen Barclay]

I will, but then I will press on, because I want to give my right hon. Friend the Member for Harlow some time.

[Sir Mike Penning]

I am sure we have time, on this important issue. The Minister raised the issue of complexity. Clearly, as has been shown by Members across the House today, some cases would be easier to address than others. I fully accept, as I said in my speech, that some ludicrous PFIs were put in place, both before the present Administration came to power and since. Do the easy ones first; that is the answer. That is what Scotland did. Then come to the more difficult ones. Ruling out any change at all because there are some difficult issues is surely not the way forward.

[Stephen Barclay]

A point was raised about whether free parking could be addressed through tokens and barriers, but colleagues in the NHS raised concerns about how that would apply, in terms of any burden on staff. We heard examples of frequent users of a hospital being able to access concessionary schemes, but staff have raised concerns about the impact on them, and how they might be expected to assist in the administration of the scheme in regard to those visiting hospitals as a one-off.

The pertinent point about the impact on staff was raised by Members from across the Chamber. Many Members have been visited recently by representatives from the Royal College of Nursing, regarding the wider discussions between NHS employers and the RCN on pay. It was helpful to hear in the debate contributions about the RCN’s understanding of the benefits, pressures and issues.

Across the House, there is no question, as was reflected by my right hon. Friend the Member for Harlow, about the desirability of addressing iniquities and variance, and about the scope to ensure compliance with the guidance, but we need to be mindful of unintended consequences, and particularly about constraining the car parking available for those who need it. I am happy to continue my discussions with my right hon. Friend on this policy. I commend him and colleagues on a very constructive debate.

Hormone Pregnancy Tests

Mike Penning Excerpts

Thursday 14th December 2017 Commons Chamber

[Sir Mike Penning (Hemel Hempstead) (Con)]

I beg to move,

That this House regrets that the terms of reference for the Commission on Human Medicines Expert Working Group on Hormone Pregnancy Tests asked the Commission to consider evidence on a possible association between exposure in pregnancy to hormone pregnancy tests and adverse outcomes in pregnancy, but the Commission’s Report concluded that there was no causal association between the use of hormone pregnancy tests and babies born with deformities between 1953 and 1975, even though it was not asked to find a causal link; believes that the inquiry was flawed because it did not consider systematic regulatory failures of the Committee on Safety in Medicines and did not give careful consideration to the evidence presented to it; and calls on the Government, after consultation with the families affected so they have confidence in the process, to establish a Statutory Inquiry under the Inquiries Act 2005 to review the evidence on a possible association with hormone pregnancy tests on pregnancies and to consider the regulatory failures of the Committee on Safety in Medicines.

I think we all, as constituency MPs, would have hoped that this debate was unnecessary. We all hoped that the “inquiry”—I use the word advisedly—that the Government constituted in good faith would give confidence to the families and loved ones of thousands—[Interruption.] Shall I pause while the hon. Member for Paisley and Renfrewshire South (Mhairi Black) stops laughing?

[Mhairi Black (Paisley and Renfrewshire South) (SNP)]

No, I was talking to my colleagues.

[Sir Mike Penning]

Thousands of people went in good faith to see their GP because they thought they might be pregnant. That is probably the most important time in any woman’s life. Certainly, as the father of two gorgeous girls, the most important time in my life was when my wife told me that she was expecting our children. It was so important to these families that often they went to their GP, which is a natural thing to do, so we had an NHS patient going to an NHS surgery to see an NHS doctor for advice about whether they were pregnant.

Look at the dates for when these potential mothers-to-be went to see their GP: between 1953 and 1975. That is quite a span of time. My mother could have gone to her GP then, because I was born in 1957. In many ways, it could easily have been me who was a victim of this—God forbid—and my mother would have been a victim as well. That is one of the reasons why I am so passionate about getting to the bottom of the disaster that happened to these ladies who went to their GPs.

These women went to their NHS GP in an NHS surgery as an NHS patient, and very often that GP would open the drawer and give them a tablet—two sometimes—with no prescription or advice, and no concern about the consequences or side effects of the drug. The GPs handed the tablets over to the ladies, and many of them took them there in the surgery. The GP simply said, “If your period starts tomorrow, you’re not pregnant. If your period doesn’t start, you are.” In good faith, which we all have for our GPs, the ladies followed that advice, even though the Department of Health and the drug companies knew that there were issues with this drug.

