Oral Answers to Questions

Philip Davies Excerpts

Tuesday 17th November 2015 Commons Chamber

[Mr Hunt]

I accept total responsibility for doing the right thing to save patients’ lives. I have to say that I think that any holder of this office would be doing wholly the wrong thing if they were to try to brush under the carpet six academic studies that we have had in the last five years that say we have higher mortality rates at weekends than we should expect. This Government are on the side of patients and we will do something about that.

[Philip Davies (Shipley) (Con)]

10. If he will take steps to reduce the number of children born with genetic problems due to marriages between first cousins.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I am aware that there is an increased risk of recessive genetic conditions in births that occur as a result of first cousin marriages. It is a complex issue, and other factors are also significant, but experienced health professionals use some well-established tools and materials. Specialist clinicians in my hon. Friend’s area are looking at this important issue.

[Philip Davies]

I am grateful to my hon. Friend for that reply, but given the severe medical conditions that are caused by first cousin marriages, is it not time that the Government considered the only proper solution—outlawing first cousin marriages in this country?

[Jane Ellison]

Such a change in the law would not be for the Department of Health. Let me respond to my hon. Friend’s specific point about the particular localised challenges. He might be interested to know that in May 2012 a major conference was held at Leeds town hall, with groups drawn from across the area he represents and from the wider West Yorkshire area to look at these issues. As he knows, I have already written to the public health director in Bradford asking what is being done locally to address this issue, and I suggest that it would be useful if my hon. Friend followed up on that. I would be happy to hear how that conversation goes.

Hospital Parking Charges (Exemption for Carers) Bill

Philip Davies Excerpts

Friday 30th October 2015 Commons Chamber

[Philip Davies (Shipley) (Con)]

First, I congratulate the hon. Member for Burnley (Julie Cooper)on being elected to the House and, in such short order, introducing this Bill. It has clearly been brought forward with a great deal of worthy sentiment with which it is very difficult to disagree. I should perhaps also congratulate her on the expert doughnut she appears to have arranged for herself. She has not long been in the House, but even long-standing Members would be proud of that doughnut. It masks the fact that there is literally nobody else on the Opposition Benches. She deserves particular praise for that, and she will clearly make an expert Member. I wish her very well in her time here.

As you will know, Mr Speaker, when I was first elected to Parliament 10 years ago, my mentor was the late, great Eric Forth, and one of the things he taught me was the importance of private Members’ Bills. He taught me early on that many of them had a worthy sentiment behind them, but that we should not just pass legislation on the whim of a worthy sentiment, because it can have lots of unintended consequences that affect people’s lives and livelihoods. It strikes me that this is one of those Bills. It is based on a worthy sentiment with which people would find it difficult to disagree, but the consequences would be sometimes impractical, sometimes unnecessary and sometimes very negative.

I have mentioned before that when a politician is given a problem, their solution always incorporates two ingredients. The first is that they have to be seen to be doing something. It is the bane of my life. I detest the fact that politicians always have to look as if they are doing something. I long for the day when a Minister stands up at the Dispatch Box—I have high hopes that the Minister today will do so—and says, “Well, that’s got nothing to do with me. It is for people to sort out themselves. It is not for the Government to do something about this.” That is seldom said in the House though. Everyone always wants to be seen to be doing something.

The second ingredient is that the proposal does not offend anybody. If a politician can be given a solution that makes it look like they are doing something without offending anybody, they will go for it every single day of the week. It does not matter whether it makes any difference or whether it is a good thing. As long as it meets those criteria, most politicians will go for it, and the Bill is a perfect example. Clearly, the hon. Lady has quickly acquainted herself with this way of dealing with things in the House.

The hon. Lady believes that carers, who might have to visit hospital very often, are charged unfairly for car parking. I can certainly sympathise with that sentiment. I say from the outset that hospital car parking charges are often very costly, but her proposed solution, which does not offend anybody and makes it look like she is doing something, is simply to make car parking free for carers. I do not think the solution is that simple, which is why I oppose the Bill, despite sympathising with the sentiment.

Before anybody misconstrues my comments, let me say I do not oppose the Bill because I am not concerned about carers. I do not believe there is a single Member in the House who has anything but praise for carers. Carers do a very difficult and very demanding job, and it comes with a great amount of emotional problems for themselves and those they are caring for. Caring is essential. I should point out, too, that the work of caring on behalf of other people in many respects saves the taxpayer a considerable amount of money each year. We should not underestimate that contribution, or indeed the wider contribution they are making to society and their families, which is almost immeasurable.

I do not believe anybody present is arguing against the Bill because they have no sympathy or regard for carers. I oppose the Bill fundamentally because in many respects it is completely unnecessary; what the hon. Lady proposes can already be done. There is no legislation that forces carers to be charged for their car parking, so we do not need legislation to force them not to pay for their car parking. These things can already be done at a local level, if it is decided that that would be the best course of action in the local area.

[Melanie Onn (Great Grimsby) (Lab)]

In that case, would the hon. Gentleman be prepared to lobby his local hospital to exempt from these charges carers in the Shipley constituency?

[Philip Davies]

I do not want to get distracted so early in my speech, but I will come to my local hospital during the course of my remarks, so I hope the hon. Lady can be patient. Of course, if I fail to deal with that point, she can always come back and chastise me for not having done so.

Let us look at the origin of the Bill. On 4 July, the hon. Member for Burnley explained it on her website blog—I am a keen reader of it, as I am sure are many others both here and in Burnley; indeed, I am sure that the Minister has a great regard for the hon. Lady’s blog. This is what she wrote:

“Having read through over 100 suggestions, and after much deliberation, I have finally chosen the subject for my Private Member’s bill: I intend to try to help carers by making provision for them to be exempt from hospital parking charges. During recent years, I have met with carers from across the constituency from different backgrounds, all of whom had different stories to tell but all with one thing in common: their willingness to support a sick person, whether it be a child with cancer, an elderly person with complex needs or a person attending hospital for regular treatments such as chemotherapy. All of these carers often have reason to be parked at hospitals for long periods and can incur charges which they can often ill afford. It seems to me that it is time we put an end to this ‘tax on illness’.”

