Physical Inactivity (Public Health)

Grahame Morris Excerpts

Tuesday 18th November 2014 Westminster Hall

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

I also congratulate my hon. Friend the Member for Blaenau Gwent (Nick Smith) on securing this debate, and I congratulate the Backbench Business Committee on allocating time for a subject whose importance is increasingly being recognised. The Select Committee on Health, of which my good and hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and I are members, will be holding an inquiry on the impact of physical activity and diet on health, so this is a timely debate. I am sure that the evidence compiled by the Select Committee will be brought to the Minister’s attention, and that appropriate action will be taken.

Many hon. Members who have contributed to the debate have covered the general subject areas, so in the interests of brevity I do not intend to repeat the statistics, but I will mention some specific issues that affect my constituency of Easington, County Durham in the north-east of England. The figures on physical inactivity quoted by hon. Members earlier in the debate are even higher in my region. Some 32% of people in County Durham are classed as physically inactive, and all the projections indicate that the problem will get worse. Higher degrees of inactivity are predicted by 2030.

International comparisons show that our levels of inactivity are twice those in Germany and France. I thought we would be rather more active than the United States, but our levels of inactivity are 20% higher. It is generally recognised that physical inactivity is a considerable public health problem. The numbers of people who are likely to suffer as a consequence of physical inactivity were identified earlier in the debate. It has been suggested that physical activity can help to combat, or at least delay the onset of, conditions such as heart disease, type 2 diabetes, obesity and even dementia.

The costs are not just for the individual; there are also costs for communities and our economy. There are various estimates of the cost to the UK economy, and I have seen a figure of £20 billion a year, so there are direct costs associated with the health issues. My hon. Friend said that £9 billion a year is spent on costs associated with treating type 2 diabetes, but many other health issues are also caused by inactivity. There are also indirect costs such as, for example, lost days of work and low productivity. Employers need to take note. Some 16 million working days are lost every year due to obesity-related illnesses, so improving workplace health could have an immense impact on individual businesses and the economy. It is in everyone’s interests to address physical inactivity.

There have been some welcome improvements, and hon. Members have mentioned local authorities that are trying to prioritise physical activity, but local authorities are facing considerable pressures as a consequence of cuts in central Government funding, which have inevitably had an impact on their ability to deliver activities and opportunities to engage in physical activity. My local authority, Durham county council, is one of the hardest hit, and such authorities face some of the greatest challenges in relation to physical inactivity. Such authorities have seen the deepest cuts to their overall budgets. Indeed, 13 of the 15 local authorities with the most inactive populations are located in areas that are considered most deprived or more deprived. Despite facing huge challenges, particularly public health challenges, Durham county council has had to implement £135 million of cuts in three years, with another £44 million of cuts in the pipeline.

[Mr Mike Weir (in the Chair)]

Order. Time is up, I am afraid.

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[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship again, Mr Weir. I congratulate my hon. Friend the Member for Blaenau Gwent (Nick Smith) on securing this debate and all colleagues across the House who supported the application for it. We have heard some important contributions by hon. Members from all parties.

I should like to take this opportunity to thank the many organisations that are doing an important job to get Britain moving—hon. Members mentioned many of them—including ukactive, Sustrans and StreetGames. I had the pleasure of joining Living Streets on a walk to work back in May, to celebrate national walking month and the benefits of walking to work, so I have seen first hand the fantastic work that it does. I also thank my hon. Friend for mentioning pedometers. Many hon. Members measure their steps on a daily basis. I am just on 2,000 already today and on my way to securing my 10,000 a day.

I share hon. Members’ concerns about the place of physical activity in our society. Just a few generations ago, physical activity was an integral part of daily life, yet today it is becoming ever less a part of our daily routines. The opportunity to move and be active in modern life has declined dramatically: advances in technology mentioned by hon. Members, the rise in passive entertainment options, community safety concerns, roads that are not safe for pedestrians and cyclists, and limited playgrounds and green spaces are just a few of the reasons why.

We have heard the statistics, but they are worth reiterating. In some parts of the UK, more than 40% of the adult population is classed as inactive and a quarter of all adults in England are failing to do enough physical activity to benefit their health. Nearly half of all 11 to 25-year-olds in England—more than 4.5 million individuals —fail to achieve the chief medical officer’s recommended levels of physical activity. This is deeply concerning. Our nation’s children and young people are not getting the activity that they need to stay strong, fit, healthy and happy, which is something that will inevitably affect them in later life.

As we heard, insufficient levels of physical activity are estimated to cost more than £7.5 billion nationally. Other figures have also been mentioned. That sum is broken down to just over £1 billion in the NHS, £5.5 billion in lost productivity and £1 billion in premature mortality among the working-age population. My hon. Friend the Member for Easington (Grahame M. Morris) also mentioned the staggering 16 million days lost in the workplace, which we must be concerned about and take action on.

More than 1 million children are classed as obese and a third of children leaving primary school are classed as obese or overweight. We know that the status quo is not working. If we are to make the NHS financially sustainable in the 21st century, it follows that we need to have the most ambitious plans for physical activity, to contend with those lifestyle diseases that the NHS is increasingly responding to.

We know that physical activity is the simplest and cheapest route to good health and staying well. Moving from inactivity to activity is one of the easiest first lifestyle changes to make. This has been looked at academically and found to be easier than altering diet, stopping smoking or reducing drinking—and it can cost next to nothing, too. However, the issue is about more than health; it is also about people fulfilling their potential and making the maximum contribution. We know that children who are more active are more likely to achieve better exam results and earn more throughout their lives. I echo the concerns of my hon. Friend the Member for Blaenau Gwent about lower levels of physical activity in more deprived communities. I should be keen to hear the Minister respond to that issue.

Put simply, physical activity and sport builds strong people and strong communities. Yet for an activity that brings such universal health benefits, there seems to be very little centrally driven support for its promotion. We have neither a way of accurately measuring the physical activity people take, nor consistent messages about what level of physical activity people should be taking. Until recently, the guideline for adults was for them to take 30 minutes or more of physical activity of moderate intensity on at least five days a week. That is a minimum of two and a half hours of physical activity per week.

In 2008, the health survey for England measured physical activity among adults by means of a questionnaire. Some 39% of men and 29% of women reported that they met the recommended minimum level of physical activity. However, when accelerometers were used on a group to measure their physical activity objectively, the real percentages were actually 6% and 4%. That was complex enough, but to make things more challenging, in 2011 new guidelines were produced by the UK’s four chief medical officers that are particularly complex—I shall not read them out; I struggle to understand exactly what the recommendations are.

There are other issues to consider, too. The active people survey does not actually measure activity and does not include recreational walking or recreational cycling. We no longer even have a way of measuring children’s participation in school sport, because the school sports survey, which measured the proportion of pupils receiving two hours of curriculum PE and the proportion participating in at least three hours of “high quality” PE a week, was scrapped in 2010. So, too, were the regulations that previously tracked schools’ travel patterns. Will the Minister share with us any plans to clarify this confusing picture and introduce a more consistent way of measuring physical activity? Are there any plans to reintroduce the school sports survey and school travel survey?

Again I share concerns raised by hon. Members about the Olympic legacy in our country, despite the huge progress made under the previous Labour Government. In 2002, just 25% of children undertook two hours of PE and sport in school, but by the end of the previous Labour’s Government time in office this had been raised to 93%. The previous Labour Government also created 422 school sports partnerships and 2,300 school sport co-ordinators, covering every school. It was my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) who promised a “golden decade of sport”, kicked off by the Olympics and Paralympics in 2012. Yet a series of decisions has meant that these ambitions have not quite been realised under this Government.

