Medical Cannabis under Prescription: Children with Epilepsy

Mike Penning Excerpts

Wednesday 3rd November 2021 Westminster Hall

[Sir Mike Penning (Hemel Hempstead) (Con)]

May I say what a moving speech that was by the hon. Member for Middlesbrough (Andy McDonald)? That sort of personal experience is exactly what this issue is all about.

I came into politics to help. To my knowledge, I do not have a single constituent who benefits from a prescription for medical cannabis, but that does not make it any less important that I campaign on behalf of the all-party parliamentary group. I could not disagree with a single word in the speech by my hon. Friend the Member for South Leicestershire (Alberto Costa), who succeeded me as co-chair when I stepped down.

In 2015, as the Home Office Minister responsible for drug policy in Government, and sat where the Minister is sitting now, I made a speech saying that the Government were minded to allow the prescribed medical use of cannabis. I did not say that for the sake of it; I said it because the then Home Secretary, my right hon. Friend the Member for Maidenhead (Mrs May), gave me permission to do so. She went on to be Prime Minister, and one of the reasons why Alfie got his medication, and why the Caldwell family’s campaign was so successful in the Province, was that she picked the issue up and said, “We are going to do something about this.” In 2018, the then Home Secretary was able to change the law for that reason.

I say to all colleagues, and to anybody listening to the debate, that this issue is not about rolling a cannabis joint. It is about a group of children, some of whom have clicked over into adulthood now, who may well not have been here today were it not for some very brave consultants turning their backs on what the profession was telling them to do, and doing instead what was right for those children. Those consultants have come under enormous pressure not to sign the prescriptions.

When we drafted the legislation, we were very careful to ensure that it was not up to GPs alone to issue the prescriptions. We did not want to get into another opioid situation—I will not say that opioids are prescribed willy-nilly, because that would be unfair, but we know there is an opioid epidemic. We specifically said that the GP had to refer the child to a specialist, and that it would be for the specialist to decide. A few have been brave enough to do so.

Sadly, as my hon. Friend the Member for South Leicestershire mentioned, and as the parents were telling us only yesterday when they were here lobbying colleagues, some of those consultants are retiring, and of those who want to prescribe medical cannabis, some are too frightened that they will be referred to the professional body. If they do prescribe it, their employers are refusing to honour the prescription. I thought we had an NHS that was free at the point of delivery when an NHS prescription is issued.

I have no notes—I have no need for them. I have discussed this issue so many times in this Chamber, as well as in the main Chamber, where I will be tomorrow. Politicians get it; Secretaries of State get it; the Minister gets it. But parts of the medical profession do not get that they are responsible for keeping these young children alive, and that they need to get off their butts and do so.

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[Patrick Grady (Glasgow North) (SNP)]

It is a pleasure, once again, to serve under your chairmanship this afternoon, Ms Bardell. I would not often say that I agree with every word said by a Conservative Member, but in the case of the hon. Member for South Leicestershire (Alberto Costa), it is accurate. He gave an incredibly considered speech. It is great to hear the consensus that exists in this room.

We have today’s debate, my hon. Friend the Member for Inverclyde (Ronnie Cowan) has a more general debate tomorrow on the medical use of cannabis, rather than in cases of epilepsy, and the hon. Member for Manchester, Withington (Jeff Smith) has introduced a private Member’s Bill on the issue. That shows the cross-party consensus, the momentum and the urgency of the issue. Everyone today is speaking about their constituents’ experiences. I pay tribute to all the families and campaigners who have come forward and are prepared to speak out. I met with some yesterday at the End Our Pain lobby. Plenty of my own constituents have lobbied on the issue, because they have been moved by the stories they have heard, and I have a particular case.

The name of the campaign, End Our Pain, says so much. It is the pain that the individual children, and the adults, are experiencing with their medical conditions. It is the psychological pain the families are going through as well, having to watch the physical pain that their children are suffering. All that pain can be, at the very least, mitigated, if some of the steps that we have heard about are properly taken.

I have spoken previously about my constituents John and Laura and their beautiful daughter Bláthnaid, who is affected by Aicadri syndrome, which is a very severe and rare form of epilepsy. There are only several thousand cases worldwide. It is very difficult for clinicians to know what might or might not work. It is incredibly distressing for both the parents and the children, who do not understand what is happening when they go through these seizures. Many of the conventional medicines that are tried have their own side effects that cause particular difficulties, or resistance builds up, which increases a different kind of suffering.

[Sir Mike Penning]

Is the hon. Gentleman aware that doctors are prescribing off-label drugs that work for adults, particularly steroids, to these children, but they are not willing to look at medical cannabis?

[Patrick Grady]

Yes, and a few years ago we had the Off-patent Drugs Bill, which sadly did not make as much progress as it could have done. That had the potential to give doctors more freedom, which is clearly one of the messages coming out of the debate. Of course there will be an element of risk, but there has to be a way of managing and mitigating it so that doctors can feel more confident about prescribing cannabis-derived treatments.

When my constituents see the positive effects that CBD can have, they wonder what effects a drug with THC might have. When they see the benefits to other children, even though every case and condition is unique, the potential must exist there, and when the alternative is to go private and pay incredible amounts of money, which is not without its own risk, the frustration becomes very real, so the Government have to speed up the trials and the opportunity for people to take part in them. They have to look at how the licensing can improve and how we can increase the confidence of doctors. Above all, they have to listen to the voices of parents and patients, and their carers and advocates in Parliament.

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[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I would like to start by congratulating my hon. Friend the Member for South Leicestershire (Alberto Costa) on securing the debate. He lobbies on this issue almost daily, representing constituents such as Maya and Evelina so well. I fully appreciate the strength of feeling and the impact that this issue has on some of the most vulnerable children in their daily struggle with drug-resistant epilepsy. That is why, three years ago, my right hon. Friend the Secretary of State for Health and Social Care, who was then Home Secretary, changed the law to recognise the need to allow unlicensed cannabis-based products to be prescribed by specialist doctors. The Government are supportive and have used many levers, which has been quite challenging at times.

My right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) hit the nail on the head when he said that this is now more a clinical issue than a political one. In many cases, doctors are unwilling to prescribe medicinal cannabis; we heard from a number of Members that we may be down to just one clinician left who is willing to do that. The main reason is that these products are still unlicensed. The way that medicine works in this country is that the Medicines and Healthcare Products Regulatory Agency will license a product after significant research, not just into the efficacy—we have heard from many Members that there is a strong feeling that these medicines work—but into the adverse events and potential side effects. In prescribing these medications, the clinicians will take responsibility both for the drugs working and for any impact of those drugs.

[Sir Mike Penning]

This is the argument that always comes up in the briefings for Ministers. If it is not safe, how are prescriptions being given for free on the NHS? If it is safe, give it to the rest of them. It cannot be right that time and again Ministers use the argument about safety, when prescriptions are given free on the NHS.

[Maria Caulfield]

These are clinical decisions. No one is saying that these products are not safe, but there is not the evidence base to get the licence. The MHRA does this for every single medicine, not just medicinal cannabis.

I want to set out how we can get to a place where we can get these drugs licensed and clinicians will feel confident in prescribing them. We recognise that, for many children, these drugs improve their quality of life—individuals have reported improvements—but without that research evidence base, the MHRA will not give a licence. The MHRA is an independent body—it is not controlled by the Government—and the clinicians will take advice and guidance from it. We may agree or disagree with how the MHRA licenses a medicine, but that is the process for all drugs. It is not just the MHRA—no country in the world has licensed this product. The Food and Drug Administration has not; the European Medicines Agency has not; the MHRA has not. The solution is in pushing the clinical research needed for a licence to be granted, which would open up prescribing for clinicians around the country.

Covid-19 Update

Mike Penning Excerpts

Monday 6th September 2021 Commons Chamber

[Nadhim Zahawi]

The hon. Member raises important points from the industry and we will always make sure that we look at them. One piece of feedback from our earlier consultation was that to be able to check IDs, for example, we would want to make this process equally straightforward for the industry.

