Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Speaker]

Order. I remind the House at the start of the Parliament—this might be of particular benefit to new Members—that topical questions are supposed to be significantly shorter than substantive questions: the shorter the better, and the more we will get through.

[Mr Jamie Reed (Copeland) (Lab)]

The Secretary of State has said that safe care and good finances go together, but clinical negligence claims are up by 80% since 2010, while trusts are posting huge deficits. Does he think that finances have deteriorated because care quality has deteriorated or that care quality has deteriorated because finances have deteriorated?

[Mr Hunt]

The evidence is very clear that safer hospitals end up having lower costs, because one of the most expensive things that can be done in healthcare is to botch an operation, which takes up huge management time as well as being an absolute tragedy for the individual involved. My message to the NHS is this: the best way to reduce your costs and deliver these challenging efficiencies is to improve care for patients. Our best hospitals, like Salford Royal and those run by University Hospitals Birmingham NHS Foundation Trust, do exactly that.

Local Pharmaceutical Services

Jamie Reed Excerpts

Tuesday 3rd March 2015 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure, as always, to serve under your chairmanship, Mr Howarth, and not for the first time. I extend my congratulations to the hon. Member for Romsey and Southampton North (Caroline Nokes) on securing the debate. She made an excellent case, and I could not disagree with a word that she said. I thank my right hon. Friend the Member for Rother Valley (Kevin Barron) for his typical insight. He will be reassured to know that I understood every single word.

With access to treatments under increasing pressure, with more people waiting in A and E and with GP appointments fully booked, it is right that we devote parliamentary time to discussing how we can increase the role of local pharmacy services in our communities, so I commend the hon. Member for Romsey and Southampton North on bringing the matter to the House. If we were not four weeks away from a general election and on a one-line Whip, I am sure that the Chamber would be packed. It is a shame that we are discussing a matter of such importance to colleagues from all parts of the House in this environment, because the subject is important to everybody who understands and cares about what is happening in their local health economy.

On 31 March 2015, as we have heard, the Local Pharmaceutical Services (Essential Small Pharmacies) Directions 2013 will be revoked. As a result, on that date, the essential small pharmacies scheme will come to an end. In contract negotiations in 2004-05, the Department of Health and the Pharmaceutical Services Negotiating Committee agreed that essential small pharmacies should be contracted under the local pharmaceutical services provisions. In discussions, NHS England has confirmed that it and the PSNC cannot negotiate a new arrangement to replace the existing contracts. Instead, that must be done locally. An NHS England document published in January this year states that contractors have two options available to them:

“1. To rely on any right of return to a Pharmaceutical List maintained under Regulation 10 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (“the Regulations”); or

2. To submit a proposal to provide Local Pharmaceutical Services (“LPS”) under Part 13 of the Regulations.”

In effect, they can either receive standard pharmacy funding as set out in the drug tariff, which would result in reduced incomes, or they can agree a new local pharmaceutical service contract with the local area team. The report by NHS England neglects to mention a third possible outcome, which is that pharmacies may be left with no option. Pharmacies on reduced incomes may no longer be viable, and they would have to cease to provide pharmaceutical services. The PSNC states that pharmacies that face having to close down will not have to give notice, because NHS England is aware of the termination of the contract, although it recommends contacting local area teams. I am sure we all agree that that could have a devastating impact on local services. Many people rely on their local pharmacy, and I am genuinely concerned that as a result of the plans, those people could be left without the pharmaceutical services that they need and rely on.

Can the Minister outline any transitional arrangements that have been made to ensure that pharmacies are not forced to close unnecessarily? Are any contingency plans in place to cope with difficulties? I would be grateful if she could outline the discussions that the Government had with industry representatives when the plans were drawn up. Notwithstanding any transitional issues, can she provide an estimate of how many pharmacies may be forced to close under the new arrangements? Pharmacies play a crucial role, especially in rural and remote communities such as mine. Pharmacies often provide key services, and the average person will visit their pharmacy more often than their family doctor—I certainly do. Such engagement is crucial in maintaining good health and well-being. My right hon. Friend the Member for Rother Valley spoke at length about the fact that community pharmacies provide services such as smoking cessation and dietary advice, and those services must be maintained.

I am sorry to disappoint my right hon. Friend, but I will mention the Health and Social Care Act 2012, because the Government’s NHS reorganisation has forced intense pressure on all parts of our NHS. That can clearly be seen, as I said at the outset, in the waiting rooms of our GP surgeries and in our A and E departments. According to the most recent GP patient survey, almost 6 million people could not get a GP appointment the last time they tried, and a further 7.8 million waited a week or more. GPs are under severe strain, and pharmacies can play a critical role in alleviating that pressure and expanding access. We also know from the GP patient survey that some 1 million patients went to A and E because they could not get a GP appointment.

More than 1 million people per day—I think the figure is 1.6 million—in England visit their local pharmacy, and the average person will visit their pharmacy 14 times a year. The GP patient survey has shown that GPs and A and E departments already struggle to cope with patient numbers, so they would simply not be able to manage if pharmacies were forced to turn patients away. The Government must make it clear that that will not happen under the new regime.

In a White Paper published in 2008, Labour made it clear how pharmacies can deliver more services to ease pressure on primary care. Pharmacies have a huge role to play in our NHS, and the service simply cannot afford for pharmacy not to play a key role. To address pressures in primary care, the Government should implement measures such as improving links between pharmacy and the NHS 111 service so that care is better co-ordinated. Can the Minister explain what steps the Government are taking to utilise pharmacy better within the NHS?

With those points in mind, I would be grateful if the Minister could outline how the Government will ensure that service coverage and access to pharmacies are not compromised by the upcoming changes. Further to that, will she explain how the Government will ensure that pharmacies provide more services to alleviate pressure on other parts of the system? That is a particular issue in remote, rural and isolated areas, as the hon. Member for Romsey and Southampton North has said, where there are no bus services worthy of the name and no other public transport. The hon. Lady made the case exceptionally well. Isolated health economies are already struggling and frequently achieving sub-optimal outcomes. Reducing access will only worsen those outcomes and increase acute service pressures. Many people rely on those services, and they will be worried that they could lose them. I hope that the Minister can address those concerns, and if my fears are misplaced, I hope that she will explain why.

I am reminded of the roll-out of NHS 111. That has nothing to do with the Minister, because she was not in post at the time, and she knows that I hold her in the highest regard. However, I ask the Government not to repeat the failings of the 111 roll-out when it comes to small pharmacies. Independent academic studies showed Ministers that 111 was not fit for purpose and not fit to be rolled out. Members from all parts of the House warned the Government that the 111 pilots had not worked. I warned the Government before the roll-out of NHS 111 that the scheme was not ready, but they ignored all the advice and rolled out a service that they knew was misfiring and that contributed to the worst A and E performance in more than a decade. That deterioration in patient care was avoidable. I urge the Minister not to repeat those mistakes, but to listen to, accommodate and respond to all the concerns raised today.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 24th February 2015 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

Cancer scanning services in Cheshire and Staffordshire have recently been subjected to a competitive tendering process, and the contract was awarded to Alliance Medical, despite its bid being £7 million more expensive than the NHS bid. Can the Secretary of State explain why the more expensive private sector bid was chosen over the better value NHS bid to provide these services? Will he commit to investigating the bidding process to ensure that the tender was conducted fairly? [Interruption.] He is chuntering from a sedentary position, but will he today confirm, because this is a matter of profound public interest, that no contact of any sort took place between his Department and the board of Alliance Medical with regard to this decision, including at any point with the current board member, the right hon. and learned Member for Kensington (Sir Malcolm Rifkind)?

[Mr Speaker]

Order. That was a considerable essay to which a pithy but comprehensive response is expected. The House seeks it.

GP Services

Jamie Reed Excerpts

Thursday 5th February 2015 Commons Chamber

[Natascha Engel (North East Derbyshire) (Lab)]

It is a pleasure to follow the right hon. Member for Sutton and Cheam (Paul Burstow) who, in his previous role as Minister responsible in this area, gained a wealth of knowledge of primary care, mental health and social care, something I want to pick up on in terms of GP services.

I do not want to repeat everything that has been said before, but without a doubt GP services are facing a real crisis. Everybody has mentioned how many people use their GPs. Most people have a GP. Over 90% of all contacts made in the NHS are made through GP services. GPs and GP practices are the absolute bedrock on which the NHS is founded, so we must get this right. At the moment something is going very, very wrong.

I want to put this in context. The hon. Member for Clacton (Douglas Carswell) said earlier that this was about patients, not doctors. Unless we get right the framework in which the doctors are working, it is the patients who suffer. We also need to understand that, over the last 20 years, the number of GP consultations has risen by 25%. There are many more appointments, without the system having changed that much to accommodate that. The average person now sees a GP six times a year, which is double what it was a decade ago, but the word “average” hides something. I represent a constituency with quite high levels of deprivation, but there are a couple of perfectly well-to-do areas where the GP services are not in crisis and are absolutely fine. The problems are in those areas of greatest deprivation. Arguably those are the areas that most need GP services to be running as well as they can. It is also where GPs are under such a lot of strain; some are retiring early and others are not going into GP practice in the first place. I want to emphasise that if a person is deprived, they will use their GP services as much more of a lifeline than others who go to see their GP.

