NHS Bursaries

Christina Rees Excerpts

Wednesday 4th May 2016 Commons Chamber

[Dr Cameron]

The hon. Lady makes her own point. It is important that people from all backgrounds are encouraged to enter our NHS. The UK has a diverse society and we must ensure that our healthcare staffing system reflects that and supports those from all backgrounds to enter it.

It is not enough just to increase numbers by creating an open market for training. In order to ensure a quality service, it is crucial that student placements are well planned, well supervised and well distributed between the various areas within the service, so much consultation is required. In response to the Government’s proposals, a former chief executive of the Royal College of Nursing commented:

“The last thing we need are disincentives to recruitment. We should be doing everything possible to attract applicants, as the country needs more nurses now than at any other time in its history.”

[Christina Rees (Neath) (Lab)]

The hon. Lady is making many valid points. If someone lives in Wales and wants to study at an English university, it is proposed that the bursary will be stopped. If someone lives in England, Scotland or Northern Ireland and wants to study nursing, midwifery or an allied health profession at a Welsh university, the Labour Welsh Government will pay the bursary. Taking that to its logical conclusion, the numbers will decrease in England and increase in Wales, Scotland and Northern Ireland. Of most concern is the fact that the UK Government did not commit to undertake an impact assessment of cross-border applications before proceeding with the changes. Does the hon. Lady think that they should have?

[Dr Cameron]

Once again, the hon. Lady makes her point very well. I believe we need to staff the NHS well right across the UK. Impact assessments may require consideration down the line if there is a shortage in England as a result of this policy. I hope that answers her question.

In Scotland, the SNP Government recognise the value of investing in our NHS, providing a support package that is hugely generous in comparison with that in England. The nursing and midwifery student bursary in Scotland provides all eligible students with a non-income-assessed and non-repayable personal allowance of £6,578 per year, excluding additional allowances. That can be topped up by a range of income-assessed allowances, and it comes in the context of there being no tuition fees. Therefore, there are other examples of ways to make progress in this policy area.

Under the SNP Government, NHS staff numbers have increased by more than 10,000, and the party is committed to supporting the development of a quality health service that will meet the needs of the Scottish people, not just now, but in the future. Workforce projections show that more than 1,000 extra NHS staff are expected to be recruited across Scotland this year. There has been an 8.4% increase in NHS staffing, to a record high. There are more qualified nurses and midwives per 1,000 of population in Scotland than there are in England and Wales. In the past year, Scotland has seen the total number of nursing and midwifery staff increase by more than 500 whole-time equivalents, with boards projecting an increase of more than 600 whole-time equivalents in this financial year. The number of doctors has increased by 26.7% or by 2,560 whole-time equivalents, and the number of consultants is now at a record high, having increased by 40.3%. Every newly qualified nurse is guaranteed one year of employment once they complete their studies—that commitment is not offered anywhere else in the UK. Our health Minister, Shona Robison, has also confirmed that the nursing and midwifery student bursary and allowance will be protected at existing levels in 2016-17. A review of the scheme is due to report in June 2016.

The NHS is a crucial public service, and the UK Government cannot continue to railroad their way through it. They are making significant changes and although reform may be needed to address current issues within the service, such decisions should not be made hastily and without full consideration of their impact and of potential workable alternatives. We have heard about some workable alternatives today. I therefore urge the Minister to commit to having a comprehensive consultation on the full proposals, to determine the best way to support and invest in this service and its students. This is a vital workforce, whom we depend on in our times of crisis. It is only right therefore that they should be able to depend on us during their training and when they hope to help the NHS in the future.

National Minimum Wage: Care Sector

Christina Rees Excerpts

Wednesday 23rd March 2016 Westminster Hall

[Christina Rees (Neath) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate my hon. Friend the Member for Sheffield Central (Paul Blomfield) on securing this important debate.

The care industry and, in particular, its workforce play a vital role in our society. The UK has a care sector that is ever growing, which is essential with an ageing population. It is important to ensure that, as people age, they can still live in their own homes for as long as possible. That will not only allow people to enjoy the comforts of home as they spend more time there, but will help to reduce the pressure on the NHS, which we all understand would help enormously.

Where it is not possible for people to remain in their homes, they should be provided with the best care possible in a care home facility that meets the high standards we can expect in our society. To ensure that people are given the opportunity to remain in their home as they get older, the work of home care workers, who care for the elderly and disabled in their own homes, is vital. That is why it is so shocking that so many home care workers are routinely paid less than the national minimum wage. The absence of the most nominal of payments is condemning huge numbers of home care staff to the contemporary phenomenon of in-work poverty, as well as significantly undermining care standards across the industry.

