Adult Social Care

Guy Opperman Excerpts

Thursday 8th March 2012 Commons Chamber

[Guy Opperman (Hexham) (Con)]

Well, they make them out of strong stuff in the west country. It is a joy to follow my hon. Friend the Member for Totnes (Dr Wollaston), who brings great medical and intellectual wisdom to the debate, and I am honoured to be speaking in a debate introduced by my hon. Friend the Member for Truro and Falmouth (Sarah Newton).

I would be humble in my approach to this matter, but I would like to think we are united in the sense that Members from all parties have a common desire to tackle what is probably the most intractable problem we face. There is in effect no dispute about what we want from social care: we want independence, dignity and privacy for those who are being cared for, and the people who provide the care need patience and humour and to know their individual clients and their family members. The question is how we develop a social care network that treats people as people within the confines of a budget that is ever changing and ever more difficult to reconcile.

How a society treats the vulnerable is surely the best definition of that society. I came into this House in my 40s, I am delighted to say, and I thought I was in the prime of my life, until last year when I became unwell. I am probably the only person in the Chamber at this moment who has needed social care. It was a great effort to become better researched in preparing for this debate, obviously, but becoming ill last April gave me a great deal of knowledge and insight from a personal standpoint about the degree to which such care is necessary and about the great service that is provided. Today’s debate is a wonderful opportunity to celebrate the great work done by individual carers in the public and private sectors and, not least, the work done by families.

I speak as an MP for the north-east, and there are shining examples of how the north-east leads the way in the provision of care to individuals. There is outstanding palliative care in my constituency through the Charlotte Straker palliative care teams in Corbridge. If I need to make a declaration it is that last summer I raised in excess of £3,000 for the charity Tynedale Hospice at Home, which provides care in Hexham. All of us as MPs will go around individual care homes in our constituency. The Helen McArdle organisation does an amazing job across the north-east, including at its Acomb Court service in Hexham. I was lucky enough to be asked to present some prizes at Wentworth Grange in Riding Mill and it was noticeable that more than 35 awards were made to individual staff members because there was a great deal of ongoing training to improve the quality of individuals’ care. I could name many others throughout the constituency, including Wellburn House in Ovingham, but I will move on, given all the support there has been across the House, to talk about the White Paper.

The White Paper on social care is coming this spring. I know that spring is drifting on, that there are pressures and that people are calculating what kind of spring it is going to be, but let me reassure the Minister. Last year, we all celebrated the Arab spring across the near and far east, which changed things. That Arab spring lasted quite a long time—virtually the entirety of last year—so we will not necessarily be critical of the Minister if the White Paper does not come within the technical confines of spring. Surely—I make a serious point—it is more important to get this right than to rush it. I accept that there have been a plethora of consultations and assessments over the past few years, but there is no doubt that the way we have approached this issue, on a cross-party basis with constructive attention to detail, is much more important than rushing something out that is not the right way forward. I welcome the fact that the White Paper is coming and I urge that we get it right and work on a cross-party basis.

This issue, I regret to say, is not about funding. There will always be small issues about the way that individual local schemes and individual approaches are funded, but the issue we will decide in the House this year is not about funding from the state: it is far more about outcomes. How do we reform the system such that we have an outcomes framework that integrates all the services for particular individuals? I endorse entirely what my hon. Friends the Members for Truro and Falmouth and for Totnes said about this. I hope that health and wellbeing boards can deliver a single commissioning process with a single outcomes framework whereby older people’s health, care and housing services in a particular area are integrated. That has never happened in the entire existence of the NHS or previously; it is a genuine aspiration. Less important than funding is attention to that detail because at the moment we have a patchwork of care.

I am conscious of the time and eager for my hon. Friend the Member for South Swindon (Mr Buckland) to get in. We speak so much in the House that we are now the rear gunners of every debate—of democracy. It is a shame because we feel that we have much to contribute but we contribute so much that we are always the last to speak. I must not dispel any chance for the House to hear from the great man from South Swindon so I shall try to abbreviate my comments.

I agree that the Dilnot proposals are correct but there has to be genuine understanding and we all need the ability to sell to our constituents what Dilnot means. The idea that Dilnot will not—I will not try that again—cost us in any way whatever is hard to grasp and hard to convey to our constituents. There are nettles that need grasping. Funding will be an issue, and a contribution from individuals will be unavoidable. If we do not accept that, there will be grave difficulties ahead.

I welcome the fact the NHS budget is protected at present. Given all the difficulties, we should celebrate the choices that are being made and that extra money is being spent on social care. It concerns me, for example, that the Government spend eight times as much on cancer research as on dementia research. I welcome the extra money going to dementia patients, but more needs to be done, as many groups have made clear.

I want to put one point to the Minister that I hope will assist. I tabled a question to the Department of Health and received the answer on 7 February. It was:

“To ask the Secretary of State for Health if he will make it his policy that the influenza vaccine should be compulsory for all public and private sector care workers.”—[Official Report, 7 February 2012; Vol. 540, c. 199W.]

I accept that certain people will want to retain the choice not to have the vaccination, which would be given only on the basis of informed consent, but it would be of great assistance to the vast majority of care workers. Vaccination would clearly cut the prevalence of infection and other problems, and the Government should lead the way. Some, for religious or other reasons, would not to want be vaccinated, and they should be exempted, but it would be a good move for the Department of Health in addressing what is clearly a problem of infection and of staffing when staff become ill themselves.

I support public sector carers, who need to be valued just as much as any other public sector workers. They do a difficult, messy and not always entertaining job. They are the unsung heroes. We also need to support our family carers and recognise the services that they provide. We must ensure, as many have said, that there is a decent system of respite care because if the family carer cannot care there will be huge problems for the Department of Health and the NHS.

With that, and allowing sufficient time for the sage of Swindon, I will sit down.

Veterans (Mental Health)

Guy Opperman Excerpts

Wednesday 7th March 2012 Westminster Hall

[Julian Sturdy]

I agree. It is also worth noting that reservists tend to suffer more from mental illness, if they have experienced conflict, than regular soldiers, so it is probably even more important that we understand where the reservists are and can monitor that and target help towards them.

[Guy Opperman (Hexham) (Con)]

I congratulate my hon. Friend on securing the debate and I support the laudable aims that he is describing. Given the established difficulties with keeping track of individual soldiers and the difficulties with giving the necessary support post discharge to all manner of servicemen and women, is it not time that we started to consider the possibility of a veterans agency that brings together all these things and provides a co-ordinating review and a hub point for all these services?

[Julian Sturdy]

I agree. As I said, there is a real problem about the joined-up thinking that needs to be done. A tremendous amount of work and services are out there, but we need to bring that all together, under one roof. I will come on to that later if I can.

There remains a real danger that too many veterans will slip through the net because they fail to be registered for initial support on leaving the service and get lost in the system thereafter. The best way to ensure that support gets through to veterans is to keep up to date with veterans, as has been said.

Having touched on the increase in mental health nurses across the strategic health authorities covered by an armed forces network, I ask the Minister to outline the initial effect that the Government believe those nurses are having. Is there sufficient demand for the increased services? Do we need to consider increasing the numbers further? Ensuring that Government provision is frequently reviewed in such a manner will help to keep the ball rolling on this very important subject.

Without wishing to ask too many questions, I should be grateful to the Minister if he confirmed how many of the 10 health networks have now developed integrated services for veterans with specific mental health problems. As I said, ensuring that our provision is targeted correctly and effectively in supporting veterans is key.

I should now like to deal with the online package of interventions for veterans. In response to a recent written question tabled by my hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips), the Minister, who I am delighted to see will respond to this debate, stated that the uptake of membership of the Big White Wall among the armed forces family is exceeding expectations. It would be interesting to know whether uptake among veterans is also high. Although I am a great supporter of online interventions, my slight fear is that information, assistance and forms of community engagement are all present and accessible online, but only if someone actively searches for them. With respect to veterans who suffer from mental health problems, we cannot expect all of them to be able or even willing to carry out such research. Are those leaving the service provided with the relevant links and information before they leave?

--- Later in debate ---

[Guy Opperman (Hexham) (Con)]

It is a great pleasure and a privilege to speak in this debate today. I have been in this House for nearly two years and I have not had the opportunity to raise the issue of the mental health of veterans in the way in which we have done today. I pay great tribute to my hon. Friend the Member for York Outer (Julian Sturdy) for securing this debate and for the measured and eloquent way in which he has brought the issues to the House.

I join my hon. Friend and other colleagues in passing on our respective condolences to the service men and women, and to the families of those who died in Afghanistan so recently. I endorse everything that both the Prime Minister and the Leader of the Opposition said. It is an utter tragedy and one of the largest losses of life for many a year. I remain of the view that the sooner we bring our troops home from Afghanistan, the better it will be.

This debate is certainly overdue. I want to make a declaration. I send out my thanks and support to the various charities, volunteer groups and individuals who provide support. I echo the words of support for the Royal British Legion and Help for Heroes. If I need to declare that I have raised funds for such groups while serving as a Member of Parliament, I do so. I certainly need to make a declaration that I have represented, as defence counsel, multitudes of soldiers facing criminal charges, which was a salutary and depressing experience. Many of the soldiers had committed criminal offences, which they had no desire to commit, because they were suffering from mental health problems and fundamentally from post-traumatic stress disorder.

I represented a Royal Marine who had broken down in a supermarket after he had been unable to get together the right amount of money at the till. He felt that the lady behind the counter, who had been perfectly civil to him, had not been as co-operative as she should have been and it all became too much. The nature and the prevalence of post-traumatic stress are such that it is always the very smallest things at the end of the process that result in the demise of the mental strength of people who have quite happily stormed up Tumbledown ridge, gone across the Gulf deserts and fought repeatedly in a way that very few of us in this House can even contemplate. It is how we provide support that is important. As defence counsel for some of these lads and, on one occasion, a woman, I saw very strongly how their spirit was broken. I have also seen, over the last 15 to 20 years of lawyer practice, plenty of examples of these people falling through the system.

[Andrew Percy (Brigg and Goole) (Con)]

My hon. Friend is making an important speech about how people fall through the net. My neighbour, the hon. Member for Scunthorpe (Nic Dakin), mentioned Charles Brindley, who has been trying to do some work around GPs. Many GPs do not seem to be aware of the military assessment programme that is available. Often if someone presents with a mental health issue, the GP is not trained or aware of the services and support that can be made available. Does my hon. Friend agree that we need to ensure that GPs are better educated and better trained in dealing with such individuals?

[Guy Opperman]

I entirely endorse that point. Although it is incumbent upon Members of this House to raise the profile of this issue and to try to disseminate information about the types of health care support that exist, it is also incumbent upon the relevant health trusts and authorities to ensure that in future a degree of information is passed down the net to individual GPs and action teams, particularly those teams dealing with alcohol abuse, so that the organisations in the regions are able to support the veterans who are out there.

I have worked with a charity called Veterans in Action. It involves some constituents of mine in Northumberland but it also involves servicemen and women who are based in Lancashire and all over the country, who are attempting to do various things. For example, they have a pilot project with the Lancashire Drug and Alcohol Action Team that involves meeting up with GPs to work with them and trying to do exactly the sort of thing that my hon. Friend the Member for Brigg and Goole (Andrew Percy) has outlined.

