NHS (Government Spending)

Andrew Gwynne Excerpts

Wednesday 28th January 2015 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

I have the real-life experience of having worked for the NHS for 33 years, and I am not a doctor.

I have seen the NHS go through many changes, but I have never seen such industrial unrest and poor staff morale as have developed under this Government. This Government claim to have employed more doctors and more nurses, yet they are not talking about the cuts to other services and other staff, and the redundancies and the outsourcing of work to the private sector.

This Government like to claim that all is wonderful in today’s NHS, but those of us who work, or have worked, within it know that that is not the case. The NHS still operates to a large extent on the good will of the staff. This Government have been withholding a pay review body-recommended rise of just 1% to all NHS staff. Only now that an election is looming has the Secretary of State finally agreed to meet the trade unions, and now that meaningful negotiation appears to have finally commenced and the strike that was planned for tomorrow has been suspended the Government are claiming that as some kind of victory. There is no victory, and this Government need to remember that they have presided over a series of strikes and industrial unrest on their watch and only now that there is an election on the horizon do they see fit to address these issues.

I welcome this motion which proposes to invest £2.5 billion into our NHS. Staff have seen £3 billion being wasted on a costly reorganisation which nobody wanted, which was not necessary and which was in neither the Tory nor the Lib Dem manifestos. NHS departments such as the one I used to work in, pathology, have been making so-called efficiency savings for the last four and a half years, to the extent that if someone resigns from a post a business case has to be made for them to be replaced. In today’s NHS, decisions are being made not on clinical grounds, but on financial ones.

It is an absolute disgrace that this Government’s spending plans will return our public spending as a share of national income to levels last seen in the 1930s, before we had an NHS. The Tories assert that they will protect the NHS yet propose to cut spending on services to levels seen in countries where almost half the health service is privately funded.

The Government even deny that the NHS is being privatised on their watch, yet the evidence is of piecemeal privatisation of services. In my own area of the north-west, ambulance services have been privatised and are now run by Arriva transport, a bus company. This service is a source of constant complaints from my constituents, with patients being left to wait and being unable to get hospital for important medical tests. Medical staff tell me they struggle to get through Arriva’s complicated system of questions and answers—to which my hon. Friend the Member for Bishop Auckland (Helen Goodman), who is no longer present, has already referred—in order to secure patient transport.

[Andrew Gwynne (Denton and Reddish) (Lab)]

My hon. Friend is making a great case and is absolutely right about Arriva and its patient transport service in Manchester. Is she aware that many of the hospital trusts in Greater Manchester are now having to put in their own arrangements, which is costing the public purse even more, because of Arriva’s failure?

[Liz McInnes]

I thank my hon. Friend for his intervention, and yes I am aware of that shocking fact. This contract needs to be looked at as a matter of urgency. The private sector is not providing the service that was commissioned.

Medical staff have trouble getting the Arriva ambulance service to come out. If medical staff have difficulty getting through the question and answer system, imagine how patients must feel, and how they manage when they try to get patient transport from home to take them to hospital for urgent tests that need to be done in order to secure the treatment they need.

My constituents also complain to me about GP appointments. A lot of them are unable to get GP appointments within a week, and this is supported by the results of the GP patient survey. If this Government are allowed to carry on as they have been, more and more people will end up waiting a week or more to see a GP or even be unable to get to see one at all. Labour will guarantee a GP appointment within 48 hours, and on the same day for those who need it, funded by our time to care fund, as opposed to suggestions made from the Opposition Benches such as “People with chronic illnesses like diabetes and thyroid disorders should be charged for their drugs”, or “Patients should be issued with receipts for the costs of GP and A and E appointments.”

The NHS is not safe under this Government, and most NHS staff are aware of that. Only Labour can reverse the damage currently being done to our NHS.

National Health Service

Andrew Gwynne Excerpts

Wednesday 21st January 2015 Commons Chamber

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

I would like to tell the House what I think is an absolute disgrace. Not once during the speech made by the Secretary of State for Health, not once in any of the speeches made by Opposition Members and not once in Welsh questions earlier today did any Opposition Member raise the issue of what is happening in the national health service in Wales. Labour has been responsible for the health service in that part of the United Kingdom for the past 16 years, and Labour Members are running scared of making any mention of it or drawing any comparisons involving it. According to a House of Commons Library document—and they don’t come much more neutral than that—the NHS in Wales, run by Labour, is doing far worse than the NHS in England on almost every measure.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I do not know whether the hon. Gentleman was present for Welsh questions earlier; I certainly was. Perhaps he was asleep, because the shadow Secretary of State for Wales, my hon. Friend the Member for Pontypridd (Owen Smith), used three of his questions to the Secretary of State to ask specifically about the NHS in Wales.

