Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 20th December 2016 Commons Chamber

[David Mowat]

I have mentioned on previous occasions that Scotland has, in some respects, gone further and faster than we have in England so far on community pharmacies. The £300 million that we have set aside in the integration fund for the rest of this Parliament is going to be used to do just the things that the hon. Gentleman has mentioned, in terms of minor ailments and repeat prescriptions. We are determined to make that happen.

[Julie Cooper (Burnley) (Lab)]

Over the festive period, in every town and city in the UK, community pharmacies will be open to dispense emergency prescriptions, and to provide specialist services and professional advice. Does the Minister appreciate that service, which not only helps the public, but takes pressure off other parts of the NHS? Will he join me in thanking community pharmacies and their staff for the work they do? Will he commit to reconsider budget cuts that will lead to a reduction of this valuable service, and instead meet the Royal Pharmaceutical Society and the National Pharmacy Association to discuss extending the role of community pharmacies, to deliver savings for the NHS?

[David Mowat]

I have met the royal college of pharmacies on a number of occasions, and indeed it has worked with us on the Murray review, which is an essential road map that sets out how we are going to move the community pharmacy network away from a remuneration model based just on dispensing and on to services as well. I agree with the hon. Lady that the 11,000 community pharmacies across the country all provide excellent services, and we expect that to continue.

Child Cancer

Julie Cooper Excerpts

Monday 28th November 2016 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is an honour to serve under your chairmanship, Mr Davies. This debate has arisen in response to a petition signed by more than 115,000 people, including 922 from my constituency, following the sad passing of Poppy-Mai, the little daughter of Mr and Mrs Barnard. First and foremost, my thoughts are with that Lancashire family and all the other families who have endured a similar devastating loss of their children. There can be nothing worse than the loss of a child, so this debate is especially important.

It is important that we increase awareness of the scale of the problem facing children and young people who have cancer and their families, and look for ways to tackle the problems. How can we improve diagnosis? How can we improve research? How can we ensure better access to treatments? Ultimately, how can we improve survival rates? The debate, outlined so well by the hon. Member for Bath (Ben Howlett), has given us the chance to search for answers to those important questions.

In the UK every year about 4,000 children and young people under the age of 25 are diagnosed with cancer. Worryingly, research by CLIC Sargent published last year found that 44% of young people and 42% of parents felt that their local GP did not take them seriously when they presented with symptoms, and 53% of young people felt that their diagnosis had been delayed. Clearly that is not an acceptable state of affairs. Inevitably, delayed diagnoses mean delayed treatment, with implications for survival rates.

In an attempt to improve awareness among GPs, CLIC Sargent embarked on a joint project to develop an e-learning module specifically focused on cancers in children and young people. That welcome work will go some way in helping to improve diagnosis and primary care support for children and young people with cancer, but far more needs to be done. It is a fact that children in the UK with a brain tumour can take up to three times longer to be diagnosed than children in other countries, most notably the United States. Reducing the time to achieve an accurate diagnosis improves survival rates and can reduce long-term disability, which many children and young people diagnosed with a brain tumour currently experience. I hope the Minister can give us some understanding of what the Government intend to do to improve diagnosis times.

Recent figures published by Cancer Research UK demonstrate that in the past 20 years we have seen a 32% reduction in the child cancer death rate. We have also seen five-year survival rates increase from 40% in the early 1970s to 82% today. It is widely believed that those improvements have arisen as a result of more research and better treatments. While they are extremely welcome, they go nowhere near far enough, because the fact remains that cancer is still the leading cause of death among children. Five children and young people die of cancer in Britain every week, and those who survive often go on to suffer long-term side effects from their treatment that can continue into adulthood.

A considerable amount of research is carried out each year in the UK by a multitude of organisations including Cancer Research UK, the Brain Tumour Charity, the Institute of Cancer Research, the Institute for Child Health, Great Ormond Street Hospital and the Teenage Cancer Trust. Last year, Cancer Research UK committed to doubling research spending on children’s cancers. That will go some way in helping to discover new treatments. We all thank it and welcome that commitment, because currently only 3% of UK funding into cancer goes to child cancers.

It is important to remind the Government that many of those organisations are charities, which have relied on high levels of funding from the European Research Council. The Brain Tumour Charity stated that the result of the referendum on EU membership has created great uncertainty for charities conducting research into childhood cancers. Post-Brexit, the Government must ensure that the UK medical research community continues to have access to EU funding programmes once Horizon 2020 has ended. Similarly, I seek reassurance from the Minister that any shortfall in research funding as a result of our exit from the EU will be met by the UK Government. If we are to improve outcomes for children with cancer, it is paramount that we have research conducted to understand further these awful diseases.

Following improvements to diagnosis processes and research, we must ensure efficient access to treatment. Children and young people with cancer face a range of barriers in accessing new and better treatments, including drugs not being tested in their age group or in the cancers they are likely to get, even when a drug may be effective in treating their cancer. Simply challenging the age restrictions set on new trials is already increasing participation rates. That should be done in tandem with the provision of age-appropriate information about trials delivered by skilled, specialist staff.

Currently, the cancer patient experience survey does not collect data on cancer patients under the age of 16, and we have seen a 40% decline in response rates from teenagers over the age of 16 and young adults in the past five years. It is unacceptable that little or no progress has been made on this issue. Understanding patient experiences is important to improve future services. The cancer strategy includes plans to deliver a methodology to collect under-16s’ experiences, and NHS England is doing that alongside CLIC Sargent. Will the Minister helpfully update us on that work and tell us when we can hope to see the data being collected?

Achieving viable numbers for clinical trials on child cancers is understandably problematic given the relatively small numbers and rarity of some child cancers. However, we cannot allow that to be used as an excuse for not improving treatments for children and young people with cancer; instead, it should push us to innovate. Cancer Research UK has led the way in challenging the age restrictions on clinical trials, calling for more flexibility when it comes to age and ensuring that researchers justify age restrictions so that they rethink approaches to include children and young people.

[Wes Streeting]

Particularly for rare forms of cancer or brain tumours such as DIPG, it is important that clinical trials take place at scale. Does my hon. Friend agree that, after the UK leaves the European Union, the Government should seek to ensure that there is as much alignment as possible in the regulatory framework between here and the rest of the European Union so that clinical trials on the European level can continue to take place?

[Julie Cooper]

I am grateful to my hon. Friend for making that important point. It is essential that the UK’s exit from the EU does not negatively impact on further research. We must benefit collectively from work done in other countries. To pick up on the point other Members made, we must pool good practice and ensure that our good practice and successful research are shared throughout the world and that we benefit similarly from experience elsewhere.

