Women Entrepreneurs

Julian Huppert Excerpts

Wednesday 18th March 2015 Westminster Hall

[Dr Julian Huppert (Cambridge) (LD)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I am really pleased that this debate has been brought to Westminster Hall, and I congratulate the hon. Member for Feltham and Heston (Seema Malhotra) on securing it. It is a shame that there are so few hon. Members here from both sides of the House. We are discussing a really important subject, and it would be good to have more participants.

I know from my constituency what a key role women entrepreneurs can play, have played and will play in our communities and economy. I have some experience in the matter, because I set up a very small biotech company with two women entrepreneurs and two other colleagues. It was extremely successful in every respect other than having a product that actually worked; as it turned out, that was quite important. One of the women with whom I worked has continued in entrepreneurial roles, and I am delighted about that.

Too often, we do not hear about women entrepreneurs. They are not the stereotype; they are too often the unsung heroes, and we must do far more about that. There has been some progress in the past five years, as the hon. Member for Feltham and Heston has described, in support for women entrepreneurs, including the appointment of an ambassador for women in enterprise, my hon. Friend the Member for Solihull (Lorely Burt), who is upset that she cannot be here this morning. Far more needs to be done, however. No Government have yet got it right, and we need to go much further.

Let me pick up on some of the examples in my constituency. It being Cambridge, many of our successful women entrepreneurs are involved in the tech sector. One example is Lily Bacon, who co-founded the pioneering software company RealVNC. She worked incredibly hard to get that company up and running in perhaps one of the earliest attempts at crowdfunding. Remarkably, the initial money for the company came from selling merchandise bearing the company’s logo. It is quite impressive to be able to do that ahead of time, and that was entirely Lily’s idea. The company is now a world-leading provider of remote-access software, and it has won three Queen’s awards for enterprise in three years.

There are many others, such as Martina King, who is doing amazing work at Featurespace, Julie Barnes at Abcodia and Annie Brooking at Bactest. I particularly want to mention Emily Mackay, who is doing some nice work with Crowdsurfer. She started the company while she was having her first child, and she has turned it into something quite exceptional. Sherry Coutu is an angel investor who helps entrepreneurs in a whole range of things and who is really committed to evidence base. She produced the “Scale-Up” report for the Government, which was excellent work. Outside technology, to pick one example, we have Julie Deane, who co-founded the Cambridge Satchel Company in 2008 with her mother. Only a couple of years later, they were making at least 3,000 bags a week in the UK and selling to 86 countries. It is an amazing company that makes very nice bags, Mr Robertson, if you ever want a satchel.

To enable women entrepreneurs to thrive, we must set the right conditions across the piece. I will talk about finance later, but much of the issue is not directly about entrepreneurs. It is about our society’s attitudes: the explicit and implicit discrimination that holds women back. We have regressive attitudes in so many areas, and one of those attitudes implies that women cannot and should not be innovators in our economy, that women should not take risks and that women should go for a safer job. I come across that attitude all too often. It is not right, and it has no place in what we are doing.

Another issue is imposter syndrome, which has been highlighted by one of my former colleagues, Professor Athene Donald. Many people, disproportionately women according to Athene and others to whom I have spoken, feel that however they are doing, they should not really be there and that they have not really earned their position. Frankly, that feeling strikes all of us. Anyone who claims that they have never felt that they do not deserve to be where they are is probably either over-confident or not telling the truth, but the feeling is expressed disproportionately by women. I recommend some of Athene Donald’s writings and comments on the subject.

We must address, rebut and debunk all those issues to make more progress. There has been work done, and I particularly highlight the work of my hon. Friend the Member for East Dunbartonshire (Jo Swinson) in both her roles as Parliamentary Under-Secretary of State for Women and Equalities and for Business, Innovation and Skills in trying to send forceful messages about sexist dogma in the workplace and, more broadly, society. Similarly, we have seen the work of my hon. Friend the Member for Solihull.

We have made some progress. We still have a society in which it is expected that women will do a disproportionate share of child care. We need to break that apart, and we have introduced shared parental leave, which is important not only for women but for men; parental leave should be open to everyone. Having spoken to many female and budding entrepreneurs, I know that that is an important issue for them. We have also worked to encourage parity of pay for men and women. There is no reason why men and women should be paid differentially for the same job. We have seen the gender pay gap come down, and after some internal coalition disagreements, we are now introducing measures so that large companies will have to publish the average pay of men and women. There are a number of schemes for women entrepreneurs, some of which the hon. Member for Feltham and Heston has already mentioned. There is the women and broadband challenge fund, support for women in rural areas, the road show of mentoring events and much more, so we are making some progress but not enough.

I completely agree with the hon. Lady that we are not there, and so long as we do not have more women entrepreneurs, we and our economy are missing out on a pool of talented, able people who could contribute much more. Research by Enders Analysis shows that raising women’s employment to the same level as men’s could lift GDP by 10% by 2030, which we should all want. As she said, the Women’s Business Council has said that if women had the confidence and support to start businesses at the same rate as men, the UK would be home to an extra 1 million female entrepreneurs, which we would all welcome. We are missing out, and we are doing too badly. Women majority-own only about one business in five, and they are about a third less likely than men to start a business. There is a lot to do.

We need to ensure that education is far more gender-neutral and to encourage women to take subjects that are not seen as traditionally feminine. I recently looked at the application rates for different subjects at the university of Cambridge in my constituency, and there is huge discrepancy between the subjects for which women do not apply and the subjects for which they do. We have to change that. Computer science is at one end and education is at the other. There is no good reason for that, and we have to change it. One thing we would like to do is to change application rates in science, technology, engineering and maths. We support initiatives such as the STEM diversity programme to address gender stereotypes. We need to ensure that each school has access to a female science champion to encourage the idea that women can be successful in technology and science.

[Seema Malhotra]

The hon. Gentleman is making an excellent speech. He reminds me that my sister studied engineering at Cambridge and now works with racing cars in America. He makes an important point about how we can attract more women into subjects that have not been female-led. Does he have a view on how we can build a stronger connection between schools and women who are running businesses and who have been successful in science or technology? Those women can be great role models and can encourage more women to come forward.

[Dr Huppert]

The hon. Lady is right that we have to do far more. In fact, her sister could perhaps be doing some of that. Various studies have asked people to draw an engineer, and almost invariably the person they draw is a man. We have to break that stereotype. There have been some great examples and, rather embarrassingly, I have forgotten the name of the brilliant engineer who worked on the Shard project. She featured in some of the television programmes, and I have met her, but I do not remember her name. She has gone out to try to encourage people in schools, which is essential. We need to show that there is diversity and that people from all walks of life can do it, whatever their background. The hon. Lady is right to raise that issue.

Female entrepreneurs have a particular issue with obtaining finance. Even if they have the background, the idea and the confidence to go for it, access to finance can be very difficult. As the hon. Lady said, banks can be very unsupportive of women entrepreneurs. Studies in the US found that when banks changed their approach to female enterprise, there was growth in female entrepreneurship. I am not saying that we should necessarily copy exactly what was done in the US—it might not exactly work here—but we should try to change the banking culture. We should work with the British Bankers Association to find information on lending to female entrepreneurs in England so that we can see how we can change it.

There are also non-bank funding issues. At the initial stage of funding, women are apparently rather more concerned to seek the three f’s: friends, family and fools. It can be difficult to ask people for money at that stage. There are similar figures for angel and venture capital investment. Only 8% of angel and venture capital investment goes to companies that are run or co-founded by women, which is an astonishingly small fraction. One ray of light is that we are seeing crowdfunding and equity crowdfunding, and 41% of successful equity crowdfunding goes to companies that are run or co-founded by women—we are seeing much more.

Amanda Boyle, the chief executive officer of Bloom VC, has talked about how crowdfunding is opening access to women. I do not have the figures with me, but I understand that men are still more likely to ask for money but women are more likely actually to get the money, which is changing the dynamics. I support all the recommendations of the report by my hon. Friend the Member for Solihull on inclusive support for women in enterprise.

I have spoken at length on some issues, and far, far more could be covered. It is good that we are having this discussion, and it is good that we are trying to make a difference. Whoever forms the next Government, and whoever is in the next Parliament, I hope that women entrepreneurs will be prioritised. So long as we have a society that stereotypes and gives the impression that women should like pink things and should be doing feminine jobs—we have no truck with those attitudes here—we will be weakening our economy and making our society less fair, which is the exact opposite of what we want. We want opportunity for everyone.

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[George Freeman]

It is important to realise that we do not want the investment funds that take equity stakes simply to shovel the money out of the door irrespective of the quality of the bids. The decisions have to be based on proper investment criteria, and it is not for me or the hon. Lady to second-guess such judgments. I am pleased to see that after an initial period during which the rate of investment was slower, it has picked up. We are actively monitoring and supporting the fund, and our ambition is for it to be spent and invested, but it is important that we send a signal that the money is going into high-quality business propositions.

As we have all acknowledged this morning, there is a challenge in trying to observe the wider cultural point made by my hon. Friend the Member for Cambridge (Dr Huppert). He said that we must promote world-class, aspirational, high start-up businesses that are capable of receiving that sort of venture capital. It is not for us to signal that the money should be pumped out of the door irrespective of the quality of the bids. It is for the fund manager to ensure that they are picking the right investments.

I have tried to be generous in giving way, but time is running out, so I want to complete my remarks. For all the reasons I have outlined, and because we agreed that we must do more, in April 2014, my right hon. Friend the Secretary of State appointed my hon. Friend the Member for Solihull (Lorely Burt) to the role of women in enterprise champion, to promote the support available to women starting a business. In February, she presented her report on how the Government could boost support for female entrepreneurs, and we agree with much of the thinking and analysis it contains. I cannot be expected to commit the Government to agree with every single one of the recommendations, but we are actively looking at them and working on an implementation plan.

I want to pick up on some of the comments. My hon. Friend the Member for Cambridge focused in particular on science and start-up companies. I join him in paying tribute to the people in the high-tech and life sciences sector, which we both know well from Cambridge, and to entrepreneurs such as Julie Deane of the Cambridge Satchel Company. He made a number of interesting points about cultural attitudes and the need to ensure that, in what can sometimes be the quite macho world of finance, the quality of women entrepreneurs and of women in science is properly recognised.

My hon. Friend also talked about the importance of getting schools better connected to businesses. We can all do something about that in our own constituencies. Tomorrow night, the Norfolk Way is launching our first innovation awards for Norfolk, linking up science teachers and students in schools with local businesses in the area. He made an important point about 8% of venture capital funding but 41% of crowdfunding going to women-led businesses. That sends a signal about the power of some of the new financing mechanisms to support women’s businesses. Although the Enterprise Research Centre has shown that there are no specific obstacles to access to finance for women, strong perceptions have a powerful effect, and that is something we need to monitor.

My hon. Friend made a particular point about STEM. Since 2009-10 the number of women starting engineering in manufacturing apprenticeships has increased threefold, which is a real success for the coalition’s apprenticeships policy in that we are getting more and more women in the STEM subjects. More action is necessary, but with the apprenticeship ambassadors STEMNET programme we are making progress. The Your Life “Call to Action”, part of the campaign launched by the Chancellor and the Secretary of State for Environment, Food and Rural Affairs, has brought together employers, educators and the professions to make concrete pledges to increase the number of women in engineering and technology. I am delighted that more than 200,000 organisations have now pledged to create in excess of 2,000 entry-level positions, including apprenticeships, graduate jobs and paid work experience posts, as well as action to support their female work force.

[Dr Huppert]

The hon. Member for Feltham and Heston (Seema Malhotra) talked about mentors and I could not remember a name. I hope that the Minister will join me in congratulating Roma Agrawal, who worked on the Shard and has a website, romatheengineer.com, which promotes females going into engineering.