The school sport partnerships—the local networks of schools and PE teachers—which had quietly been achieving notable success in getting students across England to be more physically active during school hours, have been abandoned; playing fields in some areas have been sold off; and school sport targets have been removed. We heard earlier this month that the borough that hosted the Olympic games is the least physically active in England.

[Grahame M. Morris]

Will my hon. Friend acknowledge the impact that cuts in local government have had, particularly on youth services? In national youth week last week, a number of youth clubs, including in Peterlee in my area, were reporting that they may have to close because of funding cuts.

[Luciana Berger]

I will move on to that point in a second. I was interested in the remarks made by the hon. Member for North Swindon (Justin Tomlinson). I have seen first hand some young people in my constituency who have taken part in the national citizen service, but that is just a few young people. At the same time, throughout the country, we have seen devastating cuts to our youth services. I want all young people to have access to good services. In a moment, I will mention my concerns about local authority cuts.

I should be interested in hearing from the Minister what work the Government are doing to mobilise all the different sectors, industries and organisations that have a role in getting Britain moving. My hon. Friend the Member for Easington mentioned people with dementia. We need particularly to pay more attention to and focus more on older people.

I am keen to hear what the Government are doing to encourage councils, which have the delivery system, to open up their parks, improve access to leisure centres and swimming pools, and make walking, running and cycling a key consideration of developments. However, I echo the concerns of my hon. Friend the Member for Easington about cuts sustained by local authorities throughout the country. My own area in Liverpool has had its budget cut by 56% and it is struggling to do all those things well.

We know that small adjustments to workplaces can make active travel or exercise before or after work a much more realistic option. What work are the Government doing with employers so that workplaces can become more physical activity-friendly? I have asked a number of questions about the health at work programme, and I was disappointed to learn from a parliamentary question that no records are being kept of the number of businesses that are becoming good health at work employers. That is a key issue, which needs more attention and resource directed towards it.

What work are the Government doing with sport governing bodies to ensure that the great success we have enjoyed at the elite level is matched with the same success at grass-roots level? I, for one, enjoyed taking part earlier this year in the “Back to Netball” programme, and I would like to hear about more projects like that that the Government are encouraging across the country—not only for young people, but for adults.

There is a particular concern and challenge around young people at college or university and the differing costs of accessing physical activity and organised sport in places of higher and tertiary education. In the absence of school sport partnerships and compulsory minimum numbers of hours of physical education in schools, how will the Government ensure that sport and activity are a feature of every school, with quality sports coaching and provision in all schools?

I echo the concerns raised by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and the hon. Member for Romsey and Southampton North (Caroline Nokes) about female participation in sport and physical activity. We know that there is a gap between the number of men and the number of women who take part, and I would be keen to hear from the Minister what the Government are doing in that area. Finally, what action are the Government taking to promote active travel and create environments where people are more likely to walk or cycle for short journeys?

With the right support and direction from Government, getting Britain moving is a single, simple, positive goal that the whole country can get behind—a goal that has the potential to shift our national culture. The issue is not about finger-wagging or telling people they cannot do something they enjoy; it is about promoting a positive activity that people can feel good about and an affordable route to good health and well-being for the whole population. It is the most cost-effective way of making our public services and our NHS sustainable now and in the future.

Care Workers

Grahame Morris Excerpts

Wednesday 5th November 2014 Westminster Hall

[Mr Smith]

Yes, indeed. The hon. Gentleman makes a good point, and I will say more about that later. Of course, there will be massive increased need for these workers in the future. One reason recruitment and retention are so difficult is that terms and conditions are often so poor.

Let me develop my argument further. Only 21% of councils have ever asked to see documentary evidence relating to the pay of care workers employed by their contractors. In the face of that and the other evidence I have cited, it is appalling that the Government are doing so little to uphold the legal rights of home care workers. It is indefensible that HMRC has stopped carrying out proactive investigations of national minimum wage compliance in home care, despite having revealed the extent of the breaches itself.

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

I congratulate my right hon. Friend on bringing this debate to the Commons at such an important time. In my area, Durham county council has had to implement £135 million of cuts over three years, with another £44 million in the pipeline. It is commissioning home care at £11 an hour, whereas the commissioning rate in some more affluent areas is £15 an hour. Does my right hon. Friend agree that the Government’s cuts in support for local government are compounding the problem?

[Mr Smith]

Most certainly they are, and I will say more about that later. I support, and the House ought to support, the key action that Unison and others are calling for. First, the Government should make ending illegally low pay for care workers a key priority. Secondly, HMRC should be instructed and resourced to do a proper job in ending the widespread breaches of the national minimum wage. Thirdly, care providers and the councils that commission them should be named and shamed when they do not pay the minimum wage.

It is not just trade unionists, local councillors and those whose loved ones use care services who are concerned about all this. In preparation for the debate, I spoke to local private care providers, and I will share with Members some of the points they made. They told me that care workers’ salaries do not reflect the responsibility they have; that luck and money are all too likely to decide people’s quality of care; that too many staff are on poor contracts, but that often reflects poor profit margins; that zero-hours contracts can be a barrier to recruitment, but that some employees want them; that staff turnover is high because of the high cost of living and shortage of affordable housing, which is an issue in my constituency; and that pressure on council budgets—the point made by my hon. Friend the Member for Easington (Grahame M. Morris)—means that restricted funding is available for front-line care.

Local providers also drew my attention to the fact that in six out of 14 areas in Oxfordshire, the county council is offering rates of funding for front-line care that are below the living wage, even though it has rightly pledged to pay its own staff above the living wage. Providers also told me that upper-tier councils such as Oxfordshire, which are responsible for home care, have their hands tied by the local government squeeze. Members should remember that all these points have been put to me by providers.

Pancreatic Cancer

Grahame Morris Excerpts

Monday 8th September 2014 Westminster Hall

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

Thank you for calling me, Mr Chope. I apologise for not being present for the whole debate; I meant no discourtesy to colleagues. I wanted very much to speak in the debate. I begin by congratulating my good and hon. Friend the Member for Scunthorpe (Nic Dakin) and the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw), who made a very moving contribution. I also thank the Backbench Business Committee and, indeed, all the volunteers. I had the pleasure of meeting Maggie Watts, but there are also many hundreds of others working in charities and as volunteers who have campaigned so effectively on this issue; they have helped secure the signatures to get this debate on what is very often a forgotten and neglected form of cancer.

I know that there are time constraints, but there are some specific issues that I want to raise with the Minister. I will just make some general points and then move straight to my questions. We know from earlier contributions that pancreatic cancer is not an uncommon cancer. My understanding is that by the time this debate has concluded, three more people will have lost their lives to the disease.

We heard in the contribution from the hon. Member for Basildon and Billericay (Mr Baron) that the UK still lags behind most other European countries when it comes to cancer survival rates. To be fair, there have been significant improvements in cancer treatments across the board in recent decades, but as we are aware the rates for pancreatic cancer, at 5.2%, have virtually stood still in the past four decades, so this is not a criticism of the current Minister or the present regime—the present Government.

The very nature of pancreatic cancer contributes towards poor survival rates. I do not intend to go over the arguments put so eloquently earlier about the difficulty of getting a proper diagnosis and the lack of an effective pathway to make the necessary early referrals. However, one thing that I am concerned about—I want to put this point to the Minister—is this. Yes, it is very important to have awareness campaigns, and I pay tribute to the campaigners who have brought this subject to Parliament today, but if we are to have real progress, there need to be improved treatments as well. Pancreatic cancer receives just 1% of the National Cancer Research Institute partners’ research spend. That equates to £625 per death.