--- Later in debate ---

[Dr Julian Huppert (Cambridge) (LD)]

It is a pleasure to follow the right hon. Member for Rother Valley (Kevin Barron). We have heard references to Nye Bevan and his amazing work in setting up the NHS. We should talk about Beveridge and his report, too. He was a good Liberal and he did that work during a coalition, albeit a somewhat different coalition that had come about for different reasons.

Let me start by looking at some issues that have arisen in my area of Cambridgeshire over the last month or so. There has been a number of winter challenges to be faced. Among them, I could talk about the ongoing problems with the ambulance service. The real problem that struck us was, I suspect, when the East Anglian ambulance service changed to the East of England ambulance service—and it has never recovered from that.

What has hit people most, I think, has been the problems at Addenbrooke’s hospital—a major incident took place, and a large number of operations had to be cancelled. I have spoken to the managers there and to many of the doctors and nurses. It seemed that there were two main reasons for the big problems. One was that Addenbrooke’s has been implementing the new e-hospital system—an exciting electronic records system that is the largest NHS IT project ever to be implemented. It is not as big as the one that was scrapped, but it was implemented. Although it will be a good thing when it is finally working, there have been many teething problems along the way and lessons that have to be learned. I suspect that other hospitals will want to learn from this: they should look carefully at the bad things, as well as the good things.

The other problem is the shortage of care wards, with delayed transfers of care. That has been a problem for a long time. Addenbrooke’s opened some new wards, but more are needed. I have been campaigning for some time to reopen some wards at Brookfields hospital, also in Cambridge, and I spoke about that in this place last year. I am delighted that, as of 9 February, these wards will be opened at Brookfields hospital. That is very encouraging. It is interesting to note that, in 2007, there were proposals to close down the entire hospital; I am delighted that we are opening up more wards instead.

We are trying to solve the problem for the long term through a new older people’s contract. This is the second-largest tender ever put out for the NHS, as it includes all the older people’s services in the county. I am delighted that the contract was won by the NHS—unlike the largest contract. The acute hospitals, the mental health services and the community work sector will all be working together to solve the problems we are having with things such as delayed transfers of care. That is the long-term fix for older people’s services in Cambridgeshire, and I hope it will be a model for other parts of the country to have a look at.

We have seen the news about Circle pulling out of the Hinchingbrooke hospital. This has been discussed in this place, and it is a shame that the shadow Secretary of State is not in his place, as it is always fascinating to hear him argue that he was in favour of the NHS bid led by Serco. I do not count Serco as part of the NHS, and I do not think that any Opposition Member would wish to do so.

[Andrew Gwynne]

Will the hon. Gentleman give way?

[Dr Huppert]

I will give way once on this issue.

[Andrew Gwynne]

I fear that the hon. Gentleman is, yet again, seeking to rewrite history. He will know that when my right hon. Friend the Member for Leigh (Andy Burnham) became Secretary of State, he changed the “any willing provider” policy to “NHS preferred provider”. That allowed Cambridge University Hospitals NHS Foundation Trust to become a partner of one of the three bidders. It was, of course, the Government whom the hon. Gentleman supports who signed the contract 18 months after the general election.

[Dr Huppert]

The hon. Gentleman ought to get his facts right. The Cambridge university trust put in a bid—it was the sixth last to do so—but then withdrew because the cost of the tendering process under the right hon. Member for Leigh was far too high. It did not have a partnership with Serco. The hon. Gentleman should check the facts and check the record. The trust was driven out by the tendering. The hon. Gentleman should also know that the bid to which I suspect he was referring was led by Serco. What he is saying, in essence, is that the current shadow Secretary of State had to undo the damage that had been done by previous Secretaries of State. That is a bit of Labour misery that I imagine Labour Members can sort out between them.

We know the history, and we know the problems that led to it: the Government had to decide between three private sector-led bids for Hinchingbrooke. What we must do now is work out what to do next, and I think we need to ensure that Hinchingbrooke stays in the public sector. Trying to remove it from the public sector in order to deal with the PFI problems, which was the original idea, simply has not worked. It must stay fully within the NHS.

Last year, before any of this happened, I led a debate about health in Cambridgeshire. I dealt with a number of issues, and I will not go into all the details now, but I spoke about health funding and, in particular, about mental health. I gave a number of detailed examples of some of the many challenges that we have faced and still face. For instance, huge cuts were made five or six years ago. During that debate, I called for a substantial amount of extra money, not just for Cambridgeshire—although I shall say something about that shortly—but for mental health throughout the country. Members in all parts of the House have made some excellent speeches about mental health, but it is not talked about enough. I find it regrettable that the motion does not mention it, and I suspect that a number of Members on both sides of the House do as well. Let us hope that we receive that extra money for mental health.