In the cancer strategy, there were specific recommendations relating to children, teenagers and young adults’ services and how they can be improved. I was concerned, though, that in September the Government made an announcement on wider measures in the strategy but failed to mention anything about the important issue of seeking consent from children and young people for their data and tissue collection to be used in future research studies and the development of services, nor did they include a requirement significantly to increase access to clinical trials for teenagers and young adults with cancer.

Currently 30% of teenagers and 14% of young people aged 20 to 24 enter trials for common cancer types in children and young people. In 30 years there has been no progress in that area. The cancer strategy set a target for NHS England to recruit at least 50% of children and young people in cancer centres or designated units treating teenagers or young adults. That is welcome, but will the Minister give us a progress report and tell us how long it will be before the target is likely to be met?

I pay tribute to the Barnards, to the other families mentioned today and to the children and families across the UK affected by cancer for their courage in the face of this most awful of illnesses. I ask the Government to understand those families’ need for support. We have heard some moving stories today. They need support in a wide sense—from specialist units and through better access to information. Importantly, they also need financial support. Several hon. Members have powerfully made the point today that the costs of cancer are physical and emotional but also financial. We must do more and better.

I want to hear what specific plans the Government have to improve the speed of diagnosis; I want a guarantee that the Minister will protect research funding post-Brexit; and I want to know what plans she has to increase the number of clinical trials, to ensure that access to life-saving treatments is the best possible. Children and young people deserve no less.

--- Later in debate ---

[Nicola Blackwood]

There is also work being done on making sure the workforce are in place; and there is an overall strategy with Health Education England to do that. I am happy to write to the hon. Lady to give her details. I am slightly concerned that I have a lot to get through and I am going to bore everyone.

The taskforce has also recommended a new drive to deliver chemotherapy e-prescribing, which makes a significant difference to the experience of families who are supporting children being treated for cancer. Providers are working to implement plans for children by September 2017. Under the strategy, proposals will have been developed by March 2017 to improve the transition of young patients with cancer between children’s and adult services. As the hon. Member for Bristol West (Thangam Debbonaire) has said, transitions continue to pose a problem in some areas, with paediatric services stopping at 16 in some hospitals, but adult services not starting until 18. In addition, pathways between specialist centres and shared care units currently cause great difficulty for patients. The strategy says that there is a need to address that, and I hope that the hon. Lady will be reassured that work is being done on it.

An important recommendation of the strategy is that NHS England, the National Institute for Health Research and cancer research charities should work together to consider how to achieve a significant increase in access to clinical trials for teenagers and young adults with cancer—the shadow Minister, the hon. Member for Burnley (Julie Cooper) spoke about that. A far smaller proportion of teenaged and young adult patients than of younger children take part in clinical trials. There is obviously an opportunity that we need to grasp. The strategy recommends that we explore ways in which clinical trials for children and young adults with cancer could be significantly increased. As the shadow Minister said, NHS England should set an expectation that all centres should aim to recruit at least 50% of their patients for those trials by 2025. That is the target that we are reaching for.

Outside London, only four centres treat more than 100 children with cancer a year, across all types of cancer. The strategy recommends that NHS England, working through the children, teenagers and young adults clinical reference group, should consider whether outcomes could be improved through further reconfiguration of services, as the shadow Minister said. Any review should again be based on patient outcomes, including patient experience, as few centres offer comprehensive specialist services for children at the moment.

Many hon. Members have rightly called for research to be prioritised in that context. It is good that, since 2010-11, we have increased annual investment in cancer research through the National Institute for Health Research, including research into childhood cancers, from £101 million to £142 million. However, we know that a lot more needs to be done if we are to deliver the changes that we want to see. That is why the Government announced the largest ever investment in health research in September— £816 million over five years from April 2017. Some 20 NHS and university partnerships across England have each been awarded funding through the NIHR, and we expect to see significant research activity in childhood cancers within that programme of investment.

The NIHR is also collaborating with three charities—Teenage Cancer Trust, Children with Cancer UK and CLIC Sargent—to identify gaps and unanswered questions in research into young peoples’ cancer and to then prioritise those gaps that patients and clinicians agree are the most important. The initial survey opened just last month, so we expect to see progress on that soon.

A new working group has brought together clinicians, charities and officials to discuss how we can increase the level and impact of research into brain tumours, including those in children. The group first met in October and the Government anticipate that it will complete its tasks by September. I will be co-chairing the next meeting in January with the Department of Health’s chief scientific adviser, Professor Chris Whitty, to make sure that we make the progress needed.

[Julie Cooper]

Does the Minister agree with the important comments made by brain tumour charities that EU funding is fundamental, and will she commit to ensuring that, should we not have access to EU research funding post-Brexit, the UK Government will make sure that that gap is filled?

[Nicola Blackwood]

The shadow Minister has made some important points about the EU, as have a number of colleagues, and I will come on to them before I finish. First, let me complete my remarks on the amount of funding that we have put into research, because it is important that it is seen as a package. Less than two weeks ago, the Government announced a further £112 million of funding to support the skilled personnel and cutting-edge facilities needed to help at the forefront of clinical research—experimental clinical research in particular, including research into child cancers. I visited one of those facilities myself, and they are an important aspect of the research we are supporting. The Chancellor announced £2 billion additional funding per year for research and development by 2020-21 in the autumn statement, including for scientific research at universities and businesses. That is another part of the picture.

The hon. Member for Birmingham, Selly Oak, who is not in his place, spoke of the importance of precision cancer medicines. The Government agree, which is why we have funded the 100,000 genomes project, to diagnose, treat and prevent rare disease and cancer, including childhood cancers. The Government have invested hundreds of millions of pounds in that project to date and it is already making a difference—the first children with rare diseases have received diagnoses through the project at Great Ormond Street Hospital. The project promises to offer a genuine step-change in diagnosis and precision treatment, which is encouraging.

Clinical Commissioning: North Durham

Julie Cooper Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

I am grateful to my hon. Friend the Member for City of Durham (Dr Blackman-Woods) for bringing this important subject to the fore. I have a few comments. First, on the question of the impact on patients, what assessment has been made about conditions going untreated? There has been nothing about safety implications. Patients could be affected in two ways: a condition might be untreated and, as has been mentioned, their private, confidential information would go to a private company where the people are not medically trained. We have already seen from other contracts, such as with Capita, total disrespect in the handling of patient records.

Secondly, what is happening is a challenge to the professionalism of general practitioners. We spend a lot of time and money, over many years, on training experts. No wonder we cannot retain staff in the NHS if this is how we treat them. Some important questions need to be answered. The whole thing is cloaked in secrecy. There is an underhand feel to it. It is important that we get answers to a lot of questions. Can the Minister tell us who decided that what is happening was okay? Why has there been no public consultation or transparency? Where is the risk assessment? Why were patients not informed that confidential information about their health was being shared with a private company? How much is the company paid for its role? How much has been saved? How many referrals have been cancelled? We need the answers because what is being done is rationing by the back door, with the potential to compromise patient safety.