The direct effect of underpayment is that care workers are plunged into poverty, leading to much higher rates of staff turnover, with a subsequent negative impact on care standards. Too many experienced or skilled care workers are being forced out of the industry simply because they cannot afford to stay. That is unacceptable.

Due to the lack of time, I will move swiftly on and cite an example from my constituency. The Government’s lack of concern about care workers not being paid the national minimum wage is in stark contrast to the efforts of the Unison branch at Neath Port Talbot County Borough Council. The union has worked closely with the local authority to ensure that social care has remained a priority, reaffirming that care workers feel appreciated and, most importantly, that they are not being taken for granted.

The care sector in Neath Port Talbot, as in many other places, is a mixed economy, whereby the local authority directly provides around £11 million of services, and commissions about £32 million more from third-party providers from the private and voluntary sectors. Council staff are already paid at the national living wage rate, so in-house services act as a pacemaker for pay and conditions in the local care economy—that is to be commended. Were those in-house services not to exist—so with the absence of a pacemaker—we would be in danger of seeing a race to the bottom on pay and conditions, as third-party providers sought to maximise profit by decreasing resources.

A mixed economy works because the local authority uses its influence responsibly, as a quasi-monopoly purchaser of services, to ensure that workforce contracts do not cause detriment to local communities. A good and topical example is the recent decision by members of Neath Port Talbot Council to meet in full the national living wage for staff employed in private sector residential care homes, from which the council purchases a significant amount of residential care. Neath Port Talbot Council is one of the few local authorities in the UK that has decided to afford the national living wage from the outset—it might even be unique. It is important to point out, however, that the council has not simply gifted the money to residential care providers; it pays to ensure that its high-quality standards are met. If third- party providers fall below the standards, funds are withdrawn.

To conclude, perhaps that model will be adopted by the Government. I look forward to hearing the Minister’s response to the proposal.

--- Later in debate ---

[George Freeman]

I will deal with the right hon. Gentleman’s points, with which I have a lot of sympathy, if I am given time to crack on.

Hon. Members have rightly raised the issue of non-compliance with the minimum wage in this sector. I want first to set out the measures that we are putting in place now and that we have put in place already, before touching on some things that we may go on to do in due course. HMRC responds to every complaint made by workers through the ACAS helpline. When a third party reports suspected non-compliance, HMRC evaluates the report and investigates the employer when there are grounds to do so.

Since HMRC began enforcing the minimum wage in ’99, it has identified more than £65 million in arrears. Between April and November 2015, HMRC took action against 557 businesses, clawing back over £8 million for 46,000 workers who had been illegally underpaid. That is already the largest amount of arrears identified in any single year since the national minimum wage was introduced and is possible as a result of the increased investment and extra measures we have put in place to support enforcement.

We are going further. The Prime Minister has committed to a package of measures that are currently being implemented that will build on Government action to date and strengthen the enforcement of the national minimum and living wage. First, we are increasing the enforcement budget from April 2016, demonstrating our ongoing commitment to ensuring that the hardest-working and lowest-paid people receive the pay that they are entitled to. HMRC will also continue to promote compliance with the law and respond when employers have got things wrong.

Secondly, the Government are further increasing the penalties that employers will have to pay when they break the law. From 1 April, the calculation will increase further, to 200% of the arrears that an employer owes. By increasing the penalties for underpayment of the national minimum wage, we intend that employers who would otherwise be tempted to underpay comply with the law and that working people receive the money they are legally due.

Furthermore, under changes being implemented through the Immigration Bill, we are creating a statutory director of labour market enforcement, who will set out a single set of priorities for the enforcement bodies across the spectrum of non-compliance. That should ensure a targeted approach that addresses problems and best helps victims.

Under the Immigration Bill, we are also creating a new type of enforcement order. That labour market enforcement undertaking will be supported by a criminal offence for non-compliance. We want to tackle employers who deliberately, persistently and brazenly commit breaches of labour law and fail to take remedial action. That cannot always be done satisfactorily through the repeated use of existing penalties or offences, which may lead to the continued exploitation of workers.

[Christina Rees]

I am grateful to the Minister for giving way. Will he provide examples of where that happens in the care sector? He is quoting a lot of statistics overall about the national minimum wage and recovery, but they are not specific to the care sector.

