European Union (Withdrawal Agreement) Bill

Debate between John Baron and Anna Soubry

2nd reading: House of Commons & Programme motion: House of Commons
Tuesday 22nd October 2019 Commons Chamber

[Anna Soubry (Broxtowe) (IGC)]

It is a pleasure to follow the hon. Member for Basildon and Billericay (Mr Baron). I will not be voting for the Bill this evening, because it is nothing more than a charter for a no-deal Brexit. The safeguards in the withdrawal agreement negotiated by the previous Prime Minister that would have ensured that we would not leave without a deal at the end of the implementation period in 2020 have now been removed. It is quite clear that the so-called backstop for England, Wales and Scotland has gone. The reason why so many Conservative Members who opposed the previous Prime Minister’s deal on all three occasions it came to this House are now so keen to vote for this Bill and this agreement is that it will deliver the hard no-deal Brexit they believe in, and in some cases have done for decades.

The hon. Member for Basildon and Billericay referred to the backstop having been removed, but the reality and truth is that for Northern Ireland the new backstop is an arrangement that will be there in perpetuity. As this House knows, the right hon. Member for East Antrim (Sammy Wilson) and I disagree on many things, but on this issue we are at one. In his speech, he made a number of serious assertions about the impact of not only the Bill but the withdrawal agreement on the Union and, in particular, Northern Ireland, and some Conservative Members sat and shook their heads, querying that. It concerns me that because of this terrible programme motion, there will be nothing to allow any Member, Committee or independent organisation to scrutinise and check whether his assertions are correct or false. Having read this Bill and the protocol twice, I think he is right, and we need to be sure.

[Mr Baron]

The right hon. Lady referred to me, so I thank her for giving way. Some of us were shaking our heads because we disagree with one or two of the factual statements made by the right hon. Member for East Antrim, but we are happy to pursue that conversation afterwards. As somebody who served in the troubles in the 1980s, I know that the Union means a lot to many ex-soldiers on both sides of the House. I can assure the right hon. Lady that we do not take this lightly. If I genuinely believed that this was a threat to the Union, I would not be supporting it.

[Anna Soubry]

The hon. Gentleman should listen to the voices from Northern Ireland—and it is not just the DUP or the hon. Member for North Down (Lady Hermon); it is from across the community. This is a genuine threat, and it is incredible that Members of the Conservative and Unionist party are prepared to vote through this Bill when its attendant protocols will undoubtedly mean that there will be a separate arrangement for Northern Ireland in perpetuity. There is nothing in the Bill that will allow things to change.

I would also ask: how much better is our country since we had this referendum? Are we a happier, gentler people, and are friends, families and communities more united or are we divided now in a way that we have never experienced before? This Bill will do nothing to heal divisions; it will actually increase the divides in our society. That is a concern.

I believe with a passion that not one single promise that was made by the leave campaign has been fulfilled in any way, shape or form. We were promised a deal before we left. We were promised that Northern Ireland would not be treated any differently, and we were promised that it would keep and preserve the United Kingdom. We were made a promise that we would have the same trading relationship that we currently enjoy as a member of the single market and the customs union, and none of those things has been delivered in the Bill or any of the attendant documents.

I agree with the right hon. Member for Tottenham (Mr Lammy). He and I disagree on so many things, but on this we are at one. If this is so good, it should go back to the people. That should not be by way of a general election, which will solve nothing just as the 2017 general election did not solve anything—

EU: Withdrawal and Future Relationship (Motions)

Debate between John Baron and Anna Soubry

Wednesday 27th March 2019 Commons Chamber

[Mr Baron]

Thank you, Mr Speaker.

Just so that the House is absolutely clear, my motion (B) reads:

That this House agrees that the UK shall leave the EU on 12 April 2019 without a deal.

May I suggest to the House that, as we stand at this point in time, this is, in law, the default position of triggering article 50? We all knew, those of us who were here and voted for it in February 2017, what we were voting for: the motion simply said that we would leave the EU on 29 March with or without a deal, and we passed it by 384 votes.

[Anna Soubry (Broxtowe) (Ind)]

Will the hon. Gentleman give way?

[Mr Baron]

I will in a second—I am going to make some progress first.

Although article 50 can be extended—I voted against that—we should still, as a House, reflect on that vote and recognise that, while most of us in this place want a good deal, many of us have taken the view that the deal on offer from the Prime Minister is not a good deal, and therefore the legal default position is that we leave on no deal/World Trade Organisation terms.