[George Freeman]

I absolutely join my hon. Friend in paying tribute to another beacon project that is sending out such a powerful signal to girls and women about opportunities available to them. I am delighted, too, that we allocated a further £20 million in the engineering skills fund to help employers to tackle skills shortages in engineering, including to develop women engineers.

Finally, my hon. Friend made a point about enterprise education. I am delighted to confirm that we are working actively with schools, colleges and higher education institutions to encourage and promote entrepreneurial attitudes and skills training, as well as providing mentors and role models and improving access to finance support.

I want to deal with the questions about child care and women on boards. A number of colleagues asked about child care support. The Government have increased the number of funded hours of free child care from 12.5 to 15 hours a week for all three and four-year-olds, saving families an additional £425 a year per child. Since September 2014, we have funded an additional 15 hours a week of free child care for the 40% most disadvantaged two-year-olds, saving families £2,500 a year per child. We have also increased child tax credit well above inflation to £2,780 a year, which is £480 more a year than at the beginning of the Parliament. All families under universal credit will be able to receive 80% support for child care costs, which is up from 70% under the existing working tax credit system. The introduction of tax-free child care could also save a working family up to £2,000 a year per child. In addition, we have committed an extra £50 million to introduce a new early years pupil premium in 2015-16 to support the most disadvantaged three and four-year-olds to access Government-funded early education. That is important if we are to support our entrepreneurs and innovators in all walks of society and to ensure that entrepreneurship is not the preserve of the well-off.

Women on boards is an important subject. A lot of our entrepreneurial companies do well and go on to become substantial, significant companies quoted on the stock market. We are ensuring that, at that point, women continue in leadership roles. Following Lord Davies’s recommendations in the 2011 “Women on boards” report, the Government are committed to achieving the target he set for the end of 2015 of 25% of FTSE 100 boards being women. We also want to increase the number of women on FTSE 250 boards. The graph that I have in my hands shows a line slowly climbing from 2004 to 2011, but then turning sharply upwards, going from 12.5% of women on the boards of FTSE 100 companies to 20.7% at the end of 2014. We are making a real impact and we must continue to do so. I am delighted that now 22.8% of FTSE 100 board members are women and that women now account for 28% of FTSE 100 non-executive directorships and 8.5% of FTSE 100 executive directorships. There is much more to do, but we are making real progress.

Human Fertilisation and Embryology

Julian Huppert Excerpts

Tuesday 3rd February 2015 Commons Chamber

[Luciana Berger]

That point was raised in an earlier intervention. I think it is clear from reports following reviews by the expert panel that it has already been specifically addressed, but I shall deal with it in more detail later.

[Dr Julian Huppert (Cambridge) (LD)]

There seems to be a lot of confusion between nuclear DNA and mitochondrial DNA. It might help the hon. Lady and the House if I point out that they have completely different origins. They have a different genetic code; they are not related. The origin of mitochondria is bacteria that were engulfed by cells. They are very different. The House should be aware of that.

[Luciana Berger]

I thank the hon. Gentleman for that clarification.

Many concerns have been raised, the first of which is that this process is being rushed through. Anyone who has been involved in the development of these techniques would disagree that this has moved quickly. Professor Doug Turnbull and his team at the university of Newcastle have been researching this for 15 years. It was over six years ago, back in 2008, that the Human Fertilisation and Embryology Act 1990 was amended to introduce the powers to allow regulations that would enable mitochondria replacement to take place to be brought forward. It was back in 2010 that researchers at the university of Newcastle developed the techniques to avoid diseased mitochondria being passed from a mother to her children. After another three years of consultation and review processes, the Government announced in July this year that they would be bringing forward the regulations to enable mitochondrial donation techniques to be used, and that is what we are voting on today.

--- Later in debate ---

[Andrew Miller]

The hon. Gentleman makes an interesting point, but there are plenty of occasions when such tests are not carried out. In central Africa we have been testing Ebola vaccines without first testing them on primates, because the benefits outweigh the risks. We are in that position already. My hon. Friend the Member for Stoke-on-Trent South referred to research undertaken in China 10 years ago. He rightly said that that work took place, but I put it to Members of this House that the ethical and scientific rigour applied to experimentation in the UK far exceeds anything in China 10 years ago. Indeed, the technologies have also moved on to a very high degree since then.

[Dr Huppert]

Some critics of this approach have pointed out that this country would be the first to go ahead with it. Does the hon. Gentleman agree that we should be proud to be leading the world in medical treatments and that, as he says, we can provide some of the best ethical safeguards in the world?

[Andrew Miller]

The ethical basis on which science is conducted in this country is world leading. The hon. Gentleman is right to say that we should be immensely proud of the successes—again—of our scientific community in a range of life science disciplines. This one affects a very small group of the population but does so in such a profound way. Although there are issues that need properly regulating, the regulatory structure that we have created does that properly. The Minister was asked about, and indeed mentioned, the issues associated with designer babies. Of course this House would want to impose limits, but we are considering a specific set of regulations about dealing with mitochondrial disease—they do nothing else. I, for one, would not stand here to defend the concept of designer babies and people choosing eye colour and so on. Today, we are dealing purely with those terrible illnesses.

--- Later in debate ---

[Robert Flello (Stoke-on-Trent South) (Lab)]

The hon. Member for Birmingham, Yardley (John Hemming) almost caught me napping.

It would be ridiculous to suggest that anybody in this House does not want a cure for mitochondrial disease; it is a horrible disease. But if we understood properly how mitochondrial DNA worked, we might find ourselves closer to finding a cure for that disease. My right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) said that we had heard all these arguments before. Well, yes, we did hear an argument before. It was back in 2007 when Members were marched through the Lobby to support the human-animal hybrid legislation. That legislation was going to solve numerous problems, and some Members said, “How could anybody dare to object to such legislation?” But what has happened to that legislation, that panacea? Well, nobody can get a grant for that work now because it has been proved that it does not work. All the concerns, hopes and heartache of the time got us nowhere. I really fear for the families today. If this motion passes today and it does become law, those families, who are, understandably, pinning everything on it, will be tragically let down.

[Dr Huppert]

rose—

[Robert Flello]

I will take an intervention shortly. Reference has been made to the Zhang study. That study was not considered by the HFEA. Even if we said that Chinese medicine is terrible and that 10 years ago it was irrelevant and not ethical, the HFEA should still have considered it, but it did not. A number of Members have claimed that mitochondrial donation is like blood transfusion—nothing more than that. Well, no it is not like that. It is modifying the human germ line. As the HFEA has said, maternal spindle transfer is genetic modification of the egg and pronuclear transfer is genetic modification of the embryo. Think about it, colleagues. Why are we in the Chamber today to discuss this procedure if it is not genetic modification? If changing the germ line is not genetic modification, we do not need the statutory instrument. The HFEA could get on with it. It has therefore answered itself.

[Dr Huppert]

I listened to what the hon. Gentleman said about hope, and he is right that we do not know how this will play out. There might be people who have hope who will not succeed. What I cannot understand is why he is saying that to avoid people having their hopes dashed later, we should dash them today.

[Robert Flello]

It is simply that this legislation will open up research that is illegal, as I shall describe in a moment. I also think there are greater concerns about generations down the line.

The EU clinical trials directive, which applies to all clinical work, states:

“No gene therapy trials may be carried out that result in modification to the subject’s germline genetic identity.”

The HFEA itself has said that this procedure does. In the legal opinion on the regulations, Lord Brennan QC has said that they are caught by the directive and that they are

“likely to be in breach of EU law”

on clinical trials.

The Department of Health examined the legal opinion but rejected it, saying that the licence will not be granted for clinical trial but for treatment and therefore will not be caught by that law. Apparently, this is not about clinical trials and furthering the science but about going straight for treatment.

Lord Brennan’s opinion anticipated that. He set out the relevant paragraphs from the 2011 report on safety from the review panel set up by the Secretary of State to monitor the procedures to the HFEA, which said:

“Once assessed as safe to use in clinical practice, the panel strongly recommends that permission is sought from the parents of the children born from MST and PNT to be followed up for an extensive period”

and that such permission should be sought from the children themselves once they are old enough. In the case of females, that should ideally be to the next generation. Those recommendations should also apply to pre-implantation genetic diagnosis for mitochondrial DNA genetic disease.

National Health Service

Julian Huppert Excerpts

Wednesday 21st January 2015 Commons Chamber

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

Thank you, Madam Deputy Speaker. I will do my best to comply with your instructions.

As the Secretary of State was talking, my mind went back to the “responsible opposition” of the right hon. Member for South Cambridgeshire (Mr Lansley). I remember the efforts that went on for more than 40 years around Manchester to tackle the appalling level of infant mortality by reconfiguring maternity services. As the local newspapers said, that was stopped at every stage by politicians defending bricks and mortar. In the end, when that change went through, it was the Opposition who tried to reopen the issue. Before my noble Friend Lord Ara Darzi became a Minister, he did a very important review on London, where there were more single-handed GP practices than anywhere else in the country post-Shipman, and people attending A and E was a bigger problem than anywhere else. Lord Darzi put forward sensible proposals, which were agreed by clinicians and the NHS in London, but the right hon. Member for South Cambridgeshire opposed them. He issued an unfortunate press release about polyclinics—unfortunately, he spelt it “polly”, but it was not a clinic for parrots. I said to him, “Don’t adopt a policy that you can’t spell.” There are numerous examples of the previous Opposition doing that.

I bet I am not the only one in this House—I bet there are Members in all parts of the House—who rues the day when the right hon. Member for South Cambridgeshire got his hands on the NHS. His ideas for what to do, which culminated in the top-down reorganisation, were not new—I remember them from my first day as Health Secretary. He is not a bad man who hates the NHS, by the way. In many ways, he has great affection for the NHS, but he got things totally wrong. He slung across his draft Bill on what the NHS would look like after his top-down reorganisation. I read it that evening and it was horrendous.

The Government have done two things to erode confidence in politics in this country. The first is the Liberal Democrats’ conversion from opposing tuition fees to the extent that they wished to abolish them to supporting tuition fees to the extent that they agreed to treble them. The second is the Conservatives’ conversion from a pledge that there would be no top-down reorganisation of the NHS to the implementation of a top-down reorganisation so huge that, in the words of the previous NHS chief executive,

“you can see it from space”.

That is a vivid but not inaccurate description of a reorganisation that closed 170 organisations, created 240 new ones, made 10,000 staff redundant and re-employed 2,200 of them.

[Dr Julian Huppert (Cambridge) (LD)]

I will not highlight the right hon. Gentleman’s role in tripling tuition fees. The shadow Secretary of State said that, when he came into office—this is part of his defence— he got rid of the pro-privatisation agenda that he inherited. Who does the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) believe the shadow Secretary of State was criticising in that comment?

--- Later in debate ---

[Dr Julian Huppert (Cambridge) (LD)]

It is a pleasure to follow the right hon. Member for Rother Valley (Kevin Barron). We have heard references to Nye Bevan and his amazing work in setting up the NHS. We should talk about Beveridge and his report, too. He was a good Liberal and he did that work during a coalition, albeit a somewhat different coalition that had come about for different reasons.

Let me start by looking at some issues that have arisen in my area of Cambridgeshire over the last month or so. There has been a number of winter challenges to be faced. Among them, I could talk about the ongoing problems with the ambulance service. The real problem that struck us was, I suspect, when the East Anglian ambulance service changed to the East of England ambulance service—and it has never recovered from that.

What has hit people most, I think, has been the problems at Addenbrooke’s hospital—a major incident took place, and a large number of operations had to be cancelled. I have spoken to the managers there and to many of the doctors and nurses. It seemed that there were two main reasons for the big problems. One was that Addenbrooke’s has been implementing the new e-hospital system—an exciting electronic records system that is the largest NHS IT project ever to be implemented. It is not as big as the one that was scrapped, but it was implemented. Although it will be a good thing when it is finally working, there have been many teething problems along the way and lessons that have to be learned. I suspect that other hospitals will want to learn from this: they should look carefully at the bad things, as well as the good things.

