Health Inequalities

Anna Soubry Excerpts

Tuesday 23rd April 2013 Westminster Hall

[Stephen Barclay]

The last Labour Government took more than 10 years to introduce even basic known measures such as smoking cessation programmes in deprived communities, although the science and evidence base was clear. Will the Minister assure the House that the Government will not say one thing and do another on health inequalities, but will follow the science?

[Anna Soubry]

I can say that absolutely. The hon. Member for Ealing, Southall asked whether the Government are committed to reducing health inequalities and making the sort of progress that we did not see in 13 years of the previous Government. I assure him that it is not just a question of blind intention, but an absolute fact that we have already done it.

[Interruption.] I am making a noise because I am removing the script of my speech. I am not good at following a script from my officials. They are extremely helpful, and it sometimes causes them concern that I go off script and speak off the cuff.

I am familiar with the Health and Social Care Act 2012. What the hon. Gentleman either does not know—this is not a criticism—or may have forgotten is that, for the first time ever, there is a statutory duty, not just on the Secretary of State, but throughout the NHS, to improve health inequalities. It is not a question of targets, which have not always delivered the right outcomes, and Mid-Staffordshire NHS Foundation Trust is a good example, as was identified in the Francis report. That duty is statutory so the Secretary of State and all those involved in the NHS must deliver, and the Secretary of State must give an annual account of how his work in leading the Department of Health and being the steward of the NHS in England has delivered a reduction in the sort of health inequalities that we all understand. That is there in law, but in 13 years in government, the hon. Gentleman’s party failed to do that.

[Mr Sharma]

I am not disputing the matter and, as I said at the beginning of my speech, I do not want a blame culture or to say what happened during those 13 years, but I ask the Minister to join me in my constituency on Saturday when thousands of people will march from Southall to Ealing. At the last march in September, there were more than 20,000 people, and we expect more this time. She will then know whether people believe that services have improved or got worse.

[Anna Soubry]

I am grateful to the hon. Gentleman but, with great respect, he does not understand that reducing health inequalities is not simply about saving an A and E department. I hope that, when the hon. Gentleman is marching on Saturday, he will remonstrate with anyone who has a banner saying “Fight the NHS cuts”. Whenever anyone looks at reconfiguration, they do so on the basis of how to make the service better.

[Stephen Barclay]

I am sure that the Minister is aware that, on reconfiguration, bodies such as the Royal College of Surgeons support specialised centres, because they save lives. The evidence from stroke services in London is that reconfiguration is saving around 500 lives a year.

May I draw the Minister’s attention to the fact that, at the end of the last Labour Administration, only 4% of the NHS budget was being spent on prevention? It is all very well for the hon. Gentleman to join marches, but prevention is far more helpful from a value-for-money perspective than treating things when they go wrong.

[Anna Soubry]

I am very grateful for that intervention. My hon. Friend makes the point more ably than I can that much of the great work to reduce health inequalities is not about whether there is an urgent care centre or an accident and emergency centre within 500 yards or 5 miles of where someone lives. Work on public health is critical, and that is why I am so proud that this Government have increased the amount of money available to local authorities, which now have responsibility for delivering public health. They had that historically and we have returned that power to local level. That is important in the delivery of improvements in public health. This Government’s view is that local authorities, as in the hon. Gentleman’s constituency, know their communities better than Whitehall does. In the delivery of key and important work on public health, it is right and proper that local authorities have that responsibility. They, too, have a statutory duty to deliver on health inequalities. That runs through all their work of looking after the public’s health, but, most importantly, addresses those very factors that cause the sort health inequalities of which we are all conscious. For example, there is a clear demographic link between smoking and diabetes.

If the hon. Gentleman goes to Leicester, he will see the work that is being done there and in Leicestershire with the clinical commissioning groups—the GPs are now doing the commissioning—working for the first time with the local hospital and looking at a whole new way of delivering a better pathway not just of care, but of early diagnosis and prevention, linking those up in a way that has never been done before in the NHS. If he sees those examples, far from criticising the Government or having doubt about our commitment to health inequalities, he will take the opposite view.

If the hon. Gentleman needed yet further proof of the great work that can be done under the new way of delivering public health and commissioning in the NHS, he could do no better than take a trip to Rotherham in Yorkshire. I went there to see its fantastic work in tackling obesity. Obesity is a clear issue of health inequality and Rotherham has taken a totally joined-up approach. GPs are working with dieticians, schools and planners, with the local authority at the heart. They are all coming together to deliver a considerably better strategy, with real results in tackling the problems in that area.

On funding, it is important for the hon. Gentleman to understand that we have increased the amount of money that is available. It is now ring-fenced, on a two- year deal, so that real security and certainty is given to those local authorities. In some areas, we have increased up to 10% the money that is available to spend on public health.

[Rehman Chishti]

I completely share the Minister’s opinion about an approach where local authorities know what is in their best interests—for example, in relation to obesity in Medway, which has one of the highest recordings above the national average for obesity. However, I want to raise another point with the Minister. On diabetes and organ transplants, certain parts of the community—or certain parts of minority communities—are more likely to be affected. Will there be a national strategy that covers and supplements what is going on locally, because these are national issues that affect minority communities throughout the country?

[Anna Soubry]

I am grateful to my hon. Friend for making that point. The subject of diabetes—type 2 in particular—and the clear link to obesity and being overweight is something about which I am beginning to have a passion, because I can see the great work that can be done. We have just done a cardiovascular strategy. It is a call for action about mortality, and we know that cardiovascular disease work sits within that, and that cardiovascular work—I am getting very worried, Dr McCrea, because I am beginning to sound almost as though I am a health professional, when I am nothing more than a simple hack criminal barrister, rather like my hon. Friend.

The point, however, is that we know that if we look at diabetes, many other boxes are ticked in improving the lot and the health of our population. Certain parts of our population, in particular, have suffered from health inequalities, and my hon. Friend makes a very good point about some of our communities—in the Asian community, there is a great prevalence of type 2 diabetes, as there is in the Afro-Caribbean population. If we look at diabetes prevention, earlier treatment and diagnosis, and then proper treatment and good outcomes, other boxes are ticked—for example, obesity and being overweight, and all the other things that often flow from diabetes, such as the link with cardiovascular disease and so on. My hon. Friend makes a very good point about how a local authority beginning really to drill in and target a particular illness or disease can have many beneficial spin-offs in the manner that I have described.

The Government have established a comprehensive measurement system designed to measure not only overall improvement, but, in particular, inequalities. The NHS outcomes framework—I know that these words do not trip off the tongue and that they may be lost on the majority of completely normal people, but they are important documents—forms the basis for measuring progress on delivering improved results for patients and reducing health inequalities. The NHS England business plan commits to assessing health inequalities across a range of dimensions in the NHS outcomes framework, and those important documents guide our clinicians, the commissioners, and everybody involved in ensuring that we live longer, healthier, and happier lives. That exercise may reveal important health inequalities that have not previously been evident. The public health outcomes framework includes an overarching aim to reduce differences in life expectancy and healthy life expectancy between communities, through greater improvements in more disadvantaged communities. Public Health England will regularly publish data for the indicators, including breakdowns by key equality and inequality characteristics to enable monitoring to help focus action where it is needed.

I am looking forward to the time when we begin to publish, by local authority, the outcomes in each local authority on such things as the stopping of smoking, and the work that is done on the abuse of alcohol. Invariably, we gather that information, but when we start to publish it and put it in the public domain, Members of Parliament, local councillors and members of the public will all have access to it, and they will be able to see how their local authority is performing. We will not try and trick anybody and we will not be unfair, but we will ask people to compare like with like. We make it clear to local authorities that they do not all start from a level playing field, because many of them, unfortunately, are inheriting public health policies that were not some of the best. Therefore, we will recognise that—it is one of the legacies left over from the previous Administration. However, because people, GPs, and everybody involved in the delivery of health, including councillors and Members of Parliament, will have public access to such information, I have no doubt that that will begin to drive a real desire to reduce health inequalities.

I mean no disrespect to the hon. Member for Ealing, Southall, but I know the previous job of my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) and he, like me, knows that there is no better grit in the millstone among professionals than when comparisons are made about who has a better set of results. There is always good, healthy competition between professionals. We have seen that in the past when we published—I am not going to try to pretend that I can remember what it is, and if I say what I think it is, Dr McCrea, you can bet your bottom dollar that it will be wrong, but I know that in the past we have published the outcomes of particular procedures and surgery, and that it has improved the outcomes to everybody’s benefit when there has been a bit of healthy competition between professionals. That is what we intend to do by publishing the statistics on public health outcomes by local authorities, so that everybody can see what is out there. We saw it in recycling rates. Publishing information did exactly what we hope it would—it upped everybody’s game, and that is one of the reasons why we will do it.

To conclude, we have created a new health system that makes tackling health inequalities core business, underpinned by new legal duties, measurement and assessment. The local autonomy that we have given to our CCGs and our health and wellbeing boards will enable them to take focused action that meets the needs and aspirations of their populations, concentrating on the groups that experience the worst health inequalities. I hope that the hon. Member for Ealing, Southall is now in no doubt about what has been done.

Tackling health inequalities is a key priority for the Government, and it supports the wider focus on fairness and social justice. I know from a radio interview that I gave on Friday—on the “Today” programme on the BBC—that Professor Marmot, who wrote his brilliant report on health inequalities, has already recognised how important it has been that we have made this a statutory duty. He has praised much of the work that this Government have done—I have to say, in stark contrast to the previous Government, of which the hon. Gentleman has been a firm supporter.

Our approach is to design a system that empowers those at a local level to take action on inequalities, with a strong focus on commissioning quality services and on improving the health of the poorest, fastest.

Question put and agreed to.

A and E Waiting Times

Anna Soubry Excerpts

Tuesday 23rd April 2013 Westminster Hall

[Heidi Alexander (Lewisham East) (Lab)]

I congratulate my right hon. Friend the Member for Cynon Valley (Ann Clwyd) on securing this debate.

What struck me when listening to the contributions from all parties represented in Westminster Hall this morning is the consensus that exists about the fact that we need to hear from the Government their vision for accident and emergency services. I agree entirely with the comments of the hon. Member for Cheltenham (Martin Horwood) and my hon. Friend the Member for Stretford and Urmston (Kate Green) when they say that we need clarity about how that vision is developing.

There is a fundamental tension between the centralisation of specialisms in accident and emergency services, and the desire of local people to be treated close to home. In London, there are fantastic A and E facilities in some of our central London hospitals, such as Guys and St Thomas’s hospital over the river, and yet—as hon. Members know—we equally find that hospitals in some of the outer parts of London are, frankly, either being sold off or seeing their services hugely downgraded, such as the downgrading that we are experiencing at Lewisham hospital at the moment.

Before I make some specific remarks about the situation in south-east London and some of the things that I have learned and been thinking about since we have been dealing with the issue at Lewisham hospital, I will quickly pick up on one of the other remarks made by my hon. Friend the Member for Stretford and Urmston. She talked about the problems she had experienced in extracting clear and concise information from the Department of Health about waiting times in Manchester hospitals. I, too, have asked several questions recently, not about waiting times but about the provision of health services at hospitals in London. I have simply been told that the Department does not hold that sort of information and it has been recommended that I make freedom of information requests. That is all well and good, but the public want to be reassured that Ministers at the heart of Government understand what is happening in hospitals out there and that they have an appreciation of the wider picture so that they can develop their vision of hospital services, whether they are A and E services or maternity services, but I am not sure that we feel reassured when we get such parliamentary answers that that is the case.

I will make two specific points about Lewisham hospital. Hon. Members will know that, in January, the Secretary of State for Health announced that Lewisham hospital would have a smaller A and E department, and that it would lose its maternity services. That was as a result of the trust special administration process that took place in the South London Healthcare NHS Trust, which was in huge financial difficulties. The hospitals in Woolwich, Bromley and Sidcup had a very significant operating deficit, and as a result of that we were told that the hospital down the road in Lewisham would have its services decimated. The full A and E department at Lewisham hospital will close; all blue-light ambulances will go past Lewisham hospital to other hospitals; all medical emergencies will not be able to be treated at Lewisham hospital; and yet the Secretary of State still calls it a “smaller” A and E department.