I am going to use a tiny bit of privilege, because every time I look around for information to do with this subject, including in the House of Commons Library debate pack “Hormone pregnancy tests” and the “Report of the Commission on Human Medicines’ Expert Working Group on Hormone Pregnancy Tests”, I see the phrase “hormone pregnancy tests”. The drug was Primodos. It was made by a drug company and often given free to GPs, who then handed it out without a prescription to determine whether a lady was pregnant.

Other companies in the world knew that there were issues. I will not go into all the evidence that was given to the so-called review, but let me just touch on some of the things that Ministers asked for when the group was set up. The first point was that the Government should set up an expert working panel “inquiry”. No such inquiry took place. At the third meeting, as I understand it, the barrister to the inquiry advised that the word “inquiry” should be changed to “review”. Under whose authority? When a Minister sets up an inquiry, should there not be an inquiry? Perhaps those people did not want an inquiry, but who cares? They should have come back to the group—the victims—and, more importantly, to the Minister. They could have spelled out their advice and the Minister could have made a decision. Some might think that this is just semantics, but it is not. If people are trying to get to the truth, it is vital that they know what a group can do. Even when the report came out—not the original report, because that was removed and draft was changed, as others will mention—it did not say “review”, because it was not a review.

There should be full disclosure and a review of all the evidence. That “review” said that it did that, but it did not. The Royal College of General Practitioners, to give just one example, informed the Department and the drug company that it had concerns way back in the 1960s, but its evidence was never sought. If Members read the report, they will find that no evidence at all from the Royal College of GPs was given to this review, which should have been an inquiry.

[Margaret Greenwood (Wirral West) (Lab)]

rose—

[Sir Mike Penning]

I will give way, but I will only give way on a couple of occasions because I am conscious of the time and I want everybody to have the opportunity to speak.

[Margaret Greenwood]

I thank the right hon. Gentleman for giving way. Is he aware that The BMJ reported that most of the scientific evidence considered by the working group was from the 1960s, ’70s and early ’80s. One expert in the field, Dr Neil Vargesson of Aberdeen University, told The BMJ that there were not that many scientific studies available. Does he agree that the Government should fund new research with the aim of enabling a definitive conclusion to be reached?

[Sir Mike Penning]

Yes, I do, and I will come on to that point. It is vital that we have proper evidence, not some historical evidence that was used by the report. More modern evidence was rejected because it had not yet been peer reviewed. The whole point about having all the evidence is one reason why the motion under debate today, which I hope will be passed unanimously, actually says that there should be a judge-led inquiry so that all that evidence can be considered.

[Mims Davies (Eastleigh) (Con)]

rose—

[Sir Mike Penning]

I will give way to my hon. Friend and then I will make some progress.

[Mims Davies]

I thank my right hon. Friend for giving way. I must acknowledge my constituent, Charlotte, and her family, who are here on behalf of her brother, Stephen, who has been greatly affected by this drug. One of the biggest issues is the way in which the drug was handed out with absolutely no discussion of the risks.

Jackie lost her baby, Louisa, 19 years later—in 1977. At that time, the product had been on the market for two years with Government warnings, but still GPs did not point that out to patients. There is a lot of evidence here, so why is it not in the report?

[Sir Mike Penning]

I completely agree with my hon. Friend. One thing that has surprised me is that although, on average, every single MP will have a victim of Primodos in their constituency, many of the victims think that what happened was their fault and that they are on their own. In the fantastic documentary on Sky, people came forward to say, “I have been affected by this, but I thought that I was on my own. I thought that I was the only one.”

[Mr George Howarth (Knowsley) (Lab)]

rose—

[Sir Mike Penning]

Another point was that the inquiry should be conducted fairly and independently. Members should consider that for a few seconds and take a look at who was on the committee while I take an intervention from the right hon. Gentleman.

[Mr Howarth]

The right hon. Gentleman is making a very powerful case. Given that the inquiry/review has now been very much discredited—it has certainly been rejected by all of those who have suffered—does he agree, as I am sure he will, that the way forward is set out in his motion, which calls for a

“Statutory Inquiry under the Inquiries Act 2005 to review the evidence on a possible association with hormone pregnancy tests on pregnancies and to consider the regulatory failures of the Committee on Safety of Medicines.”?