The other problem is the shortage of care wards, with delayed transfers of care. That has been a problem for a long time. Addenbrooke’s opened some new wards, but more are needed. I have been campaigning for some time to reopen some wards at Brookfields hospital, also in Cambridge, and I spoke about that in this place last year. I am delighted that, as of 9 February, these wards will be opened at Brookfields hospital. That is very encouraging. It is interesting to note that, in 2007, there were proposals to close down the entire hospital; I am delighted that we are opening up more wards instead.

We are trying to solve the problem for the long term through a new older people’s contract. This is the second-largest tender ever put out for the NHS, as it includes all the older people’s services in the county. I am delighted that the contract was won by the NHS—unlike the largest contract. The acute hospitals, the mental health services and the community work sector will all be working together to solve the problems we are having with things such as delayed transfers of care. That is the long-term fix for older people’s services in Cambridgeshire, and I hope it will be a model for other parts of the country to have a look at.

We have seen the news about Circle pulling out of the Hinchingbrooke hospital. This has been discussed in this place, and it is a shame that the shadow Secretary of State is not in his place, as it is always fascinating to hear him argue that he was in favour of the NHS bid led by Serco. I do not count Serco as part of the NHS, and I do not think that any Opposition Member would wish to do so.

[Andrew Gwynne]

Will the hon. Gentleman give way?

[Dr Huppert]

I will give way once on this issue.

[Andrew Gwynne]

I fear that the hon. Gentleman is, yet again, seeking to rewrite history. He will know that when my right hon. Friend the Member for Leigh (Andy Burnham) became Secretary of State, he changed the “any willing provider” policy to “NHS preferred provider”. That allowed Cambridge University Hospitals NHS Foundation Trust to become a partner of one of the three bidders. It was, of course, the Government whom the hon. Gentleman supports who signed the contract 18 months after the general election.

[Dr Huppert]

The hon. Gentleman ought to get his facts right. The Cambridge university trust put in a bid—it was the sixth last to do so—but then withdrew because the cost of the tendering process under the right hon. Member for Leigh was far too high. It did not have a partnership with Serco. The hon. Gentleman should check the facts and check the record. The trust was driven out by the tendering. The hon. Gentleman should also know that the bid to which I suspect he was referring was led by Serco. What he is saying, in essence, is that the current shadow Secretary of State had to undo the damage that had been done by previous Secretaries of State. That is a bit of Labour misery that I imagine Labour Members can sort out between them.

We know the history, and we know the problems that led to it: the Government had to decide between three private sector-led bids for Hinchingbrooke. What we must do now is work out what to do next, and I think we need to ensure that Hinchingbrooke stays in the public sector. Trying to remove it from the public sector in order to deal with the PFI problems, which was the original idea, simply has not worked. It must stay fully within the NHS.

Last year, before any of this happened, I led a debate about health in Cambridgeshire. I dealt with a number of issues, and I will not go into all the details now, but I spoke about health funding and, in particular, about mental health. I gave a number of detailed examples of some of the many challenges that we have faced and still face. For instance, huge cuts were made five or six years ago. During that debate, I called for a substantial amount of extra money, not just for Cambridgeshire—although I shall say something about that shortly—but for mental health throughout the country. Members in all parts of the House have made some excellent speeches about mental health, but it is not talked about enough. I find it regrettable that the motion does not mention it, and I suspect that a number of Members on both sides of the House do as well. Let us hope that we receive that extra money for mental health.

Cambridgeshire, however, suffers from a number of specific problems. We have been a test bed for experimentation for many years. We had the Hinchingbrooke experiment— the largest tender that the NHS has ever seen. We saw huge numbers of PFI projects not just at Hinchingbrooke, but at Peterborough. Paying off the NHS costs is still taking 18% of Peterborough hospital’s budget. That is only a small proportion of the 138 PFI projects that we saw under the last Government, the costs of which will amount to £11.7 billion over the next Parliament. That money could be used far more productively.

We have been hit hard by that, but we also receive very low funding. We inherited a formula from the last Government, and the process of changing it has been too slow under the present Government.

[Sir Hugh Bayley]

rose—

[Dr Huppert]

The hon. Gentleman can intervene if he wants to talk about why PFI is a great thing, but otherwise I will move on.

The Government have been too slow to move to the new formula, which properly takes account of ageing populations. We know that the elderly cost more in terms of health care. Cambridgeshire receives £961 per head, whereas West Norfolk, for example, receives £1,255. That is a huge difference. I asked for extra money during the debate that I mentioned, and I am delighted that we have managed to secure an extra £20 million as a result of the recent allocation. That will provide much more funding for mental health, on top of the extra £1.5 million that has been provided this year and the extra £2.2 million that will be provided for IAPT—improving access to psychological therapies—next year. That will make a big difference, and will reverse some of the challenges that we face.

We need that extra cash, but we still need more in Cambridgeshire and throughout the country. Simon Stevens called for an extra £8 billion by 2020, after savings and efficiencies had been taken into account. He said that an extra £8 billion, in real terms, was needed if the NHS was to keep going. I think that that is important, and we as a party think that it is the right thing to do. One of the problems with the motion is that it does not deliver what Simon Stevens has said is needed for the NHS. I am not all that keen to support the provision of less than a third of what is needed to keep the NHS going, especially after hearing from the shadow Secretary of State that, despite what the motion says, the money is not all for the NHS but constitutes the entire offer for the NHS and social care, which also needs its own funding. We need that £8 billion.

I voted against the Health and Social Care Act 2012 as I did not agree with much of it. There are some issues, such as parity of esteem, that are very good and that I hope will never be repealed. I also disagree, however, with many of the things that the Labour party did to bring in the private sector in some damaging ways, with people being paid for things that never happened.

The fact is, as was mentioned by the hon. Member for Brighton, Pavilion (Caroline Lucas), under the previous Government medical spending on private provision went from £1.1 billion a year in 1997 to £7.5 billion in 2009-10. That is a vast increase. I have no problem with people who say that they support that and that it was the right thing to do, but to suggest that that large increase was excellent for the NHS while the fact that it has continued at essentially the same rate under this Government is a disaster for the NHS strikes me as a rather bizarre claim.

I have criticisms of this Government, the previous Government and the one before that. I want the NHS to spend more of its time focusing on patients or, even better, avoiding the need for people to be patients in the first place. That needs a trained, motivated and well-paid staff—I think they should get the money from the independent review. It needs a focus on prevention and public health and proper funding—that is, the £8 billion by 2020.

[Paul Burstow]

On that point, does my hon. Friend agree that the better care fund, which is now being launched in April, is a key way in which we can deliver the joined-up care that he is talking about and that we need to have an ambition that by 2018 all CCG budgets, primary care budgets and social care budgets are in that pot?

[Dr Huppert]

My right hon. Friend is right, of course, and I pay tribute to him for the work he has done on this and on many other health measures. We must ensure that that integration happens so things work together and that is why token amounts such as a couple of billion pounds from the Conservatives, who need to go a lot further, and the £2.5 billion across health and social care from Labour—and by the way, please correct me if I am wrong, but according to The Guardian that is from 2017 onwards —will not go far enough. We need integration through the better care fund and we need that £8 billion. That is the proper funding that is needed.

Finally, we in this House ought to have a proper debate about how to fix problems and cut back on the amount of partisan bickering that happens in this place. That does not do us proud. We are all prone to it, including me. It is much better to talk about what we can do to promote health, whether it is physical or mental.

[Several hon. Members]

rose—

Mental Health (Cambridgeshire)

Julian Huppert Excerpts

Wednesday 10th December 2014 Westminster Hall

[Dr Julian Huppert (Cambridge) (LD)]

It is a pleasure to serve under your chairmanship, Dr McCrea. I am delighted to have secured this debate on a key issue for my constituents: health care and in particular mental health.

Our national health service is something to be proud of, the brainchild of a great Liberal, Beveridge, and brought into being by the pioneering Labour Government after the second world war. It is an amazing institution, providing care for all of us, free at the point of use. I pay tribute to the excellent and tireless work of NHS staff—and incidentally, I hope the Government will ensure that they are paid appropriately, because independent pay recommendations should be honoured.

Our NHS is, however, not perfect and is under strain. During debates when it was established, the predictions were that it would run more cheaply every year as people became increasingly healthy. In fact, the opposite has happened. People live longer because we are learning to treat more and more conditions, but that costs us more and more. Demand grows rapidly, the range of things we can do increases and NHS inflation outstrips standard inflation, leading to huge cost pressures. Much of the solution lies in preventive measures, because it is of course cheaper to keep people healthy than to treat them when they are not, but we never spend enough money on that as it is so often needed for treatment.

Some areas are shamefully neglected. Mental health in particular has always been left behind. A lot of that is a product of historical, outdated social attitudes—questions of shame, how people ought to be and what was “normal”. Indeed, many believed that mental health problems were a deficiency of character. That is of course rubbish, and I do not think anyone in the House would share such a view today. Nevertheless, a stigma that simply should not be there is still attached to mental health conditions. People are not prepared to talk about mental health, to admit problems or to seek help.

The stigma not only causes anguish for many people and their families, but materialises in discriminatory policies. For example, when the previous Government introduced waiting times in our NHS—arguing, perfectly reasonably, that that would improve provision for cancer patients and mean they were not left waiting for treatment—the Government did not include mental health. It was almost taken for granted that mental health delays were less important than physical health ones. Funding bodies reacted, pulling more money away from mental health in order to hit the new targets in physical health, which was an understandable reaction.

I am glad that that policy era is over. We have now legislated for parity of esteem between physical and mental health. Thanks to the excellent work of the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb), we are introducing the first ever waiting-time standards for mental health next year, described by charities as a watershed moment, although far too late in coming. Other improvements include the recent provision of £150 million to tackle eating disorders, but we have to go much further, because people are suffering and simply cannot wait.

On Saturday, I was at the wonderful Mill Road winter fair. We had a Lib Dem stall, where we were asking people to come and talk to us about mental health, to get some information and to sign a petition supporting our call for an extra £500 million for mental health, which I reiterate today. Huge numbers wanted to sign—many people care about the issue—and we raised lots of money for Centre 33, which helps to provide free and confidential counselling and support for young people.

We also heard some astonishing tales. Let me paraphrase just one of the stories of one of the people who came by, a woman who had felt suicidal for a year and had no fixed address. She went to see a GP, who asked her to come back regularly to check that she was okay. She went for a bit, only to stop going, but that triggered no alarm bells, even though a suicidal patient who was being monitored had stopped showing up. Eventually, she went to another GP and was told that she would be referred to a community mental health team, but nothing happened. Some time later, a third GP also suggested referral, but found nothing in her notes to suggest that she ever had been referred before. Three months after seeing the first GP, she was finally given an appointment to see a psychiatrist, but it was in five months’ time. The appointment happened and she was put on an 18-month waiting list for therapy. She is still on that list. In the meantime, she has lost her job and is in an extremely difficult situation. No wonder she and many others say that we need change.

Such a situation is not new. Eight years ago, my predecessor David Howarth spoke out against £3 million of cuts to mental health services in Cambridgeshire that led to the suicide of Julie Deloughery. There are many such stories across the country and across the decades. I heard some more when I worked with service users at Lifeworks, a mental health drop-in centre in Cambridge. The centre was threatened with closure, which I am delighted has now been stopped. I am proud that I was able to help with that by talking to service users and the mental health trust, and by raising the issue in Parliament, but I am far prouder of the work done by service users themselves and their friends. In particular, I pay tribute to Ann Robinson for her efforts. Too often, things are done to people with mental health issues, rather than done with them.