--- Later in debate ---

[David Mowat]

We are moving around a little bit here, but I will come to the point about consultation. The GP that the hon. Gentleman refers to is a part of a CCG that has made the decision to extend the North Tyneside pilot to North Durham. All I am saying is that those GPs are part of the CCG and that presumably the CCG is doing this because it believes the clinical out-turns are right. We have a locally driven system. I will make some progress on the benefits of this for patients.

[Julie Cooper]

Will the Minister give way?

[David Mowat]

I will make some progress; I have taken a lot of interventions.

The benefits to patients are that a consultant will review their case within two or three days of a GP referral and a decision will be made on the appropriate pathway. That is why the King’s Fund recommended these sorts of systems in 2010—in terms of patient out-turns—and that is why it is of benefit to patients.

One example that the hon. Member for City of Durham talked about was a skin case that resulted in cancer. That is a very serious situation, and if it happened in the way that she says, it should be investigated. Another example is when a patient with acne was referred to a dermatologist at a hospital. The referral system said, “Why have we not tried a cream for this first?” That process was put into place two or three days later, as opposed to having an eight-week wait for a specialist appoint. That is of benefit to the patient.

[Julie Cooper]

Will the Minister give way?

[David Mowat]

I have given way a lot; I want to make some progress.

That is also of benefit to GPs, because they can quickly validate decisions on the best pathway for those grey areas that may or may not require a referral with a consultant who knows more than them about that particular discipline. Of course, it is of benefit to the providers because it takes away something like 20% of unnecessary outpatient appointments. Indeed, one of the providers for the scheme in North Tyneside has asked for it to be extended to an additional discipline, because they feel that some of the referrals they receive are unnecessary and that the referral management system—in the way we have been doing it in the NHS for the past decade—is a mechanism for preventing that.

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Hunt]

I am happy to do that, and I would like to pass on my congratulations to Dr O’Toole, who obviously does a fantastic job for my hon. Friend’s constituents. We are investing significantly in general practice, with a 14% increase in real terms over this Parliament and our ambition to provide an extra 5,000 doctors working in general practice. This will mean that the need for locums will become much less and we can have much more continuity of care for patients.

[Julie Cooper (Burnley) (Lab)]

The Secretary of State and the Minister will be aware that Capita has wreaked havoc in GP surgeries across the land, placing extra pressures on already overstretched NHS staff, compromising patient safety and breaching confidentiality. Last week, I met a group of practice managers who told me that some patient records have been missing for months, while others have turned up apparently half-eaten by mice. Given that this contract was introduced to save the NHS money, will the Minister tell us how much it is costing to rectify the mess and what steps she is taking to compensate GPs for the expenses they have incurred as a result of ill-conceived and poorly implemented contracts?

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

The hon. Lady is right that the current delivery of this contract by Capita is unacceptable. I have met NHS England and Capita regularly to make sure that rectification plans are in place. We are assured that these steps are now in place and that the programme will improve.

Health Service Medical Supplies (Costs) Bill (Second sitting)

Julie Cooper Excerpts

Committee Debate: 2nd sitting: House of Commons
Tuesday 15th November 2016 Public Bill Committees

[The Chair]

Today we begin line-by-line consideration of the Health Service Medical Supplies (Costs) Bill. Before we begin, if Members wish to remove their jackets, they may do so. Even though it is winter, it is very warm in here, so I have asked for the windows to be opened at some point. I want people to feel comfortable and relaxed. Will Members and, indeed, members of the public make sure that their mobiles are switched to silent, so that we are not disturbed during our proceedings?

On the table to my left, the selection list of today’s amendments—the order of business—is available for colleagues. It shows how the selected amendments have been grouped together for debate. Grouped amendments are generally on the same or a similar issue, as colleagues know, and the Member who puts his or her name to the lead amendment in a group is called first. Other Members are then free to catch my eye—to do so, please will you rise from your chair by more than one inch? That would be helpful. If called, Members may speak on any of the amendments in the group. A Member may speak more than once in a single debate.

I will work on the assumption that the Minister wishes the Committee to reach a decision on all Government amendments. Please note that decisions on amendments do not necessarily take place in the order in which they are debated; they take place in the order in which they appear on the amendment paper. In other words, debate occurs according to the selection and grouping list, but decisions are taken when we come to the clause that the amendment affects. I hope that that explanation is helpful to Members. I will use my discretion to decide whether to allow a separate stand part debate on individual clauses and schedules following the debate on the relevant amendments.

Clause 1

Voluntary schemes

[Julie Cooper (Burnley) (Lab)]

I beg to move amendment 44, in clause 1, page 1, line 14, at end insert—

“for the purpose of investing in access to new and innovative medicines and treatments.”

[The Chair]

With this it will be convenient to discuss amendment 46, in clause 4, page 3, line 22, at end insert—

“(c) the NHS’s duty to promote innovation.”

This amendment would introduce a requirement for the Secretary of State to take account of the NHS’s legal duty to promote innovation, as set out in the Health and Social Care Act 2012.

--- Later in debate ---

[Julie Cooper]

It is a pleasure to serve under your chairmanship, Mr Pritchard.

I will begin by outlining our overall priority for the Bill and, in particular, this clause. Our priority is to ensure that the Bill effectively controls the cost of medicines and medical supplies to the national health service while ensuring the best possible patient access to existing products and to new and innovative treatments. In that spirit, I would like to make some observations in support of amendments 44 and 46.

The clause will amend section 261 of the National Health Service Act 2006 and it is concerned with the powers related to the control of voluntary schemes. The stated aim of the clause is to give the Government new powers to require manufacturers or suppliers to pay the Secretary of State an amount that will be calculated on the basis of sales or estimated sales. The Opposition support the move to curtail excessive profits, thereby ensuring that the NHS achieves maximum value for money. Having said that we welcome saving vital NHS funds, we also wish to ensure that those funds are retained within the portion of the health budget that relates specifically to the supply of medicines and medical supplies. We do not wish to see the savings lost in an NHS deficit black hole.

On Second Reading, the Secretary of State confirmed that £1.24 billion had been returned to the Department of Health through the rebate scheme. That is a considerable amount of money, and the figure will increase when this Bill is enacted. However, we were not reassured by his vague statement that the money returned to the Department would be reinvested in the NHS.

Also on Second Reading, the Secretary of State mentioned the considerable pressures facing the NHS and he suggested that one consequence of the Bill would be to transfer funding from the drugs bill to the frontline. I hope that the Minister present recognises that medication is often the frontline and that ensuring the timely access of appropriate medication often prevents hospitalisation and thus saves the NHS money. It is very much a case of a stitch in time.