[Sir Mike Penning]

I praise the Clerks who helped me to draft the motion. I was very angry when we started drafting it, after reading the report, but they helped me get it into some kind of parliamentary language.

An inquiry has to be independent and judge-led, and it has be able to subpoena people to give evidence before it on oath, so that we can get to the absolute truth. It also has to look at the regulatory system that was in place at the time. I am afraid that the Department of Health cannot hide behind this report. To me, that is vital.

Let us look again at the point about the inquiry being fair and independent. One of the ways we thought it could be independent and fair was to have an expert witness who was not part of the campaign, but whom everybody massively respected. For those of us who have been involved in the thalidomide campaign over the years, it was a really positive thing when we heard that Nick Dobrik’s name would be put forward.

Interestingly enough, although Nick was there as an expert witness, he was not asked to play a part in drawing up the conclusions in any shape or form. In fact, he was asked to leave the room. Nick was very surprised—actually, he was gobsmacked—when, in good faith, the Minister and then the Prime Minister said that Nick Dobrik had fully endorsed the conclusions of the report. I know now that the Minister and the Prime Minister know—I have met the Prime Minister, and Nick has done an interview with Sky today—that he categorically does not endorse the conclusions of the report. It was fundamentally wrong for anyone to advise the Prime Minister or the Minister that he did. He does not blame the Prime Minister; I do not think I blame the Prime Minister. As a former Minister—I know that there are former Ministers on the Opposition Benches—I know that we take advice from our officials and they tell us what the situation is. In good faith, the Minister at the urgent question, and the Prime Minister at Prime Minister’s questions, said that Nick endorsed the conclusions.

On behalf of Nick, who cannot defend himself in this Chamber, I would like whoever gave that advice to the Minister and the Prime Minister to formally apologise to Nick Dobrik. He is a fantastic campaigner not only for the Thalidomide Trust, but for all injustices, especially within the pharmaceutical area. The victims do not feel that the inquiry was fair and independent at all. They should have trust and confidence.

The most important thing is that the inquiry was asked to find a “possible” association—not “causal”, but “possible”. I and other members of the all-party group asked the experts from the panel why, after taking the word “inquiry” out, the remit was changed again, because “causal” is very difficult to prove. They said that they followed the science, but they were supposed to follow their remit and do what they were told. If they felt that they could not do that based on the evidence in front of them, fine. They could have gone back to the Minister and the victims and explained that. Instead, we had the farcical situation of the group looking for something when they knew full well—it is clearly in the documents—that they could not reach the conclusion that there was a causal link.

Interestingly enough, the group also could not come to the conclusion that there was not a causal link, because the evidence was not there for either conclusion. As I said during the exchanges on the urgent question, an injustice has taken place. Natural justice is the reason we are sent here. We defend our constituents when the system has come down against them and caused such horrific, horrible things to happen to them, so we need to address that injustice.

[Chris Elmore (Ogmore) (Lab)]

Will the right hon. Gentleman give way?

[Sir Mike Penning]

I will give way once more and then I will conclude to give other colleagues time to speak.

[Chris Elmore]

I am exceptionally grateful to the right hon. Gentleman. He says that everyone has constituents who have been affected. Two of my constituents have told me that they believe that they lost their children as a result of the drug. It is even more severe than losing a baby; one of them lost several children by taking the advice of their GP. This is a fundamental issue of trust—trusting the GP, trusting the NHS and trusting the inquiry. All those things have failed. Both my constituents told me over and over, “We no longer have any faith in the system.” They believe that the report is a whitewash, which is why I wholeheartedly agree that there should be a full and frank inquiry.

[Sir Mike Penning]

I thank the hon. Gentleman for his support for the victims.

As I said earlier, there is no constituency in this country that does not have someone who lost their baby due to stillbirth or dying shortly after birth, or whose life was transformed—for those who survived. However, many people were advised to have an abortion, and the figures on that are not available to us. Reports that the inquiry was not allowed to have are starting to come through.