However, the worry is that, although individual groups in our constituencies are all doing very good work to provide a degree of assistance to veterans, there is no overarching body providing global support. What often happens, therefore—for example it has happened with Veterans in Action, which was set up in my constituency and is now working throughout the country—is that the individual soldiers effectively get fed up with the process and decide to provide support themselves.

I supported what the previous Government did. They were working to do a great deal more than had previously been done. Successive Governments have improved care for veterans over time. But the “Fighting Fit” report and the work done by my hon. Friend the Member for South West Wiltshire (Dr Murrison) have clearly taken things to the next stage and a better level.

I will digress slightly, because in my constituency I have the Albemarle barracks and the Otterburn ranges, troops from my constituency are serving on a regular basis in Afghanistan with the 39 Regiment Royal Artillery, and the Ridsdale ranges provide all the weapons that are tested before the soldiers use them. I also have a large number of constituents who have served in the forces. For example, many Falklands veterans live in my constituency and have come to see me because of the experiences that they have suffered and the lack of support that they have experienced. That was under a different Government and, frankly, I am not here to criticise any Government. However, there is no question but that the degree of support given to the Falklands veterans was limited compared with the support that we are giving to the veterans who are returning from Afghanistan now. Things have got better.

[Simon Hart (Carmarthen West and South Pembrokeshire) (Con)]

Further to the point made by the hon. Member for Newport West (Paul Flynn), I wanted to say that in the 30 years following the Falklands conflict—it is rather timely to make this point, this year being the anniversary—more soldiers were reported to have committed suicide after the conflict than had actually died in the conflict itself.

--- Later in debate ---

[Guy Opperman]

It is interesting, is it not, that today is 7 March and on 7 March 1982, exactly 30 years ago, about three and a half weeks prior to the Argentine invasion of the Falklands, which happened on 2 April 1982, the British ambassador in Argentina wrote a cable from Buenos Aires to the then British Prime Minister, saying that matters were escalating. It is very well known, and it was reported in the Franks report that assessed the Falklands war, that “contingency plans” needed to be made. That was not enough and a war began, then escalated. I certainly will not go down the route taken by the hon. Member for Newport West (Paul Flynn) by digressing further. However, the point is that the treatment of the veterans of the Falklands war was not as good as the treatment of veterans now, partly because there were difficulties at that time in understanding what post-traumatic stress disorder was.

From a health standpoint, PTSD is not confined to victims of conflict. There are also plenty of victims of PTSD who were involved in normal, day-to-day accidents and disasters, whether it is industrial health accidents or factory accidents; people can have PTSD arising from those things. We need to change the way that PTSD and other aspects of the mental health of veterans are visualised, because it needs to be recognised that PTSD and other mental health conditions are just as much a disease or condition as breaking an arm or suffering from cancer, and it is just as difficult to solve or treat.

I move on. I endorse entirely what was said about the current situation, and I will abbreviate my comments to making an assessment of the current situation. Various studies have shown that a very large proportion of our veterans are suffering from PSTD. At present, approximately 24,000 veterans are in jail, on parole or serving community punishment orders. That is the astonishing number that emerges if we assess how many veterans are going through our criminal justice system. It manifestly shows that, for whatever reason, we have not done enough.

Let us also bear in mind that American studies have shown that approximately 30% of the US troops who were in Vietnam suffered from PSTD, or about one in three. That is an absolutely staggering number. Therefore, although we might look at the respective troops coming home from Afghanistan, and at those who fought in Iraq and other conflict zones, and think that they are all right, three out of 10 soldiers will genuinely suffer PTSD. They may suffer it in year one after their return. Year 14 is the average length of time that it takes, but it can take as long as 25 or 30 years, and throughout all of that time, their individual families are suffering and going through particular difficulties.

I applaud the “Fighting Fit” report and the work that is being done. However, I regret to say that that is not enough. Personally, I do not consider that it is enough. I accept entirely that we are in straitened times and that, with every budget, we have to consider the way in which things are dealt with. Nevertheless, I very much hope the Minister will give the sort of assurances that charities and individual soldiers’ organisations seek about their future, and that there are commitments on an ongoing basis to the matters outlined in “Fighting Fit”, so that those charities and organisations have the reassurance that genuine efforts will be made to ensure that their funding is sustained; that mental health systems are structured properly; that the recommendations of the inquiry into medical examinations while soldiers are still serving are properly implemented; and, given that we are introducing all these ideas from “Fighting Fit”, that there will be proper assessment of those ideas after they are introduced. I agree that organisations such as the Big White Wall are not necessarily being utilised in the way that was envisaged; they are being utilised, but not necessarily in the way that was envisaged.

I would very much like to see an overarching body for veterans. I would like a veterans agency to be considered by the Government, and the Government to consider whether there is a possibility of bringing together certain parts of the NHS, the Ministry of Defence and social services and housing elements, which make up so much of all the difficulties that our servicemen suffer, and dovetailing that with the health services that are provided in prisons.

We can look at the way that people are dealt with in terms of health services in prisons. I have extensive experience of going to see clients who are former servicemen and who have received a custodial sentence or who are held on remand. There was absolutely no doubt that they were hopelessly unable to deal with the difficulties of a custodial sentence, or the difficulties of being detained, at that particular time, in circumstances that they would normally have been perfectly able to deal with.

[Mr Gray]

I have agreed with much of what my hon. Friend has had to say, but I have some difficulties with the notion of the establishment of a new agency to carry out the functions that existing Government bodies are required to carry out at the moment. If there were a veterans agency, would there not be a risk that people at the Department of Health or the Ministry of Defence would shrug their shoulders and say, “Someone else is doing this for us, leave it to them”, and that the services received by veterans would be significantly worse than they are at the moment?

[Guy Opperman]

I accept there is always a risk that, if we create some new body, we will be in a position whereby everybody passes the buck and says, “Well, they’re sorting it out”. However, I am clear that every single MP could come to this House and say, “I have individual examples of people in my constituency, or stories that I have heard of former servicemen.” Those servicemen are continuing to slip through the net—they are unaware of the individual aspects of the services that are available to them—and the Government are not necessarily acting as an overarching body to ensure that they are aware of those services.

Let me give some examples. There is very good evidence from the “Fighting Fit” report and other studies that follow it up that there should be a leavers pack for soldiers and, for example, an ability for veterans to be monitored after they have been discharged. All those services are good, but they stop after a certain period and the Government do not go back to those individuals to ask, “Are you actually all right? Are you in a position to cope with the vicissitudes of your life and your existence on an ongoing basis?” That is the sort of thing that I would like done. I concede that it may be possible to do such things in the present Departments, but there must be more joined-up thinking, because the problem is ongoing, and there are examples.

I am conscious that other Members wish to get into the debate, so I will abbreviate my comments. I want to talk about the work of Veterans in Action, a classic charity, which is run by individual veterans. For a number of years, they have been providing in-depth support, which they have found is, sadly, lacking in the system. They tell me that there is no generic way to collect veterans’ information and that it is collected very much on a local, case-by-case basis. Similarly, they say it is extremely difficult to get organisations to work together. They also tell me that the Big White Wall is not being used as it was intended to be and that people are using the Combat Stress helpline as a first point of contact.

A great many smaller, third sector organisations and charities set up by veterans are having similar problems. With no national directory or local directories of such organisations, it is immensely difficult for individual veterans who are constantly moving around—who have problems with housing and with all the dislocation that goes with that—to harness the efforts of such organisations. Therefore, just as successive Governments have done amazing work looking after individual veterans’ health in conflict zones, we should do more to look after their mental health after they have left those conflict zones.

[Several hon. Members]

rose—

Health Inequalities (North-East)

Guy Opperman Excerpts

Tuesday 24th January 2012 Westminster Hall

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

As a Member of Parliament, my priority must be the health and well-being of my constituents, and many MPs feel the same. Regional health inequalities are of profound concern and strike at the heart of our sense of fairness and equality: people are suffering unnecessarily in this country just because of the region in which they are born, and that undermines not only the idea that we are all in this together, but our very sense of national unity. At a time when the Scottish Government are seeking independence, does it help the case of those who believe in the Union, as I do, that a Brit born in Glasgow is likely to die 14 years earlier than one born in Chelsea?

As we shall see, health inequality is a complex subject, but the key question for the Minister is, do the Government recognise regional health inequalities in their health funding? I look forward to the Minister’s reply.

I was born in Wallsend and grew up in Newcastle. In Newcastle, we are more likely to die early from cancer, heart disease and stroke. We tend to die younger, are more obese as children and are more likely to die from the cold as pensioners. We suffer more from the diseases of our industrial legacy, such as asbestosis. Last year in Newcastle, there were 89 early deaths from heart disease and stroke—19 more than the national average. Disability-free life expectancy for women in Newcastle is 3.3 years shorter than the English average. For men, it is 4.9 years shorter. Not only do we live shorter lives, but more of those shorter lives are spent with a disability.

Such inequalities are not unique to Newcastle. Thanks to the public health observatories set up by the previous Labour Government, we have a comprehensive view of the inequalities in health across the country. Every year, 37,000 people in the north die earlier than their counterparts in the south. That is enough people to fill a modern football stadium. A report published in the British Medical Journal last year said that the excess toll of ill health and disability in the north is

“decimating”

the region

“at the rate of one major city every decade”.

In Newcastle, one in 25 adults claim incapacity benefits for mental illness. That is four times the rate in the Secretary of State for Education’s constituency. Across the river in Gateshead, we have one of the highest levels of obesity in the country, and on the Wear, the 2010 chlamydia rate for 16 to 24-year-olds was almost three times the rate in Surrey.

Of course, there are inequalities within regions and within cities. The Institute for Ageing and Health at Newcastle university has produced an interesting map of the Tyne and Wear metro, which shows how life expectancy reduces by more than a decade as we ride from Ponteland north to Byker.

Although I see mainly north-east MPs here today, this is an issue for the whole country, for the Exchequer and for the Prime Minister, but given that the Prime Minister press-released yesterday’s visit to Leeds as a visit to the north-east, it is clear that his grasp of geography still leaves something to be desired.

Every year, health inequalities cost £31 billion to £33 billion in lost productivity, up to £32 billion in lost taxes and higher welfare payments and £5.5 billion in additional health care costs, so this is a problem for us all. It is important to emphasise that the poorer health in the north-east is not a function of the level of health care. The Newcastle Hospitals NHS Foundation Trust is in the top 10% of best-performing trusts in the UK. We have the Campus for Ageing and Vitality, the Centre for Life, the Great North Children’s Hospital, the Northern Institute for Cancer Research and the Northern Vascular Centre and Freeman Hospital’s Cardiothoracic Centre. They are world-class institutions.

Evidence going back six centuries tells us that the root causes of health inequalities are economic. The BMJ report that I mentioned earlier says:

“Social and economic factors are extremely reliable predictors of health”

If more resources are put into an area, its health improves, but if they are taken out, its health declines. The north-east has the lowest income per head in England, and in Newcastle, a quarter of the city’s neighbourhoods are in the 10% most deprived in the country. So the poorest are hit by a double whammy. Not only does poverty impact on their quality of life, but it reduces their life expectancy and makes them susceptible to a host of diseases.