[Sir Mike Penning (Hemel Hempstead) (Con)]

I completely support—the whole House will concur—the fantastic work that the NHS has done through the vaccine programme. It is great news that they are coming forward and are ready, but the army of volunteers I saw and worked with in my constituency are exhausted. They need to know up front how often and when they will be needed, because the programme cannot happen without not just vaccinations from the NHS, but the army of people who come forward and put their own lives at risk so others can be safe.

[Nadhim Zahawi]

My right hon. Friend raises an incredibly important point that we look at every single day. In my ops meetings, we have a section dedicated to the workforce and specifically to the volunteers, so that we can make sure that they are put on notice of where and when we think we will need them. The only caveat that I would add is that we have built a very large infrastructure, but it has to flex depending on the advice from the JCVI, the MHRA and, of course, our chief medical officers.

Medicinal Cannabis

Mike Penning Excerpts

Monday 6th September 2021 Commons Chamber

[Christine Jardine (Edinburgh West) (LD)]

It is in some ways a pleasure to speak in this debate, but in others it is a huge disappointment that we are still debating this issue years after we thought it was in fact settled. I go back in this issue to my first face-to-face meeting with my constituent, Karen Gray. It was in London, curiously—not Edinburgh—in the pouring rain. We were meeting to hand in a petition to Downing Street calling for the legalisation of medicinal cannabis. I had been in touch with Karen and her son, Murray, before that day and was aware that Murray had a rare form of epilepsy that was blighting his childhood, with multiple seizures, hospital admissions and missed school days; his parents feared for his life.

Since then, my team in the constituency have experienced all the ups and downs of the journey with Murray and Karen—the hope, the frustration and the disappointment, but always, always optimism that the medication that he needs will be there and available on the NHS. We thought the job was done in November 2018 when, after a powerful public campaign in which the right hon. Member for Hemel Hempstead (Sir Mike Penning) played a pivotal role as a Health Minister, the then Home Secretary, now Health Secretary, the right hon. Member for Bromsgrove (Sajid Javid) made medicinal cannabis oil—the substance on which so many were pinning their hopes—legal.

[Sir Mike Penning (Hemel Hempstead) (Con)]

With your permission, Mr Deputy Speaker, I will elaborate later in a speech, but the crucial thing about when the law was changed was that it was about the prescribed medical use of cannabis oil by a specialist consultant, not a GP. It was not about a spliff behind the bike sheds or anything like that; it was prescribed medical use that saved children’s lives. I agree with the hon. Lady that it is a disgrace we are still here today, debating it.

[Christine Jardine]

I thank the right hon. Gentleman for his intervention, and I share his frustration and annoyance. The measure was specifically designed in the way that it was, and it had the support of the Government at the time. The Home Secretary, the Prime Minister and the whole Department for Health team were behind this move, which we thought would change so many children’s lives. Sadly, the job was not completely done, because Murray is still unable to access that life-changing treatment on the NHS. His family have to find the money themselves every month. It is not just Murray; it is not just about his case and his life; it is not a one-off. I stand here tonight for him, and also for all those who know exactly what that feels like.

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[Christine Jardine]

The hon. Member makes exactly the point that I would make. I think we all appreciate that the Government do not have the power to make the medical profession do anything, but they can be encouraged to put their shoulder to the wheel and get behind this cause.

[Sir Mike Penning]

I thank the hon. Lady for being generous. Fortunately, we have time to debate this massively important subject this evening, which is what it deserves. The point made by my hon. Friend the Member for South Leicestershire (Alberto Costa), who co-chairs the all-party parliamentary group that I used to chair, is that specialist medics out there are writing the prescriptions, but they are being blocked and regularly threatened by other senior people in the medical profession. They are told, “Even though you are the expert and that would save a child’s life, if you do this, we will stop you.” It is right that it is not a politician’s job. The will of the House is very important, as I will come to in my speech, but if the top-expert clinicians are writing prescriptions, some of which are honoured by the NHS—I will also come to that—and they are being blocked by other medics, somebody has to step in and sort the mess out.

[Christine Jardine]

The right hon. Gentleman makes an excellent point. We do have that overwhelming body of observed evidence of the efficacy of cannabis oil. I have seen at first hand the difference that medicinal cannabis has made to Murray Gray’s life—it has transformed his life. When his mum, Karen, first came to see me, he was a very unwell wee boy who was, as I mentioned, constantly in and out of hospital with dozens of seizures a day, and his family were worried that they could lose him. Since being prescribed cannabis oil, he is seizure-free and a happy youngster who plays football with his dad. When he came to visit me in my office, he explained everything I have ever need to know about dinosaurs. It was a joy to see him so happy. The medication has given him a life that he may not otherwise have had.

It is time for the Health Secretary—just as he did when he was Home Secretary—and his team to intervene to make the case that the medical profession should put its shoulder to the wheel. It is time to close the huge gulf between what the Government promised—and, I believe, wanted—and what has been delivered.

[Christine Jardine]

I agree 100% with the hon. Lady that we need action now—it is actually overdue—and that the Secretary of State for Health and Social Care is the very person who can give us what we need.

Because this is not a political football kicked between party politicians—it never has been and never should be; we have always resisted that—a little over a year ago, more than 100 MPs across the House from the Liberal Democrats, Conservatives, and Labour and Green parties wrote to the former Health Secretary to demand action.

[Sir Mike Penning]

And the DUP.

[Christine Jardine]

And the Democratic Unionist party; I do beg your pardon.

Nor is the debate any longer about the proper use or otherwise of cannabis oil. As I have said, the evidence that it is life-changing for those in need is already overwhelming. So it appears that the debate comes down to the willingness of the medical profession. The clock is ticking, however. There are currently only two physicians in this country prescribing the medication, and one of them retires shortly. Add to that the fact that for many families, the Grays included, there will come a time when they cannot afford the medicine their loved ones need and will no longer be able to raise the money. We cannot wait for the creaking bureaucracy of the medical profession to turn.

As we have said, when the current Health Secretary was at the Home Office, he responded to the parents’ appeals, listened and made medicinal cannabis legal. Now the ball has once again found its way into his court and he can help, so my appeal is straightforward. I know a little of it personally: I have had a seizure— I have come to and seen the fear and the relief in the eyes of loved ones—and it is terrifying. What it must be like for a child I do not know. Until a more widespread solution for prescribing can be agreed, and it must be, the Government should save these families the pain of paying for prescriptions. Surely, when the quality of life for a child—so many children—is on the line, it is the right thing to do. I have always been optimistic, and I have confidence that I am right to have optimism and belief that this Health Secretary will take this opportunity.

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[Sir Mike Penning (Hemel Hempstead) (Con)]

As I said earlier, is it not great that we have a couple of hours to debate this subject, which is so important to the family and loved ones of the children who have suffered so much, and we can do something about that? But is it not a crying shame that we have had this debate not just in this Chamber time and again, but in Westminster Hall as well? It was there that I responded to the debate as the police and counter-narcotics Minister, when I actually said on behalf of Her Majesty’s Government that the Government were willing to look at the prescribed medical use of cannabis for certain treatments, particularly for seizures in children with the very rare form of epilepsy that some have.

There are myriad other illnesses, which we might get to, that cannabis could help, but this is about the closed mind of some members of the medical profession—these so-called experts who took an oath to protect lives and to protect the human beings they are responsible for—who are blocking other medics. As we just heard, fewer and fewer medics are able to prescribe, frankly because in many cases they have been scared off and threatened, or are now coming close to retirement. So what will these parents do? I ask hon. Members in the House this evening what they would do if they were a parent of one of these children. God forbid.

I remember so well Hannah Deacon bringing Alfie Dingley in to see me. Alfie was having in excess of 100 seizures a week. I think the figure was actually greater than that, but that is the figure that sticks in my head. Every time he had a seizure, Hannah and her husband did not know whether he was going to come through it, because all the other medication they were giving him was not working. We have heard this story from constituents around the country, but if I may, I will just concentrate on Alfie for a second. He was given products off-label that were never designed for children to try to help him. Doctors were willing to do that with products that were never ever medicated, designed or regulated for children, but because they were off-label, GPs could write a prescription and they did that on the NHS—trying to keep him alive in that way, while in others blocking the help he could have had.