[Philip Davies in the Chair]

I fully understand that we one cannot equate such things in financial terms, but that compares with almost £3,500 per death on breast cancer, the campaign against which receives much more public attention. If we as politicians—I am talking about all politicians; this is not a criticism of the Minister or the Government—are serious about improving survival rates for pancreatic cancer, our rhetoric must be backed up with firm action on the allocation of resources.

We have heard that relatively few treatment options are available for patients with pancreatic cancer, and research into the development of new drugs and treatments is key if we are to bring survival rates for pancreatic cancer down towards those of other common cancers. Over the past week or so, the case of the little boy Ashya has been in the news, and we have heard about the terrible circumstances and trauma that his parents went through in being unable to access the advanced radiotherapy that they felt was an appropriate form of treatment for their son. The hon. Member for Lancaster and Fleetwood has already referred to the potential of advanced radiotherapy. Forms of the treatment such as NanoKnife and CyberKnife, which can target tumours very precisely with intense bursts of radiation, may be particularly effective for some, although not all, pancreatic cancer patients.

I know that the Minister is sick of me going on about advanced radiotherapy, but we are not doing as much as we should to develop the evidence base for the treatment. I fully understand that it is not suitable for all types of cancer, or even for all types of pancreatic cancer; there are a number of different forms. The National Institute for Health and Care Excellence insists that before it allows routine use of the treatment, particularly in the NHS, there must be an evidence base.

Many of the cancer charities that I have spoken to have argued that, as a matter of urgency, the technology for advanced radiotherapy must be verified. I make an appeal to the Minister on that. Patients already receive advanced radiotherapy for other cancer types, and the treatment is available for private patients. I fully understand that we need to have an evidence base and see what is effective in different circumstances. Until research into advanced forms of radiotherapy for the treatment of pancreatic cancer is increased and the viability of the technology can be properly verified—until we actually grasp the nettle and fund the research and the trials—NHS patients will continue to miss out.

[Stephen McPartland]

The hon. Gentleman and I have debated radiotherapy and chemotherapy several times. I am proud that my NHS hospital trust was given the first CyberKnife by a wealthy donor, so it has the evidence required for advanced techniques and advanced radiotherapy. I sound a note of caution, however. My constituents have to make a 60-mile round trip to access that treatment. We have just opened a chemotherapy unit that can be used by someone who has cancer in Stevenage, but if they receive radiotherapy they often have to make a 4,000-mile journey over the course of their treatment. Although patients can have advanced radiotherapy, the difficulty is accessing that treatment.

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[Grahame M. Morris]

That is a sensible point, which I have made to the Minister and several of her predecessors on a number of occasions. My view is that each of the 28 cancer networks should have access to advanced radiotherapy and that we should carry out a series of trials to evaluate the effectiveness of that treatment.

I would be interested to hear the Minister’s response, particularly on research into advanced radiotherapy. I hope that when our successors debate the matter in 40 years’ time, they will be talking about survival rates significantly higher than the current 3%. For that to happen, I respectfully say that the Government, or a Government, must act.

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

It is a pleasure to serve under your chairmanship, Mr Davies. It has been an excellent debate, with excellent contributions from all hon. Members. I will try to do justice to all questions that I have been asked, but inevitably there will be some that I cannot pick up in my speech. I may stick more broadly to pancreatic cancer and research and perhaps pick up points on other matters outside this debate with the shadow Minister; we are happy to update him on all those.

I, too, congratulate the hon. Member for Scunthorpe (Nic Dakin) and my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) on securing this debate and thank the public for their role in it. I served for more than two years on the Backbench Business Committee and was present when the e-petition system first came in. As others have said, it illustrates how swiftly we can bring an issue of great concern to the public to the Floor of the House and, I hope, do justice to the subject in a way that they feel justifies their faith in us and their efforts to get it here. I believed in the e-petitions system then, and now, on the receiving end, as Minister responding to the debate, I am equally happy that we have it.

I reassure the public—both those who have taken care to come here today and those listening or reading afterwards—that they are very well served by the all-party group on pancreatic cancer. It is fair to say that one or two all-party groups in our Parliament do not put in much of an appearance from one year to the next, but this is an excellent all-party group that genuinely takes its mission and its role within Parliament seriously. Its members have achieved much in highlighting the needs associated with this dreadful disease, not least through their report, “Time to Change the Story” and through their current inquiry on research, which is where I will focus most of my remarks in a fair bit of detail.

Hon. Members have spoken of the impact of pancreatic cancer on those who get the disease, their friends and their families and of the need for improvement in research and services. Obviously, I will look at as many points as I can. I reassure Members that it is certainly not a low priority for me. Of all the debates on cancer that I have responded to in my time as a Health Minister, I have responded to debates on pancreatic cancer more than any other, so this subject is certainly not low on my radar and—I reassure hon. Members again—not the Government’s.

I understand why people feel frustrated. Hon. Members have mentioned awareness levels, neglect or fashion and some of those things play a part, but fundamentally this is hard: it is a hard disease that is hard to diagnose and research. The scientific opportunity is not as readily there as it is in some other areas of human medicine. This is not easy territory, but we need to do better; we all know that and that is acknowledged.

As many hon. Members and the petitioners have said, investment in research is crucial. The Government are investing a record £800 million over five years to 2017 in a series of biomedical research centres and units—my hon. Friend the Member for Pudsey (Stuart Andrew), among others, mentioned this—including £6.5 million of funding for the Liverpool pancreas biomedical research unit. So that advancements in science can lead to benefits for patients, that unit is working in partnership with industry and leading research institutions to develop new treatments for, and ways of diagnosing, pancreatic cancer. This includes research on biological markers, which might be one way to help achieve earlier diagnosis.

[Grahame M. Morris]

The Minister’s knowledge is far superior to mine in relation to advanced radiotherapy and the funding of trials—the hon. Member for Lancaster and Fleetwood mentioned the NanoKnife and the CyberKnife—so will she clarify whether there are any such trials in relation to its efficacy for pancreatic cancer?

[Jane Ellison]

The hon. Gentleman will like my next page. I move on.

The unit that I mentioned is involved in a major European collaboration. I want to put that on the record because a lot of hon. Members have asked, rightly, whether we are learning from international examples, collaborating and learning what we can from those who are best in Europe—and that happens in that unit. It is also involved in the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer, looking at hereditary factors as well.

As a number of hon. Members have eloquently described, the challenges of a stubbornly low survival rate are great, so it is also important that we consider new treatments for pancreatic cancer. For example, due to the limited evidence currently available, stereotactic ablative body radiotherapy—SABR—is available only for certain patients with lung cancer. To address this, NHS England has agreed to make up to £6 million available over the next five years to fund the treatment costs of new clinical trials for SABR. I am pleased to inform the hon. Member for Easington (Grahame M. Morris) and other hon. Members that one of these trials will be in pancreatic cancer.

I join hon. Members in welcoming the commitment made by Cancer Research UK to increase spending on pancreatic cancer research. That will in turn drive further investment by the National Institute for Health Research. I want to explain how that happens in two principal ways. First, scientific breakthroughs are translated into interventions benefiting patients, through infrastructure for experimental medicine, for example, with the Liverpool pancreas biomedical research unit. To talk to the point made about pancreatic cancer losing out and being the poor relation, Members might be interested to know that this is the only biomedical research unit that is organ-specific, with a focus on cancer.