We might think that, on the basis of taking capacity out of the system at Lewisham hospital and—I should say—having to invest £37 million in other hospitals to deal with the displacement of people from Lewisham’s A and E department, everything is operating smoothly and well in south-east London. That is not the case. One in 10 people is waiting longer than four hours at hospitals that used to be part of the South London Healthcare NHS Trust, and now in Lewisham, one in 10 people is waiting longer than four hours to be treated. That was not the case in Lewisham a year ago; in March 2012, 97% of people were being treated at Lewisham hospital within four hours. So there is huge pressure upon A and E departments in south-east London.

Yesterday, I asked Lewisham hospital for information about the number of times that ambulances had been diverted to it from other hospitals. Lewisham hospital told me that, since December 2012—in the last four months—there have been 25 separate occasions when ambulances have been diverted to Lewisham. On 10 of those occasions, ambulances were diverted from the Queen Elizabeth hospital in Woolwich, and on 11 other occasions ambulances were diverted from the Princess Royal university hospital in Bromley. Those are the very hospitals that are meant to be picking up the people who will no longer be able to go to Lewisham hospital when our full A and E department goes. I seek a guarantee from the Minister that no changes will be made at Lewisham hospital until these diverts from other hospitals have stopped, and that no changes will be made until we see that, at the other hospitals I have mentioned, they are dealing with patients within a four-hour window.

I should like to make two general points about some issues that have already been touched on. There is a fundamental problem with people’s understanding of where they should go for the best possible treatment. The Government have asked Sir Bruce Keogh to conduct a review of emergency care, which is much needed and timely. I would rather the Government waited for the outcome of that review before they took decisions about hospitals such as Lewisham.

At the moment, when people are ill, they have no idea where they should go. They are faced with a plethora of places. Should they go to their general practitioner, a walk-in centre, a minor injuries unit or an urgent care centre, or A and E? It is confusing for people. If there was better information about where people can get the most appropriate treatment, potentially people who do not need to be in A and E would not go there. I do not criticise people for going to A and E, because they know that they will get treatment there and will be dealt with—hopefully—quickly. We cannot expect them to understand all the intricacies of what is available elsewhere. That fundamental problem needs to be addressed.

The Government are making the situation worse in Lewisham, when they say that Lewisham will retain a smaller A and E. On the day that the Secretary of State made that announcement, I said to myself, “What is a smaller A and E? What will happen there?” I am not the only one who is concerned about this. On 21 February, the president of the College of Emergency Medicine, Mike Clancy, tweeted:

“We have raised questions about the lack of clarity”—

with regard to Lewisham hospital—

“and that what’s proposed doesn’t meet our definition of an”

emergency department. Even the CEM is saying that the Government are making this more confusing for people. The way that the whole process has been dealt with has been quite deceitful and potentially dangerous. Telling people that there is a smaller A and E when it will be nothing more than an urgent care centre has potentially serious implications.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I am sure that the hon. Lady is not suggesting the Secretary of State was in any way deceitful.

[Heidi Alexander]

I said that the whole process was deceitful and potentially dangerous. A legal challenge about Lewisham is under way. We have to await the outcome of that to see what the future holds for Lewisham. I stand by my remarks. The process was not really open from the outset.

My final point has already been mentioned. We need to work out exactly how we stop people going into A and E who do not need to be there. Yesterday, I was at my grandmother’s funeral. For a number of years, she had been very poorly and was a frequent attendee at her local hospital. Several times when she turned up there, she did not really need to be there. She was a poorly, lonely old lady. If we are to address the number of people who present at A and E when they do not need to be there, we must find proper ways of caring for people well and with dignity, especially towards the end of their lives, in the community. The problem at the moment is that we are trying to reduce the availability of A and Es in local areas when we do not have alternative care in place to stop people having to rely on A and E as the last resort.

I am grateful for the opportunity to speak in this debate. Again, I congratulate my right hon. Friend the Member for Cynon Valley on securing the debate. The availability of high-quality local health services matters to everyone. It will be interesting to hear what the Minister says about how she is going to address those important issues.

[Grahame M. Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my right hon. Friend the Member for Cynon Valley (Ann Clwyd) on securing this debate and compliment hon. Members who have spoken so far, highlighting concerns about the increase in A and E waiting times that are affecting their constituents.

I shall make specific references to my area and to the increase in A and E waiting times. I shall also spend a few moments reflecting on why we are in this situation and will mention the Health questions debate, during which I was bitterly disappointed by responses from the Health Secretary and Ministers to questions from hon. Members regarding increases in A and E waiting times.

An impartial observer might think the coalition Government had inherited a health service on the brink of collapse. The truth is that the Government inherited an NHS that had been transformed from what the previous Labour Government inherited after 18 years of Conservative Government and under-investment. My area was one of many, perhaps including Kettering, that were beneficiaries of considerable investment. There were 100 new hospitals; actual spend on the NHS increased from £30 billion to more than £100 billion; and much of the aged NHS infrastructure was replaced. My area and many others saw the construction of new walk-in centres, primary care centres and a new generation of modern community hospitals. GP opening hours were also extended. We have had the benefit of more doctors and nurses than ever before. We also had NHS Direct.

My contention is that Labour not only fixed the roof when the sun was shining, but laid the foundations and built the new hospitals, ensuring that patients received faster and better treatment closer to their communities. That was reflected in public satisfaction with the NHS, which went from the lowest ever recorded levels in the 1990s under the previous Conservative Administration, to the highest ever recorded levels by the time Labour left office. However, since the coalition Government took office, we have seen the biggest fall in public satisfaction with the NHS, as spending cuts have started to bite. [Interruption.] The Minister is saying no and shaking her head.

[Anna Soubry]

I am not. I am saying, “What?”

[Grahame M. Morris]

The Government have given back to the Treasury some £3 billion over two years. The Government have expended unnecessarily in excess of £2 billion or £3 billion on a top-down reorganisation. Factor in the £20 billion in cuts or efficiencies—however people choose to describe them—and this is a difficult time for the NHS.

[Anna Soubry]

Efficiencies.

[Grahame M. Morris]

Someone’s efficiency is someone else’s cut.

[Anna Soubry]

Will the hon. Gentleman not accept that the efficiencies that he speaks about were agreed between the then Opposition and the then Government—his Government—as savings within the NHS of some £20 billion? Does he also accept that his party, in its last manifesto and in comments by Ministers, stated that it would cut the amount of money going into the NHS? That is something this Government have not done.

[Grahame M. Morris]

I think that the Government are cutting the money that is spent on the NHS, not least with the costs of the reorganisation, which I have already mentioned. That money need not have been spent. We are giving back several billion pounds—some £2.5 billion to £3 billion to the Treasury—which could be spent addressing issues such as this. There are a couple of practical points that I want to raise with the Minister later, but I give way to the hon. Member for Cheltenham (Martin Horwood).

--- Later in debate ---

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to speak under your chairmanship, for what is, I think, the first time, Mr Hollobone. I thank my right hon. Friend the Member for Cynon Valley (Ann Clwyd) for securing the debate. She has an exceptionally powerful voice in these matters, and all of us, on both sides of the House, have a common interest in ensuring it is heard not only today, but throughout this Parliament. I pay tribute to the work she is doing not only in her own right, but in tandem with the Government.

I also pay tribute to the work other Members who have spoken undertake on behalf of their constituents in fighting for A and E services in their constituencies. It would be remiss of me not to thank my local A and E unit at the West Cumberland hospital for saving my life probably twice in the past two years, although I appreciate that that makes me sound careless.

Before I begin, I wonder whether the Minister can answer this fairly simple question. What have Barking, Havering and Redbridge University Hospitals NHS Trust, Burton Hospitals NHS Foundation Trust, Milton Keynes Hospital NHS Foundation Trust, North West London Hospitals NHS Trust, Portsmouth Hospitals NHS Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Shrewsbury and Telford Hospital NHS Trust, University Hospital of South Manchester NHS Foundation Trust, University Hospitals Coventry and Warwickshire NHS Trust, University Hospitals of Leicester NHS Trust and York Teaching Hospital NHS Foundation Trust all got in common? I am more than happy to give way to the Minister if she would like to hazard a guess.

[Anna Soubry]

These are serious matters and should be above such cheap party politics. The hon. Gentleman clearly knows the answer to his question, and is asking me to speculate. Given that the debate is about accident and emergency, no doubt the answer is that their waiting times are longer. The Government accept that, and also agree that it is not acceptable; and we are doing something about it. If the hon. Gentleman wants to play party politics, that is against him, not against anything else.

[Mr Reed]

That was a regrettable answer, and did not become the Minister. She clearly does not know the answer. I wonder, as do, I think, many hon. Members, whether the Government know the answer to the question. It is that those trusts have missed the A and E target for major type 1 units—

[Anna Soubry]

I just said that.

[Mr Reed]

Can she tell me for how long?

[Anna Soubry]

I am not playing silly games with our NHS.

[Mr Reed]

They have missed it for each of the last 29 weeks. These points are not silly; they are matters of fact.

[Anna Soubry]

Will the hon. Gentleman give way?

[Mr Reed]

Of course; I look forward to an answer.

[Anna Soubry]

The point that I am making is that the hon. Gentleman is playing silly games with serious matters. Other right hon. and hon. Members have addressed the issue positively, with compassion, but he is just playing silly party political games.

[Mr Reed]

I now know what it feels like to be handbagged.

[Anna Soubry]

That is sexist.

[Mr Reed]

I do not think it is sexist at all.

Does the Minister know how many times her local trust has missed its A and E target, since the end of September? [Interruption.] I will tell her. Nottingham University Hospitals NHS Trust has missed its target for 17 weeks since September.

[Anna Soubry]

Would the hon. Gentleman care to refresh his memory? If we refer to the most recent statistics produced by Nottingham University Hospitals NHS Trust for the A and E department at the Queen’s medical centre, we can compare those for the week commencing 14 April this year with those for the week commencing 15 April last year. Last year 440 patients failed to be treated or seen within the four-hour target, whereas this year the figure had fallen to 259.

[Mr Reed]

I note that the Minister prepared an answer, and I am grateful for that.

Major accident and emergency units—type 1 facilities, nationally—have missed the target for at least the last six months, and all A and E units, including minor incident units, have not hit the target for 12 weeks in a row. If anyone needs help analysing the figures, I would be happy to oblige. They are easy to find and they reveal some interesting points. For example, I wonder whether hon. Members know that only one trust with a major accident and emergency unit in England has hit its target every week since the Secretary of State took his position. That is relegation form, and if this were a football match the cry from the crowd would be “You don’t know what you’re doing.”

Before the Minister attempts yet again to dismiss those statistics, I hope she will take a moment to attend to what has been said by the chief executive of the Royal College of Nursing, by Dr Clifford Mann of the College of Emergency Medicine, and by David Behan of the Care Quality Commission. Earlier this month, Dr Peter Carter, of the Royal College of Nursing said:

“These figures are yet more proof of a system running at capacity, and patients are suffering as a result. Our members are regularly telling us that pressure on the system is rising while staffing levels fall, and as a result any increase in demand results in unacceptable waits for patients who are already going through a difficult time.”

Dr Clifford Mann, of the College of Emergency Medicine said:

“We are seeing...ambulances queuing outside departments, and patients waiting too long on trolleys before they can be admitted to hospital.”

The Care Quality Commission said:

“It is disappointing that people have said they have to wait longer to be treated than four years ago. People should be seen, diagnosed, treated and admitted or discharged as quickly as possible”.

Like me, the Royal College of Nursing, the College of Emergency Medicine and the Care Quality Commission will be appalled that the key performance indicators for the NHS, such as A and E waiting times, are getting steadily worse. In the past six months, 582,811 people waited more than four hours in major A and E units, compared with 420,921 for the same period in the previous year. That is an increase of 161,890 people. That is not silly: it is a question of people’s lives. Those figures relate to people in need who did not get treatment in the time when they needed it. They represent more than 500,000 extra waiting hours in one year. People will find it hard to stomach the fact that there are now about 5,000 fewer nurses than there were in 2010, at a time when, as hon. Members on both sides of the House have mentioned, demand in our A and E units is increasing.

One way to get the figure down—it has been touched on already in the debate—would be to offer services for people with non-emergency ailments, so that they do not feel the need to travel to an A and E department. However, instead of NHS Direct being used as a tool for easing pressure on A and E departments, the roll-out of NHS 111 has turned into a trade marked Government shambles. Patients calling the new 111 service wait hours for advice. One patient waited 11 hours and 29 minutes for a call back. No wonder they feel that they have to go to A and E, when they cannot trust a telephone service with such an inadequate response rate.