In addition, it is a fact that community pharmacists the length and breadth of the country have offered to work with the Government to eradicate waste and to cut costs. As the experts on all medication matters, they are best placed to work with GPs and patients to achieve maximum efficiency. Sadly, the Government have responded by taking steps that are likely to lead to a reduction in the number of community pharmacies. This is a missed opportunity and that is regrettable.

Amendment 44 would provide assurance by ensuring that rebates reclaimed against purchases of medicines were reinvested specifically in improving patient access to medicines. In Scotland, rebates collected by means of the voluntary prescription pricing regulation scheme are already specifically earmarked to fund new medicines. In essence, the Bill, which we support in principle, is to ensure that the NHS can procure medicines and medical supplies cost-effectively. I am sure that the intention is not to reduce funding to the NHS, so we cannot have a situation in which every pound repaid from the suppliers and manufacturers equates to £1 less of Treasury funding allocated to the NHS. We are concerned that, too often, budget constraints limit access to new and innovative medicines and treatments.

Recently, I have devoted a lot of time to supporting the campaign to achieve treatment for children suffering from the potentially life-threatening genetic condition of tuberous sclerosis. It is extremely distressing for parents to be informed that their child has been diagnosed with that incurable condition; it is even more distressing to learn that an effective pharmaceutical drug has been developed and licensed—Everolimus, marketed as Votubia —but is not available from the NHS for children in England. The drug is able to shrink the multitude of benign tumours that characterise that serious condition, thereby saving lives, improving quality of life for those affected and often removing the necessity for potentially damaging surgery.

That is one example, and there are many others. James Barrow from the Cystic Fibrosis Trust, speaking in support of the new medicine fund in Scotland, has said that using any reclaimed moneys in that way provides improved access and much needed transparency. Labour’s amendment to the clause would introduce a duty to reinvest any rebates to improve access to new and innovative medicines and treatments, as I have outlined.

Further to that, amendment 46 refers specifically to the duty of the NHS to promote innovation under the Health and Social Care Act 2012. The UK is a world leader in the field of life sciences, and the British pharmaceutical industry is at the forefront of global research and development. In 2014, 20% of all the world’s research and development into new medicines was carried out in the UK.

We have hitherto enjoyed significant benefits from European Union research funding. Given the outcome of the referendum, that is now at risk, and it is essential to ensure that we maintain our dominance in the sector, not least because the pharmaceutical industry employs close to 75,000 people. The promotion of innovation in the field is important not only for the health of the British people, but for the health needs of people worldwide. It is extremely important to the British economy, so it is vital that we do not take our eye off the ball. We need to put on record our continued commitment to research and to develop new treatments.

We face competition not only in Europe, but from emerging nations such as Brazil and China. We also need to ensure that the NHS does not trail in the take-up of those new drugs. Worryingly, the Office of Health Economics studied 14 high-income countries and found that the UK ranked ninth out of 14 across all the medicines studied. Successive studies have demonstrated relatively low take-up of new medicines in the UK compared with other countries. That is bad for patients and bad for our pharmaceutical industry.

The Bill therefore needs to achieve a balance. We need to ensure the best possible patient access to medication at the fairest price, and we need to encourage the pharmaceutical industry to continue to invest in research and development. Therefore, it is right that the Bill should outline our commitment to promote innovation. We look forward to hearing the Minister’s comments, but we are minded to press amendment 44 to a Division.

[The Minister of State, Department of Health (Mr Philip Dunne)]

Mr Pritchard, thank you for calling me and, more particularly, for taking time out of your schedule to chair this important sitting.

On amendment 44, I was interested in the comments of the hon. Lady about the motivation behind it, with which I have some sympathy. I hope that what I say will reassure her that her amendment is unnecessary.

The amendment would require income from the pharmaceutical price regulation scheme and the statutory scheme to be ring-fenced to fund and increase access to new and innovative medicines and treatments. As a Government, we are committed to ensuring that patients have faster access to new and innovative medicines and treatments—I mention briefly the accelerated access scheme that we have introduced.

The hon. Lady touched on the compelling and sometimes tragic cases of individual constituents, friends and relatives seeking to get access to innovative drugs, in particular once those drugs have become authorised. Between 1 March 2000 and 30 June 2016, NICE, the National Institute for Health and Care Excellence, made individual recommendations for 646 separate propositions, 81% of which were recommended or optimised, so there is a steady track record of introducing innovative treatments and, in particular, drugs into our health service. That is done, properly, through the independent NICE structure. I am sure we will talk more about that in Committee.

--- Later in debate ---

[Mr Dunne]

As the hon. Gentleman knows, decisions to allocate spending across the responsibilities of the Health Department were determined as a result of the spending review last year. The decisions within the NHS that I am talking about, on treatments, rather than preventive public health, are determined by clinicians.

Separate to the Bill, Government are taking action to secure the UK’s future as an attractive place for the life sciences sector and to support faster patient access to medical innovations. For example, the recently published accelerated access review sets out ways to increase the speed at which 21st century innovations in medicines, medical technologies and digital products get to NHS patients and their families. Recommendations included bringing together organisations from across the system in an accelerated access partnership and creating a strategic commercial unit within NHS England that can work with industry to develop commercial access arrangements. We are considering those recommendations with partners and will respond in due course.

NHS England and NICE are jointly consulting on a number of proposed changes to NICE standard technology appraisals and highly specialised technology appraisals, including around speeding up the appraisal process. The Department of Health continues to work closely with NHS England and other stakeholders to improve uptake of new medicines. A key element of that is the innovation scorecard, published quarterly. It is designed to help users—clinicians, patients, commissioning groups, Government and other stakeholders—to understand and monitor the uptake of innovations in the NHS and should ultimately be used to promote an equitable spread of clinically effective, cost-effective innovations.

I hope that having heard in particular what I said about the way in which income from these schemes does not rise in a continuum but fluctuates, the hon. Member for Burnley will recognise that the amendment could have the adverse consequence of leading to a reduction in funding available for medicines.

[Julie Cooper]

Will the Minister give way on that point?

[Mr Dunne]

I was about to ask the hon. Lady to withdraw her amendment, but if she has something to add, I am happy to give way.

[Julie Cooper]

Is the Minister aware of problems with the administration of the scheme in Scotland? Is he aware of what the experience has been in Scotland?

[Mr Dunne]

Fortunately, the Committee has the benefit of the Scottish National party’s spokesperson on health, the hon. Member for Central Ayrshire, who I am sure would be happy to give us her experience. The fact is that we have had some experience in England of fluctuating income from these schemes, which is the primary basis for our position.

--- Later in debate ---

[The Chair]

We have the privilege of having two shadow Ministers. I do not know whether either of them wants to respond on amendment 44 or amendment 46, or whether the hon. Lady wants to press amendment 44.