Ten days later, however, the hon. Lady said something else in her blog; there was a subtle difference on which I would like to focus. She said:

“Many of you may know that I am trying, through the bill, to obtain free hospital parking for carers. Support for this is growing but, if I am to be successful, I really do need your help. I know from my conversations with so many of you, that hospital car park charges are a problem for many carers, who often spend a lot of time hospital visiting. If you are a carer, and this is a problem for you, please get in touch and share your problem with me. Sometimes it is more than the charge (though these are quite hefty and can mount up) because I understand that visiting, particularly for extended hospital stays during winter months, can be quite stressful and distressing, and queueing for parking can sometimes feel like the last straw. If I am to get this bill through government, I need plenty of evidence.”

In my experience, people usually get the evidence of a problem first, and then bring forward a Bill to tackle it. On this occasion, we seem to have had a more novel approach to legislation, which is to bring forward a Bill and then ask people for the evidence to support it. Personally, I view that as a novel approach, but I commend the hon. Lady for starting a trend that we may see more of in the months to come.

It strikes me from the hon. Lady’s blog that the Bill has been brought forward only on the basis of a worthy sentiment, from which very few people would dissent, because she was still collecting evidence to show the need for the Bill after she had announced she was going to introduce it. She did not look at the reality of situation, find a problem and then try to find a solution.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I have to wonder whether the hon. Gentleman listened to the beginning of my hon. Friend’s speech. She said that she had based the Bill on her own experience. She had been a carer, and she had had to pay the charges. I myself have asked constituents to get in touch with me about the issue. As all Members of Parliament should know, carers are busy, stressed people, who do not have the same time that everyone else has. All of us undoubtedly hear more about issues such as football governance than about caring, but there are 6 million carers in the country, and this is an issue for them.

[Philip Davies]

I entirely agree with everything that the hon. Lady has said. I do not think anyone would disagree with anything that she said about carers. She said that there were 6 million in the country, and that is a point to which I shall return. If we are talking about free hospital car parking, the number of people with whom we are dealing is clearly a factor, to which the hon. Lady has helpfully drawn attention.

[Barbara Keeley]

The hon. Gentleman really should have been listening. My hon. Friend’s Bill applies to carers who receive carer’s allowance, of whom there are 700,000. As I said a moment ago, there are 6 million carers, and at various times this will be an issue for them, but my hon. Friend has restricted her Bill to the 700,000 who do the most for caring and for society.

[Philip Davies]

We are already slightly all over the place with this Bill, and now the hon. Lady has drawn attention—probably not intentionally—to what a dog’s dinner it is. We are already arguing about how many carers there actually are, but in fact the Bill will apply to only a few of them, and the hon. Lady has just suggested that the vast majority will not even benefit from it. The hon. Member for Burnley has said in the past—and I may say more about this later—that the Bill is just a starting point, and that she intends to extend it further and further, so we have no idea where we may end up.

[Julian Knight]

The Bill does not apply only to those who receive carer’s allowance. It also applies to those with an underlying entitlement to carer’s allowance, which brings a great many more people into the net.

[Philip Davies]

My hon. Friend has made a perfectly valid point. How the hospitals are likely to know who has an underlying claim to carer’s allowance is something that we may explore at greater length as the debate continues.

[Julie Cooper]

May I clarify a point? The only dog’s dinner is the current practice. Some hospitals have a hotch-potch of concessions, while others have none at all. The Bill specifies a clearly defined number of people. As the hon. Gentleman says, it will apply to 700,000 carers and to a further 400,000, so a total of 1.1 million stand to benefit. That is very easy for everyone to understand.

--- Later in debate ---

[Philip Davies]

I agree that that part of the Bill is clear, but as the hon. Member for Worsley and Eccles South (Barbara Keeley) has just said that there are 6 million carers but only 1 million will gain any benefit from the Bill, some people may consider that there is an unfairness there.

[Mr David Nuttall (Bury North) (Con)]

These exchanges have completely overlooked clauses 4, 5 and 6. Those clauses refer to eligible carers, who are defined in clause 5. I shall not go into the definition now, but it could bring in millions more carers, rather than just the 1.1 million who we have just been told are covered in the Bill.

[Philip Davies]

My hon. Friend has made a very good point, and I hope that he will expand on it in his own speech. I do not want to steal his thunder.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

Did the hon. Gentleman not hear the compelling cost-benefits analysis presented by my hon. Friend the Member for Burnley (Julie Cooper)? It is the Conservatives who go on about a long-term economic plan. The proposed exemption for the carers who prop up the NHS in so many ways will save the NHS billions upon billions of pounds, so it will be good value in the long term.

[Philip Davies]

I was prepared to hear lots of arguments in favour of this Bill and some of them I was going to find quite compelling. The idea that this provision is going to save the NHS millions of pounds is an argument I was not prepared for, I must admit, because it is quite clearly a load of old nonsense. If that really is the economic thinking of the Opposition that we can look forward to over the next five years, then Lord help the lot of us, because the Opposition clearly have no economic credibility whatever if that is the case the hon. Lady is making. This clearly incurs a cost—

[Dr Huq]

rose—

[Philip Davies]

I will let the hon. Lady have another go.

[Dr Huq]

The briefing all MPs were sent based on research by Leeds University and Carers UK puts the figure at £119 billion, because these are people who take stress off the NHS. As my hon. Friend the Member for Burnley clearly described in her speech, they are people who change incontinence pads and do the feeding; they keep people out of hospital in the long run. This proposal will cost less than bed-blocking in the NHS. Furthermore, of all the representations all of us on both sides of the House have received, it is only the parking industry that wants to keep things as they are.