Accident and emergency departments are a litmus test, or a barometer, for the performance of the NHS as a whole. If people are waiting in A and E, it means that there are too few beds or too few staff to cope with demand. That is just a fact of health service planning. If there are too few beds, it is because community services are being cut and patients who should be at home are kept in hospital. That reverberates back through the entire system. If patients who could be at home are in hospital, beds are occupied. If beds are occupied, A and E staff cannot admit patients. If A and Es are full, paramedics cannot hand over patients. If patients are queuing in the back of ambulances, those ambulances cannot respond to a potentially serious call-out. One failure leads to another. Each compounds the other. That is what is so serious about the debate. It is not just about the patient sitting in A and E for hours on end; the statistics I have highlighted show much more than that—the experiences of patients throughout the entire system.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is a pleasure to serve under your chairmanship, Mr Hollobone.

I have just about eight minutes to respond to all the valuable contributions made in this debate. I will not be able to answer all the questions, but I will write to anyone who has asked a question that I cannot answer.

Obviously, I begin by paying tribute to the right hon. Member for Cynon Valley (Ann Clwyd) for securing this debate and for the way she is championing the cause of the patient. She will not hesitate to leave no stone unturned. As many others know, she is doing great work in leading our independent review of NHS complaints. She mentioned just some of the many cases that have come her way. She did not give dates, but I suspect the cases were not all fresh by any means, because, as she, I and many others recognise, this is by no means a new phenomenon; it is a serious problem that requires serious action, which the Government are taking. Would it not be refreshing and brilliant if we could have a debate on a serious issue without falling into the trap of cheap party politics, which, unfortunately, has been a little evident in some, but mercifully not all, the speeches? As the right hon. Lady said in her speech, there are no easy answers.

Some important points have been raised. We know that there is a problem, and we recognise that. It is not uncommon for the four-hour waiting time standards not to be met, especially during the winter period. That happened under the previous Government as well as under this Government. Indeed, in 2008-09 there were 23 weeks in which the waiting time target was breached, and it was breached during a further 14 weeks in 2009-10 up to May 2010. We know that those problems continue. We want to know and understand why, and we want to take quick action.

[Mr Jamie Reed]

Will the Minister give way?

[Anna Soubry]

I have only six minutes to address all the contributions, so the hon. Gentleman had better be quick.

[Mr Reed]

I am grateful to the Minister for giving way. This is a very important point. Does she accept that Labour’s A and E target for hospitals was tougher than the one set by her Government?

[Anna Soubry]

No. I am not going to go into all that in the short time that is available to me. We accept that waiting times are a problem—we are not trying to hide from that, and we are up for transparency—and I will address the data in a minute.

The hon. Member for Cheltenham (Martin Horwood) rightly identifies the seasonal nature of waiting times. He speaks with passion about changes in his constituency, and rightly so. It is right and proper that people who have such concerns, as other hon. Members have said, come to this place to champion the cause of the health service within their own communities, especially when it faces reconfiguration. He spoke about 111, which is an important thing to talk about when considering some of the causes that may contribute to the unacceptable failure to hit targets. I know that the data are being monitored on a daily basis by NHS England, and the deputy chief executive of NHS England is meeting twice a week to consider what is happening and to make sure that action is taken to ensure that any problems are addressed.

The hon. Gentleman makes an important point on the difficulty of filling posts, and I will write to him on that because I know it is a problem. I also know that action is being taken by some of the royal colleges, and it is probably best if I give a fuller answer, because he makes a very important point. Of course, I can say that the Keogh review is considering exactly the other problems that he mentioned. As the Secretary of State announced, the Keogh review, which has been alluded to, will report next month. All those matters will be reviewed by Sir Bruce, and it is much to be hoped that some positive forward-thinking will come out of that.

The hon. Member for Stretford and Urmston (Kate Green) raised various issues. I am particularly concerned that she says she is not getting the answers to the questions she has quite properly asked. I think there is sometimes a problem with hon. Members not going in the first instance to the actual hospital, trust or whoever it might be. Her point, and it is a good point well made, is that when she asked my Department, she did not get those figures, and I will make further inquiries.

Only today I saw a question from the hon. Member for Ashfield (Gloria De Piero) asking precisely what the figures are for her hospital in Sherwood and, as it happens, the hospital she and I effectively share, the Queen’s medical centre A and E department. I have given those figures, and I want to set the record straight because, in fact, for the same week last year in Sherwood, 75 people waited more than four hours; this year the figure is 266.

[Kate Green]

I have two points to make very quickly. First, I asked for data on all Manchester hospitals. I cannot be expected to go to each one, but, obviously, what is going on in every hospital in the city matters because patients will have to move from one to another if capacity is short. Secondly, I specifically asked for data on Trafford general hospital, which falls within the Central Manchester University Hospitals NHS Foundation Trust. The Minister told me in a written answer that data were not available, but when I approached the trust itself, it told me.

[Anna Soubry]

I know, and I do not understand why that is. I will absolutely make further inquiries, because it is nonsense that the hon. Lady did not get the data.

I will come on to address the points made by the hon. Member for Lewisham East (Heidi Alexander), but, on the data, it is important that we monitor such things. That is precisely why the Department of Health and Health Ministers are very much alert to what is happening in A and E. We share the concerns of hon. Members, which is why we have the Keogh review, why we are considering how to solve the problem and why we are looking at the underlying causes, which, in the short time available, I hope to address. I will ensure not only that the Ministers to whom the hon. Member for Stretford and Urmston has spoken read Hansard, but that a copy of this debate goes to NHS England, which I know also shares those concerns. NHS England also wants to hear about the experiences of hon. Members, and it is taking action to ensure that we are on top of this and, most importantly, that we do what we should do.

[Heidi Alexander]

Will the Minister give a commitment today that no changes will be made to Lewisham’s A and E until there are no ambulances being diverted to Lewisham hospital, and waiting time targets are met in the neighbouring hospitals?

[Anna Soubry]

I took that intervention in good faith, hoping that I might be able to assist. The hon. Lady is more than experienced and knows that I cannot give her any such assurance. She, too, talked about the provision of data in her speech. All I know is that 75% of the people who would ordinarily have gone to A and E in Lewisham will continue to go there, but she makes important points, all of which will be put in the right place.

I conclude by addressing the cause. Well, we do not know. There are various factors, but, as has been said, there is no easy answer and no silver bullet. We know that a seasonal downturn in performance in not unusual, but the dip in performance this year is deeper and longer than in previous years. One million more people—perhaps this is not understood by some hon. Members—are using A and E departments every year, and it is important that we understand why that is. We know that there are nearly 4 million more A and E attendances compared with 2004, when the previous Government carried out what I and others believe was a disastrous renegotiation of the GP contract, which has had a clear knock-on effect on access to out-of-hours services.

Obstetric and Paediatric Services (East Sussex)

Anna Soubry Excerpts

Thursday 18th April 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate my hon. Friend the Member for Eastbourne (Stephen Lloyd) on securing this debate. Given that no doubt many people in his constituency will, I hope, read all my speech and all the comments I make, it is very important that I make a number of matters very clear. As I am confident that he knows extremely well, this decision does not lie with the Department of Health. When he asks me a series of questions, which of course I am more than happy to answer, he must know, and those reading or listening to this speech must know, that these decisions are local decisions.

The coalition Government have taken the view that it is only right and proper that decisions of this nature regarding the provision of NHS services are made locally. My hon. Friend, quite properly, comes to this place to raise these matters on behalf of his constituents. I make no complaint at all about any Member of this place doing that, because, in many ways, it is our primary job. However, it is also absolutely imperative that when hon. Members, like my hon. Friend, come here and put forward a complaint on their constituents’ behalf, it is made clear where the decision-making process lies and where the responsibility lies—and it lies at a local level. That is why, in replying to his speech, I rely on information provided to me not by my officials in the Department, because they are not party to this decision, but by the various trusts, knowing the processes and understanding that this, as he must know, is a local matter.

I am told that the trust has been experiencing challenges in recruiting doctors for the specialties associated with obstetric and paediatric services. This has been followed by advice the trust has recently received from local clinicians and the national clinical advisory team. That advice, I am told, indicates that the trust’s current maternity and paediatric services cannot continue as they are. I am told that the current arrangements are unsustainable in terms of delivering a safe service to patients. I am sure that my hon. Friend has at heart a desire to ensure that all his constituents receive safe treatments and the safe delivery of their babies. That must be his, and indeed everybody’s, priority.

I am told that it is because of those factors—the shortage in recruitment and the safety of patients—that the trust has had to take urgent action, primarily on the grounds of patient safety. As my hon. Friend knows, the trust met in March and made a temporary decision—this is not a permanent decision.

[Stephen Lloyd]

Will the Minister give way?

[Anna Soubry]

In one moment, if I may, because the clock is against me and it is really important that I place on the record a proper and full response to my hon. Friend’s speech.

I am told that this is a temporary measure whereby the consultant-led obstetric service, neonatal services, including a special care baby unit, and in-patient paediatric and emergency gynaecology services will, in order to make sure that they are safe, be provided by Conquest hospital alone.

[Stephen Lloyd]

Will the Minister give way on that particular issue?

[Anna Soubry]

Briefly, yes.

[Stephen Lloyd]

I appreciate that. The Minister will be interested to know that I went to an extraordinary general meeting where the chair said that the measure would be temporary. I got a commitment that it would last for 18 months. I then publicised that and three days later I got a clarifying letter saying, “No, Mr Lloyd, we are saying that in 18 months we will consult on whether it is temporary.” I do not believe that it is temporary, and having the Minister support the idea that it will be temporary means that it is more likely to stay as such.

[Anna Soubry]

I get the point, but it is not a question of me supporting or believing in anything. I have been given information and am placing it before the House to ensure that the good people whom my hon. Friend represents have the full picture. It would be a serious allegation to suggest that the information with which I have been provided is false. I can say only what I have been told, which is that it is a temporary decision.

That is combined with the establishment of a stand-alone, midwifery-led maternity unit, alongside a short-stay paediatric assessment unit at Eastbourne district general hospital. This means that if a paediatric patient requires in-patient admission, they will be transferred to Hastings under the interim change.

As yet, no woman or child has been transferred to Conquest hospital. I understand that the project plans are in place for the delivery of the interim configuration of maternity and paediatric services, providing a single-site service at the Conquest hospital from 7 May.

My hon. Friend is fully aware that the trust has confirmed, as I have said, that this is a temporary change and, indeed, that a strategic and long-term solution will need to be agreed within 18 months. It is also important to remind hon. Members that I am told that the process will be led by local general practitioners and what we now call local clinical commissioning groups.

I am conscious that the clock is against me, but there is much I wish to say. I press on my hon. Friend that, as I have said, there are no specific proposals at the moment. I am informed that in order to develop a solution, the future of maternity and paediatric services is being considered as part of a separate, countywide programme called Sussex Together, which will bring together doctors, nurses and health professionals, in conjunction with local authority colleagues from across the county, so there is a real opportunity to improve health services and outcomes across organisational boundaries.

I will, of course, write to my hon. Friend to try to answer all his questions. I wish I had been given notice of them, because I could have answered them today, but I am precluded from doing so. At the moment there is no point in my meeting any of his good constituents who are leading the campaign, because there is nothing that we in the Department can do. As I have said, this is a local decision and it is temporary.

[Stephen Lloyd]

Will the Minister give way on that point?

--- Later in debate ---

[Anna Soubry]

No, I am afraid that I cannot take any more interventions, because I am keen to place the following on the record. The trust’s latest decision has been taken on urgent safety grounds as a temporary solution, and CCGs—clinicians, doctors and nurses—hope to and will find the long-term solution to the problem. In arriving at that solution, CCGs will want to assess proposals against the four tests that have already been outlined. Adhering to those tests and continuing to focus on the needs of the local population will ensure that proposed changes to services are locally led, not Government-driven or directed by Whitehall.

We hope that everyone will work together, including the local authority’s health and wellbeing board. Moreover, the health overview and scrutiny committee is a very important organisation that can refer proposals to the Secretary of State. It comprises democratically elected members and professionals, all of whom can ensure that the right thing is done.

[Stephen Lloyd]

Will the Minister give way?