[George Freeman]

Perhaps I can come back to the hon. Lady on specific cases—I do not have them to hand. I just want to talk about what we are doing to deal with the issues that have been raised, but she makes an interesting point.

In the care sector, we have a particularly high incidence of workers who have not been paid the national minimum wage in the right way. Other sectors are hairdressing and retail, and there is some dispute about where the worst practice exists, but the care sector clearly has a major historical problem. That is in part attributable to the fact that many of the more complex rules on calculating working time are prevalent in the sector—for example, the calculation of travel and sleeping time. On those points, although I am sure that Members will appreciate that I cannot comment on individual cases, I want to restate the Government’s position: when workers are performing work under their contracts, they must be paid the minimum wage.

It is also worth noting that there is no perfect measure of non-compliance within the sector, and there is a possibility that current estimates of non-compliance overestimate work time and underestimate pay, because the information is reported by workers themselves. That is why we are continuing to work with the Low Pay Commission, the Office for National Statistics and others in order to improve our estimates and better understand the scale of the problem.

On the point that was mentioned by the right hon. Member for Oxford East (Mr Smith) and others, the Low Pay Commission’s proposals on transparency merit serious consideration, and we are looking at those and a number of its other recommendations. We are determined to continue to drive forward and send the very clearest signal to companies and employers that we are becoming less tolerant of non-compliance, and we want them to recognise that.

None the less, increasing compliance with the minimum wage in the sector remains a top priority for us and we are taking a number of steps to promote compliance and take stronger action against those who break the law. First, HMRC continues to focus on tackling non-compliance, but that activity is no longer reliant on worker complaints and instead targets employers with the highest risk of non-compliance, based on a range of intelligence and information. HMRC can now analyse information from, for example, other Departments, trade union representatives and the Low Pay Commission, and the evidence indicates that this targeted approach in the care sector is working. From April 2013 to January 2016, HMRC opened 443 cases in the social care sector and closed 308 of those. Of the 308 closed cases, underpayment of the national minimum wage was found in 32% of investigations—for total arrears of £442,000 to 3,000 workers, with penalties issued for a total value of £100,000.

Members have also raised the important issue of affordability within the sector, given the introduction of the national living wage. That pay rise for the lowest paid could be seen to be a threat in terms of increasing non-compliance. That is partly why we are taking steps to signal strongly our commitment to clamp down on it.

With an ageing society, social care funding is a major strategic issue for the country and this Government. We are engaging closely with all the relevant stakeholders on that issue to ensure that councils recognise the need to increase the price that they pay for care in order to cover costs and to reflect rising costs and, not least, the national living wage. That is partly why we are giving local authorities access to an extra £3.5 billion of new support for social care by 2020, to be included in the better care fund. Councils will also be able to introduce a new social care precept, allowing them to increase council tax by 2% above the existing threshold. Taken together, the new precept and the additional better care fund contribution mean local government has access to the extra funding that it will need to increase social care spending in real terms by the end of this Parliament.

Clinical Negligence Claims

Christina Rees Excerpts

Wednesday 9th March 2016 Westminster Hall

[Ben Gummer]

I hope that I in no way suggested that any of the claims brought forward were frivolous. I am saying that the way in which the current system is constructed loads costs at the beginning, and that does not help get us to a fair and equitable solution as quickly as possible. I am merely positing, but I believe there is fault on both sides. It is not necessarily the fault of either organisation; it is the fault of the system as a whole, which does not encourage good behaviours. The result is that we are not extracting learning as quickly as possible from litigation; we are not using claims, when unfortunately they are brought, to ensure that we improve medical practice; and, frankly, we are not using the early stage of complaints sufficiently well to ensure that claims are not brought.

I entirely agree with my right hon. and learned Friend that almost all complainants are not after a financial reward; they just want someone to say sorry and to accept responsibility for what happened. If we can achieve that far quicker in a learning culture, we will do something remarkable, not just for them, but for the many people who will follow. In answer to the right hon. Member for Wolverhampton South East (Mr McFadden), the estimate of savings proposed in the initial consultation document was part of the spending review round, and it was done through the usual modelling processes employed by the Treasury and the NHSLA, which understands the value of claims coming through.

My right hon. and learned Friend asked about the £250,000 limit. That limit was not arbitrary, but drawn from the original intentions of Lord Justice Jackson’s review on civil litigation costs in 2010, with which I know he is well acquainted. In that review, Lord Justice Jackson pressed for fixed recoverable costs in the lower reaches of the multi-track up to £250,000. That was in relation to personal injury claims, but, in trying to draw a line somewhere, we felt that that was an appropriate place, given his recommendation to do so. That is, however, subject to consultation. We want to hear the full range of views about where the limit should be placed. My right hon. and learned Friend’s contribution will be an important part of that consultation, and I and officials will take note of it.