[Philip Davies]

The hon. Lady is approaching this Bill as if nobody at the moment does any caring and if we have this Bill everyone will start caring and save the NHS billions of pounds. The point is the people—

[Liz McInnes (Heywood and Middleton) (Lab)]

Will the hon. Gentleman give way?

[Philip Davies]

I will deal with the first intervention first, then I will give way to the hon. Lady; there is plenty of time.

On those people who are saving the NHS millions of pounds—I think I made very clear at the start of my remarks how much we all rely on carers—they are already saving the NHS that money. This Bill does not come with any savings to the NHS. This Bill only comes with a cost to the NHS. If the hon. Member for Ealing Central and Acton (Dr Huq) cannot see that, she really needs to go and look at the Bill again, because that is clear to everyone. She may well want to argue that it is a worthwhile cost to the NHS, and I am perfectly prepared for her to make that case, but people should not be claiming that this is a cost-saving Bill for the NHS because it is anything but.

[Liz McInnes]

The hon. Gentleman seems to know the price of everything and the value of nothing. Did he not hear my hon. Friend the Member for Burnley (Julie Cooper) talk about Torbay hospital and the benefits that it has found the scheme brought to the hospital in terms of patient care and wellbeing, which is surely what hospitals are about? They are not about charging people to park.

[Philip Davies]

If I might be able to make some progress, which I am always keen to do on these occasions, I will come later to the situation at Torbay, because it is very interesting and does not make the case for this Bill as the hon. Lady seems to think.

It has also been interesting to learn from these exchanges that whereas not that long ago during the passage of a different Bill the Labour party claimed it very much supported the principle of localism—that it was the champion of localism and devolution and it wanted to jump on that agenda—today, early on in this Parliament, when we actually have localism in action, where local hospitals can make decisions which they think are in the best interests of their local residents and local patients, the Labour party goes back to type and wants to centralise everything.

[Julian Knight]

My hon. Friend is making an important point about how this ties in with the devolution agenda. We are going headlong towards a combined authority in Greater Manchester, which will be in charge of the NHS in the area. Presumably that will mean that it will be in charge of hospital parking charges, and will be able to do many things, including giving discounts to carers, if it deems that necessary.

[Philip Davies]

My hon. Friend is right, and my understanding was that the Labour party in Manchester was in favour of devolution and it had agreed to the devolution package the Chancellor had proposed. I suspect it could not ever have got off the ground if the Labour party in Manchester had not been supportive of it. The whole purpose of devolution is to allow local decision making on things such as the NHS, and presumably as part of that car parking charges within the NHS, yet it seems that at the first step the Labour party wants to take the whole devolution agenda from under the feet of the locally elected people before it has even started.

[Liz McInnes]

Is the hon. Gentleman not aware that, although car parking charging decisions are made locally by individual hospital trusts, they follow the Government’s guidelines?

--- Later in debate ---

[Philip Davies]

That is the point I was making. If I did not make it, I apologise for not being clear. For the avoidance of doubt, those decisions are made locally and I support that fact. Labour Members clearly do not believe that they should be made locally. They believe that the rules should be set nationally. In a nutshell, that is where we have a difference of opinion. I believe the decisions should be made locally; the hon. Member for Burnley clearly believes they should be made centrally. That is a perfectly respectable position to hold, but it happens to be one that I do not agree with. That is the nub of the point on localism.

[Mr Chope]

In Scotland within the past week there has been enormous criticism of the quality of healthcare being delivered by the Scottish Government. Is not that an example of a place that has free hospital car parking but does not necessarily have a better quality of health service?

[Philip Davies]

My hon. Friend is absolutely right. I will say more about Scotland and Wales in due course, because we have seen the impact of this policy in those countries. There is not a never-ending supply of money, and if more is spent on free car parking in the NHS, less will inevitably be spent in other areas. Labour Members seem to think that money grows on trees and that there is a never-ending supply of it, but back in the real world, we have a certain amount of money and we choose how to spend it. If we choose to spend it on one thing, we inevitably have to take it away from somewhere else. The hon. Member for Burnley did not mention the need to make that choice, but it is important that we face that fact.

The hon. Lady has clearly had difficulty in finding evidence to support her Bill, so I thought I would help her out a bit. She has clearly spoken to lots of carers groups, and she has set up the Park the Charges campaign with Carers UK, for which I commend her. For the sake of balance, however, we should not just listen to the views of carers, important though they are. We should also seek the position of the hospitals on this matter, because they would ultimately be the most affected by the proposed changes.

I am not sure what discussions the hon. Lady had with the hospitals, given that her Bill would force them to change their car parking policies. I contacted the East Lancashire Hospitals NHS Trust, which I believe is the hospital trust that covers her constituency. I asked the trust what consultations she had had with it on this policy. I put in a freedom of information request to ask what communication Burnley general hospital had received from the hon. Lady on the issue of carers and hospital car parking charges. I received a response on 25 September, which stated:

“I can now confirm that we have not had an enquiry of this nature from Ms Cooper”.

[Julie Cooper]

For the purpose of clarification, I should like to point out that the majority of people in my constituency who require a hospital stay normally go to Blackburn hospital. It is also part of the East Lancashire Hospitals NHS Trust, and I have discussed these proposals extensively with the chief executive there.

[Philip Davies]

I am pleased to hear that. I am sure that it will be a matter of great reassurance to the East Lancashire Hospitals NHS Trust that the hon. Lady was not interested in its opinion, even though Burnley happens to be her local hospital. I was surprised to find, given that she is trying to make such a fundamental change to hospitals, that the one in her own constituency—Burnley general hospital—had not received a request from her to discuss the impact of her proposals. I would have thought that, as the MP for Burnley, she would have taken an interest in that. I personally believe that the people who tend to know best about things are the people who deal with them every single day of their lives, be they nurses, teachers or checkout operators in supermarkets. When assessing the impact of her Bill on hospitals, I would have thought that Burnley general hospital would have been a good place to start.