I fully endorse the fact that we need some money so that we can ensure that we have modern reports, because the methodologies used back then would never be allowed today. We also need to see the missing reports. We need to find the stuff that has gone missing in Germany, where the drug company knew there were issues. We need to know why the drug company settled in America—it was using a slightly different name for the product, but it was the same company. What evidence was put before the legal system in America, where the company settled as fast as possible, and then gagged everybody and kept everything quiet?

We have a duty in this House to call things into question when they go wrong. These things started going wrong many years ago—before I was born. I have been a Minister, so I know that Ministers have to support their Department, but one role of a Minister is to question the advice that they get. I know that that is what the Prime Minister is going to do now, and I hope the House will support the victims so that they can have some confidence in the system and the NHS once again.

[Several hon. Members rose—]

--- Later in debate ---

[Peter Heaton-Jones]

I thank the hon. Lady for that clarification. Many of these studies have been into the historical evidence and the paperwork, which have been sifted through over and again—she is right to make that point—but there are still differences of opinion between what was said in the 1970s, in 2016 and in 2017, and that is the difficulty.

I have asked the House of Commons Library for quite a lot of background information, which I was going to try to get into, but in the six minutes allowed to me I cannot do too much. What I will say, however, is that, having read the latest report by the expert working group, it is clear that there is a concern, highlighted by my right hon. Friend the Member for Hemel Hempstead and others, about the contradiction between what it was asked to do and what it then actually found out. The question is whether there is a causal link or an association. We need to explore that: were the terms of reference of this expert working group followed in the way it carried out its investigation? On that, I absolutely agree: we need to look further into what exactly has been done here.

Further evidence from the expert working group is due to be published in the new year. That will be important.

[Sir Mike Penning]

It is not coming from the expert working group; it is coming from a professor. The expert working group rejected the evidence because it had not been peer-reviewed, but it will be in the next few days.

[Peter Heaton-Jones]

My point is that there is more information to come and I thank my right hon. Friend for that clarification on its source. It is really important that we keep looking for this information and that we gather everything we possibly can to help the people affected.

Many other right hon. and hon. Members wish to speak, so I shall not continue for too long. The Government and previous Administrations have consistently tried to look for answers and I know the Minister is sincere in seeking to do that. To support the Government and the people affected, I would like to work together to find a way forward to find the answers they seek. Let us get together and everyone be experts—the Department of Health, Members on both sides of the House and, crucially, the families—to try to get the answers.

I would like to end by referring back to my constituent Diane Surmon, because those affected must be at the centre of our work. In a further letter to me, she wrote:

“In my heart, I feel positive it was the drug Primodos which caused Helen’s injuries. After I took those tablets I was in and out of hospital. I carried a lot of fluid, which I have since been told is a sign of an abnormal foetus. I had had two normal pregnancies before Helen.”

She ends with these words, which I think are extraordinarily powerful:

“I feel very angry. I feel we were used as guinea pigs.”

For the sake of Diane Surmon and all the others whom we on both sides of the House represent, let us focus on the effect the drug has had on them and their families. Let us all work together. I know the Minister is sincere in wishing to do that. Let us all work together to find the answers they seek, while keeping them and their suffering at the centre of our work at all times.

--- Later in debate ---

[Sir Mike Penning]

I thank everybody for giving up their Thursday in their constituencies to be here. I have been praised extensively for securing the debate, but I would not have been able to do it without the all-party group—we had 57 signatures.

I have constituents whose lives were changed—blighted, completely wrecked—by Primodos, and we have heard of others on both sides of the House today. I heard the Minister say, “Nothing is ruled out. I am willing to listen.” I am really pleased, because he is going to have to listen an awful lot. If this report is still on his desk and being used as a way to go forward, I am afraid that that is an insult to the victims.

This document was described to me in a way that I cannot repeat in the House today, but a better way of describing it is that it was crap. It is fundamentally flawed and does not do what it said on the tin when the Minister asked for it to be done. The Department can talk and move on, and talk and move on, but there has to be an independent public inquiry. If that inquiry decides it needs further evidence, it needs the finance to get that, and it needs to suspend while we find further evidence—and there will be evidence coming forward in the next couple of days.