Cambridgeshire, however, suffers from a number of specific problems. We have been a test bed for experimentation for many years. We had the Hinchingbrooke experiment— the largest tender that the NHS has ever seen. We saw huge numbers of PFI projects not just at Hinchingbrooke, but at Peterborough. Paying off the NHS costs is still taking 18% of Peterborough hospital’s budget. That is only a small proportion of the 138 PFI projects that we saw under the last Government, the costs of which will amount to £11.7 billion over the next Parliament. That money could be used far more productively.

We have been hit hard by that, but we also receive very low funding. We inherited a formula from the last Government, and the process of changing it has been too slow under the present Government.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 13th January 2015 Commons Chamber

[Norman Lamb]

Call volumes doubled over the Christmas period compared with those a year ago, so the system was certainly under enormous pressure. As I say, the survey results show that a lot of people were diverted away from A and E, but there is absolutely a case for seeking to improve 111.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Secretary of State earlier complacently claimed that England has the best A and E service in the United Kingdom, but last week 86 hospital trusts in England operated below the Wales average. Suzanne Mason, professor of emergency medicine at the university of Sheffield, said that ambulance services in some parts of the country have been “brought to their knees” by 111. Does the Minister now think it was a mistake to scrap the nurse-led NHS Direct service? Will he urgently implement Labour’s proposal to get more nurses answering 111 calls, to relieve pressure on our chronically overstretched A and E departments?

[Norman Lamb]

I understand that about 22% of callers do get to speak to a clinician and, as I have already said, we are seeking to develop the service so that there are more referrals to an appropriate clinician. Let me again repeat the fact that the performances of A and E, ambulances and people waiting for hospital are considerably better in England than they are in Wales, and the Opposition need to recognise that.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 25th November 2014 Commons Chamber

[Mr Hunt]

I do agree with my hon. Friend. I took my own children to an A and E department at the weekend precisely because I did not want to wait until later on to take them to see a GP. We have to recognise that society is changing and people do not always know whether the care that they need is urgent or whether it is an emergency, and making GPs available at weekends will relieve a lot of pressure in A and E departments.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I am afraid it is yet more spin from the Government. Everybody knows that it is getting harder not easier to see a GP under this Health Secretary. He has as much as admitted today that emergency departments across England have failed to hit the Government’s A and E target for 70 consecutive weeks, and that is in part because people are struggling to get a GP appointment in the first place. Will he now get a grip on this problem, and call on his Chancellor of the Exchequer in next week’s autumn statement to use £1 billion from banking fines to help ease pressure on the NHS this winter, as the Labour party has pledged?

[Mr Hunt]

We will not take any lessons from the Labour party about general practice. It is not just the disastrous 2004 GP contract. The president of the Royal College of General Practitioners says that the shadow Health Secretary’s plans

“could destroy everything that is great and that our patients value about general practice and could lead to the demise of family doctoring as we know it.”

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 21st October 2014 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. Under this Government, with the new inspection regime, we have had to take the difficult decision to put 18 hospitals into special measures, including East Kent. Six have now come out of special measures. We are tackling these problems in the NHS by being honest about them. I gently say to the Labour party that if it wants to be the party of the NHS, it has to give the country confidence that it will be honest about poor care when it comes across it.

[Andrew Gwynne (Denton and Reddish) (Lab)]

On A and E, does the Secretary of State accept that we must do more to address the appalling statistic that one in four cancers is diagnosed in A and E departments? At the weekend, Labour outlined plans dramatically to reduce the wait for tests and results, paid for through a tobacco levy, which are supported by Macmillan, Cancer Research UK and the Royal College of Radiologists. Will he now back those plans?

[Mr Hunt]

I welcome the fact that Labour is thinking about how to improve our performance on cancer, because in 2010 we had the worst cancer survival rates in western Europe. I gently say to the Labour party that the issue is only partly about the amount of time it takes to get a hospital appointment when one has a referral; a much bigger issue is the fact that we are not spotting cancers early enough in the first place. That is why I hope that Labour will also welcome the fact that in this Parliament we are on track to treat nearly 1 million more people for cancer than we did in the previous Parliament. That is real progress of which the whole House can be proud.

Surrogacy

Andrew Gwynne Excerpts

Tuesday 14th October 2014 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I congratulate the hon. Member for Erewash (Jessica Lee) on choosing this interesting and important subject for a Westminster Hall debate. She put the case eloquently, sensitively and sensibly.

It is some decades since the main rules controlling surrogacy were put in place, and it is no exaggeration to say that they are a product of their time. Although there has been welcome progress on some aspects of surrogacy—for example, provision for adoption leave and pay for intended surrogate parents was included in the Children and Families Act 2014—a more fundamental examination of our position on surrogacy is needed, so the debate is extremely timely.

Of course, it is important to say at the outset that the health and well-being of any children born as a result of surrogacy arrangements must be at the heart of our concerns. As the hon. Member for Stevenage (Stephen McPartland) rightly said, that must sit firmly alongside the need to prevent exploitation of any of those involved in surrogacy, but the welfare of children must be paramount.