We have already discussed who currently decides hospital car parking charges. The hon. Lady is right that such matters are decided locally. We should also note that there are guidelines around hospital car parking charges. NHS services are responsible locally for their own car parking policies for patients, visitors and staff. Back in August 2014, the Government published new guidelines on NHS patient, visitor and staff car parking principles—I hope the Minister will expand on this matter when he responds to the debate. They are guidelines only; they are not mandatory. The car parking guidelines recommend the provision of concessions to groups that need them, such as disabled people—both people with blue badges and people who are temporarily disabled—frequent out-patient attenders and visitors with relatives who are gravely ill. The Government guidelines on car parking charges say:

“Concessions, including free or reduced charges or caps, should be available for the following groups: people with disabilities…frequent outpatient attendees…visitors with relatives who are gravely ill…visitors to relatives who have an extended stay in hospital…staff working shifts that mean public transport cannot be used…Other concessions, e.g. for volunteers or staff who car-share, should be considered locally.”

It was also reiterated in the previous Parliament that relatives of people who are gravely ill or who require a long stay in hospital should also be exempt from car parking charges. The then Health Minister made that clear in an answer to a parliamentary question, in which he set out the people who should be exempt as far as the Government were concerned.

[Barbara Keeley]

What the hon. Gentleman is showing is the fact that we have a postcode lottery on this matter now. I want to give him a recent example that was given to me of relatives of somebody who was gravely ill and who then died on the 13th day that she had been in hospital. They were helpfully told, “If you had been coming here one more day, you would have got free car parking.” That was said to a distressed family on the day that their relative died. Does he really think that that is a suitable way for hospitals to go on?

[Philip Davies]

Everyone will have a massive amount of sympathy for the relatives in that example. However, I must point out to the hon. Lady that this Bill will not end terrible situations such as the one she has just described. Even if this Bill is introduced, there will be very many other similar cases, for which we can all feel sympathy. I am not entirely sure why she thinks that this Bill will eliminate any other terrible situation involving someone paying car parking charges; it will not.

[Barbara Keeley]

No one on the Labour Benches is suggesting that the Bill will eliminate the issue; it will ameliorate it and send an important signal to carers, who repeatedly find themselves in this situation. The example I gave was to show how badly some hospitals behave.

[Philip Davies]

If I had a pound for every time somebody brought forward a private Member’s Bill, or supported a private Member’s Bill, on the basis that it would send a signal, I would be a very wealthy person. Unfortunately, the problem is that we do not pass legislation to send signals. We pass legislation to bring something into the law of the land. The hon. Lady has sent a signal by making that point in this debate. If the whole purpose of this was to send a signal to show how important carers are to the country and how important it is that hospitals show some compassion for carers when they come to visit hospitals, the hon. Lady has achieved that by making that intervention. Perhaps therefore she may feel satisfied that we can leave the matter at that. We have all sent a signal about how important carers are, and I now want to move on to the Bill that is being proposed, which goes way beyond sending a signal.

We already have Government guidelines that set out a range of people who they think should be exempt, all things being equal. When hospital car parking charges were debated back in September 2014, the Minister stated that

“40% of hospitals that provide car parking do not charge and of those that do, 88% provide concessions to patients. However, I am aware that there are 40 hospital sites—which is 3.6% of hospitals in acute and mental health trusts—that have charges and do not allow concessions to patients who need to access services. As a Government, we want to see greater clarity and consistency for patients and their friends and relatives about which groups of patients and members of staff should receive concessions and get a fairer deal when it comes to car parking.”—[Official Report, 1 September 2014; Vol. 585, c. 89.]

Furthermore, in his latest position on the Bill, Lord Prior said that NHS organisations must have autonomy to make decisions that best suit their local circumstances and community interests, and that although the principles provide clear direction and leadership, a one-size-fits-all policy is not appropriate for car parking.

Although the Government have given strong guidance on where concessions should be made for hospital car parking they have, rightly in my opinion, left the final decision to be made by the hospital implementing the policy. Therefore, importantly, each hospital sets its own parking policies and is not required under law to make any exemptions. The Bill today will be the first time that Parliament has intervened to demand that hospitals give free car parking to a particular group of people.

The Government have set out guidelines about the people who, in their opinion, should be exempt from parking charges, or should receive concessions. They are people with disabilities, all frequent out-patient attenders, visitors with relatives who are gravely ill, staff working shifts who cannot use public transport and visitors to relatives who have an extended stay in hospital. Why does the hon. Member for Burnley not believe that those people should have the same benefit as regards hospital car parking charges as the people she includes in the Bill? Is she saying today that the people in the list I have just given are not as important as the people she wants the Bill to cover? Does she think that people with disabilities are not as important as carers? Is she saying that their needs are not as great? Is she saying that staff who cannot get there by public transport are not as important as the carers to whom she refers? Why are the carers so much more important? We all agree that they are important, but why are they so much more important than all the other vulnerable groups who she has spectacularly not included in her Bill while the Government are saying to hospitals that they should make some provision for those people? There is a great unfairness in her proposals.

[Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)]

If the hon. Gentleman believes in what he has just said—I agree that most of the people he has listed should be included—will he not propose an amendment or another Bill to say that all those people are important and that we should help everyone we can who has an issue with these horrendous charges?

[Philip Davies]

I would have more sympathy with the principle of the Bill if it wanted to make the Government’s guidance mandatory, because there would be some logic to that. Clearly, a whole range of people struggle, but just to pick out one group at random seems iniquitous.

[Julian Knight]

My hon. Friend is making an interesting case about other groups and how the Bill picks out carers individually. Many people do not travel to hospital by car but by public transport or by using subsidised bus services. The Bill does not cover them in their time of need, so will my hon. Friend reflect on the fact that the Bill is purely for car owners who are generally in the higher income groups?