I praise the End Our Pain campaign of Peter Carroll and his team. They have worked tirelessly over the years, and I will give him a name-check because it is very important that people understand that he has never taken a penny for running such campaigns. There is all the media coverage we have had from lots of famous people, but at the end of the day it is his team who have pushed this. There is the bravery of the parents of these children—some out of desperation. But now, as hon. Members will hear in my speech, they want to make sure it does not happen to other families and other children who are desperate to make this change happen.

I made that speech in Westminster Hall with the full permission of the Home Secretary at the time, who then became the Prime Minister—my right hon. Friend the Member for Maidenhead (Mrs May)—and we started that process. The process then progressed because it was nothing to do with the Department of Health at that stage; this was a Home Office matter. I remember going to No. 10 with Alfie, and he was his usual naughty self, which was fabulous because that is how we want our young children to be to experience life. We were due to meet at No. 10 the police Minister at the time and some of the experts, and my right hon. Friend the Prime Minister came into the room, sat with Alfie and his mum and dad, and talked to them. She said, “We will do something about this: we will change the regulations and the law,” and to her credit, that is exactly what she did. With the help of the Home Secretary, who is now the Health Secretary, we changed the law.

The bit I am so upset about is that if we had not changed the law fully to move this into the Department of Health, other children would be getting the prescription that Alfie and some of the others are getting. They were not given that prescription free on the NHS by the Department of Health; they were actually given it by a committee in the Home Office. We had not moved it across through the legislation, so it was done by that committee, based on evidence that it was going to save the life of this little boy and the lives of subsequent other little boys and girls.

Then we got this impasse. The children got the prescription for free—there are not thousands of children out there; this is a really very rare condition—but when this moved across to the Department of Health, it stopped. They carried on getting their free prescriptions, but even though prescriptions were being written, they could only be written as private prescriptions, and we have heard about the cost of medication for families trying desperately, from all means, to raise the money to get this prescribed medical use of cannabis. There are different types and we could go into the different mechanisms and what is in them, but at the end of the day that is a medical or doctors’ decision, not a politicians’ decision.

Believe it or not, I had to phone the Home Secretary several times and say that there was a family at Stansted airport, at passport and customs control, who were having the medication taken away from them even though it was perfectly legal in this country to have that product. Parents had raised the money and they went to Holland—most of them went to Holland—and saw the specialist, went to the pharmacist and brought it back, and then had it taken away from them. Believe it or not, when we eventually got the authorities to agree to let them have it, they tried to charge the parents for the transport cost of moving the product back to the family. That is ignorance, a lack of knowledge, but we are beyond all that now.

We are now in this situation for the families. I spoke fairly recently to Hannah Deacon, the mother of Alfie. Alfie is what we would expect a boy of that age to be—he can ride a bike and he can have a relationship with his sister that he has never had before, and vice versa. At times he is a naughty boy; hey, that happens. Is that not what we want for our children? Yet families are still in this limbo situation of having to raise money—beg, borrow, I am not going to use the word “steal”, but all of us in the House this evening know where I am coming from; they have to desperately try to raise money. The Government could use their power to buy this product so the families would not have to pay £2,000 for it; if the Government bought the product it would be vastly cheaper as it would not cost the NHS £2,000 per prescription.

[Adam Afriyie]

My right hon. Friend is making a powerful and passionate speech, and I thank him for his work in the Home Office and in pushing this through. Does he share my frustration that in many other countries around the world, including Germany, manufacturing is coming up to speed and producing well-defined products that could be exceptionally helpful, but because of the impasse we have here among the medical profession it will prove almost impossible to introduce those products here even though, based on the evidence we have, they are perfectly safe?

[Sir Mike Penning]

We are not reinventing the wheel, as my hon. Friend says: we started this but are now lagging behind the rest of the world. The product is slightly different—the oil has different forms of THCs in it. The Minister used to be my Parliamentary Private Secretary all those years ago—how the mighty fall, and how the mighty have risen up the greasy ladder—and she is passionate about trying to help on this, but it is not about Epidiolex; it is about the particular product being prescribed actually working, and it is normally to do with the levels of THCs.

I think this problem might be to do with the terrible word “cannabis” that we use in this country. This is not anything to do with cannabis, really; I wish we could invent another name for it and just say “oil with TCHs in it”, because that would eradicate much of the fear that there is at present—and it is not just fear, it is dangerous to the argument.

[Ronnie Cowan (Inverclyde) (SNP)]

I feel a little sorry for the medical profession, because a slight correction should be made. Fifty years ago in the Misuse of Drugs Act 1971 we pretty much classified cannabis as a poison. That is why the medical profession has not felt confident enough to use it, test it and research it; it simply could not. Now we are saying, “You guys have got to catch up and catch up quick,” and the Government have a role to play in facilitating that. Research is kicking off now, which is great, but although some say the medical profession should have been doing that for all these years, it could not do so because this place stopped it. On the right hon. Gentleman’s last point, let us call it “medical hemp”.

[Sir Mike Penning]

I completely agree on the medical profession and know exactly where the Home Office stood when I was at the Department. I would love to say that the whole of the Home Office and my civil servants in the narcotics part of it were thrilled by what I said in Westminster Hall all those years ago, but I can assure colleagues that they certainly were not, to say the least; fortunately, I had covered my back with the Home Secretary.

We need to move on from this, however. This is not about reform of the 1971 Act. It is about whether there is a group of children who we know get benefit from this, and whether, as we all know from our constituency postbags, there are other conditions that could also benefit from this type of oil with a THC product in it. That is where we are struggling.

We need to roll back this debate and talk, as I did at the start of my speech, about children—children who deserve the best possible start in life and just happen to have been born with a medical condition that the medical profession, in its infinite and great wisdom, has not quite got an answer for. This product is part of the answer, although it only alleviates the condition. As parents have said to me on many occasions, it does not take away the condition but it does let the children live a life as close to normality as possible; it is not normal, because it involves dropping oil on a little boy or girl’s tongue on a daily basis, but it is as normal as we can get.

[Tonia Antoniazzi]

It was a pleasure to serve with the right hon. Gentleman as co-chair of the all-party group on medical cannabis under prescription. On the point he makes about children, we have Bailey Williams in Cardiff, a constituent of my hon. Friend the Member for Cardiff West (Kevin Brennan), and that case highlights that these children are no longer classified as children after four years; they become adults. Bailey Williams is now 18, and the question arises of how things will change for him in a different health system with different rights. What would the right hon. Gentleman say on that?

[Sir Mike Penning]

The hon. Lady was a brilliant co-chair with me for all those years; we agreed on most things even though there is a tiny number of things we do not agree on. The hon. Lady is absolutely right. I have a constituent who has now turned 18, although it is not the THC but another medical component that particularly helps her. People come out of the care of one part of the health service and there is a little bit of a transition period but there is very little research on the evidential base going forward, and we need to do that research.

Let me touch for a second on what has been said to me by senior medical people in the Department of Health and Social Care. They said, “We need to do trials, Mike. We need to use placebos. We need to find out whether this actually works or whether it doesn’t work.” What parent on this planet is going to take their child off a medication that actually works, with the risk that they may get a placebo, have a seizure and die? Is that where we are in the 21st century, really and truly?

We had a statement earlier from the Minister for Covid Vaccine Deployment, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi). We are a world leader in doing medical things. We have done things in this country around the vaccines that no one dreamed possible, yet we are talking about giving placebos—and those people were serious. I can tell the House that the parents were very serious, too. I cannot repeat some of the comments I got from some of the parents, but they quite rightly said—I will speak politely on their behalf—“Not in a million years.” Let us put it in those terms.

I know that the Minister will do her level best, but this is not about the Government taking over Epidiolex. Yes, they need to pay for research—I absolutely agree with the hon. Member for Inverclyde (Ronnie Cowan) about that—and research in this area could change the whole way that pain is addressed and perhaps get us away from using so many opioids, but this is actually just about having trust in the expert who has written the prescription for a child who may well die if he does not get that oil with the THC component on prescription.