My hon. Friend the Member for Walthamstow (Stella Creasy) spoke passionately on behalf of her constituents. We found in one of our practices where services were starting to crumble that problems compounded each other. Once things start to go wrong, there is a terrible domino effect. A high number of patients are signed up to my practice and one of the partners retired. That one retirement caused the GP practice to go into crisis. We can all sometimes make the situation worse by highlighting an individual practice, in order to try to help as much as possible, and saying that it is in crisis. That means that GPs will not then apply to work there, when actually the issue is not about that one practice; it is one piece of an entire jigsaw. Patients then leave that practice and sign up at a neighbouring practice, causing that practice to go into crisis. We need to look at this not from the perspective of North East Derbyshire or Walthamstow, but as a national problem.

[Mr Jamie Reed (Copeland) (Lab)]

Does my hon. Friend share my concern that unless we as a country address these problems quickly, holistically and in a detailed way, we run the risk of creating a two-tier NHS service, in which those who, as she rightly points out, most need care are less able to access it?

[Natascha Engel]

Absolutely. I am deeply concerned about that, and about where the pots of money are that people are accessing. I will come to that in a moment. One thing I hear a lot locally is, “The problem is that we are all living longer.” Of course it is not a problem that we are living longer; it is fantastic, but we need to change the way we look after people as they get older. The problem is not just dementia, cancer or heart disease; diabetes, as we have heard, is an absolute killer. We need to invest much earlier to make sure that people can manage their illnesses or, hopefully, avoid them altogether. GPs have a fundamental role in that.

What I really wanted to talk about was the interconnection locally. We have had enormous cuts to the budgets of local authorities. Derbyshire county council, which is responsible for social care, has had its budget slashed to a point where it is difficult to provide the levels of care that were provided before. I have a sheltered housing facility called Mallard Court, where 50 people are living independently because they have a warden service. That warden service and the care line allow people to live active, social and healthy lives with a minimum level of support. Cuts to local authority funding mean that that social care can no longer be provided. We are looking at finding other ways to provide it, but taking that warden away means that those people will, in a matter of weeks or months, go into crisis, whereas now they are living independent lives. In looking at GP services, we need to look at that issue as well, as it is the local GP practices who will feel all the pressure of those 50 individuals.

That goes back to my point about pots of money and the ring-fencing of them. We can have social services, GP services and acute care in different places, which sucks up all the money in the NHS. Unless we start to look at all of this, as my hon. Friend the Member for Copeland (Mr Reed) said, as one big picture, the solutions will not be found.

Younger generations are much more demanding, and people have access to the internet. It is good that people are more demanding. That gives a rocket boost to the NHS by making people develop and keeping them on their toes, but we really need to make sure that people are realistic in their demands. The group of practice managers that I meet regularly—they have joined us here today—would say that it is a question of people being realistic in the demands they make on GP services. As MPs, we need to promote that.

I want to talk about normal GP practices. Most of my practices have multiple members. At the moment, there is immense stress and strain on GPs who are partners and own the building that the practice is in. Those employed just as GPs in the practices do not have the same pressure, financial uncertainty and risk that a partner does.

What often happens is that partners retire young and sell their shares in the ownership of the practice. People are not taking on that risk, but are instead working, often in the same practice, as locums. As locums, they can earn around £100 an hour, and that is before they start charging for additional things on top. Rather than having all that stress and strain, and never really having the time to take a step back and look at the bigger picture of where the GP practice is going, partners are standing down and working as a locum, doing the work that they want to do and getting highly paid for it; that is, so far as I can see, a no-brainer.

--- Later in debate ---

[Mr Jamie Reed (Copeland) (Lab)]

I congratulate my hon. Friend the Member for Halton (Derek Twigg) and the hon. Member for Brighton, Pavilion (Caroline Lucas) on securing this incredibly important debate. We have had a series of genuinely good speeches from right across the House. I thank the following for their contributions: the hon. Member for Henley (John Howell), my hon. Friend the Member for Walthamstow (Stella Creasy), the hon. Member for Truro and Falmouth (Sarah Newton), the right hon. Member for Sutton and Cheam (Paul Burstow), my hon. Friend the Member for North East Derbyshire (Natascha Engel), the hon. Member for Newton Abbot (Anne Marie Morris), who made a brilliant contribution, my right hon. Friend the Member for Knowsley (Mr Howarth), my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), and the hon. Member for Rochester and Strood (Mark Reckless), who told us about his constituents who have to wait up to six weeks for an appointment, which is clearly not acceptable,

Finally, I thank my hon. Friend the Member for Easington (Grahame M. Morris), who made some incredibly important points. He mentioned that 1 million people today will visit a GP in England, and that 1.6 million will visit a pharmacist. Some of the answers to the questions he raised lie in making better use of the interfaces that patients have with medical professionals, whether it be GPs, nurse practitioners, district nurses or pharmacists. We need to look at the capacity that we have across the system to do more. He said that 30% of training places for GPs in the north-east remain unfilled, and I am with him on that. It is a real issue affecting my community in Cumbria. I hope he forgives me for calling him telepathic, but I think that we need to produce our own doctors to serve our communities.

We should approach the Royal College of General Practitioners, higher education institutions and further education institutions about identifying people at a young age and encouraging them to go into medical careers and to stay in their communities to practise. I am trying to do that in my own community with the university of Central Lancashire. If that idea is to take wings, it will need significant support from the centre—the Department. Hopefully, we will reach a cross-party consensus on that. My hon. Friend hit the nail on the head with his practical solutions to the problems that so many communities face, particularly in the north-east, north-west and the midlands.

I also extend my thanks to the Backbench Business Committee for ensuring that this debate took place. The sustainability of our GP services is crucial to the health of the nation and to the overall performance of the national health service.

There are 372 million GP consultations each year and that number is rising. As my hon. Friend the Member for North East Derbyshire pointed out, around 90% of all patient contacts with the NHS are through a local GP. No one can dispute that GPs provide a vital service, but increasing pressures on this service are having a major impact on the NHS as a whole. The service does not exist in isolation, and so a holistic approach to our national health service must be taken if we are to have a system that is fit for the challenges of the 21st century.

I wish to touch on three key tenets to our GP services: the issues surrounding the work force and the impact that they have on the profession; the concerns regarding access; and the wider impact that all these pressures are having on the NHS as a whole. Before I address those issues, I wish to pay tribute to the Royal College of General Practitioners and its chair, Dr Maureen Baker, for its Put Patients First campaign, which has put the problems facing general practice to the top of the political agenda. Like other MPs, I thank GPs around the country for their work under such extreme pressures. They really do perform superbly in difficult circumstances.

The latest GP patient survey was a timely reminder of the problems facing both medical practitioners and patients. It found that one in four people is waiting a week or more for a GP appointment, or not getting one at all. If such a trend continues over the course of this Parliament, we will find that by 2020-21, the number will have risen to more than 22.5 million people. A Patients Association survey revealed that four in 10 people are concerned about the impact that the wait for a GP is having on their health. We may disagree over the causes of those concerns, but there can be no doubt that the Government have overseen a deterioration in the patient experience. Colleagues across the House will have repeatedly heard that from their constituents. Hopefully, the one thing we can all agree on is that there are not enough GPs.

In March 2014, the Government’s taskforce report, “Securing the Future GP Workforce” was published. It said:

“The taskforce has concluded that there is a GP workforce crisis which must be addressed immediately even to sustain the present role of General Practice in the NHS.”

The Government’s own report paints a damning picture. It says that GP recruitment has remained “stubbornly below” the Government’s target, and that

“this cumulative recruitment shortfall is being compounded by increasing numbers of trained GPs leaving the workforce, most significantly GPs approaching retirement, but perhaps more worryingly women in their 30s.”

We have heard that concern from Members across the House.

The report goes on to say:

“Disturbingly, evidence is also emerging from the NHS Information Centre that the GP workforce is now shrinking rather than growing.”

It also shows that the number of GPs per head has fallen below levels seen in 2009. At a time when demand is rising, such a reduction is having a profound impact on the service that GPs can provide. We know from personal experience and from our constituents that the vast majority of GPs work tirelessly in extremely trying conditions to provide the best care possible for their patients, but under this Government that is becoming harder and harder for patient and practitioner alike.

I speak to GPs from all around the country, including in my constituency, who are on the verge of burning out. GPs are concerned that they are so overworked that they are at risk of harming a patient. I have written to the Secretary of State with regard to comments made to me by a local GP, who said that unless something changes, unless recruitment improves and unless service pressures ease, “we are going to kill someone”. Clearly, that is an untenable and unacceptable state of affairs.