Secondly, new investment, including NIHR investment, is driven by support from Government spend, as emerging interventions are investigated in studies and trials through the NIHR clinical research network. I was talking to the chief medical officer earlier this afternoon, ahead of this debate, to understand how this comes about. This is essentially known as NHS research support costs. For example, there might be, in a trial considering a specific treatment for people with pancreatic cancer, a lot of wrap-around care needed for the patients in that trial that might be beyond pure treatment for that cancer. That is where NHS research support costs come in and support the work going on in a specific trial.

The National Cancer Research Institute is a UK-wide partnership—it has been mentioned in this debate—between the Government, charity and industry, which promotes co-operation in cancer research among the 22 member organisations. In turn, NCRI is a member of the International Cancer Research Partnership, which includes cancer research funders from all over Europe, the United States, Canada and Japan.

The NCRI clinical studies groups—I apologise for the number of acronyms that crop up in health debates; I am afraid that it is just one of those things—bring together clinicians, scientists, statisticians and lay representatives to co-ordinate development of a strategic portfolio of trials within their field. The upper gastrointestinal cancer clinical studies group has a pancreas sub-group that plays a vital role in developing pancreatic cancer trials. It is effectively doing the same job as the US Recalcitrant Cancer Research Act—looking strategically at what is needed and where the gaps are.

My hon. Friend the Member for Pudsey made the point about looking at inter-regional and international comparisons and variation. We would expect the NCRI to look at that area, but I will make a point of making it aware of the strength of feeling in this debate on a number of issues, although I am sure they will be following it closely.

More broadly, improving cancer outcomes is a major priority of this Government. Our ambition is, as has been said, to save an additional 5,000 lives a year by 2014-15 and, crucially, to halve the gap between cancer survival rates in England and the best in Europe. Tackling late diagnosis, as many Members have said, is vital, as is raising public awareness and encouraging earlier presentation. Significant money has been put into that, and to put a cost in human lives on that, we know that we could save an additional 75 lives a year from pancreatic cancer if we matched the best in Europe. As many Members have illustrated, with so many examples from their constituencies, that does not begin to tell the story of the human suffering that could be averted if we did that.

To touch on Be Clear on Cancer, symptom awareness campaigns are a difficult area. Since 2011, the Department of Health has undertaken a series of local, regional and national Be Clear on Cancer campaigns, some of which have had excellent results. Public Health England now leads on that work in partnership with the Department, NHS England, charities and others. New campaigns are tested locally and then regionally to ensure that messages are correct for the target audience and to assess the impact on NHS services. That is important, because in some cases the balance has to be found when sending a lot of people in for diagnostics that might not be there or might stretch capacity. We ask experts to strike a careful balance and, if appropriate, we run the campaigns nationally.

The focus of those campaigns so far has been on cancers with the largest number of avoidable deaths, but the campaigns are under constant review and we work with relevant experts to see what more can be done to tackle the cancers, including pancreatic cancer. The group that makes decisions on the campaigns is called the public awareness and primary care steering group. It is chaired by the national clinical director for cancer, the excellent Sean Duffy, who I am sure a number of Members have met. Those who have met him will know what an important and serious clinician he is and how dedicated he is to making progress in this area. The group has considered pancreatic cancer for a possible campaign. Although it could not recommend that at this time, because symptoms are not always clear, it will keep that under review and would be happy to look at it again in the light of new evidence. Again, that group will note this debate and the interest in it.

During the debate, Members have raised the issue of how we support GPs to recognise signs and symptoms, particularly for such a difficult to recognise and difficult to diagnose cancer. Pancreatic cancer is often symptomless. When symptoms do develop, however, diagnosis can be complicated because, as Members have said, those symptoms are often similar to a range of benign conditions. We therefore have terrible rates of presentation through emergency routes, and that is clearly unacceptable. NICE is updating its guidelines on the referral of suspected cancer to ensure that they reflect the latest evidence. A number of Members raised that issue, and we anticipate a publication date of May 2015.

In early 2013, the Department of Health part-funded a six-month pilot, run by Macmillan Cancer Support, of an electronic cancer decision support tool for GPs. It is designed to recognise the symptoms of five cancer types, including hard-to-detect cancers such as pancreatic. Some 500 GP practices across England participated in the pilot, and I am aware that the all-party group is keen to see that tool being widely used by GPs, if evaluation shows that it can help to identify patients with symptoms. Initial indications were that the cancer decision support tool influenced a GP’s decision on around half the occasions that it was used. A full formal evaluation of the pilot has been undertaken by Cancer Research UK and one of the Department’s policy research units, and we hope to publish the results in an academic journal. I want to see that happen as quickly as possible, if the tool can do good, and I have made that clear. Macmillan has already begun to address many of the issues, which were highlighted by the draft evaluation that was shared with it, through changes made to the diagnostic software. It will continue to make further changes as it rolls the system out across the country.

In introducing the debate, the hon. Member for Scunthorpe spoke about allowing GPs to refer patients directly for MRI scans, as did my hon. Friend the Member for Milton Keynes South (Iain Stewart). I thank the hon. Member for Scunthorpe for giving me advance notice of that point. We have promoted direct referrals through the cancer outcomes strategy and have increased funding for GPs to access a range of diagnostic tests. NHS England is now working with providers to identify innovative ways of diagnosing cancer earlier, which could include extending direct referrals by GPs. Again, I will make sure that the strength of feeling expressed today, which I share, about looking seriously at whether that work can be accelerated is brought to the attention of NHS England.

Recently, the Secretary of State for Health announced a joint piece of work with Cancer Research UK and Macmillan to look at a number of innovative ways in which we can support GPs to ensure that cancers are diagnosed as quickly as possible. It is worth saying that last year GPs referred nearly half a million more patients to cancer specialists than were referred in the last year of the previous Parliament. A number of Members have said that this is not an easy one for GPs, because they see this cancer very rarely. The average GP actually sees some of the more common cancers surprisingly rarely, and this cancer is particularly rare, so anything we can do to support GPs is important.

Further policies have been unveiled that will improve the quality of life of cancer survivors. NHS England is rolling out additional support, in co-operation with Macmillan, so that cancer survivors will have their needs fully assessed and plans agreed for meeting those needs. In that regard, we are drawing heavily on the cancer patient experience survey, which has been mentioned.

The work going on to help to support cancer survivors to take regular physical activity will help. Physical activity is important in recovery and might help prevent recurrence. We have not touched a lot on lifestyle factors, but they are definitely an issue in some instances of pancreatic cancer. I undertake to talk to Public Health England about what more can be done. A major piece of work will be announced this autumn on physical activity, and I will have that conversation with Public Health England in that context. That new package of measures adds to the extra £750 million that the Government invested at the beginning of the Parliament.

At the end of August, the Health Secretary announced that thousands more cancer patients in England will be offered vital treatment through the £160 million boost to the cancer drugs fund in 2014-15 and 2015-16. I note the concerns of my hon. Friend the Member for Lancaster and Fleetwood about the interactions between NICE and the cancer drugs fund. I am happy to talk to him further about that, but NICE, for lots of good reasons, is an independent expert body, free from ministerial intervention. I do, however, note his concern. We discussed and explored that in a bit more detail in the Adjournment debate that he so ably led earlier in the year, when we looked specifically at NICE and new drugs.