The now reversed decision on Lifeworks was partly the result of funding problems, so let me focus on the funding situation in Cambridgeshire, which has one of the most troubled health economies in the country. We are very underfunded. In 2013-14, our clinical commissioning group received the second lowest funding per head in the entire country. It has improved slightly since, but we are still far below where we should be. Somewhere has to be second lowest, but that is not a fair share. The Government have a fair share formula, but since it has been revised, rightly, to take account of deprivation, we have been left £35 million below the fair funding calculation. We get £961 per head in the Cambridgeshire and Peterborough CCG, whereas the figure for next-door West Norfolk is £1,255 per head. We are getting a slightly larger increase than others, at 2.9% rather than 2.14%, but at that rate it will take about a decade to catch up, with no compensation for the years of underfunding. I accept that NHS England makes decisions on how we get to the fair rate, but I hope the Minister will agree that the pace of change is simply too slow.

We have other problems. Our population is growing quickly: Cambridgeshire’s population growth is the fastest in the country and Peterborough is the fastest growing city. That means an even greater strain on funds, because the population increase is not properly taken account of. Our funding per head is going up slower than the national average, in spite of being low to start with. Will the Minister ensure that growth is no longer penalised? We also have a legacy of poor decisions, such as the two massive private finance initiative projects under the previous Government at Hinchingbrooke and Peterborough hospitals, the biggest and perhaps worst PFI projects in the country. They are still sucking money out of the system. When preparing for the debate, I was shocked to find that the PFI repayments for Peterborough represent a staggering 18% of the hospital’s budget.

We have less money than elsewhere, and we have more of that taken away from us before we even start, but we also have other legacy issues. Cambridgeshire is repeatedly used as a test bed for experimentation, such as the £1 billion privatisation of Hinchingbrooke hospital, led by and legislated for by the previous Government. They put the hospital out to tender and had not a single NHS bid among the final five bidders—Addenbrooke’s hospital pulled out because the cost was too large—so a list of three private bidders was left to the Government to choose from, which is not exactly a great choice to have to make. That is why I find it frustrating when the shadow Health Secretary claims to have clean hands over what happened with Hinchingbrooke. He claimed that one of the three bidders was an NHS provider, as he did in the House today, and I have been trying to find out which of the three—Circle, Ramsay or Serco—he considers to be part of the NHS. He said on Twitter today that it was the one associated with an NHS mental health body, but the day Serco counts as an NHS bidder is one I hope we will never see. Problems remain at Hinchingbrooke.

I am pleased, by the way, about the recent tendering for Cambridgeshire older people services, which I will talk about later. However, under the current Government’s legislation—which, incidentally, I opposed, because doing things in that way was not right for this Government or the previous one—the bid went to the NHS, with the mental health trust and Addenbrooke’s hospital providing the better services.

Cambridgeshire starts off with a particular historical situation and no money, so it is no wonder that we struggle to fund mental health properly. Things get worse. The CCG ran a small deficit last year, which is hardly surprising, but that makes it ineligible for quality premium payments, which could have brought in another £1 million. How can it make sense to starve CCGs of funding as a punishment for not having enough money to do the job properly? No one will be surprised to find that there is a correlation between budget outcomes and how well funded CCGs are: areas with funding above their fair-share calculations run surpluses, while those funded below their fair share run deficits and get punished for it. The deficit of £4.9 million from last year has to be repaid this year, putting even greater strain on the CCG, given an underfunding level of almost 10 times that figure.

In fairness to the CCG, it provides proportionately about the same allocation to mental health as everywhere else. We start off with far too little, however, so mental health gets far too little—one of the worst levels of funding in the whole country. That is in spite of long-term underinvestment and the huge pressures of growing demand—a 12% increase in the number of people with serious and enduring mental illness, but no extra money to cope with it. Given that the previous Government introduced a payment by results tariff system for physical health, but left mental health using the block grant system, extra demand—extra work—does not lead to extra funding. Yet again, changes were made to help physical health care rather than mental health care. As we rightly reduce stigma and tackle the huge unmet need for mental health support, more and more people will realise they need help and will seek it, but will discover that it is not there for them.

We have seen other problems. There was a suggestion from NHS England that there should be differential deflators—larger savings on mental health treatments than on physical health treatments. I know that infuriated my right hon. Friend the Member for North Norfolk, and I understand that the situation will not be repeated, which is welcome. I was disappointed to see that my own CCG complied with the suggestion, although in fairness it gave an extra £1.5 million for mental health services and as of next April will give a further £2.2 million to help meet targets for improving access to the psychological therapies programme.

The Nobel laureate Ernest Rutherford said, “We haven’t got any money, so we’ll have to think”, and providers in Cambridgeshire and Peterborough have had to be creative to cope with the awful funding position. We have seen many innovations. The mental health trust has set up a single point of access known as ARC—the advice and referral centre—reduced out-of-area placements and focused more on community teams. Its recovery college is doing good work in advancing the recovery model of mental health care.

We are doing some amazing things to use resources more efficiently in joint working. The £800 million contract for Cambridgeshire older people’s services—as I said, that stayed in the NHS—will combine acute trusts, mental health and community care, to help people seamlessly so they are not passed between one organisation and another. In particular, it should mean a sharp decline in the number of delayed transfers of care, where an older person is stuck in an acute hospital bed—at great expense and not to their benefit—because there is no alternative available in the system. No longer will Addenbrooke’s hospital have to negotiate desperately for community care beds; there will be one system. The contract design, with outcomes-based contracting, means that, rather than rewarding activity, there is an incentive to reduce the need for treatment. Keeping someone healthy longer is better for them and cheaper for us than treating them when they are ill.

We have to do much more on prevention, an issue I know the Minister cares greatly about. In his Five Year Forward View, Simon Stevens called for a radical emphasis on public health and prevention; promoting public mental health must surely be a key part of that, with resilience and well-being as the core. Mind recently called for local authorities to prepare public mental health strategies. Cambridgeshire county council’s health committee, chaired by the excellent Councillor Killian Bourke, has already commissioned such a strategy and plans to spend £120,000 on it. It will attempt not only to promote mental health in the very widest sense but to target groups that are particularly susceptible to experiencing problems, investing in effective, evidence-based interventions.

We also need to focus on recovery, on which the mental health trust’s recovery college is leading the way. Recovery is an approach to mental health that recognises that full recovery is not always possible—some conditions are lifelong—and seeks to enable patients to recover their lives from their conditions so they can live more fulfilled lives. That is in contrast to the attachment model, in which people are stuck as service users for ever. However, a recovery-led approach has to be properly resourced and must not simply be used as an excuse to close down services; otherwise, discharged patients will just be shut out of services and will return to being bounced around the system, looking for crisis care.

We need good crisis care as well, so that people can receive help. I again pay tribute to my right hon. Friend the Member for North Norfolk for his work on the crisis care concordat, bringing organisations together to deal with such crises. Currently, a huge load is placed on the police and acute hospitals—they end up dealing with people who should not be there but have nowhere else to go.

We must also make sure that there is a wider understanding of mental health throughout the health system. Primary care is key. I am astonished that GPs do not have compulsory training in mental health care. They will surely deal with mental health issues regularly, given that one in four of us will have a serious mental health condition at some point. Why are GPs not expert in mental health care? They could do far more to help people recover, remain independent and live better lives.

The voluntary sector is also key. I pay particular tribute to organisations such as Mind in Cambridgeshire, led by its very able chief executive Sarah Hughes; she has driven forward the crisis care concordat which was signed for Cambridgeshire and Peterborough just a couple of weeks ago. I also pay tribute to organisations such as Rethink Mental Illness, the Richmond Fellowship, Lifecraft, Centre 33, pinpoint, the SUN network, Arts and Minds and many more, whose work is hugely valued.

Finally, I will focus on an issue particularly close to my heart: child and adolescent mental health. It is a very important issue, because those who experience their first mental health problems at that stage can often be helped to recover completely. Often, the problems are a product of their environment, so early intervention can be radically preventive; however, waiting lists are far too long. In Cambridgeshire the health committee is trying to work with Centre 33 to provide more counselling support for young people. We have to go further on that and sort this issue out. Pinpoint and Healthwatch have recently contacted me about the urgent need to do more for child and adolescent mental health services. Many of my constituents have been in touch on that matter, as well.

There is far more that I could talk about. For example, I could discuss the troubled implementation of the Epic e-hospital system at Addenbrooke’s and the lessons we have to learn from that, the ongoing problems in the East of England ambulance service, or the desperate need to reopen community care beds in Brookfields hospital so that people can be moved from Addenbrooke’s into appropriate care. I could also talk about many positive things, such as the move of Papworth hospital to the Cambridge biomedical campus, which is proceeding apace, planning permission having recently been granted after my right hon. Friend the Chief Secretary to the Treasury approved the funding.

I will conclude instead with a plea. Mental health services in Cambridgeshire, and indeed across the country, are simply not good enough. I welcome the Government’s commitment to change that, and the idea of parity of esteem in particular, but it is not enough. We also need more money in mental health care across the board—hence my plea to the Minister for an extra £500 million targeted on mental health care.

In Cambridgeshire, we face a financial crisis across all forms of health care. Our low funding levels, historical commitments and growing population create a triple whammy. However, there is a way forward. Just yesterday, I took the chief executive of the mental health trust and the chair of the clinical commissioning group to see my right hon. Friend the Member for North Norfolk to make the case, and I think he was sympathetic to our position.

I will say here, to this Minister, what I said then to that one. There is an opportunity now, given the extra money that I and others campaigned for in the autumn statement. That extra £2 billion will have to be allocated somehow, so what formula should be used? I urge her in the strongest terms not to use the current ratios. That would mean giving extra money to areas already getting more than their calculated fair share, and less to those of us who are behind that fair share. Instead—I hope she will press NHS England on this—the money should be used to jump-start the shift to the new fair formula.

I understand why the transition is being made slowly—those areas with more funding than the fair share probably do not feel overfunded, even though they are able to run a surplus. But the new money allows us to correct the deficiencies for low-funded areas without creating losers. I am aware that £200 million has been earmarked for challenged health economies, and we are one of the 11 that have been so labelled. Although I welcome that, the Government should allocate all the money to move people up to the fair share if they are below it. I know that if our clinical commissioning group got the missing money—the £35 million that the fair shares formula says we should have, plus our share of the extra £2 billion—a high proportion of it could and would go on mental health care, transforming, helping and saving many lives. I hope the Minister will do what she can to make sure that that happens.

Patient Safety and Medical Innovation

Julian Huppert Excerpts

Tuesday 9th December 2014 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

Like books, one should never judge a Bill by its cover. Later this week, the Medical Innovation Bill reaches Report stage in the House of Lords, but I would like to demonstrate that it is fundamentally flawed in its premise, it is unnecessary, it removes essential protections for patients, and it increases the risks of their exposure to maverick doctors. I believe it will undermine not only patient safety but medical innovation and so will have precisely the opposite effect to that intended.

Under current law, a doctor is negligent if he or she acts in a way which no responsible body of medical opinion would support, or which is irrational or illogical—the so-called Bolam test, as refined in the case of Bolitho. The Bill would rewrite the law on clinical negligence and a doctor whose decision to treat would not be supported by any responsible body of medical opinion, or was illogical or irrational, would be able to call on a new Saatchi defence if they fulfilled the procedural requirements of the Bill. That is important: the Bill’s protection of doctors applies if the procedural requirements are met. The Bill states:

“For the purposes of taking a responsible decision to depart from the existing range of accepted medical treatments for a condition, the doctor must…obtain the views of one or more appropriately qualified doctors in relation to the proposed treatment”.

There is no requirement for the second doctor to have seen the patient or even read their notes, and no requirement for them to be independent. They could be working at the same private clinic. It is of little reassurance that the treating doctor must

“take full account of the views”

of the second doctor if the second doctor is in collusion with the first in that treatment, which may be unreasonable.