The increase in demand and workload is having a detrimental impact on the morale of GPs. A BMA survey in March last year revealed that more than half of GPs reported that their morale was either “ low” or “very low”. This is a matter not of professional whinging, but of patient safety. The chair of the BMA GP committee said at the time of that report:

“It is clear that General Practice is facing a workload disaster that is threatening its long-term future.”

The Government’s inaction is only making things worse. The work force issues that I have outlined now mean that more GPs are considering early retirement, thus potentially exacerbating an already unsustainable situation. The BMA survey showed that more than a quarter of GPs were considering leaving the profession, six out of 10 were considering early retirement, and a third were already planning for that decision. Instead of delaying, I hope that, in the days remaining before the election, the Government will back Labour’s time to care fund, which, with a budget of £2.5 billion a year, would recruit 8,000 more doctors, 5,000 more care workers and tens of thousands of other new staff by 2020. We would do that by taxing mansions, clamping down on tax avoidance, and raising a levy on tobacco companies. We can fund new medical professionals to ease the work force pressures and to give GPs the support that they need to provide a service on which we all rely.

In response to Labour’s announcement on the time to care fund, particularly on our pledge to produce 8,000 more doctors, the chair of the Royal College of General Practitioners, Dr Maureen Baker said:

“It is good to see that the Labour Party have recognised the resource and workforce pressures facing General Practice and their pledge of 8,000 more GPs by 2020—something the RCGP has long called for—is very welcome.”

In contrast, the Government have missed their own recruitment target, which is having a profound impact on the overall service. I hope that they will back our plans to ease the work force crisis that they have, in part, helped to create.

Moving on to access, despite the best efforts of GPs and other professionals, work force pressures are having adverse effects on patient experience. More than one in four people do not get a GP appointment within a week. The GP patient survey shows a deterioration in access to GP services. When Labour left office, the vast majority of patients could get an appointment within 48 hours, but one of the first acts of this Government— something I am sure that they now regret—was to scrap Labour’s guarantee. As a result, it is now getting harder and harder for patients to see their GPs. That is not surprising, given the worsening work force pressures that the Government have presided over.

The Government have failed not just on overall access, but on the continuity of care. They talk of the continuity of care and access to a named GP, yet the GP patient survey shows that one in five people are unable to see their preferred GPs regularly. This, too, is unacceptable. The overall picture of GP access is one of deterioration, not improvement. The Government have heaped pressure on primary care, and now, as we all know from our constituency surgeries, patients are feeling the effects.

By cutting competition and rolling back the market that the Government have imposed on the NHS, Labour has committed to investing an extra £100 million to deliver new options for GP access. The Government should back Labour’s plans to give patients three options for accessing their GP: first, a same-day consultation at their GP surgery; secondly, a GP appointment at their surgery within 48 hours; and thirdly, the ability to book ahead to see the GP of their choice. All Members who have spoken today have raised precisely such issues, and only the Labour party has produced the solutions to those issues, which so many constituents are taking to colleagues. Where possible, some GP surgeries already provide those options, and with Labour’s extra funding and new doctors, we want to give all practices the ability to deliver them.

Timely access to GP services is essential for the whole NHS. The GP patient survey has shown that almost 1 million people have gone to A and E because they were unable to get a convenient GP appointment. That is creating unprecedented demand on our A and E departments, manifesting itself in the number of patients now waiting for more than four hours—something that we all see—and causing reverberations throughout the whole system. The Government’s cuts to social care have also increased pressure on primary care services, and that, in turn, is also increasing pressures on A and E

The constituent services of the NHS do not exist in isolation, and the Government’s failings in easing work force pressures for GPs have had profound effects throughout the system. Instead of addressing these issues, most of which were predictable, the Government blew precious time and more than £3 billion on a reorganisation that was deliberately hidden from the public before the last general election. Only by backing Labour’s plans for thousands of new doctors, funding to improve GP access, and moving towards the greater integration of health and social care, can we really ensure that all parts of the NHS, including GP services, are sustainable for the future.

We have heard about profound difficulties in Walthamstow and other communities. I am one of those fathers who hang on the phone for 30 minutes or longer, trying to get an appointment for a sick child. I do not blame GPs; they are under huge pressures and we have heard about recruitment problems all over the country. I have written to the Secretary of State for Health about recruitment problems in Cumbria, but sadly, I have yet to receive a reply. Will the Minister, if nothing else today, commit to write to every Member who has expressed concerns in the debate to illustrate in detail what the Government will now do to help those communities to assist with GP recruitment and sustainability? Universal services require universal standards and the ability of patients to access these services universally.

--- Later in debate ---

[Dr Poulter]

My hon. Friend is right. I spoke to medical students and those teaching them in Cornwall on a visit earlier this year. It is important, particularly for rural areas, to encourage more placements in rural areas in general practice. Often at my hon. Friend’s medical school and other medical schools in remote rural areas, there is a good track record of recruiting more local young people so that they are being educated locally. The hope is that those people will stay and work in the local work force and contribute to the local NHS after they graduate. I hope all hon. Members will agree that that is a good thing, particularly in more deprived areas.

I must make progress as I do not want to intrude upon the House’s time for too much longer. There are two or three important points that I want to make. I mentioned that in the health education mandate in 2014 we mandated to increase the number of GP trainees from 40% to 50% of all trainee doctors. That will make 5,000 extra GPs available by 2020. It is important to note, however, that as well as having the appropriate size work force, we must plan for the future shape of the work force. The new models of care set out in the NHS England “Five Year Forward View” will require different models of staffing, and we need to plan with that in mind. That is why Health Education England has established an independent primary care work force commission, chaired by Professor Martin Roland of the university of Cambridge.

In line with the contributions to the debate from a number of hon. Members, including my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), the commission will identify models of primary care that will meet the needs of the future NHS, including a greater emphasis on community and primary services and the more integrated delivery of care, which will involve the better use of multidisciplinary teams. We have been talking about GPs today, but delivering better care in the community is also about nurses, physiotherapists, occupational therapists, pharmacists, speech and language therapists and the many other health care professionals who play a part in delivering high-quality care to patients in general practices and in the community every day through our NHS.

In response to concerns raised by hon. Members about access to services, GP services need to be available to patients in a convenient place and at a convenient time. Achieving improved access to general practice not only benefits patients, but has the potential to create more efficient ways of working, which benefits GPs, practice staff and patients. The previous Government attempted to improve access to GP services by establishing a 48-hour access target. We know now that that target did not work. From 2007 to 2010, the proportion of patients who were able to get an appointment within 48 hours when they wanted one declined by 6%.

A 48-hour target can make it more difficult for some of the more vulnerable patient groups who GPs look after, particularly people with complex medical co-morbidities, to get the important routine appointments that they need. We should bear in mind that targets can be perverse. That target did not work in its own right, and could make it more difficult for people with complex needs and the vulnerable and frail elderly to get the routine appointments that keep them well and properly supported in the community.

Many points have been made about Labour’s disastrous 2004 GP contract. I do not need to rehearse those. The single biggest barrier to access to care is not being able to see their GP when people need to, in the evenings and at weekends. We have put together the Prime Minister’s fund with £100 million to back it to improve access to GP services in the evenings and at weekends, to make sure that patients receive the better service that they deserve.

[Mr Reed]

In 1997, only half of patients could see a GP within 48 hours. By 2010 the vast majority could do so. Does the Minister agree with Maureen Baker of the Royal College of General Practitioners, who said:

“It is ludicrous to continue to blame a GP-contract that is more than ten years old for the woes currently besetting the entire NHS”?

[Dr Poulter]

It is easy for the hon. Gentleman to take quotes out of context. It is undoubtedly the case that A and E admissions rose dramatically and the pressure on A and E increased dramatically because people could not access their GP out of hours. Of course that is the case. The facts and the statistics bear that out. Also, many people work, so having access to their GP service in the evenings is increasingly important to working people, so that they can see their GP at a time that is convenient to them. We have a chronic disease burden, which all hon. Members are concerned about, so why should primary and community care services be unavailable at weekends? That is not a well structured GP contract or arrangement. It is important that we do our very best to put that right.

Mike O’Brien, who was a Health Minister in the previous Labour Government, is on the record as having criticised that GP contract and the damage it did to patient care. We want to support GPs to provide a seven-days-a-week service again, which is why we have put in place the Prime Minister’s fund. I hope that the hon. Member for Copeland, putting aside party political differences, will recognise that GP services need to be properly available to patients seven days a week.

NHS Specialised Services

Jamie Reed Excerpts

Thursday 15th January 2015 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to serve under your chairmanship, I think for the first time, Sir David, although you do look an awful lot like someone we used to call Mr Amess. I extend my genuine thanks to the hon. Member for St Austell and Newquay (Stephen Gilbert), whom I congratulate on securing this debate and on raising these issues in such detail. That is extremely important.