[Julie Cooper]

I am grateful to the Minister for his comments, but I am still keen to press amendment 44 to a Division. The lack of transparency in what is currently available is unacceptable, and there is a danger that the Bill will be contrary to what I am sure is its real intention and cut funding to front-line medication. The amendment would prevent that.

I take the Minister’s point about fluctuation in funding, but I am sure he will agree that if this can be made to work in Scotland, it can be made to work here. I do not want us to fall behind on that. We are all aware of the massive deficit within the NHS. It is very important that funding recouped from pharmaceutical profits is not lost for the NHS and for the real purpose of providing new medicines, and that people in England do not lose because of the Bill. I thank the Minister for his comments, but I will press the amendment to a Division.

Question put, That the amendment be made.

Division 1

Ayes: 8

---

Labour: 6
Scottish National Party: 2

Noes: 9

---

Conservative: 9

[Julie Cooper]

I beg to move amendment 45, in clause 1, page 1, line 14, at end insert—

“(2A) After subsection (1) insert—

‘(1A) In exercising functions in relation to the controls on the costs of health service medicines, the Secretary of State must ensure that any medicine covered by a voluntary or statutory scheme that requires payments calculated by reference to sales of that medicine shall be made available to all NHS patients if recommended by a qualified NHS clinician.’”

The amendment continues in the vein of amendment 44, given our concern to ensure the best access to medicines. We are very much aware of the barriers that exist and are keen that every piece of legislation takes the opportunity to remove those barriers and make medicines more accessible to patients. It is important that the Bill does not inadvertently become a way of restricting that access. Where a clinician deems medicines necessary and desirable, patients should have access to them.

I was worried on Second Reading to hear the Secretary of State’s comment that the prescribing of some medicines is “not strictly necessary”. That questioning of the clinical judgment of the medical profession is not just inappropriate but could be suggestive of a dangerous precedent. We must never reach a stage where politicians decide which medication is appropriate and when. I assume that that was not the Secretary of State’s intention, but we would like to ensure that drugs approved by the National Institute for Health and Care Excellence are made available to patients if so desired by a qualified NHS practitioner.

There is already an agreed fixed limit on NHS spend on branded medicines, with any additional expenditure above that level paid for by the pharmaceutical companies via the clawback by the Department of Health. Currently, NICE assesses new medicines for cost-effectiveness, which provides a further restraint on pricing. There is therefore no reason for the NHS to deny patients any treatment covered by the scheme. We would like the Minister to look favourably on the amendment. We will not press it to a Division, but we are very concerned about the issues I have outlined.

[Mr Dunne]

Again, I understand the hon. Lady’s intent. I was a little confused by her interpretation of the Secretary of State’s remarks on Second Reading as meaning that politicians are involved in making decisions on prescribing. I assure her that, although I have been in the Department for a short amount of time, there has been no suggestion at any point that any politician should get involved in making decisions about which drugs should be prescribed.

[Julie Cooper]

I thought it inappropriate that the Secretary of State for Health expressed an opinion on which medications are necessary and which are not. I question his qualification to make that comment.

[Mr Dunne]

I do not have complete recollection of what the Secretary of State said, but he may have been referring to things such as the over-prescription of antibiotics, which we know is a problem globally. A great deal of work is being undertaken right across the NHS and with other health bodies around the world to reduce the scale of antibiotic prescription.

--- Later in debate ---

[Mr Dunne]

From time to time, local circumstances may mean that clinicians do not have access to the drugs. They may be newly innovated, and given the scale of the NHS in this country, not all clinicians will get the information they need to provide new drugs as rapidly as some patients may like. It can take time to introduce a new drug, as the hon. Gentleman will understand. I recognise that it is the role of clinicians to prescribe in the best interests of their patients, and I know that local or national commissioning policies or technology assessments by NICE will mean that in some cases patients are unable to access the treatment that their clinician has recommended, but it is important to recognise that local and national scrutiny and the independent assessments of NICE are essential to promote evidence-based prescribing, protect patients and secure value for money. Undermining that system of checks and balances, as I am afraid the amendment tabled by the hon. Member for Burnley would, could endanger patients and result in significant variation in prescribing practices. I ask her to withdraw the amendment, since she has indicated that she does not intend to press it to a vote.

[Julie Cooper]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

[Mr Dunne]

Clause 1 will amend the powers relating to voluntary schemes in section 261 of the National Health Service Act 2006. The voluntary scheme referred to in that section is the pharmaceutical price regulation scheme. Although the scheme itself is voluntary, there are statutory powers that can be used in relation to its operation. Other than with respect to the entry and exit mechanisms, the Government do not currently use those powers for the 2014 PPRS, but we wish to retain the option of making regulations or directions with respect to those powers in future. The Government do not intend the amendments to the 2006 Act to affect the operation of the current 2014 voluntary scheme.

The amendments to the 2006 Act will put it beyond doubt that the Secretary of State’s existing powers can apply for the purposes of operating a voluntary scheme that includes only a payment system. They are part of our policy to align the powers relating to voluntary and statutory schemes, which we will come on to when we consider later clauses of the Bill. They will also ensure that when a company leaves the voluntary scheme, it is still able to make payments covering the period in which it was a member. That will clarify the requirements and ensure that there will be no loophole that companies can exploit to avoid making payments that are due after they have left the scheme.

It may also be helpful if I clarify a point that arose on Second Reading. In response to a question from my hon. Friend the Member for South West Wiltshire (Dr Murrison), the Secretary of State inadvertently indicated that the Bill would prevent companies that are part of the current voluntary pharmaceutical price regulation scheme from parallel importing of medicines. I would like to clarify that statement, because it did not completely accurately reflect our intent. Parallel imports made in accordance with the EU single market rules are a legitimate part of the medicines market, and the Government have no intention of taking action to prevent such trade. The Bill does not exclude the possibility of parallel import prices being controlled; they could be covered through regulation at a later date if the evidence warranted action. I hope that helps the Committee in its consideration. I commend the clause to the Committee.

--- Later in debate ---

[Julie Cooper]

I beg to move amendment 43, in clause 3, page 2, line 27, at end insert—

‘(2A) An amount calculated under subsection (2) may only be calculated using the same methodology as an amount payable by any member of a scheme made under Section 261 of the National Health Service Act 2006 (voluntary schemes for controlling the cost of health service medicines) is calculated.”

We support clause 3 in principle and the amendment aims to clarify that. Under the current system, following the National Health Service Act 2006, two schemes operate to control prices of medicines: the statutory scheme and the PPRS voluntary scheme. It is important to align those two schemes, because since 2014 there has been a significant movement of companies deciding to shift from the PPRS scheme to the statutory scheme to reduce the level of rebate payable. That has reduced savings to the NHS, so it requires urgent revision.