If the Bill is passed, we will put patient safety at risk and we will no doubt have to return to amend the legislation subsequently. Let me quote from a letter forwarded to me by a constituent who had met a visitor to my constituency who managed to convince him utterly that this individual’s company had found a cure—a miraculous treatment—for cancer, but was being obstructed by a vast conspiracy in the medical community. In the letter, David Noakes, who describes himself as the chief executive of a biotechnology company, refers to a compound he calls GcMAF, which he describes as

“a human protein, present in 5 billion healthy people, that removes a number of diseases, including terminal stage 4 cancer. It has no side effects.”

He attaches a couple of scientific-y looking papers, which have no bearing on proving its clinical effectiveness. Mr Noakes continues:

“It’s always difficult to get feedback, but we have hundreds of superb results. In Guernsey, we treat over 100 people and…have 50 successes including 10 excellent cancer results. We have perfect feedback in our German and Swiss clinics, where our 7 doctors reduce tumours at the rate of 25% a week”.

He says that he cannot do it in the UK

“because the law is so destructive.”

Here is the bit that really worries me. Mr Noakes states:

“But we state that if you have terminal stage 4…cancer, have not had chemotherapy, and you do the”

so-called

“GcMAF protocol, you have an 80% chance of being cancer free in a year.”

In other words, what the company is specifically saying to people is that they can look forward to that result if they do not have chemotherapy—it is actively encouraging people not to have evidence-based treatment and promising that it has a cure for cancer.

Mr Noakes says that

“The pharmaceutical industry is not interested in”

this treatment, because there is no profit in it—

“it is too cheap, and can’t be patented”.

He says:

“The chemo lobby is so powerful it has changed British law so that doctors are only allowed to prescribe the poison of chemo for cancer when there are…better treatments.”

He adds, specifically:

“Lord Maurice Saatchi is trying to get that law changed with his Medical Innovation bill, but against so powerful a lobby”—

and so on. In other words, for this individual and the seven doctors to whom he refers, the Bill would be carte blanche. They see it as a Bill that would provide them with protections. The Bill specifically refers to medical practitioners and doctors as the people who can take this forward—not homeopaths or unregistered doctors. He says that he has seven doctors in his company. If one of those seven consulted another doctor in the clinic, it is highly likely that they would agree that this was an eminently sensible treatment.

[Dr Julian Huppert (Cambridge) (LD)]

I thank my hon. Friend for giving way and for securing this debate on an important subject. It is a shame that more people are not in the Chamber to discuss it. There are some very real concerns. Does she agree that people who are terminally ill may be desperate for treatment, and that simply makes them prey to people who may be unethical, who may be trying to push the envelope, and who may be doing things that would harm them but that sound quite good?

[Dr Wollaston]

I agree with my hon. Friend. In my constituency a medically qualified individual attempted to set up a cancer conference. It had to be pointed out that under the Cancer Act 1939 it is not legal to advertise cures for cancer. The Bill would allow people to circumvent the Cancer Act. How easy is it to get a reference to a miracle treatment planted into a magazine article, for example? This is the real danger here. While the Cancer Act protects people against blatant advertising, it does not provide protection against the back-door advertising that we already see. What is to stop individuals who are absolutely desperate—as my hon. Friend has said—going to doctors with articles saying, “This is a cure. I want you to refer me to this clinic.”

[Dr Huppert]

I will try to resist the temptation to intervene too often. Does my hon. Friend agree that this is not just about cancer? We have already had homeopathic doctors, who may practise medicine as well as homeopathy, claiming that they have powerful treatments for Ebola that the World Health Organisation will not let them work on. The Bill would open the door for all sorts of quacks who will do serious harm in the name of medical innovation.

--- Later in debate ---

[Dr Julian Huppert (Cambridge) (LD)]

It is a great pleasure to follow my hon. Friend the Member for Totnes (Dr Wollaston) and the excellent comments she made, although she should keep an eye on her Committee—I am sure she will—which I believe is currently questioning on the subjects of complementary medicine and homeopathic doctors in her absence. It is also good to have the Minister here. Between the three of us, we have a commitment to the idea of evidence-based medicine, which sadly not all Members of the House appear to share. I hope we are all singing from the same hymn sheet in that regard, as my hon. Friend has already set out so eloquently.

Suffering from terminal cancer, or any other serious condition, is clearly awful for anyone, so I understand why people would want to try something in the desperate hope that it might alleviate the problem and help them to survive. I absolutely understand that rationale. However, it does have real risks, and that is part of the problem with the Bill.

Of course we should innovate. We come up with new techniques all the time. As my hon. Friend said, we are far better at treating things now than we have been over time. However, we must avoid using the politician’s syllogism: we must do something; this is something; therefore, we must do this. That is not how it works, but unfortunately it seems to be the approach taken in the Bill.

As we have heard, there does not seem to be a serious problem of stultification and lack of innovation. Oncologist after oncologist will say how they are able to innovate. However, there is a system of research ethics regarding how we decide what is acceptable and what is not. There are ways of making sure that we do not just look at things with a selective bias. The paper that my hon. Friend mentioned described two patients who had had some reductions in tumour sizes, but it said nothing about how many patients had been looked at, or about the outcomes for those who had not been treated. If we pick people out from a large enough pool, we will always find strange things that we can write about or make a lot of money from by setting up a company, if we are allowed to go ahead.

We have to avoid dealing merely with anecdote, because that will lead to people getting substantially sub-optimal treatments. The safeguards in the Bill—I have been through all the proposed amendments as well—are very thin. As my hon. Friend said, asking another doctor makes little difference when that doctor could be somebody else who believes in the same slightly bizarre theory. Moreover, the doctor could be asking another doctor who works for them, because there is quite a hierarchy in medicine. A junior doctor would not feel able to challenge a more senior doctor on something like this.

This Bill tries to solve a problem that does not seem to exist, according to the doctors and lawyers involved. It puts patients at risk, especially if these innovative treatments replace standard treatments that are known to be effective. It opens the door to quacks of all persuasion who want to try out their pet theories but have no proper background and no evidence.

I hope that on Friday, their lordships will see the problems with the Bill and that they will not proceed with it and bring it to this place. I sincerely hope that the Minister, whom I respect for his efforts to improve innovation and his understanding of the role of an evidence base, will make sure that we do not have Government backing for such a Bill. If it does make it here as a private Member’s Bill, I am confident that this House will make the right choice to protect patient safety.

--- Later in debate ---

[George Freeman]

I will happily come on to the existing law and the protections within it.

Three weeks ago, I announced a major review of the landscape of innovative medicines development, which will involve a review of NICE and the Medicines and Healthcare Products Regulatory Agency. It will look closely at how we can develop a new landscape for the quicker development of innovation with patients in the NHS.

I reassure the House that the Government are committed in all this work to putting patient safety first and developing a landscape of evidence-based medicine. I have listened carefully to the concerns of my hon. Friends the Members for Totnes and for Cambridge. I reassure them that I and the Government take their concerns very seriously.

Lord Saatchi has identified the threat of litigation as a potential barrier to innovation. The purpose of his Bill is to set out a series of steps and a clearer legal framework that will make it less likely for doctors to be put off reasonable innovation because of the rather circular defence that the best treatment is one that is already well established. The intention of the Bill is to tackle the risk that the fear of clinical negligence could undermine the commitment of doctors to embracing innovation in the system. It does not claim to be a panacea or silver bullet to solve all our innovation challenges, but to be one measure in the broader landscape.

In Committee in the House of Lords, the Government supported Lord Saatchi’s amendments to the Bill, which added an objective test of responsibility to the doctor’s decision to innovate. The amendments exclude any doctors who act irresponsibly from enjoying the protections of the Bill.

The amended Bill provides a number of other safeguards for patients, including the requirement for doctors to take full account, in a responsible way, of the views of other appropriately qualified clinicians. My hon. Friend the Member for Totnes argues that that does not go far enough. I would be interested to hear the views of Members of the upper House who are more qualified than I am when they debate Third reading at the end of the week. The package of amendments is intended to ensure that there is expert peer review of any doctor’s proposal. Furthermore, it ensures that the doctor must act responsibly in taking account of that review, thereby applying an objective standard to their conduct. In addition, the Bill requires any doctor to consider the risks and benefits associated with the proposed treatment, alternative treatments and doing nothing. That provides a further safeguard.

Let me be clear that we do not want the Bill to prevent patients from taking doctors to court when there is a good reason to do so. Doctors who follow the steps set out in the Bill or the steps required in normal practice should be able to demonstrate more easily that they have acted responsibly, because they will have considered the necessary steps in advance of any innovation. However, by invoking the freedom to innovate that is set out in the Bill, one does not in any way avoid the scrutiny of the courts. Doctors will still have to justify their actions if any case is brought against them, just as they do now.

[Dr Huppert]

At the beginning of the Minister’s comments, he said that he and the Government were keen to ensure that this would not be a divisive issue, and that they would not progress with it if it became one. He now sounds like he is being very supportive of the Bill. Will he provide an assurance that if the Bill continues to have the vast weight of medical and legal expertise against it, whether that is expressed in the House of Lords or by the organisations that my hon. Friend the Member for Totnes mentioned, he will ensure that the Government do not back it?

[George Freeman]

I am merely trying to set out a balanced review of the arguments. In closing my speech, I will give an assurance that I hope will satisfy my hon. Friend on that point.

On protection, under existing common law and in the Bill doctors must show that they have acted responsibly. They cannot simply go through the motions and seek advice from an inappropriate source as that would not be “responsible”, which is the key test in the Bill and common law. Even if doctors follow the steps in the Bill when deciding to adopt an innovative treatment, they might still carry it out negligently and be subject to a negligence claim in the same way. When something goes wrong it is right that patients are free to seek compensation, and that will continue to be the case. The Government do not want any undermining of protection for patients against clinical negligence.

My hon. Friend the Member for Totnes made a point about the Bill not requiring doctors to seek the prior agreement of an appropriately qualified doctor, and instead being required only to take account of their views. I would not want the Bill to give a carte blanche to quackery or non-evidence based medicine. The Bill requires a doctor to take full account of the views of at least one appropriately qualified doctor, just as any responsible doctor would be expected to do, and they would not be able to ignore certain views or give them minimal weight by just “noting” them unless there were reasonable grounds for doing so. All doctors will be bound by the core and primary duty of responsibility and care to their patients. If the Bill were to require the explicit agreement of another doctor to innovate—that is one suggestion made in the other place—we are worried that that would open the possibility of a new negligence action against the countersigning doctor and lead to more confusion. We would not be able to give the countersigning doctor any certainty about their legal position, and they would not be able to rely on provisions in the Bill.

My hon. Friend made a point about undermining confidence in clinical trials. Although the Bill has raised awareness of innovation in medical treatment, it does not confer additional rights on patients to demand innovative treatment. It will still be for the doctor to decide the most appropriate course of treatment in discussion with their patient and using their best professional clinical judgment. Nothing in the Bill allows doctors to bypass any processes or requirements set by their trust when undertaking innovative treatments in the NHS, which includes ensuring that the commissioner would fund the treatment if it is to be provided within the service.

Individual innovation is important but no substitute for medical research and testing the efficacy of new treatments in a systematic way. A large part of my work is about ensuring that we use all of our £1 billion a year for the National Institute for Health Research infrastructure in the NHS, to ensure—as the Prime Minister set out in his speech when launching our life science strategy—that every willing patient is a research patient and every hospital a research hospital, and that we learn from evidence that we develop daily in our interaction with patients. Lord Saatchi and Ministers are determined that doctors should learn from innovative medicine as we go along, and a large part of the NIHR and our data programme is about ensuring that we pick up and track innovations and outcomes more accurately across the system.