European Union (Notification of Withdrawal) Bill

Debate between John Baron and Anna Soubry

Ping Pong: House of Commons
Monday 13th March 2017 Commons Chamber

[Anna Soubry (Broxtowe) (Con)]

I am going to keep my comments as brief as possible so that as many Members as possible can speak. I spoke when we last considered, effectively, Lords amendment 2 in its new form, and I just say this: it is surely perverse that we are in a situation whereby if there is a deal it comes back to this place and we debate it and vote on it, but if there is the worst scenario—which is no deal—we are not entitled to that say that or vote. That simply cannot be right.

This is not a debate about Brexit. We have had that vote; I voted against my conscience in accordance with the promise I made to the people of Broxtowe that I would honour the referendum result, and I voted for us to leave the EU. So we have had that one; we are moving on.

This debate is actually all about parliamentary sovereignty, and there are some uncomfortable truths that need to be said. It took a few brave souls—and they were brave—to go to the High Court and then the Supreme Court to establish parliamentary sovereignty. That is why we now have this Bill—not because we did it in this place, and history will record all these things, but because of what they did. But to the credit of the Government, they accepted that.

I understand that there is a good argument to be made that this is a short and simple Bill, but the difficulty, and the reason why I found myself for the first time voting against my Government, is this intransigence—this inability to accept that in the worst-case scenario this place is not going to be allowed a say. And for this Secretary of State, of all Members of this place, with his fine track record of establishing, and fighting at every opportunity for the sovereignty of Parliament, to be standing up and denying us that on this particular issue is deeply ironic.

[Mr Baron]

Will my right hon. Friend give way?

[Anna Soubry]

Because I am being generous, I will.

[Mr Baron]

But does my right hon. Friend not accept the simple point that this place made a contract with the British people at that referendum—[Interruption.] The Scottish National party might not like it, but it is true. Therefore, if there is a good deal, we will take it, and if there is not, the Prime Minister has made it very clear that we will not accept a bad deal, so we move on, and we move out of the EU.

[Anna Soubry]

My hon. Friend forgets that there was just one question on the ballot paper—did we want to remain in or leave the EU—and 52% of the people who voted chose to leave. That is what we are doing. We—some of us—on this side have honoured that result and voted for us to leave. Now, however, we are talking about the sovereignty of this Parliament and about what would happen in the event that our Prime Minister does not strike a good deal. I trust our Prime Minister to do everything that she can, and I will support her in her efforts to get that good deal, but let us be under no illusion that if she does not do so, there will be no alternative but WTO tariffs, regulations and rules, and the people in my constituency certainly did not vote for that—

[Mr Baron]

So?

[Anna Soubry]

My hon. Friend says “So?” I can assure him that it is not only me but our Prime Minister who takes the view that falling off a cliff edge would be the worst possible outcome for the people of this country. That is the one thing that we must ensure does not happen. In the light of that, we in this place must assist the Government with what happens next.

There is going to be a remarkable set of negotiations to achieve three bespoke deals—on trade, customs and security—in what will actually be an 18-month timeframe. But let us say that that worst-case scenario happens and that there is no deal at the end of that. If I may, I should like to say to Opposition Members, especially those in the north of Ireland—

BHS

Debate between John Baron and Anna Soubry

Monday 25th April 2016 Commons Chamber

[Anna Soubry]

As I said, our thoughts are with the workforce. It is important to point out, however, that the stores are still open and people still in work—they have not lost their jobs—so we must not talk down the business. We want somebody to come forward and buy the company and to make sure it has a good, sustainable future. That is where my thoughts are at the moment. We want to help in any way we can to make sure a buyer comes forward. I pay tribute to the excellent workers at BHS not just in the stores but—not forgetting—in the various distribution centres around the country. I also have to say, however, that we are the Government who delivered 2.5 million new jobs in just five years.

[Mr John Baron (Basildon and Billericay) (Con)]

Tens of thousands of BHS pensioners are set to suffer from this news, so I ask that the Government do what they can to ensure answers to the following questions: how did a £5 million pension fund in 2001 turn into a deficit of £571 million and was there any wrongdoing? If so, will they ensure that those responsible are brought properly to book?

[Anna Soubry]

As I said, the Pensions Regulator is looking at the many concerns that hon. Members on both sides of the House are raising, and the PPF is now involved. My hon. Friend makes important points. Unfortunately, some companies find themselves with very large pension fund deficits, which should concern us all.