It is also ironic that in the north-east we live with the health consequences of industries that were long ago allowed or even encouraged to die. Just last month, Cabinet papers showed how Margaret Thatcher’s Cabinet discussed the managed decline of the north. We are still dealing with that. Last year’s figures from the Health and Safety Executive show that rates of death from mesothelioma in the north-east are by far the highest in the country, and although we address the symptoms, we can do nothing for the causes. But in other areas we can and are tackling the causes.

The north-east has the highest number of mothers smoking during pregnancy—22%—so Fresh, a local charity, is working with local primary care trusts to make smoking history for children. Higher than average alcoholism in the north-east has resulted in excessive numbers of hospital stays for alcohol-related harm, so a campaign to reduce alcohol dependency is supported by local press, such as the Newcastle Journal and the Evening Chronicle. But I am worried that essential work to improve health in the north-east is threatened by measures that the Government are taking.

Under Labour, health funding doubled in real terms, waiting times reduced and death from heart disease and stroke went down by a massive 40%. The previous Government also worked hard to tackle poverty and its associated evils—poor housing, high fuel costs and low wages—but the inequalities remained. So although the health of people on low incomes improved significantly, the health of those on high incomes went up by the same amount or more. In some areas, health inequalities decreased. For example, the infant mortality health inequality for manual workers fell by almost a third to 12%. To understand why that is so, we must go back further than the previous Labour Government.

The Thatcher Government refused to acknowledge the relationship between poverty and ill health. The Department of Health was prohibited from using the phrase “health inequalities”. It had to talk about variations in health, and they were always couched in terms of its being people’s fault because they led such an unhealthy lifestyle.

Labour’s experience with infant mortality shows that targeted interventions can work. Infant mortality is really interesting, because it is a sensitive measure of immediate health, which is susceptible to direct interventions, such as the ones the Labour Government introduced, including improving the health of expectant mothers through the pregnancy health grant and of babies through Sure Start.

As the Labour-commissioned Marmot review demonstrated, to reduce health inequalities we cannot just focus on lifestyle factors; we need to address their social and economic root causes.

[Guy Opperman (Hexham) (Con)]

I have listened carefully to the hon. Lady’s arguments, and I congratulate her on this debate. It is good to see so many hon. Members from the north-east in the Chamber. She talks about inequalities, and referred to Surrey’s excellent mortality rates and alcohol abuse recovery rates compared with the north-east and Scotland—people in Glasgow have the lowest life expectancy rates in the country. Does she support the proposal for an alcohol Act that would statutorily restrict alcohol availability?

[Chi Onwurah]

I thank the hon. Gentleman for his intervention. As I said, the causes of health inequalities are complex. Alcohol dependency certainly varies significantly throughout the country. We need, and we are seeing, targeted campaigns to address that. I hope that the Government will introduce concrete measures to address alcohol dependency, such as legislation and a minimum price if that is appropriate.

Labour prioritised addressing health inequalities. We could not overcome the legacy of inequality in 13 years, but we made real progress, as the figures for infant mortality show. However, that is set to change. There are three main ways in which the Government are undermining work to reduce health inequalities.

First, the Government have changed the funding formula, and reduced the component designed to address health inequalities. I have been in Parliament for 19 months, and I have raised this matter directly with Ministers four times, not counting written questions. I am hoping it will be fourth time lucky for receiving a direct answer. Will the Minister confirm that in 2010 the Secretary of State decided, against the advice of the Advisory Committee on Resource Allocation, to reduce the health inequalities component of the primary care trust target funding allocation from 15% to 10%? Two weeks ago, during an exchange on the Floor of the House, the Secretary of State cited a 2.8% rise in funding when I asked him about changes to the funding formula. Will the Minister address the change to the formula, rather than the overall increases that the Government claim?

During a speech on the Floor of the House in December 2010, I asked the Secretary of State to confirm that more will be invested in health services for every man, woman and child in Newcastle for every year of the comprehensive spending review as the Government claim that they are increasing NHS spending. He declined to do so, so will the Minister step into the breach?

Clearly, if funding is changed to reduce the amount associated with health inequalities, the north-east will lose out. The Minister will say that the Government have ring-fenced public health spending and handed it over to local authorities. She may refer to the public health outcomes framework, which was published yesterday, just in time for today’s debate, and is very interesting reading. It includes 66 measures, which will be monitored, but they cannot distract from the assault on public health that the Government’s wide-ranging cuts represent for local authorities. For example, cuts to fuel poverty reduction programmes such as Warm Front will leave pensioners in Newcastle colder and more vulnerable to illness. Cuts to area-based grants such as the Supporting People programme mean there will be less investment in support services for those with mental health issues.

The second way in which the Government are undermining work to address health inequalities is the top-down, unnecessary and destructive health care reforms. It is estimated that they will cost £3 billion, and we now know that in the north-east the NHS has been asked to put aside £143 million for those organisational changes. The Government claim that efficiencies will make up for that, but the service is already being asked to meet the 1.5% efficiency cuts challenge at a time of wholesale reorganisation. As the Select Committee on Health said today, it is incredibly difficult, if not impossible, to make such efficiency savings when everything is changing.

In the north-east, our strategic health authority and primary care trusts are being abolished. Funding will be in the hands of GP consortia. Newcastle already has a pathfinder consortium in place. Newcastle Bridges GP commissioning consortia covers most of the city, and has shown that it is keen to work with other stakeholders across the city to promote public health, but it is having to make it up as it goes along in the face of huge uncertainty and change in the public sector and in the third sector, with unprecedented local authority cuts, watched over by an eager private sector that is keen to take advantage of the profit-making opportunities that the Prime Minister and the Health Secretary have promised.

A recent letter to the Health Service Journal, signed by more than 40 directors of public health and more than 100 public health academics, argued that the Bill will increase health inequalities, not reduce them. If the Government will not pay attention to what the Opposition say, perhaps they will pay attention to what the profession says. Michael Marmot told the Health Committee that there is little evidence that the health premium will reduce inequalities. Indeed, he said that it is most likely to increase them. Seven former presidents of the Faculty of Public Health have said that the Bill will “exacerbate inequalities”.

--- Later in debate ---

[Guy Opperman (Hexham) (Con)]

My grandmother was an NHS matron, and I worked with health care professionals for nearly 20 years in my former profession as a barrister. I also spent far too much time as a patient, attempting to become an expert on all health matters. I probably hold the House record at the moment for the most time spent in hospital in the past year. I certainly spent a lot of time in hospital in my other former profession of jockey. I think that I have broken 19 different bones at various times. I was actually quite a good jockey, but I did not always stay on board in a 20-year career. If people ride over fences at 35 mph, they occasionally hit the deck.

I congratulate the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) on obtaining the debate and welcome the chance to speak on behalf of the citizens of Northumberland whom I represent. I should make a declaration that, before I first came to the House, I worked as a barrister in health care matters. I also worked for the Free Representation Unit, providing assistance as a lawyer in health care cases. I am proud that two successive Labour Governments gave me awards under the national pro bono scheme for lawyers. I do not expect that to happen again in a hurry, but it is still a great source of pride about the work that we did on behalf of patients.

As I was ill last spring and summer, I could not speak in the health debates about the children’s heart unit, but I am most pleased to support the Freeman hospital in its campaign to keep its amazing unit open. The hospital is outstanding. It is not in my constituency, but everyone in the north-east recognises that it is a flagship. We all very much support the work that it has done and continues to do. I was proud to see that my constituents Graham and Andrea Wylie, who have raised a phenomenal amount of money and supported the hospital very well, were able to bring their daughter Kiera home last week.

The debate is about inequality in health care, and all hon. Members present would acknowledge that disparities exist within the region. I accept that in Northumberland the quality of the health care and the results and optimum findings will be better than in some of the more urban parts of the region. There are also disparities by comparison with other parts of the UK. The point that I was trying to make in intervening on the hon. Lady was that clearly, when compared with Surrey or other places down south, there is a genuine difference. We all recognise that. The statistics are overwhelming. The point can also be made that in Scotland, in parts of Glasgow that I have been to, where life expectancy is barely 59 or 60 for some people, the situation is considerably worse.

I spoke in the debate on alcohol pricing before Christmas and expressed my support for an alcohol Act similar to the one that exists in Scotland. It seems to me that that is supported—to this extent I disagree somewhat with the hon. Lady—by a vast number of health care professionals and clinicians. I hope that the Minister will support that today. I welcome the fact that the Prime Minister seems to have swung behind the idea of an alcohol Act. We should all applaud the work done by Balance and Smoke Free North East. When I was a barrister, I used to see the effects of crime and the links to alcohol. Hon. Members who go out on the beat with the police in any of our constituencies will be aware that the rate of alcohol-related admissions is the highest in the country; 46% of all violent crime is alcohol-related; and about 50% of domestic abuse is alcohol-related. I strongly support the campaign of my hon. Friend the Member for Totnes (Dr Wollaston) to change the law.

To touch briefly on hospitals, I am lucky enough to have Hexham hospital in my constituency. I accept it was built by the former Prime Minister, Mr Tony Blair—[Hon. Members: “Personally!”] Not personally; he was not there with the bricks and mortar, but he certainly signed off on the upgrade to the original hospital. It is an outstanding hospital, with a tremendous cancer support group, which I went to listen and talk to in the summer. The quality of care and its integration into the health care trust’s programme is outstanding. However, I am pleased that finally, after successive Governments—I am going back in history 20, 30 or possibly even 40 years —the small hospital in the west of Northumberland called Haltwhistle is being rebuilt. It is impossible to go there without being asked when the hospital will be rebuilt, and I think that successive MPs have had to deal with that repeatedly.

I want to talk about inequality in relation to provision throughout the region. I represent the far west of Northumberland and the people of Bellingham, Kielder and the far west are very conscious of the fact that there is no hospital or ambulance provision all that close to them. There are outstanding paramedics and other people and a system that works very well, but there are rural inequalities, and I wholeheartedly support the campaigning by the Friends of Bellingham Surgery and by those who are trying to introduce a more integrated system to take care of the inequalities suffered by those who are far away from hospital. It is not easy to explain why the hospital at Hexham, which was built as a particular type of hospital, is unable to deal with certain things on an ongoing basis, including significant accident and emergency. It is necessary to drive past that hospital to Wansbeck, the Royal Victoria infirmary or other hospitals.

I am living proof that people should not necessarily go to the nearest hospital, but should go where the specialists are. I wholeheartedly support—I hope that the House does, too—specialist hospitals where people go for the best possible treatment. When I was taken ill on 26 April and collapsed in Central Lobby, I was taken initially to St Thomas’, which is a very good hospital; there is no dispute about that. I was subsequently taken to the National Hospital for Neurology and Neurosurgery, a specialist hospital for the treatment of meningiomas and brain tumours. I have broken umpteen bones, and I would want to go to the hospital that is best able to deal with the problem and that does so regularly.