[Tonia Antoniazzi]

I am sorry for intervening on the right hon. Gentleman again. The NHS keeps asking experts, but those experts are not experts in medical cannabis; they are experts in the condition of epilepsy but have no insight into that. Where is the foresight and vision to help these children with intractable epilepsy?

[Sir Mike Penning]

I alluded earlier to the narrow-mindedness of people who have taken an oath to protect people and protect children. No one, I would have thought, goes into the medical profession to hurt people, but at the end of the day, we have a group of children—not thousands, but a small group—whose parents are crying out, “Please listen to my specialist. Please listen to me, as a parent trying to save my child’s life.”

[Alberto Costa]

I thank my right hon. Friend for the good work that he did as my predecessor on the APPG. Does he agree that, given that there is such a small number of children across the country who suffer from severe forms of epilepsy, a temporary measure would be for the Government to be bold and simply cover the cost of private prescriptions until we develop the proper framework, along with the science that demonstrates conclusively the efficacy of this medicine?

[Sir Mike Penning]

I could not agree with my hon. Friend more strongly. That was what we did in the Home Office, which is why Alfie and some of the other children got their prescriptions paid for by the NHS. We set the committee up and we did it. I say again that I feel personally guilty, because we worked in all good faith to get the issue across to the Department of Health and it still has it, and those parents feel guilty, because they feel that other children should be having the benefits that Alfie is getting.

Surely, given the will of this House, the will of the Government, the will of previous Prime Ministers, the cross-party support, the fact that the previous Health Secretary came and met the parents here in the House and made them a commitment, and the fact that the Home Secretary who changed the legislation is now the Health Secretary, it must be a no-brainer. Let us look after these kids.

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[Jim Shannon]

The hon. Lady is absolutely right: we do have to move forward, and that is the message from us all in the Chamber tonight. I know that Robin, on behalf of Jorja, and Darren and Danielle, on behalf of Sophia, tried almost every other thing that they could before they came to medicinal cannabis, and they have seen the difference almost right away.

[Sir Mike Penning]

I am sorry to come back in because I did speak at length, Mr Deputy Speaker. Some of the medics have tried all the other medications. Many of those, as I alluded to in my speech, are completely off-label, were never intended for this and have not worked, but they are willing to block the medical use of cannabis oil with THCs. Why?

[Jim Shannon]

I bow to the expertise of the right hon. Gentleman and I wholeheartedly agree with him.

We need the Government and the Minister tonight to give us an assurance that they will cover the prescription beyond September. The letter I referred to asked the Government

“to clarify the guidance which enables children…to continue to receive this vital treatment”

via their GP

“under guidance from a specialist and funded by the NHS.”

The clinical trial for a treatment manufactured by MGC Pharma, which is due to begin in the autumn, was also referred to. Until that happens and until those trials are completed, we really need to recognise the proof that each of us as MPs have, on behalf of our constituents, and confirm that medicinal cannabis improves quality of life.

I also want to mention my sister and her son, Jake. Jake never had medicinal cannabis when he was young. I wish he did, because I tell you what: I can see the improvement that he would have had at a very early stage, which he does not have today because of all those years of epileptic fits. It grieves me greatly to realise that the opportunity that Sophia and Jorja had was something that wee Jake did not. If we had had that years ago, perhaps his improvement would have been much greater.

I support the hon. Member for Edinburgh West tonight and the right hon. Member for Hemel Hempstead and everyone else who will speak afterwards, including in interventions—I thank all those who have intervened. We are all united tonight on retaining medicinal cannabis for our constituents. We as MPs, on behalf of these parents and children, can see the evidential base, and what an evidential base it is. We always say, “Let’s have the evidence.” Well, we have the evidence. We have it individually and on behalf of those families, and tonight, I look to our Minister to give us the reassurance that we need on behalf of our constituents back home.

--- Later in debate ---

[Crispin Blunt]

I wholly agree with the hon. Lady, whose leadership of the all-party parliamentary group on access to medical cannabis under prescription, along with that of my right hon. Friend the Member for Hemel Hempstead, adds to the whole discussion and illuminates the fact that our drugs policy is in a serious state of strife. It is not based on evidence, and we have to drag it in that direction. Behind the hon. Lady sits my friend the hon. Member for Manchester, Withington (Jeff Smith), with whom I have the honour of co-chairing the all-party parliamentary group for drug policy reform. We took over from the hon. Member for Brighton, Pavilion (Caroline Lucas) and from Paul Flynn. My objective, as the first Conservative to take his place, was to drag this conversation into the mainstream, which is where it belongs.

However, we need to remember just what got this over the line in the first place. The Dingley family behaved perfectly within the rules. They made applications and everything else, and indeed we had an urgent question on the subject. I remember my right hon. Friend the Member for Hemel Hempstead interrogating the then Policing Minister, who had taken on the responsibility, about when this was going to happen, particularly for Billy Caldwell.

What got this over the line, however, was the fact that Bill Caldwell’s mum, Charlotte, was brave enough to obtain the medicine in north America, present it to customs and have it confiscated. Her son was then hospitalised and was fitting, and within three days the overseeing consultant was on the steps of the hospital saying, “I do not care about what is going on here; it is unbelievably cruel to take a medicine that works away from a child.” The following day, the then Home Secretary—now, wonderfully, the Health and Social Care Secretary: what a brilliant repositioning that is—authorised the return of Billy’s medicine, or at least some of it, from customs so that he could receive his treatment.

[Sir Mike Penning]

While we are name-checking colleagues, we should mention one chap who is not here because he has left the House, and that is Frank Field. My hon. Friend referred to Frank—[Interruption.] Oh, he is in the other House now, is he? Lucky fella! Frank and I were absolutely adamant that the following day, we were going to go to Holland and come back, and that unless a change to the legislation had been indicated the following day, we would be arrested. But what a great reason to be arrested, trying to save someone’s life! It was Frank’s idea, and I jumped on with him—we should also acknowledge other people including Billy Caldwell’s family and Alfie’s family; I completely agree with that—but without Frank jumping in as well, we would really have struggled.

[Crispin Blunt]

This is where we come to the cost, to which the hon. Member for Gower (Tonia Antoniazzi) drew my attention. In order to get Alfie Dingley’s prescription over the line, it would have taken £5,000 for the person who was going to make the application, who happened to be on holiday in the Galapagos Islands and who then had to be interviewed by Home Office officials before he was allowed to make the application; £5,000 for the pharmacy to get a licence to bring it in; £5,000 for the pharmacy then to hand it out to the doctor; and then £5,000 for the licence for the prescribing doctor. I mean, I ask you! It might have been possible to pay in that case, but behind the case of Alfie Dingley, there is not just a score of epileptic children.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

First, I congratulate the hon. Member for Edinburgh West (Christine Jardine) on securing this debate. I agree with colleagues’ comments: it has been incredibly helpful to have time to talk about this issue. As I sat on the Front Bench, the debate highlighted to me, first, the needs of these children and their families, and secondly, the complexity of the whole situation. We can make statements, but there are no easy solutions. This issue involves the medical profession, licensing and trials.

Let me thank all those who have contributed to the debate. In no particular order, so as not to upset anybody—I have met many of those who have contributed on numerous occasions—I thank my hon. Friends the Members for South Leicestershire (Alberto Costa) and for Windsor (Adam Afriyie), and the hon. Members for Strangford (Jim Shannon), for Gower (Tonia Antoniazzi) and for South Antrim (Paul Girvan).

I thank my right hon. and learned Friend the Member for Kenilworth and Southam (Jeremy Wright), who is not in his place but with whom I have met. As is the constituency MP for Hannah Deacon and Alfie, he has contacted me and spoken to me on several occasions.

I thank the hon. Members for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) and for Inverclyde (Ronnie Cowan), to whom I shall not forget to wish a happy birthday.

As my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) said, we have known each other a long time and I have carried his bags on more than one occasion—

[Sir Mike Penning]

Not no more!

[Jo Churchill]

Not no more, but I understand where his passion comes from.