Oral Answers to Questions

Debate between John Baron and Anna Soubry

Monday 4th November 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Defence (Anna Soubry)]

I am grateful for that question. I am aware of the difficulty and that is also my understanding of the issue. I will make further inquiries. Of course, one of the problems we know we will face is when we have bereaved families both north and south of the border and what will occur in such circumstances. I would be more than happy to discuss the issue further with the hon. Gentleman.

[Mr John Baron (Basildon and Billericay) (Con)]

T4. Parliament sent a very clear message to the Government—the vote was 92 to nil—not to disband regular units until we were sure that the Army Reserve plan was both viable and cost-effective. What plans do the Government have to enact Parliament’s will?

Nuclear Test Veterans

Debate between John Baron and Anna Soubry

Tuesday 29th October 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for Defence (Anna Soubry)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Streeter. I congratulate my hon. Friend the Member for Basildon and Billericay (Mr Baron) on securing the debate. I pay tribute to all those who have contributed: the hon. Members for Scunthorpe (Nic Dakin) and for Coventry South (Mr Cunningham), and my hon. Friends the Members for South Derbyshire (Heather Wheeler) and for Cleethorpes (Martin Vickers) and my right hon. Friend the Member for Hazel Grove (Sir Andrew Stunell).

This subject evokes considerable passion among some, perhaps even many, people. We have heard the veterans’ cause argued with that passion yet again by my hon. Friend the Member for Basildon and Billericay, and he is right to do so. Members should bring issues that are dear to their hearts to this place, so that we can debate them and causes and ideas can be advanced, only for Ministers then to say too often, unfortunately, “Well, it all sounds very good, but I am afraid I don’t agree with you, and I’m afraid that at the moment this proposal will not advance particularly far within Government. We’ve made our position clear.”

Before I explain why that is, I want to make something absolutely clear. It seemed to be suggested that the Government have not acknowledged the significant role played by the men and women who participated in the nuclear test programme. My hon. Friend quite properly mentioned a letter written to him by the Prime Minister. I repeat some of the Prime Minister’s words, because I cannot put it as eloquently as he did:

“This Government continues to recognise the servicemen who participated in the British nuclear testing programme. Their contribution ensured that the UK was equipped with an appropriate nuclear deterrent during the cold war, which thankfully we never needed to use.”

To be absolutely clear, I do not hesitate to acknowledge the hugely significant role played by all those veterans, and I pay tribute to all who participated in the programme. We owe them a huge debt of gratitude.

[Mr Baron]

I do not doubt the Minister’s genuineness on this issue, or indeed the Prime Minister’s. The letter that the Minister read out was a response to me. All test veterans would welcome a statement from the Prime Minister addressed to them, officially recognising their role and our debt of gratitude to them. We would prefer it to be given orally—perhaps in a statement in the House—but if not, a written statement would go a long way towards ticking that box, rather than just giving part of a response to me about a wider issue in the campaign.

[Anna Soubry]

It is not for me to say what the Prime Minister should or should not do, but he has written in clear terms to my hon. Friend, who I assume shared the letter with all those in the association. However, I understand—he will correct me if I am wrong—that not all those who participated in the test programme necessarily belong to the association. I am now putting it on record, in Hansard, for all to see and to broadcast to all veterans the Prime Minister’s clear acknowledgement and tribute to those veterans, as well as his acknowledgement of the great service that they did our country.

[Mr Baron]

That is very much my point. The Prime Minister’s response was to me. Not every test veteran is a member of the British Nuclear Test Veterans Association. Although I welcome the Minister’s warm words of acknowledgement and gratitude and I do not doubt her genuine intent, a statement to all test veterans from the Prime Minister, preferably orally but if necessary in writing, would cost nothing and would tick that box, and it would be gratefully received by all concerned.

[Anna Soubry]

I will ensure that the Prime Minister hears my hon. Friend’s words. He will then decide how he may or may not be able to advance the matter. However, I think that my having read out the letter so that it can be publicly recorded in Hansard goes a considerable way towards making it absolutely clear that the Prime Minister acknowledges the great work done and why it was so important.