That is because the victims are the most important people in what we have been discussing today. If we forget that, we forget why we are here and why the NHS has the greatest reputation in the world. Schering is a great brand—we need its drugs—but its reputation has been damaged, and so has the national health—

Deafness and Hearing Loss

Mike Penning Excerpts

Thursday 30th November 2017 Westminster Hall

[Sir Mike Penning (Hemel Hempstead) (Con)]

It is a pleasure to serve under your chairmanship, Mr McCabe, and a pleasure to speak in a debate secured by my good friend the hon. Member for Poplar and Limehouse (Jim Fitzpatrick). We have been on many campaigns together over the years, not least in our previous careers.

I need to declare an interest at the outset. I have been honorary patron of the Hertfordshire Hearing Advisory Service—a fantastic charity that works not only in Hertfordshire but across many counties—for more than 10 years.

I disagree with hardly anything that has been said in this really positive debate. I think that people watching and others will realise that the House can work together not only for people who are hard of hearing, but for people who are hard of hearing and have other issues. We have not discussed the fact that people who are hard of hearing or deaf often have other ailments, which can be as difficult for them as being hard of hearing.

I can assure hon. Members from experience that Ministers usually do not like former Ministers to stand up and talk about things that they might know something about. For a short time, I was the disability Minister and responsible for Access to Work. Let me be positive about Access to Work and break some of the taboos about it. As we have heard, it is one of the great schemes for people across this great nation who had been left behind, ignored and told that they could not work. Employers told people that they could not employ them because it was not safe to do so. That was complete and utter rubbish. I do not have to take the hon. Gentleman’s word for it, because there is evidence in the Department for Work and Pensions that people with disabilities work harder, are more likely to turn up for work and are more dedicated and more committed than any other employees. That is a fact. We know that.

I went around the country as part of the disability confident scheme trying to encourage employers to take on people with all types of disabilities. That was pretty easy with bigger companies. There are some fantastic large companies out there—particularly Royal Mail. It gets biffed around a little at times in the House, but its commitment to people who either arrive with disabilities or acquire disabilities during their employment is fantastic. However, it is really hard with small and medium-sized enterprises. There is a myth that there is a risk: people say, “Health and safety prevents me.” I was the Minister with responsibility for health and safety, too, and I was happy to go around and dispel that myth. We have to work really hard with SMEs.

Access to Work was fantastic in helping thousands of people to get into work and have the confidence to stay. The cap was brought in just before I became the Minister responsible, and one of the first things I said was, “Where is the Department’s evidence that we need to do this and that the cap will work?” Let me put this on the record: there is evidence in the DWP, the Department knows exactly what it is, and it is continually reviewed. Ministers are taught always to say at the Dispatch Box, “The Government continue to keep under review” this, that or whatever. I assure hon. Members that the Department keeps that evidence under review.

It is a shame that my hon. Friend the Minister, who was my Parliamentary Private Secretary, is responsible for responding to this debate, but the DWP, which will see the record of this debate, knows whether the cap will work, is keeping it under review and needs to be open and honest about how it is working. If it is not working, it needs to be adjusted. As a former Minister, I will not have all that great work and all those people’s aspirations and commitment to work lost because of a cap that does not actually save a huge amount of money in real terms.

[Jim Fitzpatrick]

The right hon. Gentleman makes the same points that we have all made. Access to Work is a great scheme. It works. As I understand it, the logic for the cap is that there is only so much money in the pot—that is always the case for Governments—and therefore its purpose is to try to spread what is available as widely as possible. But for people with fantastic talent who could be advocates and champions for the deaf community by becoming chief executives and leaders of their professions and so on, the glass ceiling has been reinforced, because they can now get only £43,000. This is not a criticism—well, it is in some respects—but we need to ensure that the evidence is looked at regularly.

[Sir Mike Penning]

Governments need to be kicked and beaten up when they get things wrong and praised when they get things right. I was proud that a Conservative Government brought in Access to Work, which is massively important. There will always be examples of abuse in the system and so on, but that does not give the Government carte blanche to say, “No, the only way this can work is with a cap,” particularly if the evidence does not show that a cap will work. The Minister will have looked twice when he came into the Chamber and realised what this debate would mostly be about, which is not his responsibility but the DWP’s. I am more than happy to go across to my old Department and sit with my old officials and explain to them exactly where the evidence is in their cupboards.