In conclusion, I thank all those who have contributed to the debate. There is a huge challenge for us all, and we need to make a significant improvement to outcomes for people with pancreatic cancer. I do not underestimate the nature of that challenge—I know that Members do not—and I hope that my response has illustrated to the Chamber and to the many thousands who have signed the e-petition that pancreatic cancer is a priority and that more money is going into research, and not only what is directly invested. I have tried to illustrate what the wrap-around research support is.

As I said, I spoke today with the chief medical officer. She heads up the Government’s research policy, and some of the bodies that I have referred to report to her. Given the strength of feeling in this excellent debate, which has had thoughtful contributions, I will ask the chief medical officer if she is happy to meet with me and the debate’s co-sponsors to look in a bit more detail at the research package and to understand the research journey and where it might go. I will get back to my hon. Friend and the hon. Member for Scunthorpe after the debate about that.

We all know that change needs to come, and that it will not be easy, but we can make change. We have seen it in other hard areas of medicine, so it is not impossible; it is just difficult. Through the Government working in partnership with patients, charities, the nation’s excellent research teams, the pharmaceutical industry and the NHS, as well as by drawing on international data, we can make progress, and we all know that we must.

Special Measures Regime

Grahame Morris Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

I am happy to do so. The hospital has recruited 95 more nurses and nursing support staff since last July. It has appointed a director of nursing and a medical director and lead for patient safety, which strengthens clinical leadership. Some very important changes have been made, and I pay tribute to the hospital’s leadership for making that possible. I hope my hon. Friend understands that, under the new system we have set up, it is not for the Secretary of State or any Minister to say when a trust is ready to come out of special measures. We have deliberately given that judgment to an independent chief inspector, so that no one who has a vested interest or a hope that a hospital will come out of special measures, and no one who is involved in turning around a trust, is responsible for that important independent judgment. However, that means that, when hospitals come out of special measures, people can have confidence that the judgment has been correctly made.

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

This is an important statement, but it is regrettable that the Health Secretary is implying that the care failures were all the fault of the previous Government. Will he confirm that Sir Bruce Keogh, who gave evidence to the Select Committee on Health yesterday, and not the Secretary of State, decided which hospitals would be placed in special measures? I understand that Sir Bruce’s decision was based on those hospitals being outliers for two consecutive years. According to my maths, that means that the failures described by the Secretary of State occurred on this Government’s watch. If he is apologising and feeling contrite, would he like to own up to that failure?

[Mr Hunt]

The examples of poor care I gave happened under this Government. I am therefore being absolutely clear that failures in care happened under both the previous Government and this one. The difference is that this Government are doing something about it. We are taking action and taking the difficult steps to get those trusts out of special measures. The public are beginning to have confidence that, when there are problems, they are not being swept under the carpet but being dealt with.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 15th July 2014 Commons Chamber

[Norman Lamb]

The truth is that progress is far too slow. This has been a scandal that has dragged on for many years. It is not a new problem, and helping people who are capable of living independent lives with support in the community to get out of institutional care is long overdue. Changing the culture is complex and difficult, but we are absolutely determined to sustain the pressure to ensure that change is achieved.

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

22. I thank the Minister for those replies, but I understand that Sir Stephen Budd has been asked to lead a working group on these issues, reporting to NHS England. Will the Minister say a little more about the purpose of this group and its significance, in the light of the failure to meet the June deadline?

[Norman Lamb]

That is absolutely right, but Sir Simon Stevens took the view that it was essential to get the voluntary sector much more involved in the whole process. There are brilliant organisations such as Mencap and the Challenging Behaviour Foundation which are absolutely committed to achieving change, and the more we can work with them to achieve that change, the more likely we are to be successful.

NHS Investigations (Jimmy Savile)

Grahame Morris Excerpts

Thursday 26th June 2014 Commons Chamber

[Mr Hunt]

I commend my hon. Friend for his campaigning for vulnerable children over many years. The letter I sent to NHS England this morning asks it to make sure that all the lessons are learned from the reports, and it includes the very clear suggestion—I want the NHS to interpret my letter in this way—that it should ensure that it commissions the support needed for children in these circumstances so that they get the very support that is necessary. This is not just about encouraging people to speak out; it is about making sure that when they do, they feel listened to and supported.

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

I thank the Secretary of State for his statement and my right hon. Friend the shadow Secretary of State for his considered response. In relation to the scale of the abuse—with ages ranging from five to 75, and involving 28 hospitals—lessons need to be learned about the systematic failure not just within the NHS, but within other institutions. Will the Health Secretary have discussions with the Cabinet Office and others to make sure that appropriate lessons are learned?

[Mr Hunt]

Absolutely. I want to reassure the hon. Gentleman that we are taking a cross-Government approach—across a range of Departments, but particularly the Department for Education and the Home Office—and that the Government as a whole will draw the lessons from this whole horrific series of episodes to make sure that we have a joined-up approach.

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 10th June 2014 Commons Chamber

[Jane Ellison]

My hon. Friend highlights that there are a lot of different approaches to reducing the pressures on A and E. The great thing is that we are seeing real innovation from local clinicians, supported by local Members of Parliament. That shows what can be done when we address these problems with an innovative approach, and think about how we can reduce these pressures and ensure that as many people as possible are served in the right way and treated outside A and E, if that is not the place they should be.

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

7. What discussions he has had with NHS England on the future of the cancer drugs fund.

[The Minister of State, Department of Health (Norman Lamb)]

We have committed to continuing the cancer drugs fund until the end of March 2016. We will consider carefully with NHS England how, in the longer term, we can support patients in accessing cancer drugs that could benefit them, at a cost that represents value to the NHS.

[Grahame M. Morris]

I thank the Minister for that answer, but is it not true that last year the cancer drugs fund was again underspent—funds that could be used to pay for advanced radio therapy? Every MP has received a letter from the England rugby legend Lawrence Dallaglio asking for a meeting to highlight this problem. Why is the Secretary of State refusing to meet Mr Dallaglio, along with top cancer clinicians in Cancer Research UK?

[Norman Lamb]

First, if only it was underspent. More than 50,000 patients have now benefited from the fund, which is fully spent. More than £1 billion will have been committed in the full period of the fund. I have confirmation from the Secretary of State that he has already met Lawrence Dallaglio. I hope that will reassure the hon. Gentleman.

Ambulance Resources and Response Times

Grahame Morris Excerpts

Wednesday 14th May 2014 Westminster Hall

[Mr Iain Wright (Hartlepool) (Lab)]

May I begin by saying what a pleasure it is to serve again under your chairmanship, Mr Crausby? I hope that you will pass on my most grateful thanks to Mr Speaker for assisting me in securing this important debate so quickly after I made my request to him.

I also want to thank the front-line ambulance staff and paramedics whose professionalism and expertise, combined with care and compassion, can often mean the difference between life and death. Time and time again, we hear of the dedication beyond the call of duty of front-line staff in the NHS, and it is entirely right that we hold them in high regard and give them the recognition, remuneration and resources to do their job.

This debate was prompted by the tragic circumstances surrounding the death of one of my constituents, Mr William Gouldburn. Mr Gouldburn was 73 and had served his community as a special needs teacher. He had heart problems, and in the previous couple of days he had come out of hospital after surgery to his shoulder. After leaving hospital, he had felt unwell, to the extent that a doctor was called to his home at 9 am. Less than 90 minutes later, Mr Gouldburn collapsed in his bedroom and an ambulance was called by 10.32 am. The call was not considered to be urgent by the contact centre that took it, and a response time of 60 minutes was given. However, even that response time was not met. It was after 12 noon that a St John Ambulance arrived.