[Philip Davies]

My hon. Friend makes a good point. The Bill applies only to car parking charges, and many carers cannot afford a car, let alone car parking charges. They travel faithfully on a probably more tortuous journey to hospital by public transport. If the Bill were to be passed, people who could afford a car would get their parking charges reimbursed but those who cannot afford a car and have to travel by public transport would not get their public transport costs reimbursed. Clearly, there is something not quite right about that. My hon. Friend makes a good point. While we are on that subject—I may come back to this as well—I should have thought that we were trying to deter people from using a car. Some people have to use a car, as he said, and nobody argues with that, but it would be perverse to give people an incentive to use a car rather than using public transport if they could. My hon. Friend has made a good point as to why the Bill would give people a perverse incentive to use a car rather than public transport.

[Mr Jacob Rees-Mogg (North East Somerset) (Con)]

I am rather surprised by my hon. Friend’s burst of socialism and that he should be discouraging the use of the motor car, which should be encouraged in a free society.

[Philip Davies]

I have been accused of many things in my time. A burst of socialism is a first, even for me. I may try and put that out to my left-wing constituents to show them that there is hope for me yet. If I did come out with a burst of socialism, I apologise profusely, not least to my hon. Friend, who always keeps me on the straight and narrow. I apologise for a burst of socialism; it was not intended to be such. I feel chastised.

We should consider why hospital car parks are not already free. There is an argument, I guess, that instead of picking out parking for carers, all hospital car parking should be free. In its 2009 report, “Fair for all, not free-for-all—Principles for sustainable hospital car parking”, the NHS Confederation stated:

“Charging for car parking is often necessary, but needs to be fair – and to be seen to be fair.”

It is important for Opposition Members to recognise that the country and the NHS do not have millions of pounds to spend on covering the cost of parking for a certain section of the population. The Labour Government left this country in a huge financial black hole which we are still struggling to recover from. Policies such as this could severely affect local NHS hospitals and services and their budgets.

There is an analogy that I always give in such situations, which I first heard Lord Tebbit use. I hope that goes some way to restoring my hon. Friend’s faith in me after my earlier lapse. The analogy in this context, which is not necessarily the context in which Lord Tebbit used it, is this: if somebody asked, “Do you think we should have free hospital car parking?”, the chances are that virtually everybody who was asked would say yes. If they were asked, “Should we have free hospital car parking? By the way, that will mean having to get rid of lots of doctors, nurses and essential staff”, people may give a different answer. In the analogy that Lord Tebbit used, the question was, “Would you like a free Rolls-Royce?”, and he suspected that the vast majority of people would say yes. If they were asked, “Would you like a free Rolls-Royce? You’ll have to live in a tent for the rest of your life to pay for it”, people may come up with a different answer.

Of course, in principle, people would love to have free hospital car parking, but we have to think what the consequences would be and whether people would want to face those consequences. When it comes to the crunch, I suspect the answer may be different. If the Government had an additional £180 million to spend, which would be the cost of free hospital car parking, I am sure there would be many other pressures to spend that £180 million on in some part of the NHS. For example, it may pay for another 2,500 doctors or 8,000 nurses for the NHS. If we had a vote on what is the most important thing that we should do with that money, I suspect that the additional doctors and nurses would carry quite a weight of support, not just in this House, but across the country as a whole. It is not just a free-for-all. The harsh reality is that there are consequences of doing these things.

[Mr Chope]

We are talking not just about free car parking, but about car parking? Too many hospitals do not have adequate car parking. That is one of the great complaints that so many patients have—that they cannot find anywhere to park when they go to hospital.

[Philip Davies]

My hon. Friend makes a very good point. The hon. Member for Worsley and Eccles South made the point that people find it very stressful to have to pay after they have been to visit a relative in hospital, but as my hon. Friend rightly points out, it is probably even more stressful if they cannot find a car parking space at all. We need to bear that in mind.

[Julian Knight]

In my constituency, one of the reasons hospital parking charges were introduced in the first place was that the car park of the hospital, which is very close to the town centre, was being used at weekends by shoppers leaving their cars, and so patients, carers and those with urgent medical needs were unable to get into it. Will my hon. Friend reflect on that point?

[Philip Davies]

I was about to come on to that point, and my hon. Friend makes it very well. One of the essential reasons for hospitals charging is that, particularly near town centres, people use the free parking and then go and spend all day at work. That does not help any carer who is trying to find a parking space. That is why it is so important that hospitals have to be able to use charges in a way that suits their particular local circumstances to ensure that visitor and staff parking is always available when it is needed. Without their being able to make some restrictions on a local basis, there will be nothing to prevent people from using the site as a free car parking area.

I have no idea—perhaps the hon. Member for Burnley could tell me—whether parking would be free for carers only when they are coming to the hospital as a carer or free for them all the time because they are a carer. That is not clear in the Bill. I am looking for assistance from some of my more learned colleagues, but it appears that nobody knows the answer to that question, including the promoter of the Bill, so I will leave it there as something that does not seem to have been thought through.

This issue applies not only to hospitals close to town centres, as mentioned by my hon. Friend the Member for Solihull (Julian Knight), but to those that are close to railway stations, where there is also a large demand for parking. My hon. Friend the Member for Christchurch (Mr Chope) mentioned Scotland earlier. This issue has arisen at hospitals in Wales and Scotland since they scrapped car parking charges. The NHS Confederation said:

“The NHS Confederation represents 99 per cent of NHS trusts in England. On behalf of our members we support the right for NHS trusts to determine their own car parking and transport arrangements within current regulations and good practice”.

That is what is under threat today. A response from the House of Commons Library states:

“There is nothing specifically stopping hospitals from giving concessions or free parking to carers or other groups—although all public bodies need to operate within the framework of the Equalities Act—i.e. avoid discrimination against protected groups. Decisions on hospital car parking charges are a matter for the NHS body running the car park.”

Hospitals clearly have the flexibility to offer a free parking policy for carers—as the hon. Member for Burnley said, some have already done so—but it is not right that we as a House should force them to do so. Hospitals that do not already have a free car parking policy for carers have clearly assessed the situation and chosen not to, for whatever reasons. There may well be good reasons that we are better not second guessing. If she feels so strongly about this issue, perhaps her time would be better spent lobbying her own hospital trust in Burnley to persuade it of the argument for giving carers free parking, as opposed to coming along here and trying to impose it everywhere else when she has not even persuaded her own hospital in Burnley to do it.

