Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 24th February 2015 Commons Chamber

[Mr Hunt]

Absolutely. It was a fantastic development for Worcestershire Royal hospital. My hon. Friend campaigned very hard for it, and it is fantastic for his constituents. Cancer treatment is expensive, which is why we can only fund developments in cancer if we have a strong economy. That is what this Government are committed to doing for our NHS.

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

May I draw the Secretary of State’s attention to an excellent debate we had in the Chamber on 5 February under the auspices of the all-party group on cancer? May I also draw his attention to the uncertainty surrounding the funding of the national cancer peer review group programme? That programme has recently been reviewed and the Minister had indicated that the funding would continue. Will he take the opportunity to give a commitment to funding that peer review group, because there seems to be some doubt among the 17 national cancer charities that support its work.

[Mr Hunt]

Let me reassure the hon. Gentleman that we are absolutely committed to furthering and improving peer review as a way of winning the battle against cancer. The NHS is committed to that programme, and it is just looking at how it can be improved. [Interruption.]

Francis Report: Update and Response

Grahame Morris Excerpts

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for his interest in the issue of culture change, including at his local hospital, which I visited last week and where I was pleased to see a change in culture happening, despite some very severe problems. It is excellent that PASC is doing this inquiry, and his suggestions sound very worth while. We will consider them as part of our consultation—in fact I would encourage his Committee to submit them formally, to ensure that we give meaning to these “freedom to speak up” guardians.

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

I welcome the report by Sir Robert Francis and the Secretary of State’s commitment to changing the culture around the protection of whistleblowers—the Health Committee recently published a report making specific recommendations about such protections. May I draw the Secretary of State’s attention to the actions of the General Medical Council, which wrote to the employer of a whistleblower who gave evidence to the Committee after he had expressly stated that he was acting in a personal capacity in raising questions and providing evidence of financial inducements being paid by private health care companies to secure referrals?

[Mr Hunt]

I am happy to look into that case carefully, if the hon. Gentleman will supply me with the details.

Improving Cancer Outcomes

Grahame Morris Excerpts

Thursday 5th February 2015 Commons Chamber

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

I place on record my thanks to the Backbench Business Committee for allocating time for this timely debate on cancer services. I also thank the hon. Member for Basildon and Billericay (Mr Baron) and the various co-sponsors who made the case for this debate. I pay tribute to the various all-party groups covering the issues. Many Members are dedicated to particular groups and play an important role in compiling research, getting information to Ministers and raising specific issues in Adjournment debates. We should pay tribute to all of those people for all the work they do, irrespective of which party they represent.

I wish to raise two specific issues; one that, I hope, is not terribly controversial but another—an issue I have raised previously—that I suspect might be. The hon. Member for Castle Point (Rebecca Harris) touched on it as well. I echo the comments of the hon. Member for Basildon and Billericay that we have made excellent progress within the NHS on tackling cancer and bringing forward new treatments and on promoting early diagnosis. But there is still an awful lot we need to do. I get angry when I see reports indicating how badly we are doing in this country at treating cancer patients when looking at international comparators. I know it is difficult because like has to be compared with like and there are issues about centres of excellence. I understand all that, but I think the NHS should be the best in the world. We argue about resources, but the funding should be there to deliver an excellent service.

The most recent Concord report on the use of advanced therapeutic radiotherapy puts the UK behind in Europe for certain cancers, but also behind Malaysia, Indonesia and Puerto Rico. It says there are a range of reasons why we are falling behind, and one of them is the lack of access to advanced radiotherapy.

Today, cancer treatment in England is an area of health care where the most money is spent on the least efficient method of treatment. I do not want this to become an argument between the cancer drugs fund and alternative cancer treatments, because they are, in essence, complementary. My concern is that we have taken our collective eye off the ball and have not made sufficient investment in what could, as the hon. Member for Castle Point mentioned, save many thousands or tens of thousands of lives, particularly outside the regions where there is limited access.

According to the Department of Health commissioning guidelines, radiotherapy cures 16% of all cancers on its own. When combined with surgery, that figure becomes over 40%. I know that my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), on the Opposition Front Bench, has heard all these figures from the Society of Radiographers before, but they are important statistics. In comparison, cancer drugs, which are incredibly expensive—there is a huge outcry if the National Institute for Health and Care Excellence does not approve a cancer drug or if resources are not put into the cancer drugs fund—are statistically very different. If we look at the statistics in a cold and objective way, we find that cancer drugs by themselves cure only 2% of all cancers. The drugs are effective only in combination with other therapies such as surgery and radiotherapy.

Modern technology has made radiotherapy more effective and much safer for cancer patients. Yet the cancer drugs budget consumes a far larger proportion of the NHS budget in comparison with the radiotherapy budget, which I believe is in the order of £400 million. The disparity is huge because of the requirement to invest in the infrastructure, staff, training, evaluation of techniques and so forth. I personally do not understand how we can make a moral or economic case for not putting greater emphasis on advanced radiotherapy.

There is, in my view, no better example of unbalanced spending than in this country’s appalling record in delivering SABR—stereotactic ablative body radiotherapy—to cancer patients. This is one of the most precise ways of delivering radiotherapy. It is so accurate that it allows tumours to be targeted in a way that was almost impossible 10 years ago, and it can do so without causing harm to healthy tissues.

I went to see one of these machines in operation. I managed to get one of my constituents referred to a unit in St Bartholomew’s hospital. I saw that the machine focuses a beam—in fact, 200 beams—of intense radiation precisely on to the tumour. This is an incredible development in medical technology. It has the added benefit, because of its accuracy, of reducing the number of radiation doses a cancer patient needs from 30 to five. I recall undergoing two courses of radiotherapy like that myself some years ago. That was the standard procedure then; now it is potentially condensed through this advanced form of treatment to five doses. That will be invaluable for older patients. Members have talked about inequalities and how patients over 75 are often unable to access surgery. Perhaps the medical opinion is that they might not stand up to surgery or that conventional radiotherapy might not be an option for them.

SABR is now used to treat 18 different cancers in the United States. Closer to home, in Europe, it is used routinely in countries such as Italy, Belgium and Switzerland. Its use in France is so well developed that in one centre in Lille the SABR machine is treating 500 patients a year, whereas an identical machine in our country treats fewer than 100. It is all to do with the number of staff who are trained to deal with extended operations. I met a member of the Lille team at a conference in London, and he explained to me how they were able to achieve such a tremendous throughput.

A recent international survey of more than 1,000 clinicians in 43 countries revealed that 83% of them were using SABR. Only 34% of our radiotherapy centres in the United Kingdom—and it should be borne in mind that we have 28 cancer networks—have the capability to deliver SABR, and nearly all of them use it only for treating lung cancer.

Five years ago the National Radiotherapy Implementation Group, which consists of some of the best cancer doctors in our country, produced a plan which received extensive support, and which I have raised—not with this Minister, but with her predecessors—during Health questions and Adjournment debates. The plan would allow a wider range of cancer patients in England to be treated with SABR. More importantly, the group recommended that patients should be treated closer to their homes, in centres of excellence. My region, in the north-east, has two cancer centres. Why should your constituents, Madam Deputy Speaker, have to travel from Bristol to London in order to have access to advanced radiotherapy?