Aspects of the current situation can certainly be described as troubling. The growth of the internet continues to accelerate, and it takes only a few keystrokes to bring up a search engine web page with paid advertising for commercial surrogacy services abroad. The revelation that Britain may account for as many as 1,000 surrogate births in India every year is shocking enough, but when it is contrasted with the low numbers known to be taking place in Britain, it is clear that the situation requires serious review. There is a clear need for further research to establish the size of the international trade in surrogacy and to enable the development of a deeper understanding of how it functions.

It is not just the hon. Member for Watford (Richard Harrington) and my hon. Friend the Member for Bolton West (Julie Hilling) who have experienced tricky constituency casework on this issue. Earlier this year, she and I had almost identical cases, which we discussed. The legal issues got very tricky, and that was compounded by the passport fiasco. Thankfully, my case, like hers, has been satisfactorily resolved for the parents and the child. However, the cases were tricky, which highlights just how difficult some of these surrogacy arrangements can be. While that can be compounded by factors outside the control of those involved, the arrangements in India were incredibly tricky and caused the parents a lot of heartache and trauma, as well as a lot of unex—I am trying to think of the word. I have lost my train of thought.

[Sir Edward Leigh (in the Chair)]

Unexpected.

[Andrew Gwynne]

Thank you, Sir Edward—unexpected expense. That placed the family in severe difficulties while they were in India.

Although our legislative framework might restrict exploitation in connection with surrogacy in the UK, it might simply be shipping exploitation abroad, where there are undoubted commercial opportunities to make large amounts from the exploitation of poor women. In the past few days the case has been reported of an Australian couple who are said to have abandoned one of two surrogate twin babies born in India, taking only one of them back with them. That amply demonstrates the need for international action. I hope that today’s debate will highlight the need for consideration of an international convention on surrogacy, so that we can put an end to such unethical and immoral practices.

The international dimension is important, but inevitably the question arises of how we might alter the situation in the UK to enable aspiring parents to explore the option of surrogacy in a way that protects all parties and puts children’s interests first. I suggest that we consider three things. The first is an assessment of the scale of the need for surrogacy and whether we can reduce that need through action to reduce the incidence of infertility in women. The second is an assessment of the extent of the international trade in surrogacy; on international health questions, we are much more effective if we operate in concert with other countries. The World Health Organisation appears to take little interest at present in surrogate motherhood issues, and perhaps the United Kingdom, as a member of its executive board, should take a lead in raising the issue and ensuring that it is included in the WHO programme of work. I should be interested to hear how the Minister can take that matter forward. The third thing to consider is a review of UK legislation on surrogate motherhood. Difficult issues will inevitably need to be considered, particularly the potential involvement of commercial interests in arranging surrogacy. The hon. Member for Erewash set out a possible framework, and that should be considered carefully. I am interested to hear the Minister’s response to the important points she made.

The current position is clearly unsatisfactory and in need of attention. If the population is to continue to make use of surrogate motherhood to deal with the problem of infertility, it would surely be better for the processes to take place within an ordered, regulated system here, than in a system that is not ordered, halfway round the world. It would be better for the parents, the surrogate mother and the child. The comments and suggestions made by the hon. Member for Erewash were compelling. She is right to raise the question of how to strengthen our domestic law to protect all concerned. This is a sensitive area that needs to be considered carefully, but there is a need for change at home as well as internationally, and I look to the Minister to give direction, answer questions and consider the possible solutions that Members have suggested. Thank you, Sir Edward, for filling the gaps that were left in my speech when, sadly, my train of thought left my brain.

Community Hospitals

Andrew Gwynne Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is, as ever, a pleasure to serve under your chairmanship, Mr Owen. I congratulate the hon. Member for Dover (Charlie Elphicke) on the eloquent case that he made in opening the debate, and I warmly welcome the Minister, for whom I have a great deal of respect. He will be a huge asset to the Government.

Now that the hon. Member for Strangford (Jim Shannon) has been deserted by the hon. Member for Upper Bann (David Simpson), we are on an equal footing. I assure him that he can aspire to be the second party, because I hope very much that in eight months’ time my party will be back in its rightful place as the main one in the House. However, I am sure that that view will not garner full support in the Chamber today.

As many Members have testified, community hospitals play an important role in the communities they serve. They provide rehabilitation and follow-up care, and they can help to move care, diagnostics and minor injury and out-patient services, among others, from acute hospitals back to the community. They provide planned and unplanned acute care and diagnostic services for patients closer to home, and contribute to the local community by providing employment opportunities and support for community-based groups. It is fairly clear that people prefer the more common medical treatments, whether palliative care, minor injury services or maternity care, to be brought nearer to their homes. Those are exactly the services that community hospitals can help to deliver, as we have heard in the debate.