I pay tribute to all hon. Members who have spoken today. I single out my hon. Friend the Member for Luton North (Kelvin Hopkins), who made a superb contribution. He will be pleased to know that a Labour Government would increase spending on the NHS, more so than any other party. I am keen to give my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) the engagement that he seeks at a time of his convenience. I commend my hon. Friend the Member for Alyn and Deeside (Mark Tami) for his compelling personal testimony. Every contribution has been very important. I also pay tribute to the Backbench Business Committee for ensuring that this and other important debates go ahead.

[Mr Peter Bone in the Chair]

Tens of thousands of people across the country rely on specialised health services. Far from being for the very rarest conditions, those with relatively common illnesses and diseases regularly depend upon specialised services. Those conditions and services include, but are by no means limited to, epilepsy, haemophilia, many cancers, HIV and cystic fibrosis. The list also includes fertility treatments such as in vitro fertilisation. The hon. Member for St Austell and Newquay gave a much more detailed list. The issue not only covers a wide range of conditions but accounts for £14.6 billion of the NHS budget, meaning that more than £1 in every £7 spent by the NHS is on specialised health care.

How those services are commissioned and provided is not a peripheral issue. It has a meaningful impact on the health and well-being of many thousands of families throughout the country. As we have heard today, we represent many constituents who require such specialised services. That is why it is right that these issues are debated in detail.

What is of real concern to those of us who use the NHS is the ability to access high-quality care and services. While access is available, many will not be concerned by the commissioning process, but widespread changes to the process could damage services and therefore patient care. The fundamental issues being debated today are the proposed co-commissioning of specialised services and, as has been mentioned, the proposed tariff change for these services. Each presents challenges that the Government must address. I am sure that the Minister will speak at length about how it is now the responsibility of NHS England, but Government must share responsibility for services and their performance. The public and the House expect it.

The Health and Social Care Act 2012 made NHS England the sole national commissioner for prescribed specialised services. The intended effect was to ensure that access and services were uniformly available across the country. It was meant to ensure that all patients would have access to available treatments. The rationale behind the change was that local funding and commissioning of specialised services had led to variable access and quality for patients.

National service specifications ensure that all patients, no matter where they live, have access to the same standard of care. They are currently underpinned by national access policies, expert advisory groups and national accountability for services. The proposed changes that we are discussing and the adoption of co-commissioning could pose a risk to those national standards. Many stakeholders have expressed concerns that specialised services are not easy to plan for on a local level. The Specialised Healthcare Alliance has said that

“given the highly variable incidence of rare and complex conditions, individual CCG allocations will not be aligned with actual need in-year.”

The Government should give assurances to hon. Members, stakeholders and patients about plans to change how such services are commissioned. For example, where will the budget rest? Will it be divided between NHS England and local clinical commissioning groups? Will clinical commissioning groups have any degree of autonomy in decisions about which services to commission in their locality? Why does the Minister believe that the changes will not result, as hon. Members have said they will, in a postcode lottery of services where patients in one area will have no access to some services on which they rely, but other patients will?

On 30 September last year, NHS England published its commissioning intentions 2015-16 for prescribed specialised services. Section 11 states clearly that NHS England has recommended to the prescribed services advisory group that renal dialysis should no longer be commissioned by NHS England and should instead be commissioned by CCGs. The National Kidney Foundation and its members have expressed deep concerns about the change. Patients are anxious about how the changes will affect services that keep them alive. There are 52 centres at present, each with a number of CCGs. How would those arrangements change as a result of the new commissioning framework?

The Cystic Fibrosis Trust has also echoed similar concerns. It is worried that the result of the changes could be

“ a lack of accountability and wide differences in provision of care across the country.”

Will the Minister reassure those stakeholder groups that that will not be the case as a result of the proposals?

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

I apologise that I could not be here for most of this debate, but among the conditions that my hon. Friend is mentioning, I urge him and the Minister not to forget sickle-cell anaemia. Sufferers feel that there is a damaging variability in the quality of treatment available throughout the country and feel that a move away from national commissioning to local-only commissioning might exacerbate that problem.

[Mr Reed]

I thank my right hon. Friend for that intervention. He will be pleased to learn that other hon. Members have made that point as well. Sickle-cell anaemia and the needs of people with that condition must be at the forefront of commissioning intentions and guidance.

It is absolutely clear that there is widespread opposition to the changes among key stakeholders. When the Specialised Healthcare Alliance conducted a survey of patient organisations, expert clinicians and industry representatives, asking for their views on specialised commissioning, 90% of respondents preferred their services to remain part of specialised commissioning. Co-operation between NHS England and CCGs should be welcomed in order to ensure best outcomes for patients, but wherever there is a risk that provision could suffer, NHS England must clearly retain sole responsibility for such services.

Patient care is central to the debate, as it is to all health debates. CCGs could not accurately predict the demand on some key services across a small population, so they are not in a position accurately to commission those services. Many CCGs are already overwhelmed; are they truly capable of doing what is being proposed? The ability to commission effectively will inevitably differ from CCG to CCG, which runs contrary to the initial intentions behind specialised commissioning.

Another concern is the speed with which the proposed changes will be implemented. NHS England plans to begin implementing co-commissioning arrangements in April this year, but it has yet to confirm which services will be co-commissioned. Such fog is damaging for patients and medical professionals alike. The Government and NHS England must be clear about their intentions to allow for proper planning and effective service provision. Perhaps the lessons of the 111 fiasco, for which the Minister was in no way responsible—the service was rolled out even though Ministers knew it was not ready—should now be heeded. These are real concerns expressed by those who will be most affected by the changes, and I hope that the Minister will reflect on that.

On the proposed tariff changes, in November 2014, NHS England and Monitor published a consultation notice on the national tariff payment system 2015-16. The consultation notice included a proposal for a 50:50 gain and loss share arrangement between NHS England and providers of acute prescribed services, meaning that for any service whose value exceeds national base levels, providers would receive payment only for the national base plus 50% of the difference, whereas on any service costing less than national base levels, the commissioner could save 50% of the difference between the actual value and the national base. That will give commissioners a financial incentive to restrict access to treatments for non-clinical reasons, which I find unacceptable.

Given the financial difficulties facing many CCGs throughout the country, that incentive might proving damaging and counterproductive in some cases. Will the Minister commit to undertaking an impact assessment on the tariff change and publish that assessment? If the tariff change has any detrimental impact on patient care, it cannot continue. I hope that when he responds to the debate, he will tell us whether he accepts that view. Will he also consider the views of the specialist hospital network? There is potential to do real damage to such hospitals: not only to the service that they provide, but to their research and development work as well, as my hon. Friend the Member for Luton North mentioned.

The Government’s engagement with stakeholders on health policy throughout this Parliament has been woeful. At best, it has been characterised by a refusal to engage in discussions about what is best for services, professionals and patients; at worst, by wilful ignorance of what experts, clinicians and patients need. A “carry on regardless” attitude has permeated most Government policy across all Departments, but nowhere is it more prevalent than within the national health service. The proposals represent the end of “no decision about me without me”. Stakeholder after stakeholder is calling on the Government to rethink their plans for the commissioning of specialised services.

The 2012 Act is seemingly never-ending; it appears to be changing yet again. The NHS has been plunged into never-ending reorganisation. It is an object lesson in bad law. Again, in fairness to the Minister, that happened before he arrived in post. Let us try to restore consensus on this issue and give commissioners the comfort, certainty and predictability that they and patients deserve. Let us put patients first and stop what could be a retrograde step. I look forward to the Minister’s response.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. It is one of the underlying causes of pressure in A and Es that for an over-75 attending an A and E in winter, there is an 80% chance that, rather than going home, they will be admitted to hospital and probably stay there a long time. That is why improving community care, as she says, is at the heart of this Government’s strategy to reduce pressure on hospitals.

[Mr Jamie Reed (Copeland) (Lab)]

If it is not too late, let me wish you, Mr Speaker, a happy new year.

The care failings uncovered by the Care Quality Commission at Hinchingbrooke hospital are appalling and unacceptable. The inspection

“found poor emotional and physical care which was not safe or caring.”

The response to call bells was so bad that some patients were told to soil themselves; drinks were left out of patients’ reach; and one member of staff was overheard telling a patient,

“don’t misbehave you know what happens when you misbehave.”

Will the Secretary of State tell us when he was first told about the problems at Hinchingbrooke? Given that the CQC inspection happened in September, why was the trust put into special measures only last Friday?

[Mr Hunt]

What I can tell the hon. Gentleman is that what happened at Hinchingbrooke completely destroys what Labour has been saying about privatisation, because it was this Government who introduced an independent inspection regime, which did not exist before, that roots out poor care without fear or favour. That is what we have done in 18 hospitals run by the NHS and it is what we are doing at Hinchingbrooke run by the private sector.

Health and Social Care (Safety and Quality) Bill

Jamie Reed Excerpts

Friday 9th January 2015 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

I beg to move, That the clause be read a Second time.

Before I begin, I am sure that the eyes of every Member are on events in France and we wish the French authorities the very best of luck in their endeavours in the aftermath of Wednesday’s events.