[Anna Soubry]

No, I only have 10 seconds left. The committee has the power to refer proposals for changes to services to the Secretary of State—

Oral Answers to Questions

Anna Soubry Excerpts

Tuesday 16th April 2013 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

2. What progress he has made on the commitment that patients would have access to appropriate radiotherapy wherever they lived.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I am pleased to say that from 26 March £22.7 million of the Prime Minister’s fund to improve access to what is called intensity modulated radiotherapy—IMR in short—has already been committed. The money is being used to update machines and ensure that radiographers receive extra training if they need it. We are well on our way, especially as it is now a nationally commissioned service, so there is no reason why anybody should not have the access they need to this treatment.

[Grahame M. Morris]

I thank the Minister for that response, but is she aware that new guidelines released by NHS England for treating patients using stereotactic ablative radiotherapy—advanced radiotherapy—say that only commissioning for early stage lung cancer will be approved, and that other treatments for all other cancers can be paid for only in clinical trials? As no trials are being commissioned in England, can the Minister explain how the treatment for patients with prostate, liver and spinal cancer, who were receiving SABR treatment last month, will be funded in the future?

[Anna Soubry]

What I do know, having had a long meeting with my officials only this morning, is that the evidence, as they have explained it to me, is clear: SABR is effective only in a small number of people who have, unfortunately, a certain small tumour in their lungs, and it is not suitable for other treatments of cancers. However, if the hon. Gentleman wants to discuss the matter further, my door is always open.

[Mr James Gray (North Wiltshire) (Con)]

The trouble with all these things is that medical science moves faster than the targets set by the Government. Does the Minister agree with me that proton beam therapy is now almost as important as radiotherapy? How much have the Government spent on this therapy, and how many patients have been helped by it?

[Anna Soubry]

We are building two new machines specifically to deliver that treatment. I accept that these things often take a long time, but those machines are planned. In the meantime, NHS England has made it clear that people who need this specific type of treatment can receive it overseas and it will be funded accordingly.

[Tessa Munt (Wells) (LD)]

Two years ago, the Prime Minister accepted the installation of CyberKnife as the latest in cancer radiosurgery equipment at the world-leading Royal Marsden hospital cancer centre. At the last Health questions, I asked the Secretary of State whether he would accept one of the countless invitations to visit the Royal Marsden. The consultant clinical oncologist has issued and reissued that invitation, but has had no response from the Department. Will the Secretary of State now please visit CyberKnife at the Royal Marsden?

[Anna Soubry]

I have to tell the hon. Lady that, as she knows, there is some controversy over this treatment, which is backed by a very large and powerful American company. The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), has visited, and I know that the Secretary of State has an extremely busy and full diary. It is not as simple as a visit; it is all about whether there is any clinical value.

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

3. What steps his Department is taking to raise awareness of the signs and symptoms of cancer.

[Fiona Bruce (Congleton) (Con)]

12. What steps his Department is taking to raise awareness of the signs and symptoms of cancer.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It would take me a very long time to give all the details of the Department’s work. In short, we have run a number of specific campaigns, both locally and regionally, to deal with a number of cancers. We will now evaluate whether those pilots have been successful. What I can say is that, such is the success of the lung cancer campaign, we will be recommissioning it in July.

[Eric Ollerenshaw]

I thank the Minister for that reply. May I raise, in particular, the issue of poor outcomes in pancreatic and prostate cancer? The problem we face is how to achieve the earlier diagnosis that is needed by GPs, so that we can achieve better outcomes in terms of international comparisons.

[Anna Soubry]

It was a great pleasure to meet my hon. Friend and the hon. Member for Scunthorpe (Nic Dakin) to discuss prostate and pancreatic cancer. Those cancers are difficult because often the symptoms are not obvious. The “Know 4 sure” campaign highlights some of the symptoms associated with them. We are evaluating this matter, and if we think that there is benefit in a campaign specifically on those cancers, we will run it.

[Steve Brine]

The Minister will be aware that the all-party group on breast cancer, which I co-chair, is holding an inquiry into older people and breast cancer, starting this afternoon. We look forward to seeing her there. What plans do the Government have to ensure that everyone affected by breast cancer, regardless of their age, is diagnosed at the earliest possible stage?

[Anna Soubry]

I pay tribute to the work of my hon. Friend and all those involved with the all-party group—I am indeed looking forward to this afternoon’s session. I particularly commend the group’s work on targeting women over 70. Again, we have run a pilot campaign on that and are evaluating the results, and if there is value in it, it will be rolled out in order to bring huge benefits.

[Fiona Bruce]

Given the link between smoking and cancer and the fact that 70% of smokers start before they are 18 and 94% before they are 25, what consideration have the Government given to introducing plain packaging in order to drive down the number of young people attracted to smoking in the first place?

[Anna Soubry]

We are considering what has been a huge consultation, but I must correct my hon. Friend—I am in no way criticising her—because it is not plain packaging, but what we call standardised packaging. If, like me, hon. Members were to see the cigarette packets now issued in Australia, they would realise that they are far from plain. Some would say that they are a counterfeiter’s nightmare, not a charter for counterfeiters.

[John Healey (Wentworth and Dearne) (Lab)]

People remember the massive improvements in cancer care services under Labour. Now, more and more people are having to wait longer and longer for those crucial diagnostic cancer tests, when they might be worried sick about what they will have to face. Is the Minister happy that more people are waiting longer and what is she doing now to cut those waiting times?

[Anna Soubry]

We have invested £450 million in improving exactly the matter that the right hon. Gentleman raises, and I do not share his analysis one bit.

[Valerie Vaz (Walsall South) (Lab)]

As well as raising awareness of cancer, will the Minister clarify whether this new list of 28 prescribed drugs produced by the NHS Commissioning Board will increase access to the cancer drugs fund?

[Anna Soubry]

What I know is that the cancer drugs fund is delivering in a way that, if I may say so, was not delivered under the last Administration.

[Ms Margaret Ritchie (South Down) (SDLP)]

What discussions have taken place with Health ministerial colleagues in devolved Administrations on the need to share best practice in diagnosis, analysis of biopsies and future treatments and care for those suffering from different forms and types of cancer?

[Anna Soubry]

We are always open to discuss anything that can improve outcomes for anybody suffering from cancer, and certainly we are alert to all new research. As I said, if that involves talking to devolved Administrations, my officials do that in order to improve outcomes for people in England.

[David Tredinnick (Bosworth) (Con)]

Is my hon. Friend aware that one of the most effective treatments in reducing the impact of prostate cancer is traditional Chinese herbal medicine and acupuncture, and does she agree that it is crucial that we get the regulation of herbal practitioners in place as soon as we can?

[Anna Soubry]

All these things have to be evidence-based. I am reminded of the evidence that the chief medical officer gave recently on this subject.

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

A freedom of information survey by Labour showed that cancer networks saw their funding cut by 26% between 2010 and 2013 and lost 20% of their work force over the same period, losing vital skills and expertise along the way, despite repeated reassurances from the Government that funding for clinical networks would be protected. Even more shockingly, all this is happening at a time when the Department of Health has handed back £2.2 billion to the Chancellor of the Exchequer. How can the Minister justify handing vital NHS funding back to the Treasury when cancer networks are being cut, specialist staff and skills are being lost and thousands of nurses are being axed?

[Anna Soubry]

I think that that was about four questions in one, but I would certainly dispute all that has been said. Let me make this absolutely clear: we know that there was great success in the cancer networks, which is why we have extended them, so that they now include, for example, dementia and mental health, and far from cutting the overall money going to all the strategic networks, we have increased it by 27%.

[Christopher Pincher (Tamworth) (Con)]

4. What support his Department has given to local authorities and NHS commissioners to improve cardiovascular disease outcomes.

--- Later in debate ---

[Dan Jarvis (Barnsley Central) (Lab)]

10. When the Government plan to respond to the consultation on standardised packaging for tobacco products; and if he will bring forward legislative proposals on standardised packaging.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I am afraid that I cannot give a timetable, and I make no apology for the fact that this Government are taking a careful look at all the evidence that has come out of the consultation.

[Dan Jarvis]

Figures from Cancer Research UK show that more than 1,100 of the 10 to 14-year-olds in Barnsley are regular smokers. Given that countries such as Australia and New Zealand have now committed to standardised packaging, I ask the Minister again: are the Government planning to legislate to give millions of children one less reason to start smoking?

[Anna Soubry]

I find it most bizarre that the advice I am given by my officials—and I absolutely accept their advice—is that, as the hon. Gentleman will understand, because of judicial reviews of consultations, I am not allowed to have an opinion, so I do not give any opinion, notwithstanding the fact that many people would say that he advances a number of important arguments. I will say, however, that it is important to look at all the emerging evidence, including that coming out of Australia. As he will no doubt know, Australia continues to face a legal challenge that is yet to be resolved. It is also important to be aware of that.

[Dame Angela Watkinson (Hornchurch and Upminster) (Con)]

Does the Minister agree that adult smokers have already made a conscious decision to disregard all the health warnings that are so highly publicised, and are therefore unlikely to be influenced by the appearance of a packet of cigarettes? Is not the best way of deterring children from smoking the setting of a good example by responsible parents who know how much money their children are spending without supervision, and what they are spending it on?

[Anna Soubry]

If only it were as simple as that. Emerging evidence that I have seen suggests that it is the attractiveness of the packets that leads young people to decide to take up smoking. It also suggests—it is important for us to bear this in mind—that standardised packaging is not intended to persuade those who choose to smoke to continue to do so, and will make no difference to their choices. The aim is to protect children and young people.

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

22. It is a well-known fact that for many decades cigarette packaging has been there to attract the eyes of not just current smokers, but those who are yet to become smokers. Given that 50% of people who smoke die prematurely, it is clear that, over those many decades, the tobacco industry’s intention has been to attract new smokers, including young children. The sooner we get on with standardising packaging, the better.

[Anna Soubry]

As I have said, I am precluded from giving any personal opinion, but I am sure that we will all take on board what the right hon. Gentleman has said.

[Jackie Doyle-Price (Thurrock) (Con)]

Recent press reports have revealed that as many as a third of the number of cigarettes sold in the London area are contraband. Will the Minister discuss the matter with those in other Departments, in order to ensure that the objective that we are trying to achieve by standardising packaging will be achieved by that means?

[Anna Soubry]

I shall be meeting the relevant Home Office Minister today to discuss that very issue, but let me repeat that, far from being a counterfeiter’s dream, the packets produced in Australia would clearly be a nightmare here. A variety of colours, watermarks and holograms, and all manner of other things, can be attached to them, which is why they are described as “standardised” rather than “plain”.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

20. This decision is taking too long, and those who care about the impact of smoking on children are at a loss to understand why. Given the U-turn on minimum alcohol pricing, the delaying of the sexual health strategy and, now, the stalling on standardised packaging, I must ask whether the Government have simply given up on public health.

[Anna Soubry]

And it was all going so well. I will take no lectures from Labour Members, who had 13 years in which to resolve this issue, but did not do so because they knew that these were difficult and tricky matters, and that it was important for all the evidence to be considered properly. I do not know what peculiar gestures Opposition Front Benchers are making, but they are clearly not listening and understanding when it comes to stuff that they themselves must have considered when they were in government.

[Mark Durkan (Foyle) (SDLP)]

11. What steps the Government plan to take to ensure that patients with rare and very rare muscle-wasting conditions have access to high cost drugs when such treatments become available.

--- Later in debate ---

[Mr John Baron (Basildon and Billericay) (Con)]

14. How the NHS will be held to account on the experiences of cancer patients using the NHS.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

The Secretary of State made it very clear to NHS England in his mandate that we expect to see an improvement in patient experience.

[Mr Baron]

The Francis report recommended that the NHS be held to account on patient experiences. Given that the national cancer patient experience survey is a proven tool in driving up the quality of care, will the Minister endorse calls for the survey to be carried out annually, and support the development of a clinical commissioning group outcomes indicator set indicator based on the results in order to incentivise CCGs to improve cancer patient experience?

[Anna Soubry]

I am grateful to my hon. Friend for those comments; as he knows, these are now matters for NHS England. I will make sure it is aware of what he has said and his urging it to do both those things for the obvious benefits they would have for a cancer patient’s experience.