We agree with the principles of the Bill on ensuring that both schemes achieve the same level of savings and that the system is not open to abuse. We are concerned, however, that the Bill is not specific about how payments would be calculated under the statutory scheme. We agree with the Secretary of State that the purpose of the Bill is to clarify and modernise provisions to control the cost of health service medicines.

The amendment seeks to clarify beyond doubt that the Bill is in line with the stated aim of achieving equivalence between the two price-control schemes, by ensuring that under the statutory scheme members' rebates are calculated using the same methodology as for PPRS members. We commend the amendment, but will not push it to a Division. I am interested to hear the Minister’s comments.

[Dr Whitford]

One issue arises because the statutory scheme was based on prices in December 2013. The further on in time we are, the less proportional the return. Whether it is the same or a similar mechanism, we should avoid having a price rebate to the NHS stuck in time, which might be five years ago, and does not reflect the actual costs of the drugs.

--- Later in debate ---

[Julie Cooper]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

[Mr Dunne]

The clause amends the provisions relating to statutory schemes in section 263 of the National Health Service Act 2006, which describes the purposes for which the Secretary of State can make statutory schemes. The amendments make it clear that a statutory scheme may require companies to make payments to the Government, based on their health service sales. For those companies not in the voluntary scheme, the Government operate a statutory scheme. That is currently based on a cut to the list price of products, rather than a payment mechanism on company sales, as in the voluntary scheme. The cut to the list price has delivered fewer savings to date than the payment mechanism under the voluntary scheme.

Health Service Medical Supplies (Costs) Bill (Third sitting)

Julie Cooper Excerpts

Committee Debate: 3rd sitting: House of Commons
Tuesday 15th November 2016 Public Bill Committees

[Mr Dunne]

Rare praise indeed from the hon. Gentleman. That is definitely going to go down in the annals of the Wolverhampton Echo, which I am sure will attribute an appropriate front page to that praise for the Government from the Member of Parliament.

To revert to where I had got to, I am sure hon. Members appreciate that there is clearly a limit to the level of detail we are able to publish, and I am sure that hon. Members appreciate that. Any information that we publish will be at a consolidated level, protecting suppliers’ confidentiality, which I have touched on several times, but will allow the Secretary of State to be clear on the basis of the conclusions to his review. We will, of course, be able to use supporting information to evidence our conclusions.

Turning for a moment to the detail of the proposed new clause, while the requirements set out in it reflect the duties placed on the Secretary of State in the Bill, I must be clear that the content of such a report should not be restricted. It must be able to address key issues arising during the course of the year, in the case of the annual report, and during the seven-year duration of the information regulations, in the event that such implications might have an impact on the operation of the schemes. Flexibility is at the heart of our proposals to address the issue through regulations. It would not be appropriate for such a report to address matters relating to the NHS duty to promote innovation. That is the one point of more substantive difference that we have with the drafting proposed by the hon. Member for Ellesmere Port and Neston.

We have already discussed the Government’s position on innovation. We are very clear that we are for it, as is the hon. Gentleman. However, we do not think it is appropriate to link measures in the Bill to that issue, which is a wholly different and much more wide-ranging issue than the narrower one of pricing and the cost of the medicines and medical supplies.

[Julie Cooper (Burnley) (Lab)]

Does the Minister agree that there is a direct connection between control of the price of medicines and innovation, and that, if we do not achieve the correct balance, pharmaceutical companies will lack the motivation to invest in the extensive research and development that we all want to see?

[Mr Dunne]

I do not actually agree that there is a direct link. There is no question but that, in order to stimulate continued investment in R and D, it is appropriate for the industry to see a stable marketplace in a country as significant and important as the UK, and throughout the nations of the UK, for medicines and medical supplies. We are a large market. We spend more than £15 billion a year on pharmaceutical products, and we are also acknowledged by those companies to be a reference market for many other countries that do not have such a large or well-organised supply chain as we do. I accept that, in principle, it might be rather different if this were an emergent market.

Individual drugs are emerging through R and D programmes, but I do not think that is the same as the measures we are introducing, which are primarily designed to limit excessive abuses of pricing position, in which a company may be a monopoly supplier, in the case of the unbranded generics. For the branded products, we have a long-established procedure for recognising the recovery of R and D costs through the pricing mechanisms, and while we may not like paying for some of those branded products at the rate that we have to, we recognise that it is a competitive marketplace and, because of the cost of innovation—the cost of conducting clinical trials and so on—it is necessary to stimulate that innovation to ensure that those companies make a reasonable profit.

Promoting innovation is a high priority, not only for the Government and the NHS but for many other stakeholders in the industry. In our view, it would not be possible to quantify the contribution of the schemes in the Bill to that endeavour, for the reasons I have discussed. Trying to assess the impact on innovation is a much wider endeavour that does not just rely on price. For those reasons, I urge members of the Committee to reject the new clause.

Community Pharmacies

Julie Cooper Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

It is my pleasure to respond to this interesting debate. I was not feeling very well today so on my way here I called at my community pharmacy, and I am feeling much better now. This is a very important subject. I wish first to pay tribute to my hon. Friend the Member for Barnsley East (Michael Dugher) for his sterling work in standing up for community pharmacy, and to the chair of the all-party parliamentary group on pharmacy, my right hon. Friend the Member for Rother Valley (Kevin Barron), for ensuring that the contribution of pharmacy is always recognised.

I have to say that this subject is very dear to my heart. I worked with my husband, who is a pharmacist in community pharmacy, for 24 years. I must make it clear that I no longer own a community pharmacy, but I do have a clear understanding of the contribution that community pharmacies make to patients, communities and the wider NHS. Many members have spoken powerfully today about the pharmacies in their constituencies and how much they mean to the people they serve. We have heard from my hon. Friends the Members for Hyndburn (Graham Jones), for Bolton South East (Yasmin Qureshi), for Bristol South (Karin Smyth), for Stoke-on-Trent Central (Tristram Hunt), for Oldham West and Royton (Jim McMahon), for St Helens North (Conor McGinn), for Wirral West (Margaret Greenwood), for Sedgefield (Phil Wilson), for Bradford West (Naz Shah) and for City of Durham (Dr Blackman-Woods).

Make no mistake, community pharmacy is for many the gateway to the NHS, providing far more than prescriptions and paracetamol. As my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) pointed out, it is a lifeline for many people. The Minister spoke last week about the need to move to a focus on quality and not just on the volume of scripts dispensed. He also spoke of the desirability of community pharmacies becoming an integrated part of the primary care team. I say to him that that has been happening for years. The fact that he does not know this is in itself proof that he needs to take his plans back to the drawing board.