Community hospitals usually have good relationships with their local communities, and many of the speeches this morning attest to that. They are often supported by local fundraising and, indeed, many were opened prior to the creation of the NHS, by public subscription, as the hon. Member for Congleton (Fiona Bruce) outlined.

We have heard from a number of right hon. and hon. Members today about the great work being done by friends groups. The right hon. Member for North West Hampshire (Sir George Young) and the hon. Members for Stroud (Neil Carmichael) and for Totnes (Dr Wollaston) mentioned those in their areas. I pay tribute to those groups and to the staff and volunteers who work to make things happen in those hospitals. Staff in community hospitals can also build personal relationships with patients and carers as they deliver continuous care from outside the hospital environment, as the hon. Member for Strangford, among others, pointed out. That is an important point that should not be overlooked.

Community hospitals continue to play an important part in health care provision. Their role is valued, and we are right to support it. For the record, Labour continues to be committed to community hospitals when they represent the best solutions for local communities. My constituency is urban and it is served by several large district general hospitals, with not one community hospital, but I acknowledge that other parts of the country have a very different geographical make-up, and that community hospitals are the right way forward for the provision of health care in those communities.

However, the NHS Healthier Together consultation is under way in my area; that is a proposed radical upheaval of hospital care, with fewer and larger specialist hospitals, which will leave some of the smaller district general hospitals to become, effectively, large urban cottage hospitals. It remains to be seen whether that approach will work, but it is at least an option that keeps some hospital care in the community in urban areas. Often full-scale hospital reorganisations do not do that, so perhaps what is happening is a new venture.

Community hospitals can provide a vital step between social care and acute care, and Labour would seek to develop that further. The case made by the right hon. Member for North Somerset (Dr Fox) about, particularly, the invaluable role that community hospitals could play in providing extra respite care beds, is one we should take seriously, especially given the new obligations under the Care Act 2014.

Perhaps community hospitals could move into that role more, along with the provision of more GP and dentistry services. There could be much more provision from within the existing bricks and mortar—services could be nearer to where people live, and there could also be support provision, which is particularly relevant for community hospitals that may at present be only marginally viable. That possibility should be explored.

Some concerns remain, however, and I hope that the Minister will be able to offer the House some reassurance today. He will, I hope, be aware of our ongoing concerns about the Government’s structural reforms. I know that the hon. Member for Stroud has come to a different conclusion, but I think that evidence is mounting that some of the reforms have made the co-ordination and delivery of integrated services far more difficult. I suspect the Government now agree with that view, and that they are permitting the emerging integrated care organisations to be exempted from parts of the regulations on competition under section 75 of the Health and Social Care Act 2012 for precisely that reason. We believe totally that the future requires the integration of care and health services. Yet I fear that some of the Government’s policies are driving us more towards fragmentation. Let us not be in any doubt: community hospitals have a vital role to play. However, as we have discussed, the approach may not be the right one everywhere.

The Labour party remains committed to community hospitals. The last Labour Government introduced a fund specifically to help them, and I suspect that the Vale community hospital in the constituency of the hon. Member for Stroud, which opened in 2011, was paid for partly from that fund. The fund was not automatically taken up by primary care trusts throughout the country and in some areas there was a different view of the role of community hospitals, but where it was taken up, it has clearly made a huge difference to those communities.

I looked at the Care Quality Commission’s website, and the Vale community hospital has an outstanding reputation. The Labour party made a commitment to community hospitals where they are the right choice for the local community, and that commitment continues. I hope that the hon. Member for Maldon (Mr Whittingdale) secures a future for his community hospital because it sounds as though it is really needed in his community.

We are just over a year into the changes introduced by the Health and Social Care Act 2012. I hope that the Minister will take stock of some of those changes and some of the service reconfigurations that are now being proposed in different parts of the country, and reassure us that community hospitals are not being unfairly penalised in the new internal market.

Responsibility for commissioning health care services has moved into the hands of clinical commissioning groups from the former primary care trusts, and there was a worry during deliberation of the Bill that the role of community hospitals might be overlooked. Has the Department assessed whether those fears have come to anything anywhere in the country? The hon. Member for Totnes hit the nail on the head when she referred to the complexity of tendering rounds for funding at the expense of local services. I would be interested to hear the Minister’s view on that.

One obvious consequence of the 2012 Act has been the introduction and rapid expansion of “any qualified provider”, which made it easier for commissioning groups—indeed, it often became necessary—to look outside the NHS to the private sector to provide even more services than ever before.

I am still worried that when trusts are faced with the financial pressures that we have heard about, which arise for a variety of reasons, they often look at the need to remodel clinical services and centralisation, as the hon. Member for Dover said. That takes services away from the community and sometimes from district general hospitals. Sometimes there are sound clinical and financial arguments for that, but it is often financially driven. That will almost certainly have an effect on any extension to the provision of those services in community hospitals.

