NHS Bursary

Nigel Evans Excerpts

Monday 11th January 2016 Westminster Hall

[Several hon. Members rose—]

[Mr Nigel Evans (in the Chair)]

If I heard correctly, Mr Newlands, you said that your mother had just been admitted to hospital—our thoughts are with you.

The debate will finish no later than 7.30 pm. The Front Benchers may divide up the time and should not exceed it, so that everyone gets an equal amount of time. It is customary to allow Mr Scully an opportunity to wind up right at the end. I call Philippa Whitford.

Oral Answers to Questions

Nigel Evans Excerpts

Tuesday 17th November 2015 Commons Chamber

[Alistair Burt]

The syndrome to which the hon. Gentleman rightly draws attention is well known here as well. I understand from the public health Minister, my hon. Friend the Member for Battersea (Jane Ellison), that a consultation in relation to this will be announced shortly, and of course there will be new guidelines in response. The all-party group is right to draw attention to this, and anything that can protect women during pregnancy and, of course, their children is of benefit to all.

[Mr Nigel Evans (Ribble Valley) (Con)]

In one family in my constituency, three of the four youngsters have autism. Will the Minister look at the work of local authorities? In this specific case, Lancashire is clearly not working closely enough with the mother, who has one idea about how she wants her youngsters to be educated. The local authority, for cost reasons alone, is simply not working with the parents. It would prefer to see her prosecuted, rather than working with her.

[Alistair Burt]

I fairly regularly meet families and others who have had young people and older people in the system and where there is a difference of opinion about what might be done. Some of the stories are very distressing. Families will sometimes feel that people have not listened to them. There can be quite difficult clashes of opinion on occasion. Of course, any case that my hon. Friend wants to bring me I would be happy to see, but this is a perpetual issue. The important thing is always to listen to those who are closest to a problem. That is likely to be the best way forward. Even if there is a difference of opinion, if people feel that they have been listened to, there is a proper opportunity to explore what can be done.

Oral Answers to Questions

Nigel Evans Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

May I start by saying that it was an incredible privilege to work with the right hon. Gentleman on the Government Benches on mental health issues over many years? He was a great inspiration to many people in the mental health world for his championing of that cause. It is my absolute intention to ensure that his legacy is secure and that we continue to make real, tangible progress towards the parity of esteem that we both championed in government.

[Mr Nigel Evans (Ribble Valley) (Con)]

I welcome the expansion of GP services to seven days a week. Will the Secretary of State remember rural areas such as Ribble Valley when GP services are expanded? Funnily enough, people who live in rural areas also get ill at the weekends.

[Mr Hunt]

We will absolutely remember them. That is why it is so important to embrace new technology. Sometimes people who have to travel long distances are able to use such things as Skype or to make a phone call to receive important advice. This is a big priority for us.

HIV Prevention

Nigel Evans Excerpts

Thursday 12th March 2015 Commons Chamber

[Mike Freer]

The right hon. Gentleman makes a good point. If he bears with me for just a minute, he might find that I am in agreement.

We have to accept that many teenagers will become sexually active, yet sex and relationship education—SRE—remains poor. The National Aids Trust recently published a report showing that in SRE there is little teaching about, among other things, same-sex awareness or HIV transmission. Teachers can be nervous of sex education full stop, let alone same-sex issues, sexual health or, in particular, HIV. That is compounded when schools struggle with homophobic bullying, which can contribute to teenagers feeling uncomfortable about seeking advice or information about their attractions or about having a safe sexual relationship when the time comes.

[Mr Nigel Evans (Ribble Valley) (Con)]

Is my hon. Friend as alarmed as I am by recent newspaper reports in which it appears that an increasing number of youngsters are being bullied or harassed at school for being gay, and in some cases even being taunted by teachers? Surely there has to be a completely different attitude in the 21st-century UK.