The typical community pharmacy, whether it serves a rural or an urban population, provides a wide range of services to support the sick, the elderly and the disabled, together with a host of initiatives to promote health and wellbeing in the community. Community pharmacies have close working relationships with other members of the primary care teams, including GPs. Of all those health professionals, the community pharmacist, who employs a no-appointment-necessary approach, is the most accessible and often provides the only continuity of care in a health service that is struggling to recruit and retain staff.

On the subject of NHS staff, the promise of more than 1,000 additional pharmacists in GPs’ surgeries is a red herring. It is a separate issue and will do nothing to mitigate the loss of local community pharmacies. The Minister spoke last week of the need for pharmacists to move to a more clinical approach to healthcare. Again I say to him that that has been happening for years. All community pharmacies have consulting areas where patients can speak privately. They also provide a perfect space for the provision of a variety of important services. There is an ever-expanding list of services, which a number of Members have described in their speeches. My hon. Friend the Member for Garston and Halewood (Maria Eagle) mentioned the fact that pharmacists often go above and beyond the call of duty, sometimes delivering prescriptions at 8.30 in the evening. I well recognise that situation. The list is limited only by the Government’s unwillingness to engage and the clinical commissioning groups’ lack of funding to commission services.

Let me make it clear that community pharmacies, far from being a costly drain on NHS resources, actually save the NHS money through a variety of schemes, some of which have been mentioned today. The minor ailments service is already available in some areas, and I welcome the Minister’s suggestion that it will have a full roll-out. Medication use reviews carried out in the pharmacy often identify medicines that are routinely ordered but are no longer taken, and wasteful stockpiling of such items can therefore be avoided. In addition to the specific services, every prescription item dispensed presents the opportunity for a productive health intervention. Given that the average community pharmacy dispenses thousands of prescriptions each month, the potential impact is enormous and the professional advice of the pharmacist is undoubtedly invaluable in the promotion of health and wellbeing. The right hon. Member for North Norfolk (Norman Lamb) rightly identified the prevention work that pharmacists do, and mentioned the fact that the promotion of health and wellbeing can reduce demand on the NHS overall.

Despite statements to the contrary, community pharmacies have been making substantial efficiency savings in recent years. The vice-chair of the all-party group, the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile), mentioned a 40% increase in funding over the past 10 years, but he omitted to mention that prescription numbers have increased by 50% during the same period and that pharmacy funding has been static for the past two years.

Under the Government’s current plans, pharmacies would have to implement a year’s worth of cuts in four months with only six weeks’ notice. As someone with considerable experience of community pharmacy, I know that the plans will force the closure of many pharmacies and a service reduction in others. I do not know how many will close and neither does the Minister. The right hon. Member for North East Bedfordshire (Alistair Burt) suggested that the number could be as high as 3,000, and I can assure the Minister it will not be the large pharmacy chains that close but the small independents, the owners of many of which have put their heart and soul into providing an excellent service to the community.

Those that do not close will reduce services. An NPA survey of 250 pharmacies found that 76% are likely to reduce services from April 2017 if the cuts go ahead. The assessment of the financial impact of the closures is flawed and provides no evidence to support the Department of Health’s claim that access to services will not be compromised. It is clear that community pharmacies satisfy an ever-growing demand for services. When they close, that demand will not just disappear. Where will all the patients go? Some will pack out their GP surgery and others will head straight to A&E. The NHS is already in the throes of a staffing and funding crisis. Forcing community pharmacies to cut back services and close down is short-sighted in the extreme and could be catastrophic in the long term.

The Minister has frowned on the growth of pharmacy clusters, but he really needs to understand that clusters have grown, often in the most deprived areas, in response to considerable demand. My hon. Friend the Member for Bradford West outlined examples of such areas of deprivation. Is the Minister really suggesting that forcing the closure of such pharmacies is the most effective way to reduce demand for healthcare in deprived communities? The Minister has got this wrong. The proposals on the table are short-sighted and will do more harm than good. They will have a negative impact on patient care and will force extra demand on already stretched GP surgeries and hospitals. The proposals will not save money. They will not reduce the number of patients with long-term conditions or the number of medicines they require.

It is right to review the situation. I agree with the Government Members who said that it is right to examine the funding issues, but instead of forcing through damaging changes to a service that the Government clearly do not understand, I ask the Minister to listen to pharmacists and sit down with them to discuss how pharmacies can help to ease the burden on the wider NHS in a planned and cost-effective way. I ask the Minister to listen to his Conservative colleagues who spoke against these simplistic cuts, which have not been properly planned. I ask him to recognise that the access scheme will do little to protect the long-term future of urban or rural community pharmacies.

The Government have shown time and again an unwillingness to listen to professionals. I urge the Minister to listen to community pharmacists, to the pleas of Members and to people across the country, and to rethink the funding cut. I ask him to sit down with pharmacists and their representatives and work with them to develop and extend services that will take the burden off GPs and off the NHS. I ask that he do so now before he makes a decision that will devastate a whole sector and bring even more pressure to bear on our overstretched health service. I ask Members to support the motion.

Healthcare (Devon)

Julie Cooper Excerpts

Tuesday 18th October 2016 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

I thank the right hon. Member for East Devon (Sir Hugo Swire) for tabling a debate on this important issue. It is heartening to see Members for Devon coming together with a unified voice on this subject. I, too, will mention Members who are not here today: the hon. Member for Totnes (Dr Wollaston), who has been mentioned, and my right hon. Friend the Member for Exeter (Mr Bradshaw). As we speak, they are questioning the Secretary of State for Health on finance for the NHS—a subject that cannot be totally separated from the issue at hand.

The healthcare challenges that Devon faces are immense, but I disagree with some of the points that hon. Members have made. I do not believe that the challenges are limited to this region; I believe they are systemic. Demand for NHS services is increasing nationally faster than ever before, fuelled in part by an increase in social deprivation and an ageing population. The need to address the increased demand, together with the need to keep pace with new technologies, is placing hitherto unseen financial pressures on NHS providers.

There are 280,000 people in Devon living with one or more long-term conditions, such as asthma, diabetes, hypertension and cancer; 150,000 people have a mental illness; and there are 40,000 people with cancer who need rapid access to high-quality services. Alongside that increased demand, there have been cuts to adult social care, and to public health and prevention budgets. If we are just to stand still, funding needs to be increased by an extra 2.6% above inflation. I am interested to see whether the Minister’s promised extra funding matches that; I doubt that it will. If no changes are made by 2020, the NHS in Devon will face a deficit in excess of £440 million.

In 2015, the Northern, Eastern and Western Devon success regime was introduced by Simon Stevens, the chief executive of NHS England, in an attempt to address the rising deficit and the failure to meet important health targets, including cancer waiting times. There is no doubt, as I am sure hon. Members agree, that there is a compelling case for change. Change is desirable; it would indeed be better for care to be more patient-centred, and of course it would be better to have more care needs met in the community. It is also true that the majority of patients receiving end-of-life care would prefer to die at home.