I can also see in their places the hon. Member for Manchester, Withington (Jeff Smith)—we have spoken about this matter—and my hon. Friend the Member for Reigate (Crispin Blunt).

At the heart of this debate for me are Alfie; Billy; Eddie Braun, who was not mentioned; Murray; Jorja; Maya; Bailey Williams, mentioned by the hon. Member for Gower; Sophia; and others. It is about those children. I have personally met several of the families and heard at first hand how it feels not to be able to have anything more. To be honest, as a mum of four, I can say that sympathy feels a bit useless when it comes to a mother who, in some cases, can watch their child fit 100 times a day. They have explained to me the relief that applying Bedrolite under the tongue brings to their children. They have spoken about the financial challenges, but I would like to use the time available to go over some of the challenges that I am trying to wrestle with to get to a solution.

We have had an accordion debate tonight. Initially, the hon. Member for Edinburgh West said that this debate was about access to NHS prescriptions. However, many others also spoke about how much this might benefit multiple sclerosis sufferers and those with chronic pain. Indeed, Lord Field in the other place has written to me on this subject and spoken about the relief of chronic pain that I think he himself gets from using a cannabis-based product. However, there does have to be an evidence base that is more than observational.

--- Later in debate ---

[Jo Churchill]

I understand that point and I have said to those parents that I would struggle. In fact I would probably find it impossible to offer my child something else when they were already gaining relief from something. However, as we have debated here today, there are probably two issues here: the treatment of those children who are already on Bedrolite; and the need for an evidence base, particularly when we start to talk about expanding the use of cannabis medicines for those suffering from a large range of other medical issues, be it MS sufferers and so on. This is where the challenge comes. Clinicians rightly want to prescribe based on the evidence so that they do their patients no harm. Many people have said that this is the place of last resort for these parents, but we have this difficulty.

[Sir Mike Penning]

rose—

[Jo Churchill]

I will go on to explain why after my right hon. Friend’s intervention.

[Sir Mike Penning]

I have two points. The first is that it is not all Bedrolite. A lot of these parents do not have Bedrolite. There are myriad specialist ones with different THC levels, but they have been prescribed by a consultant. I know what my hon. Friend said, but these are consultants, and they do want to prescribe the drug and they have prescribed it, but they are not allowed to put it on an NHS prescription unless you are Alfie, Billy or any of the others. It just does not make sense.

[Jo Churchill]

I agree that there are other medicines, but one of the challenges is how we treat people with ongoing needs as their conditions vary, if we do not have the ability to understand how the body is responding.

I will push on a little bit. Let me provide an update on Bedrocan oils from the Netherlands. As stated previously, the commercial agreement between Transvaal Apotheek and the UK special medicines manufacturer, Target Healthcare, is progressing. The Medicines and Healthcare products Regulatory Agency and the Home Office are working with those companies to ensure that all regulatory standards for manufacturing these medicines in this country are met. We continue to work closely with the Dutch Government, Transvaal, the Home Office and the MHRA—which I have met with and which says it will look at the international evidence—to ensure continuity of supply until domestic production has been established. We have had movement; I can sense the frustration in the House tonight, but we are moving forward. I will continue to keep the House informed of progress.

On the main topic of the debate, it is undeniable that it is incredibly hard for many of the patients and their families. As many Members have said, the challenges have done nothing but worsen during the covid-19 pandemic. The Secretary of State for Health and Social Care, my right hon. Friend the Member for Bromsgrove (Sajid Javid), when he was Home Secretary, changed the law to allow unlicensed cannabis-based products for medicinal use to be prescribed by doctors on the General Medical Council’s specialist register. This removed legislative barriers to legitimate use as a medicine. However, there is still caution across specialists in their ability and willingness to prescribe. [Interruption.] Indeed. However, with respect, if the prescribing of these medicines by a clinical specialist was that seamless, we would have more of it, but we do not.

The whole thing comes back to the fact that clinicians want to rely on an evidence base, and that includes clinicians in Scotland. We recently received a letter from the Scottish Government, outlining that Dr Rose Marie Parr, former chief pharmaceutical officer, had chaired a teleconference with key paediatric neurologists from specialist centres. The clinicians had a clear and united view that, following the GMC and British Paediatric Neurology Association guidelines, they would be unwilling to prescribe CBPMs containing THC, including Bedrolite, until there is clearer, published evidence available following a clinical trial.

--- Later in debate ---

[Jo Churchill]

I am going to make a little progress, because at this rate we will go up to the end of the time. I will come to my right hon. Friend the Member for Hemel Hempstead.

While saying that it should remain a clinical decision for doctors—indeed, that was very much what I took from the hon. Member for South Leicestershire, because it would be inappropriate for Ministers in Whitehall or the Scottish Government to influence individual prescribing decisions—with the exception of three licensed medicines, cannabis-based products for medicinal use are not first-line medicines and are not routinely funded. Most cannabis-based medicines are unlicensed medicines, and that means they are yet to have their quality, safety or efficacy assured by regulators here or, indeed, anywhere else around the world. Nor has their cost-effectiveness been decided by the National Institute for Health and Care Excellence, which is how we administer medicines. Those are the foundations of NHS decisions about routine funding. The cost of treatments sought privately remains the responsibility of the patients, and I am not cloth-eared to how difficult that is and why we need to try to find a solution.

[Sir Mike Penning]

rose—

[Tonia Antoniazzi]

rose—

[Jo Churchill]

I will give way first to my right hon. Friend.

[Sir Mike Penning]

The Minister is being very generous, although we have plenty of time. I think we have until half-past 10, Mr Deputy Speaker, should we or you wish. I have two questions. The hon. Member for Gower (Tonia Antoniazzi) asked a specific question: how is it safe on the NHS for three prescriptions to be given to three children, paid for by the NHS, but not any others? Is it safe, or is it not? The Minister referred earlier to clinicians not having the confidence to give the prescriptions. Is she aware that one of the clinicians was reported to the General Medical Council for writing a prescription and was exonerated? That is why they are scared; they are scared for their careers. How can it be safe for three children, but not the other children whose lives can be saved?

[Jo Churchill]

I thank my right hon. Friend. I have met clinicians, as well as the families. Like just about every other area of medicine, there is divergence in how they approach it. There are those who prescribe and those who do not. I have also spoken to Alfie’s general practitioner, who was very articulate in describing the benefits that Alfie saw from taking medicinal cannabis. However, it is still fundamentally the decision of the clinician who has the child as the patient. One thing that has been said to me is that it is important, as we try to move forward and do better, to ensure that private specialists also have conversations with those who are treating the children for other issues in their NHS care, because of contraindications and so on, as was referred to earlier.

Independent Medicines and Medical Devices Safety Review

Mike Penning Excerpts

Thursday 9th July 2020 Commons Chamber

[Ms Dorries]

I thank my hon. Friend—I do regard her as a friend because she is such a principled campaigner on issues such as this. I hope she does not mind my saying that I know that her mother gave evidence to the review and went along to one of the hearings. I thank her for that, because it was a very brave step to take. This is not an easy thing to talk about, so that was incredibly brave of her. We owe her for her bravery in coming forward, and I thank the hon. Lady for mentioning that.

I completely agree with the hon. Lady. I cannot comment on the specific point about individual doctors with expertise because work has to go forward on removals of meshes and on where we go in the future. However, on specialist centres—I think she is aware of this—NHS England is assessing bids from NHS providers to become specialist centres and to provide treatment for women with complications from mesh inserted for urinary incontinence and vaginal prolapse. Following the covid-19 pandemic, during which some of this work has unfortunately been halted, every effort is now being made to finalise the centres quickly. Stakeholders will be kept up to date with progress, but we do want to see more of that work.

[Sir Mike Penning (Hemel Hempstead) (Con)]

In October 2017, I stood in this very spot with the report in my hand, and it was a whitewash. It was disgusting to the victims—we have not heard that word yet today, but they are victims—of what has gone on in these three terrible cases. In particular, the Primodos victims were shown no compassion in the report and were in many ways blamed for what had happened to their children.