I will finish on two matters on which I want to give support. First, I strongly urge local authorities to work together with the health care trusts during the coming changes, because across the region there are examples of local authorities’ failure to do that. I urge them to integrate the provision of services, particularly care, on a continuing basis. Finally, in the north-east, we are proud to be the champions of certain screening programmes. I raised the matter of bowel cancer screening in an Adjournment debate on 23 November. Two hospitals in the north-east, in South of Tyne and Wear and Tees, piloted bowel cancer screening by Flexi-Scope. It is likely that the pathfinders for the future will be there, too. I applaud and recommend to anyone the quality of continuing health care screening that successive Governments have introduced.

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

It is always a pleasure to serve under your distinguished chairmanship, Mrs Riordan.

I congratulate my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this debate. Its importance to the north-east is exemplified by colleagues’ high level of attendance this morning, but it is also important because the lifestyle issues and the social and, if I might say so, class determinants behind health inequalities lie at the heart of bringing down levels of acute diseases such as cancer and heart attacks. Until we tackle the range of public health issues that underlie health inequalities in the north-east, we have no hope of building a healthier Britain overall, or of containing the cost of the national health service.

My colleagues have comprehensively dealt with the data on health equalities in the north-east, and I do not plan to repeat most of them. I want to talk specifically about smoking and alcohol, which are big issues in the region, and to pose some questions to the Minister. I was very pleased to visit Newcastle last year, at the invitation of the then, and current, leader of the city council, Councillor Nick Forbes. I chaired a round table on tobacco and alcohol, and heard about the work of Fresh under the leadership of Alisa Rutter, and saw a presentation by Balance North East. On the same day, I visited Newcastle Royal Victoria infirmary and discussed the devastating impact of the excessive alcohol consumption in the local community with a top north-east liver specialist and consultant gastroenterologist, Dr Chris Record. He kindly gave me a chart of alcohol units, and I have it up in my office because I need reminding that the average glass of wine nowadays contains 2.5 units. How many people know that?

There is no question but that we did not achieve all we wanted to on health inequalities under the previous Labour Government, but we did make progress, and I hope that the Minister will acknowledge that. Drilling down into the overall figures shows that we made progress in specific areas, and the Minister acknowledged during a speech to a fitness industry conference in London that the previous Government were indeed firmly committed to reducing health inequalities. As colleagues have said, and as the North East Public Health Observatory tells us, the health of people in the north-east generally is worse than that of people in England as a whole, and that is largely to do with the social determinants I referred to earlier, and also the region’s industrial legacy.

I now want to talk specifically about tobacco. Work in this area is an example of good practice and partnership, but it is the sort of public health work that is potentially threatened by some of the changes the Government are bringing forward. Smoking remains the major cause of premature death and disease in the north-east, killing more than 5,000 people a year. It costs the region £174 million, the NHS £104 million—£35 million through passive smoking—and businesses £34 million in absence days alone. The average age at which people start smoking in the north-east is 15. The region has historically had the highest smoking rate in England, but, as we have heard, the rate has come right down due to the activity of Fresh.

Fresh has won all sorts of awards, including the gold medal in the inaugural chief medical officer’s public health awards, and it delivers work across eight key strands, but it is concerned about the changes in public health that are coming forward. It is currently funded on an annual subscription basis by all 12 north-east PCTs, and the PCTs are worried about what will happen when they finally fold. I understand that discussions are under way to secure the continued commissioning of the Fresh programme by local authorities. Is the Minister aware of those discussions? Can she update the House on what progress has been made to secure funding for this important and successful initiative, which is leading the nation?

Fresh is also concerned about the loss of the regional tier of tobacco control programmes in England as a whole, and the advent of the localism agenda might make it more difficult for local authorities to co-ordinate, and to attack some of the public health issues. How will the Government ensure that all local authorities prioritise tobacco issues? How does the Minister plan to ensure that there is no fragmentation or duplication of resources and efforts when the PCTs go? How will she ensure that localities work together to achieve economies of scale and have a population-level impact, as we have seen happen so successfully with Fresh? Can the Minister tell the House today when the new tobacco marketing strategy will be published? Will the Government ensure that there is a clear focus on tobacco?

Alcohol is another major cause of health inequalities in the north-east. We know that generally the affluent tend to consume the most, but for a variety of reasons the health effects of disproportionate alcohol consumption are felt most keenly among the poorest, and in areas such as the north-east. We also know that although in a recession levels of drinking tend to level off, among young people they go up, and we are seeing evidence that levels of self-harm are going up among young people. Alcohol is therefore a worrying issue, not just because of the physical health issues, but in relation to mental health and public order. The north-east continues to have the highest rate of alcohol-related hospital admissions, and in the past nine years alcohol-related liver disease has increased, sadly, by 400% among 30 to 34-year-olds, which is the highest rate in the country. I want, therefore, to know from the Minister about the Government’s alcohol strategy. Is she content that the constituents of my hon. Friend can buy two litres of cider for £1.34? That is less than the cost of an equivalent quantity of a soft drink.

On my recent visit to the region, I found that availability was a genuine concern, with alcohol available 24/7 and many off-licences centred in the more deprived areas. I see that in Hackney; we have more off-licences and bookies than shops where we can buy fresh food.

[Guy Opperman]

Will the shadow Minister give way?

[Ms Abbott]

I would love to, normally, but I have to try to get through my speech so that we can hear from the Minister.

Last September, the leader of Newcastle city council, Nick Forbes, amended a motion calling for the introduction of a minimum price for alcohol. He made the motion more comprehensive, calling for a wider range of measures to address the availability of alcohol. They included more powers for the council to refuse or withdraw licensing applications, following a report last year that linked under-age drinking to areas with a high density of licensed premises. Nick Forbes said:

“Figures show that alcohol is being sold for pocket money prices in Newcastle. Cider is available for 16p a unit…Most pubs back the idea of a minimum price for alcohol, as it would only affect the loss-leading deals offered by some supermarkets and wouldn’t have any impact on the price of a pint. It’s a controversial step, but there’s evidence that more and more people are ‘pre-loading’—downing cheap spirits at home before going out on the town. Minimum pricing would reduce this, and thereby reduce the overall figures for anti-social behaviour and hospital admissions”.

What decisions are being made at a national level to support local leaders such as Nick Forbes, who are committed to reducing health inequalities overall, and are taking strong action on issues such as alcohol?

The figures show that NHS North East has been told to set aside £143,350,133 to pay for the Government’s plans over the next two years. The NHS operating framework published in November requires health trusts to set aside 2% of their budget to pay for the Health Secretary’s changes in the Health and Social Care Bill. County Durham PCT has to set aside the greatest amount, followed by Sunderland and Northumberland. It is wrong to force local health trusts to set aside money to pay for bureaucracy and redundancies, when patients in the north-east, and constituents up and down the country, are waiting longer for treatment.

The Minister will know that the Heath Committee, chaired by not just a Tory Member of Parliament but a distinguished former Health Minister, the right hon. Member for Charnwood (Mr Dorrell), has raised a number of concerns about public health. It is concerned about whether the so-called responsibility deals can help alcohol and obesity problems, and about whether the health premium will just involve money going to people in regions where they are managing to tackle the problems, perhaps because they do not have the underlying social and class issues of other regions, at the expense of regions with genuine problems. The Health Committee also raised concerns about the closure of public health observatories in regions including the north-east.

What we are debating is not just a matter for the north-east. The underlying social issues apply to the health service all over the country. Even the north-east, with all the challenges posed by its industrial past, has examples of excellence and of path-breaking partnership work. We want an assurance from the Minister that the proposed changes—the confusion, chaos and cuts—will not hold back that work, and that she will not confine herself to discussing Labour’s record in general terms but will address the issues that affect the day-to-day lives, life expectancy and life chances of millions of people throughout the country, including in the north-east.

Care of the Dying

Guy Opperman Excerpts

Tuesday 17th January 2012 Westminster Hall

[Mr Burrowes]

I am grateful for that point. Integration is needed, and we see that in the context of hospices and palliative care. We hope for that future in the reforms that are going through Parliament.

Although we should be proud, rightly, of individual examples in our constituencies, we should not rest on our laurels. We need to build on that solid foundation, because far more can be done. End-of-life care is not available to everyone who needs it. In fact, the palliative care funding review found that 92,000 people die in England every year without access to the services that they need. That figure equates to nearly 500,000 people during the term of this Parliament, and 700 people in each of our constituencies dying without the good palliative care services that they deserve.

Nationally, hospices receive about a third of their funding from the NHS, but that can vary substantially across the country. Indeed, in my constituency in Enfield, the NHS contributes less than 20% of what the hospice spends on care for Enfield patients. One of the biggest issues facing the terminally ill is where they will die. Currently, more than half the people who die in England do so in hospitals and just 20% die at home, although various studies have shown that two thirds of people would choose to die at home.

In Enfield, there are excellent palliative care services. I pay tribute to Nightingale Cancer Support Centre and North London hospice, which provides a community service providing care in people’s homes alongside an in-patient unit. In Enfield, the North London hospice community team are able to ensure that only 28% of people cared for by the hospice die in hospital.

According to the Minister, the Government should consider allocating national resources to continue to promote and extend palliative care. I look forward to hearing from the Minister about the progress in implementing the new per-patient funding system for hospice and palliative care providers, which will provide incentives to enhance services within community settings.

[Guy Opperman (Hexham) (Con)]

Will my hon. Friend give way?

[Mr Burrowes]

I will conclude in a moment, because a large number of colleagues want to contribute.

Jean Rostand, the French biologist, said:

“For my part I believe that there is no life so degraded, debased, deteriorated, or impoverished that it does not deserve respect and is not worth defending with zeal and conviction. I have the weakness to believe that it is an honour for our society to desire the expensive luxury of sustaining life for its useless, incompetent and incurably ill members. I would almost measure society’s degree of civilisation by the amount of effort and vigilance it imposes on itself out of pure respect for life.

I look forward to hearing hon. Members demonstrate that respect for life, for the dying, today.

--- Later in debate ---

[Tony Baldry (Banbury) (Con)]

I do not intend to refer to the policy of the Director of Public Prosecutions in cases of encouraging or assisting suicide or to the report of the Commission on Assisted Dying because I note that my hon. Friend the Member for Croydon South (Richard Ottaway) has been given a debate by the Backbench Business Committee. Hopefully that debate, in which I suspect that many hon. Members present today will seek to catch Mr Speaker’s eye, will give us the opportunity to make our views known on those matters.

I fully endorse everything said so far today in the debate initiated by my hon. Friend the Member for Enfield, Southgate (Mr Burrowes), so I hope not to repeat anything. However, it is important for us to recognise that we will all die. As a society, we need to talk much more about dying and the care of the dying. As the psalmist says:

“The days of our age are threescore years and ten; and though men be so strong, that they come to fourscore years: yet is their strength then but labour and sorrow; so soon passeth it away, and we are gone.”

All too often in modern medicine death is seen as a failure in some way, but supporting those who are dying is an important part of modern medicine.

Three crucial things, therefore, ought to happen for anyone who is dying. They should be informed and fully know and understand, as far as possible, what is happening with their medical treatment. So far as is possible, they should be relieved of pain and should be able to die where they would most like to die. Most people, when asked, say that they would like to die at home, yet home hospice services in this country are pretty noticeable by their absence. I agree with the comments of hon. Members so far: we do have exceptionally good palliative care in this country—where it is good it is very good—but all too often it is mediocre.