Sadly, that report was ignored—before the present Minister took office, I should add. However, the hon. Member for Wells (Tessa Munt), to whom I pay tribute, has been tenacious in raising the issue since I entered the House in 2010, and, following a campaign by the former England rugby captain Lawrence Dallaglio, which lasted for about two years, NHS England was finally persuaded to start putting it right. The “Dallaglio agreement” will allow our country to start treating cancer patients with SABR and to increase the number of cancers that are treated. It will facilitate the development of centres of excellence in the English regions. I certainly hope that we shall have some in the north-east. Those of us who represent constituencies outside London should pay attention to the agreement. We need to ensure that those centres of excellence are created, because they will be able to treat hundreds of cancer patients each year closer to their homes and families, and will have the right technology and staff who are trained to use it.

However, the Dallaglio agreement is just the beginning. We have a long way to go before we can catch up with our European neighbours. In particular, we need to adapt more skilfully to new technologies as they become available. Quicker adaptation does not mean cutting corners with patient safety; other countries appear to be able to use new technology safely, and to be adapting to it much faster than we are. New technology does not have all the answers, but it cannot be a coincidence that countries that adapt speedily to technological advances seem to have much higher cancer survival rates than we do.

This week, Cancer Research UK said that half of us living today will get cancer. The NHS needs to work out how to deal with that. Cancer is one of the biggest health challenges we face in the 21st century and we need to know that in tackling it we are utilising our valuable resources most effectively. The Government should conduct a full and independent review into the matter, particularly if they are going to spend many billions of pounds on cancer drugs as the best way forward, at the expense of adopting rapid advances in technology, especially robotic technology that is making radiotherapy safer, more efficient and better for patients.

I would like to address another important matter: end-of-life care and the need to make improvements for people with cancer. Seventy-three per cent. of cancer patients want to die at home but less than a third are able to do so. The palliative care funding review has pointed to the fact that providing free social care is key to supporting people to die at home. Evidence from Macmillan suggests that savings of £345 million could be made. The right hon. Member for Sutton and Cheam (Paul Burstow) will remember the debates that we had. I think we won the argument, although we lost the vote. I sensed that there was a lot of support for free end-of-life care across all parties. I press the Minister to consider that. The Government previously stated that they saw much merit in such a policy. Does the Minister still see merit in the principle of free social care for people at the end of their lives?

Two further policies are fundamental to improving end-of-life care. The first is the provision of 24/7 community care to ensure that, regardless of what time of day it is, if someone is at the end of their life, they do not have to contact the emergency services to be admitted to A and E. Secondly, there should be better recording of patient preferences at the end of life and better sharing of information between all the services that come into contact with that patient. I support the motion.

GP Services

Grahame Morris Excerpts

Thursday 5th February 2015 Commons Chamber

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

I congratulate my hon. Friend the Member for Halton (Derek Twigg) and the hon. Member for Brighton, Pavilion (Caroline Lucas) on securing the debate, and all those right hon. and hon. Members who supported the bid to the Backbench Business Committee, and the Committee itself, on accommodating the debate.

It has been said before that when someone is the last person to speak in a long debate they find that perhaps everything has been said—but not everything has been said today. I will try not to repeat the arguments that have been rehearsed, but I wish to air two specific points that have not been covered. One is about the importance of GP work force planning, and the other is about the north-south divide and the need to refine our recruitment to address inequalities in areas of particular need.

We must accept, although Government Members are reluctant to do so, that we have a crisis on the front line—primary care and GP services are the first line of our NHS. I do not want to apportion blame—I can see the Minister staring at the heavens thinking, “Here we go again”—because I will let others do that. However, I wish to identify some problems and propose some practical solutions to address this crisis, because we face an unprecedented health challenge and it certainly has a bearing on what is happening elsewhere in the health service, particularly in accident and emergency.

We are all aware now, because it has been repeated many times, that we have an ageing population; people are living longer, and they are living with multiple and much more complex long-term conditions. Numbers have been given on the rapid increase even between 2008 and 2018, when we estimate that the number of people living with multiple long-term conditions will rise from 1.9 million to 2.9 million. Dramatic projections are made about the numbers of people who will have dementia, who will be living with cancer—surviving it and living beyond that—who will have diabetes, and who will have heart disease. Despite the increase in the age of the population and rising demand, GP numbers have not kept pace with population growth and with this increase in demand.

As today’s motion states, local GP services play a “vital role” in our communities, with 1 million patients every day receiving care from their family doctor or a nurse based in a GP practice. Many Members have mentioned being contacted by the Royal College of General Practitioners about its Put Patients First campaign, which highlights some alarming statistics: as many as 90% of doctors are saying that general practice does not have sufficient resources to cope; and spending on GP services as a share of the NHS budget has been falling and, at 8.3%, is at an all-time low. Surveys carried out by the BMA have been showing that six out of 10 GPs were considering taking early retirement because of the stress of an increasing work load, with a third of them actively planning for their retirement.

The problem we face relates not only to early retirement, but to retention and recruitment. A large number of GP trainee vacancies are unfilled and there is a stark north-south divide; almost all trainee posts were filled in the south, but in my region of the north-east—an area with the highest levels of deprivation and health inequality, where there is already an acute shortage of GPs—30% of training places were unfilled. That was confirmed by the deputy chair of the BMA, Richard Vautrey, who said:

“These figures are deeply concerning and represent a serious threat to the delivery of effective GP services to patients.

They show that we are experiencing serious shortfalls in the number of doctors choosing to train to become GPs, which will ultimately mean fewer GPs entering the workforce across large parts of the UK, most worryingly in already under-doctored areas such as the North”—

including the north-east—

“and the Midlands.”

We need to address the imbalance in posts between the north and the south, because if we do not, as my hon. Friend the Member for Copeland (Mr Reed) indicated from the Front Bench, we will see a division in the standard of care. There is always a risk of this in different parts of the country.

I also recommend the “Securing the Future GP Workforce: Delivering the Mandate on GP Expansion” report by Health Education England. It states:

“There is a variation in availability of GPs of more than 40% between the most under doctored areas”—

which include the area I represent—

“and the areas with most GPs. Our most under doctored areas tend to be those with most deprivation, and therefore with the highest incidence of health inequalities.”

The Centre for Workforce Intelligence analysis shows that GP coverage is especially critical in the north-west and north-east.

I welcome my party’s announcement in this area and the important commitments that have been made to improve the NHS and, in particular, access to GPs. Our £2.5 billion “time to care” fund will help to integrate health and social care services, with more health services delivered in our communities. Inevitably, that will create additional pressures on primary care, and I fully support the aim of setting aside funding to employ 8,000 more GPs. I wish, however, to raise a question with my Front Benchers as well as the Government’s. Increasing the number of GPs alone will not address health inequalities, nor will it improve the health care services of my constituents if those resources are not properly targeted to the areas of greatest need, so I want to see real and practical solutions to the crisis.

First, I would like the Government to take a long-term approach, targeting and offering careers advice to children in secondary schools, sixth forms and colleges in areas where there are GP shortages, raising aspirations and promoting medicine as a viable career choice. If we increased the number of people from the north-east going into medicine, we would increase the pool of medical students willing to work in our communities, particularly if they have an affinity with and personal connection to the health and well-being of the community where they would be in general practice. The problem is that many newly qualified medical students are going back to their home areas in the home counties in the south and south-east.