The new report is completely different. I apologise to my right hon. Friend the Member for South West Surrey (Jeremy Hunt), who was the Secretary of State, because I was critical of the three problems being put to Baroness Cumberlege in one inquiry; I thought it would be much better if each was looked at individually. I apologise to Baroness Cumberlege, because I said that to her as well as to the then Secretary of State, and I was wrong. This report is probably the best report on what has gone wrong inside the NHS that I have ever seen.

The NHS does wonderful things, but it gets things wrong. We all praise the NHS. We stood outside last weekend—I hope people did—and praised the NHS on its 72nd anniversary. But when it gets it wrong, it gets it seriously wrong. In 1967, it knew that Primodos was a danger: the company knew and the NHS knew. Young women went to their GP, and said, “I think I might be pregnant”. Very often, no prescription was issued. There were no warnings and no concept of what could happen to their foetus if they were pregnant. The drawer was opened and the tablets were given to them. Those tablets were given by the drug company to the GP, who in many cases did not even issue a prescription.

Today, we have the report, with nine recommendations, but how are we going to compensate those families? It is not just for the women, but for their families, including the men who have stood next to them, such as Marie Lyon’s husband, who has been with her all the way through. How are we going to compensate those who lost their baby, who were told to abort their baby or who had a stillbirth? How are we going to compensate and help those families when the loved ones, the mums and dads of the survivors—they have terrible disfigurements, and they did brilliantly well to give evidence for the report—are no longer with us and the survivors need such support afterwards? While we must make sure this never happens again, we must also make sure that we look after those families and that the drug companies pay for what they did to those families.

[Ms Dorries]

My right hon. Friend makes an impassioned and compassionate contribution, and he should be recognised for his long-term campaigning and his advocacy of the people he mentions who have suffered as a result of what has happened. I cannot comment on the individual points he has raised, particularly on Primodos, because there is legal action pending, but I hear everything he said and others will hear his comments too.

Acquired Brain Injury

Mike Penning Excerpts

Thursday 6th February 2020 Westminster Hall

[Chris Bryant (Rhondda) (Lab)]

I beg to move,

That this House has considered acquired brain injury.

In 1980, I woke up in the middle of the night on a train from Barcelona to Madrid. All I could sense was the world moving in and out. It was not the worst headache that I had ever had or anything that could even be described as a headache; it felt as though my brain was struggling to burst out of my skull. As it turned out, I had viral meningitis. In the end, I was fine after a lumbar puncture and treatment in Madrid, but I feel very lucky, because many people who have had meningitis—with that precise feeling of the world going in and out as the brain pushes against the meninges and the skull—now have permanent brain damage.

Because of the work that I have done on the issue over the last couple of years, I am very conscious that there are some phenomenal people working with those who have brain injuries. Last year, I spent a beautiful day with the Children’s Trust in Tadworth, where a third of the children have had a haemorrhage of some kind, while others have been in road traffic accidents. The trust does phenomenal work to rehabilitate those children—restoring in them a sense of themselves—and to get them back into the education system.

I spent a day with the National Star College near Cheltenham, which does phenomenal work teaching many of these youngsters skills that they can take into the work environment. I saw people whose injuries put them in a challenging position learning to socialise again, and to understand their personal lack of inhibition and its impact on other people. Professionals working in south London explained to me the difficulty in moving people out of hospital and into other forms of community support, especially when families may have been broken up by, for example, the same road traffic accident that led to the injury.

Whether in Norwich, Lincoln, Birmingham or Manchester, the most extraordinary people are doing what looks like miracle work. They can take somebody from needing five or six people just to be able to clean, feed and clothe themselves during the week to the point where, after a year or two of neurorehabilitation and care and support of every different kind, they can do the vast majority of those things more or less on their own, relying perhaps on only one person. The narrow-minded might say, “That is a great success, because it means that the state will not have to spend so much money on them,” but it is a miracle to see such a transformation of those people’s lives. It is also depressing to see, for example, a young lad who has been sitting in an east London hospital for far too long because there is nowhere else for him to go that is safe and can provide the right kind of care.

In Cardiff, I met a young lad for whom we recently held a fundraising dinner at the football stadium—he is a magnificent chap. He had to go all the way to Tadworth because it is the only place in the country with residential neurorehabilitation of that kind for children. I want to that care to be provided closer to home so that parents do not have to make enormous journeys and children do not feel discombobulated and uncertain about their role in the family and how their life will proceed.

The Disabilities Trust has done amazing research—partly in Cardiff prison, but in other prisons, too—that the Government now wholly accept as factual and as the basis on which we should proceed. Who would have thought, even five or 10 years ago, that analysis of both male and female prisoners arriving in prison would show that more than half had sustained a significant brain injury at some point in their lives? The Government’s website states that someone who has suffered a significant brain injury is twice as likely to commit a serious crime. There is perhaps not just a correlation between the two, but a causal link. Maybe this is not, as some of us have said, a hidden epidemic affecting 1.3 million people across the country, but something much more systemic. If we can spot those who need support, ensure that they get it and deal with brain injuries sooner, so many other societal issues might be addressed.

Work with young offenders in my patch of south Wales, where we have a very good co-ordinated approach, made it clear that a child from a poor background is four times more likely to suffer a brain injury under the age of five, with similar figures for teenagers from poor backgrounds. Those ages are both important developmental periods for the brain, which is a soft organ inside a hard, craggy shell, and is therefore extremely vulnerable if pushed around or jarred. In my patch, three quarters of the youngsters in the criminal justice system who caused the biggest problems were those who had suffered significant brain injuries that had been left largely untreated. If we had dealt with those injuries in the first place, we might have been able to help those children in the education and health systems long before they entered the criminal justice system. That would have meant a much better outcome for those individuals, their families and society, and a much greater saving to the public purse.

Members will know that a brain injury can come about for all sorts of different reasons: a traumatic incident, such as a fall or a crash, or just a single punch. I can remember so many horrific incidents in my constituency, outside pubs and so on, where somebody has been punched in a fight. That punch, or the individual hitting the pavement or the wall, may lead to an injury that completely changes their life. The cause of a brain injury could be that, or it might be a haemorrhage, an aneurism, a tumour or carbon monoxide poisoning. Carbon monoxide poisoning can particularly affect people in rental accommodation, and we have to make sure that landlords properly test all the equipment in the house to ensure that a faulty boiler or heating system does not poison those who live there. We now have a much better understanding of carbon monoxide; not only can one big exposure to it do damage to an individual, but even relatively low levels sustained over a period of time can damage the brain in the same way.

Hypoxia is another cause of similar problems, as is stroke. I am quite conscious of this issue, because quite a lot of people have got in touch with me and said, “Why don’t you talk more about stroke?” It is not because I do not understand the problems in relation to stroke and brain injury—many of the issues are exactly the same; it is an injury, just by a different means—but because there are organisations specifically dedicated to stroke, such as the Stroke Association, which have been dealing with it. We in the all-party parliamentary group on acquired brain injury have tended to leave that to one side. But when we bring it all together, we realise that we still have a limited understanding of how to look after, treat, care for, provide for and protect the part of our body that we think of as the place where our personality resides, and therefore as the bit that is most intimate to us as human beings.

It is only recently that people at the Ministry of Defence have started to think that perhaps some people who have been diagnosed with post-traumatic stress disorder actually had brain injuries that were not treated and that led to all the other issues.

[Sir Mike Penning (Hemel Hempstead) (Con)]

I congratulate the hon. Gentleman on securing the debate. As other Members want to speak, I will not intervene for long. A lot of diagnoses were not made at the time, sometimes because the symptoms were just not there. There needs to be an understanding, not just in the Ministry of Defence but in the medical profession—I will come on to social services—of what a brain injury is. A brain injury does not necessarily show itself straight away, and it does not necessarily have physical symptoms; it is inside this little cocoon that we rely on so much.

[Chris Bryant]

Perhaps we have thought, “Well, a little blow to the head is okay; we don’t mind and we’re not going to worry about that.” The right hon. Gentleman is right; perhaps we have been a bit blasé about it, and perhaps even more so in the armed forces, where people want to show that they are tough and can carry on.