Hospital parking charges are a key part of income generation. Hospitals may choose not to give free parking because car parking on healthcare sites is an income- generation scheme under the income-generation powers that enable NHS bodies to raise additional income for their health services. NHS bodies are allowed to charge for car parking, and to raise revenue from it as an income-generating activity, as long as certain rules are followed. Income-generation activities must not interfere to a significant degree with the provision of NHS core services. It is also crucial to note that these income- generation schemes must be profitable, because it would be unacceptable for moneys provided for the benefit of NHS patients to be used to support other commercial activities. It has to be the other way round; the commercial activity has to support the core NHS services. The profit made by income-generation schemes has to be used to improve health services. That is absolutely crucial. The money has to go towards that particular purpose.

The Department of Health’s “National Health Service Income Generation—Best Practice: Revised Guidance on Income Generation in the NHS”, which was published in February 2006, clearly sets out that income generation must be profitable. Paragraph 30.10 states:

“For a scheme to be classed as an Income Generation scheme, the following conditions need to be met: the scheme must be profitable and provide a level of income that exceeds total costs.”

It then goes on at great length, but that is the key part, so I will not bore everybody by reading the whole paragraph. The document goes on to say that

“the profit made from the scheme, which the NHS body would keep, must be used for improving the health services”,

and

“the goods or services must be marketed outside the NHS. Those being provided for statutory or public policy reasons are not income generation.”

Therefore, if exemptions are made for other people, that must be taken into consideration when calculating the estimated annual revenue and whether it will make a profit or a loss.

I fear that if the hon. Lady’s Bill is successful, the consequence will be not just exemptions for carers—worthy sentiment though that may be—but, I suspect, higher car parking charges for everybody else who visits the hospital so that it can protect its revenue stream. The hon. Lady did not mention that and she has not been open about it, but the chances are that that will be the consequence of the Bill. Everyone else will have to pay more in order to meet the NHS’s criteria for income generation. That means that all of the people the Government think should get a concession from car parking charges, including people with disabilities and those who visit hospital regularly, will not be exempt, but will have to pay more as a consequence of this Bill. Does the hon. Lady really want to tell all disabled patients who go to hospital that, in order to pay for her Bill, they are going to have to pay more to park at their local hospital? If that is the message she wants to send, I think she is rather brave. I would not want to tell my disabled constituents that they are going to have to pay more. It seems to me that that would be an inevitable consequence of the Bill. That is why we cannot pass legislation based on a worthy sentiment; we have to think through the consequences. [Interruption.] If the hon. Member for Birmingham, Perry Barr (Mr Mahmood) wants to intervene, I would be very happy to give way to him.

[Mr Mahmood]

I do not want to intervene.

[Philip Davies]

The hon. Gentleman was chuntering—I misinterpreted him. I thought he had something worth while to say, but clearly not.

Given the guidelines, I would be interested to know what information the hon. Member for Burnley has obtained to determine an impact assessment for the scheme in question to be rolled out nationally. Indeed, during my research on the Bill, the House of Commons Library—which, as ever, I praise for its fantastic work—confirmed to me that

“no central data is collected on NHS hospital car parking charges or concessions”.

It therefore seems to me that the hon. Lady could not possibly have done an impact assessment, because no assessment has been made of the current impact.

Where is the money made from car parking charges spent? Obviously, the provision of car parking incurs overheads, including for the running of it and for maintenance costs. If no charges were imposed, the maintenance costs would have to be sourced from elsewhere, at the risk of diverting funds from patient services. There is also the cost of monitoring the car park, to make sure it is being used for its intended purpose. That money has to be recouped, and it is recouped through car parking charges.

[Julian Knight]

The contracts for hospital parking maintenance costs in my constituency are signed by the Heart of England NHS Foundation Trust, and some of those costs, such as those for drawing lines and for preparing machines and barriers, are very high indeed. If this Bill comes to pass, would that not mean that that money would potentially have to come directly from healthcare budgets, because no profit would be being made?

[Philip Davies]

My hon. Friend is right. There is a considerable cost involved in maintaining car parks, including setting them up in the first place and drawing the lines. The Bill would have a number of potential consequences. The maintenance money would have to come from patient care and there would be less provision for car parking spaces. Maintenance would not be carried out and the spaces would not be monitored, so there would be no point in carers being exempt. Everyone may as well be exempt, because no one would be checking whether they had paid to park their car. There would be a number of potential consequences, all of which would be adverse.

Given that foundation trusts are independent bodies, they are not covered by the Department of Health guidance on income generation. Their non-NHS income is governed by a board of governors who are drawn from NHS patients, the public, staff and stakeholders. Non-NHS income streams need to demonstrate concretely how new revenue from sources outside the NHS will support the principle purpose of a foundation trust, which is to provide goods and services for the NHS.

The hon. Member for Great Grimsby (Melanie Onn) has not stayed to hear me talk about my local NHS trusts, despite encouraging me to do so. Back in August, one of my local NHS trusts, Bradford Teaching Hospitals NHS Foundation Trust, said:

“We are determined to keep car parking charges as low as possible, this is the first time in 11 years that rising costs and growing pressure to create extra parking has forced us to increase them.

Our car parks are self-funding, ensuring we do not have to divert money away from frontline services and patient care. Demand for 24 hour parking is low and it is normally used under exceptional circumstances. We will review 24 hour parking if it becomes problematic for our visitors. Reduced parking rates will continue for people frequently attending outpatient clinics and those visiting relatives who are gravely ill or having an extended stay in hospital. Parking for people with disabilities will remain free of charge”.

That strikes me as a perfectly reasonable policy.