My understanding is that Mr Gouldburn’s family, who were naturally frantic about his condition, placed a total of seven calls about his case to the emergency services during this period. At this point he was lying on the floor of his bathroom, and he was to do so for more than 90 minutes. A regular ambulance was eventually dispatched, but Mr Gouldburn was pronounced dead shortly afterwards. I hope that the whole House will join me in sending condolences to Mr Gouldburn’s family.

At the inquest into Mr Gouldburn’s death last month, a manager for the North East Ambulance Service said that the service had been experiencing a high level of calls and that ambulances were delayed in admitting patients to North Durham hospital due to a lack of available beds. The manager was asked by the coroner:

“Is what I’m hearing you don’t have resources to meet demand?”

The ambulance service manager stated:

“Yes, that’s correct. It is a national problem”.

Mr Gouldburn’s case raises some significant questions about ambulance services, which is why I wanted to secure this debate.

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

Will my hon. Friend give way?

[Mr Wright]

I will certainly give way to my parliamentary neighbour.

[Grahame M. Morris]

I am grateful to my hon. Friend for giving way and I congratulate him on securing this important and timely debate. There are serious concerns about the performance of the ambulance service in the north-east region. What is his opinion of the assessment by its chief executive, Simon Featherstone, that the service’s unsatisfactory performance is not as a result of the cuts, given that the trust is having to make £23 million of cuts during the lifetime of this Parliament?

[Mr Wright]

I must praise my hon. Friend, because he does fantastic work on health issues through his passionate commitment to the NHS and in his work on the Select Committee on Health. He is absolutely right, and I will come on to the finances and resources for ambulance services in a moment.

Mr Gouldburn’s case was tragic, and from what the coroner said, it was avoidable. However, a further tragedy is that his case is not unique or isolated. I have been told about similar cases, as my hon. Friends have been.

--- Later in debate ---

[Mr Wright]

I know that my hon. Friend has spoken in the House about this issue before, and I praise him for that. The use of private ambulances is taking resources away from our having a sustainable public service, which all our constituents want. As a result of that, the ambulance services are not able to invest in their work force, and something needs to be done about it. I hope that the Minister will respond directly to my hon. Friend about that issue, because the use of private ambulances is simply unacceptable.

[Grahame M. Morris]

I am grateful to my hon. Friend for giving way again. As this is a 30-minute debate, I will keep my interventions short, although I have a whole list of constituents who have waited an inordinate length of time; there is not the opportunity in a short debate, such as this one, to give all those examples.

In relation to the specific point about private ambulances, is it possible that the Government’s health reforms have led to fragmentation? I ask that because I have met representatives of front-line ambulance staff who have told me that the one-year contracts from the clinical commissioning group are not helping with the North East Ambulance Service NHS Trust’s forward planning of the services and resources that are needed to meet local demand.

[Mr Wright]

My hon. Friend makes an important point. How can an ambulance service plan for the next five years if it faces annual commissioning rounds? That does not work and does not provide long-term sustainability.

The North East Ambulance Service, which, like other ambulance services, has received a flat cash offer from the Government over the course of this Parliament, has been required to cut £4.83 million from its budget for 2012-13, which is some 5% in real terms, and another £4.35 million for 2013-14. Unison estimates that real cuts of about 20% to 25% have been made to ambulance services so far over this Parliament. Those cuts, coupled with rising demand, are having a detrimental impact on the quality of ambulance service that people receive.

--- Later in debate ---

[Jane Ellison]

No, because I have only just begun and the hon. Gentleman took many interventions.

Emergency services are the first port of call for many of us when serious illness or accident strikes. The total number of emergency calls to ambulance services in England in 2013-14 was 8.4 million, which is a 0.9% drop over the previous year. Unfortunately, a small proportion are unnecessary or frivolous, but the overwhelming majority are from people who feel in need of urgent help.

The growing number of people living with chronic conditions and the ageing population to which the hon. Gentleman referred are placing increasing pressure on urgent care services, something that we all acknowledge. It is important for my Department to work with Public Health England, local commissioners and health care providers to educate and engage the public on measures to prevent chronic health problems from developing. There are a number of people who end up in A and E because they have not taken medication properly or who suffer acute problems as a result of a chronic condition. Hon. Members will be aware of some of the longer-term problems in their region, which result from difficult public health challenges. Tackling those is my own particular portfolio, and is one way in which we can make the emergency services more sustainable in the longer term.

I hope hon. Members recognise that. At times, it seemed that they were merely committing themselves to significant additional future spending rather than also turning their minds to the longer-term challenges.

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

I am going to continue and try to make a few substantive points. If I have time, I will give way.

All 999 calls are triaged into two basic categories, red and green, depending on the seriousness of the call. Those placed in the red category are calls where the patient is in a life-threatening condition; an example would be someone suffering a cardiac arrest. Such calls require assistance on the scene as quickly as possible and the Government have set targets for all ambulance services in England of a response within eight minutes in 75% of cases. The latest figures, for March 2014, show that in north-east England—the area of the hon. Member for Hartlepool—the median average response time for red category calls was 6.4 minutes. Nationally, those figures show that 76.2% of red 1 calls, which are the most critical, received a response within eight minutes. In the north-east the target was also met, with 75.2% of patients receiving a response within eight minutes. That is not to say that there are not significant problems in some cases, but it is important to place on the record the service’s effective work in meeting that target.

Less critical 999 calls placed are in the green category. Those calls are not subject to national targets. Some ambulance services set their own targets for response times, and NEAS uses a one hour standard. It is important that such calls receive a timely and appropriate response, but red calls must be prioritised, as a person’s life may be in immediate danger.

There has been recent media coverage of long waits for ambulances, and hon. Members have alluded to constituents’ experience of such waits during this short debate. Every patient should expect to receive first-class care from the ambulance service, but the nature of emergency response work means there will always be incidents where unfortunate timing leads to a situation in which someone who is assessed as being in a non-life-threatening situation calls 999 at the same time as several other people who are in life-threatening situations. I am sure that hon. Members recognise that that would be the case under any Administration.

[Grahame M. Morris]

Will the Minister give way?

[Jane Ellison]

Briefly.

[Grahame M. Morris]

I am grateful to the Minister for giving way, but I cannot let that pass, because the situation is different now. I have had the honour of representing Easington for four years and it is evident from the cases that are coming to me and to colleagues from the region that the situation is worsening. One case was that of a young man who broke his hip playing football and waited for two and a half hours in the rain. He was in the centre of the constituency, in an area that is readily accessible. Another was of an old lady who waited two and a half hours for an ambulance. She died the following day. Something is sadly wrong with the North East Ambulance Service and the situation is deteriorating. We have all had cases that are really quite shocking, and something needs to be done.

[Jane Ellison]

I am not familiar with the cases that the hon. Gentleman mentioned, but I will draw them to the attention of my ministerial colleagues and of the trust. I spoke to the head of the trust yesterday, and will make sure that the debate is brought to the trust’s attention. However, I gently say to hon. Members that they surely cannot be suggesting that at no previous time, under any previous Government, have there been any cases in which a service did not get this right. It is important to—

Oral Answers to Questions

Grahame Morris Excerpts

Tuesday 1st April 2014 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. Last week I was in one of the safest hospitals in the world, Virginia Mason hospital in Seattle, which has cut litigation claims by three quarters since it introduced safer care. We have fantastic hospitals in this country too, such as Salford Royal. The truth is that safer care is better value for money: it means that more money can be spent on the front line, not on litigation.