The concept of whole-person care necessitates patient-centred care closer to where people live, and there may be a huge opportunity for cottage hospitals and other smaller localised health facilities to adapt and to fit comfortably into this model. Clinical commissioning groups and integrated care organisations should look seriously at the possibilities that such facilities provide for the future delivery of joined-up health and social care in a community setting.

The hon. Member for Dover and other hon. Members, including the hon. Member for Totnes, raised the prospect of community hospitals becoming social enterprises. To me, as a member of the Co-operative party, that is an interesting concept. However, in response to an intervention, the hon. Gentleman referred to the NHS “leviathan”. There are pressures on centralisation, as we have heard, but I am worried that under the 2012 Act cottage hospitals will also have to compete with the leviathan of large corporate private providers. I am worried that “any qualified provider” means that private sector organisations will cherry-pick services and leave cottage hospitals vulnerable to the pressures of centralisation and of losing key local services; such organisations are often better at going through the bidding process, as the hon. Member for Totnes said.

This Government and the next should do all they can to ensure that patients can make real choices about receiving the health care they need close to their homes. We must make the vision of whole-person care a reality. Community hospitals are valued and must have a real role in developing and delivering a more integrated and people-centred health care system. I hope that we all support that, and I look forward to the Minister’s reply.

[Albert Owen (in the Chair)]

Before calling the Minister, I add my congratulations to him and welcome him to his new position.

Hospital Car Parking Charges

Andrew Gwynne Excerpts

Monday 1st September 2014 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to follow the hon. Member for Hexham (Guy Opperman). I also thank the hon. Member for Thurrock (Jackie Doyle-Price) for opening the debate in a very thorough and meaningful way. There has been a large degree of consensus across the Chamber on this important issue.

The Opposition welcome any move that could help to ease the financial burden on those suffering from illness. As said, when people go to hospital, the last thing they want to worry about is keeping the car parking ticket up to date. For some patients and their families, the costs can really rack up, and we have seen big increases in charges in recent years, adding to the cost of living crisis facing people up and down the country. In the past four years, more than a quarter of hospital trusts have increased their charges, some of them substantially, as we have heard today, and it cannot be right either if some people do not get visitors because they cannot afford the parking fees. We know that having friends and families around helps patients to get better quicker, which can save the public purse—the NHS—money down the line, as several hon. Members have pointed out.

As we have also heard, the problem extends to staff, too. In my role as a shadow Minister, I get to visit hospitals around the country. A nurse working in Liverpool told me fairly recently how unfair it was that she had to pay for parking, even when her shift ended past 10 pm. She said she often felt vulnerable when using public transport at night, yet she had to pay extra for the privilege of using her own method of transport. Even when public transport is still running, it is not unreasonable to expect better treatment when working late hours.

It is right that we debate this issue today, and I pay tribute to the Members who secured this debate and to the Backbench Business Committee for finding the time to have it in the main Chamber. I also pay tribute to Members on both sides of the House, particularly the hon. Member for Harlow (Robert Halfon), who has pushed this subject on to the Minister’s desk. Despite the consensual nature of Backbench Business Committee debates, it would be wrong of me not to point out that this issue was on Ministers’ desks back in May 2010, when the previous Labour Government left fully costed plans to phase out charges for in-patients—to be fair, the hon. Member for Peterborough (Mr Jackson) mentioned that. Our plans would have seen patients given a permit to cover the length of their stay that visitors could also use to park for free.

The hon. Gentleman also touched on the important issue of information. I do not wish to enter into a game of hospital top trumps with the hon. Member for Hexham, but in 2010 I also spent an awful lot of time in my local hospital through illness. Three weeks into an eight-week stay—my first of two long stays in hospital—my wife was told that she could apply for a parking permit. It was not advertised; somebody mentioned it in passing when she was visiting me in the high-dependency unit. Frankly, that is not on. If there are permit schemes, it should be advertised to all patients and their visitors.

We were also consulting on extending free parking to out-patients, and I want briefly to pay tribute to Macmillan Cancer Support for its campaign on this, but for whatever reasons, Health Ministers shelved our plans soon after the election. At the time, they said there were better uses of public money. I am pleased that there has been an apparent change of heart. Members can imagine my delight in the summer recess when, reading the news, I learned that Ministers had changed their minds. “Victory over parking cowboys” and “End of the hospital parking rip off”, the headlines read. I think we know it is probably not quite as simple as that. Perhaps the Minister will admit that, despite their good intentions, the Government have no power to force hospitals to follow these laudable principles and that trusts are under no such obligation. Is it not the case that all the Secretary of State has done is effectively to amend existing guidelines to suggest that some people should not have to pay to park?