[Guy Opperman]

I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing the debate. A lot of people present are passionate Christians and see the subject from a religious standpoint. I speak as someone who was given warning of death on 26 April, before my operation last year, and with respect I take the view that, of the choices faced by individuals, one is the choice of their death—when they would choose to go. Does my hon. Friend the Member for Banbury (Tony Baldry) accept, as a matter of both law and faith, that that choice belongs to us?

[Tony Baldry]

I want to resist the temptation to be drawn into a debate on assisted dying, because many people present want to talk about palliative care, but I state simply that the only person who should determine when we die is the Almighty—it is not us. If we get into a situation in which we pick and choose who dies and who lives, it is a slippery slope. However, I will wait until the debate to be initiated by my hon. Friend the Member for Croydon South before I develop those arguments.

On the need to enhance palliative care, I hope that much more emphasis can be given to junior doctors in particular. I understand that at present they get comparatively little training on palliative care and, given the pressures that junior doctors are under, they often feel that if a patient dies they have somehow failed that patient. They might not have: patients die, and it is a fact of life that people will die. Every hospital trust should have a clear policy on palliative care and on how to enhance it. We should never forget the role of hospital chaplains. People approaching death often need spiritual support as well as medical assistance. Spiritual support is no less worthy and necessary.

We should never underestimate the role of hospices. Hon. Members have referred to hospices in their constituencies, and I have the excellent Katharine House hospice in mine. However, we must try to ensure that they are better integrated in support of NHS palliative care services. Many moons ago, in the mid-1980s, Jack Ashley and I set up the all-party group on hospice support, which is now the all-party group on hospice and palliative care. Even then, we were concerned about the varying amount of support from the NHS to local hospices. I hope very much that NHS commissioners will, whenever possible, see local hospices not just as a resource in developing excellence in palliative care, but as an invaluable resource to help those who are dying and those who are terminally ill. I suspect that the voluntary hospice movement still needs to be much better integrated in supporting the NHS and those who are terminally ill. I hope that the introduction of new forms of commissioning will enable that to be done much better. How we support those who are dying is a measure not just of the NHS, but of us as a society, and we should be judged by how we care for those who are bereaved.

NHS (Private Sector)

Guy Opperman Excerpts

Monday 16th January 2012 Commons Chamber

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

To respond to some of the misrepresentations of the Opposition, I worked for the NHS for some 12 years and hold it in the very highest regard. I am here to defend the NHS against privatisation, and I make no apology for doing so to Government Members or anyone else for that matter.

It is fitting to pay tribute to all those who work in the NHS and who make it such a tremendous institution. I also pay tribute to members of the British Medical Association consultants committee who took part in Bevan’s run to mark their opposition to the dreadful Health and Social Care Bill as part of the “Drop the Bill” campaign. They ran 160 miles in six days from Nye Bevan’s statue in Cardiff to deliver a postcard to the Department of Health in Whitehall to call on the Secretary of State to drop the Bill.

In the limited time available, I should like to address the point in the motion about the cap and to address Government Members’ misrepresentations. The private patient income cap, which was set up under the previous Labour Government in the Health and Social Care (Community Health and Standards) Act 2003, which established NHS foundation trusts, was a protection against the need for profit overtaking the needs of NHS patients. With all hospital trusts set to become foundation trusts by 2014, a meaningful cap on the amount of resources that can be directed to the care and treatment of private patients becomes even more important.

The passage of the Health and Social Care Bill—it is in the Lords at the moment—can only be described as a shambles. It is an incredibly unpopular measure. There could have been agreement on, for example, clinical involvement in commissioning, but that could be achieved without this incredible disruption to the service. I certainly believe that it is harmful to the future existence of the NHS. There is no mandate or basis for it in the Conservative or Lib Dem manifestos or in the coalition agreement. This NHS privatisation plan might be better described as an NHS privatisation paving Bill—

[Guy Opperman (Hexham) (Con)]

Will the hon. Gentleman give way?

[Grahame M. Morris]

With all due respect, I have very limited time and I am not going to take any interventions.

Any utterance about the nature of the NHS reforms planned by the Secretary of State during the general election campaign was heavily disguised. He weaved a tangled web in private health care during his seven years as Opposition spokesman on health. A few moments ago, he mentioned Labour’s involvement with the trade unions, but it is the involvement of the Conservatives with private health care interests that should be the subject of scrutiny.

NHS professionals, staff, the public and experts alike have all rejected the ethos of profits over patients, but the Secretary of State will not be deterred. He has defended his move by claiming that foundation trusts have a core legal duty to care for NHS patients. However, at the same time he is telling these trusts that they must make a profit to survive, and that if they run a deficit, they risk failure. That could mean being taken over by another trust or, as we have seen in the case of Hinchingbrooke hospital in Huntingdon, being taken over by a private sector provider.

We have not seen the Bill’s risk assessment, but as a member of the Public Bill Committee, I saw the impact assessment, and in point B95 it confirms that rather than improving services at hospital level through performance management, poor providers

“may need to contract or exit completely.”

That has created the ultimate Catch-22 for foundation trusts, with a conflict between patients and profits. A further Government proposal to scrap the provision in the 2006 Act which allows failing foundation trusts to return to NHS control puts further pressure on the need for trusts to pursue profits and has been opposed by the NHS chief executive, Sir David Nicholson.

I urge hon. Members to vote for the motion to ensure that patient care is placed before private profit and to send a clear and strong message to the Government that they must think again about their plans to ratchet up privatisation in our beloved NHS. The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) has often quoted Nye Bevan, but to quote Robin Cook,

“If he believes that the spirit of Nye Bevan supports his changes to the NHS then there is a wheel missing from his ouija board.”

Oral Answers to Questions

Guy Opperman Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Burns]

The right hon. Gentleman says it is garbage. I think that is confusing from him, because I remind him that of course it was in the Labour party manifesto at the last general election to remove the private patient cap.

[Guy Opperman (Hexham) (Con)]

12. What steps he has taken to implement a flexiscope bowel cancer screening test.

[The Minister of State, Department of Health (Paul Burstow)]

The IT system to support the pilots of flexible sigmoidoscopy screening is under development and local bowel screening programmes will be invited to become pilot sites shortly. We remain determined to deliver our cancer outcomes strategy commitment of 60% coverage across England by March 2015.

[Guy Opperman]

The Government rightly chose two out of the three pathfinder sites to be in the north-east, at South of Tyne and Tees. When will the date be given for local screening centres to be invited to bid to become pilot sites and have patients as a future part of that bowel cancer screening programme?

Manufacturing

Guy Opperman Excerpts

Thursday 24th November 2011 Commons Chamber

[Guy Opperman (Hexham) (Con)]

I beg to move,

That this House has considered the matter of the future of manufacturing.

Manufacturing should be at the heart of any long-term plan for economic growth. It is a sleeping giant that, if revived, would become the backbone of a strong UK economy. It is entirely right that, five days before the autumn statement, we should have the opportunity to debate the subject in broad terms in the House. I thank the Backbench Business Committee and the House of Commons staff for their assistance in bringing this matter before the House and, in particular, I pay tribute to my co-sponsors, the hon. Member for Huddersfield (Mr Sheerman), my hon. Friend the Member for Warwick and Leamington (Chris White) and the hon. Member for Burnley (Gordon Birtwistle), who have adopted an all-party approach to this problem which affects us all.

It is well known that I used to be a jockey and a lawyer, so it is legitimate to ask how on earth I can have any credibility in speaking about manufacturing. All MPs do, because we all have small and medium-sized enterprises that make something in our constituencies. We all have credibility on this issue.

My family came to this country as immigrants. They were engineers, specialising in gears. In May 1924, in the depths of a very bad recession, they set up Opperman Gears in a basement in Albemarle way in Clerkenwell. It had four staff—my great-grandfather and his three sons—who worked in the basement on two lathes, three milling machines and a couple of tools. They had borrowed £110 from a distant relative to set up the business. It grew rapidly and by early 1939 it moved to Newbury, where my family set up a larger firm that was able to produce the parts for the Wellington bomber with its long-term partner, Vickers.

We do not run that company any more, but I should declare that I am a shareholder in the small manufacturing business run by my father and that my family members are involved in a number of different manufacturing businesses up and down the country. I should also make it clear that I resigned my directorship of the family business in 2009 and am not paid by it in any way.

I should also declare that I am a wholehearted supporter of my local manufacturing businesses in the north-east, notably Kilfrost, EGGER, SCA, Agma and others, and their financial support allowed the charitable functions I ran this summer in the constituency. I should declare an indirect link, in that a director of one of those firms made a contribution to my association.

I hope I am doing my bit to try to create jobs. I was the second Member of this House to employ an apprentice and I urge those Members who have not to do so. She is a young lady who works in my office in Hexham and who has been with me now for nearly a year, and is doing extremely well. Members of all parties can take on apprentices—it is allowed under the rules—and I urge them to do it.

The scale of the manufacturing deficit is huge. The nations that expanded post-war specialised in and pushed manufacturing. Those nations—Germany, Japan, Taiwan, Korea and China—knew what they were doing. Today, the services sector alone can prop up Britain no longer, and there is a strong argument for greater industrialisation and changing things. We have seen the demise of manufacturing—it accounted for 20% of gross domestic product in 1997 and now accounts for 11%—and there is a strong argument for specialising not just in high-tech industry but in other industries, which are often derogatively labelled “metal-bashing”. Their products are unassuming, even if they are created by some of the most precise machines on the planet.

My constituency is in Northumberland and my four biggest non-public sector employers are all manufacturers. The north-east might be the birthplace of ships and steel, but we have reinvented ourselves. I was pleased to see SCA recognised in the Government-backed “Made by Britain” awards, which were so ably organised by the hon. Member for Huddersfield. That company employs about 435 local people in Prudhoe, including 60 apprentices. It could not be doing any more to support its local community. It does not make glamorous, eye-catching products—or perhaps some people think it does—but it produces one in every five toilet rolls in this country, as well as vast quantities of paper towels. I am sure we all agree that those are essential products.

[Graham Evans (Weaver Vale) (Con)]

Flushed with success.

[Guy Opperman]

It is, indeed, flushed with success, as my hon. Friend so ably quips from the sidelines—as always, he is on the money. The wood pulp goes in at one end of the factory and paper products come out at the other. The machinery is highly technical; this is modern manufacturing in the modern age.

In this time of austerity, I am extremely proud that the north-east has a positive balance of trade and is the only region consistently to do so. We should trumpet the fact that the North East chamber of commerce is the only regional chamber of commerce in the country. It represents more than 4,000 businesses and covers more than 30% of the region’s work force. If I had to single out one local concern that it has highlighted to me from the multitude of things it would like to be done, it would be to urge the Minister to conduct the review that it is hoped will be undertaken of the planned carbon floor price and other climate change and energy-related matters.