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

The Secretary of State is not showing much compassion towards hard-working NHS staff, who have a 1% pay rise. One year on from the top-down reforms, what does he think of the survey showing that 69% of front-line staff think his reforms are damaging patient care?

--- Later in debate ---

[Norman Lamb]

I remember well the meeting I had with my hon. Friend, other hon. Members and some families, and indeed I remember the testimonies those families gave. I will write to NHS England about his question and report back to him on the progress it is making.

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

T2. How does the Minister respond to a warning from the UK’s top cancer doctors that the planned closure of 18 specialist centres for treating the victims of brain cancer is putting patients’ lives at risk by delaying treatment? It is clearly at odds with the Prime Minister’s assurance about improving access. Those top brain surgeons say that it is appalling. Will the Secretary of State stop it and engage in a proper and meaningful review?

[Mr Jeremy Hunt]

The review the hon. Gentleman refers to is a consultation by NHS England to ensure that we commission specialist services better. There has been a 23% increase in the number of cancer sufferers getting treatment under this Government. We want to improve on that record even more, which means having sensible discussions on how to improve specialised commissioning, and that is what is going on.

NHS Patient Data

Grahame Morris Excerpts

Tuesday 25th March 2014 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I am pleased to speak in this debate with you in the Chair, Ms Dorries. Other Members may not know that we made our maiden speeches together, so we have always been inextricably tied in that way.

I am raising issues today because I want the Minister, NHS England and the Health and Social Care Information Centre to appreciate some of the real concerns about past and current uses of NHS patient data. I will talk about concerns about a lack of transparency in decision making, the commercial use of patient data and the lack of consent for that use.

The chair of the HSCIC talked last week about the organisation’s having an “innocent lack of transparency”. That was an inappropriate description of an organisation that is causing serious concern about its handling of NHS patient data. A lack of transparency cannot be tolerated in the part of the NHS that is trusted with safeguarding patient data and I do not accept the description of “innocent” for that lack of transparency.

At a recent meeting of the Select Committee on Health, Members asked questions about decision making on data releases from the NHS Information Centre. The panel members, who included the Minister, were asked how many of the key decision makers from the NHS Information Centre, which released patient data to insurance actuaries, had later become decision makers in the HSCIC. Max Jones, director of information and data services, said:

“The executive directors of the HSCIC with responsibility for this area were not part of the old information centre.”

When asked again whether the individuals who made the decision on transferring data to insurance actuaries became decision makers in HSCIC, he replied that

“the very senior management in the HSCIC is not the same as very senior management that was in the”

information centre.

The Minister has recently given me an answer to a written question that directly contradicts that and I am concerned about that. I asked him about the numbers and levels of staff who had transferred to the HSCIC from the NHS Information Centre. His answer stated that, of the 11 members from the management board of the HSCIC:

“Three of the non-executive directors and two of the executive directors were previously members of the NHS Information Centre management board. One of the executive members is graded as a very senior manager post and the other transferred as a senior doctor.”—[Official Report, 17 March 2014; Vol. 577, c. 457W.]

Given that that directly contradicts Max Jones’s answers to the Select Committee, will the Minister ask Max Jones why he gave those incorrect answers?

Dr Mark Davies, one of the senior executive directors, joined the NHS Information Centre in 2008 and transferred to the HSCIC when that was established. Indeed, an article last August described how Dr Davies sits in the exact same office in Leeds that he occupied when the HSCIC was the NHS Information Centre. He is the director of clinical and public assurance—a post that, surprisingly, is being made redundant this month. Will the Minister tell us why a senior post on public assurance is judged to be redundant, given the lack of public confidence in the plan for care.data and the many questions being raised by me and others about commercial uses of patient data?

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

I congratulate my hon. Friend on securing this timely debate, which is raising some important issues that we need clarity on. We have just come from a seminar in which the Health Committee had some expert witnesses. Does she agree with the conclusions put forward there about the need for clarity before we go ahead with this data collection? I am thinking particularly about the cyber-security review, safeguards on anonymous or pseudo-anonymous data, separating out purposes for controls, a tighter definition of the care data—

[Nadine Dorries (in the Chair)]

Order. Mr Morris, this is a 30-minute debate, so can you keep your intervention short, please?

[Grahame M. Morris]

I will. I just want to mention governance arrangements as well.

[Barbara Keeley]

Very much so. I must tell the Minister that we have not had time to absorb all of what has happened at the HSCIC, but we are disturbed by much of what we have learned. It seems as if there has been a proliferation of organisations and committees and that, as the use of that data and commercial data has burgeoned, the NHS has lost control of what is going on. That is of real concern.

[Barbara Keeley]

I very much agree. Last night I tweeted that I was to have this debate today and I was astonished with the response I got—an awful lot of people are very concerned about the issue. I will come on to opt-out in a moment, but let me conclude the point I was making about the director of public assurance’s post being made redundant. There will be considerable interest from Parliament on the basis for and the terms of that redundancy. I hope there will be no suggestion of a compromise agreement or gagging clauses. There are serious questions to ask about some of the activities.

While Dr Davies is still in post, there are a number of questions to ask about his role and those of his colleagues in the NHS Information Centre that later became the HSCIC. Dr Davies has been the chair of the four-person data access advisory group. Having two senior HSCIC employees on the advisory group on sensitive data releases, including its chair, brought criticism about a lack of independence. As chair of the group, Dr Davies also had the right to approve data releases unilaterally from the HSCIC, outside the committee. He was therefore in a powerful position. Indeed, it was reported in The Guardian last year that Dr Davies used that power to release to the Cabinet Office the confidential medical records of teenagers taking part in the national citizens service.

Perhaps more recently, Dr Davies’s views were becoming out of line on some aspects of the Government’s stance on care data. The Guardian reported in January that Dr Davies said that there was a “small risk” that certain patients could be “re-identified”, because insurers, pharmaceutical companies and other companies had their own medical data that could be matched against the pseudonymised records. He said:

“You may be able to identify people if you had a lot of data. It depends on how people will use the data once they have it. But I think it is a small, theoretical risk”.

The risks in this area have been rightly getting much attention and the Health Committee heard more about them this afternoon. Examples can be taken from the websites of both Harvey Walsh, a company that boasted of having more than a billion linked patient-level records and an ability to track patients over time, and OmegaSolver, the company with the patient analyser tool that it claimed can track patients throughout their hospital care.

In the case of OmegaSolver, its website held example screens showing use of its Patient Analyser tool, which it said could track actual patients within every hospital in England, providing up-to-date information for every disease area.

[Grahame M. Morris]

My hon. Friend is making an essential point. Whole data sets from the hospital episode statistics have been handed over to third parties, and that is absolutely reckless. We need those data to be deleted to restore public confidence in who has got the data and for what purpose.

[Barbara Keeley]

Indeed, and I say that they “held” that information because websites such as those that I mentioned were suddenly altered when attention was drawn to the capabilities that those organisations claimed to have when it came to tracking patients. The Minister and hon. Members may have seen reports about how the medical histories of people in public life could be tracked using online tools of that type. Widely reported accidents or medical procedures undergone in NHS hospitals clearly provide enough information to spot one patient event in the records and then read across to every hospital visit for that individual.

I ask the Minister not to echo the mantra he has used before or the one the HSCIC used when asked about OmegaSolver—that only aggregated patient data are used and that that does not represent the experience of an individual. It is clear that commercial companies granted commercial reuse licences have claimed that they can track

“actual patients within every hospital within England”.