I congratulate the hon. Member for Stafford (Jeremy Lefroy) on navigating his Bill to this stage. Not many private Members’ Bills make it to this point. This is a good Bill and I am sure we would all like to see it on the statute book. I hope that it can complete its final Commons stages today.

On 13 November 2014, the Secretary of State for Health announced that Dame Fiona Caldicott would be the new national data guardian for health and care, and that her role would become

“the patients’ champion on security of personal medical information.”

She will

“be able to intervene if she is concerned by how an organisation is sharing data. She can refer concerns directly to the Information Commissioner’s Office (ICO) and the Care Quality Commission (CQC)”.

Those principles are supported by all Opposition Members. Sharing data and information can and, indeed, should improve health care, but we must ensure that patient privacy is protected at all times.

If Dame Fiona’s role is to look at how organisations share data, that role will become directly relevant to the provisions in clause 3. In his announcement, the Secretary of State for Health said:

“I intend to put the National Data Guardian on a legal footing at the earliest opportunity”.

The business of the House is not so demanding that he can blame a lack of parliamentary time for not introducing such plans, especially as there have been concerns about data for a very long time. Those concerns have become even more acute since the bungled implementation of the care.data scheme, which is so important to our research base.

In Committee, I told the Minister that if the Government did not make progress on their announcement, the Opposition would help them out. That help has arrived today. The Government have done nothing, so I have tabled new clause 1 to place a duty on the Secretary of State to hold a consultation process on the role of a statutory national data guardian. We do not wish to prejudice the role by prescribing its functions. It is right that the role should be determined by consulting those on whom it will have an impact, not least Dame Fiona herself. Many stakeholders will be keen to contribute to a consultation process; they are crying out for progress.

The Bill places a duty on health care providers to share information wherever relevant. As new systems are put to the test, there will inevitably be more pressure on the national data guardian. The new clause would place a duty on the Secretary of State to start a consultation within 30 days of the passage of the Bill. We are all keen to see progress, and the new clause would ensure that the process got under way almost immediately.

We want the consultation to be meaningful and thorough to ensure that the new role is as effective as possible in maintaining standards by highlighting and, more importantly, fixing poor practice as and when it occurs. The Minister said in Committee that the delay to date was because the Government wanted to consult widely with stakeholders. That is the precisely the purpose of new clause 1, so I can only imagine that the Government will support it. If they oppose it, will he explain why? Will he commit himself to writing to me about the proposed timeline for the consultation and the planned legislative timetable for putting the role on a statutory footing, as we discussed in Committee?

Sharing data can lead to much better outcomes for patients throughout the health and social care sector, but we must ensure that personal data are used safely, and that any promotion of data sharing is done responsibly to improve health outcomes. That principle has already been explored in depth, and the Labour party is clear that it supports that principle, as I am sure do all Members. There is wide support for the role of the national data guardian. Putting it on a statutory footing has cross-party support. I hope that the Government will get on with it today.

[Jeremy Lefroy (Stafford) (Con)]

I thank the hon. Member for Copeland (Mr Reed) for tabling new clause 1, which allows us to debate the issue. I am most grateful to him for his full and constructive engagement with the Bill. A consultation on making the role of the national data guardian statutory is extremely important, and I fully appreciate the reasons why he has tabled the new clause.

I welcome the appointment last November of Dame Fiona Caldicott as the first national data guardian. Her extensive knowledge and experience in this area will ensure strong and visible leadership. She, together with her panel, will act as a source of clear authoritative advice and guidance across the health and care system. The Secretary of State said at the time of her appointment:

“We need to be as determined to guarantee personal data is protected as we are enthusiastic to reap the benefits of sharing it. Dame Fiona will oversee the safe use of people’s personal health and care information and hold organisations to account if there is any cause for concern, ensuring public confidence.”

Let me make it quite clear that the clauses on the duty to share information are not about care.data, which is another issue for another time. My Bill is about data being shared only with those who are directly responsible for an individual’s care for the purposes of that care. Its remit is very restrictive.

A consultation should, as the new clause provides, include reference to

“oversight of data sharing as set out in”

the Bill. Understandably, concerns have been raised that a duty to share information might somehow dilute the vital principle of patient confidentiality, which is protected by statute and common law. As I have explained before, I do not believe it will do so.

The seventh of the revised Caldicott principles, as set out in “The Information Governance Review”, is that

“The duty to share information can be as important as the duty to protect patient confidentiality. Health and social care professionals should have the confidence to share information in the best interests of their patients within the framework set out by these principles.”

As was set out on Second Reading and in Committee, clause 3 introduces a duty to share information. That must be done when it is in the person’s best interests and it is

“likely to facilitate the provision to the individual of health services or adult social care”.

Having a statutory duty to share information for the benefit of a person’s care, within the clear limits set out in the Bill, would, alongside the existing strong statutory protection for confidentiality, provide health and social care professionals with the confidence to which Dame Fiona’s report refers.

The consultation on the national data guardian will provide the opportunity to set out how oversight would work for the duty introduced by the Bill, should it become law, under the legislation that will make the role of the NDG statutory. If the consultation cannot be established through a clause in the Bill, which I understand may be the case due to the timing of the general election—the Minister will go into that, I believe—it needs to happen at the earliest possible opportunity.

--- Later in debate ---

As there is so much common ground on the role of the national data guardian, and a clear commitment to consult fully, I hope the hon. Gentleman will agree with the approach I have outlined and be satisfied with my reassurances, and that he will withdraw the new clause.

[Mr Jamie Reed]

I am grateful to the Minister for his response and for the constructive way that we have dealt with the Bill, which in many ways demonstrates some of the best traditions of the House. I am a little disappointed, given the fallow—dare I say useless—fifth year of this five-year Parliament, that time has not been found to address these issues. The protection and use of individual data, not just in health services but across the public sector, is one of the biggest and most important emerging issues facing our politics and society, and the Minister is right to say that such matters need to be treated carefully, judiciously, and with diligence and attention to detail.

Given the cross-party support and the Minister’s assurances, I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 2

Care and Quality Commission reviews and performance assesments

‘(1) Section 46 of the Health and Social Care Act 2008 (health and adult social care services: reviews and performance assessments) is amended as follows.

(2) For subsection (3) substitute—

“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”’—(Sir William Cash.)

Brought up, and read the First time.

[Sir William Cash (Stone) (Con)]

I beg to move, That the clause be read a Second time.

--- Later in debate ---

[Mr Jamie Reed]

I listened closely to the hon. Member for Stone (Sir William Cash). As I said earlier today, and on Second Reading, in Committee and throughout the passage of the Bill that became the Care Act 2014, patient safety is our guiding principle, and we are responsible for ensuring that all that we do is intended to improve it. The purpose of NHS regulation should always be to improve safety and achieve better patient outcomes. I therefore strongly sympathise with the principle of the new clauses. However, I should be grateful if the hon. Member for Stone explained why he does not agree with the hon. Member for Stafford (Jeremy Lefroy) that the duties for which they provide are already covered by the Bill and by other legislation.

A little over 12 months ago, I was a member of the Committee that scrutinised the clause in the Care Act that amended the Health and Social Care Act 2008, which new clause 2 seeks in turn to amend. The new clause adds the following words:

“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”

That is sound in principle, but it seems to me that it would remove from the CQC the flexibility that allows it to exercise its own judgment. Existing legislation gives the CQC a duty to describe and justify its indicators, and to consult on them before carrying out inspections. As the hon. Gentleman said, the Care Act also gives it a power to amend and revise those indicators.

Section 3 of the 2008 Act states:

“The main objective of the Commission in performing its functions is to protect and promote the health, safety and welfare of people who use health and social care services.”

Will the hon. Gentleman explain why he thinks his new clause is needed on top of that, and in combination with the CQC’s duty to consult on the indicators that it uses to assess services? If we support the principle of independent inspection, we need to guard against making unnecessary changes to legislation that could deter the CQC from performing its central role of ensuring the safety of the services that is inspects.

New clause 2 requires the CQC to

“include indicators of the safety of health and social care services.”

We all want the best and most effective legislation to be passed, but I fear that the new clause could be open to significant misinterpretation. The section of the 2008 Act to which the new clause relates concerns CQC reviews of the performance of service providers. The CQC will inspect a number of different services, including services that do not directly involve social care. The new clause, however, could require it to include indicators of safety in social care services regardless of whether the service concerned involves social care. If that is the hon. Gentleman’s intention, will he explain why he believes the provision to be necessary? Furthermore, new clause 2 refers to “social care services”, whereas new clause 3 refers to “adult social care services”. I hope that the hon. Gentleman will be able to explain what appears to be a discrepancy.

As Labour Members have made clear, we believe that patient safety is paramount in our NHS, that effective regulation is key to securing it, and that producing such regulation is our role in the House. I should be grateful if the hon. Gentleman explained why he believes that his new clause is essential to more effective regulation, given that—as the hon. Member for Stafford has pointed out—it seems merely to repeat existing provisions.