[Mr Jamie Reed (Copeland) (Lab)]

The hon. Member for Basildon and Billericay (Mr Baron) is absolutely right: it is essential that the NHS is held to account for the experiences of cancer patients and patients with other conditions, too. Accountability has undoubtedly been weakened, however, as a result of the NHS reorganisation that came into effect this month. Last week, the outgoing deputy chief executive of the NHS, David Flory, said that the loss of experience in the NHS is greater than he has ever seen and that hospitals have been left struggling as a result. How can a service stripped of so much skill, knowledge and expertise provide the accountability that patients deserve?

[Anna Soubry]

I am afraid that the hon. Gentleman’s question depicts a situation that I simply do not recognise. As I visit hospitals and other organisations, both in my constituency and across the country, I am told that there has been a huge improvement, especially in commissioning—[Interruption.] No, by front-line clinicians, who talk with enthusiasm about how the commissioning of services has improved because now at last the clinicians—those who know best—are in charge, and not, as has often been the case, faceless bureaucrats and managers.

[Kate Green (Stretford and Urmston) (Lab)]

15. When he expects to take a decision on the reconfiguration of hospital services in Trafford.

--- Later in debate ---

[Paul Uppal (Wolverhampton South West) (Con)]

T2. The all-party group on men’s health, of which I am vice-chairman, has assisted in research that seems to show that men’s poor sexual health is often symptomatic of more serious problems, such as type 2 diabetes and cardiovascular disease. Will my hon. Friend assure me that all robust measures are being put in place to ensure that that is not overlooked and that men do not die unnecessarily because that situation is taken for granted?

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I completely agree with everything my hon. Friend has said, and the sexual health document we published in March relates specifically to those matters. Men are not very good at going to see their GP, a nurse or another health professional when they fear that they might need some sort of assistance. It is beholden on all men to follow the lead of women.

--- Later in debate ---

[Annette Brooke (Mid Dorset and North Poole) (LD)]

T3. The all-party group on global tuberculosis has just published a report on rising rates of drug-resistant TB. One recommendation is for a national strategy for TB in the UK. Will the Minister comment on that? The officers of the all-party group would also be grateful if he fitted us into his very busy schedule of meetings.

[Anna Soubry]

My hon. Friend the Member for North Norfolk (Norman Lamb) is having a break on that one. The continuing outbreaks of TB cause a lot of concern, especially in certain communities. I have no hesitation in agreeing to meet my hon. Friend to explain what NHS England is doing and the development of a national strategy.

[Andy Burnham (Leigh) (Lab)]

Here comes another request for a meeting with the very obliging Minister. Last month he promised the House that he would rewrite the section 75 regulations to rule out enforced competitive tendering in the NHS. However, before Easter the respected House of Lords Secondary Legislation Scrutiny Committee said this of his redraft:

“The substitute Regulations are substantially the same as the original Regulations.”

It is no surprise that it seems to many that the Government are intent on privatisation by the back door, putting large parts of the NHS up for sale. With a crunch vote in the Lords next week, it is turning into another shambles. I make this offer to the Minister: will he again agree to withdraw the regulations and to sit down with us and the professions this week and come up with wording that is acceptable to all?

Fetal Anti-convulsant Syndrome

Anna Soubry Excerpts

Tuesday 26th March 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is, as ever, a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for Glasgow Central (Anas Sarwar) for bringing this matter to the House and for his speech, which was clearly based on careful consideration of a number of matters that have, properly, been brought to his attention by his constituents and by the action group to which he has referred.

I concede that it is never attractive for a Minister to begin opening remarks by saying, “This particular issue is not within my brief.” Immediately, it sounds like trying to pass the buck to somebody else. However, notwithstanding that the issue is not within my brief—I am standing in for the Minister with responsibility, who is unfortunately unable to attend this debate—I assure the hon. Gentleman that on my return to the Department of Health, I will speak to the Minister’s officials and ensure that they are fully aware of all the matters that he has raised and the many questions that he has rightly posed, some of which I will be able to answer. I will ensure that all the answers are given, if not by me today then certainly in a letter.

I will speak directly with the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb). Knowing him as I do, I am sure that he will be keen to meet the hon. Gentleman. It might take a little time—our diaries, as one might imagine, are fiendishly full—but I can see no good reason why my hon. Friend would not want to know more about the issue. Anybody hearing the hon. Gentleman’s speech, the arguments advanced and the stories behind this unfortunate condition would want to know more and to see whether anything can be done.

What we do know is that fetal anti-convulsant syndrome can occur when a mother must take anti-epilepsy drugs, as the hon. Gentleman has explained better than I can. We know that it can result—although, it is important to say, not always—in delays in developing speech and language skills in the babies born, difficulties with social interaction, memory and attention and physical defects such as spina bifida, heart defects, ocular abnormalities and characteristic facial features.

It is important to say that most women with epilepsy will have successful pregnancies and healthy children. However, epilepsy during pregnancy can pose challenges. Epilepsy is associated with the risk of giving birth to a disabled child, and for women on anti-epilepsy drugs, the risk is greater. Pregnancy may also increase the frequency of seizures in about one third of women, and it can alter their metabolism of AEDs. Prolonged fits can be dangerous for the baby as well as the mother, so ideally, pregnant women should be seizure-free.

The hon. Member for Glasgow Central rightly made the point that women have been diagnosed and prescribed this treatment but have not had sufficient explanation of the risks involved in continuing to take that form of medication, which many epilepsy sufferers take without any difficulty, for the sake of their health because of its positive effect.

I commend my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) for the important point he made about the role of general practitioners in ensuring that National Institute for Health and Clinical Excellence guidelines are followed. I have those guidelines in front of me and what they say is important. It is all well and good that the pros and cons of the medication are set down, but it is also imperative for GPs and everyone else involved in the treatment of a woman with epilepsy who is thinking of becoming pregnant or is of childbearing age to understand the potentially bad consequences of taking AEDs throughout a pregnancy. Such women need proper information and a full and frank discussion so that they can make an informed choice—I emphasise that it should be an informed choice—before and during pregnancy.

The NICE guidelines are clear:

“In women of childbearing age, the risk of the drugs causing harm to an unborn child should be discussed and an assessment made as to the risks and benefits of treatment with individual drugs…In girls of childbearing age, the risk of the drugs causing harm to an unborn child should be discussed between the girl and/or her carer”—

in most cases, a parent—

“and an assessment…made as to the risks and benefits of treatment with individual drugs…Prescribers should be aware of the latest data on the risks to the unborn child associated with AED therapy when prescribing for women and girls of childbearing potential…Specific caution is advised in the use of sodium valproate because of the risk of harm to the unborn child”.

The NICE guidelines could not be more clear, but proper information sharing and full and frank discussion are critical to informed choices.

[Anas Sarwar]

I thank the Minister for reading out the NICE guidelines, which I have also read. When that system fails, however, as it clearly has for so many years, affecting thousands of families, what happens then?

[Anna Soubry]

Indeed. I was about to move on to that very point, which was also made by the hon. Member for Strangford (Jim Shannon), and to discuss support for children who have such an affliction, obviously through no fault of their own or of their mother. Before I do so, let me add that data related to the safety and use of AEDs during pregnancy remain under scrutiny; the information and the advice are updated and issued as appropriate. The MHRA regularly reviews both the evidence on AED use in women of childbearing age and the information provided in the product information and in patient information leaflets—although many people think that we are lucky if anyone reads leaflets in boxes, and that they are not the way to convey information to a patient; they are no substitute for sitting people down and telling them face to face, going through everything in the manner I have described. The important fact is that we are continually scrutinising the information and advice so that they are regularly updated.

On the specific point about children with this unfortunate condition, better care and outcomes for disabled children are a priority of the Government. The mandate to the NHS Commissioning Board sets out our ambition to give children the best start in life and to promote their physical and mental health and their resilience as they grow up. At national level, the new Children And Young People’s Health Outcomes Board will bring together what my brief describes as key system leaders in child health to provide a sustained focus on improving outcomes throughout the child health system. The Children and Young People’s Health Outcomes Forum will provide continuing expertise in child health and offer constructive challenge as we take forward plans to improve the system.

Those are fine words, though the brief was not written by me—it is not in the nice, clear, plain English that I would like. When I return to the Department of Health, however, I will make the point that, given the structures and our good, strong ambitions, it is imperative for us to ensure that the case of children who suffer from the syndrome is advanced within such forums, and today’s debate will help with that.

[Anas Sarwar]

The Minister says that she likes plain language, and I, too, like plain language. With due respect, any family with a child suffering from such a condition will not want to hear strategy documents; they want to hear what specific action is to be taken to help such families, what compensation they might get, what action is to be taken against the medical companies, or what change of structure will take place in the health service to prevent such failures happening again. They do not need strategy documents; they need plain language and action. What will they get?

[Anna Soubry]

I am trying to assist the hon. Gentleman by explaining that women with epilepsy should, from the very outset, get proper, sound information and should have a full and frank discussion with their medical practitioner so that they can make an informed choice based on everything put forward and knowing the pros and cons. There are many pros—[Interruption.] I prefer not to be heckled. I am happy to give way, and I will in a moment, because I do not have a difficulty with doing so.

I was absolutely clear in my explanation. I then discussed a series of organisations and structures—call them what you will—that also make it clear that the health and well-being of all children, including those who suffer from this syndrome, must be considered, and they must be looked after and cared for as we all wish them to be. The hon. Gentleman now seeks for the spotlight to be turned on this particular syndrome as it has perhaps not been before, and he is achieving that through the debate and by bringing me to this Chamber so that I can assure him that I will take the matter back to the responsible Minister. The hon. Gentleman has already pushed the syndrome up the list of priorities by casting the spotlight on to it, as should be the case.

Furthermore, services for children with special educational needs—some of the children we are discussing will need such services—will be enhanced by the provisions in the Children and Families Bill. From 2014, local authorities and clinical commissioning groups—this is an important provision to understand—will commission services jointly to meet the educational, health and care needs of young people with SEN through a single, integrated assessment process. In other words, we are now beginning for the first time ever to integrate all the specific needs of a particular child, right across all the various departments and people involved, in a way that has not been done before. If we do that, we will undoubtedly see an improvement in the lives of those children.

[Anas Sarwar]

I assure the Minister that I was not heckling her; I am too much of a gentlemen to do that. I was trying to say yes to action on proper advice for potential mothers with epilepsy and to future guidance to stop the condition happening, but my direct question was about the support to be given to the families for whom that is too late. They already have the condition and the difficult circumstances. What specific support will they get?

[Anna Soubry]

Those families are already receiving support; no one is saying that the children have been completely abandoned and are not getting any support at all. Perhaps much more can be done but, as the hon. Gentleman knows, in a debate of this length and given the constraints placed on me or any Minister, he will not get an instant answer, especially without notice of such questions. If I cannot answer all his questions in the short time that we have, and the clock is against me, he will get a letter with all his questions answered. Furthermore, when I go back to the responsible Minister, the hon. Gentleman will no doubt get a meeting to follow.

I thank the hon. Gentleman again for securing the debate. He has cast the spotlight as it needed to be done, and I am sure that there will be positive outcomes as a result.

Sudden Adult Death Syndrome

Anna Soubry Excerpts

Monday 25th March 2013 Westminster Hall

[Steve Rotheram]

I thank the hon. and learned Gentleman for his contribution. Until I did some research, I did not realise what a huge problem SADS actually is. I drew out some statistics, which I will share with the Chamber: some 250 people die every single day in the UK as a consequence of sudden arrhythmic death syndrome or one of its counterparts, and some 270 schoolchildren die in British schools from SADS each year. The disease kills more people in Britain every year than lung cancer, breast cancer and AIDS combined; it is an absolutely huge issue, and it is fantastic that the OK Foundation has brought it to our attention in Parliament, because Oliver’s story is like that of any of the 60,000 SADS victims across the country each and every year.

The debate is crucial to raise awareness of the condition. We as parliamentarians have to date not done enough to address people’s concerns. I hope the fact that my right hon. Friend the shadow Health Secretary is in his place and will be responding for the Opposition demonstrates just how seriously we are taking the issue. I would like to place on record my thanks to the Leader of the Opposition for meeting campaigners in recent months, which is something that the Health Minister has refused to do so far.

I will briefly outline what sudden arrhythmic death syndrome is—or SADS, as it is known.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Will the hon. Gentleman explain what he just said in more detail? I am very concerned if he is saying that any Minister has refused to meet campaigners. If that is the case, I assure him that it should not be. I certainly do not have any problems with meeting anybody. I know that some people turned up at my constituency office unannounced on a Sunday morning, which was not very helpful—obviously, I was not there—but I am quite happy to meet any campaign group on the issue.