As we know, for many years, veterans of the nuclear tests have claimed that their health has been damaged by exposure to ionising radiation. The Ministry of Defence has consistently rejected those claims on the basis of the findings of three comprehensive studies on cancer incidence and mortality among nuclear test participants carried out by the independent National Radiological Protection Board. The three studies were conducted and published over a 20-year period, beginning in 1983 and finishing in 2003. Overall levels of cancer incidence and mortality were similar to those in matched service controls, and death rates from all causes were lower than expected from national rates.

On specific cancers, there was some evidence of a raised risk of certain leukaemias, but the researchers concluded that it was due to chance rather than radiation exposure. The Government has every confidence in those independent studies. Accordingly, we believe that there are no grounds for paying compensation to British nuclear test veterans as a group.

In 2010, the MOD commissioned a health needs audit of all BNTVA veteran members resident in the UK. The survey, which had a return rate of 71%, asked respondents to self-report on serious illnesses and long-term conditions diagnosed by a doctor since their participation in the nuclear tests. Overall, the range and severity of problems reported was typical of older people in the UK in general. Whatever their health experience, most respondents indicated that, in general, they felt that their health care needs were being met very well by the NHS; primary care services were particularly well regarded.

My hon. Friend referred to the Rowland report. I am reliably informed that the report, published in a specialist genetics journal, concerned a laboratory-based study of peripheral blood lymphocytes—I apologise for my pronunciation, which may not be great—that were taken in the mid-1990s from 50 New Zealand naval veterans who had been on weather ships 50 to 100 km from the detonation centre of Operation Grapple in 1957-58. Dr Rowland reported the findings of three cytogenetic tests. Two showed no difference between the veterans and matched control groups. The third showed an elevated translocation frequency in the peripheral blood lymphocytes—I am more than happy to share that in plain English with my hon. Friend—of the veterans compared with the control group.

The sample size was acknowledged to be small, and there has been some doubt about the suitability of the control group. Known possible causes of increased translocation include ageing and cigarette smoke as well as ionising radiation. The report emphasises that the study makes no comment on the health status of the veterans. At this time, such cytogenetic tests are not in routine clinical use, because no relationship has been shown between any genetic abnormality and health effects or clinical state.

[Mr Baron]

May I return to the health needs analysis? I am pleased that the hon. Member for North Durham (Mr Jones) has now taken his seat, as I paid him a compliment earlier by suggesting that he was instrumental in helping us get the health needs analysis, which was our campaign’s first objective. The veterans of the BNTVA have found it helpful as a pathway to guide them through the NHS.

To return to the science briefly, we can argue about it. Professor Rowland’s report was peer-reviewed and was accepted by the New Zealand Government of the time; the Minister should not skirt over that too lightly. The point that I am suggesting to her is that, compared with other countries that have test veterans, we are near the bottom of the table in terms of how we treat them. Surely, there is a moral obligation to consider where Britain fits in. In many other countries, veterans do not have to establish a causal link between being at the tests and ill health. Compensation comes automatically, although I stress once again that I am not arguing for compensation in this case; I am asking for recognition, as highlighted.

[Anna Soubry]

I am interested by that intervention. My hon. Friend now seems to be saying that we should put the science to one side, because it perhaps does not suit his argument, but the science is absolutely clear. However, I am more than happy to turn now to the comparison of international provisions for nuclear test veterans.

[Mr Baron]

Will the Minister give way?

[Anna Soubry]

I will deal with this first, and then I will be more than happy to give way. I hope that I can set the record absolutely straight.

Comparisons of provisions in the United Kingdom and other countries can be very misleading. We are not at the bottom, and I do not want these good people, who have served our country so well, to feel that they are in some way being short-changed and that an advantage is being given to test veterans from other countries. I will go through some of the other schemes.

Let us talk about America. The compensation scheme offered by the United States Department of Veterans Affairs must be seen in the context of the United States health care system, which, as we know, is not free. Access to veterans’ health care is for those with service-connected disability of a certain level, and it is means-tested for all veterans, including atomic veterans. I would therefore argue that is not as good as the scheme in our country.

[Mr Baron]

Will the Minister give way?

[Anna Soubry]

No. I am so sorry. I will be happy to give way at the end, but I want to go through all these other countries to put the record straight.

Let us look at the compensation scheme run by the Canadian Government. It was run for just one year—from 2008 until 2009—and it was principally designed for approximately 900 personnel involved in the clean-up of the Chalk River radiation leak, without reference to any illness or injury. If I may say so, therefore, its relevance to our nuclear test veterans is, at best, peripheral.