[Dr Poulter]

I thank my hon. Friend the Member for Stone (Sir William Cash) for tabling these new clauses and I commend him on his tireless work in taking forward the interests of his constituents around the terrible events that occurred at Mid Staffordshire NHS Foundation Trust and the subsequent steps he has been involved with all the way through to improve standards of hospital care provided to the people of Stone and the surrounding areas. He is also right to pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), who has worked tirelessly not just on this Bill, but as an advocate for his constituents and local patients. He is a great credit to the people of Stafford and, party politics aside, being a Member of Parliament is about public service, and he embodies the very best of that in the work he has done in bringing forward this Bill and in his advocacy of the needs of his local patients.

--- Later in debate ---

[Mr Jamie Reed]

Thank you for calling me to speak, Madam Deputy Speaker, and happy new year.

I listened closely to the hon. Member for Stone (Sir William Cash) introducing his new clause 4 and to the other hon. Members who have spoken on it. They are correct to say that good communication between professionals and patients is crucial for ensuring positive health outcomes. I would go so far as to say that it is critical. One of the issues that we need to address in this regard is the needs of patients with sensory impairments, such as deafness and blindness. That is not covered by the new clause and it has no regard for nationality or language skills.

In April 2010 the Health Committee conducted an inquiry called “The use of overseas doctors in providing out-of-hours services” following the tragic death, to which the hon. Gentleman referred, of David Gray in 2008 after receiving medical treatment from Dr Ubani from Germany, who was working his first shift as an out-of-hours doctor in the United Kingdom. The report recommended that the Government make the necessary changes

“to enable the GMC to test the clinical competence of doctors and undertake systematic testing of language skills so that everything possible is done to lessen . . . the risks of employing another unsuitably trained . . . doctor in out-of-hours services.”

Following this case, I understand that the Government have, with the support of Labour, worked to strengthen the powers of the General Medical Council in this regard. We welcome that.

Notwithstanding all this, I am unsure what the hon. Gentleman is trying to achieve. Given the existing practice of the GMC, the new clause, although agreeable in principle, is superfluous. The GMC conducts English language assessments already, and failure to undertake an assessment or failing such an assessment can result in fitness to practise hearings, which can lead to a loss of registration to practise.

These assessments can be triggered in a number of ways. A single complaint from a patient, a health professional or another party can result in an assessment, as can prescribing errors and poor record keeping. Overseas medical regulatory authorities can prompt an English language assessment if they believe that a doctor does not have sufficient knowledge to treat patients in an English-speaking context. Indeed, the GMC website tells international doctors that

“you must satisfy us you have the necessary knowledge of English to get registration with a licence to practise”.

So the GMC needs to be satisfied before a licence to practise is granted. These tests relate to all forms of communication—speaking, reading, writing and listening. It is right that the GMC continues to be vigilant in its oversight of this requirement. Good communication is central to patient safety, and the GMC does a great deal to ensure that those practising in the NHS have the skills required to do so safely.

I want to place on record an acknowledgement of the contribution made to our national health service, which I know nobody doubts, by the many overseas health care workers without whom the NHS would not be able to cope, including in my constituency. On Second Reading of the National Health Service (Amended Duties and Powers) Bill, my hon. Friend the Member for Bolsover (Mr Skinner) commented that he had received a “United Nations heart by-pass” operation, by which he meant that people from all over the world had done a great deal for the health of this country, and we should all be thankful for that.

We have touched briefly on unintended consequences. Some politicians have recently sought outside the House to manipulate and inflame the issue with a view to creating an imaginary bygone Britain in the public consciousness as part of a long-standing flight from reality based on bizarre notions such as “gay rain”, the enforced segregation of breastfeeding mothers from public spaces and the right to use racist language. We must all be careful not to legitimise this abhorrent, detached, cultish behaviour or the perverted mindset which underpins it.

[Dr Poulter]

I am grateful to my hon. Friend the Member for Stone (Sir William Cash) for tabling the new clause. We all agree that it is vital that doctors can speak and communicate effectively in English. My hon. Friends the Members for North East Somerset (Jacob Rees-Mogg) and for Shipley (Philip Davies) made a number of important points.

I hope I can bring some reassurance to hon. Members that there are already in place, thanks to changes introduced by this Government, a number of strong tests for language competency and the ability to communicate. It is not good enough for a medical professional to be able to speak English; it is important in all aspects of health care that we can communicate effectively with our patients. The ability not just of doctors from overseas when they work in and contribute to the NHS, but of doctors who have been working here for many years to communicate effectively is at the heart of good medicine. There are a number of steps that this Government have taken to strengthen the tests in place.

To echo the comments of the shadow Minister, I have worked alongside many doctors and many health care professionals from all over the world who have come here to contribute to our NHS and to the care of patients. Many of those doctors have been outstanding and continue to look after patients today as we debate the new clause. One of the strengths of our diverse NHS is that because we have a world-class health service, doctors want to come here and contribute as part of their careers, often for a short period, before they return to New Zealand, Australia or the many other countries from which they have come. The diversity of our NHS and the fact that we attract doctors—often the very best doctors—from all over the world is a great strength, but it is vital that all doctors can both speak English and communicate effectively in English. That is not controversial, and it is what good patient care is all about.

Clause 5 and the schedule will introduce a consistent overarching objective for the Professional Standards Authority and professional regulators—the General Dental Council, the General Optical Council, the General Osteopathic Council, the General Chiropractic Council, the Nursing and Midwifery Council, the Health and Care Professions Council and the General Pharmaceutical Council—to ensure that public protection is at the heart of what they do.

The clause introduces the term “well-being” into the objectives of a number of these regulators. This has been a long-standing and established feature of the legislation for the General Pharmaceutical Council, the Health and Care Professions Council and the Nursing and Midwifery Council. The term encompasses those aspects of a health care professional’s role that may have an impact on individuals but may not directly impact on their health or safety: dignity, compassion and respect are all vital aspects of delivering high-quality care. This was highlighted most starkly in the Francis inquiry report of February 2013, which put into focus the terrible and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust, which was the basis on which my hon. Friend the Member for Stafford (Jeremy Lefroy) introduced the Bill.

One specific area where real changes in the protection of patients are being made relates to the strengthening of arrangements to ensure that all health care workers have sufficient knowledge of English and the ability to communicate effectively with patients in English before being allowed to work in the UK. The General Medical Council has always been able to check the language skills of doctors from outside the European Union who want to practise medicine in the UK. It does this through the international English language testing system, which covers all four language skills—listening, reading, writing and speaking—and it is widely accepted by employers, the other health care regulators and professional bodies as a means of assessing proficiency in English in a professional environment. The GMC continually assesses the effectiveness of this test to ensure its robustness.

In addition to this test of their language skills, the GMC conducts a professional and linguistic assessments board exam—often called the PLAB exam—for doctors from outside Europe. This tests their reactions to a number of clinical scenarios and their ability to apply their clinical knowledge to the treatment of patients and is the main route by which international medical graduates demonstrate that they have the necessary skills and knowledge to practise medicine in the UK.

However, following the death of a patient, David Gray, and the tragic circumstances surrounding that death in 2008 after he received medical treatment by Dr Ubani, a German national, where language skills were a strong component in the incident, a House of Commons Health Committee report recommended that the Government change the law to allow the GMC to extend language tests to doctors within the European economic area, providing consistency in how doctors from both within and outside the EEA are treated with regard to assessing their language skills, before being allowed to practise medicine in the UK.

The Government made a commitment in the 2010 coalition agreement, which the shadow Minister has mentioned, to stop foreign health care professionals working in the NHS unless they have passed robust language tests. We have fulfilled that commitment in respect of doctors, and we are now putting in place additional measures, through section 60 orders, to introduce language testing for other health care workers.

--- Later in debate ---

[Mr Jamie Reed]

I, too, pay tribute to the work of the hon. Member for Stafford (Jeremy Lefroy). The diligence and tenacity with which he has pursued the Bill, and the collegiate nature in which he has done so, are to his eternal credit.

Members across the House, many professional bodies outside this place and others support the principles and aims of the Bill. Harm-free care is something to which everybody in our NHS aspires. Although it is something that, frankly, we should take for granted, it is something that any health care system in any part of the world must work tirelessly to achieve. Credit must go to the NHS staff, both clinical and non-clinical, who work tirelessly, often in very trying circumstances, to deliver high-quality care. I am sure that Members from all parties will echo that sentiment.

I do not wish to repeat what I said on Second Reading, in Committee or on Report, so I will keep my remarks relatively brief. The key principles of harm-free care, data sharing, and consistent objectives for regulatory authorities have been welcomed by the Opposition, and I will touch briefly on the why those things are important.

I have already mentioned harm-free care, and the Bill will give power to the Secretary of State to bring forward regulations to ensure that high-quality, safe care can be delivered. A wide-ranging power is being granted to the Secretary of State, and I welcome the Government’s assurances that any measures introduced will be subject to full parliamentary scrutiny, as is proper with such issues.