[Steve Rotheram]

It is fantastic that the Minister has agreed to meet campaigners. Some are here, and if she has time at the end of today’s debate, I am sure that they would be happy to spend a few minutes trying to organise something more substantial in future. I am sure that people will welcome what she has said.

SADS is a term that is used to describe a group of medical conditions that lead to sudden, unexpected and life-threatening instability of the heart rhythm. It has also been commonly referred to, as it is in the motion, as sudden adult death syndrome, but given its propensity to strike in children, it is now often referred to simply as sudden arrhythmic death syndrome. In the majority of cases, the unstable heart rhythm—the arrhythmia—develops a rhythm called ventricular fibrillation, in which the ventricles, which are the main pumping chambers of the heart, lose all rhythm and regularity and start beating at rates in excess of 250 beats per minute. Ventricular fibrillation causes sudden collapse, seizure-like activity and cardiac arrest—in other words, the total loss of heart function—but if it is diagnosed quickly and if cardiac massage and shock from a defibrillator are applied, normal heart rhythm and signs of life can be restored.

--- Later in debate ---

[Andrew Percy]

Members of Parliament are never backward in coming forward to praise their local newspapers, not least in the hope that it guarantees them a friendly quote next week, but the hon. Gentleman makes an important point. Newspapers can be part of our going out to challenge—I do not want to say “shame”—businesses. I am a Conservative and I love businesses, but businesses make profits and do so on the back of their workers, to whom they have responsibility. [Interruption.] Well, I think that I am a Conservative. Of course, I am; or just the Brigg and Goole party these days, perhaps. [Interruption.] Well, I am certainly not a Liberal Democrat—no offence to my hon. Friend the Member for Southport (John Pugh)—because my views on Europe count me out.

Newspapers have a responsibility to go to businesses and challenge them, particularly big businesses. I understand that defibrillators would be expensive for smaller ones and those employing only one or two people, but we should ask big businesses, “What are you doing for the welfare of your workers? Where are your defibrillators?” Newspapers such as the Liverpool Echo and the Scunthorpe Telegraph have an important role to play in that.

[Anna Soubry]

I am grateful to my hon. Friend, and I congratulate him on his excellent speech, which follows another excellent one. Does he agree that there is a good argument that we can build an Olympic legacy based on the great volunteers who took part in the games by considering whether we can use some of the skills that they helped to bring to the games, and take those skills into the issues of training people and campaigning for defibrillators, which he has identified?

[Andrew Percy]

Indeed. My way to address the problem is to have a multi-faceted approach. In many ways, it has to come from the bottom up. We need people in communities to say, “I will be trained and I am happy to filter down that training, and I am even happy to knock on some doors to raise some money to get defibrillators in our communities.” A lot of parish councils have money in the bank, so we should go to them as well. We need a bottom-up approach through volunteers and the Olympic legacy, as the Minister says, but there is also a role for the Government to say to nursing homes and schools, “We want and expect you to provide a defibrillator, which is relatively cheap,” and of course to say the same to businesses. Is it not true corporatism to bring all three of those elements together? As I have said, there is a role for businesses in looking after the welfare of their workers in that way.

Goole high school has a pilot this year in which everyone in year 11 has been funded to go through the National Citizen Service. I have suggested to the head teacher that, as part of the community payback for that, all those young people should be trained in CPR this summer. Therefore, 100 or 200 young people in that community in Goole will leave at the end of the summer having received training, which is 200 more advocates for the whole issue and potentially 200 more life-savers.

--- Later in debate ---

[John Mann (Bassetlaw) (Lab)]

It is a pleasure to take part in this debate and I congratulate my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) on the fine way that he introduced it. I pay tribute to the campaigners who have given Parliament an appropriate kick in the pants to ensure that this issue is debated with proper time. This is a great opportunity for us to look at what can be done and the best way to do it. I will be giving the Minister some proposals on how this can be taken forward that will not cost her any money—there are ways that Governments can spend money, but some suggestions are cost-neutral.

By a remarkable coincidence, in Bassetlaw we are about to launch a campaign. When we agreed to launch it, I did not know that this debate would take place. After we had set our campaign dates, I got some e-mails and twitters telling me about it—[Interruption.] Tweets, apparently. Anyway, I got them, read them and responded. There was a good bit of pressure, but we had already decided, because we have a campaign group that has been battling. People power has brought this debate here, and we had our own people power in our ambulance campaign in the east midlands, which was resolved today—the Minister will want to know this, because I doubt whether she had anyone in the meeting this morning, but I did.

In our area, we put forward the idea that, rather than have all our ambulance stations closed, going down to none, we should have them kept open and have three. We have won. All three are being kept open, as a result of people power. The number of fully crewed ambulances with qualified staff will remain as is, rather than being cut. I asked for six guarantees—I put it in writing—and got the formal answers on the record this morning. We won that campaign.

I offered the ambulance service a bit of a deal when I met it. Our group, the “Save Our Services” campaign, which just so happens to include Councillor Adele Mumby and Mr Gavin Briers, community first responders, and various others, has campaigned with me and the local council on this matter. I said, “Look, I’ve seen some figures that say Bassetlaw has a less than 2% survival rate. However, in Lincolnshire, it is apparently 11%. Hang on a minute. I don’t know who’s not been informing me about this, and I’ve not seen these figures before, but if our survival rate is under 2%, and Lincolnshire’s is 11%, something’s wrong.” When I looked into it, the community first responders were clear about what is needed: they said we need defibrillators everywhere in our community and we need training.

We have therefore agreed the Bassetlaw defibrillator campaign, which we are launching on 11 April. It will be an unusual campaign, compared with some. I have heard a lot of medical jargon, but we will not be using any of that, because I cannot follow it, and I am the MP. Many of my constituents will have more medical knowledge than me, but some will not be able to follow that jargon, so we will keep the campaign really simple. It is going to be like this. Every school will have to have a defibrillator; those that do not will get a visit from me to hold their governors to account. I do not care who funds this: the council, the county council or the school governors. The Lions are also raising money. What I do care about, though, is that the defibrillator is registered with the ambulance service, which can then do the training to make sure the defibrillator is properly used.

I have been to have a look at a defibrillator, and I was photographed trying one out. Like my hon. Friend the Member for Liverpool, Walton, I know how simple they are; us simple guys, we can get it. It is easy to use one, and I can do it. However, I want to make sure the systems are good, and I want people to think them through. That is important for the kids. When I was 11, a lad in my class at school died suddenly, so I am very aware of the problem. However, I also want to make sure the community can use these defibrillators, so we are not stopping just at schools, although if a school does not want to have a defibrillator, I will name and shame them. I am sure they all want one, and some have them already, but they should all want to participate fully.

To help, the Minister could have a word with the Secretary of State for Education, as others have said. I could suggest bits of the national curriculum that could be dropped. We could lose a king or queen who is long dead, and put in a bit about defibrillators. If the Minister or the Education Secretary wants to come up with other bits of the national curriculum we could lose, I do not mind, but they should get these issues on the curriculum, so that everyone in school learns about it. In areas such as mine, the children will then go back home and teach the old folk such as me—the grandparents and all the rest of them—the skills they have; they will tell them what to do. That knowledge will spread through the community like wildfire; that is what I want.

However, there is more than that. My neighbour, the hon. Member for Brigg and Goole (Andrew Percy), is well trained, and I am glad that he is, because I do not live too far from him. However, nursing homes are provided by the health service, county councils and others, and they are licensed by the CSQ—

[Anna Soubry]

The Care Quality Commission.

[John Mann]

The Minister knows them. She could have a word with these bodies and insist that homes have a defibrillator. What are they doing employing staff who have not been trained? We should insist they train them; we should make it part of the licensing process. It costs the Government nothing; it is also good business practice for the private homes and good public practice for the publicly run homes.

However, we can do more than that. The Retford, Gainsborough and Worksop Times has agreed to back and publicise the campaign, and it is going to do a sticker. Every building—say, a shop—that has a defibrillator will get good publicity. It will not need me to go there for a photograph to launch it, although I am available, if any shop wants me; they would regard that as good publicity. They can have the Minister if they really want. The sticker will tell people the defibrillator is in the shop. To me, that is a really obvious step.

However, I want more than that. We give a lot of money to sport. Another mate of mine got taken ill playing football. I pulled my hamstring, and he thought he had pulled his, but it was far worse. Luckily, we got him to hospital, because he had a heart attack just outside it. He lived, and he is perfectly fine now. However, that made me think, and it is part of the motive behind the campaign. Where are the defibrillators and trained people in all these community sports facilities? We give these facilities money. There is the Football Foundation, which my right hon. Friend the Member for Leigh (Andy Burnham) knows well. I think it spends £30 million a year. It should be built into the small print that people should get defibrillators when they get the money for their fancy new facilities. It does not matter whether it is public money, football money or lottery money. The Minister could be raising this issue with these bodies. The Government are also rightly putting money into school sports. We could use the leverage provided by money going into sport to say that defibrillators should be part of the deal. If we do that, we will get them without the Government having to put in lots of money; indeed, if they follow my suggestions, they will not have to put in any money.

I have two other suggestions that are also cost-free. On the planning system, people are always asking for planning permission. We have heard how the system can work against what we are trying to do, but, used sensibly, it can work for us. If someone wants to get planning permission to set up a new shop, a new factory or a new community centre, having a defibrillator should be built into the planning conditions; that is really simply, and it does not cost the state anything. Yes, it will take some time to make that happen, but we can establish the principle in council policy, and that is what we want to achieve with our campaign in Bassetlaw. People will retrofit. They will jump the gun.

Like me, the Minister is a good friend of the unions, and it would be great if the shop steward and the health and safety rep negotiated to ensure that every workplace with such a representative—it will tend to be the bigger workplaces—has a defibrillator. Indeed, it might be more than one if we are talking about some of the big workplaces in my area, which employ 1,000 to 2,000 people. There might be plenty of trained people throughout the work force who know what to do. That is an easy win; it is good publicity. Those suggestions are all cost-free for the Government.

[Mr Gary Streeter in the Chair]

I have a final suggestion. The Minister will like this, because it suits her area, just as it suits mine. I have about 80 parish councils in my area, and they are elected—well, allegedly, because there is never an election in most of them. However, through the democratic process, they are anointed as the village representatives. I shall contact them and go to those who are reticent. Every parish councillor should be trained up. Every parish, every village and every estate should know where the defibrillators are and publicise them so that everybody else knows.

If we get our act together, we can do something significant, without it costing the Government money. It is pure coincidence that Bassetlaw’s campaign is happening now. We waited until we had won our ambulance campaign. I did not want people going round saying, “You’re only doing this because you lost your ambulance stations.” No, the proposals are additional to the professional staff at the ambulance stations and all their brilliance. Now that my area has won its ambulance station campaign, we can deal with our defibrillator campaign properly and efficiently. We will name and shame.

I invite the Minister to come up to be photographed with a business or a parish council, or with councillors and county councillors who have donated a bit of money to assist the process. She can be photographed with me and them; it will be a great photo. However, I hope she will take these proposals forward, which are cost-neutral to the Government, and use leverage to get them moving.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is a pleasure to serve under your chairmanship, Mr Streeter.

I thank everyone who has spoken in this excellent debate. A debate normally consists of one side of an argument versus the other side, but today we have had an outbreak of agreement and there has been no one side or the other. The debate is also momentous because I can say with my hand on my heart that I found myself in agreement with not only my hon. Friend the Member for Brigg and Goole (Andrew Percy) but, most concerning, the hon. Member for Bassetlaw (John Mann), with whom I share history, because I was born and brought up in his constituency. I would be absolutely delighted to take up the hon. Gentleman’s invitation to visit, because it means a great deal to me. To be serious, however, because I was being flippant, this has been a good debate. I pay tribute to all those who signed the online petition and particularly to the hon. Member for Liverpool, Walton (Steve Rotheram) who opened the debate so well. He spoke with great passion and feeling and with considerable knowledge. We have had a good debate because of the outbreak of agreement and some well formed speeches, based on real argument, facts and figures, as well as on constituents’ experience.