Secondly, what steps are the Government taking to improve the number of GPs in under-doctored areas? Will they encourage postgraduate training in areas where there is the greatest work force need? One practical suggestion is to pay the student loans of medical students who are willing to work in under-doctored areas. In exchange, medical students would be expected to train and spend a specified number of years in employment in an under-served area. A survey by the BMA showed that up to 80% of medical students reacted positively to that option.

I am delighted to support today’s motion. I am interested to hear the responses from the Front-Bench teams on how we intend not only to increase GP numbers but to target and direct GP services to the areas of the greatest need. Without that distinction GP services will never be sustainable in the areas of highest deprivation, and the very communities that need access to greater GP services, such as east Durham, will not have it.

--- Later in debate ---

[Dr Poulter]

Indeed. My hon. Friend makes an important point and echoes that made earlier by my hon. Friend the Member for Truro and Falmouth (Sarah Newton). At the moment, a valuable part of our general practice work force, perhaps due to life circumstances or the fact that they have started a family and have had two children quickly one after another, face difficulties in going back into practice. Issues to do with the operation of what is called the performers list need to be looked at, and I will ensure that NHS England does so and considers how we can better support GPs to get back into practice when they have had career breaks for legitimate family and other reasons.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

I hope that the hon. Gentleman will forgive me. I may give way later, but I want to make some progress because this is a debate for Back Benchers. I will address the points that he made a little later on.

General practice funding is, of course, important. We must have regard to the primary care work force, how patients access their GP and how we structure primary care to get the best results for patients. It is only by looking at all these together that we can properly ensure the sustainability of the general practice services, which we are all so rightly proud of in each of our constituencies. Some excellent points on local sustainability were made by my right hon. Friend the Member for Chelmsford (Mr Burns) in an intervention, and by my hon. Friend the Member for Henley (John Howell). They spoke about the importance of co-ordinating local planning processes with the local NHS to better support GPs to develop practices in areas of housing growth. I am sure all local authorities will want to look at that in more detail.

On work force issues, being a GP is still a rewarding and well-paid career, with the average salary for a GP close to £110,000 per year. GPs are often the first point of contact for patients when they use our national health service. We should not lose sight of that in this debate. We have already delivered an increase of 1,051 full-time equivalent GPs who are working and training in our NHS since September 2010. This brings the total number of full-time equivalent GPs to 36,294, which represents a real increase in capacity under this Government. However, we know that there is still more to do. A report undertaken by the Centre for Workforce Intelligence last year warned of a demand-supply imbalance emerging by 2020 unless there is a significant boost to GP training numbers.

Before the report came out we had already made plans through work that Health Education England was undertaking to increase the number of GPs. NHS England has been working closely with Health Education England, the Royal College of General Practitioners and the British Medical Association to produce a 10-point action plan to increase the size and capacity of the general practice work force, which we have backed with £10 million of funding. This plan covers a wide range of measures to recruit more young, aspiring medical students to take up a career in general practice, retain those doctors already working there, and provide support for those GPs who have taken a career break and help them to get back into work—an issue that a number of Members raised in the debate.

[Grahame M. Morris]

Will the Minister address the point that I raised about under-doctored areas, particularly deprived areas, where we find it difficult to attract GPs? Would he consider writing off the student loans of those individuals in order to make it attractive to work there?

[Dr Poulter]

The hon. Gentleman and I do not often agree, but I agree with him on this. We have to do more to support medical students and to encourage people from all backgrounds to become medical students. It was a sad indictment of the previous Government that social mobility into many degree courses was falling, and that was particularly the case in medicine. We have been working with the medical schools to look at the importance of early engagement, supporting people from a much younger age, and universities engaging with local communities, as is the case at my medical school, Guy’s, King’s and St Thomas’, where people from more deprived backgrounds are supported and encouraged into medicine by the medical school’s engagement with schools and with pupils from an early age. That is the sort of approach that works.

One of the challenges is the distribution of medical schools and medical places often around our larger cities. The challenge is to support smaller and important medical schools, such as Lancaster, which does a great job of supporting local young people to become medical students and then into medical careers. We need to support those universities to expand where that is appropriate. Many of our traditional models of medical training at medical schools tend to focus from day one on encouraging people to become surgeons. We know that we need to support more people to become general practitioners. What works well and what Lancaster and Keele universities in particular do through their syllabus is to encourage more young people to undertake more placements in general practice. That has a good effect in encouraging those medical students to want to become GPs in their later medical careers.

NHS (Government Spending)

Grahame Morris Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie]

I think we got the gist of the intervention. The hon. Member for East Worthing and Shoreham (Tim Loughton) opposed such competition, but I think he voted for it in the Health and Social Care Bill. He has his own demons to worry about on that.

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

I, too, served on the Health and Social Care Bill Committee. Does my hon. Friend agree that one of the great problems we face with work force planning, as Government Members have highlighted, is that private sector providers by and large are not training the doctors and the range of staff we need to deliver an integrated health service?

[Chris Leslie]

My hon. Friend is right. That is the crucial difference between those on the two sides of the Chamber: Government Members are not interested in having private or voluntary sector supplements where there is need in the NHS; their agenda is to replace provision across the NHS and to contract out across the board.

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

I welcome this opportunity to discuss the NHS. In answer to the question from the hon. Member for Nottingham East (Chris Leslie), I reconfirm the Government’s commitment to an NHS free at the point of need and free at the point of delivery. Only with a strong economy can we afford to pay for our NHS.

It would be wrong to open my remarks without commenting on the Labour party’s increasingly regrettable approach of weaponising the NHS. I still work as an NHS hospital doctor. There are a lot of professional politicians on the Opposition Front Bench. In my capacity as a local MP, I have been out on the front line with the East of England ambulance service during night shifts over this busy winter period. Front-line NHS staff do not appreciate the way in which the Labour party is trying to run down our NHS. There are a lot of staff working incredibly hard over this busy winter period and they should be congratulated on the effort and dedication that they put into front-line patient care. I hope that the hon. Member for Nottingham East and the Leader of the Opposition will reflect on that.

As this is an economic motion, it is appropriate in my opening remarks to address the economic situation our country was in when we came into government. We inherited the worst economic record of any new Government since the 1930s. Labour’s record of economic incompetence and profligate spending meant that the annual deficit was £134 billion and that we were paying back £367 million each and every day in debt interest alone. I believe that the hon. Member for Nottingham East was a special adviser who advised on that profligacy and incompetence. Labour left Britain with its largest deficit since the second world war. One pound in every four that was spent by the Government came from borrowing. Labour’s outgoing Chief Secretary to the Treasury, the right hon. Member for Birmingham, Hodge Hill (Mr Byrne), summed it up in his note to his successor with the words, “Good luck. There’s no money left.” There we have it—Labour’s record of economic incompetence. Britain was bankrupted by the last Labour Government, but thanks to our long-term economic plan things have changed for the better and Britain is back on track. There are now 2.16 million more private sector jobs since the coalition came to power, and 2 million more people have started an apprenticeship. The Government are giving more young people a chance in life and the opportunity to take home a pay packet.