[Mike Freer]

My hon. Friend makes a very good point, and I agree entirely. In the Department for Education—I apologise to my hon. Friend the Minister for straying away from health, but this is a cross-Government issue—work has been done to fund teacher training on dealing with homophobic bullying, but we need to go one step further and make it integral to teacher training, not an add-on paid for by schools and local education authorities. One of the problems is that if gay men or men who declare as MSM are bullied for showing any form of attraction to other men, for seeking advice or for showing that inclination in any shape or form, they will simply not seek that information. In school they may be afraid of being bullied, whether by other schoolchildren, teachers or other members of staff. They will close down and withdraw, and as a result they might make ill-informed decisions about their sex lives.

In my view, therefore, it is time for SRE to be made compulsory and inclusive. I appreciate that that is not the view of my colleagues in the Department for Education, but I think that they are wrong and that they need to reassess that. We are talking about people’s health and future relationships, so this is too important to get hung up about the ideology of compulsion.

There is also the issue of new technology. When I was at school, in the dim and distant past, sex education was skirted around and pupils, if they were lucky, were given a rather dusty old book with some rather dodgy drawings—clearly that did not teach me very much. Today, teenagers have access to technology. They are accessing sex differently, and accessing information differently, so we need to educate and inform differently. The increasing use of dating apps—I use the term loosely —means that increasing numbers of teenagers are finding sexual partners through their phones. Are colleagues in Government and in health authorities nimble enough in using that technology effectively to ensure that appropriate sexual health messages are there too? Are we constantly playing catch-up, or can we innovate too? How can we intervene differently to support those who are HIV-positive? I said that we need to start with education and that we need to use technology, but when people present as HIV-positive, how can we intervene differently?

It is true that new anti-retroviral drug treatments—ARVs—have transformed the lives of those who are HIV-positive, and they help most people to live near-normal lives, but it is still a life-changing diagnosis. ARVs have to be taken every day for the rest of the person’s life. Relationships can be harder to find and to maintain because potential partners often reject someone who is HIV-positive. Despite anti-discrimination laws, few employees volunteer their HIV-positive status. To my knowledge, only one Member in the history of this House has ever declared his HIV-positive status. That former Member is now in another place. People will not volunteer their HIV-positive status for fear of discrimination—not just overt discrimination but the subtle passing over for promotions or snide comments in the workplace. Then there is the fear of shunning or harassment by co-workers. Despite all the work over the years, some people still believe that HIV can be transmitted through saliva or through sharing crockery and cutlery— 30 years after a major education programme.

All these factors combine such that the human cost of HIV-positive status can be significant. Despite the medical breakthroughs and ARVs, the costs of depression, isolation and the fear of being open remain. We still have work to do to ensure that health education is provided in the workplace, and not just in health education teaching or clinics. The impact on mental health is often missed by health services and sexual health clinics. Sexual health clinics should be more about general well-being and not just sexual health. It should not just be about treating a symptom. If someone goes in with gonorrhoea and comes out with a pill, it is “Job done” for many clinics, but what if they are treating someone who is presenting as HIV-positive? What is the back-up? What about their mental health? Are we providing that total well-being package?

I mentioned chemsex, where men use drugs that enhance sexual performance combined with drugs such as crystal, methedrone or GHB. This can lead to reduced sexual inhibitions and so increased risk-taking. I understand that someone presenting at a sexual health clinic who has chemsex is more likely to have broad sexual issues, and the clinic will deal only with those issues, while the drug-related issues will often be subject to referral to a drug treatment facility. That is often a separate facility and the referral may take six, eight, 10 or 12 weeks, during which time the person who has been interested in seeking treatment falls through the cracks. The separation of treatments, particularly for those involved in chemsex, not only breaks the treatment plan but increases the chance that the patient will not take up the treatment referral, and so behaviours are not changed.

Only this week I had the chance to visit 56 Dean Street and Dean Street Express in Soho. They are absolutely stunning facilities that look nothing like what we imagine the NHS to look like. It was not clinical and there was no plastic seating—it looked for all the world like an attractive boutique hotel. Dean Street Express has harnessed technology. Rather than someone having to go into a clinic, stand at a counter and announce to the world why they are there, or having to sit in an open waiting room, with everyone looking sheepish because they may recognise somebody else, they can book in using technology. They can also swab themselves, and then use the technology. That is the way forward if we are to make the system friendly and receptive, to innovate and to make it worth while and easy for people to seek help and treatment. Most importantly, it provides help on total well-being, not just sexual health. In my view, the Department of Heath should look at rolling out that innovative technique.