[George Freeman]

I would be interested to see the Bill once it has completed its passage through another place and ensure that it contains adequate provision for evidence-based medicine, and that, by encouraging innovation, we are not in any way encouraging medicine that is not supported by the best evidence available.

My hon. Friend spoke about consultation. The Department of Health carried out a full consultation on the issues raised in the Bill, which ran from February to April this year. It was delighted to receive 170 responses to that consultation, making clear a range of opinions. Responses came from a range of audiences, professional bodies, patients and clinicians. Four regional public consultation events were also held. Lord Saatchi attended those events and it was in no small part thanks to his involvement that a number of changes were made to strengthen the oversight mechanisms in the Bill. At every stage, the Department of Health has engaged with Lord Saatchi to develop amendments to align the policy of the Bill with the legal and expert clinical advice we have taken, including from Sir Bruce Keogh.

[Dr Huppert]

The Minister is being very generous, although we do appear to have quite a lot of time. He talked about 170 responses. How many were supportive of the Bill and how many were not?

[George Freeman]

I do not have that information at my fingertips, but I will happily look into it and come back to my hon. Friend if I may.

Crucially, following the Committee stage, Lord Saatchi and the Government have continued to engage with peers and key stakeholders. Let me take this opportunity, on the question of the Government’s support, to reiterate that this is a private Member’s Bill. This is not a Government Bill. We are very supportive of the Bill’s aims and intent to promote a culture and regulatory framework that is supportive of innovation within the NHS, but it is equally important that we do not in any way damage or undermine public or patient confidence in research in this country and in the NHS. I stress that the Bill has not been given Government time. We are supportive of its principles, but it is very important that when it leaves the House of Lords, where it will have been subject to extensive scrutiny by very eminent medical and legal opinion, it comes to us in a format, even if not every single point is unanimously supported, that has the very strong support of our most senior lawyers and medics.

I want to close by highlighting the fact that the Bill has generated substantial interest, both in Parliament and outside. In many ways, if those concerns can be reflected in high-quality scrutiny and the tabling of amendments, we should be able to demonstrate that democracy works and end up with a Bill that both achieves the aims of Lord Saatchi and reassures those with concerns. I want to be clear that, as the Bill completes its passage in the House of Lords, I hope it returns to this House in a form that the vast majority of medical opinion and respectable bodies in the medical field feel able to support. It is not our intention to have a Bill that undermines public or patient trust in research medicine.

We cannot legislate for best practice; we can only legislate to support our front-line clinicians to do what they believe is best for their patients. At the heart of that is a sacrosanct duty of care that all clinicians share, and which the Bill does not in any way weaken or undermine. That duty is to do what is best for patients.

I want to close with some supportive quotes the Bill has received from a number of important people, lest the House should form the view that it is unanimously opposed, which is not the case. Dame Sally Davies, the chief medical officer, has said:

“I am confident that, with the amendments made in Committee stage, the Bill is safe for patients and has the potential to encourage responsible innovation.”

Sir Bruce Keogh, at NHS England, said:

“Encouraging innovation in medicine and protecting patients are both of vital importance. That is why I am pleased that amendments have been devised to address concerns about patient safety.”

Sir Michael Rawlins, president of the Royal Society of Medicine, said that the Bill will allow responsible innovation and treatment:

“I believe the use of the provisions in the draft Medical Innovation Bill will benefit patients, especially those with rarer diseases, and the furtherance of medical science.”

A letter to The Telegraph from 40 leading medical professionals, including David Walker, professor of paediatric oncology at Nottingham university, and Riccardo Audisio, the president of the Association of Cancer Surgery, said the Bill

“legally protects doctors who try out innovative new techniques or drugs on patients when all else has failed. This Bill will protect the patient and nurture the innovator. It will encourage safe medical advancement, while at the same time deterring the maverick, thereby recalibrating the culture of defensive medicine. Finally, it will work with evidence-based medicine and provide new data that will inspire and support new research.”

I hope very much that that is the case and that when the Bill leaves the House of Lords, the vast majority of qualified senior opinion in this field is able to agree with it. It is absolutely our intention to support the Bill’s noble intent to promote medical innovation, but equally our intention is to not undermine in any way the Government’s commitment to patient safety or the duty of care that all clinicians share and owe to their patients.

Question put and agreed to.

National Health Service (Amended Duties and Powers) Bill

Julian Huppert Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford]

There are numerous examples of contracts that are going out to tender, and the cost to the national health service of lawyers and accountants is increasing. The Government have made so much of the issue of bureaucracy in the NHS, but when I asked the Secretary of State about the cost of those lawyers and accountants to oversee the tendering process, what was the response? It was, “We do not collect those figures centrally.” I wonder why that is.

[Dr Julian Huppert (Cambridge) (LD)]

rose—

[Clive Efford]

Ah! The hon. Gentleman is presumably getting to his feet to apologise for supporting the 2012 Act.

[Dr Huppert]

I have no need to apologise, because I voted against it. I was actually about to give the hon. Gentleman credit for introducing this Bill, which I look forward to supporting, and for his role in opposing some of the things that the Labour Government did. Does he welcome the fact that the £800 million tender for older people’s services in Cambridgeshire stayed within the NHS? Does he also accept the concerns that many of us had about the contract at Hinchingbrooke that was put out to private tender by the last Labour Government? I am sure he would agree that that was a problem.

[Clive Efford]

It is just not realistic to compare what went on under the previous Labour Government with what is going on now. Yes, the contract in Cambridgeshire, at Peterborough, was won by an NHS bidder, but what was the cost? How much money was diverted from patient care into running that tendering process? That is an increasing cost to the NHS that we cannot allow to continue. By the way, I unreservedly withdraw my accusation that the hon. Gentleman voted in favour of the 2012 Act, because that is a calumny I would not use against my worst enemy.

Through the House, the Secretary of State would be accountable—

--- Later in debate ---

[John Pugh (Southport) (LD)]

It is a pleasure to follow the right hon. Member for Wentworth and Dearne (John Healey), and I agree with most of what he said, but probably not the conclusion.

It gives me pleasure that we are having this debate. I think we all accept that the Bill will not go right the way through Parliament and end up on the statute book by 2015. We know what will happen: private Members’ Bills are lining up behind one another, and most of them will hit the buffers. However, the Bill moves the NHS debate up a notch.

It is fashionable at the moment to regard the Health and Social Care Act 2012 as a disastrous mistake. In fact, I believe that view is now shared in the Treasury. I did not support the Act, and not for the usual reasons—that it was not in the manifesto or the coalition agreement and was sprung upon Parliament. Those were good reasons, but they were not my main reason, nor was it because I am awkward or I thought it was a good career move. It was not because I did not see some of the upside, which I am sure the Minister will rehearse later—the emphasis on public health, clinical involvement, health inequality and mental health, and a smidgen of democratic accountability.

My main reason for opposing the Lansley Bill was that I saw it as the logical conclusion of a trend that began under Mrs Thatcher, was carried on by Blair and survives to this day. That trend, fundamentally, is an attempt to run the NHS as a market—not a real market, of course, but an internal market; a funny sort of Alice in Wonderland market with none of the advantages of a real market and most of the downside. It is one where everything is free, but prices, wages and policies are set by the Government; where NHS bodies compete not just against the private sector but against one another; where, as others have said, integration and real efficiency often go out of the window; where strategic leadership just does not seem to exist, as the right hon. Member for Wentworth and Dearne said; where we struggle to deliver not products, as in ordinary markets, but entitlements; and where half the NHS, which we call commissioners, is billing the other half, which we call producers—that point has already been made—and bean-counters proliferate on either side and lock horns over bills.

In my view, the Health and Social Care Act was not so much about privatisation, or private industry helping to deliver NHS services—that was already happening under Labour—but primarily about marketisation. Some of course see that as a conspiracy—marketisation as the prelude to total privatisation—but I have to tell hon. Members that marketisation as a faith is still very much around, including on the Front Benches of most political parties, and is supported by practically every health think-tank we talk to.

The market, external or internal, tweak it as we may, simply cannot deliver entitlements and the moral objectives of the NHS in anything like an efficient manner. It cannot deliver to people the care that they need regardless of their means. Worse still, it solves none of the current problems of the NHS, which were largely parked in 2010—the financial pressures on the acute sector, which have come back to haunt us recently; the poor integration of services, which we have still not got right; and the separation of health and social care, which is unfinished business.

If I have a proposal to put to the House, it is that I would like to see the commissioner-provider split ended. That has been mentioned already. We moved an amendment at the Liberal Democrat conference to try to see whether and how that could be permitted. I would like to see the creation of local health boards, charged with integrating services and running them efficiently.

[Dr Huppert]

The amendment my hon. Friend is talking about was proposed by Cambridge Liberal Democrats, and I pay particular tribute to Councillor Kilian Bourke, who chairs the health committee in Cambridgeshire. It suggested allowing NHS commissioners and providers in a local area to form an integrated health organisation if that was what they wanted to do. Does my hon. Friend agree that that would achieve the benefits that he and I seek without the need to force through a massive top-down reorganisation? Would he urge the hon. Member for Eltham (Clive Efford) to accept such an amendment if the Bill made progress?

[John Pugh]

If the hon. Member for Eltham (Clive Efford) wished to talk about that, we could happily move away from the internal market where local circumstances required and demanded it. That would be an entirely sensible policy. I see no reason, though, why health boards should not procure goods and services based on simple best-value principles without all the competition legislation that has been vilified in the debate. They should be funded—as most services are—by capitation and according to local need, and they should be in some way democratically accountable, and I think we can get a genuine public service element back into the NHS. However, not every political party is advocating that at the moment, and some are steering in quite the opposite direction.

--- Later in debate ---

[Mark Reckless]

I will continue, if I may.

[Dr Huppert]

rose—

[Mark Reckless]

I will give way to the hon. Gentleman.

[Dr Huppert]

Although I do not agree with the hon. Gentleman on many things, I welcome him back to the House. He has talked about the history and the evidence. He might be interested to know that, according to the House of Commons Library, the amount spent by NHS England on buying health care from outside the NHS rose from £1.1 billion in 1997-98 to £7.5 billion in 2009-10. Those are the facts, according to the Library.

[Mark Reckless]

The hon. Gentleman is correct. There was a great deal of privatisation and, indeed, fragmentation of the NHS under Labour, and I do not deny that there has been more of it under the current Government. I think that it is a problem that has afflicted both main parties.

--- Later in debate ---

[David Tredinnick]

The Act is complicated. It is a big Act and it landed with a thump when the right hon. Member for Wentworth and Dearne (John Healey) dropped it on the Opposition Benches. I think he did so intentionally; and it was very theatrical and effective. It is true that there is more money there, and it is clear that the Government pledged at the last election to maintain the funding of the health service and have done so. We also have in place the Nicholson challenge, a phrase coined by my right hon. Friend the Member for Charnwood (Mr Dorrell)—formerly the Member for Loughborough—when he was Chair of the Health Committee, and we now face even greater challenges.

Let me set out to the hon. Member for Eltham what he could include in his Bill if it goes forward. He could examine the next stage of bringing together health and social care. On Tuesday, the Health Committee heard from Dame Kate Barker, the chair of the Commission on the Future of Health and Social Care in England. We were examining the transitional costs of bringing health and social care together, and looking ahead at the savings that can be made. The hon. Gentleman might apply his mind to the complications arising from the different streams of funding represented in health and social care, whereby health is funded by general taxation and some private support, which I have already discussed, whereas social care is the subject of means tests and other constraints. We are therefore talking about completely different funding stream. I do not know how the Health Committee will report this, but I was struck by Dame Kate Barker’s determination that there should be one person running health and social care. That is essential if we are going to bring those two things together.