[Grahame M. Morris]

May I just point out one of the lessons from history? When the NHS was established after the second world war, the country was tasked with rebuilding and its debt and deficit were considerable. But the Labour politicians of the day had the strength of character and the will to make that investment in the interests of the health of the nation. Should we not do that now?

--- Later in debate ---

[Mr Mark Spencer (Sherwood) (Con)]

It is a pleasure to follow the hon. Member for Islington South and Finsbury (Emily Thornberry).

It is a little sad, to be honest, to be having this debate today, because we could approach this issue in a much more mature way as politicians. Clearly there are enormous challenges facing our health service and our adult social care services, not only for this Government or the next, but for the two Governments after them. As politicians, we owe it to our constituents to have a mature debate about how we are going to avert the demographic time bomb that is heading our way. Frankly, we all have an interest in that. Just like the hon. Member for Nottingham East (Chris Leslie), we are probably going to need those services at some point. I hope I will not find myself in a bed next to him, but we could end up on the same ward.

It is worth saying that every Labour party election leaflet for the last 50 years has said, “You can’t trust the Tories with the NHS.” Yet we have had countless Conservative Governments over that period, and the NHS continues to thrive, to look after people and to offer its services.

[Grahame M. Morris]

The hon. Gentleman is saying that the NHS is safe in Conservative hands, but let me remind him that in 1997, when Labour came to power, there had been 18 years—a considerable length of time—of under-investment. Expenditure on the NHS was increased 300% by the Labour Government: from £30 billion to over £100 billion. Every accident and emergency unit was rebuilt and many hospitals were rebuilt, too.

[Mr Spencer]

That is where the hon. Gentleman’s party falls down. Labour Members obsess about cash and forget about clinical operation. That is why we ended up with crises such as that at Mid Staffs hospital, with people dying in their beds because of bureaucracy, target setting and obsession with process rather than the care of patients.

The Opposition also have an obsession with the private sector. My father had to have a new knee, unfortunately. He went to the local hospital, which happens to be the one that the constituents of the hon. Member for Nottingham East attend. Rather than being treated in the NHS Queen’s medical centre, he was sent to a hospital in Sherwood in his constituency, which looked after him very well. It was a private hospital and this was in 2008—under the previous Government. The NHS was making use of private services back then. It was very efficient and well delivered. I do not understand this obsession with the private sector. We need to remember that private companies make the drugs that the NHS uses; private companies make all the crutches and the ambulances; and GPs are, in effect, private companies. It works very well. As long as we can deliver a service that is free at the point of use and run in the most efficient way but with the highest levels of care and consideration, I think that is the right place to be.

--- Later in debate ---

[Grahame M. Morris]

I am sorry to interrupt the hon. Lady’s flow, but I want to defend the land of my fathers, Wales. I do not know whether the hon. Lady was present for the urgent question. We often measure the stress on the system according to the declaration of emergency and major incident plans. There have been 15 in England but, as far as I am aware, none in Wales.

[Margot James]

I do not want to cast aspersions relating to cover-ups and the like on some of the NHS management in Wales, but I think that some members of the hon. Gentleman’s own party have some salutary tales to tell on that front.

However, as was pointed out by my hon. Friend the Member for Sherwood (Mr Spencer), this is not just about spending; it is about how we control the budget and what we get for the money that we spend. I appeal to those who rate the Labour party on the basis of its health policies to reflect on its record. They should remember how much Labour was borrowing when it was running the NHS, and that it was spending money as though it were going out of fashion.

Under the last Government, the number of managers increased three times as fast as the number of nurses, and managers’ pay increased far faster than nurses’ pay. The management pay bill more than doubled under the last Government, but we have reduced it by nearly a fifth. There was absolutely no integration of health and social care under the last Government, although they had 13 years in which to put that right. Despite severe financial constraints, our record has been so much better than theirs, and that is the position I will put to my electorate when the time comes. We have produced 13,000 more doctors and nurses, and 21,000 fewer administrators and managers. That is what the public want to see. They know that this Government have the right priorities. In my area, that has translated to 353 more nurses and 84 more doctors in my hospital since this Government came to power. I congratulate our health ministerial team on not caving in all the time to producer interests—another facet of the last Government, with their command and control culture.

I want to mention a few of the things I am proud this Government have achieved within severe spending constraints. We have ended the indignity of mixed sex-wards. We have reduced infection rates dramatically. C. difficile infection rates have come down by a staggering 63%. The last Government grappled with this issue for 13 years, leaving a disaster when they left office. They had an appalling record. Another great innovation—one of many; I have not got time to mention them all—is the Cancer Drugs Fund, which has helped many of my constituents to get the treatment they were denied under the last Government, with all their spending largesse. That has also flowed through to the hospital sector—imaging and radiodiagnostic tests have increased by 34%. All these benefits have been achieved with very small real-terms increases in spend. That is what this Government have been able to do: deliver more with less.

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

I am pleased to follow the hon. Member for Dover (Charlie Elphicke). I wish to make it clear that I have chosen to be here in the Chamber today to participate in this important debate rather than attend the Health Committee, which is also considering important matters, because I feel that we need to set out our view of the direction of the health service.

I was very interested in some of the hon. Gentleman’s views about fair funding. Having experienced NHS funding under the Conservatives and Liberal Democrats, I must say that my view is rather different. After the general election in 2010, the funding for a brand-new hospital that would have served my constituency—it was to be funded not through the private finance initiative scheme but by NHS capital—was cancelled by the present Government. It is an absolute disgrace that we still do not have modern facilities to serve my constituents and those of neighbouring constituencies. It prompts us to ask whether fair funding or some kind of gerrymandering is being applied.

The hon. Gentleman was talking about opening urgent treatment centres. That is a revelation to me because the two centres that opened in my constituency under the previous Labour Government are now threatened with closure. We have neither a modern hospital nor modern facilities.

I am proud to say that, although I am not a doctor, I did work in the health service. Like my hon. Friend the Member for Heywood and Middleton (Liz McInnes), I worked in a pathology laboratory, doing some important diagnostic work. I am proud of the people who deliver that service; I think they deserve enormous credit.

The creation of the NHS is Labour’s proudest achievement. More than anything else—more than football or cricket—it is what binds us together as a nation. The principle of a free national health service, which is free at the point of use, has huge popular support among the general public.

When the Prime Minister said that his priorities could be summarised in three letters—NHS—we might have been forgiven for thinking that the Conservatives had been transformed and had come to cherish the NHS as much as the British people do. But, with fewer than 100 days to the general election, it is apparent that his words were nothing more than a smokescreen. It is clear that the Government knew that they could never go into a general election stating their true intentions. Now, we have been accused of weaponising the NHS.

[Charlie Elphicke]

Yes, you have.

[Grahame M. Morris]

I would rather weaponise it than privatise it, which is what I accuse the Government of doing. That would not have been possible without the active support of the Liberal Democrat party—talking of which, the hon. Member for Redcar (Ian Swales) has just taken his place in the Chamber. I feel bitter about what has happened. The hon. Gentleman and I both served on the Health and Social Care Bill, which has now been enacted. The lead advocates were the right hon. Members for Chelmsford (Mr Burns) and for Sutton and Cheam (Paul Burstow). That Act was a really dangerous move, because part 3 opened up our national health service to the full force of competition. Conservatives may say that the difference is only marginal, but the truth is that that Act allows hospital trusts to have up to 49% of their income come from private patients.