We have already debated the benefits and risks of data-sharing, and Third Reading is not the place to do so again. I have been clear about the benefits that can be realised through effective data-sharing, although there are still concerns, many of which I raised on Second Reading. It is important that the national data guardian is put on a legal footing to ensure that any issues that arise can be dealt with effectively and swiftly.

On the regulation of health and social care professions, it is logical to have a consistent overarching objective for regulatory bodies, and right that that objective is patient safety. A number of bodies continue to express concerns about a possible conflict between the practical implications of a number of those objectives, and I ask the Government to keep that under review to ensure that the Bill is effective.

The issue of public confidence runs through the entire Bill, and the hon. Member for Stafford touched on that in some detail. We all want to have confidence that the care we receive is of the highest quality, and to have confidence in the integrity and security of the data and private information that the NHS holds about us. We need to know that our data are used only with our permission and for the betterment of health and social care provision. Finally, we want confidence that doctors, nurses and others are properly supported and regulated to ensure that best practice is always followed. The Bill should help to ensure public confidence in those areas, which is why Labour will support it today.

Branded Medicines (NHS)

Jamie Reed Excerpts

Thursday 4th December 2014 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

Time is short, so I shall keep my remarks brief, but it is a shame to truncate such an important debate on a matter that touches many lives.

The availability of medicines in our national health service affects millions of families throughout the country and with that in mind I must thank the right hon. Member for South Cambridgeshire (Mr Lansley) and congratulate him on securing the debate. I also thank the Backbench Business Committee for ensuring that the debate was heard. I know that the right hon. Gentleman tried to make progress on these issues when he was Health Secretary and I am sure that he is frustrated by the lack of progress in more recent years. In addition, I am sure that he will be amazed and potentially aghast when he hears that I agree with a great deal of what he said.

As I say, this is an important issue affecting millions of patients who rely on these drugs everyday. Members on both sides of the House want to see progress on improving access and ensuring that more people get the drugs they need. The issue was brought into sharp focus recently when, in September, NICE announced that it was not going ahead with its proposed value-based assessment reforms. That this was in part due to a lack of consensus in stakeholder consultation submissions to the proposals serves to highlight how complex an issue it is. We all accept that.

There are clear problems with access to medicines, as demonstrated clearly by recent publications from the Office of Health Economics and the Association of the British Pharmaceutical Industry. I want to make a number of points from those publications in my speech. There are issues, too, about the proposed changes to the cancer drugs fund, which have been highlighted by the concerns of charities such as Breast Cancer Care, that I shall come to later. None of them will be a surprise to the Minister.

A vital tool in improving access to treatments is the pharmaceutical price regulation scheme, the latest iteration of which came into effect this year. Some questions need answering about it. In 2010, the Conservative manifesto included a commitment to increasing access to drugs. The commitment was echoed and bolted down in the coalition agreement, which stated:

“We will reform NICE and move to a system of value-based pricing”.

As we have heard and discussed, value-based pricing was meant to be introduced in January this year when the drug pricing agreement between the Government and pharmaceutical industry expired, but despite the comments in the coalition agreement, when the new drug pricing agreement, the 2014 pharmaceutical price regulation scheme, was published in November 2013 it contained no plans either to introduce value-based pricing in 2014 or on the promised reform of NICE’s processes towards evaluating how treatments would be made available on the NHS.

When proposals were finally brought forward this year, they included not value-based pricing but value-based assessment, which is altogether different. The plans would have included two new modifiers entitled “burden of illness” and “wider societal impact”. The burden of illness modifier would have replaced the current end-of-life criterion. The burden of illness criterion that would have been introduced is already largely counted in the current quality-adjusted life-year measures. There are also wide-ranging issues with the other suggestions, so it was no surprise that, after lengthy consultation, NICE confirmed that the plans to introduce the changes had unfortunately been shelved. What this means in practice, though, is that the Government have failed to deliver on a key commitment, the fulfilment of which many people were looking forward to. I should be grateful if the Minister would reflect on progress to date.

Access to medicines is key because the UK is lagging behind other countries. From analysis of more than 60 medicines launched in the UK, the Office of Health Economics found that people living in the UK are less likely to have access to a new medicine for the first five years after its launch than people living in other countries. That shows clearly that reform is vital.

[Roger Williams (Brecon and Radnorshire) (LD)]

Does the hon. Gentleman agree that one of the real problems is that some of these treatments, such as abiraterone, are not available in Wales but are available in England? That is leading to people leaving Wales and taking up residence in England in order to get that treatment.

[Mr Reed]

I am grateful for the question. Without doubt, there are issues that need to be addressed on both sides of the border.

One major part of the issues that we are discussing today is the pharmaceutical price regulation scheme, which caps the expenditure of the NHS on branded medicines. It has existed since the 1950s. It is an excellent scheme in principle but must work properly in practice. Given that there has been essentially no parliamentary debate on the PPRS, I should be grateful if the Minister would explain a bit more how the new agreement is intended to work in practice.

As I understand it, if the NHS exceeds the agreed expenditure, as the right hon. Member for South Cambridgeshire said, the money is rebated back to the Treasury. But given that the outgoing moneys will presumably be taken from clinical commissioning group prescription budgets, can the Minster explain how the CCG in question will actually feel the benefit of the PPRS? If the rebate stays in the centre, rather than being reimbursed to CCGs, how will the PPRS work as a tool with which to increase access to treatments? Has the Minister considered how the rebate might be better used for incentivising improvements in access? What can be done to speed up drug accessibility and reduce the duplication by CCGs of work already undertaken by NICE? That is clogging up the system and slowing down access to new medicines.

The Minister will be aware that at Health questions last week I raised some of the genuine concerns of patients, such as Clive Stone in the Prime Minister’s constituency, and charities, such as Breast Cancer Care, about the cancer drugs fund. As the Minister knows, the overspend in the cancer drugs fund last year and the way in which it operates has led to its being under considerable pressure, and many in the industry believe it to be unsustainable. The former Health Secretary has been absolutely clear that it was always intended to be a bridge, and I welcome his candour on that.

The issue with any new medicines, which I know NHS England is now looking at, is how to balance clinical benefit and cost-effectiveness. None of us would pretend that that is an easy task, but it is clear that it needs to be done in a much clearer and more transparent way than is currently proposed, and I should be grateful if the Minister would set out how patients will be involved in the evaluation of drugs and represented in that process at the meeting of the cancer drugs fund clinical panel later this month.

One way to improve access to medicines would have been to back the Off-patent Drugs Bill that was before this House only a few weeks ago. That would have improved access to many drugs for many people but, as the Minister is aware—he was speaking opposite me at the time—the Government refused to support it. Will the Minister again take the time to explain why the Government opposed that piece of legislation, which originated from one of their own Members? It was certainly supported by Labour Members. The innovative medicines review has the potential to do real good in this area. I should be grateful if the Minister would speak to that, too, in some detail in the time available for his speech.

I realise that time is short, so I will draw my remarks to a close. We all want to see improvements to access and we are all desperate—I use the word in its accurate sense—for progress on this, so will the Minister set out what action he will take over the next few months and what progress he realistically expects to make before the election?

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

It is a pleasure to respond to this debate and to follow the hon. Member for Copeland (Mr Reed) and my right hon. Friend the Member for South Cambridgeshire (Mr Lansley). It is a shame that there are not more Members present, because I know that the debate has been warmly welcomed across the House. I congratulate the Backbench Business Committee on granting it and my right hon. Friend on securing it.

I would like to take this opportunity to pay tribute to my right hon. Friend for all his work in this field, both as the Member for South Cambridgeshire—I do not think there is a constituency that more represents this cluster—and as the former Secretary of State for Health, because he led many of the initiatives that he spoke about so eloquently this afternoon. He is as well placed as anybody to describe the evolution of policy in that space, and it is my great privilege, as the first Minister for life sciences, to inherit that baton of leadership.

I also want to acknowledge the very helpful comments and questions from my hon. Friend the Member for North Herefordshire (Bill Wiggin) on whether there is more of an opportunity for the NHS to become more of a partner in the development of novel medicines. He is absolutely right, and I will come to that in a moment. He also raised the question of off-label drugs, as did the hon. Member for Copeland, and I will also address that shortly. The hon. Gentleman also requested an update on progress in this field and some detail on the review of innovative medicines that I announced two weeks ago. I am grateful for his support for that and for his recognition of NICE’s work on value-based assessment.

My right hon. Friend the Member for South Cambridgeshire set out eloquently, and incredibly helpfully for the House, the challenge we face and the evolution of policy in this area. He talked fluently about the challenge facing the Government, and indeed all mature western democracies, with an ageing population, a demographic time bomb and the rise of chronic diseases. As the Chancellor reminded us in yesterday’s autumn statement, we inherited a very serious structural deficit in the public finances and huge pressure on our budgets. We have to balance the requirement to spend our drugs budget as effectively as we can for patient benefit, but in a way that supports our leadership in medical research for the benefit of patients. That goes to the heart of my mission as the new Minister for life sciences: how do we embrace science, research and innovation so that we spend every health pound more effectively? It is about embracing precision medicines, cutting out waste and ensuring that we deliver maximum health benefit for patients through our health budget, but in a way that attracts inward investment to our economy to equip us better to pay for the modern medicines that we will all need.