How are we to address the manufacturing deficit? I have three main suggestions. First, we need a Minister for manufacturing. That is not to decry the efforts of the Minister with responsibility for business or the Business Secretary, both of whom are worthy men, or those of any parties in that Department. However, the fact remains that, according to the House of Commons Library, there has not been a Minister for manufacturing since 1945.

[Gordon Birtwistle (Burnley) (LD)]

In my constituency, I get a lot of requests from local manufacturing companies for advice on various issues, mainly in relation to exports and where to go for help with them. Does my hon. Friend agree that a Minister with responsibility specifically for manufacturing would be a major asset to the Government and the manufacturers of this country? Businesses would be able to go directly to the person who could give them the answer they required rather than having to go through myriad Departments. People get lost in that process—even Ministers sometimes, I imagine—and if we had someone who could be accessed directly and who reported directly to the Prime Minister, that would be a major asset to the Government.

[Guy Opperman]

I completely agree. To put it in the vernacular, we need a go-to guy who is the one person looking after manufacturing.

[Chris Ruane (Vale of Clwyd) (Lab)]

Or a go-to girl!

[Guy Opperman]

Of course, it could be a woman—I accept that entirely. I was using the term generically. Such a Minister could provide co-ordinated responses to the concerns of manufacturing businesses. Having such a Minister would send out a message that this really matters. I challenge anyone to say that that is not a good idea. It is something that successive Governments have consistently failed to do, and I do not blame previous Governments for that, but doing it would send out a positive message for the future.

The second issue I want to address is banking and the chronic deficit that every Member of the House must be facing in their constituency—a lack of bank financing for businesses. Every one of us, in every constituency surgery, will regularly have businesses coming to us and saying, “I cannot get the funding I need,” or “I cannot get the borrowing I used to have.” It is a chronic problem. Much good work is done by business angels and credit unions—those hon. Members who attended the debate on credit unions yesterday will know that very positive steps were discussed there—but when it comes to bank finance, the system of the main banks is clearly logjammed. What can we do about that?

Currently, to set up a bank one needs £110 million-worth of assets—of cash, effectively—or the Financial Services Authority will not allow it. If the FSA relaxed that rule or changed the figure to £10 million, for example, then prominent local businessmen or businesses in a local community could set up a local bank.

Traditionally, the problem has always been that banks go bust, as they did in the 1920s and ’30s, because they over-borrow and over-lend in effect. If there were a restriction such that they could not exceed the money held on deposit with the Bank of England, the only loss that could be sustained would be the funds in that bank. The effect would be true localism. Someone could set up the bank of Hexham—or, in the Minister’s case, the bank of Bognor—and that bank would be specifically focused on providing small and medium-sized enterprise lending to local businesses.

[The Minister for Universities and Science (Mr David Willetts)]

In my case, it might be the bank of Havant, rather than the bank of Bognor.

[Guy Opperman]

There could be competition throughout the region. That would not be difficult. Would it not be great if we had some competition among local banks?

[Andrew Stephenson (Pendle) (Con)]

In Pendle, a local businessman called David Fishwick is trying to do exactly what my hon. Friend suggests. He is trying to create his own bank to help small and medium-sized enterprises in Pendle and Burnley. The regulations are so detailed and engrossing that the FSA has refused to help him, despite his instructing high-flying lawyers. So far, it has even refused to meet him to discuss the creation of a bank that would directly help small and medium-sized manufacturers in Pendle and Burnley.

[Guy Opperman]

I will give way again.

[Lorely Burt (Solihull) (LD)]

The hon. Gentleman has obviously excited a lot of interest with his suggestion. Will he consider the American model of community banks, which have stood the test of time and served their communities?

[Guy Opperman]

My hon. Friend anticipates my next move, which is to say that such matters are already road-tested in other jurisdictions in other countries. Sadly, the FSA is reluctant to change its regulatory system. I have heard other examples of its failing to meet individuals who want to provide local financing—something that would be immensely good for local communities and could provide a flexible approach. Instead of being stuck with a loan from Barclays, for example, people would have a much lower flexible interest rate and adopt a much more interesting way to recuperate their finances at a later stage when the company was in profit. Banking would be local. We all know what happens when we are approached by a constituent when a business is in trouble. The decisions in relation to such financing are made not in Hexham or Newcastle or even in the north-east, but in a place such as Nottingham or Leatherhead or, ultimately, in London. That must change.

[Mike Weatherley (Hove) (Con)]

Does my hon. Friend agree that the banks in his example would facilitate help for some of the failures in respect of the enterprise finance guarantee scheme? There are 4.8 million SMEs, but the Government are targeting only 6,000 of them with help through the EFG at the moment.

[Guy Opperman]

My proposal would provide an alternative way forward for the financing that those businesses clearly need. I suggest that the Minister take it back to the future Minister for manufacturing and the Treasury, with a view to trying to move forward. I am conscious of the time, so I will not take any further interventions.

My next suggestion is an industry bank. We could extend the remit of the existing green investment bank to form a general enterprise bank, for which there are successful models in Germany and the United States. The German KFW—a product of Germany’s social market tradition—and the US Small Business Administration industry bank are specialists in long-term lending to SMEs, and they are effectively financed by their Governments, with a bottom line of commercial viability and social benefit.

The blueprint also exists in this country. What is presently 3i, which is a FTSE 100 company, was originally the UK Industrial and Commercial Finance Corporation, which had tremendous success when it was set up. On practical realisation, given that we have quantitative easing, would it not be better, instead of investing all those sums in bank bonds, for some of that money to go into an industry bank, so that it would go directly to the people who need it most and who are creating the jobs and growth that we all want and need?

I must conclude my remarks. I urge the Government to have a more pro-business policy. Others will talk of what the Government are doing and the positive steps they are taking, but I put in a plea for flexibility. There are repeated examples in my constituency of viable and successful businesses being penalised heavily for being a day late with their tax returns, or three days late with their VAT returns. Effectively, the Government are penalising those who are working the hardest to create the jobs that we need. I thank the House for its indulgence.

--- Later in debate ---

[Mr Bailey]

That issue was recognised by the previous Government, and measures were being put in place to replicate that approach in the context of the British industrial scene. The current Government are, to their credit, taking that up.

Bank lending is a hugely significant issue for small and medium-sized enterprises in my constituency and nationally. The Merlin targets are not being met. That, combined with low consumer confidence and low business expansion expectations on the basis of the domestic market, means that companies are not applying for loans because they do not feel positive about future market opportunities and because they are wary of the banks making their credit lines even more difficult than they already are. That is having a stultifying effect on the ability of small businesses to expand.

Quantitative easing in order to address that issue may, indeed, keep interest rates low, but I have yet to meet a bank that knows how that will help SMEs directly, and I have yet to meet a business that knows how it would make any difference to its relationship with its local bank. Although lower interest rates may be welcome in general, that will not necessarily feed through to more investment in small businesses. I am concerned that the effect low interest rates are having on pension fund incomes could lead to some manufacturing businesses having to pay more into their pension funds, thereby diverting money from other areas in order to sustain their pension levels. This could be a counter-productive step, therefore.

There is now a lack of provision in the crucial area of small grants and loans for small businesses that want to expand to take the market opportunities that will be available to them. The regional development agencies will not be reintroduced—that is a debate for another day—but they did provide small loans to businesses that wanted to expand. Those loans are gone now, and they are not being replaced by the banks. The regional growth fund is not yet delivering for small businesses. If we are to expand the capacity of manufacturing SMEs in the time that they have available to make an impact on employment, that vacuum needs to be filled. Either local enterprise partnerships must be given more powers or the RGF needs quicker and more localised means of distributing money.

[Guy Opperman]

Will the hon. Gentleman give way?

[Mr Bailey]

No; I am sorry, but I am running out of time.

I reiterate the points made about research and development tax credits and capital allowances—they might go some way to dealing with that problem. As they have been mentioned, I will not repeat the discussion of the issue.

The second issue to address is skills. As has been said, Tata has invested £300 million in Jaguar Land Rover in a site to the north of Wolverhampton, with enormous employment potential locally. The concern within the industry is that the extended supply chains of small and medium-sized enterprises that could service JLR may have a shortage of skilled apprentices, and I have already mentioned the potential need for capital investment to improve the capacity to meet the demand from JLR. I have no doubt that JLR will attract all the people it needs, because it is a high-paying iconic company that is very attractive to everybody. It will be the SMEs in the area that will need to recruit, and we need to expand our vocational skills base to ensure that that happens.

The Government have rightly concentrated on apprenticeships. However, there is emerging a picture of apprenticeship provision that will not necessarily address that need. First, a high proportion of the new apprentices are over 24, and there is considerable concern that these are just Train to Gain people rebadged. There is nothing wrong with Train to Gain, because it has an important role to play, but it will not necessarily meet the skills need that it is directed at. Secondly, there is increasing evidence of private providers coming in with short-term courses, which do not meet the historically longer-term need for training in a particular industry to meet capacity. I believe that the black country local enterprise partnership is examining the issue to try to scope out the skills provision that will be needed and ensure that it is provided. That LEP will be able to its job far more effectively if the Government were prepared to back their localism agenda by providing it with the resources to assess the skills need and to deliver on it locally.

--- Later in debate ---

[The Minister for Universities and Science (Mr David Willetts)]

It gives me great pleasure to respond to the debate. I congratulate the hon. Members who tabled and secured the debate: my hon. Friend the Member for Hexham (Guy Opperman) who began with an excellent speech, my hon. Friend the Member for Warwick and Leamington (Chris White) and the hon. Members for Huddersfield (Mr Sheerman) and for Burnley (Gordon Birtwistle).

This is a very important debate, and I welcome the fact there has been very little partisanship. There have been a lot of shared themes, which I hope to touch on in my remarks. Perhaps the main difference is almost a temperamental one, between the people who take a more optimistic view and those who take a more pessimistic view. I am certainly with the optimists. We can be proud of the revival in our manufacturing sector that is already under way.

Instead of drawing attention to the overall statistics, perhaps I can reflect on the announcements that we have had this week, which tell us what is going on. Today, the Prime Minister has been able to welcome Toyota’s plans to build its new generation family-sized hatchback at its UK factory in Burnaston near Derby during his visit there. That investment of £100 million will secure many jobs. In addition, Airbus has today announced 200 extra engineering jobs at Feltham, and Nestlé has announced a £110 million investment at its Tutbury plant, which will involve 300 extra jobs. Those are today’s announcements. Yesterday, Coca-Cola announced a £50 million investment in a new bottling facility at Wakefield and other investments as well.

If one considers the build-up of announcements, there is clearly the sense that a revival is under way in our manufacturing industry. It has been very encouraging to hear from hon. Members on both sides of the House about the strong support that there is for manufacturing. There is a recognition that the future of our economy must include manufacturing, just as our proud history has manufacturing at its heart.

My hon. Friend the Member for Hexham made an excellent opening speech, and I shall briefly respond to two themes that he touched on, particularly as they were picked up by other hon. Members. He called for there to be a Minister for manufacturing. Let me make the role of the Minister of State, Department for Business, Innovation and Skills, my hon. Friend the Member for Hertford and Stortford (Mr Prisk), clear. Incidentally, he is not here to respond to the debate because Ministers are fanning out across the country today as a result of all the excellent news on manufacturing. The Prime Minister is in one part of the country, my hon. Friend the Member for Hertford and Stortford is elsewhere and, of course, the Secretary of State is somewhere else.