I know that we are desperately short of time, but I want to set out some political dividing lines. Labour and the Conservatives are making very different offerings for the NHS. Labour’s offering is that it will provide more nurses and GPs, and I think it will find favour. In the next general election—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to follow the hon. Member for Leicester West (Liz Kendall). In truth, I think we have heard a great deal more consensus about the future of our health services than the Opposition sometimes like to pretend. It has been obvious that Members in all parts of the House care passionately about their local services. They have spoken up clearly on behalf of local staff who are working so hard through this winter. I thank all hon. Members for their contributions.

All Members speaking up for their constituencies are doing so because they care about their local health services. They also accept the challenge that the NHS and the whole health service in England is facing but is collectively rising to meet. Hard-working NHS staff do not need to hear the endless politically driven scaremongering that we hear all too often from Opposition Members. That was highlighted by my hon. Friend the Member for Daventry (Chris Heaton-Harris) and by many colleagues who have come here with scaremongering leaflets from their constituencies saying the very opposite of what is true. Far too much of that is going on. It must be absolutely demoralising for staff who are working hard in the face of winter pressures.

Despite the huge financial pressures we were faced with when we came to office, such as the need to reduce the deficit we inherited, which was, as Members have said, the worst peacetime—

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

I will make some progress; the hon. Gentleman has made a contribution.

Not only has NHS funding in England been protected; it has risen in every year of this Parliament. That is an indisputable fact that flies in the face of the Opposition’s financial scaremongering. As a result of the additional £2 billion funding for 2015-16 the Chancellor announced in the autumn statement, funding in 2015-16 will be £16 billion higher in cash terms than in 2010-11. Those are the facts. That equates to an increase of £6.8 billion in real terms. That additional investment is a down-payment on the NHS’s own plan, which was set out in the “Five Year Forward View”. The chief executive of NHS England, Simon Stevens, has said that the autumn statement gives the NHS what it needs for next year.

Winter is always challenging for the NHS. This year, it comes on top of a significant increase in A and E attendances, which have been higher than in any year since 2010. On average, 3,000 more patients each day are being seen and treated in under four hours than under Labour. As my hon. Friend the Member for Stourbridge (Margot James) set out clearly in going back over the past few years, the additional funding the Government have put in emphasises the priority we place on the NHS. That makes utter nonsense of the claim that we are going back to 1930s levels of funding. That is ludicrous, and Opposition Members parroting that because they have been told to insults the intelligence of every Member of the House. It is nonsense.

NHS Major Incidents

Grahame Morris Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. I have spoken to the chief executive of Northamptonshire county council and I have heard about the excellent integration of services that is now starting to happen between the local authority and the local hospital. That is the way forward. The guidance simply says that trusts must pay attention to the impact on the local health economy before they make a local decision. It is time that Labour stopped playing politics with something that they know is a disgrace.

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

Is the Secretary of State satisfied that the new guidance with its 17 criteria, to which my right hon. Friend referred, will not have the effect of making it less likely that NHS hospital trusts in the west midlands or in my region declare an emergency plan?

[Mr Hunt]

Declaring a major incident is the decision of the local hospital trusts, and that is right. But it is important that, before they make that decision, they should take proper account of the impact on the rest of the local health economy. That is what every responsible hospital wants to happen, and that applies to the hon. Gentleman’s area as well as everywhere else.

A and E (Major Incidents)

Grahame Morris Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

When we did the autumn statement last year, we asked Simon Stevens and NHS England how much they needed for their plan next year and they told us it was about £2 billion, so we made that commitment. We also said that that was a down payment on delivering the entire plan, not a one-off payment. I agree about the importance of long-term certainty over funding, but the most important thing in that regard is to have a strong economy that can deliver the money that will support our NHS. It is only Government Members who have shown that they are capable of delivering that strong economy rather than the instability that would come from disastrous economic policies.

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

The Secretary of State and Prime Minister accuse the Labour party of using the NHS as a political football and as a weapon. May I advise the Secretary of State that the NHS is a weapon—a very powerful one—for the treatment of illness and the relief of disease and suffering, and that it is being blunted by this Government and his Department under his stewardship? I met the chief executive of City Hospitals Sunderland NHS Foundation Trust about the NHS crisis and the A and E crisis, and one of the problems he identified was the lack of sufficient staff and the need to recruit locums. What is the Secretary of State doing about recruiting more staff and how many vacancies are being carried?

[Mr Hunt]

I agree that we need more staff, but the hon. Gentleman should welcome the fact that under this Government there are 9,000 more doctors and 3,000 more nurses. Such an increase was made possible by a reorganisation that took money away from bureaucracy and management and put it on to the front line. What is wrong is for the Leader of the Opposition to say that he wants to weaponise the NHS—turn it into a political weapon. The NHS is not a political weapon; it is there for patients. Labour should be ashamed of trying to turn it into a political football.

Late Stage Hepatitis C

Grahame Morris Excerpts

Tuesday 6th January 2015 Westminster Hall

[Stephen Pound]

I profoundly endorse my hon. Friend’s comments and I very much hope that what he refers to will be the outcome. It is a cruel irony if one presents at a hospital in search of good health, and ends up iller than when one went in. I certainly will refer to that later.

One of the highest levels of hepatitis C infection in this country is from injecting drugs. That is part of the stereotype, and it is the case that 49% of identified hepatitis C cases in England, 34% in Northern Ireland and 33% in Wales are from that source. There are significant public health risks of further transmission if hepatitis C is left untreated. This is the astonishing and terrifying aspect of hepatitis C, and if we achieve nothing else today, we can at least ventilate the issue and, I hope, bring it to the attention of a few more people in the country. Hepatitis C is one of the most sinister blood-borne diseases, in that it in effect lies dormant for 20 to 30 years in the blood. A person who lived a fairly rackety life in the 1960s may have no idea that they have been infected with hepatitis C. It may present itself 30 years later, when the symptoms of lassitude, fatigue, inexplicable tiredness lead the individual to go and see their medical practitioner; and it is a simple blood test—it does not require anything other than a spot of blood on a piece of paper—that reveals it. The sinister, long-standing, dormant nature of hepatitis C is something to which I wish to refer.

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

I congratulate my hon. Friend on securing an important debate. Does he agree that one problem that we face in tackling hepatitis C—he has outlined the scale of the problem; more than 200,000 people suffer from it—is the mixed messages coming from the Department of Health and, in particular, the information provided in an earlier debate in this Chamber by the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who said that hepatitis C is not curable when in fact, with appropriate treatments, the cure rates are between 80% and 95%?

[Mr James Gray (in the Chair)]

Order. One must be brief in a half-hour debate.

--- Later in debate ---

[Stephen Pound]

I enthusiastically endorse the approach of the Welsh Assembly Government on the matter, and their efforts have been widely respected and appreciated. One of the things that I seek today is precisely such an overarching, UK-wide strategy. It is important to note that the United Kingdom is the only country in Europe that is showing an increase in liver disease. All the statistics indicate that cases of liver disease, particularly hepatitis C, will continue to increase until they peak in about 2030. It is hoped that in 2030 they will tail off, partly because if we backtrack 20 or 30 years to the turn of the century, people had a bit more knowledge and understanding. One hopes that debates such as this will extend that knowledge and information outwards.