I have mentioned the black African community. It is a difficult community to reach, and I do not have any answers, but we need to work harder to reach it, whatever the method—perhaps through its community groups or churches—both to educate and to support those who disclose themselves as MSM or those who are afraid of doing so for fear that their own community will reject them.

We have to accept that people will make poor choices and have unprotected sex, which leads me on to intervention. I pay tribute to the PROUD report. Its initial studies show that post-exposure prophylaxis and pre-exposure prophylaxis—treatments taken immediately after suspected exposure to HIV or as a preventive measure—work. The initial findings show that they are cost-effective approaches to the prevention of transmission, or at least to ensuring that infection rates drop dramatically.

I accept the fact that the use of PEP and PrEP has cost implications. I understand that PrEP costs up to £6,000 a year, but we should compare that with cost of treating someone who is HIV-positive. The lifetime cost of treatment for a person with HIV is between £250,000 and £330,000 a year, so a £6,000 investment could save between a quarter and a third of a million pounds a year.

I have outlined some of the human and financial reasons for understanding what is driving up infection rates, and the action we could take. That brings me to my last point, which is that we need to increase testing. We need to make it easier and less clinical so that people do not fear that it means always having to go into clinics. A clinic is not a friendly—to overuse the pun—environment.

If clinics are used, they should at least make routine tests for HIV across the board so that people who are HIV-positive can have early intervention. Early diagnosis and early treatment dramatically improve the lives of individuals and reduce transmission rates. Let us remember that 25% of those who are HIV-positive do not know it. Easier and faster testing will help to reduce the number of transmissions and new infections. That should include the roll-out of home testing, because it must be right to make testing accessible and easy.

We often shy away from talking about sex, and we certainly find it uncomfortable to learn about sexual practices outside our own experience. Yet if we are to tackle the issues, we have to deal with the problems that exist and with the world as it is, not as we might like it to be. That is why I call on my hon. Friend the Minister to explain how we can redouble our efforts to educate and innovate in HIV prevention.

NHS Mental Health Care

Nigel Evans Excerpts

Wednesday 11th February 2015 Westminster Hall

[Mr Hancock]

I am sorry. I was quoting the Minister, Mr Chairman. He stated that 25% of young people with mental health problems had access to mental health services, which he described as both “dysfunctional and fragmented”. That cannot persist. That cannot be right in a society that claims to care and aims to try to deliver services that are perfect for it. There are serious problems with mental health services and the way in which young people are treated. So many of them have ended up in prison, because there are simply no beds available.

If I may, I will talk about my own experiences. I was very fortunate. I will praise my own GP, Dr Chhabda, who was excellent and got me help. I have praise for Talking Change, where I had several sessions, and for Dr Barker and his intermediate crisis team at St James’s hospital. They were of enormous benefit to me. Subsequently, I was under the care of Simon Kelly, the psychiatrist who looked after me when I was in hospital for a long time.

What did I learn during that long period of mental illness? I learned about the stigma. When I was in hospital for several weeks with major heart surgery, the problem was obvious to people—I did not worry about telling them that I had had major heart surgery—but for the last two months of my being in hospital getting over a mental breakdown, I was worried about how I would explain to people where I had been. I was making myself ill with the worry of how I would explain to people that I, this strong person who could fight off most things, was suddenly unable to do so and had to seek help.

But I was not alone. The other people, who have become close friends of mine, were going through the same thing: the GP who did not know how he was going to go back to face his patients, and the dentist who did not know how he was going to work things out. Many other people, from different professions and none, were struggling with the reality of going home to face their immediate families with what had gone wrong with them, and there was little or no help coming from outside the hospital to give them the support that they needed.