In France, nuclear test veterans have been eligible for compensation only since 2009, and they were not consulted on the design of the scheme now in existence. As a result, although it may appear more generous than the UK’s war pensions scheme, which I will describe later, the scheme in France demands a greater burden of proof of a link to service. If I may say so, it would do, because it was introduced only in 2009. As a result, we believe only one award has been made in France, which speaks volumes about that scheme.

It is a similar story in Australia, where the compensation scheme operates in part on the basis of a reasonable hypothesis. Again, that may appear, at first blush, to be more generous than the terms of our war pensions scheme, which demands only that a reasonable doubt of a link to service is raised on the basis of reliable evidence. However, in fact, nuclear test veterans in Australia face a tougher test, which is set out in the legislation. For example, for cancer of the bladder, veterans must have received a cumulative dose of at least 100 mSv of ionising radiation a number of years before clinical onset, while there is no such requirement in the UK scheme.

My hon. Friend mentioned the Isle of Man scheme. The Isle of Man decided to award £8,000 to nuclear test veterans, with no proof of medical causation required. That is, of course, a matter for the Manx Parliament. The UK Government rightly have an evidence-based policy. They also strive to provide value for money for the taxpayer, which the Isle of Man has less need to be concerned with, because it has made only two payments.

[Mr Baron]

Our central argument is not to put the science to one side, as the Minister suggested. We can argue about the science, and both sides will be able to draw justification for their particular line. The Rowland report was certainly peer reviewed and accepted by the New Zealand Government of the day, so it cannot be easily discarded by the Minister.

Let me return, however, to what I call the international table of decency. The Minister needs to check what happens with regard to US veterans, because those who turn up at a veterans’ hospital have access to free health care. In addition, there does not have to be a causal link between being at the tests and one of a series of illnesses—mostly cancer, but other illnesses, too.

The Minister also mentioned Canada; again, no causal link is required, but it is clear that the payment is there to be made. Likewise, the Minister is slightly incorrect, or disingenuous at least, to suggest that we can simply discard the example of the Isle of Man. She says that only two payments have been made, but she also needs to check that figure, because my evidence suggests that 17 have been made to date.

--- Later in debate ---

[Anna Soubry]

I am grateful to the hon. Gentleman for providing that information. That is another compelling argument in relation to the science.

I want to make it absolutely clear that it gives no one any pleasure to stand up and to have to talk about these things, because it sounds as if no one cares. On the contrary, those of us who do not agree with my hon. Friend and the £25 million fund that he advances do so not because we do not care, but because we know what the science says and because—I certainly take this view—we have to set this issue in the context of all our veterans, so that we do justice by everyone. We must always be careful not to be seen in any way to single out one group and put it above another.

I really take issue with the idea that we are somehow being shameful, or that we are in any way wrong, in our attitude to our nuclear test veterans. That is not the case. The existing scheme is good, fair and, arguably, generous, and it is one we should be proud of. Of course one could always argue that anyone in receipt of any form of compensation or benefit should have more, but what we have at the moment is fair and generous.

Let me come on to our scheme, because it is important to put on the record that any veteran who believes they have suffered ill health due to service has the right to apply for no-fault compensation. We therefore have a no-fault compensation scheme under the war pensions scheme. Where there is reliable evidence that disablement is due to service, a war pension is awarded, with the benefit of reasonable doubt always given to the claimant. Nuclear test veterans are no different, and war pensions are paid to claimants for disorders accepted in principle as being caused by radiation, where the evidence raises a reasonable doubt of service-related radiation exposure. In addition, awards are made automatically to nuclear test veterans who developed certain leukaemias within 25 years of participating in the tests. For some, therefore, there is an automatic entitlement, which is absolutely right. Again, that begins to move us up that so-called league table, if, as some would argue, such a table exists.

It should be noted, however, that in May this year the first-tier tribunal, the war pensions and armed forces compensation chamber, delivered a decision in a group action of 14 nuclear test veterans’ war pension appeals. The majority of the appeals were rejected. The tribunal found material exposure where appellants undertook work in forward areas or otherwise came into contact with radiation, but not in relation to the majority of the bystander appellants. The decisions of the tribunal support the MOD’s current policy relating to claims for a war pension made by nuclear test veterans.

[Mr Baron]

The veterans have made it clear that they find the war pensions process time-consuming and arduous, even when they are successful. We talk about success rates, but 90% of the veterans membership have failed to get a war pension.