[Grahame M. Morris]

On that point, I completely agree that we need an overarching national plan and strategy as in Wales and Scotland, but is there not an obligation on the health and wellbeing boards, as part of their joint strategic needs assessment? In my region, my constituency has the highest incidence of hepatitis C, which is often associated with high levels of poverty and deprivation, but less than half of the health and wellbeing boards in our region identify it as any sort of priority.

[Stephen Pound]

I knew my hon. Friend’s predecessor very well, and we discussed the matter at the time of my Bill on presumed consent. I entirely endorse my hon. Friend’s comments about the health issues that affect his constituency, and I will come to precisely that point later when I refer to clinical commissioning groups.

On the question of how lethal hepatitis C is, there are a range of brand new therapies, many of which are moving rapidly through the health system. Treatments such as daclatasvir and sofosbuvir provide shorter courses of orally administered treatment with fewer side effects than previous treatments. Traditionally, people with hepatitis C have tended to be given treatments such as interferon or ribavarin, which are partly injected intramuscularly and partly oral, and which have some pretty horrific side effects. I made it my business to go and speak to the practice nurse at the hospital across the river who deals with such cases and supervises the courses of treatment. I heard the rather chilling comment that the side effects of interferon included not only nausea, dizziness, sickness and fatigue but nightmares, depression and occasionally suicide.

We have moved on a great deal, and we are no longer talking about purely an interferon or ribavarin treatment. Modern treatments do not cause the awful problems of anaemia and skin reactions that the older treatments did. I give credit to companies such as Bristol-Myers Squibb and others that have undertaken groundbreaking work in the area. Treatment used to take 48 weeks, and it is incredibly difficult to work or even simply to endure while receiving the treatment. The treatment cycle for the new treatments lasts 12 to 14 weeks, which is quite incredible and much more attainable. We reckon that 10% of people who are HIV-positive also have hepatitis C, and the new course of treatment is particularly effective in those cases. Patients will almost certainly continue their course of treatment if it is shorter and less painful. I do not have time to go fully into the economic benefits of somebody being able to remain economically active while they have hepatitis C, but under the new treatments, there is absolutely no reason why a person should not continue in employment, providing a useful function and benefiting the state.

The real difficulty is late diagnosis. The benefits of early diagnosis to the NHS and to the patient are self-evident. If patients do not receive early treatment, we can see the occurrence of cirrhosis, liver cancer and even the need for transplants. If we could only address the issue of early diagnosis, it would be not only cost-effective but good for the humanity of the individual. That is one of the reasons why I am particularly pressing for early diagnosis.

I have mentioned hepatitis A, B and C, and within each of those are genotypes that have different characteristics. There tend to be four different genotypes within hepatitis C, which are known as 1, 2, 3 and 4. Genotype 1 is typically associated with intravenous drug users, and my hon. Friend the Member for Ealing, Southall referred at great length and with considerable knowledge to genotype 3 at the recent launch of the programme of treatment for the south Asian community. Bizarrely, genotype 1, which was supposed to be the hardest to treat, has turned out to be one of the easier to treat. However, genotype 3, of which the opposite was the impression, is becoming extremely hard to treat. That is one of the reasons why “The Challenge of Hepatitis C for the South Asian Community” is all the more important. One way to deal with hepatitis C is to wait until the symptoms present, but the symptoms are very difficult, because there is no typical symptom of someone who has liver disease. Most commonly, the symptoms will be things such as lassitude and fatigue, but there can be numerous other factors.

I have mentioned the hepatitis strategy in Scotland. The effect of that strategy has been to improve access to treatment from 10% to 20% through better integration among health care providers. Of course, I understand that there is a smaller population in Scotland. People often talk about the situation in the Republic of Ireland, which has a very good identification programme. The reason for that is that there is only one place in the entire Republic of Ireland where someone can get the test, which happens to be in the Dublin health district, so all the data are gathered in one place. In GB, the United Kingdom and England there are a multiplicity of areas, so it is harder to get hold of and keep such data.

That brings us to the hepatitis framework document. I am reluctant to criticise the Minister, even tangentially, because she is a good person. However, the document is a little bit overdue. I think we were promised it at the beginning of the year. I blame no one for that; the Government have other matters to deal with, and I know the Minister has been working extremely hard. I do not think anyone would disagree, however, that we are due that document.

There are a number of questions that I would like to raise as we flesh out the shape of that document. What exactly is the timetable for its presentation and implementation? Will there be targets in it? The previous documents have not contained targets. What about the role of the clinical commissioning groups? When the document was first mooted, CCGs were not the powerful agency they are now. There will be no point in having some sort of strategy if we do not address the questions of funding streams and co-commissioning. That will almost certainly happen, and we need to know where we are. We cannot revert to a situation whereby a particular area provides a particular course of treatment that is denied to someone in another area.

Who will be involved with the document? Perhaps it is an illness of politicians that we often take refuge in strategy when implementation becomes too difficult, but a working party can be a useful thing. As part of the Government’s strategy, will they consider the establishment of a working party, which might include the Association of the British Pharmaceutical Industry, Professor Graham Foster from Queen Mary, university of London—the pre-eminent diagnostician in the area—patients’ groups and the Hepatitis C Trust? I mentioned Bristol-Myers Squibb earlier, and I have no financial or other interests in the company, but I admire people who can produce good, life-saving products and I think that such people should be involved.

We need to have a strategy. I would like to suggest that, first of all, the strategy should improve outcomes for people with hepatitis C. That may seem obvious, but let us get it down on the record. We should improve the prevention strategy. We need to tell people that if they get a tattoo in Thailand, it is not enough that the needle and the syringe are clean if the bowl of ink is not. That happens to people. I will keep my shirt and jacket on, but if I did not, Members would see a large number of tattoos up and down my arms that were mostly inflicted on me in Hong Kong in the ’60s. At that time we did not consider the sterile nature of tattoos. People nowadays should be savvier, wiser and more aware, but we need to tell them.

Above all, we need early diagnosis and prompt treatment, which will not only save lives and money but improve the health of the nation. It will improve on an individual, collective and community basis. We have an opportunity, because there is a coming together of a whole range of different streams: advances in medical science, the recognition of the scale of the problem and the possibility of a solution. We are also in a fortunate position because the Minister is extremely sympathetic to this issue.

--- Later in debate ---

[Jane Ellison]

I cannot take an intervention on that point because I must deal with the rest of the debate.

On presumed consent, within the past year we have had two good, thorough debates in this Chamber on issues of organ donation and consent. It is a very interesting area of discussion. I am watching the Welsh experience with interest; I do not dismiss it, but it is very complex. I would be happy to debate it at any time with any Member because it is a topic to which I have given quite a lot of thought and consideration.

I pay tribute to the Hepatitis C Trust for its work. More recently, I have met the Hepatitis C Coalition, which has impressed on me with great force some of the issues that it wishes to see addressed—issues that were picked up by the hon. Member for Ealing North.