My right hon. and learned Friend spoke of the Chinese walls and why the Department of Health is bringing forward this review. He is well aware of the usual practice that Departments bring forward proposals that relate to their areas of responsibility. The Ministry of Justice did so in previous reforms in which it had a financial interest, just as the Department of Health is doing here. I hope that, in our open approach, we will be able to explain that our primary concern is around changing the culture of the NHS and making sure that we are driving down claims for good reasons—that there are fewer of them because we are improving clinical practice—rather than just trying to deny people access to justice, which is the opposite of one of the intentions of the review.

The hon. Member for Torfaen (Nick Thomas-Symonds) is entirely right to say that we should ensure that we make justice as open as possible. The litmus test of the reform will be that, if people feel that, despite everything we are doing to make the NHS a better organisation—listening to complaints, learning from mistakes and providing restitution early—they still wish to bring forward a claim, it will be easy to do and no unreasonable barriers will be placed in their way.

[Christina Rees (Neath) (Lab)]

If a person has a claim as a result of a serious injury, but they cannot get legal representation, that person is still severely injured and the costs will still fall back on the state.

[Ben Gummer]

I am well aware of that, and that is why we need to ensure that, at the end, the reform produces good effects rather than deleterious ones. I am aware of the concerns of the hon. Lady and many hon. Members, but I ask her to be open to what the Government are trying to do and to feed in her suggestions for how we can make the system better, because clearly at the moment, as I have tried to explain, it is not working in the interests of patients in the NHS. That is why we so badly need reform of the clinical negligence system.

Finally, my right hon. and learned Friend spoke about the speech that the Secretary of State is due to give—he will brief the House in due course—and wondered whether punishment was being confused with civil law remedies. We must all understand—many in the clinical negligence community have not quite grasped this—that a revolution is going on in medicine at the moment, learning from other sectors such as air accident investigation, that appreciates that one can have learning and lessons learnt in an organisation only if one provides safety for clinicians, for example, to speak openly when something has gone wrong. Sometimes we need to provide context around such discussions to make them feel safe. That has been achieved for air accident investigations and we want to do something similar for the NHS, so the Secretary of State will make more of that plain to the House in due course.

None of that is to change the basic freedom of people to find remedies in law. As we develop this exciting area of medicine in the next few years, I hope that the interplay between those two will mean reductions in deaths, accidents and patient safety problems in the NHS by tens of thousands and then hundreds of thousands in the years to come. That will possibly be one of the biggest factors in reducing mortality in the NHS since its foundation more than half a century ago.

Question put and agreed to.

Crohn’s and Colitis Treatment: England

Christina Rees Excerpts

Wednesday 24th February 2016 Westminster Hall

[Mrs Anne Main (St Albans) (Con)]

I beg to move,

That this House has considered the treatment of people with Crohn’s and colitis in England.

It is a delight to serve under your chairmanship, Sir Roger. I am aware that there are different treatments in Scotland and Wales, but I want to focus on Crohn’s disease and colitis in England.

I am pleased to be leading this very important debate on Crohn’s and colitis, which affect more than 250,000 people in England and 300,000 in the UK. I have been working with the charity Crohn’s and Colitis UK, some of whose members are here today. They would be delighted to meet any hon. Members participating in the debate because they would like to get some publicity for that particularly wonderful charity, which is based in my constituency in St Albans. It does a tremendous amount of work for those who live with these challenging conditions.

I am also pleased to say that I have been reading the feedback from the digital debate on Facebook. That is a new concept, and I am very pleased that the House is offering it. I wish to express my thanks to Crohn’s and Colitis UK and the Westminster Hall digital debate team for arranging the online forum. We received 1,068 comments on the forum, and the posts were shared 258 times and liked 734 times, so it has been highly informative to this debate.

Crohn’s disease and ulcerative colitis are the two main forms of inflammatory bowel disease. Both are chronic lifelong conditions that cause inflammation of the digestive system. Ulcerative colitis affects only the large intestine, whereas Crohn’s disease affects the whole digestive system. According to the National Institute for Health and Care Excellence, it is estimated that in the UK 115,000 people have Crohn’s disease and 146,000 have ulcerative colitis. That is an estimated 460 people per constituency. I keep using the word “estimated” because there is no national database. At my last meeting with the charity, it stressed that it would very much like there to be a national database and better record keeping on those people who are presenting with the disease.