The other point the hon. Gentleman should take on board as we look at the Bill is the high profile that the Secretary of State and his predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), have given to patient choice. The Government have said time and again that patient choice is at the heart of the health service, and we have already seen the benefits. The personal budgets now available for people who are seriously ill have had three benefits. First, they enable the patient to choose whatever treatment they want, be it tai chi, yoga or piano therapy—I believe that there have even been cases where tickets to a football match have been given. This is not something regulated by double-blind placebo controlled trials, as some of the other access arrangements for health care are. Secondly, the personal budgets enable the carers to go out into the world and get jobs, so freeing them up. Thirdly, when the personal budget money is given, it is spent responsibly by the patients. We have a whole new paradigm of health through personal budgets, and that should be examined through this Bill.

I have always felt that the 2012 Act and the reforms that were made produced something that put in place two legs on the stool, not three. The third leg comprises the vast and diverse multiplicity of support services that are not used in great depth in the health service now. Using them would considerably reduce costs and increase choice. The choice of these other support services will inevitably come to the fore as patients demand what they want, and we really have to bring this into the health service.

I have had many conversations about these things with the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter)—the Minister on the Front-Bench today. He has entrusted me with being vice-chair of the herbal working group, which is trying to sort out herbal medicine regulation. When we examine the support services that are not now part of mainstream health care, we see that we have a fundamental problem relating to the insistence that we rely on evidence-based medicine. I do not know where that phrase came from—it has not been around for a long time. Various bodies protect the public, and all new drugs are carefully scrutinised, by the pharmacists and the Herbal Medicines Advisory Committee, which has put together a list of what are, in effect, poisons and bans the use of some herbs. The public are protected in that way, but it is very difficult to use normal measurements to assess the effectiveness of, for example, acupuncture, which the National Institute for Health and Care Excellence has approved for treating lower back pain. A lot of evidence shows that acupuncture can reduce the effects of lower back pain and save the NHS a lot of cost. With homeopathic medicine, which I have long supported and advocated, it is impossible to run trials on every dilution: some are so dilute that they do not show up.

[Dr Huppert]

Will the hon. Gentleman give way?

[David Tredinnick]

I am always glad to give way to the hon. Gentleman—I am sure he will agree with my every word.

[Dr Huppert]

My hon. Friend will be well aware that there have been many trials of homeopathic medicines, and the fact is that none of them has shown that they work better than a placebo. He is right that they are very dilute; that is why they do not work.

[David Tredinnick]

The hon. Gentleman makes my point. I remember when some of his friends went to Boots in Kensington high street and consumed the entire stock of homeopathic medicine. They saw that as a huge triumph, as they felt it illustrated the fact that homeopathic medicine was not effective. Of course it did nothing of the sort; it proved that it was absolutely safe to take these preparations under any circumstances, and that the only time they work is if they are in the right preparation and are taken in the right amount, as prescribed by a professional.

I say to the Minister—I hope he will tune in to what I am saying—that we must move away from this insistence on evidence-based medicine and look at evidence-based practitioners. This is an area that has been overlooked for a very long time. There is much evidence that practitioners are well regulated, and we do not need to insist on checking every single preparation that people consume. Five areas of regulation already exist. The hon. Member for Eltham might want to think about that, as it is a matter that could be put into the Bill if it goes to Committee.

--- Later in debate ---

[Andy Burnham]

I told the hon. and learned Gentleman earlier that that was incorrect and that he should withdraw the suggestion, because I did not do that. The contract for Hinchingbrooke was awarded under his Government. I will tell him who this man is. This is the man who, when Secretary of State, introduced the concept of NHS preferred provider, because I believe in the public NHS and what it represents, unlike him. I believe in an NHS that puts people before profit, unlike him. That is the man he is talking to, and that is what I will always stand up for.

[Dr Huppert]

The right hon. Gentleman correctly says that the contract for Hinchingbrooke was let under this Government, but does he not accept that it was he who, when Health Secretary, reduced the list of bidders to five, none of which were NHS bidders, and then to three, all of which were private companies? Does he accept that he could have left NHS bidders in the process, rather than only private bidders? Then he complains when one of the providers that he shortlisted got the contract.

[Andy Burnham]

I am afraid that the hon. Gentleman has to get his facts right, because they are wrong. When I was Health Secretary and Hinchingbrooke needed to find a new operator, I asked local NHS trusts in his area to come forward, and at the time none of them wanted to do that, so we had to find an operator—

--- Later in debate ---

[Andy Burnham]

“Attempted” is the operative word, Madam Deputy Speaker. The hon. and learned Gentleman says that it was my decision, but it was the decision of his right hon. Friend the Member for South Cambridgeshire (Mr Lansley). He did it when their Government came in, and the hon. and learned Gentleman should have the good grace to withdraw what he said.

I was in the middle of answering the intervention from the hon. Member for Cambridge (Dr Huppert)—the hon. and learned Gentleman should listen to this, because he will get his answer. I said that the process should go forward under the NHS preferred provider principle, which I introduced—he seems not to understand that. To correct him, when the previous Government left office there were three bidders, one of which was an NHS provider, so he really needs to get his facts straight—

[Dr Huppert]

Will the right hon. Gentleman give way?

[Andy Burnham]

No. The hon. Gentleman needs to get his facts straight before he tries to shout the odds in my direction.

The Bill gives back to this House sovereignty over the national health service, which millions of people will welcome. The Bill means so much to so many people who are concerned about what is happening to the NHS right now under this Government.

[Andy Burnham]

My hon. Friend is right to remind the House that in 1997 people were spending years on NHS waiting lists, and even dying while still on them. As my hon. Friend the Member for Bolsover (Mr Skinner) said, we brought those waiting lists down, and by the time we left government in 2010 this country had the lowest ever NHS waiting lists and the highest ever level of public satisfaction in the NHS. That is Labour’s record, and we will not let the Government forget it.

What is happening now? NHS waiting lists are back at a six-year high. That is the result of the reorganisation that the Government ploughed through, which nobody wanted. The country did not want it. There are millions of people out there who are concerned about what the Government are doing. It will not have escaped their notice that scores of Government MPs have failed to turn up today to defend what was one of their flagship Bills. What a shower! There are people who kept a vigil outside the House last night, in cold temperatures, imploring Members to be here to pass this Bill because the issues it raises matter so much to them. Then we have the spineless MPs of a disintegrating Government, some loaded up to the eyeballs with links to private health care, who do not have the guts to come here today to argue for what they have done. Is it any wonder that people are losing faith in this place?

[Dr Huppert]

On a point of order, Madam Deputy Speaker. The right hon. Gentleman claimed earlier that one of the bidders at Hinchingbrooke was an NHS provider, but according to the National Audit Office there was Circle, Serco and Ramsay. Can he now either correct the record for the House, or let us know which of those three he believes is an NHS provider?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The hon. Gentleman makes a perfectly good point of debate, but it is not a point of order.

--- Later in debate ---

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I am grateful to have the opportunity to make a few short remarks. The hon. Member for Worsley and Eccles South (Barbara Keeley) is right to be concerned about any problem that occurs in the NHS, but I am sure she would accept that it is an enormous organisation and that the key point is that when things go wrong, the lessons are learned and things are put right. Most of the life of the NHS has been under Conservative Governments, and we on the Government Benches are as proud of the NHS as Labour Members are.

I congratulate the hon. Member for Eltham (Clive Efford) on being a strong voice for Labour principles, but I am concerned that the effect of his Bill will be to undermine the operational independence of the NHS, cause disruption and introduce unnecessary bureaucracy. Putting powers back with the Secretary of State through the re-establishment of powers of direction is going in the wrong direction. Preventing illness, diagnosing and treating patients are not political activities. They should be in the hands of professionals and the operational independence of the NHS means that clinical considerations are paramount. When I was a health spokesperson, I went to look at health systems in Europe, and the key point I took away was that the best systems were those with a lot of clinical input in management.

It is not necessary to rewrite the Act. Instead, the changes we have made need to work their way through. The shadow Secretary of State said that the competition element is dominant in the Act, but that is not true. The procurement policy is set out to secure the needs of patients and improve quality and efficiency. I want to give an example from my constituency of how the reforms are working. Royston is part of the Peterborough and Cambridge CCG. Before that was so, we had a proposal for the redevelopment of Royston hospital. A Royston hospital action group was formed, while the friends of Royston hospital were concerned about the proposals, which were top down. However, Tom Dutton, the CCG strategic lead, has worked tirelessly with the NHS and the local community, as has the local chairman, Dr John Hedges, a GP in Royston, and they understand local needs, so we are now getting tailored provision that suits the needs of my constituents.

I meet the CCG, councillors, local groups and other stakeholders every six weeks, and I believe that we are now getting a service for Royston and a proposal that meet local needs. The £1 billion tender for older people’s services was in our CCG area. The hon. Member for Eltham criticised the cost, but we had a consultation meeting in Royston that 150 local people attended, while 250 local people filled out the questionnaire. The proposal and consultation will have cost money, yes, but the end result was that the tender process was won by the Uniting Care partnership, an NHS partnership involving Addenbrooke’s hospital and the Cambridge and Peterborough NHS trust, and it is now delivering more joined-up care.

[Dr Huppert]

I was delighted with that outcome. One of the successes I hope the hon. and learned Gentleman will mention is the better joint working between acute care, mental health care and community services to avoid delays in the transfer of care. This could be a very good outcome for the NHS and patients.

[Sir Oliver Heald]

That is exactly the point I was going to make. The process, which involved local people, has resulted in a reform that gives us the sort of joined-up care the hon. Gentleman mentions.

To conclude, the Bill seeks to prevent privatisation that is not happening on the ground, while some of the changes we have made are bringing positive benefits for people in my constituency.

Pancreatic Cancer

Julian Huppert Excerpts

Monday 8th September 2014 Westminster Hall

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

Thank you, Mr Chope. It is good to serve under you, and we did hear the applause.

I congratulate my colleague the hon. Member for Scunthorpe (Nic Dakin) on such a brilliant start to the debate and I thank him for the support that he has given the all-party group on pancreatic cancer month after month. May I also put on the record that my interest in the subject comes from having lost my partner to pancreatic cancer in 2009, only six weeks after diagnosis? I am grateful for the support that I received, and continue to receive, as a result of my loss from my hon. Friends the Members for Pudsey (Stuart Andrew), for Milton Keynes South (Iain Stewart) and for Redditch (Karen Lumley). They are sat close to me to keep me going in the debate, and I am always grateful for their support.

I decided to campaign on pancreatic cancer and helped to set up the all-party group, which I now chair. As the hon. Member for Scunthorpe pointed out, that has meant starting to meet others campaigning on the same issue. I have met representatives from charities such as Pancreatic Cancer UK, which acts as a secretariat for the all-party group and is ably led by Alex Ford, its chief executive; from Pancreatic Cancer Action, founded and led by pancreatic cancer survivor Ali Stunt; and from the Pancreatic Cancer Research Fund, founded and led by Maggie Blanks, who lost her husband to the disease.

I have also met Maggie Watts, whose petition ultimately led to today’s debate. As it happens, she lost her husband, Kevin, only two months after I lost my partner, so we have shared and similar frustrations. That shared sense of loss, the sense of injustice and the shocking survival rates for pancreatic cancer, along with the small amount of time that can generally be spent with people following diagnosis, drive us all—whether MPs, chief executives, charity workers or volunteers—to raise awareness and, I hope, to bring about change so that others do not have to go through what we did.

I thank Maggie Watts and the hundreds of people who campaigned so hard to get more than 100,000 signatures on their petition. I know it was touch and go, but they have managed it in only the past few days. The effort that they have put in to change the status quo, in honour and memory of their loved ones, should be applauded. I really thank them.