As for the international table, the compensation payments in the USA, Canada and so on—although I am focusing on recognition, not compensation—are made in addition to war pensions that are already given to veterans. We should not paint this country’s war pensions as doing anything special, when those are very much automatic in other countries, and there is compensation on top of that.

[Anna Soubry]

I have made my comments about the so-called league table, and have relied on the information I have been supplied with, but I do not believe that our nuclear test veterans are at the bottom of any league table. I certainly do not believe that our record is shameful.

The Government’s second reason for remaining unable to support a benevolent fund concerns the comparison that my hon. Friend has made with compensation packages provided abroad. I hope that I have dealt with all that. My hon. Friend mentioned the sum—it is actually £20 million—given by the UK Government as compensation to the Australian Government in the 1990s. We should be clear about why that money was made over. The £20 million was ex gratia and was given to the Australian Government to contribute to the total cost of rehabilitating the test sites in Australia. Payments were made in instalments, the last being made in 1998. I do not want it to be suggested that the Government somehow advantaged veterans or other people who served in the forces in Australia.

The Government hold the view that to create a benevolent fund would be tacitly to accept liability for which no legal grounds exist. That was demonstrated in the atomic veterans group litigation for damages against the MOD in 2006. In 2009, 10 lead cases were allowed to proceed to a full trial on causation, at the judge’s discretion, under the Limitation Act 1980; normally, there is a three-year statute of limitations on personal injury claims. The MOD appealed, and in 2010 the Court of Appeal overturned the High Court ruling in all respects, except for one case. In arriving at its judgment, the court also considered the merits of the claims in terms of causation and concluded that their general merits were extremely weak.

[Mr Baron]

The Minister has been generous in giving way, which is appreciated in a debate of this sort. Payment to a benevolent fund would not necessarily be an admission of liability. An ex gratia payment makes no admission of liability or guilt. We need to make that clear. The Government have made ex gratia payments to other countries, as the Minister readily admits.

[Anna Soubry]

I must throw that back to my hon. Friend and ask him for what purpose he wants a benevolent fund. Is he saying that the nuclear test veterans’ need is greater than that of other groups of veterans? What would the payment redress?

[Mr Baron]

I am pleased that we are clarifying this. To repeat what I said earlier, the payments would be dispensed on the basis of need, to help with care and treatment, not on the basis of entitlement. Not all veterans would receive it, but it would be recognition of the fact that their service was in many respects unique, that the science was at the time unknown and that the risk was unquantifiable. Let us not forget that those servicemen were doing national service; that is an important factor. In many respects their service was unique, and we should recognise that.

Oral Answers to Questions

Debate between John Baron and Anna Soubry

Tuesday 16th April 2013 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

14. How the NHS will be held to account on the experiences of cancer patients using the NHS.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

The Secretary of State made it very clear to NHS England in his mandate that we expect to see an improvement in patient experience.

[Mr Baron]

The Francis report recommended that the NHS be held to account on patient experiences. Given that the national cancer patient experience survey is a proven tool in driving up the quality of care, will the Minister endorse calls for the survey to be carried out annually, and support the development of a clinical commissioning group outcomes indicator set indicator based on the results in order to incentivise CCGs to improve cancer patient experience?

[Anna Soubry]

I am grateful to my hon. Friend for those comments; as he knows, these are now matters for NHS England. I will make sure it is aware of what he has said and his urging it to do both those things for the obvious benefits they would have for a cancer patient’s experience.

NHS Cancer Services

Debate between John Baron and Anna Soubry

Friday 14th September 2012 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate my hon. Friend the Member for Basildon and Billericay (Mr Baron) on securing the debate. I am aware of the excellent work that he has done with the all-party parliamentary group and with cancer charities to promote the inclusion of relevant cancer indicators in the NHS, public health and commissioning outcomes frameworks.

As you will know, Mr Deputy Speaker, there is a lot of terminology in the Department of Health—to which I am very pleased to have been appointed—and I apologise at the outset for any jargon that is used. One thing is certain: my hon. Friend will be more than familiar with it. However, I hope to explain the position in as much plain language as possible.