The most common symptoms of inflammatory bowel disease include diarrhoea, cramping pains in the abdomen, tiredness and fatigue, and loss of appetite and loss of weight. The exact causes of Crohn’s disease and ulcerative colitis are unclear, but there is evidence that IBD can cluster in families, and having an affected family member is a risk factor. IBD is a lifelong condition, but people can get it at any age. It most commonly first presents in the teenage years and early twenties—the mean age of diagnosis is 29.5 years. About 18,000 new cases of IBD are diagnosed each year, and that number is increasing. This is not a trivial complaint. IBD can be painful, disrupt normal activities and reduce quality of life, particularly during periods of active disease. These conditions can affect the individual’s ability to work, learn, socialise and form and maintain relationships.

We British are famous for our lavatorial sense of humour, and just saying the word “bottom” or “bum” is usually enough to bring on a fit of the giggles, so it is no surprise that we, the British public, are not good at discussing bowel problems or even seeking help for them—no wonder IBD has been described as a hidden disease. That reluctance can lead to sufferers feeling isolated and stigmatised.

According to Crohn’s and Colitis UK, the causes of IBD are a combination of factors. Those include the genes that a person has inherited, together with an abnormal reaction of the immune system to certain bacteria in the intestines, probably triggered by something in the environment. Viruses, bacteria, diet, smoking and stress have all been suggested as environmental triggers, but there is no definitive evidence that any one of those is the cause of IBD. That is why, as I know the charity would also say, we need more research and more evidence. We need IBD to have a higher profile, as it affects so many of our constituents.

There is currently no cure for Crohn’s or colitis. The main aim of treating IBDs is either to heal the inflammation and so reduce symptoms during a flare-up or to prevent flare-ups from happening. NICE has recommended a number of different medicines for IBD, which can be taken in different ways by patients, but if individuals do not respond to medication, surgery is considered as an option—20% of people with ulcerative colitis and about 60% to 70% of people with Crohn’s disease go on to have surgery. A large number of our constituents will be forced to have surgery as a result of the disease. The lifetime medical costs for IBD are comparable to those for other major diseases such as diabetes and cancer. It is estimated to cost £900 million per annum, UK-wide. Crohn’s and Colitis UK currently funds about £500,000-worth of research every year into the causes of IBD, and treatments and care for people with IBD. Although that sounds like a large amount of money, in terms of the number of sufferers it is not a large amount.

There is a new research study under way from the National Institute for Health Research, called the IBD BioResource. The aim is to accelerate research into Crohn’s disease and ulcerative colitis and build on recent major advances in the understanding of the genetic basis of these conditions. The IBD BioResource is being launched for roll-out nationwide through 2016. I ask my hon. Friend the Minister how much support the Government are giving to the IBD BioResource study.

Crohn’s and Colitis UK says that there is a low level of awareness of IBD among the public, policy makers and even clinicians. It says:

“Public awareness of IBD is lower than for Parkinson’s and MS”—

multiple sclerosis—

“respectively, despite more people being affected by IBD than both diseases combined.”

Most of us will be very familiar with those two diseases.

At this point, I want to include some of the comments from the digital debate on Facebook. One contributor said:

“I’ve had Crohn’s for 18 years. For me it’s pain, fatigue and always having to explain to people what’s wrong with me and why I can’t come to work or do things.”

Another referred to:

“The Stigma of having a bowel disease. People not believing you and belittling how you feel because they can’t see it.”

Another said that we need:

“To raise more awareness of the illness! Make people more aware of what we go through on a day to day basis!”

Another talked about:

“Having to try, and try, and TRY to make people realise that it’s a disability and that just because you ‘don’t look ill’ (in a wheelchair) you still have issues that they will never understand.”

Many made the point that the illness controls and disrupts their lives to such an extent that they are in fact disabled by it. It is a hidden disability, and many call for it to be recognised as a disability. Therefore my question for the Minister is this: what are the Government doing to increase awareness of inflammatory bowel disease, and what are they doing to measure accurately the number of people living with IBD in England?

The charity tells me that early diagnosis of Crohn’s and colitis can prevent emergency hospital admissions, which have a cost to the NHS, and can help to avoid clinical complications. Unfortunately, in a substantial number of cases that is simply not happening. Studies have shown that 35% of people with Crohn’s and 16% of people with colitis had three or more emergency admissions before they received their diagnosis.