As the hon. Member for Scunthorpe mentioned, the all-party group on pancreatic cancer produced a report last year, which made a number of recommendations on how to improve awareness, diagnosis, treatment and care for pancreatic cancer patients. We did not even broach the subject of research in that report; to have done so would have complicated things unnecessarily. This year, therefore, the all-party group is carrying out an inquiry into how to increase the quantity and quality of research into pancreatic cancer in the UK. We held the last of the four evidence sessions last week and will be producing a report in late October. I want to spend some time talking about issues that emerged from the inquiry.

[Dr Julian Huppert (Cambridge) (LD)]

I thank the hon. Gentleman and the hon. Member for Scunthorpe (Nic Dakin) for securing this important debate. Before I was elected, I used to do research into cancer targets. Pancreatic cancer was one of them, and I was looking for new targets. I support the call for research. An oncologist who worked on the issue and with whom I was collaborating said, “All my patients will die very quickly from this unless they are hit by a car in the meantime. We have to change that situation.”

[Eric Ollerenshaw]

I thank the hon. Gentleman for underlining that critical point about survival rates and their impact on the ability of researchers to get that much-needed research.

The consensus we found was that more work is needed and that one of the reasons why survival rates for other cancers are increasing is that effective screening and markers have been developed to allow early diagnosis, thus giving more time for curative treatments to be given to patients. The other side of the argument, which we will go into, is that what we are looking for is support and treatment to allow survival rates after diagnosis to increase. In this day and age, having only six weeks left in which to make life-shattering decisions is unbelievably difficult for people.

Mitochondrial Replacement (Public Safety)

Julian Huppert Excerpts

Monday 1st September 2014 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I beg to move,

That this House takes note of the Human Fertilisation and Embryology Authority’s most recent scientific review into the safety and efficacy of mitochondrial replacement techniques which highlights concerns for subsequent generations of children born through maternal spindle transfer and pronuclear transfer; welcomes the recent comments of scientists including Professor Lord Winston that, prior to the introduction of such techniques, more research ought to be undertaken and a full assessment conducted of the potential risk to children born as a result; and calls upon the Government, in light of these public safety concerns, to delay bringing forward regulations on mitochondrial replacement.

I am pleased to move this motion and to have gained support from so many Members from across the House, and I thank the Backbench Business Committee for allowing us the time to debate it.

It is in our interest as a nation to be at the cutting edge of technological progress. However, in striving for such progress, we cannot afford to cut corners when it comes to public safety. Surely this can nowhere be more true than in relation to the proposal that pronuclear transfer or PNT and maternal spindle transfer or MST be permitted in an attempt to create children who do not inherit mitochondrial disease. In 2011, 2013 and 2014, the Human Fertilisation and Embryology Authority or HFEA assessed the safety of the procedures, and on every occasion it reported that further research was required before the public could be satisfactorily reassured regarding them. It described experiments as “critical”, with some not even having started in June 2014. It stated that

“there are still experiments that need to be completed before clinical treatment should be offered. The panel considers that some of these experiments are critical and others desirable.”

Even more concerning, it stated, was that

“the process cannot be expected to guarantee safety or efficacy when applied for the first time in a clinic.”

In other words, to allow these procedures at present would be tantamount to experimentation.

[Dr Julian Huppert (Cambridge) (LD)]

Does the hon. Lady accept that when anything is tried on a human for the first time, we cannot be absolutely certain what will happen? Is she really saying that we should not do anything—no cancer treatment, nothing—until we are absolutely 100% certain that there are no side effects? Does she not accept that we are trying to treat hideous diseases?

[Fiona Bruce]

I accept that in no case can one be 100% sure that a technique will be safe. However, we are very far from that in this case. This is a case of genetic engineering; it is the alteration of a potential human being—the removal of certain genes and their replacement with others, to create children. Surely, in such cases, we should be very careful over safety before we proceed.

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[Dr Julian Huppert (Cambridge) (LD)]

It is pleasure to speak in this debate, and I pay tribute to the work of so many, but particularly the Lily Foundation and the Wellcome Trust which have done a huge amount to prepare for this debate, to educate the public, to support Members of Parliament and to support some of the research.

I do not know, Mr Deputy Speaker, if you or others in this House have met people with serious mitochondrial disorders, but those disorders are absolutely awful. Cells fail to function, and people can get seizures, strokes, blindness, deafness, heart failure, lung failure and liver failure. Most of the people afflicted will not survive to adulthood. There is no treatment and no cure, and about 1 in 6,500 babies born will suffer from something like this. I would hope everybody in this House would want to stop that, and I simply do not understand how opponents of this can argue that they want to continue to inflict that sort of suffering on so many children, because that is the consequence of not finding a way to treat these disorders.

The hon. Member for Congleton (Fiona Bruce) expressed concern that there may be consequences for people who are helped in this way. Her first example was, I think—I am sure she will correct me if I am wrong—lower fertility. Now, that is possible—we will not know until we try it on people—but if I had a choice between a hideous disease that was likely to kill me before adulthood or the possibility of lower fertility, I know which one I would choose.

We also heard the comparison to eugenics. This is fundamentally different. Mitochondrial DNA is very different from nuclear DNA. It has a very different history, and it is a fascinating history—I used to work on mitochondrial DNA and other nucleic acids so I have some interest in this. This is not the same as eugenics, as the right hon. Member for Havant (Mr Willetts) explained well—it is good to have him in the Chamber, even if he is not in his former place.

We have heard arguments about multiple parents and the idea that this approach means that somehow there are three parents, but there are clearly two parents. I have not heard people say that if someone is given an organ donation and they have someone else’s organ inside them, they then have four parents because they have a lot of different DNA inside them which could interact. I think—I would hope—that all of us support organ donation, because it has saved many, many lives. Why should we not allow what is, in effect, mitochondrial donation?

We have heard the view that we should wait for there to be much greater safety. My mother had breast cancer a couple of years ago and she wanted to choose which of the two most modern treatments she should have. She wanted to know what the life expectancy was and whether she would live for 15 more years with either treatment. The answer was, of course, that we do not know, because with the most modern treatments we have not waited 15 years to find out. But I do not think any of us would say that we should not use any single cancer treatment that has been used this century because we do not know whether someone will live for 15 years after having it.

[Graham Stringer (Blackley and Broughton) (Lab)]

I agree completely with what the hon. Gentleman is saying. Does he agree that the motion would be better if it was asking for these enabling regulations to be hurried up? They will take into account, as much as one can, all the safety issues, and by delaying them we may be condemning more children to horrible diseases that could be prevented if we hurried this process up.

[Dr Huppert]

The hon. Gentleman is absolutely right, but I would improve the motion in a number of ways. I would not try to characterise Lord Winston’s position as being fundamentally different from what it is. I would also say that we need to have these regulations so that the tests can be done and so that we can go ahead with clinical trials and find out what happens in humans. I hope that the Government will introduce the regulations promptly. It has been useful to have this airing of views, but it will be helpful when we have the regulations before us to have that debate. This House will then be able to vote on whether or not to adopt the regulations.

[Lady Hermon (North Down) (Ind)]

May I assume—I am sure I am right in doing so—that this technique has already been trialled on mice and that the hon. Gentleman will know whether those trials have been successful? It would help the House if he could enlighten us about the success or otherwise of using this technique on mice.

[Dr Huppert]

I do not have a list of the organisms it has been tested on, but it has been widely tested on a number of organisms—I assume that mice are one, but I could not be absolutely certain—and has been successful. Obviously, if it was not successful on any other organism, it would be perverse to want to go ahead with it. However, I do not have details on the experiments with me.

I understand and appreciate that some people have genuine religious or ethical objections about interfering with an embryo. They are entirely welcome to make that case, but they should not claim other reasons as a cover for that. People are welcome to their ethical opinions—that is fine—but to say that we should not do this because we should wait indefinitely for more and more tests, so that we can be more and more sure before we ever try it in a human is simply to condemn more children to more pain and more anguish. That is not the right way to go. We do need to do more tests; there is much more to do before this will become a regular thing on the NHS and people can be saved—there is no doubt about that. But for that to happen, it has to be tested in humans—it has to be tested in children. We will help at that point, and I hope we will have children who do not have the sort of hideous problems we see now. I urge the Government to get on with this. We have to reduce the number of children who have these hideous conditions. The Government have the chance to reduce it and they should act promptly.

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[Dr Huppert]

indicated dissent.

[Ian Paisley]

Yes, you did. Check Hansard. You said, “You have inflicted this disease on people.”

The debate has got very personal—it has gone into that realm—and people are trying to felon set, to emotionally blackmail, to emotionally charge the debate and to say that people are, to quote another Member, scaring us into opposing this. We must be abundantly clear that such emotional blackmail should be removed from the debate. There should be an honest debate and we should be allowed to discuss the ethics and to put on the table our views, including our moral views.

Oral Answers to Questions

Julian Huppert Excerpts

Tuesday 1st April 2014 Commons Chamber

[Jane Ellison]

The hon. Gentleman is right that research is vital, and a great deal of it is going on in this area. I recently met the all-party group on ovarian cancer to update it on that research, and I will be happy to update him after questions. He has mentioned before how research applies across our United Kingdom. As he knows, whatever we learn through research in England is always shared across the different countries.

[Dr Julian Huppert (Cambridge) (LD)]

Health care in Cambridgeshire has been underfunded for years, and mental health care particularly so. This is getting worse as a result of the private finance initiative contracts that were signed, the differential deflator for mental health and physical health, and the simple fact that mental health demand is up. Will the Secretary of State meet me and the mental health trust to work out a way out of these problems that will not harm patients?

[Norman Lamb]

I would be very happy to meet my hon. Friend if that is acceptable to him.

Oral Answers to Questions

Julian Huppert Excerpts

Tuesday 25th February 2014 Commons Chamber

[Mr Hunt]

May I gently tell the hon. Gentleman that the reason why we are having the debate is that this Government decided that people should be able to opt out from having their anonymised data used for the purposes of scientific research, which the previous Labour Government refused to do? When they extended the programme to out-patient data in 2003 and to A and E data in 2008, at no point did they give people the right to opt out. We have introduced that right, which is why we are having the debate.

[Dr Julian Huppert (Cambridge) (LD)]

There are of course huge benefits from using properly anonymised data for research, but it is difficult to anonymise the data properly and, given how the scheme has progressed so far, there is a huge risk to public confidence. Will the Secretary of State use the current pause to work with the Information Commissioner to ensure that the data are properly anonymised and that people can have confidence in how their data will be used and how they can opt out?

[Mr Hunt]

I will do that, and NHS England was absolutely right to have a pause so that we ensure that we give people such reassurance—[Interruption.] When we had a pause before, the result was the very good Health and Social Care Act, which is doing good things for patients throughout the NHS. This programme is too important to get wrong, and while I think that there is understanding on both sides of the House about the benefits of using anonymised data properly, the process must be carried out in a way that reassures the public.

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[Jane Ellison]

I am aware of this case. The point made is rather unfair. My colleague Marina Yannakoudakis MEP has dealt with this issue in correspondence with other Members. The motion was a composite motion. All Conservative MEPs completely condemn FGM, but there was a technical reason why they voted in that way. It is clear that the Conservative party—along, I think, with all Members—absolutely condemns this practice. I am happy to give the hon. Gentleman the detail on that vote afterwards.

[Dr Julian Huppert (Cambridge) (LD)]

T8. Papworth hospital is a world-renowned heart and lung hospital. For years, it has wanted to move to Cambridge, supported by Addenbrooke’s hospital, Cambridge university, the British Heart Foundation, AstraZeneca and many more, but it has been put on hold yet again. Will the Secretary of State make sure that this move, which will help patients, help to develop new treatments and save money, will happen?

[Dr Poulter]

My hon. Friend will be aware that local commissioners take decisions on local services. I will be happy to meet him to discuss this matter further, so we can talk through his concerns and ensure that local health care services are as strong as possible.