As I said in the recent debate on the Care Bill, the hospital episode statistics database was originally an administrative database. When did any of us sign up to having our data used to recalculate the cost of insurance cover or by pharmaceutical companies as customers of OmegaSolver? I do not recall signing up to that and I am sure that other hon. Members did not, either.

Does the Minister agree that perhaps we should go back to thinking that patients should have the option of having their data used only for clinical care and for commissioning that care? In his response in the Care Bill debate on these issues, the Minister said that

“people can, at any time, object or change their mind, and the Health and Social Care Information Centre must respect their wishes and remove their data from records.”—[Official Report, 11 March 2014; Vol. 577, c. 206.]

At the time he said those words, I thought, “That is not currently the case.” I understand that deletions are not permitted and, once a patient’s record has been extracted, they cannot get it removed from the database. If it is in fact a new development that patients can change their minds and request that their data be removed from the records held by the HSCIC and by commercial companies, that will be welcomed, but I really look forward to the Minister telling us how that happens.

I gave the example of Harvey Walsh. They have described themselves as main suppliers of hospital episode statistics and NHS data to the pharmaceutical industry. Can the Minister tell me how an NHS patient can have their records removed from Harvey Walsh’s AXON database or any of the other databases that are outwith the HSCIC?

In the Care Bill debate, the Minister was also asked a question about whether free text would be uploaded from patient records either now or in the future, and he answered:

“As things stand at the moment, free text is not going to be used. That is the reassurance given by the HSCIC”.—[Official Report, 11 March 2014; Vol. 577, c. 206.]

However, Professor Julia Hippisley-Cox and Professor Ross Anderson have pointed out to Health Committee members that researchers already make use of free text from GP patient records. Indeed, medical students and computer science postgraduates at the university of Sussex and at Brighton and Sussex medical school have begun work on analysing doctors’ notes for data from free text.

The data being used come from the Clinical Practice Research Datalink, and Select Committee members were told that those patient data are being used without specific patient consent or section 251 support—it is section 251 of the National Health Service Act 2006. If the HSCIC has given the Minister an assurance that free text from GP records will not be used, can he tell us whether and when the use of free text from GP patient records in the CPRD will be stopped, particularly given that that appears to be happening without patient consent? Patient consent is important, and I still get the feeling from the HSCIC that individuals are somehow being labelled as selfish if they have concerns about sharing their data.

I want to come back to concerns about the existence of the commercial reuse licences granted by the HSCIC. I have tabled a written parliamentary question on this, but I also put the question to the Minister now. He has confirmed that the HSCIC has granted commercial reuse licences. Will he now provide me with a list of each past and present holder of a commercial reuse licence granted and, for each licence holder past and present, will he list the purpose or purposes for which they applied and were approved to use NHS patient data from the HSCIC and its predecessor, the NHS Information Centre? As patients of the NHS, we deserve to know in which places and with which organisations our data are sitting and what they are being used for.

--- Later in debate ---

[Grahame M. Morris]

My hon. Friend is being very generous about interventions. Again, she makes an excellent point. We need an effective audit trail. If these data sets are being sold on, we need some effective control. That should be stopped. I hope that the Minister—

[Nadine Dorries (in the Chair)]

Order. Barbara Keeley.

--- Later in debate ---

[Dr Poulter]

I will give way in one moment. It is also the case, in relation to a number of the other issues and concerns that have been raised during this discussion, that some of the events and some of the evidence given to the Select Committee have of course been superseded by the amendments made to the Care Bill that we debated a couple of weeks ago, so it is difficult to see those points—

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

I am giving way to the hon. Gentleman’s hon. Friend in one moment. Let me complete the explanation and then I will be very happy to give way. Events have moved on since some of those evidence sessions, because of course amendments were made to the Care Bill that gave greater clarity and greater reassurance about the protection of patients’ data.

--- Later in debate ---

[Dr Poulter]

The hon. Lady will recognise that NHS England is an arm’s-length body, so it has less accountability than—or certainly not the same accountability as—a civil servant does to a Minister, and it has a degree of independence. If there are concerns to be raised, as she has just outlined, it is for the Chair of the Committee to write to obtain clarification if he believes that to be appropriate. I am sure he will do so if he feels that that is right. It is not for me, as a Minister, to interfere with the workings of a Select Committee and I do not propose to do so.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

No. I have listened to the same speech from the hon. Gentleman as did my right hon. Friend the Member for Chelmsford (Mr Burns). The hon. Gentleman is always very helpful in tying himself in knots and confusing debates. On this occasion, however, I will make some progress, because I have got 10 minutes left and I would like to put down some further reassurances. I may give way later on, time permitting.

Once again, I congratulate the hon. Member for Worsley and Eccles South on securing the debate, and I would like to say at the outset that we all believe care.data to be a good thing. It is good news for patients, for improving transparency in health care and for improving the quality of research. Those are undoubtedly good things, and we must not lose sight of them in our discussion. The lessons of Mid Staffordshire point out that if we do not properly expose examples of bad care—if we do not have the data, and the transparency in the use of those data, to expose good and bad care in the NHS—bad things can happen to patients. That is a lesson that we must heed.

We must also recognise that if we had had better data sharing in the past, we might have been able to learn better how to recognise patterns in prescribing that were to the detriment of patients, such as the example that has been cited of the use of thalidomide during pregnancy. We might have avoided some very bad things happening to patients if we had had the necessary data. That is what our proposals are about.

This is not a sudden, big-bang change. Opposition Members have put it about that we are dealing with a big change in approach to the use of data in the NHS, but I remind the Chamber that in 1989, hospital episode statistics were first collected for in-patient data, in 2003 for out-patient data and in 2007-08 for A and E data, and primary care data are now being made available.

Of course we understand that the use of data can be concerning, so I want to reassure everyone that the right safeguards are in place, many of them established by the Health and Social Care Act 2012. The new body, the Health and Social Care Information Centre, must have regard to the safeguards put in place by the 2012 Act. The Government take the safeguarding of patient data very seriously.

The commercial reuse of licences was raised in the debate. The Health and Social Care Information Centre has confirmed that some reuse agreements remain in place for specific organisations in relation to approved purposes. The purpose of each application is carefully considered by the HSCIC before it is agreed. That consideration includes the application’s benefit to the health and care system, a safeguard established by the 2012 Act for the use of data.

--- Later in debate ---

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

I will give way in a moment; I am just going to finish this point. Following concerns expressed by the Health Committee in its meeting of 25 February, Sir Nick Partridge, a non-executive director on the HSCIC board, has agreed to conduct an audit of all the data releases made by the predecessor organisation, the NHS Information Centre, and report on that to the HSCIC board by the end of May.

Furthermore, a report detailing all data released by the HSCIC, including the legal basis on which those data were released and the purpose to which they are being put, will be published by the HSCIC on 2 April. That report will be updated quarterly. I reiterate that the HSCIC will release information for health and care uses only.

[Grahame M. Morris]

The Minister is arguing that the scheme is an extension of what happened before, but there is clearly a quantum difference. There is general agreement that it is a wonderful thing to have data sets for research and public health purposes. The difficulty that the public have, about which we need to restore confidence, is when that information is being used for marketisation—for marketing purposes—by commercial reusers. I am not reassured by the Minister’s comments, but he has an opportunity to correct the problem in the House of Lords.

[Nadine Dorries (in the Chair)]

Order. Mr Morris, that is a very long intervention.