In the rest of the time that I have in politics, and in the rest of the time that I am alive, I want to fight to lift once and for all the stigma attached to mental health issues and be proud to say that I was broken but I got fixed, because of the love and skill of the people who were there to help me.

Some of the people whom I met in hospital had travelled long distances. One was from the Minister’s own constituency in Norfolk. There was not a single bed available, from the coast of the North sea, where this person lived, to the waters of Southampton, where a place was available. That was the nearest place. They were transported down there and eventually transported back.

Other people I met in the hospital came from Truro. They had been brought from the furthest edge of our country to the edge of Southampton, because no bed was available. Ironically, when they arrived at the hospital, they came in an ambulance with a driver plus two nurses, and they stayed for four days. Then they were transported all the way back to Exeter, because a bed became available nearer there.

What sort of society are we living in? Somebody at the lowest ebb of their life is transported across the country, away from their family and support networks, because there are no beds available. The way in which people are treated is a national disgrace. We could see in the faces of the people that they knew it would not be possible for their families to come and visit them, because of the enormous distances involved. We have got to do something about that. We cannot allow that situation to persist.

There is the situation of somebody whom the NHS sends into a hospital for a detox programme. They are given a six-day detox programme, probably costing several thousand pounds, and then, on a Friday night, they are told that they have to go 50 miles up the road to spend two nights in a Premier Inn, with no support available over the weekend to help them. For anybody going on a full-time detox programme, the minimum time is 28 days. The NHS will spend a lot of money several times, but limit it to six days and then give the person little or no support when they are out. That cannot be right. No Government should be proud of the record that we have on mental health issues.

[Mr Nigel Evans (Ribble Valley) (Con)]

I am pleased to stand alongside my hon. Friend and I congratulate him on the debate that he has secured today. Mental health is one of the Cinderella conditions that people tend not to want to talk about, because of the stigma that my hon. Friend talked about earlier on. If someone has a broken leg, it is fine, but if someone’s mind is broken or there is a mental health issue, nobody wants to talk about it. It is easier to sweep it under the carpet.

Will the Minister understand that we really need to get to a situation in which the stigma is no longer there? All we need to do is to give people the help that they need—and, indeed, the hope that they need—as if they had a broken leg or a broken arm, so that they can get back to normal living.

[Mr Hancock]

I agree entirely. We lucky ones who are privileged and proud to be in this House of Commons must use whatever elements are available to us, whether in speeches here or outside this House, to do more to expose this issue.

I was fortunate because the people I was in contact with were able to put me through a series of different things. They saved my life—I have no doubt whatever about that. I could not stand my life any more and, like so many people, I realised that far too late. I had probably left it six months too late, and because of that my recovery took much longer.

There are others outside the system—people and organisations that try to help. They include Talking Change, which is in my constituency. However, I say to the Minister—through you, Mr Pritchard—that the crisis care service is at breaking point. Services are understaffed and under-resourced; they are overstretched. As for talking therapies, which a lot of people mention and which I have heard the Minister himself praise in the past, 40% of the people who want to use them have to wait more than three months just for an assessment, and that assessment is normally carried out on the telephone. I urge the Minister to try that interview over the telephone. Then, if they are lucky, they will receive some treatment, but one in 10 people wait more than a year to get even the chance to talk about the problems that have driven them to the edge of the abyss, so that they are living in total despair. In addition, a third of the people who are assessed have to wait more than three months to start the therapy.

I ask this Government and whoever is in power after 7 May to really mean what they say about mental health services. There is a crying need for that. When I heard the Deputy Prime Minister talk about mental health services, I thought, “Oh! Maybe we’ll get somewhere and something might happen.” I live in hope, but my experience—having looked into this issue in quite some detail—tells me that the same promises have been made many times during the past 20 years.

I was someone who felt that he could tough out most things, but in the end I had to succumb to the stress and strain I was under, to such an extent that I had no alternative but to seek real help. However, there are literally thousands of people out there who are affected. A quarter of the population of this country will come into contact with mental health problems at some time during their life. Unfortunately, so many of them are disappointed by what they get in the way of treatment from the NHS.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

Thank you very much indeed, Mr Pritchard, for calling me to speak. It is good to serve under your chairmanship.