One of the few changes to the guidelines is the addition of pay-on-exit schemes, which is something that we have discussed tonight and which I fully support. As we have heard, appointments often take longer than planned. However, these schemes come with their own additional costs, which was why I was interested in the suggestion from the hon. Member for Harlow of a special fund. Is the Department of Health considering that and will it be contributing towards the purchase and installation of the new equipment and software, not to mention the lost revenue from people paying less across the board?

More broadly, will the Minister confirm that there is no new money attached to the implementation of any of these guidelines? When money is tight, is there not a huge danger that some trusts will be left with the choice of either implementing the principles, which we all support, or threatening to cut back on services? That point started to come out in the arguments put by Members. Indeed, that is exactly what one hospital has already warned about. A governor at Dorset county hospital said:

“When the government makes announcements like this, it has an effect right the way along the line. The money has to come from somewhere.”

That was why I was interested in the special fund idea suggested by the hon. Member for Harlow. It needs proper consideration by the Treasury and the Government.

Is there anything to prevent trusts from no longer offering parking as part of their hospital provision and selling off any car parks they might have developed—particularly multi-storey car parks—with capital costs to a private operator? If we are not careful, that could be one of these unforeseen consequences. Forgive my scepticism, Mr Deputy Speaker, but the problem is that the Government are trying to use the carrot-and-stick approach without either a carrot or a stick. It reminds me of when a public health Minister told a crowd that the Health and Social Care Act 2012 had pretty much given away the Government’s control of the NHS. That is the real reason why I fear those headlines possibly will not match the reality, because the Government have given away so much day-to-day control that I fear they are powerless to do anything about ever-increasing car parking charges, particularly if no funding follows that. The former Health Secretary would be more than entitled to ask the current Health Secretary, “Whatever happened to operational independence?” The guidelines are not mandatory on hospitals, so what confidence can we have that trusts will pay even a blind bit of notice to the new regulations?

Members are right to raise this issue and to push the Government further on it. The aims are laudable, and anything that helps people with the squeeze on living standards, especially at a time of need, when somebody is in hospital, has to be welcome. The challenge for the Government now is actually making it happen.

Mitochondrial Replacement (Public Safety)

Andrew Gwynne Excerpts

Monday 1st September 2014 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

May I first place on the record my thanks to the hon. Member for Congleton (Fiona Bruce) and the other sponsors of this debate for securing the time from the Backbench Business Committee to ensure that the House can discuss such an important issue? I also hope that my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) will get well soon: she should have been closing this debate on behalf of the Opposition, but unfortunately she is not well today. Some people have greatness thrust upon them and I have had to do two Back-Bench business debates this afternoon.

I also thank all hon. and right hon. Members for their contributions throughout the 90 minutes that we have had to discuss this very important issue. We have had no fewer than 19 Back-Bench contributions, which have all been of incredible quality. The impassioned and thoughtful considerations we have heard are a testament to what a sensitive and complex matter this is. As my hon. Friend the Member for Stoke-on-Trent South (Robert Flello) said, it is important that we have this debate, wherever one comes from and wherever one arrives at, and that the House of Commons discusses these issues.

On the one hand, we have celebrated the triumph of science that these new techniques represent. As my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah), the hon. Member for Hexham (Guy Opperman) and the right hon. Member for Havant (Mr Willetts) have said, it is thanks to years of pioneering research at the university of Newcastle into how we can prevent the transmission of genetic mutations that we are finally reaching the point at which we can consider using these transformative techniques in humans. We have within our reach the possibility of eradicating mitochondrial disease from families who have been blighted by it for generations—families who have endured a disease for which there is no cure, who have suffered daily battles with painfully debilitating symptoms and who have lost their children prematurely.

[Glyn Davies (Montgomeryshire) (Con)]

Does the hon. Gentleman accept that those of us who remain uncertain about the proposals share the exact same concern as those who support them about those who suffer from mitochondrial disease? That should never be forgotten: the concern of those of us who are uncertain about the proposals is every bit as great.

[Andrew Gwynne]

I absolutely agree. I have to say that I do not often agree with the hon. Member for Cambridge (Dr Huppert), but he made the very important point—one of many in his speech—that whether people are coming from a scientific perspective or a religious one, their views are equally important in this debate. I am very glad that both sides of this debate have been able to air their views.

Of course, families have had to face up to the risk—perhaps the certainty—that to be a parent will come at the expense of a difficult and, in too many cases, painful life for their children. On the other hand, we have grappled with the undoubted ethical and moral questions raised by the proposed introduction of such techniques. Some hon. Members have shared their anxiety about the uncharted territory we are now in, but that has been good for the public debate. Indeed, the proposed regulations would make Britain the first country to legalise mitochondrial transfer, and scientists have acknowledged that there will always have to be a leap of faith when the technique is first used.