In the digital debate on Facebook, a sufferer said:

“I was treated for 6 months by my GP for food poisoning and/or anorexia before eventually ending up hospitalised as an emergency. The hospital did biopsies that day and confirmed Crohn’s. My Crohn’s turned out to be particularly aggressive and unresponsive to treatment and numerous surgeries.”

Another said:

“GPs need to be more up to date with IBD and stop saying it’s just a virus or IBS”—

irritable bowel syndrome. They continued:

“It took quite a few years of pain and complaining before I was diagnosed with Ulcerative Colitis.”

There is clear guidance from NICE on referral. The NICE quality standard for IBD states that people who have been experiencing abdominal pain or discomfort, bloating or a change in bowel habits, such as diarrhoea, with or without rectal bleeding, for at least six weeks should be suspected of having IBD. However, the feedback is clear that for many that is currently not happening and the guidance is not being followed.

NICE recommended faecal calprotectin testing as an option to help doctors to distinguish between inflammatory bowel diseases, such as Crohn’s and colitis, and non-inflammatory bowel diseases, such as IBS. That testing should enable quicker identification of suspected IBD and referral to a specialist, and reduce the number of unnecessary endoscopies carried out. Therefore more effective use of faecal calprotectin testing in primary care should enable quicker and more economical diagnosis of IBD patients, ensuring better and more efficient care in England.

What steps will the Minister take to improve the identification of suspected IBD? What are the Government doing to increase awareness of IBD in general practice among GPs? What steps will she take to improve the rate of referral of people with suspected IBD from primary care to the experts in secondary care? Will the Department undertake an evaluation of the uptake of faecal calprotectin testing by clinical commissioning groups, which NICE recommends, and the time taken by labs to process the results?

The IBD standards have been widely recognised throughout the IBD community, and later rounds of the IBD audit have benchmarked IBD services directly against them, but there is still a lot to do. Some 14% of services are still unable to provide people with Crohn’s or colitis with access to an IBD specialist nurse. Many of us would think of having access to a Parkinson’s specialist nurse, but IBD specialist nurses are few and far between, and many that have them struggle to maintain that vital service. Nearly one in four—23%—of all services have no access to specialist nutritional support despite the high level of malnutrition experienced by people suffering with IBD. Only 12% of services have a clear process to enable people with IBD to see a psychologist or a counsellor with a particular knowledge of IBD, and IBD has been described on many occasions as being a traumatising disease that leaves many people feeling isolated and unable to discuss with anyone—sometimes even their partners and closest friends—the reasons why they are often ill.

Sufferers complained online of a postcode lottery with IBD nurses. The lack of nurses was cited by many, who also said that GPs needed more training to identify people with Crohn’s and to assist in providing faster referrals or appointments when treatments need adjusting. Some sufferers found that their GP even seemed reluctant to make those referrals. Many sufferers said that employers need to have a greater awareness of the impact of IBD on their employees, especially given that flare-ups can occur at any time.

What is the Department doing to ensure the implementation of the IBD standards in England, and can the Minister give assurances to those living with IBD that they will not be forgotten on a strategic level by the NHS? What action is the Department taking to ensure that the NICE quality standard for IBD disease is being implemented across England? For those living with IBD, debilitating symptoms such as diarrhoea can occur instantly and unpredictably. Crohn’s and Colitis UK has been championing quick access to suitable toilet facilities. I hope the Minister will encourage all local authorities to evaluate the public toilet provision in their locality.

[Christina Rees (Neath) (Lab)]

Increasing access to toilets away from home is of benefit to all groups in society but it is especially crucial for those living with Crohn’s and ulcerative colitis, who have concerns about not reaching a toilet in time. Does the hon. Lady believe that other nations in the UK can learn from Welsh Labour’s Public Health (Wales) Bill, which treats access to toilets as a public health issue?

[Mrs Main]

It certainly is a public health issue. In the first Parliament I was in, from 2005 to 2010, I was on the Select Committee on Communities and Local Government and we looked into the issue of toilet access. I do not think that much has improved since then and that was under a Labour Government. I am sorry to say that we have not made a lot of progress. At the time, ordinary businesses were showing and displaying signs reading, “We welcome people using our public facilities.” The evidence that came out of that Communities and Local Government Committee report was that toilet provision was not just needed for people with things such as Crohn’s and colitis—there was a vast spectrum of other conditions for which people would welcome toilet provision, but that is for another debate.