Where are we? We all agree that defibrillators are good things; many hon. Members have spoken about the role that they can play and how we need considerably more of them. We all agree that we need more people trained in their use and in CPR and all manner of emergency measures for someone in a life-threatening situation. I congratulate the hon. Member for Bolton West (Julie Hilling) on her speech; she explained how training our children could bring us real benefits in the number of people trained, which would mean more lives being saved. I pay tribute to my hon. Friend the Member for Brigg and Goole, who spoke about his experiences as a community first responder and about how volunteers from the community, not only young people at school, could be trained in such skills. He gave some good examples of how effectively such a programme could be rolled out. Other hon. Members talked about the value of screening and, for example, I pay tribute to the right hon. Member for Knowsley (Mr Howarth) for his comments on the need for screening.

Unfortunately, I am going to be somewhat of a fly in this otherwise rather pleasant ointment, because I do not agree with everything said about legislation. My view is that we do not need legislation. We already have all manner of programmes locally. I am not denying that our system is patchy and that some parts of the country are clearly doing a far better job than others, but it is understandable why the previous Government decided to put defibrillators and training down to the local ambulance trusts: they know their communities best and they are the people to ensure delivery, to the best of their abilities, to meet the needs of their communities.

I usually flinch from legislation, because it can take a long time to go through this place and because when we start to be prescriptive, we can run into all sorts of dangers. We have accepted that different communities have different needs, and I pay tribute to the hon. Member for Bassetlaw for his compelling case for defibrillator training to be rolled out through our communities, depending on the nature of the community. For example, his constituency has a large number of parish councils—mine does not have as many, but it matters not—and he discussed putting pressure on and working and campaigning with the parish councils to start installing defibrillators. The parish councils can look at their own communities and at what would suit the needs of those communities. He then made a good point about work forces and the possibility of defibrillators in every place with more than a certain number of employees, and that is where the debate begins, because the difficulty with legislation lies in whether we look at a workplace with 50, 100 or 1,000 employees. The hon. Gentleman described how he could work with the trade unions in his patch and in effect, as a result, roll out a campaign of asking the work forces whether they think something is a good idea in a particular workplace or not in another. If we begin to prescribe, however, we will not deliver the sort of service that we want.

[Andy Burnham]

I realise the situation is slightly unusual: the Minister is defending the policy of the previous Government and I am asking her to reconsider and to go further. She said that ambulance services are best placed because they understand their communities. I partly agree, but the problem is that ambulance services do not have the power to insist on defibrillators going where they are most needed. The ambulance services are not the planning authority or the owners of the big buildings; they can only use persuasion and cannot ensure that defibrillators go where they really need to go, where lives can be saved. That is why legislation is necessary. If she is worried about overly burdensome legislation, it could start with a simple requirement to have a defibrillator publicly available in towns of, for example, 30,000 or more; it could be a modest requirement to get the ball rolling, as other countries have done.

[Anna Soubry]

I am grateful for the intervention, but it rather makes my point. Once we stipulate, for the sake of argument towns of 30,000, we can imagine that in the towns without that level of population people will think, “Well, we’re all right, so we won’t do much work on it.” That is the problem with a more prescriptive approach.

While we are discussing ambulance services, and referring again to the speech of the hon. Member for Bassetlaw, I wish to set the record straight on the East Midlands ambulance service. EMAS has been struggling for some time, with a number of difficulties that the hon. Gentleman and I are familiar with. As mentioned by my hon. and learned Friend the Member for Harborough (Sir Edward Garnier), my hon. Friend the Member for Loughborough (Nicky Morgan) has been involved in a campaign following the death of Joe Humphries, who did not live in her constituency but went to school there. As a result of her work, for which I am grateful, Leicestershire has 109 static defibrillators in public areas, 14 of which were installed in partnership with the Leicestershire police, and there are 24 Heartstart schools in the county.

The hon. Member for Bolton West also talked about the Heartstart scheme and its success in her area, although I can see that that may not be the case universally throughout the country. What is happening because of the debate, however, is that not only are we holding it and everything is being recorded in Hansard, but I will certainly go away and not hesitate to have that conversation with the relevant Minister in the Department for Education. An extremely forceful message has come out of this debate about the need for such training to be included in the national curriculum. I could not possibly give my own views on that, but the argument has been advanced extremely strongly and it has much merit and power.

[Steve Rotheram]

I was not aware that the Minister is an anti-legislationist parliamentarian.

My right hon. Friend the Member for Leigh (Andy Burnham), off the top of his head, suggested a population of 30,000 as a starting point. It does not matter whether the threshold is 30,000, 25,000 or 50,000; basically, there has to be a starting point. Even if the threshold is 30,000, once automatic external defibrillators are in place, they are there for life, and we can then start to concentrate on places with fewer than 30,000 people. We could do that for large factories or organisations before we go to the small ones. There is no magic wand and provision will not happen overnight, but we need to start somewhere.

[Anna Soubry]

The hon. Gentleman’s point is good and is well made.

[Mr George Howarth]

In some respects I share the Minister’s scepticism that legislation is always the answer; it can, on occasions, be a blunt instrument. The problem, however, is that whenever we look at what the alternative is, it is not straightforward. My hon. Friend the Member for Bassetlaw (John Mann) talked about parish councils, but not everywhere is covered by parish councils.

[Anna Soubry]

That, again, is a good point. Clearly, one size does not fit all. Every area has different needs.

[Andrew Percy]

The problem with looking to the ambulance services is that they do not have the money to provide defibrillators to each of their communities. I would also question whether they necessarily know their communities all that intimately, being organisers, as they are, on large, regional scales.

We have discussed areas of responsibility outside those of the Minister’s Department, but will she undertake to look at the situation of nursing homes, particularly in Texas? Will her officials contact the health department in Texas to see what impact there has been as a result of requiring defibrillators in nursing homes? Then we can come to an evidence-based decision on the matter.

[Anna Soubry]

My hon. Friend’s point is, again, good and well made. I am glad that we worked out which part of the United States it was that something good could be said about in this respect. I am more than happy to take his point away, as one of the many ideas that hon. Members have suggested in this debate, and see whether we can consider in any way, be it making provision mandatory or issuing guidance to nursing homes and other institutions—[Interruption.] I think my hon. Friend the Member for Brigg and Goole said that he was going to send it to me. I will be interested in anything that ever comes across my desk. I will give it due consideration and pass it on, if necessary, to those who have responsibility for nursing homes in the Department of Health. As I said, it is a good idea.

One could argue that only a limited number of hon. Members have participated in today’s debate. We should stop here for a moment, because all the Members who have spoken have come from the standpoint of having experienced someone—normally a child—dying suddenly from a heart attack. That touches people in a raw way, because it involves a child. Mercifully, out of all the horrors and badness invariably comes something good, which is a point raised by the right hon. Member for Belfast North (Mr Dodds). Hon. Members have raised many examples of the good that has come out of the terrible and tragic loss of a young life.

[Julie Hilling]

Does the Minister agree that we should take some of the luck out of the issue? Fabrice, Malcolm and Mrs Hobbs were lucky, but Oliver was not. We need to take the luck out of the issue, to ensure that people who suffer a sudden cardiac arrest have a good chance of survival. We can do that only if we have some sort of legislation that says, “You must have defibs and you must do training.”

[Anna Soubry]

I have given my reasons for why I do not believe legislation, at the present time, is the answer. I agree with the hon. Lady that a lot of the matter depends on luck. Certain areas seem to offer a better service than others because of some unfortunate tragedy that has befallen them. With the Oliver King Foundation and many other charities that we have heard about today, people have come together and raised money to install defibrillators or to ensure that school children receive the right sort of training.

We heard examples of the work of mayors. The hon. Member for Barrow and Furness (John Woodcock) talked about the work of the mayor in his constituency, and the hon. Member for West Lancashire (Rosie Cooper) spoke about the work that had been done in her constituency by the mayor. She also mentioned the death of a young man and the work that his family has done as a result to ensure that other youngsters did not suffer a similar fate, and that the things that should be in place were there.

[Andrew Percy]

Again on legislation, I agree with the Minister’s point that we want a mixed approach to the matter, but if we expect communities to take charge of the matter themselves, we must understand that some communities do not have the capacity to do so. They might not be able to raise money quite as easily as more middle-class and better-off areas can. Some communities might be slightly better organised because they have a parish council speaking for them. We must bear in mind that not every community will have the resources or the individuals who feel confident enough to raise money for such provision.

[Anna Soubry]

My hon. Friend’s point is another well made point.

I will return to where this debate started—the subject of sudden adult death syndrome. Starting with screening, often when there has been a case of a sudden cardiac arrest, many people say, “Screening will have a big impact in the future.” As the right hon. Member for Leigh will know, the UK National Screening Committee, an independent expert body that advises Ministers about all aspects of screening, assesses the evidence for screening against a set of internationally recognised criteria. No doubt that is why the right hon. Gentleman listened to and followed its advice, which is that, while screening has a potential to save lives, it is not a foolproof process. The footballer Fabrice Muamba suffered cardiac arrest, and many of us will remember what happened to him at the game. We have heard many people describe the amazing medical assistance that he was given—I cannot remember for how long he was unconscious, but it was an incredibly long time—and that young man has made a remarkable recovery. However, I am told that he had received several screening tests throughout his career.

In 2008, the UK NSC reviewed the evidence for screening for the most common cause of sudden death in those under the age of 30, hypertrophic cardiomyopathy, including looking at athletes and young people who participated in sport. A number of the cases that we have heard today involved, invariably, young men or boys who died while playing sport, notably football. The UK NSC concluded that the evidence did not support the introduction of screening. Sudden cardiac death is a complex condition and is difficult to detect through screening; there is no single test that can detect all the conditions, nor is it possible to say which abnormalities will lead to sudden cardiac death. However, in line with its three-yearly review policy, the UK NSC is again reviewing the evidence. This time the review will go further than only looking at the evidence for screening for HCM and will cover screening for the major causes of sudden cardiac death in young people between the ages of 12 and 39. The review will take into account the most up-to-date international evidence, including evidence from Italy, where screening is currently offered to athletes between the ages of 12 and 35.

There will be an opportunity to participate in the review process later this year, when a copy of the latest review will be open for public consultation on the UK NSC’s website. No doubt, a number of the organisations and charities that we have heard about today will take part in that consultation. I am told that although screening is not routinely available in England, work to prevent premature death from cardiovascular disease is a priority, as it should be.

On 5 March, the cardiovascular disease outcomes strategy—not exactly words that trip off the tongue—was published. It sets out a range of actions to reduce premature mortality for those with, or at risk of, cardiovascular disease. The NHS Commissioning Board will work with the Resuscitation Council, the British Heart Foundation and others to promote the site mapping and registration of defibrillators, and to look at ways of increasing the numbers trained in using them. I pay tribute to the foundation, which a number of hon. Members have mentioned, and rightly so, as we are all grateful for its work in, for example, placing defibrillators in Liverpool primary schools. That is, no doubt, because of the outstanding work of the Oliver King Foundation.

Ambulance trusts have had responsibility for the provision of defibrillators since 2005, and in my view they are best placed to know what is needed in their local area. However, it is important to recognise that defibrillators help only in a minority of cases. The majority of out-of-hospital heart attacks—up to 80%—happen in the home. Bystander CPR doubles survival rates, but it is only attempted in 20% to 30% of cases. It is clear that although defibrillators play an important part, we have to bear in mind, as I said, that 80% of heart attacks, if they do not happen in hospital, happen at home, and I absolutely concede that there is a real need for an increase in the amount of people trained in CPR, because we know that that also plays a hugely important part in ensuring that people who have a heart attack survive it.

When there is a sudden cardiac death, we need to take action to ensure that potentially affected family members are identified and offered counselling and testing to see if they are also at risk. We know that that does not always happen. There are continuing discussions with the chief coroner for England to determine how coroners’ services might help in the identification of potentially affected family members, so that more lives can be saved. The national clinical director for heart disease, Professor Gray, will work with all relevant stakeholders to develop and spread good practice around sudden cardiac death.

In conclusion, I will wait to see the latest recommendation from the UK NSC, following its latest review of evidence. The national clinical director for heart disease will continue to promote good practice and awareness around sudden cardiac death. However, as I have said before—forgive me for repeating myself—I will ensure that I speak to the relevant Minister at the Department for Education about all the arguments that have been advanced today for training in CPR and life-saving techniques to be part of the national curriculum. It is my understanding that that particular part of it is under review, and I will impress on him or her how strongly Members have spoken today.