It is important that all these arguments are debated at length and given full and proper consideration, but it is also critical for the integrity of the eventual decision that the debate should be based on the facts. When debating such matters, we will naturally hear a number of contradictory assertions. I hope that the Minister can reassure the House about some of those issues we have discussed.

The first concern raised is that the process has been rushed through. Anybody involved in the development of the techniques would disagree that this has moved quickly. Indeed, my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) pointed out that the consultation on the process began in 2003. It was more than six years ago—back in 2008—that the Human Fertilisation and Embryology Act 1990 was amended to introduce powers to allow regulations to be brought forward to enable mitochondria replacement to take place. It was back in 2010 that researchers at the university of Newcastle developed the techniques to avoid diseased mitochondria being passed from a mother to her children, and it was not until after another three years of consultation and review processes that the Government announced in July that they would introduce regulations to enable mitochondrial donation techniques to be used. As we have heard, expert scientific review panels in April 2011, March 2013 and June 2014 found no evidence to suggest that the techniques are unsafe for clinical use.

If Parliament passes the regulations, specialist clinicians will have to obtain a licence from the HFEA to use the techniques. A licence will be granted only once the HFEA, operating case by case, is satisfied that any risk of using the techniques is low. I hope that the Minister will provide the House with more detail on the robust process that has been followed for us to reach this point. I ask her to set out the further safeguards built into the regulations to guarantee that the decision to use these techniques cannot be taken lightly.

We have heard concerns that allowing mitochondrial donation is a dangerous road to start down, and might lead to designer babies and parents being able to select the physical characteristics of their children, which I would find absolutely abhorrent. However, we have also heard that those fears do not take into account that the regulations are very specific and cover only mitochondrial DNA, not the nuclear DNA that determines our physical characteristics, as was so eloquently outlined by the right hon. Member for Havant. We are talking about the use of these techniques only in the clearly defined situation of incurable mitochondrial disorders.

The fact that the techniques apply only to the mitochondrial DNA and not to nuclear DNA should provide further reassurance to hon. Members who are concerned that the process will result in three-parent babies, as my right hon. Friend the Member for Holborn and St Pancras said. As we have heard, mitochondrial DNA controls only mitochondrial function and energy production; it is important to point out, as many hon. Members have done, that nuclear DNA, which makes us who we are and determines appearance and personality, is not altered by the proposed techniques. The Nuffield Council on Bioethics conducted an ethical review, which concluded that by “societal norms”, mitochondrial DNA

“does not confer genetic identity.”

Again, it would be helpful if the Minister put it on the record that children who are born from mitochondrial donation will have two biological parents and one mitochondria donor.

Finally, I come to the issue of safety. There have been questions about the safety of the techniques. Again, we must be sure that we base our arguments on facts. Comparisons have been made with the cytoplasmic transfer techniques that were used by a private fertility clinic in the United States in 2002 and the current investigation into the health of the children born from that process. However, this is a fundamentally different technique, as the hon. Member for Mole Valley (Sir Paul Beresford) suggested.

There are other safety concerns that apply directly to mitochondrial donation techniques, and those must be examined in detail. As we have heard, the technique has received unprecedented scrutiny by the HFEA’s specially convened expert scientific review panel. The question for us is whether the benefits of preventing the transmission of mitochondrial disease and the likelihood that children will continue to be born who will die in infancy outweigh the risks of the techniques. The scientific community and the families experiencing mitochondrial disease say that they do. It is now up to Parliament to decide whether it agrees.

We are approaching the final stage in what has been a long and considered process, and we cannot delay it any further. Time is precious for the parents who are at risk of passing on mitochondrial inherited disease to their children. The research has been done, the reviews have been carried out, and the experts and the public have been consulted. The arguments have been made and the families are waiting. It is time for us to make a decision.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Hunt]

The hon. Lady is absolutely right. The figure always in my mind is that by the end of the next Parliament we will have more than 1 million additional over-70s. We need to totally change the way we look after those people, through the single point of contact and a different attitude to continuity of care. One of the things that matters most to those people is the feeling that there is someone in the NHS who knows about their particular needs, their family and their carers. That is the big challenge for the NHS in the next few years.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Health Secretary does not seem to realise that continuity of care is actually getting worse under him. The GP patient survey shows that the proportion of people who cannot regularly see their preferred GP has risen from 34% in 2012 to 39% in 2014, an increase equivalent to 1.2 million people. Experts say that that is one of the reasons why A and E is under so much pressure. Will he confirm that on Friday it will be precisely one year since hospital A and E departments last met his Government’s own A and E target?

[Mr Hunt]

What I will confirm is that the worst possible thing for continuity of care was Labour’s scrapping of named GPs in 2004. The single thing that makes the biggest difference is to have, for every frail and elderly person in our NHS, someone who is responsible. That is what we are bringing back.