It is very obvious that more focus on the cure and cause of IBD is urgently needed. I hope the Minister will give sufferers of this debilitating disease a cause for hope and a better future. I look forward to her answers—I hope she can give them today—to a large number of the questions that I have raised on behalf of those who have responded to the online debate and on behalf of the charity Crohn’s and Colitis UK, which is doing such a lot of good work. Look for the purple badge.

Off-patent Drugs Bill

Christina Rees Excerpts

Friday 6th November 2015 Commons Chamber

[Nick Thomas-Symonds]

I do not accept that that is a risk of the Bill. As the hon. Lady knows, the drugs are available for pennies a day. Under the Bill, the Government would step in to address a market failure. The Bill will not have the impact that she believes it will have. She makes a reasonable point, but it is not one that will arise under the apparatus and structure proposed by the Bill.

The alternative to the Bill—I firmly believe that if this Government do not do this, a future Government will have to legislate—is to continue to encourage more off-label prescribing. Even if that were desirable, very little has happened. In a letter dated 2 November, the Royal College of Physicians states:

“As there has been no meaningful progress on a non-legislative solution to this issue, we believe that your Bill is an important first step towards expanding access to these vital drugs.”

The proposal was debated a year ago and we have had a year to see whether there is a non-legislative solution to the problem.

The Bill has incredibly wide support across the professional spheres. I apologise in advance for not naming every charity that supports it.

[Christina Rees (Neath) (Lab)]

The Bill has the support of a huge number of medical research charities, which lead the way in research on the use of repurposed drugs. Currently, there is no route to market for off-patent drugs in new indications. Does my hon. Friend agree that the Bill will fix that anomaly?

[Nick Thomas-Symonds]

I agree entirely with my hon. Friend. Twelve medical research charities back the Bill; the NHS clinical commissioners in England back the Bill; and the British Medical Association backs the Bill. More than 10,000 members of the public have written to their MP in support of it. That is in addition to the 20,000 who wrote last year to the former Member for Cardiff North. Four of the medical royal colleges support the Bill. Forty eminent clinicians wrote in recent weeks to The Daily Telegraph to support the Bill. It has incredibly wide support across parties and among the professions.

Oral Answers to Questions

Christina Rees Excerpts

Tuesday 13th October 2015 Commons Chamber

[George Freeman]

I will happily look into that specific issue, discuss it with the right hon. Gentleman and see whether there is anything we need to do.

[Christina Rees (Neath) (Lab)]

11. What steps he is taking to improve support for carers.

[The Minister for Community and Social Care (Alistair Burt)]

I am not quite sure what the situation is in Wales, but in England I do not think that carers’ invaluable contribution to society has ever been better recognised. We are working very hard to see the implementation of the improved rights for carers enshrined in the Care Act 2014. I am also responsible for developing a new national carers strategy to see what more we can do to support existing and new carers in England.

[Christina Rees]

There are more than 6.5 million unpaid carers in the UK, with nearly 11,000 in my constituency. In total, they save the state more than £119 billion each year, which is more than this Government spend on the NHS . Research by Carers UK has found that nearly 50% of carers are struggling to make ends meet, and that is seriously affecting their health. What plans does the Minister have to work with the Department for Work and Pensions and the Treasury, and across government, to ensure that the improvement of carers’ finances will be a key part of the Government’s care strategy?

[Alistair Burt]

The work I am doing on developing the new strategy involves other Departments, and it will look at not only the economics, but what is happening internationally and where we can take the whole concept of caring for a different society in the future. The economics is certainly important; we could not do without the contribution that carers make, but it would be impossible to replace it with total Government finance.

Health and Social Care

Christina Rees Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Christina Rees (Neath) (Lab)]

Thank you for calling me to make my maiden speech, Mr Deputy Speaker. I congratulate the other Members who have made their maiden speeches today.

It is an honour and a privilege to be elected to represent the people of the Neath constituency, which is made up of beautiful villages and towns that are steeped in history, culture and sport. The people are caring and compassionate, with a great sense of humour. I pay tribute to my predecessor, the right hon. Peter Hain, who served Neath diligently for more than 24 years and held many ministerial and Opposition Front-Bench posts, including serving as Secretary of State for Wales and for Northern Ireland. His has been a consistent and prominent voice on domestic and international affairs, speaking for Neath, for Labour, for internationalism and for social justice. His and his family’s fight against apartheid and his role in the Northern Ireland peace process will long be remembered.