I congratulate my hon. Friend the Member for Portsmouth South (Mr Hancock) on securing this debate; I know that he has been trying to secure such a debate for some time. I particularly congratulate him for speaking out about his own mental ill health, because it is at the heart of changing attitudes and addressing the stigma that he and other hon. Members have talked about that people who have been successful in life should speak out and explain that they themselves have suffered mental ill health. Every time someone speaks out about their own mental ill health, that makes it easier for a youngster to be open about their own issues and seek help. That is the critical change that is needed, so that mental health comes out of the shadows and we lose the embarrassment about discussing it.

I commend to hon. Members the brilliant campaign, Time to Change, which this Government have funded, along with Comic Relief. It is all about tackling stigma. Interestingly, attitudes are changing. They are being measured on a regular basis and the dial is moving; people feel more able to talk about their mental ill health.

[Mr Nigel Evans]

I am extremely grateful to the Minister for what he has just said. When I was 27, I had depression for a year. I did not know where I was; I did not know whether I was going to come through it. It was awful. I received support from a lot of people who loved me and who got me through that particular period. Then I became an MP and eventually Deputy Speaker of the House of Commons.

The one thing that we must give people is hope, and I hope that the Minister’s response to this debate will be one not only of understanding—he has already expressed that—but of hope for people out there and their families, who look on, feel dejected and want support.

[Norman Lamb]

I totally agree. I hope to be able to convey some sense of optimism, actually, because, despite all the challenges that my hon. Friend the Member for Portsmouth South referred to, there are very some exciting things happening, which are laying the foundations for genuine equality for mental health. We have legislated in this Parliament for parity of esteem, but to be honest I am not interested in empty rhetoric—our words must mean something for people in need of help.

My hon. Friend referred to many aspects of the system that need to improve significantly. I will deal briefly with one—the issue of beds. We must be a bit nuanced here. It is absolutely clear that when there is a moment of crisis a bed must be available, and available locally. Incidentally, we should also look at places such as recovery houses. Increasingly, there are lots of third sector organisations that provide recovery houses around the country and it is often better for people to go into a place such as that than to be an in-patient admission, which might not be the best thing therapeutically for them. But the idea that in a middle of a crisis someone is shunted somewhere else in the country, or even put into a police cell, is really an outrage in a civilised society.

The interesting thing is that when I came into this job I realised more and more that I was operating in a fog. The data that we are absolutely used to when it comes to physical health, and the scrutiny of that data and evidence, have simply been lacking when it comes to mental health. Traditionally, we have not collected the information about access to services and what is happening to people on the ground, and that has been a fundamental issue that I have sought to address.

On out-of-area placements, I had no idea from the data that came to me about what actually happens around the country. Last week, we finally got the first sight of real data, which will now be provided on a regular basis, so that we can hold trusts to account if they fail to meet local need. The fascinating thing is that there are many trusts around the country that have no out-of-area placements at all under existing financial circumstances, while there are others that completely fail and are sending many people out of area. We need to understand why that is happening and address the causes, whether they are in commissioning, in the provider organisation or because of lack of funds, because some areas have demonstrated that that is not necessary.

Ebola

Nigel Evans Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

The hon. Lady speaks extremely wisely and there is cross-party agreement on that matter. That shows why it is so wrong to make an artificial division between helping people abroad and helping people at home. I think we have a moral responsibility to help people in the poorest countries abroad in any case, but in my time in this House there has been no better example than this one of how doing so is in the interests of people in the UK, too. It helps to make us more secure, and we can be incredibly proud of the work we are doing as a result.

[Mr Nigel Evans (Ribble Valley) (Con)]

The Secretary of State has spoken about multiple points of entry, and major connection points are via Schiphol, Charles de Gaulle, Madrid and Frankfurt. Has he spoken to his opposite numbers in those countries to see whether they are following the best practice that is being rolled out in the United Kingdom? Will he ensure that those who are manning the points of entry in the UK have the ability to deal with children, because if a parent is detected with symptoms, their children will have to be properly looked after?