My hon. Friend the Member for Hertford and Stortford, who deals with business and enterprise, has the following responsibilities: aerospace, the defence sectors, the automotive sector, professional and business services and the delivery of the advanced manufacturing growth review. In addition, he is the architect of our next manufacturing summit in Bristol, and he has overall responsibility for manufacturing and materials. Although he does not have the word “manufacturing” in his ministerial title, he is for all practical purposes our Minister for manufacturing. Several Members have asked: who is the go-to Minister? He is the go-to Minister for manufacturing and he does an excellent job. Of course, the Secretary of State also has a clear personal commitment to manufacturing. My view, therefore, is that there is a key Minister in the Government with that responsibility and a Secretary of State with very strong personal commitment to the subject. We are all, as Ministers in BIS, working on this and trying to contribute in our different ways and with our different responsibilities, whether they be for universities, research, science, high tech, skills or apprenticeships.

A second question put by my hon. Friend the Member for Hexham concerned access to bank finance. That subject is raised regularly in the House, as I often notice in BIS questions. His particular point, which has been pursued by several Members on both sides of the House, is about whether we can do more to enable new banks, especially new small banks, to set up. One of the key recommendations in the report by the Independent Commission on Banking was that we should look at barriers to entry, which are too high. It should be easier for new entrants to come in and set up banks, and we are now pursuing that recommendation. There has already been a round table meeting with challenger banks—the banks that want to come in and do more. The Chancellor himself touched on the subject in a major speech on the subject on 3 October.

Given my responsibilities for research, high tech and science, I have been frustrated by the time it has taken to establish Silicon Valley bank, which originates, as its name implies, in silicon valley and is a specialist in venture debt that lends to start-up businesses at early stages. I was told that it took it a year just to assemble the paperwork that was necessary for the Financial Services Authority approvals process, and another year for the FSA to consider that paperwork. We in BIS, and the Government as a whole, with the Treasury in the lead, are absolutely persuaded by the argument that we need to think about whether we have ended up with a system that has barriers to entry that are too high. That is why we are looking to see how we can pursue the recommendations of the Independent Commission on Banking.

[Guy Opperman]

Would the Minister be interested in facilitating a meeting with the FSA and the Treasury? While I have no doubt that BIS may be fascinated by the idea of local banks and better business banking, the Treasury and the FSA seem a little more reluctant to oil the wheels, if that is the right term.

--- Later in debate ---

[Mr Wright]

I absolutely agree, and my hon. Friend and I share the view of my right hon. Friend the Member for Wolverhampton South East that we should be bold and ambitious about manufacturing. We do not hark back to the past, but we want to engender that spirit of enterprise, innovation and ambition to ensure that we are the best engineering nation anywhere on the planet, that people can go into a career in manufacturing engineering secure in the knowledge that it is rewarding and produces products that we can sell to the rest of the world, and that Britain leads the world in that area.

[Guy Opperman]

May I take the shadow Minister back to the future? Does he agree that the idea of local banks, as outlined by several hon. Members, and an industry bank such as KfW, should be supported by Opposition Members?

[Mr Wright]

I listened closely to what the hon. Gentleman said in his excellent contribution, and in a moment I will mention the problems that companies—especially manufacturing companies—have in accessing funds that would allow them to grow, especially in export markets. I have a particular suggestion to put to the Minister on whether the Government are trying to do anything about that.

I hope that I have mentioned the huge potential and the enormous scope for us to be a leading player in manufacturing and engineering in the 21st century. None of that is inevitable, of course, and nor will it happen by chance. In the era of the most intense global competition imaginable and with economies such as China—known for its low-cost manufacturing—anxious to move up the value-added chain, Britain needs to put in place the best possible policy framework to ensure that our ambitions are realised. In the words of Richard Lambert, the former director-general of the CBI, the Government, particularly the Department designed to champion British growth, enterprise and industry, need to provide

“a vision of the kind of economy we want to have in ten years time and what it’s going to take to get from here to there”.

Instead, however, a leading global manufacturer has stated flatly:

“The government is not giving us a reason why we should be in the UK in 10 to 15 years’ time.”

The Government are not doing all that they can to allow British manufacturing to fulfil its potential. Worse than that, decisions taken by Ministers in the Department for Business, Innovation and Skills in the past 18 months have ensured that British manufacturing has taken a backward step. Our economy has grown by just 0.5% in the past year compared with 1.5% in the US and 2.3% in Germany. Export activity is stalling, and both output and sentiment are at their lowest levels since the height of the recession two years ago.

That situation is confirmed by today’s publication of the CBI’s industrial trend survey, the briefing on which reported:

“UK manufacturers reported a weakening in order books in November, with export orders in particular deteriorating significantly… As a result, firms expect a fall in production over the coming quarter”.

Not all of this is the Government’s fault, but an awful lot of it is—far more than BIS Ministers will acknowledge. BIS, charged with being the Department for growth, is weak and out on a limb in Whitehall. Whether trying to secure a stimulus for the economy—we will see what happens on Tuesday with the autumn statement—or support for the UK train manufacturing industry, the solar panel industry, Sheffield Forgemasters or long-term investment in oil and gas, the Secretary of State always plays the game but always loses. Worse than that, though, he always loses by putting the ball in his own net. The CBI’s director-general, John Cridland, described the appalling decision, which the House debated yesterday, on feed-in tariffs and the threat to the solar panel industry as

“the latest in a string of government own goals”.

--- Later in debate ---

[Guy Opperman]

I thank colleagues who have contributed to the debate, in which there has been a cross-party optimism about the fundamentals of manufacturing. It is a noble profession and a wonderful sector to work in. There is optimism for the future of manufacturing, and that is what this debate is about, rather than the past.

There has been an understanding of the past difficulties from which successive Governments and businesses down the years have suffered and of the present problems of globalisation, the Chinese influence, energy prices and the extent to which the state is struggling with the debt and difficulties faced by each country in the eurozone, particularly this one. There has been recognition that we must subsidise and support individual businesses and manufacturing organisations, whether with a form of capital allowances, R and D, tax credits or the like.

Although there is a tradition for men to be involved in manufacturing, I was particularly heartened to hear my hon. Friend the Member for Erewash (Jessica Lee) contribute so robustly to the debate. As a female Member of Parliament, she spoke very eloquently of the role of women entrepreneurs. I strongly support the view that this is a profession not only for men but for women. I apologise to all women for saying, when I described the need for a Minister for manufacturing, that we needed a go-to guy; of course, it could just as well be a go-to woman.

[The Minister of State, Department of Health (Mr Simon Burns)]

Or gal.

[Guy Opperman]

Or gal, as my right hon. Friend on the Front Bench so eloquently puts it. The learned Minister has intervened on many previous occasions, and we have another bon mot at last.

I listened to the 19 speakers who contributed to the debate. We finished, last but by no means least, in Watford, having journeyed north to Morecambe and the bay, taken in Bradford East and Hove, and travelled back up to Yorkshire and Calder Valley and then on to Carlisle and Hartlepool. At this stage, the Minister appeared. I must apologise to him, because I think I said that he was from Bognor. Of course, I have nothing against Bognor—everyone loves Bognor—but he is the representative of Havant, as we all know, except the hon. Member for Hexham. We then journeyed to Erewash, Derby North, Pendle, Blaenau Gwent, Warwick, West Bromwich West, Burnley, Wolverhampton South East, Weaver Vale, and then to Huddersfield and up to the finest constituency of them all—which is, of course, Hexham.

The future of manufacturing is worth our taking up the debating time of the Backbench Business Committee. The three co-sponsors of the debate—my hon. Friends the Members for Warwick and Leamington (Chris White) and for Burnley (Gordon Birtwistle) and the hon. Member for Huddersfield (Mr Sheerman)—have done so much to try to put manufacturing back in the frame in the House of Commons, and that is the right thing to do. It is noticeable that we are already receiving press coverage on the need for a Minister for manufacturing.

There seems to be widespread agreement that the banking system needs reform and improvement so that these businesses, which we all so cherish and want to receive support, receive that support, whether it is from a local bank or an industry bank such as that championed so well by the Germans with the KfW model. Such possibilities give businesses an endless ability to thrive in future. We all agree that that is the model for the way ahead. I look forward to the forthcoming meeting with the Financial Services Authority to discuss the local bank project. The Government should clearly be picking winners; manufacturing is a winner, and it has a very good future.

Question put and agreed to

Resolved,

That this House has considered the matter of the future of manufacturing.

Bowel Cancer Screening

Guy Opperman Excerpts

Wednesday 23rd November 2011 Commons Chamber

[Guy Opperman (Hexham) (Con)]

Thank you, Mr Deputy Speaker, for giving me the opportunity to raise this matter in the House. Bowel cancer affects men and women, and it is the second-highest killer after lung cancer. The debate is, I suggest, both timely and genuinely needed.

I have personal experience of the NHS that is probably too long to list. When I was a jockey, I was saved by a gastro-surgeon at Warwick hospital. I hoped I was riding the winner at Stratford races, but we turned over and the horse ruptured my spleen, perforated my left kidney and broke nine bones in my ribs. I can assure the House that it hurt a great deal. The surgeon saved my life on that occasion. Subsequently, it is well known that I had a meningioma in April and was recently given the all clear by Mr Neil Kitchen and the amazing staff at Queen Square hospital in north London.

My grandmother was an NHS matron and I have had bowel cancer screening. Certain family members have had this cancer, so I had the colonoscopy that was medically advised in those circumstances. I would certainly not be an MP were it not for the campaigns I waged on behalf of Savernake hospital in Wiltshire, where I was born; that hospital also saved my mum’s life.

I would like to declare an interest as a taxpayer. The NHS’s approach to individual screening is surely an issue in which we should all be interested—from the point of view of prevention of loss of life and the maintenance of good health, but also in respect of how NHS funding, which is clearly finite, is spent on preventing future problems.

I pay tribute to the Beating Bowel Cancer regime, to Cancer Research UK, to the British Society of Gastroenterology, and to Professor Wendy Atkin, her funders and the 170,000 volunteers who took part in her definitive study of flexible sigmoidoscopy, which is known as a flexi-scope. I also pay tribute to Imperial College London, University College London, the University of East Anglia and St Mark’s hospital, and to the variety of doctors, constituents, charities and members of the public who have worked so hard to combat this problem and have helped me to prepare for the debate—including the clinicians, particularly Dr Colin Rees.

As a Member of Parliament representing a constituency in the north-east, I am proud to say that the north-east leads the way in bowel cancer screening. It was the first to complete coverage of an entire region in April 2010.

Before I embark on the substance of my argument, I also make an apology on behalf of my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), who sponsored the Beating Bowel Cancer reception in the House last year. Much to his regret, he cannot be here tonight. He is a good friend of mine, but he is well known in the House—and, indeed, throughout the world—for having worn the Beating Bowel Cancer tie, which I am now wearing, in the Chamber after that reception. My hon. Friend, who has quite a generous build, was attempting to restrain that generous build with his suit when he accidentally touched a button on the tie, setting off a melody that lasted for nearly two minutes. Madam Deputy Speaker virtually extracted him from the Chamber. I understand that the incident was reported in 25 countries, and did more for the screening of bowel cancer worldwide than anything that anyone has said since.