My right hon. Friend highlighted that NICE has led the world in health economics on the 20th century model, which is really based on an averaging of health economic benefits, as he explained, and that is under increasing pressure from some of the breakthroughs in science that are bringing us a new generation of stratified and personalised—in some cases, literally—medicines, which do not fit well with the model of averaged, whole-population health economic assessments.

My right hon. Friend made the point fluently that it is ironic that we are a leading centre for research, but unless we also become a leading centre for adopting these new medicines, we will struggle to retain that. We set that out very clearly three years ago in the life sciences strategy. The Prime Minister was very clear about that. We do not believe that we can rest on our laurels simply as a 20th economy with a strong pharmaceutical footprint; in the 21st century we have to use all our resources, including our NHS, to accelerate the discovery of new medicines and their adoption into the system.

[Mr Jamie Reed]

I wish the Minister every success in that mission and offer the fulsome support of the Opposition in ensuring its success, but does he agree—I do not wish to divert him too much—that critical to that success is that Britain remains in the European Union?

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 25th November 2014 Commons Chamber

[George Freeman]

I am grateful to my hon. Friend for his notice. I have spoken to NICE. It is appraising the use of Abraxane for pancreatic cancer and has not yet published its final guidance. It would not be appropriate for me to intervene at this point. Obviously, we respect NICE’s clinical independence. Abraxane is available through the CDF for patients meeting specific clinical criteria. I understand that the NHS England’s CDF panel plans to reassess the inclusion of Abraxane in the national list, but no decisions have yet been made.

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to follow the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw). Everyone in every part of the United Kingdom wants to improve access to cancer medicines. When the Prime Minister launched the cancer drugs fund in the home of Clive Stone, he promised to get

“more drugs to people more quickly”.

Mr Stone recently criticised proposals to remove a number of drugs from the fund, writing in his local newspaper that

“People are going to die, there is no doubt about it. Why don’t people keep their promises?”

Additionally, the Breakthrough Breast Cancer campaign has said that it is

“deeply concerned that several very effective breast cancer drugs appear on the list of drugs at risk of delisting”.

We all know someone affected by cancer in some way. What does the Secretary of State have to say to those patients relying on those drugs that are being removed from the fund?

[George Freeman]

The first thing I would say is that we have given an undertaking that any patients currently on drugs will not have the drug removed. Secondly, we are dealing with some very difficult issues. We have had extraordinary breakthroughs in the progress and rate of development of new cancer drugs, and we need to have a system for ensuring that the cost-benefits—the health economics—are done properly. NICE leads the world in making these difficult clinical judgments and we support its independence in doing so, but we need to ensure that we are not turning this issue into a political football. I notice that the shadow Health Secretary said that this was good politics but not good policy. It is really important that we ensure that when we set a benchmark on this debate we are guided by what is best for patients.

Off-patent Drugs Bill

Jamie Reed Excerpts

Friday 7th November 2014 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

I congratulate the hon. Member for Cardiff North (Jonathan Evans) on introducing this excellent and concise Bill, which Opposition Members support wholly. I will keep my remarks brief, because I think that there is plenty of time for us to do the business with the Bill this morning.

The principle of the Bill is one that the Labour party supports. We must do all we can to ensure that patients have timely access to safe drugs. As the hon. Gentleman has pointed out, the Bill would benefit very many people indeed. There is no doubt that the subject of off-patent drugs needs to be debated and, more importantly, requires action from this House. Now that we are aware of the issue, it would be remiss of us not to do something about it. We will support this Bill to ensure that people who are at risk of, or have been diagnosed with breast cancer, multiple sclerosis, Parkinson’s disease, Alzheimer’s, leukaemia and many others—as well as all those who may be diagnosed with any of these conditions in future—have access to treatments that they would otherwise be denied: treatments that are effective and low cost, and change lives.

I hope that the Government are also going to support this potentially life-saving—as the hon. Gentleman pointed out, life-changing—Bill. The Minister himself has stated that a central part of his mission

“is to accelerate the discovery, design and adoption of new drugs in the NHS, making the UK the best place in the world to discover and design 21st-century health care technologies”,

and for Britain to be

“once again the best place in the world to discover new medicines and to be treated by them.”—[Official Report, 1 September 2014; Vol. 585, c. 141-144.]

That is an aim we all share. We have our work cut out, but it is achievable.

Existing drugs can demonstrate great benefits but do not have licences under which to be marketed, meaning that access to them is low. Often a repurposed drug offers the best hope of a step change in treatment and therefore should not be forgotten or deprioritised. The views of clinicians on this issue have been exceptionally powerful. I will quote just a few. Harking back to the previous debate, we should listen to medical professionals when they are giving us advice that is, frankly, beyond dispute. Professor Anthony Howell, professor of medical oncology and research director of the Genesis breast cancer prevention centre at the University Hospital of South Manchester NHS Foundation Trust, says:

“Clinically-proven therapies to reduce the risk of breast cancer developing and spreading could bring a step change in breast cancer survival rates, but without the Bill we will not see a step change in the availability of these treatments.”

Professor Robert Coleman, Yorkshire cancer research professor of medical oncology at Sheffield cancer research centre, says:

“Repurposed bisphosphonate drugs could significantly reduce the risk of breast cancer spreading, and ultimately killing women, and would cost the NHS very little. However, without the Bill we are unlikely to see the wholesale change in prescribing behaviour that would be required to make these drugs routinely available.”

Dr Jeremy Chataway, consultant neurologist at the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, and St Mary’s hospital, Imperial College Healthcare NHS Trust, says:

“There are currently re-purposed medicines that have shown strong preliminary evidence that they could be effective in the treatment of multiple sclerosis (MS), however the UK is currently lacking a system by which old drugs can be re-licensed for new purposes. This Bill would create a mechanism to potentially provide access to medicines that could help tens of thousands of people with untreatable MS.”

It is also powerful to see that, as the hon. Member for Cardiff North pointed out, the Bill is supported by a whole spectrum of medical charities: the Association of Medical Research Charities, the Breast Cancer Campaign—I praise it for its absolutely phenomenal work on the Bill—the Multiple Sclerosis Society, Cure Parkinson’s Trust, Breakthrough Breast Cancer, Breast Cancer Care, Leukaemia CARE, the Alzheimer’s Society, the Teenage Cancer Trust, and Leukaemia & Lymphoma Research. All agree that we have a one-off opportunity to change the law and would like the results of research to be translated into clear, demonstrable, deliverable patient benefit.

We are talking about clinically proven drugs that cost virtually nothing but could bring a step change in survival rates. Zoledronic acid costs less than 5p a day per patient and could reduce the risk of death from breast cancer in post-menopausal women by 17%. This Bill is not about bringing untested drugs forward for use in the NHS—it is about ensuring that the drugs that can benefit patients, but in which pharmaceutical companies have no commercial interest, are available to treat myriad conditions and bring real patient benefits.

We must remember, though, that drugs are not the only tool to fight these conditions. With specific regard to cancer, we must ensure that bringing new drugs through is not to the detriment of patient access to radiotherapies and surgeries. We should remember that it is crucial that patients can get tested quickly if cancer is suspected. That is why a future Labour Government will guarantee that NHS patients will wait no longer than one week for cancer tests and results by 2020. Labour supports the principle behind the Bill, and we will support its Second Reading.

There is something else to consider. This Bill provides a simple remedy to an obvious and avoidable problem. It is underpinned by irresistible logic. To thwart it would represent an act of vandalism. Right now, our country is facing a collective nervous breakdown. Faced with internal separation and separation from the European Union, fear and loathing stalks this septic isle. Every day, people ask themselves, “What is the point of politics? What is the point of Parliament?” Unless we act to address these legitimate concerns, this place will drift towards not only irrelevance but illegitimacy. The purpose of each of us in this House, on both sides, is to make better the lives of the people who sent us here. That is our principal aim. I urge Members in all parts of the House, and the Government, to do what we were sent here to do—act to make life better and to demonstrate that Parliament, and politics, can work.

--- Later in debate ---

12:36

Division 75

Ayes: 20

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Labour: 11
Conservative: 8
Plaid Cymru: 1

Noes: 2

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Conservative: 2

[Mr Jamie Reed]

On a point of order, Madam Deputy Speaker. I seek your guidance on whether or not it is in order for Government Whips to instruct their own Members not to vote in order to ensure that the Division was not quorate.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I understand why the hon. Gentleman wishes to draw the House’s attention to what happened, but he knows as well as I do that the behaviour and actions of Government Whips is no business of the Chair.