Let me touch briefly on two other areas, and then on one thing that has not been touched on at all. I do not understand why, in the 21st century, a recognised language is not recognised in the House or across the country. I really do not understand why, all these years after I made a point of order in the main Chamber in 2005 to complain that a hearing loop was not available for my constituents when they were in the House—even when it was installed, it did not work properly—this is the first time a debate has been signed for our constituents. People will always go on about how that must cost more money. The cost is minimal compared with the benefit to our constituents of being part of the democratic process.

[Stephen Lloyd]

I thank the right hon. Gentleman for kicking off about the induction loop years ago, because I could not function as an MP in the Chamber without it.

[Sir Mike Penning]

The things I do for everybody in this House. It was genuinely embarrassing. I remember it vividly. I said to the Speaker, Michael Martin, “My constituents have come to see this world heritage site and their Parliament at work. I took them on a tour, and frankly they got hardly any benefit apart from visuals, because they couldn’t understand or hear a word I was saying.” I seem to remember that there was the comment, from a sedentary position, “Well, they didn’t miss very much,” but I was trying to get across a point. This is the mother of Parliaments, and as we have heard from colleagues, we are way behind the loop again. I am sorry to use that terrible pun, but we are really behind. I hope that we will have a lurch forward. I have noticed all the Clerks coming in, and have heard that the Speaker will be reported to, and all that, and that is great, but it is absolutely useless unless someone actually does something. Then we can move on. I know this is a trial, but signing should be transmitted live.

Secondly, there should be a GCSE. I find it fascinating: we can see all the different courses that our young people do in schools and colleges, yet they are excluded in this way. If people do not want any more GCSEs, we could drop one of the ones that would not get used anywhere near as much as this. It would make people aware. In my constituency, people who are not deaf or hard of hearing have said to me that they want to be able to communicate like this; they want to do these courses as well. They want to have a GCSE, so that they can chat away with their mates in that sort of way. That is a simple thing, and I cannot see huge cost implications, so it should be moved on, as we have heard this afternoon.

Finally, I will touch on people whose hearing has been impaired by industrial injuries. That has not been mentioned at all in the debate, but not because people think it should not be. It is just one of those issues. People cannot see this type of industrial injury. It is not like the industrial injuries that my hon. Friend the Member for Poplar and Limehouse and I saw in our former jobs as firemen. There is something very wrong about how we measure industrial injuries, and hearing impairment industrial injuries in particular. So many people who have a hearing impairment do not admit it to themselves, their wives and their loved ones, even though their wives and loved ones are probably aware that there is an issue. They certainly do not talk about it to their employer or previous employers.

I can talk about this, because my eardrum is perforated. I did not know about that until I started to miss conversations that I thought I should be picking up. You just do not think there is something wrong. However, when I was a Minister at the Ministry of Defence, I had to have a medical before I was allowed to go into operational fields, and it was obvious that I had a perforated eardrum. It was almost certainly from live firing when I was in the armed forces—the specialists told me that—although it was not picked up then. That is not so important to me, but where industrial injuries are common, it is massively important that there be a level playing field on decibel levels. Completely different levels are used for hearing damage in the armed forces and what I call civvy street, and that cannot be right.

We must encourage people to come forward, not so much so that they can get compensation, but because, as we heard earlier, if we can pick this up earlier, it saves the state and everyone a lot of money, and also makes life much better for that person, who can start to accept the disability that they have and continue to live a happy life.

[Ms Karen Buck in the Chair]

[Jim Fitzpatrick]

When I had the hearing test that identified my audiological loss, as the right hon. Gentleman will know, the printout showed whether it was down to age or genetics, or whether it was industrial. Mine was at least partly industrial. I was told by my clinicians, “Your hearing loss is above the threshold for applying for industrial injury compensation.” I never did, because I had a great job here, so I did not have to, and it was not a matter of money. I have always felt a bit difficult about saying, “Well, I should have gone down as a statistic.” I am sure that, as the right hon. Gentleman says, there are a lot of us out there who have not registered and do not appear in the statistics. The base statistics are only of the people who absolutely needed to make sure that they registered.