Incidentally, the appearance of symptoms some time later is equally an issue in education. A child might come back to school wearing a bandage, at which point everybody is warm, friendly, loving, caring and supportive. Nine months later, when the bandage is gone and everyone presumes that the child is getting on with their life, the child may start becoming difficult in class, finding it difficult to concentrate and falling asleep in lessons. They may be less in control of their inhibitions, and all the rest of it. The teacher may not recognise that as part of what happened nine months before.

Unless teachers and the whole education system are trained to understand fully the concept of neurocognitive stall, there is a real danger that the child will end up becoming increasingly difficult because they do not know anything else; they get shouted at, which sends them into panic rather than making them say, “Please, Miss or Sir, I need some support and help.” Then the child ends up getting excluded and falling into the criminal justice system. If the support had been sustained from day one for at least a year, and if we had made sure that all the teachers in the school understood those issues, we might have been able to save that person’s education.

--- Later in debate ---

[Sir Mike Penning (Hemel Hempstead) (Con)]

It is a pleasure to take part in this debate. I campaigned for free car parking with my right hon. Friend the Member for Harlow (Robert Halfon), and I completely agree with what the hon. Member for Mitcham and Morden (Siobhain McDonagh) said about it. Perhaps the Minister cannot commit now to abolishing car parking charges, but I am sure that the Government will do so because we campaigned for that all the way through. No distinction should be made between one type of case and another; people who need to be by their loved one’s bedside should not be paying car parking charges. The NHS was designed to be free at the point of delivery, and that includes car parking for people in that position.

The hon. Member for Rhondda (Chris Bryant) is right in most, if not all, of what he said. His personal experience has given him an outlook that someone like me could not possibly have. Interdepartmental work is the only way to take this forward. Like my right hon. Friend the Member for South Holland and The Deepings, I have been a Minister—in my case, in seven Departments, before I managed to upset the last one and came to the Back Benches. This will only work if the Prime Minister says that there will be an interdepartmental group that will meet regularly and will be chaired by so-and-so—probably the Deputy Prime Minister, as it was then, or the Cabinet Office—and that they will report back what each Department is doing.

As we have heard, nearly every Department will be affected, from the Department for Digital, Culture, Media and Sport—the hon. Member for Airdrie and Shotts (Neil Gray) has alluded to football, and I will declare an interest about rugby and boxing in a moment—to the Department for Work and Pensions, which deals with how personal independence payment is assessed, and where I used to be a Minister. As I said earlier, because of the nature of the injury, it is not always visible; very often, it is inside.

I will touch on some other points. I understand exactly where the Scottish Football Association is going in looking at the issue of younger people and heading, but if those young people go on to play professional football later, they will head the ball. The rest of the world of football must take a leaf out of rugby’s book—particularly rugby union. I declare an interest: I stupidly started playing rugby when I was 11, and I am still playing now. I will be playing against the Welsh Assembly at Richmond in a couple of weeks’ time; that game might be slightly more interesting than the England-France one was.

Perhaps because we have seen some shocking injuries and we know what is going on, the game has changed, not just in that we now pull people off the pitch to be assessed, but in how we tackle. To be fair, a lot of that has to do with American football, where they used to lead with their head because they had the protection of the helmet, and because of machismo. Women’s rugby is the fastest-growing female contact sport in the country, and it has been for years; quite right, because it is brilliant to watch. However, in women’s rugby as well as men’s rugby, the game had to change to protect the players—those going into the tackles as much as those coming out of them.

[Neil Gray]

Like the right hon. Gentleman, I declare an interest in view of my past, rather diminished career as a rugby player. Football certainly has a lot to learn from rugby, not least when it comes to what he is saying about the contact area. The enforced absence of a player from the pitch for a period of time following a concussion diagnosis is also important, and it is something that football needs to learn from.

[Sir Mike Penning]

I could not agree more, and I was just coming on to that point. The Football Association and FIFA do not need to reinvent the wheel. We need to take time to assess whether a person has been concussed and, if so, they should not play the following week or the week after that. Those assessments have to be done by professionals, away from the pitch, and sometimes with scans.

Rugby has led the way. I watched a rugby league match this weekend—I have a rugby league team in my constituency, even though I am deeply in the south. Some of the tackles just would not be allowed in rugby union any more. As far as I could work out, they were old-fashioned spear tackles—the player is allegedly going for the ball, but they catch their opponent around the top of the neck, and that causes damage to the brain, which rattles around inside the piece of bone that protects the brain. It is plainly obvious that we needed to change, and it has taken time—probably too long—but it has happened.

Boxing also has to change for the better. I declare an interest, in that I boxed for many years. I am talking not just about the terrible things have gone on in the ring, as a result of which people have died for a sport that they love and want to be involved in, but about what happens to people years later. I will not name names, but I know several former world boxing champions who now suffer the consequences of the brain damage that they incurred. They can be read about in the papers. I do not need to name them, and it would be improper to do so.

This is not just about concussion. People in this situation have gone through clinical depression, and their injuries affect them and their loved ones for the rest of their lives. We must support more awareness and encourage the sport to do all it can to open up. We do not need to reinvent the wheel, but we must learn from other sports. I wish the hon. Member for Airdrie and Shotts luck in Scotland on Saturday, and I hope that England play somewhat better than they did against France. Let us hope that there are no injuries like some of the ones we have seen in the last couple of weeks. There was a neck and spinal injury at the Saracens-Worcester game the other week, and it was spine-chillingly horrible. People want to play the sport and it is their passion—stupidly, I still play—but we have to make sure that we protect them.

I want to touch on long-term care and the assessments that are carried out when people with a pre-existing brain injury of some description get dementia. Continuing healthcare is an absolute minefield. I have heard about this from too many of my constituents, and from colleagues in the House over the years. Even though someone who is going into care has a medical condition—a brain injury—before dementia comes on, that seems to be put to one side when the panel look at continuing health provision for them. That is fundamentally wrong.

Just because someone develops dementia or Alzheimer’s, it does not mean that their other medical conditions have vanished off the face of the earth. They have not. But time after time, I have had to help individuals and their families to go to appeals and tribunals to get something that they would probably have got if the individual had not got dementia, but that that they do not get because they have dementia alongside the pre-existing injury. It sounds very complicated, but it is actually very simple. If someone has a medical condition, such as a brain injury, that brings on dementia—we do not really understand that, and I was reading some research last night on the reasons for it—surely, the medical and nursing care that they needed for that brain injury should not be put to one side when they go for an assessment if they have Alzheimer’s or dementia.

I give praise where praise is due. I was a shadow Health Minister for four and a half years when the last Labour Government were in power, and they started the major trauma centres. The debate started with them, and they progressed it. The issues with major trauma centres are about where they should be, how quickly people can get to them and whether enough people are using them to make them viable, given the required expertise. To be honest, it is the same old story as with A&Es. Major trauma centres are not A&Es; they are specialist units for people who need specialist care. People who need to go to A&E should go to A&E, and people who need to go to a minor injuries unit should go to a minor injuries unit. It is about making sure that people go to the right place.

With major trauma, the decision is made for people. All the major trauma centres have helipads now. I truly hope that as they develop as centres of expertise, we will recognise that people need travel to the right place to see the specific consultant specialist who can save their life. That may not be the centre that is just down the road or the one in London—for my constituents, such things often involve coming into London—but it might be one that is 20 minutes away by helicopter ride. That is absolutely right, if that is where the expertise is. The time when people need to be closer to home, and to the support of their loved ones, is when they come out of major trauma centres and into rehabilitation.

Public understanding about major injuries is better these days. I was a fireman for many years and, sadly, I went to too many road traffic incidents. People are increasingly surviving major road traffic incidents or collisions. We tend not to call them accidents these days, because they are not accidents—they are preventable—and victims feel very strongly that we should not call them accidents. I understand that view. I made a big booboo as road traffic Minister when I talked about road traffic accidents. I did so because that is what firefighters did, but I respect the point: every accident is preventable, and these are collisions in which people’s loved ones are involved.