Oral Answers to Questions

Nigel Evans Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Hunt]

I thank the right hon. Gentleman for that question. He is absolutely right to suggest that the lessons of Francis need to be applied to the care home sector, to general practice and to all out-of-hospital care every bit as much as they are applied to NHS hospitals. That is why we have legislated in the Care Act 2014 not only for a chief inspector of general practice but for a chief inspector of adult social care, Andrea Sutcliffe, who has made an excellent start. She is going around all the care homes, and she is bringing back the rigorous Ofsted-style analysis that was unfortunately taken away by the last Government. That will mean that we have proper transparency in standards. Going back to an earlier question from my hon. Friend the Member for Lichfield (Michael Fabricant), we also need to do more to help whistleblowers working in care homes. Because there are so many care homes, we cannot depend solely on the inspectors to get this right. We have also introduced the ability to prosecute offenders, which did not exist before.

[Mr Nigel Evans (Ribble Valley) (Con)]

T3. The fears of the people of the Ribble valley that the old Clitheroe hospital would be closed and not replaced were allayed when the new hospital was built. It recently opened with 32 in-patient beds, radiology, diagnostics and other facilities. Will the Secretary of State come to Clitheroe to have a look at this brand-spanking-new hospital, which is being welcomed by the local community, and to say thank you to the staff there for all they do? If he does so, I promise to take him for a pint of healthy real ale afterwards in the Campaign for Real Ale pub of the year in Pendleton in the Ribble valley, to celebrate the opening of the new hospital.

[Mr Speaker]

What a generous fellow the hon. Gentleman is!

Tobacco Packaging

Nigel Evans Excerpts

Thursday 7th November 2013 Commons Chamber

[Mr Nigel Evans (Ribble Valley) (Ind)]

It is a delight to take part in this important debate, and I declare my interest in the register. Although I no longer own a convenience store in Swansea, I suspect over my lifetime I have sold more cigarettes than everybody in the House has consumed.

I see this as a non-partisan issue. It should be evidence-based. We are talking about treating the sale of a legal commodity completely differently from the sale of any other commodity, and before going down that route, we should ensure that our decisions are properly evidence-based.

I do not smoke, apart from the odd cigar—it is just the odd one—but I am cognisant of the fact that there are over 12 million smokers in this country. The vast majority of them are adults and this is all about individual choice and liberty. The hon. Member for North Antrim (Ian Paisley) made an important point when he said he believes we are going in the direction of possibly banning cigarettes and tobacco completely, and we should be more honest about that. If these products have the consequences that were described by the hon. Member for Stockton North (Alex Cunningham) and my hon. Friend the Member for Harrow East (Bob Blackman), that is perhaps the direction in which we will be going. My hon. Friend spoke emotionally about the loss of his parents through cancer. I lost my own dad through cancer as well, and it is hideous seeing loved ones dying in that way.

My father switched brands. He used to smoke Senior Service, then Player’s, and I even think he toyed with Capstan Full Strength at one stage, and as he was dying he switched to Silk Cut—but all far too late, of course. The fact is that anybody who has seen someone die of cancer knows it is hideous.

As has been said, we need education. People must be properly educated about the damaging effects of smoking, and the damaging effects it can have over a lifetime.

I think it is right that we should wait for the evidence from Australia and any other countries that are about to embark down the route of standardised packaging. I know there are World Trade Organisation issues and European Union issues and these will all be dealt with in the right arenas. The EU is looking at standardising 65% of the packaging as far as the health warnings are concerned and making the sale of packs of 10 illegal.

There have been a number of changes to smoking laws in this country, including the banning of smoking in public places. Indeed, we have the Smoking Room in this Parliament where nobody is allowed to smoke, and I have always joked with friends when they leave the pub to have a quick cigarette outside that, given the cold winters in the United Kingdom, pneumonia will become a smoking-related disease. We have brought in these rules, however, and in many cases they are sensible.