The whole point of the governance of foundation trusts is that it is not some NHS baron who decides these things. Foundation trust governors are drawn from NHS patients, the public, staff and local stakeholders. They are the best people to determine their local hospital’s car parking policy. Members of Parliament and Ministers should not dictate to them what is best for them. That is why I am very happy with what my local NHS trusts are doing. I am sure they would like to go further if they could, but there is always a balance to be struck.

During my discussions about this Bill with my local hospital—I did contact my local hospital—it said:

“It must be acknowledged that there is a cost of operating and maintaining the Foundation Trust’s car parks. If car parking income is reduced because of the introduction of the new legislation then the balance would have to be met from elsewhere. Ultimately, this could mean higher charges for other car park users or funding diverted from budgets that could potentially impact on patient services.”

That is a very serious concern. A one-size-fits-all central policy is simply not appropriate for regulating hospital car parking charges and it could have those severe unintended consequences.

I congratulate the hon. Member for Burnley on being a clear champion for the NHS and I praise and support her for it. Time and again she is quoted as being extremely worried about staffing and patient care in the NHS, particularly in her local area, but it is ironic that her Bill could have serious implications for staffing and patient care in local hospitals.

How would the Bill be enforced? That is one of the key practicalities involved. One of the main concerns of many local trusts will be how on earth it will be implemented. I must say that the hon. Lady was quite light on that.

The nearest comparison to a group of individuals being given free parking is the free parking scheme for people with disabilities. The scheme is monitored by ensuring that people using a disabled parking space have a blue badge. That in itself is not as easy as it might seem. I speak as somebody who, in my many years working for Asda, was responsible for our facilities for disabled customers. I also had to ensure we had a system to protect the parking bays for use only by disabled customers. That is one of the biggest problems. I suspect that if hon. Members ask car parks what their biggest problem is, they would all say that it is trying to protect the spaces for disabled blue badge holders to make sure that they can use them when they need them and that the spaces are not abused by other people who want to get nearest to the entrance or whatever. I know that from my own experience.

That scheme uses the blue badge, but it is not all that easy. People go on holiday, break their leg, get themselves crutches and then they are—albeit temporarily—disabled, but do retailers have to tell them, “Actually, you’re not disabled, even though you’re on crutches”? Some discretion must be allowed, otherwise the whole thing becomes a farce and the staff who have to monitor the scheme can be put in very difficult situations, including dealing with conflict. We should always bear in mind that, ultimately, somebody has to enforce such policies. If policies are not very clear, or always have exemptions and shades of grey, somebody somewhere will be in the line of fire. They have to implement the policy, and we must make it as clear and as fair as possible for them, and allow them sufficient discretion. We need discretion in any car parking policy or any policy that involves dealing with customers.

I do not know what the hon. Member for Burnley envisages. Does she expect all carers entitled to free car parking to be issued with a badge for a similar purpose? If so, I am not entirely sure what the cost would be of developing, creating and distributing the new badge, or how everyone to be issued with a badge would be identified. Perhaps she does not envisage having such a system. Perhaps she thinks that car parks could be fitted with automatic number plate recognition technology to ensure that when a car goes into the car park, the number plate is recognised and no charge is therefore allocated. That can of course be successful. We tried such a scheme at Asda to protect disabled parking bays. The problem is that it is extremely expensive to introduce. Another problem is that when a carer goes into a car park for the first time and has not registered, they get clobbered like everybody else. They have be go to the hospital to register, so although it is all right for subsequent visits, they fall foul of the rules on their first visit.

[Julian Knight]

I have discussed with my local hospital trust aspects of free parking and what we can do to help people. One point mentioned to me is that such a scheme might take people off front-line care services, or at least off front-line administration services, when they are asked to step in and help with the parking or to administer a parking scheme such as the one proposed in the Bill.

[Philip Davies]

My hon. Friend is right. There will, as an inevitable consequence of the Bill, be issues about preserving the integrity of the spaces.

I am not sure, but perhaps the hon. Member for Burnley intends to ask hospitals to provide designated spaces for carers to use, in the same way that there are designated spaces in car parks for people with disabilities or for parents with toddlers. If so, how many spaces should the hospital provide? There are rules and guidance on how many spaces there should be for disabled customers. From my memory of working at Asda, I think the rule is that 4% of all the spaces in a car park plus four should be set aside for disabled customers. That was certainly the situation when I was at Asda. Does she envisage a similar system—a number of designated spaces for carers, but when they are full they are full?

Does the hon. Lady expect someone to police the car park at all times to ensure that carers use the right spaces and that no one is charged unfairly? I do not know what system she wants. Perhaps she envisages a system of reimbursement, with carers paying for parking normally, just like everybody else, and then going into the hospital to demonstrate that they are a carer and have their costs reimbursed. That may require 24-hour-a-day, constantly manned reimbursement desks to be open at the hospital. Does she envisage that?

[Mr Rees-Mogg]

I am following my hon. Friend’s speech very closely. Is the heart of what he is saying that the scheme proposed in the Bill would prove so complex to administer that it would in effect be the end of all car parking charges, because to continue to have any charges would make the whole system collapse?

[Philip Davies]

Yes. That is absolutely my fear. Once we start down this route of having a centrally imposed system that has not been worked out locally, there will be all sorts of consequences. Ultimately, hospitals will be forced to turn a blind eye to this person or to that person, because their situation justifies having free parking just as much as a carer’s situation. It would be terrible for someone in the hospital car park to say, “Yes, you are a carer so you can have the free parking,” but, “You have a disability, so no, you can’t have free parking.” I do not see how we can allow hospitals to get into such a situation, because that would be grossly unfair.

From time to time, there will inevitably be disputes about whether somebody is a carer. If the system uses badges, somebody may forget to take their badge. As a carer, they would be entitled to free car parking, but if they had forgotten their badge, the hospital would not have to grant it. I am not entirely sure how such disputes would be policed. Would somebody be on site to adjudicate, or would the hospital do so? What training and qualifications would such people be given? Is this something for the Parliamentary and Health Service Ombudsman to adjudicate on? Is the hon. Member for Burnley suggesting that a new adjudicating body should be created to settle hospital car parking disputes? Those are all practical matters that need to be considered. This is not an easy yes/no question. There will be disputes from time to time, so who will sort them out, how will it be paid for and who will organise it and set it up? Will the hospital be judge and jury on its system of parking charges, or will that be monitored by an independent board?