Peter Hain was elected in a by-election in 1991, after the sad and sudden death of Donald Coleman when he was on his way to the House. Donald Coleman was elected in 1964, taking over from D. J. Williams, who was from Tairgwaith and was a self-educated man—a true working intellectual who went to the Central Labour College with Aneurin Bevan and Jim Griffiths. Last Saturday, I visited constituents in Tairgwaith with the Welsh Assembly Member for Neath, Gwenda Thomas, a former Welsh Government Minister for health and social care. She is from nearby Gwaun-Cae-Gurwen, famous as the birthplace of the legendary rugby player Gareth Edwards and the actress Siân Phillips. My agent, local councillor Arwyn Woolcock, was with us. He lives in Lower Brynamman, next door to the grandmother of Welsh First Minister Carwyn Jones. Wales is just one big family.

Donald Coleman’s life and the history of the Neath constituency is commemorated in a beautiful stained glass window in St Thomas’s church in Neath town centre. I am going to describe the window to give the House a flavour of my wonderful constituency. At the top of the window is the portcullis. Donald Coleman was very proud to be the MP for Neath, as I am now. The red kite and the badger are in the window, illustrating his love of wildlife. Just before he died, he presented to the House the Wildlife and Countryside (Amendment) Bill, which extended protections to the red kite. The Bill should have fallen, but it was taken through posthumously by the right hon. Ron Davies. I saw a red kite flying over the village of Seven Sisters last week and it was a wonderful sight.

Seven Sisters village was named after the seven daughters of the local coal-owner, Evan Evans Bevan, but do not ask me to name them all. However, I can name the captain of Seven Sisters ladies rugby football team, who have adopted me as their mascot. She is Bethan Howell, Welsh rugby international extraordinaire. She offered me a game with Seven Sisters, but there are already too many left wingers in the team.

The president of Seven Sisters rugby club is the former MP for Aberavon, Dr Hywel Francis, who has returned to live in the Neath constituency. Aberavon’s loss is undoubtedly Neath’s gain.

In March, there was the 30th anniversary of the formation of the miners support group that was set up by Hefina Headon and others. The anniversary was celebrated in the Onllwyn Miners Welfare Club, which is otherwise known as the palace of culture. Bronwen Lewis sang “Bread and Roses”, as she did in the film “Pride”. The words of the song and Bronwen’s beautiful voice reduced us all to tears.

“Pride” was filmed in Banwen, the home of the Dove workshop, which was set up by Hefina, Councillor Moira Lewis and Mair Francis at the end of the miners strike. Dove retrained women to work because the men had lost their jobs, but later it opened its doors to men as well.

Aberdulais Falls is the centrepiece of the church window and one of the top tourist attractions in Wales. Its beauty was captured on canvas by Turner.

The town centres of Neath, Pontardawe and Glynneath have been regenerated with the help of European funding drawn down through the Welsh Government. They are vibrant again, and a reminder of the importance of European Union membership for my constituency, Wales and the United Kingdom.

The children of Ysgol Maes Y Coed in Bryncoch recently visited St Thomas’s church and were so inspired by the window that they have based an exhibition on the story of St Thomas’s life. That exhibition has been entered in the national schools heritage competition. These children have additional learning needs. They have created their own windows and made a video on human rights. These are remarkable achievements that deserve the highest recognition.

The last five years have been very tough for the people of the Neath constituency. I am concerned about the lack of employment opportunities, especially for the under-25s. Youngsters have to leave their communities to find work and I pledge to work on their behalf in Parliament. Communities have been split apart by the bedroom tax. The disabled have suffered the most. In-work benefits have soared because of poor wages, and many working people have to borrow from credit unions to make ends meet; indeed, many people have to rely on food banks.

I am afraid that the contents of the Queen’s Speech show that the next five years will be even tougher. It is my job to serve all my constituents without fear or favour to overcome these injustices, and to work with councillors, Assembly members, trade unions and our Member of the European Parliament, Derek Vaughan, who was once the distinguished leader of Neath Port Talbot council. One of Derek’s last duties before entering the European Parliament was to ensure that the new Swansea University campus was achieved, and of course that it was located within the Neath Port Talbot area. The present leader of the council, Alun Thomas, is the only Welsh council leader to have been awarded an honorary doctorate by Swansea University.

I urge the Government to approve the Swansea bay tidal lagoon project, which will bring green energy, jobs, apprenticeships, tourism and water sports to the bay region, of which Neath constituency is an important part.

I am grateful to you, Mr Deputy Speaker, for allowing me to speak today.