Today’s survival rate has a lot to do with the manufacture of the vehicles, airbags and how crush plates work inside vehicles. Those things mean that more people are surviving, but with very serious injuries. As I alluded to in my intervention, some of those injuries are physical and show themselves there and then, but a lot do not show signs until much later—sometimes nine weeks or nine months, or sometimes many years later.

That brings me to my final point, which is about our armed forces. We send our armed forces around the world. They work in a very dangerous occupation, and we try to make it as safe as possible. Sometimes, there are injuries in training. We sadly lost one of our Royal Marines only the other day; he was doing the job he loved and training to do something he was passionate about. Our thoughts and prayers are with his family, friends and loved ones.

We must look after our armed forces personnel after they are injured. I can remember so many incidents around head injuries when I was a squaddie, and there was no way that I would have gone down to the medical officer the day after a head injury with a headache. The barrack room humour would have been all about, “Get on with it. You are supposed to be robust.” I have been the Minister for the Armed Forces, and I think we are getting there, but the way forward is to improve public awareness. That involves debates such as this, and perhaps an overall Government body that can look at the issue in general terms. I hope we do not need too many of these debates—I have been around a long time—before we get to a better position in Government.

--- Later in debate ---

[Caroline Dinenage]

I will certainly seek to get that in writing for the hon. Lady.

My right hon. Friend the Member for Hemel Hempstead spoke about continuing healthcare. I know that that is a concern for many people, but what concerns me is that actually, CHC is needs-based, not diagnosis-based, so eligibility should be assessed by looking at all of an individual’s needs and considering their nature, complexity, intensity and unpredictability. If he wants to drop me a line about an individual case that he is concerned about, I will be more than happy to look at it.

[Sir Mike Penning]

It might be a lot of cases; I think the Minister will have had a lot of cases from across the House. I completely agree that that is what the principle should be. In practice, however, I ask her to look at the amount of appeals that have taken place, and she will realise it is not quite working.

[Caroline Dinenage]

I will very much take that on board.

The hon. Member for Washington and Sunderland West asked me a number of questions. I may not have written them all down, but she asked about workforce. We have the people plan, which Baroness Harding has been working on, which will be released later this year. It will look at all forms of medical professionals, but also the allied health professionals that the hon. Lady mentioned.

The hon. Lady asked what conversations I had had with the Department of Education. That Department is currently undertaking a review of special educational needs and disability, which will look at all aspects of supporting young people through their education. We are playing a key role in that SEND review. She also asked what conversations I had had with the Department for Work and Pensions about training. Case discussions about claimants with ABI now form part of a new entrant training for all healthcare professionals undertaking work capability assessments, and they all have access to a learning module on ABI, which was updated in 2018 and has been quality assured by Headway.

I hope that today’s debate has continued to demonstrate how seriously the Government take ABI. We are committed to ensuring that people get treatment, care and support when they need it.

Health and Social Care

Mike Penning Excerpts

Thursday 16th January 2020 Commons Chamber

[Matt Hancock]

I am, because Milton Keynes’s new MP has already been working with me to bring this concern to light. I can inform him that the new cancer unit will be handed over to Milton Keynes hospital at the end of next week. That problem is indeed temporary and it is being resolved, very much thanks to the hard work of the new MP for Milton Keynes.

[Sir Mike Penning (Hemel Hempstead) (Con)]

I thank the Secretary of State for his meeting the other evening. I am sure my right hon. Friend the Member for Harlow (Robert Halfon) is thrilled that he is one of the six to get a brand-new hospital.

In south-west Hertfordshire, as the Secretary of State knows, we are not happy about having a hospital in the middle of Watford, next to a football stadium. It is not right for my constituents or for many constituents of Members in the Chamber today. The Secretary of State has committed to me privately to look at whether we can have a new hospital elsewhere, and I know there is a review going on about the funding and how much that would cost. Would he like to reiterate that at the Dispatch Box?

[Matt Hancock]

Yes, we are doing that work to make sure that, as we pump hundreds of millions of pounds into Hertfordshire to improve its healthcare, we get the exact locations right. I look forward to working with my right hon. Friend on that.

--- Later in debate ---

[Sir Mike Penning (Hemel Hempstead) (Con)]

When I sat in the Chamber earlier, I was not certain that I was in the right place. As you will know, Madam Deputy Speaker, we are not used to so many people listening to speeches—and what brilliant speeches they have been, particularly from the new entrants in the House. I say to newly elected Members of Parliament: this will not last. As we get further into the Session, trust me, it will not last.

I thought back to my maiden speech in 2005, when I made a promise to my constituents that I would go on and on and on about the acute problems at the hospital in my constituency. There was a bit of politics. I am not making a maiden speech, so I can be a little more controversial than some of my colleagues here today. The Labour party made the decision—in those days it was the Minister’s decision—to close the acute facilities at Hemel Hempstead Hospital. Acute facilities at St Albans had already been closed, and promises were made that those facilities would always be looked after at Hemel Hempstead Hospital, which was fairly new. We are a new town, so this was not about dilapidation. It was a fairly new hospital, but the decision was made to move those facilities to the centre of Watford, next to Watford football club.

I have nothing against Watford football club. As you may have heard, Madam Deputy Speaker, I am an ardent Spurs supporter, so this weekend will be very difficult for me as the Spurs play Watford. I want every success for the local clubs, but we have a Victorian hospital next to that football club, in a very difficult traffic area of Watford, and it is well over 100 years old. In the modern world we live in, would we dream of building a hospital in the middle of a town, next to a football club? Of course we would not. So I was simply thrilled—this is where I am going to get controversial on my own Treasury Front Bench—when it was announced that in south-west Hertfordshire, in my part of the world, we would get one the first six new hospitals—six new hospitals were announced; five new hospitals and one refurbishment—guess where, Madam Deputy Speaker: next to Watford Hospital.

We can moan and moan at Ministers, but the difficulty these days is that we have devolved so much power to local health authorities. That sounds good on the tin, but having oversight from local, democratically elected people is really very difficult. The clinical commissioning groups should listen and in our community they are not particularly listening. West Hertfordshire Hospitals NHS Trust is absolutely determined that this is where they want to build £400 million of new facilities: in the middle of Watford, nowhere near the community it should be serving—apart from the people of Watford, to be fair.

We continue to campaign. We have not given up. We do not want to reopen the facilities at Hemel Hempstead Hospital and we do not really have the land available in St Albans. What we have said is this: let us build a new hospital for south-west Hertfordshire. That is what we would do today; that is what the money in the new hospitals plan would do. To be fair, the Secretary of State has seen me and he has asked his officials to look into what the cost-evaluation would be. We have had costings of £1 billion for a greenfield site put out on local radio, interestingly by the Mayor of Watford, and we have had costings from other parts of the country as low as £375 million. So something is seriously going wrong between the costings.

We have got into a situation where the only way we can fight this, believe it or not, is to take the trust to court. There is a lack of accountability—I have called for debates in this House on that for years now. The only way we can fight the fact that the trust has only put in a bid for refurbishment of the Watford site is to take it to court and challenge it under judicial review. I have a fantastic community. We have raised the money. We will go to court. But is it not crazy that here I am praising, and I will be voting for, the Queen’s Speech and against Labour’s amendment, when I am saying that the £400 million being offered by the Government is going to the wrong place?

I listened deeply to the former Secretary of State, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), when he said that we have to admit it sometimes when we make mistakes in the NHS, whether they are clinical mistakes, mistakes on Primodos—another thing I like going on about in the Chamber, although I do not have the time to do so this evening—or the fact that we do not have prescribed medical cannabis free at the point of delivery to our children when a consultant says it should be prescribed. The only way we can fight this at the moment is to go to the courts. I am pleased with the Secretary of State on this, and I know that this will all be fed back. There was supposed to be a letter to me in the last couple of days from the people looking at the funding. That has not arrived yet, so—hint, hint, Front Bench—let us get the letter to me.

I do not want to go to court and the community do not want to go to court, but I was sent here to fight for something. The biggest issue in my constituency is the future of my hospital and the future provision of care in my constituency. We want a new hospital on a greenfield site. This Government, I believe, could fund that.