I am fully aware of the frustration felt by my hon. Friend, his all-party group and the cancer charities over the recommendations from the National Institute for Health and Clinical Excellence about the indicators for the commissioning outcomes framework and the difficulties that are likely to occur in 2013-14, but I can assure him that a methodology for possible one-year and five-year survival rate indicators for potential inclusion in COF is under way. I hope he will accept that that is good news, as is the fact that work is also under way to investigate composite cancer survival indicators at both national and clinical commissioning group level. I will say more about that, but I wanted to begin by reassuring my hon. Friend that we had taken his previous points fully on board.

As my hon. Friend knows, the Government published “Improving Outcomes: A Strategy for Cancer” in 2011. It set out our ambition to halve the gap between England’s survival rates and those of the best in Europe. My hon. Friend spoke of the disappointment that many people feel about our survival rates, and said that everyone wanted them to improve. It is estimated that halving that gap would save 5,000 more lives every year by 2014-15. The strategy is intended to reflect the importance of improving outcomes through the five domains—or areas, as I would call them—of the NHS outcomes framework: preventing people from dying prematurely, improving the quality of life for people with long-term conditions, helping people to recover from illness or injury, ensuring that people have a positive experience of care, and treating and caring for people in a safe environment and protecting them from avoidable harm.

In recognition of the fact that cancer is a big killer—more than 130,000 people die of the disease each year—we have included seven cancer indicators in domain 1 of the NHS outcomes framework. They cover the under-75 mortality rate from cancer and one and five-year survival rates for three major cancer killers, namely colorectal, breast and lung cancer. In addition, two overarching indicators will include cancer data: potential years of life lost from causes considered amenable to health care, and life expectancy at 75.

My hon. Friend has urged us previously to consider other indicators that would reflect improvements in survival rates for rarer cancers, and he mentioned them again today. I can confirm that we have asked the London School of Hygiene and Tropical Medicine to develop composite indicators that might allow improvements in survival rates across all cancers to be assessed. We hope to be able to make a decision in time for the NHS outcomes framework for 2013-14, which is due to be published later in the autumn.

[Mr Baron]

I am heartened by what the Minister is saying, but does she appreciate our view that a composite index should complement the one and five-year survival indicators rather than replace them? We fear that a composite index will mask bad news on rarer cancers with improvements on the more common cancers, which would have greater force in the index because they are more numerous.

[Anna Soubry]

I thank my hon. Friend for making that point, and I certainly take it on board. If there is anything that I am not able to cover in the short time that is available to me today, we will write to him; and, as he knows, my door is always open so that we can continue the debate. It is important, and it is especially important that we do things right.

The NHS Commissioning Board will translate the national outcomes goals for the NHS into measures that are meaningful at a local level in the commissioning outcomes framework. The board authority is now working with clinical commissioning groups and other stakeholder organisations to discuss the shape of the commissioning outcomes framework for 2013-14 and beyond. COF will play an important role in driving up quality in the new system. Covering £60 billion in services commissioned by CCGs across the NHS, it will translate the NHS outcomes framework into clear, comparative data on the quality of services that CCGs commission for their local populations and the outcomes achieved for patients.

Concerns have been expressed that the NICE COF advisory group recommended only one indicator for inclusion in COF and, in particular, that the group recommended no survival rate indicators. NICE’s advisory group is independent of both the Department and the NHS Commissioning Board. NICE was asked to give advice on potential measures to include in the framework, based on the best available evidence. It is now for the NHS Commissioning Board to decide on its final shape for 2013-14.

The NHS Health and Social Care Information Centre has been asked to work with the London School of Hygiene and Tropical Medicine and the Office for National Statistics to develop a methodology for one-year and five-year survival rate indicators for potential inclusion in COF. These will be composite indicators, because of the difficulties associated with getting statistically valid indicators for individual cancers at CCG level.

[Mr Baron]

The national one-year and five-year figures for the three main cancers have been calculated. They must have been drawn from local figures. Experts in this area tell me that once the boundaries are known, it should be possible to slice those figures to show the one-year and five-year picture at a local level.

[Anna Soubry]

The difficulty is that the numbers in each CCG might be very small indeed, and therefore the statistical benefit will be limited. It may well be possible to look at the situation in respect of the health and well-being boards, however; we might be able to look at this at a local authority level.

[Mr Baron]

The Minister is being very generous in giving way, and one of the purposes of Adjournment debates is to enable us to have a bit of a discussion. I take on board her point, but the CCGs are larger than was originally estimated. I would also say that we have suggested the use of proxy measures such as staging and accident and emergency admissions figures to complement, but not replace, the one-year and five-year figures, because they would give a more complete picture at the local level.