--- Later in debate ---

[Sir Mike Penning]

Thank you very much—not Mr McCabe, but Ms Buck; I did a quick double-take. My hon. Friend has hit the nail on the head. It is not just about the money. Getting people in, whether at pensionable age or when they leave an employer or the armed forces, is vital. When I left the armed forces, my hearing was not tested. It was supposed to have been tested, but it was not, and if anyone can find a record of it being tested then, I can take them on about that. I am not raising the issue of whether people are entitled to compensation—that is someone else’s decision—but they are not entitled to compensation unless we get them tested. If we can get them tested, the specialists will know, as my hon. Friend said, the cause of the deafness. There are myriad reasons, but industrial damage is pretty well defined.

I am thrilled that there are so many people here on a Thursday afternoon—the other Chamber probably has half, if not less than half, the amount of people we have here. Perhaps my hon. Friend and I might go back to the Backbench Business Committee to get a proper debate on the Floor of the House on some of the specifics we have discussed. If necessary, that should be on Access to Work, because that is a life-changer and has been for many people. We must not lose that life-changing ability.

Hormone Pregnancy Tests

Mike Penning Excerpts

Thursday 16th November 2017 Commons Chamber

[Steve Brine]

The hon. Gentleman referred to a “whitewash”. As I have said, this was a comprehensive, independent, scientific review of all available evidence by experts on a broad range of specialisms who, with respect, are far more qualified to consider the subject than either him or me. It was a rigorous, important and impartial review conducted over the best part of two years, and the experts were given access to all the available documents.

As for the families and issues relating to disclosure, yes, Mrs Lyon was on the panel. However, it is standard procedure for expert working groups to sign such an agreement, as all members of the panel did, in order to keep the process free from external influence and to prevent it from being constantly discussed in the media. The companies did meet the group and gave evidence to it. Having discussed the matter briefly with members of the Medicines and Healthcare Products Regulatory Agency this morning, I have to say that I think the families could have been treated a great deal better when they met the group. I thought that the layout of the room was intimidating. Not everyone is like a Minister or a Member of Parliament who can sit in front of a Select Committee and know how to handle it. I think that the process could have been handled better, and I made that very clear.

As for Ministers and meetings, my noble Friend Lord O'Shaughnessy, who ultimately has responsibility for the MHRA and whom I “shadow” in the House of Commons, has met the all-party group and the families group. He will meet them again on 6 December, now that the report has been published. The APPG is also meeting the chair of the expert working group.

The hon. Gentleman mentioned other research. He might have been referring to Dr Vargesson, an Aberdeen-based researcher who is, I believe, working on the components of Primodos in fish. He was invited to give evidence to the group, and he did so, but he did not want to leave his work and the evidence, which he said would shortly be published, with the expert working group. As far I am aware, that work has still not been published, but I know that the MHRA will be keen to look at any new work that is published.

[Sir Mike Penning (Hemel Hempstead) (Con)]

I know the Minister very well. He is a passionate and caring Minister, but I am afraid that I disagree with many of the things he said this morning. The families do—I think, rightly—feel that the report is a whitewash. Material has been removed from the draft, and the group looked into matters that were not within its remit. The question of a causal link was not in its remit. The question was whether there was link with a drug that was often given to our constituents with no prescription: a drawer would be opened, and it would be handed out to them so that they could find out whether they were pregnant. An open inquiry was needed, but I am afraid that the families, and many Members who are present today, will not feel that that was what happened. Will the Minister please meet the families again, with members of the all-party group, and try to understand why they are so upset? Will the Minister please also watch last night’s report on Sky News, which exposes much of what has being going on over many Parliaments? No matter who was in government, Governments have ignored these people, and we cannot continue to do so.

[Steve Brine]

My right hon. Friend and I do know each other very well, but I am afraid we will have to agree to differ on this; I do not agree that this is a whitewash. At the request of the Association for Children Damaged by Hormone Pregnancy Tests, an expert, Nick Dobrik, who the House and outside world will know well as a respected and well-known thalidomide campaigner, attended all meetings of the expert working group and was invited to give a statement to the Commission on Human Medicines. Mr Dobrik is many things, but the notion that he is some sort of Government yes-man who would have allowed a whitewash to go on does not stand up to much scrutiny, if any at all.