I have no future as a surgeon, and I assure the House that I have removed the bottom half of my own tie so that there is no possibility of my being extracted from the Chamber for being too musical.

Let me now make some serious points about the clinical position. Traditional bowel cancer screening involves the faecal occult blood test, known as the FOB. In the last few years 11 million people in the country have been offered the test, 6 million have accepted it, 120,000 scopes have followed, and 12,000 diagnostic findings of cancer have resulted. It is clear from the statistics that lives have been saved. Previously those screened were aged between 60 and 69, but screening has now been extended to those aged between 60 and 74. It should be noted that the north-east—leading the way, as it does so often in a medical context—was the first region to extend the age group.

Tragically, take-up of that vital free NHS screening is only 54%, whereas take-up of breast cancer screening is 74% and take-up of cervical cancer screening is 79%. However, the situation is changing. Professor Wendy Atkin and her team have brought flexible sigmoidoscopy to the forefront of bowel cancer screening. The results of their 16-year study were definitive. Their randomised trial, which followed 170,432 people, established that the flexi-scope examination reduces the incidence of bowel cancer in those aged between 55 and 64 by a third. Mortality was 43% lower among that group than it was in members of the control group.

The flexi-scope test works by detecting and removing growths on the bowel wall, known as polyps, which can become cancerous if left untreated. It can prevent cancer from developing by removing polyps before they become cancerous, and provides long-lasting protection from bowel cancer.

[Harriett Baldwin (West Worcestershire) (Con)]

I congratulate my hon. Friend on securing this very important debate. Does he agree that screening for certain kinds of hereditary cancers, such as non-polypsosis colorectal cancer, should begin at a much earlier age, and should take place relatively frequently throughout the lives of those who are screened?

[Guy Opperman]

I do indeed. I welcome the fact that the guidelines from the National Institute for Health and Clinical Excellence have changed to allow screening to become considerably more frequent in such cases. I am sure that the Minister will comment on that.

Flexi-scope screening will undoubtedly save thousands of lives. FOB screening saved 700 to 1,000 lives a year, and flexi-scope screening will save about 3,000 lives a year. To confirm that, the Government implemented a pathfinder project in three areas. Unsurprisingly, two of those areas were in the north-east, this country’s leading medical region. The three areas were South of Tyne and Wear and Tees, along with Derby. The pathfinder findings are with the Department of Health and have not yet been published, but I can assure the House that, in broad terms, they accord with Professor Atkin’s findings. Last October, the Prime Minister announced a proposal to pilot the scheme nationally in 2012, but there are clinical and funding issues that need to be addressed.

First, when is the Department of Health going to invite bids for the follow-on pilot process, given that that was supposed to be done in 2011 and it is now 23 November?

Secondly, clinicians raise the specific concern that the flexi-scope system is only manageable if we have a sufficiency of trained nurse endoscopists, so where are we in respect of this crucial training? Even with the most amazing piece of equipment, if we do not have the people to operate and interpret it, it is useless. Under this scheme, several hundreds of thousands of endoscopies will have to be carried out, with colonoscopies to follow in about 10% of cases. Therefore, everything will depend on training.

Thirdly, how does the Department of Health plan to assess its age groups? My understanding is that the current group of 60 to 74-year-olds will have FOB testing, and those aged 55 will have a flexi-scope. That is relatively clear, but what will happen for gentlemen and ladies in the 56-to-60 age group is not at all clear. Will they be offered the flexi-scope as well, or is that to be based solely on GP referral? Trusts need guidance on what they are to do with such a large and unknown number of people, as they need to plan budgets, staffing and much more besides.

Fourthly, we need to assess what we are going to do with those who have a flexi-scope at 55 and receive the all-clear and then reach the age of 60. Will we rescreen? Anyone who has ever worked in the health industry will know that there is “health speak”, and in this case the following question would be asked: “What is the parallel screening modality for the future?” As always, “health speak” is gibberish, but the simple question here is: are we going to rescreen people who are fine at 55?

[Jim Shannon (Strangford) (DUP)]

I have also gone through the screening process because of a family history of cancer. My GP and consultant at that time said the screening would have to be done again in a year’s time and then again a year later, in order to be absolutely sure. Has the hon. Gentleman considered whether there should be checks not just every now and again, but on a periodic basis?

[Guy Opperman]

It is ultimately up to the clinician—which it should be, frankly. The Minister must say how this policy will be implemented, but it should always be clinically driven.

Fifthly, trusts need confirmation that the pilot projects to be implemented next year will be funded from national funding.

I want to turn briefly to the financial case. The researchers behind the Atkin study suggest that the screening programme will reduce the costs associated with treating people with bowel cancer. Ministers will be aware of the Department of Health-commissioned report, as set out in the memorably named journal, Gut, in 2006, which suggested that if a screening programme based on this test was effective, it could save an average of £28 for every person screened. I urge the Minister to follow what a lot of doctors and others have recommended. We must understand why people do not take up the state’s offer to safeguard their health. If only 54% of those eligible are taking up this offer, that is a serious issue that needs to addressed.

When should we start screening? I speak as an MP whose constituency borders Scotland, and we are often told that in Scotland the health care system is much better, much more expansive and so much more free. In Scotland, FOB screening takes place at 60, not 50 as it does in this country and my understanding is that they do not intend to take up the flexi-scope screening. Personally, I am yet to be persuaded of the clinical or financial basis for screening at the age of 50 given the immense task of screening from the age of 55 onwards, with all the numbers of people who will go through the system. Although there might be pressure—obviously, the Opposition Benches are packed—to move towards such screening at 50, there is no clinical or financial basis in the current system to justify such an approach.

I want to address the possible role of private or other public organisations, suitably supervised, in this process of change. We need to explore the issue of those whom the state must look after but do not take up the offer of screening. It affects both their health and our finite budget. The state must and will always be the provider of medical services in the future—no one disputes that—but it must also enable change and encourage private or public organisations to help in health care. All acknowledge that the take-up of screening is tragically low, as 46% resist the chance to screen themselves for bowel cancer and more than 20% of women resist the chance to have cervical or breast cancer screening. Everybody must accept that there is a problem with that. How can we address that?

Only the short-sighted or extremely socialist would suggest that the state always has the answer to all those problems. What if public sector organisations were to go the extra mile and care for their employees in a different way? We should bear it in mind that the state spends a fortune training its employees to carry out their designated tasks, whether they are consultants, surgeons, endoscopists or nurses. It surely makes sense to safeguard one’s assets—that is, one’s employees. Why not use the public sector as a lead by making it either mandatory or strongly advisable that all permanent core workers should have the screening that their health deserves and that we ask of the rest of the public? I would suggest that they should lead the way. That follows on from the point that is made about flu jabs and the prevention of winter problems in hospital.

We should also consider companies; I want to finish on a localism point. We always criticise employers in this House, but let us say that we had an enlightened employer. Why could they not be allowed or even encouraged to conduct screening of their workers, in whom they invest so much? There is clearly a benefit to the worker, the employer-employee relationship would improve as the employee was valued and cared for, and the state would not necessarily have to pay for the health care screening provided to its citizens. I am talking not just about bowel cancer screening, which is quite complex. Breast cancer screening, for example, is important but not necessarily that difficult.

The cost of such privately paid screening could then be borne in the form of a reclaimable tax break to the company, such as an equivalent cut in the cost of the company’s local business taxes. That would offer localism, increased health screening and better care for employees. Although there might be some data protection issues and concerns about who would pay for the follow-up care, it would unquestionably improve the take-up of screening. I refuse to accept that there is no mileage in my suggestion, which surely brings true localism and better screening to the workplace.

In the minute or so I have left, I want to address the fact that this is men’s health awareness month and individual members of the public must take responsibility for their own health. All around us, perfectly sane men are sporting moustaches as “Movember” kicks into gear. For too long, men have ignored their health. It is well known that they do not have regular check ups. The reality is—I am not surprised the House is not packed this evening—men do not like to talk about the prostate or their bowel. As one of the nurses I met in hospitals put it to me: “Men and their bits—they get so precious about them! If men had to go through what women have to go through with cervical cancer screening and pregnancy they would be a great deal more healthy and self aware.”

I praise the television celebrity Chris Evans for his campaign to show that there is no shame and in fact great benefit in having bowel cancer screening. The shame in such matters exists when people ignore the signs and even die through false manliness or ignorance.

Oral Answers to Questions

Guy Opperman Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Paul Burstow]

No.

[Guy Opperman (Hexham) (Con)]

15. What plans he has to ensure that the NHS is prepared for winter pressures.

[The Secretary of State for Health (Mr Andrew Lansley)]

The NHS and social care systems are well prepared for winter. Our Winterwatch summary was first published last Thursday. It showed higher flu vaccination uptake, and I announced additional extracorporeal membrane oxygenation—ECMO—capacity, which will be in place by December. There is always more pressure on the NHS during winter. This year will be no different, but the preparations are in place.

[Guy Opperman]

Given the director of immunisation’s recent report on the take-up by medical staff of the flu jab and the local efforts of Dr Alastair Blair, the chair of the Northumberland clinical commissioning group, will the Minister expand on the need for patient protection in the form of flu jabs in hospitals and surgeries around the country?

[Mr Lansley]

I would like to take this opportunity not least to commend the work that the chief medical officer has done this year in encouraging health care workers to have their seasonal flu jab. The latest figures are that 29% have done so, compared with 11% at the same point last year. We heard earlier from my hon. Friend the Member for Kettering (Mr Hollobone) how well Kettering has done, and there are hospitals that are demonstrating that a higher level is entirely achievable. I urge staff across the NHS to have their flu vaccination. It is the ethical thing to do, not least to provide protection to their patients.

Organ Donation

Guy Opperman Excerpts

Wednesday 9th November 2011 Westminster Hall

[Paul Uppal]

My hon. Friend makes a valuable point. I know how hard he works with the BME community in his constituency, and he is a champion of such issues. I have been heartened by most of my colleagues, who have shown a wide and passionate interest in specific concerns involving the BME community. He is right to highlight the issue.

[Guy Opperman (Hexham) (Con)]

I congratulate my hon. Friend on securing this debate. It is great that he is standing up for such an important issue, and for the BME community. The issue affects all hon. Members, whether their constituencies are urban, or rural like mine. I declare an interest in that I once thought I needed a kidney donation because I tore my left kidney in half at Stratford when I was a jockey. That was due to poor jockeyship, and a good doctor saved me. My question is simple. Does my hon. Friend believe that GPs could play a greater role in the community in stimulating more organ donation?

[Paul Uppal]

My hon. Friend makes an important point. This is a difficult issue, and the nub of the problem is that clinicians and individuals in our communities often find it difficult to talk about the matter and to face reality. I see no reason why it would be harmful if GPs spoke openly and candidly about it to people who attend their surgeries. They could highlight the matter, and spread the broader message among the broader populace about how vital the need is.