It has always struck me that there was a very good argument against banning tobacco advertising. Advertising is influential and therefore important, of course, and it was always the advert at the bottom of the advert that I found most important. The advertisers could put anything on top—“the fat lady sings” adverts, or the Marlboro ones which we had to look at very carefully to work out whether they were advertising cigarettes or something else—but it was the advert below, which was the health warning saying “Smoking kills”, which was always more persuasive to me than anything else displayed.

[Mr Nuttall]

Does my hon. Friend share my concern that if branding is banned, tobacco companies may use the money they currently spend on branding to cut the price of cigarettes?

[Mr Evans]

That is exactly what is going to happen, and I think one hon. Member intervened to say that that is part of the evidence from Australia. A lot of people like brands, such as Benson & Hedges or Regal, but others will go for the own-brand—whatever is cheaper. If it is £1 cheaper than the more expensive brands, that is what they will go for. Some people, I swear, will smoke the dust off the floor if it is sold at £1 cheaper than a branded pack. The point my hon. Friend raises therefore has got to be looked at as a possibly unintended consequence of bringing in standardised packaging.

I visited Clitheroe grammar school a few months ago and the issue of why the Government have delayed introducing standardised packaging was mentioned. I thought about it for a while and then I said to the pupil concerned, “Right: how much cannabis and ecstasy is consumed in the UK?” The pupil said, “Oh, quite a lot,” to which I said, “I think you’re probably right. Do us a favour: describe to me the packaging on cannabis or ecstasy.”

I ask Members to think about that for a second. What is the packaging for cannabis or ecstasy? There is no packaging. They come in foil or see-through bags, or in an envelope, perhaps. Clearly, people are not buying these products because of the packaging, standardised or otherwise. They buy them because they want them. That is a strong counter-argument to the proposal to get rid of branding.

[Mr Kevin Barron (Rother Valley) (Lab)]

Surely the answer to the question is that if those things were legal, health warnings would be on them, and quite right, too.

[Mr Evans]

Certainly there is no health warning on cannabis and ecstasy, and we know they kill a lot of people.

[Jake Berry]

Surely if making something illegal stops people consuming it, the fact that it is illegal for those under 18 to buy cigarettes would already stop any children taking up smoking.

[Mr Evans]

We know that is not an effective law, but that does not mean we should not have that law.

I believe we ought to look at education for young people. I do not want to see young people taking up cigarettes or any tobacco products at all. Doing more in the schools is vitally important, as is doing more through public health education campaigns. Will the Minister tell us what plans the Government have to roll out health campaigns particularly aimed at young people, to discourage them from starting to consume tobacco products?

I believe we should wait until we get the proper evidence from Australia and other countries about the impact of standardised packaging. Once we have the evidence, it will be appropriate to decide whether or not to introduce standardised packaging. As I said at the outset, tobacco would be the only product sold in the UK where the state entirely governed the packaging. Before we go down that slippery slope, which may be extended to other products in the future, we should make absolutely certain we have the science and evidence to back up the decision.

Accountability and Transparency in the NHS

Nigel Evans Excerpts

Thursday 14th March 2013 Commons Chamber

[Mr Cash]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Please resume your seat, Mr Cash.

--- Later in debate ---

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Eight Members are trying to catch my eye and we will finish at 5 o’clock, with Charlotte Leslie having the last two minutes. In order to accommodate everybody, as well as interventions, the time limit is now five minutes.

--- Later in debate ---

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I am encouraged by the speech from my hon. Friend the Member for South West Bedfordshire (Andrew Selous) because it shows that accountability is not just about supervising organisations, regulators, targets, safeguards, mechanical things and statistics. Accountability is about creatively getting the intelligence into the system about what is happening and reacting to it positively, welcoming it and generating the complaints so that more intelligence comes into the system. That is the kind of accountability we want.