The NICE appraisal of the first of the new hep C therapies is due very soon, so this debate is timely. Understandably a lot of the focus is on the new therapies, but focus on prevention runs right through the NHS long-term strategy. That is highly relevant because if people are to be treated with good, new and expensive therapies, it is important to address issues such as re-infection rates and good public health prevention. Members should be in no doubt about the Government’s commitment, which I suspect would be shared by any Government, to reducing the big killers—the main reasons for premature mortality in our country—one of which is liver disease. We cannot tackle the big killers if we are not tackling hepatitis C. We are clear that the contribution that tackling hepatitis C can make to reducing current rates of end-stage liver disease is an important part of any premature mortality strategy.

[Grahame M. Morris]

Will the Minister take this opportunity to put on record the fact that hepatitis C is indeed curable and clear up any misunderstandings inadvertently created by her predecessor?

[Jane Ellison]

I have read the transcript of the previous debate and dealt with some of the issues subsequently raised in correspondence, so there is no need to go over that again. I am well aware of the issue.

The single biggest risk group for hepatitis C is people who inject drugs, or have done so in the past. Public Health England estimates that such people comprise about 90% of all those infected in England. There are also high rates of hepatitis C among the prison population, which presents significant challenges for the NHS, particularly in terms of re-infection and changing risky behaviours. We obviously need to prioritise making the best possible treatment available to people who are suffering the worst ill health. From a public health perspective, the starting point must be prevention. Some of the new treatments will clearly be focused on people who are the most ill. Although it is right to focus on the exciting opportunities offered by new drugs and treatments, we must not lose sight of the fact that we have to make sustained progress on reducing infection in the first place. I therefore welcome the emphasis on prevention in NHS England’s five-year forward view.

Public Health England has been working with drug treatment services to improve health promotion resources for injecting drug users and those sharing needles, and to increase coverage of opiate substitution therapies and needle syringe exchange programmes. Joined-up drug treatment services commissioned by local authorities are important. We are very conscious of the need to raise the priority of hep C in local authorities and their joint strategic needs assessments—I note that it is mentioned in Ealing’s, but it is not mentioned by some authorities that face a significant challenge. That is one reason why, early this year, I will host a joint hepatitis C and tuberculosis summit with elected members from those local authorities with the highest rates of both diseases in England. The aim of the summit will be to explore how we can bring together different parts of local health systems with local authorities to control TB and hepatitis C rates in particular communities. Distinctly different communities are affected and need distinctly different approaches to tackling the problem.

As the hon. Member for Ealing North said, NHS England and Public Health England are working together on a framework. I apologise that it has been delayed, but it is due to be published this year and I will use this debate as an opportunity for another discussion about the timetable. Nevertheless, those bodies are working together very carefully on the framework, which will set high-level aims for the public health system towards the elimination of hepatitis C-related liver disease as a public health issue, with specific, time-bound objectives that feed into the overarching plan. I think that that deals with one of the issues raised earlier.

Clearly, the framework must have key targets, involve clinical commissioning groups and address co-commissioning. PHE has been working with a range of local partners—such as GPs, CCGs and NHS commissioning—to look at the rates of testing, diagnosis and treatment for people at risk of hepatitis C. That will be a core part of the framework. I will pick up the issue and write to Members when I have more detail on when we are going to publish the framework, but it will be very thorough, which is why it is taking a little longer to finalise.

In recent years, the Hepatitis C Trust has played an important role in piloting innovative ways of increasing testing rates through the use of a mobile testing van and pharmacy-based testing. We always underestimate what can be done in pharmacies, but I am very keen to make far more of what we can deliver through them. It is important that people can access early diagnosis. Those accessing drug treatment services should routinely be tested for hepatitis C, as recommended in NICE guidance. I welcome data from PHE that show increasing rates of testing. Nevertheless, we clearly must do more to ensure high levels of professional awareness about that.

PHE has also been working with NHS England and other commissioners to look more generally at how best to commission to meet the needs of patients with hepatitis C. For example, its work has included issuing extremely informative liver profiles to each local authority area, including information about hepatitis C. Every single local authority in England was sent the liver profile for its area, in the hope that that would provide the basis on which services could be planned. I urge Members to look at those profiles, and if any Member has not seen the one for their area, I would be happy to supply it.

Time is very much against me and I have not really had the chance to discuss the new therapies. We are very conscious of the potential that they offer, but I must also put on record the fact that there are existing therapies. They come with great challenges, as the hon. Member for Ealing North outlined, and they are also more difficult for people who struggle to access health care and keep to regular therapy programmes. We see great potential in some of the new therapies, but careful thought must be given to how they are delivered to patients. More than 700 patients have already been treated through the policy on access to new therapies for patients with liver failure, which has cost about £38 million, with specialist centres established to deliver early access around the country.

I am afraid that time has beaten me, as I thought it might given the interest in this subject, but I hope that I have given hon. Members the sense that we have real momentum, with the summit and the plan to come. I will write to them with further detail.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 25th November 2014 Commons Chamber

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

3. What representations he has received on exemption of the NHS from the provisions of the transatlantic trade and investment partnership.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Government will not allow TTIP negotiations to harm the NHS. Any suggestion to the contrary is both irresponsible and false. I am grateful to the former Labour shadow Health Secretary for confirming that.

[Grahame M. Morris]

That is an interesting answer but, without specific exemption from TTIP, how can the Secretary of State give any reassurance that predatory organisations such as the Hospital Corporation of America, which was prosecuted for fraud in the US, will not use the TTIP provisions to seek contracts in our NHS?

[Mr Hunt]

The best assurance I can give the hon. Gentleman is not what I have said, but what the EU Trade Commissioner, Karel De Gucht—I challenge colleagues in Hansard to spell that correctly without looking at my notes—has said. In an interview in September, he said:

“Public services are always exempted—”

from TTIP—

“there is no problem about exemption. The argument is abused in your country for political reasons but it has no grounds.”

National Health Service (Amended Duties and Powers) Bill

Grahame Morris Excerpts

Friday 21st November 2014 Commons Chamber

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

I congratulate my hon. Friend on introducing this Bill. Does he agree that the Liberal Democrats have got a brass neck in making criticisms, given that not only did they sit on their hands during that Bill Committee, but the right hon. Member for Sutton and Cheam (Paul Burstow) was the prime advocate who led the Bill during its passage through Parliament?

[Clive Efford]

And then led a campaign to stop his local accident and emergency department closing, having done that for the Government.

--- Later in debate ---

[Sir Tony Baldry]

My hon. and learned Friend makes a very good point. There is confusion about whether we have got new Labour or old Labour. The Labour party has to set out how it would undo the market it created without further top-down reorganisation. It could not do it simply by removing the health rules that manage it. There has been no change on when to tender competitively; the rules on procurement are the same as those used by the previous Government. The Act makes it clear that the Secretary of State remains politically accountable to the NHS. The changes in the Bill would restrict the greater autonomy given to the NHS and inhibit staff from making the innovative changes needed to secure sustainable, high-quality care for patients. In particular, it would tie the hands of clinical leaders on CCGs, which the NHS England five-year forward view says should have more powers, not fewer.