But, and it is a big “but”, change on this scale—massive, transformational change—needs leadership, transparency, a whole system change and, above all, investment. Making changes of this order—closing community hospitals with no proven plan for care in place—is downright reckless. That is why so many GPs in Devon are opposing the proposals, and have stated that they have

“grave concerns over patient safety.”

They say:

“we are concerned that the untried, untested closures of so many community hospital beds in this area could prove dangerous for a significant population of patients who might need to rely on community beds”.

The well-respected Chair of the Health Committee, the hon. Member for Totnes, has declared that she also cannot support the plans without an assurance that services will improve as a result of the changes.

People the length and breadth of Devon have expressed their concerns. The very active women’s institute in Devon has raised objections, as have communities across Devon. As we have heard from Members today, the consultation process has been woefully inadequate; there have been undersized rooms, and an online consultation. Frankly, it is not good enough.

Everybody is right to be worried. Only last week, the Care Quality Commission published its report, entitled, “The state of health care and adult social care in England”. The report states that

“the sustainability of adult social care is approaching a tipping point”.

In addition to the financial pressures, the sector is also experiencing massive problems with recruitment and retention of staff. The people of Devon are being asked to place their trust in a system that is on already on the brink and, quite understandably, they are not going to—and nor should they.

Local GPs have described the proposals as a “hasty cost improvement process”. This is the crux of the matter: the proposals as they stand, without adequate funding for alternative care, will save money, but they will not improve patient care, and may even compromise patient safety. I agree with the right hon. Member for East Devon that the cart is being put before the horse; that absolutely hits the nail on the head. Local NHS trusts in Devon are on their knees, desperately crying out for more funding to enable them to plan for the increased demand and changing needs of the population in the 21st century. This is not just about extra funding, but about making the kind of transformational change that is needed to deliver high-quality, excellent healthcare in the 21st century. It needs proper planning and proper systems in place, and that cannot be achieved on the cheap.

I am shocked that in this context, the Prime Minister is refusing to give the health and social care sectors more funding, which they desperately need. We have one of the lowest percentages of health and social care funding, as a proportion of our GDP, in the entire region of Europe. That cannot be right. I urge the Minister to use whatever influence he has with the Prime Minister to get her to revisit this issue, for the sake of the people of Devon, and for people across the country. This situation is not unique to Devon; we face many of the same problems in my region of Lancashire and, as I know from my work with the Health Committee, across the country.

I also ask that the consultation process be firmed up, and that people be offered a full, transparent and real consultation, rather than lip service being paid to having one. During Health questions the other day, the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), promised to visit Devon and to listen at first hand to stakeholders. I urge this Minister to take that away with him, and to look at making sure that the Government listen properly to the voices of Devon and the very legitimate concerns being raised in this debate. No one is trying to say that change is not needed, but one system cannot be taken away until there is a fully proven plan in place.

[Mrs Anne Main (in the Chair)]

I call the Minister. If possible, could you leave a minute or two at the end for the right hon. Member for East Devon (Sir Hugo Swire) to respond, Minister?

Oral Answers to Questions

Julie Cooper Excerpts

Tuesday 11th October 2016 Commons Chamber

[David Mowat]

The STP process is locally led, not led from the centre, but I would expect clinical judgments of the type mentioned to be made if they could be confirmed on the basis of scientific and trial-based evidence.

[Julie Cooper (Burnley) (Lab)]

Central to the aim of the five year forward plan for the NHS is a sustainable health service in which all patients receive the right care at the right time in the right place. With that in mind, can the Minister tell me what action he is taking to address the problem of delayed hospital discharges, which have risen by 20% so far this year? That amounts to an additional 926 people every day condemned to stay in hospital longer than is medically necessary.

[David Mowat]

First, may I welcome the hon. Lady to her post and wish her luck in the new job? There has been an increase in delayed discharges in England over the past year. Only a part of that increase is due to difficulties in the integration between social care and the NHS—a large part of it comes from within the NHS itself—but it is not uniform across local authorities. Indeed, many local authorities are improving in this regard. What is very clear is that those making the most progress the most quickly are those that have gone furthest in integrating social care and healthcare.

NHS Spending

Julie Cooper Excerpts

Wednesday 6th July 2016 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

I want to begin by speaking about the NHS as experienced by my constituents. Getting an appointment to see a GP can be very difficult because recruitment of doctors in Burnley and Padiham is an enormous problem and many posts remain unfilled. This is not a temporary situation; this is how it is all the time.

The fact is staff do their best, but they are not magicians. Too often patients requesting an appointment are told to phone back the following day at 8.30 am and hope for a cancellation, and heaven forbid that a patient should want to have some continuity of care. This is especially difficult for the elderly and those suffering with mental illness. I tell the Minister that they really need to see a familiar face, and to have access to a GP with whom they have an established rapport. Sadly, they are denied this.

Unplanned admissions to hospital are also difficult. Patients often wait for hours on trolleys in cubicles and draughty corridors until a bed is available. This bed queue is the direct result of the fact that there is a shocking shortage of quality support for the elderly and mentally ill in need of care in the community.

The elderly and mentally ill really do bear the brunt of an NHS in crisis. Every week in my surgery I hear of their suffering at the hands of a poorly resourced and inadequately staffed NHS. One lady told me only a couple of days ago that she took her daughter, who is self-harming and threatening to hang herself, to the mental health crisis unit. The unit was so busy that she had to wait 23 hours for a diagnosis, after which it was decided that she needed to be sectioned and admitted. For the next four days, because no bed was available, she slept in an easy-chair. At that point a bed was found in Potters Bar, London. The family of this lady, including her five-year-old daughter, live in Burnley, at a distance of over 200 miles. They cannot afford the train journey to visit her.

I mention all of this not as a criticism of any of our NHS workers—far from it; they are at the sharp end doing their best in an impossible situation. They work in the health service because they care, and it pains them to see patients treated in this way. I mention all of this, none of which is untypical, because it is this misery that the Brexit campaign spoke to.

The leading Brexiteers, who have been mentioned in this place already today, played out the most cruel deception. They promised in their campaign that if the UK left Europe the NHS would receive a funding boost of £350 million per week. This untruth—that is what it was—was not a mistake or a miscalculation, although it was totally reprehensible; it was a deliberate attempt to deceive the British public. When deception of this magnitude is peddled by senior people, some of them Government members, who could blame people for believing that they would get a better NHS outside Europe?

Only hours after the referendum result was known the Brexit camp withdrew this promise of extra NHS funding because, of course, the fact is that it is this Conservative Government who starve the NHS of funding, not the EU.