Again, I thank everybody, especially those who signed the petition, for bringing the debate into this place and, effectively, for shining a spotlight on the matter. I hope that hon. Members will take the issue to their local press, as I am sure they will, and that the national press might also look at it. It is absolutely right that the more we ventilate it, the better the situation will be.

[Mr Gary Streeter (in the Chair)]

In debates of this kind, the mover of the motion may have a few moments to summarise or respond at the end.

[Steve Rotheram]

Thank you, Mr Streeter. First, I thank all right hon. and hon. Members for taking part in the debate on behalf of the campaigners, and obviously I thank the campaigners, who have made a long journey in certain cases to come to Parliament today to hear what we have been saying and what the Minister has been saying. Can I just pick the Minister up on one point? It is very important to some people here; we have a doctor and other medical staff here. She continually made reference to heart attacks; I think that what she meant was cardiac arrests, which are a very different thing.

[Anna Soubry]

Sorry.

[Steve Rotheram]

I just wanted to put that on the record.

Many excellent points have been raised in the debate. What we have seen demonstrated during the past three hours is the clear and absolute desire for Parliament to act. I understand that the Minister has a difficult job. There are obstacles and challenges to overcome in relation to cardiac arrest and SADS, including raising awareness and overcoming people’s initial fear of helping someone who has sustained a cardiac arrest. The hope is that this debate will have teased out some of those things.

We have also heard about a number of issues that are not directly relevant to the Minister’s remit, so she may well have to have conversations not just with the relevant Education Minister, but with the Department for Business, Innovation and Skills and certainly with the Department for Communities and Local Government in relation to the planning issues. However, that does not mean that she or the Government can abrogate their responsibilities. As has been highlighted, some of these things are cost-neutral; they just need action. We are not asking for money or, at worst, they cost very little. They simply require political will.

A few weeks ago, after the debate was announced, I received numerous phone calls and e-mails from organisations and charities that have been campaigning for years on this issue, so it is only right that they receive recognition for their efforts. Therefore, in praising again the efforts of the OK Foundation, I would also like to pay tribute to SADS UK, the British Heart Foundation, Cardiac Risk in the Young, the London Ambulance Service, Hearts and Goals, the Arrhythmia Alliance, the North West Ambulance Service, AED Locator, the Community HeartBeat Trust, Kays Medical and Liverpool football club and the great Steven Gerrard, the England captain, who has also recently come on board and lent his support—my right hon. Friend the Member for Leigh (Andy Burnham) is shaking his head.

There is growing momentum for action, and campaigners will not give up on this issue until progress is made. Including first aid training in the school curriculum would take up 0.2% of the timetable, but have an incalculable value.

Informal Health Council

Anna Soubry Excerpts

Thursday 14th March 2013 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

EU Health Ministers met in Dublin, in Ireland, on 4 and 5 March. I represented the UK. The agenda included discussions on childhood obesity, the impact of the economic crisis on health systems, children with complex developmental needs, patient safety, and on moving towards a smoke-free environment.

The meeting began with a discussion on childhood obesity. There was broad agreement that it was beneficial to continue to develop voluntary collaboration between member states in this field. This discussion was followed by a debate on the impact of the economic situation on health systems, focusing on avoiding or mitigating a negative impact on the provision of health services. There was also a discussion of complex developmental needs in children, with a particular focus on autism.

The second day included discussions on smoke-free environments and patient safety. The discussion on patient safety focused on healthcare associated infections, and the experience of member states in preventing and combating these.

The Council also gave the opportunity to stress the UK position on the economic cost of not addressing the causes of non-communicable diseases and that prevention is vital to the health of UK patients and the UK economy. It is therefore important that the UK works with other member states in tackling issues such as tobacco misuse and obesity and the Council provided a forum to share best practice at the European level.

The meeting concluded with an AOB item on the importation of active pharmaceutical ingredients from third countries, following the coming into force of the falsified medicines directive. A number of member states, including the UK, called on the Commission to redouble their efforts to ensure that there were no shortages of active pharmaceutical ingredients following the implementation of the legislation.

Horses: Slaughterhouses

Anna Soubry Excerpts

Friday 1st March 2013 Ministerial Corrections

[Mary Creagh]

To ask the Secretary of State for Health pursuant to the answer of 31 January 2013, Official Report, columns 903-4W, on horses: slaughterhouses, when each positive sample was collected; and when the positive results were reported to the Food Standards Agency.

[Official Report, 11 February 2013, Vol. 558, c. 523-24W.]

Letter of correction from Anna Soubry:

An error has been identified in the written answer given to the hon. Member for Wakefield (Mary Creagh) on 11 February 2013.

The full answer given was as follows:

[Anna Soubry]

The information is shown in the following table:

[Anna Soubry]

The information is shown in the following table:

National Health Service Charges

Anna Soubry Excerpts

Friday 1st March 2013 Written Statements

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

My noble Friend the Under-Secretary of State, Department of Health (Earl Howe) has made the following written ministerial statement.

Regulations will be laid before the House shortly to increase certain National Health Service charges in England from 1 April 2013.

There will be an increase in the prescription charge of 20p from £7.65 to £7.85 for each quantity of a drug or appliance dispensed.

For another year, the cost of a prescription prepayment certificate (PPC) will remain at £29.10 for a three-month certificate. The cost of the annual certificate will remain at £104. PPCs offer savings for those needing four or more items in three months or 14 or more items in one year.

Regulations will also be laid to increase NHS dental charges from 1 April 2013. The dental charge payable for a band one course of treatment will increase by 50p from £17.50 to £18. The dental charge for a band 2 course of treatment will increase by £1 from £48 to £49. The charge for a band 3 course of treatment will increase by £5 from £209 to £214.

Dental charges represent an important contribution to the overall cost of dental services. The exact amount raised will be dependent upon the level and type of primary dental care services commissioned by the NHS Commissioning Board and the proportion of charge-paying patients who attend dentists and the level of treatment they require.

Charges will also be increased, by an overall 2.5%, for wigs and fabric supports.

The range of NHS optical vouchers available to children, people on low incomes and individuals with complex sight problems are also being increased in value. In order to continue to provide help with the cost of spectacles and contact lenses, optical voucher values will rise by an overall 1%.

Details of the revised charges are in the following tables.

Merton and Sutton PCT (Prescribing Policy)

Anna Soubry Excerpts

Friday 1st March 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing the debate and on rightly bringing this matter to the House’s attention. I hope that I can offer her, if not the answer to her question, a number of points and perhaps arrange some sort of meeting between her, the local PCT and all those involved in Mr Aziz’s care to establish why he is not receiving the treatment that he and Professor Madden believe he should have. The PCT should be held to account for why it has not provided that treatment. That really is where the problem, if it is a problem, and certainly where the responsibility lies.

The hon. Lady will know that PCTs have been around for some time. One of the reasons why the Government were so keen to introduce the Health and Social Care Act 2012 was to abolish PCTs and have exactly these sorts of commissioning decisions, which have frustrated so many Members on both sides of the Chamber, made by those best placed to make them: clinicians, effectively through GP-led clinical commissioning groups. As a result of the Act, those people will make such decisions in future.

The hon. Lady started her speech with a political point, so I will make a political point as well. We wanted to get rid of PCTs because too often they are overly bureaucratic and they are certainly not accountable. It was our desire to change that by taking the decisions away from bureaucrats and putting them back in the hands of clinicians. That was one of the fundamental underlying reasons why we were so keen to get the Act through this place and on to the statute book. Far from damaging the NHS, and far from denying patients medications and, perhaps most importantly, explanations, the Act will ensure that these types of problems no longer exist.

It is not for me, as Minister for Public Health, or through any other role that falls within my brief in the Department of Health, to make a case for or against the PCT’s decision. Its members will certainly receive a copy of the Hansard report of this debate so that they can read the hon. Lady’s remarks and mine. I understand that there is a chance that they may be watching this debate. If so, no doubt many of them will be hanging their heads in shame. If they are not, then frankly they should be, if the hon. Lady is accurate in her description. I think that she must be, because I too have a copy of the letter from the Sutton and Merton borough teams that she quoted. It seems that they have a profound problem somewhere in their system, because they clearly did not answer her letters or e-mails or respond to her telephone calls. She is the Member of Parliament. This is about her constituents and her local PCT, and if there is anybody they should respond to, it is the Member of Parliament. MPs are the people who come to this place to represent the people in their wards and absolutely to do what she has done, which is to advance the case of Mr Aziz.

For all I know, there may be a very good reason, not just financial but clinical, as to why this particular gentleman should not receive this particular drug—I know not. I know it sounds awful to say it, and I hate saying it, but it is not my job to know. It is not the job of a Minister to say that somebody should or should not receive a treatment. However, it is my job to make it absolutely clear that whoever someone is in the NHS, they should treat that person with care and compassion. That means that they should sit down with somebody like Mr Aziz and explain to him, or perhaps to his elected representative or his general practitioner, the good, solid reasons as to why or why not a particular decision has been made. It is absolutely vital for them to have the courtesy, never mind the care that we would hope for, to do that.

I admit that it might have been late in the day, but I specifically asked my officials to contact NHS South West London to obtain some sort of statement that I could present, because I do not want to do anybody any injustice—Mr Aziz or, indeed, the PCT. Unfortunately, the statement that I have is handwritten and I am having difficulty reading it, so I will not read it out. In fact, it does not tell me anything that I have not already been told.

It is important to explain that the National Institute for Health and Clinical Excellence provides the NHS with evidence-based guidance on the clinical effectiveness and cost-effectiveness of drugs and other technologies. NICE, as an independent body, makes the decisions on whether a particular drug has a clinical or cost-effectiveness basis on which it should be prescribed. Where treatments have been positively appraised by NICE, PCTs are legally obliged to provide funding for them. However, NICE has not issued any guidance to the NHS on the use of sildenafil nitrate for the treatment of pulmonary arterial hypertension. That is the problem. It is because NICE has not given that advice to the NHS that the treatment is at the discretion of the PCT and we are in difficult times. There were difficult times under the previous Administration. There always are, because we do not have a bottomless pot of money, and treatments—often brilliant treatments—increasingly cost huge amounts of money.

[Siobhain McDonagh]

On that precise point, Mr Aziz, who is here listening to this debate, said to me on the way in, “Siobhain, I have paid my taxes for 35 years. I do not want a drug that makes me look better—I want a drug that is going to save my life.”

[Anna Soubry]

I was coming to that in due course.

Apart from making these comments at the Dispatch Box, I cannot advance Mr Aziz’s case, because I do not know his case. I know what the hon. Lady has said, and I know that he has been through, to use these awful words, due process. His application has been considered. Having looked at what the PCT says in its letter, I can see that his case has been through all the sorts of processes that one would expect. I hope and pray that in the course of all that and through the various appeals that he has made, everything has been properly considered by the PCT.

It strikes me, however, that the most obvious thing that should have been done has not been done. Nobody seems to have sat Mr Aziz down—this is not the hon. Lady’s job, because she knows no more than I do—and explained things to him. If there is a good reason, he should be told. If it is about the money, we need to know exactly what the problem is. I suggest that those who may be listening, whether they be in this building or watching on television, should sit down with this man and discuss the way forward for his treatment. They should provide him with an explanation, because he is not just a human being—and it does not matter whether he is a good or a bad man—but one who is extremely ill with a life-threatening disease. Somebody needs to sit down and do a proper job on this, just like the hon. Lady has done in bringing the case to the House.

I despair—we should not have to be here, but we are. The emergence of the clinical commissioning groups will lead, I hope, to a far better system. They will make decisions based on their own knowledge and understanding as clinicians. They will also, in many ways, be far more accountable than primary care trusts have been. Every CCG will have a representative on the upper-tier local authority’s health and wellbeing board. The theory that generated the highly controversial legislation that went through this place is that it would be much better for decisions to be made at a more local and accountable level by those best placed to make them, namely health professionals.

I fear that I have not been able to answer the question asked by the hon. Lady and Mr Aziz, whom I wish well, as we all do. I hope that, as a result of this debate, which the hon. Lady quite rightly called for, people will sit down and not only perhaps have a rethink, but certainly give a human being an explanation, if for no other reason than because, at the end of the day, he pays their wages. On those somewhat positive remarks, I hope that this matter might be concluded to everybody’s advantage.

[Mr Deputy Speaker (Mr Nigel Evans)]

As we conclude proceedings, may I wish you all a happy St David’s day.

Question put and agreed to.