[Grahame M. Morris]

The right hon. Gentleman is engaging in a lengthy filibuster, in my opinion. I served on the Committee for the 2012 Act, and a plethora of organisations pointed out during the passage of that Bill the folly of what the Government were doing. They introduced a lengthy Bill; we spent 40 sittings in Committee; they tabled more than 1,000 amendments to their own Bill; it had 20 different sections; part 3 introduced Monitor. To suggest to the House that that Act introduced no change to the system operated under Labour is—well, it is not disingenuous, but it is not correct. I am not sure what term is best to use.

[Sir Tony Baldry]

During the passage of that Bill, the Labour party and certain organisations, including some trade unions, sought to rewrite history. Interestingly, when Labour introduced things such as the independent treatment centres, the Darzi centres and the 2002 concordat, the trade unions that rallied to support the hon. Gentleman in Committee were totally silent. I do not think it lies in the mouth of those organisations, which did not complain when the Labour party introduced a partnership and a concordat with the independent and voluntary sector when it was in government, now to complain, simply because it is the Conservative party in a coalition Government, that we are somehow “privatising” the NHS. It is simply not true.

--- Later in debate ---

[John Healey]

We on the Labour Benches cannot wait for the debate on the NHS to be put right at the heart of the next five months of policy and political debate, and my right hon. Friend the shadow Secretary of State will make sure that happens.

Let me return to my point about the way that we in this House were misled about the reorganisation and the legislation. I am disappointed to see that the man who led it, the right hon. Member for South Cambridgeshire (Mr Lansley), is not in the Chamber today to explain himself. He argued—it was completely wrong, but he argued it—in the debate on Second Reading in January 2011:

“It is about gearing the entire system towards supporting the relationship between doctor and patient”.—[Official Report, 31 January 2011; Vol. 522, c. 617.]

Of course, it was not and it is not. As I argued, at the time from the Opposition Front Bench:

“The reorganisation and legislation is designed to break up the NHS, to open up all areas of the NHS to private health companies, to remove requirements for proper openness, scrutiny and accountability to the public and to Parliament, and make the NHS subject to both UK and European competition law.”—[Official Report, 16 March 2011; Vol. 525, c. 378.]

The Government were and are driving free market political ideology through the heart of our NHS.

The arguments that those of us on the Opposition Benches made then are those that we make now, and that my right hon. Friend the Member for Leigh (Andy Burnham) makes especially strongly from our Front Bench. That is why the Bill that my hon. Friend the Member for Eltham (Clive Efford) has introduced is so essential and why I am so pleased and proud to be one of his sponsors.

[Grahame M. Morris]

My right hon. Friend made some powerful points when the Health and Social Care Act 2012 was going through Parliament, when Tory Members were denying the purpose of the legislation. He quoted the last Health Secretary, but the current Health Secretary, the right hon. Member for South West Surrey (Mr Hunt), said in a book:

“Our ambition should be to break down the barriers between private and public health provision, in effect denationalising the provision of healthcare in Britain”.

What could be a more succinct and clear expression of their intentions?

[John Healey]

My hon. Friend has been a strong champion of the NHS and followed this issue from day one of this Parliament. To answer directly his question of what could be more succinct and clear, I suspect that when we hear from the new Member for UKIP, the hon. Member for Rochester and Strood (Mark Reckless) or his colleague, the hon. Member for Clacton (Douglas Carswell)—given some of the things that they have argued should be the basis of the NHS in future—they will make the vision of the right hon. Member for South West Surrey look positively UKIP-lite.

This Bill is essential because it starts to correct the three fundamental flaws, brought about by the reorganisation legislation, that are now driving the NHS. We could call them the three Cs—cost, complexity and competition.

On cost, the scale of the reorganisation was simply huge. As the chief executive of the NHS said at the time, it was

“beyond anything that anybody from the public or private sector has witnessed”.

The cost of the waste has been huge. We reckoned beforehand that it was about £2 billion; we now reckon £3 billion. What is clear is that getting on for £1 billion has been paid out in redundancies, much of which was to staff who were paid off and then re-hired by our NHS.

--- Later in debate ---

[Mark Reckless]

Indeed, I am proud, and many people in my constituency have moved down from Eltham and the surrounding areas, and I am delighted that they returned me to the House in the early hours of this morning.

I found the hon. Gentleman’s speech compelling. At half-past 4 this morning or thereabouts, I was extolling the virtues of the Levellers and the Chartists. I can only think that I had a premonition of the speech that the hon. Gentleman was to make in the House this morning.

The other reason for my presence here is that, in the by-election I have just fought, we had in Naushabah Khan a Labour candidate who made—quite eloquently, I thought —the case against fragmentation and privatisation of the NHS, and she and others in Medway Labour commended the Bill to me.

[Grahame M. Morris]

I was not in Rochester last night. I joined a vigil outside Parliament by groups who are campaigning to save our NHS, and I had a conversation with a consultant oncologist on that very issue of fragmentation. He said that the only competition we should have in the NHS is the competition to defeat disease. Does the hon. Gentleman agree with that?

[Mark Reckless]

That sounds a good statement. I myself feel a certain degree of scepticism, as the hon. Member for Southport (John Pugh) said, about internal markets in the NHS and other public services. Much depends on the circumstances of the service provided, and an ideological predisposition either against or in favour of internal markets is probably not wise.

The Labour candidate in the by-election opposed fragmentation and privatisation of the NHS, and the Bill appears to do so as well. I have discovered that this is now the Labour party’s position. I had assumed that the Labour party was in favour of fragmentation and privatisation in the NHS, because that was my understanding of what the record had been.

--- Later in debate ---

[Dr Poulter]

I will come on later to the costs that the hon. Gentleman’s Bill would directly create. The point is that we should be proud—the Labour party should be supporting the Government—that we are reducing administration and bureaucratic costs, because that money is now being spent on patients. Why cannot Labour for once accept that a good thing has happened and that more money is now going into front-line patient care?

The second effect of the 2012 Act is that it empowered local doctors and nurses, as those closest to and most able to determine the needs of their patients, to design and lead the delivery of services around the needs of those patients. Thirdly, the Act placed great importance on and sought to drive increased integration across our NHS, a point clearly articulated by my hon. Friend the Member for Bosworth (David Tredinnick). Commissioners had duties placed on them by the Act to consider how services could be provided in a more integrated way, and we have since built on the Act by supporting a number of integration pioneer sites, which will trail-blaze new ideas to bring care closer together, particularly for frail elderly people and people with complex care needs. They will be leaders of change—a change we have to see in the health system, if we want to offer the very best quality of care to patients.

We are also supporting the health and care system through the £5.3 billion better care fund, with commissioners working in partnership with local authorities to deliver more integrated person-centred care. Offering seven-day services and delivering care that is centred on patients’ needs will encourage organisations to act earlier to prevent people from reaching crisis point. That is the sort of clinical leadership that the Act has fostered. It will refocus the point of care towards more proactive community-based care, for the benefit of so many patients.

[Grahame M. Morris]

The Minister is defending fragmentation, but may I, as a former member of the Health Committee, remind him that Sir David Nicholson, the former chief exec of the NHS, summed up the situation last year by saying:

“You’ve got competition lawyers all over the place, causing enormous difficulty. We are getting, in my view, bogged down in a morass of competition law which is causing significant cost in the system”.

Is the Minister saying that the chief exec is wrong in his assessment?