As Chairman of the Public Administration Committee, I feel I can add a new dimension to the debate because of what we are thinking about in our inquiry on the future of the civil service. We need to ask ourselves, “What does accountability feel like?” We think we know what accountability feels like, but my goodness, it goes up and down a bit. During the previous Parliament we felt very accountable in some periods, every single one of us. What do we want accountability to feel like in the health service? With the greatest respect to my hon. Friend the Member for Wycombe (Steve Baker), the lawyers must be the last resort. We do not want accountability to be about finger-pointing, blame and holding people to account. Indeed, that is part of the disease that afflicts the health service. We want accountability to be about nursing staff on the ward feeling accountable to each other for sharing information, accountable to the patients and welcoming the information they receive from them, and accountable to their managers and holding them accountable for what they do not feel is being done, in an atmosphere of trust and co-operation.

What is chilling about the Mid Staffordshire story is the question of what accountability felt like in that hospital at that time? To whom did people feel they were accountable. What did they feel they were accountable for? There must have been almost an atmosphere of “Apocalypse Now” in the hospital, in which nobody knew where to turn.

In the evidence we are receiving about the civil service, we have had powerful testimony from an adviser to our Committee, Professor Andrew Kakabadse of Cranfield university, who rather chillingly points out an obvious truth. Very few people who work in a failing organisation do not know that it is failing. Most people in a failing organisation know that it is failing. What is wrong? The answer is that they do not know how to talk about it. They do not know what to say, who to tell—or, if they try to tell people, it will be bad for them—or what to do. So people often just leave failing organisations, saying, “I can’t do anything about it.” I bet most of those on the board of the hospital trust knew it was going wrong and did not know what to do. There is this idea that this was just an isolated case, but it represents a systemic failure. There is absolutely no escaping that.

I remember the Paddington rail crash. One’s instant reaction was, “Well, the driver went through a red light; it must have been his fault,” but everybody knew that there must have been something much more fundamentally wrong. Something was wrong with rail safety. In aviation, when there is a plane crash, it is very rarely the pilot’s fault. Even if it is down to pilot error, that will be down to pilot training and that will be a system failure. We need to look at this issue in an holistic and sensible way.

The reaction of the NHS to the Francis report was immediately to reach for statistics and to start doing things. It immediately started a storm around our local hospital, the Colchester General, by latching on to one statistic and naming it as one of the hospitals being investigated, even though—I have written to Andrew Dilnot at the UK Statistics Authority and got a reply from him—a single statistic should never be used in such a fashion. In fact, the Colchester General is in the top quartile of its class of hospital, so that was entirely unnecessary. My wife has just had a knee replacement in that hospital. I was completely confident that she would get good nursing care and she indeed got very good nursing care.

There is now an uncomfortable atmosphere surrounding this issue. There is an atmosphere of denial, and this relates to Sir David Nicholson. Is he still in denial? Is the system still in denial? Can the system change dramatically enough unless people are seen to take responsibility for the culture? It is difficult to argue that he has not been individually responsible for the broad culture in the national health service that has led to this pass.

[Mr Deputy Speaker (Mr Nigel Evans)]

I am sure the House wishes Anne Jenkin a speedy recovery.

Medical Implants (EU and UK)

Nigel Evans Excerpts

Wednesday 6th March 2013 Commons Chamber

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I am giving the hon. Gentleman a little leeway but the matter under discussion is as on the Order Paper, so I would like reference to be made to that, rather than a general debate.

[John Pugh]

I am coming to that, Mr Deputy Speaker. In a way, that illustrates my point, because what we are actually debating is the supplementary estimate. My hon. Friend the Member for Gainsborough and I were tasked with looking at how the House debates supplementary estimates, and the answer we came to was this: not very well. Our report, a copy of which is in the Library for hon. Members to consult, testifies to that finding, and we produced adequate evidence for it, because the report was co-ordinated to some extent by the Treasury, which keeps a close eye on these things. I am suggesting that the work of examining the nation’s finances is boring, dull and, at times, anorakish, but it certainly needs to be done, and it probably should be done by Parliament, and on occasions like this.