[Mr Rees-Mogg]

To follow on from that, will the public or the private appeals system for parking offences be used? The two are completely different and have different statutory backings.

[Philip Davies]

My hon. Friend makes a good point. I do not know. The Bill covers not only NHS hospitals but private hospitals, which is another factor that needs to be considered. The hon. Member for Burnley did not say anything about how this would work in practice. In effect, we are being encouraged to vote for a pig in a poke.

The Bill will have unintended consequences. Hospitals may or may not be able to cope with the number of carers who use their car parks. The shadow Minister talked about the figures. According to the Department for Work and Pensions, just short of 721,000 people were claiming carer’s allowance in February, and a further 408,000 were estimated to be entitled to it. In England, 613,000 people actually claim it, and a further 331,000 are entitled to it. The number of people entitled to it varies quite widely from region to region.

I do not know whether this is why the hon. Member for Burnley has introduced the Bill, but she may be interested to know—this will certainly be of interest to my hon. Friend the Member for Bury North (Mr Nuttall) —that the north-west has a very high proportion of people entitled to carer’s allowance and a very high number who receive it compared with any other region in the country. I am not entirely sure of the reasons for that, but that is the fact of the matter, according to the figures from the Department for Work and Pensions. If, just under such a narrow definition, nearly 1 million people are suddenly automatically entitled to free parking in hospitals, how will hospitals cope with any potential increase in demand for car park places? Hospital car parks are bursting at the seams and unable to meet the current demand for car parking.

The principle of supply and demand is obvious in this regard. If the price of something is put up, the demand for it goes down, and vice versa. If we exempt people from car parking charges, an inevitable consequence will be a surge in demand. We all know that, much to the delight of my hon. Friend the Member for North East Somerset (Mr Rees-Mogg), car use is increasing in the UK. Presumably, the demand for hospital car parking places will get more acute as time goes on—something that he will no doubt welcome regally.

[Mr Rees-Mogg]

I do indeed. The more the motor car is used, the better. My hon. Friend is getting to the nub of the matter. One can ration either by price or by queue. There is no other way of determining how supply and demand meet.

[Philip Davies]

I am glad that we have got back to a situation where I am in agreement with my hon. Friend.

The Cumberland infirmary in Carlisle has outlined its concern over its four car parks on its website:

“We are currently experiencing unprecedented levels of cars requiring parking spaces at the Cumberland Infirmary.”

It is already having that problem. How on earth is it expected to find the additional car parking spaces for carers to park free of charge?

In the north-west alone, 102,000 people are receiving carer’s allowance and a further 60,000 people are entitled to it. That is 162,000 people just in the north-west who would be entitled to free car parking under this regime. Where on earth will they all go?

In the 2015 edition of the Department of Health’s health technical memorandum entitled “NHS car-parking management: environment and sustainability”—they always have catchy titles at the Department of Health—Leeds Teaching Hospitals NHS Trust was quoted as saying:

“The car-park occupancy levels often reach and surpass 100%.”

It is not as though there are lots of car parking spaces available to allocate to worthy groups of people who might need to use them.

[Mr Rees-Mogg]

I am momentarily puzzled about how the usage of a car park can exceed 100%. Are the cars crashing into each other or parked on top of each other? Can my hon. Friend explain?

[Philip Davies]

I suspect it means that people are parking in places where they should not be parking within the car park because there are not enough spaces, so they park somewhere where there is not a space.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I do not think we need to worry too much about going over the capacity of 100%. We need to concentrate on the Bill and worry about carers’ parking.

[Philip Davies]

I very much agree, Mr Deputy Speaker. I will move on. I will discuss how it might work with my hon. Friend in the Tea Room afterwards.

[Mr Chope]

If there is increased demand for car parking spaces at hospitals and it is desirable that those hospitals provide extra provision, that has to be paid for. How will it be paid for?

[Mr Deputy Speaker]

I do not think that is our worry for today.

[Philip Davies]

Whether it is or not, Mr Deputy Speaker, I will move on.

I asked my local hospital how many carers already use its car parking spaces, which very much is our concern today. It replied:

“The Foundation Trust is currently unable to determine how many carers use the designated hospital car parks. It would therefore be difficult to assess the potential impact on car parking revenue”.

That goes some way towards answering the question my hon. Friend the Member for Christchurch asked. The honest answer is that we do not know what the impact will be on any particular hospital. My local hospital certainly does not know.

[Julian Knight]

My hon. Friend is making the important point that his foundation trust does not know how many carers park at the hospital. I have asked similar questions and have not received any answers. That shows that we do not know how much the Bill would cost the country if it were put in statute.

[Mr Deputy Speaker]

In fairness, we have had an hour of explaining that we do not know the cost. I am sure that we do not want to rerun that.

[Philip Davies]

Absolutely, Mr Deputy Speaker.

Although there are no official statistics on this matter, in the NHS car parking impact assessment for 2009, the Department of Health provided an estimate of the revenue raised from hospital car parking charges as a whole, which was in the range of £140 million to £180 million. University Hospitals Birmingham NHS Foundation Trust raised £1.5 million from car parking in 2004-05. This measure would clearly leave a substantial hole in NHS hospital budgets.

As I have made clear, one consequence of the Bill would be increased car parking charges for people who do not apply for the free parking. One of my concerns is that we have already seen considerable increases in car parking charges at hospitals. Wye Valley NHS Trust has increased its average hourly rate from 33p in 2013-14 to £3.50 in 2014-15. I would be loth to put any additional cost on people who are using that car park. The Whittington health trust in London doubled its average hourly rate from £1.50 to £3, and Medway Maritime hospital in Gillingham increased its price for a five-hour stay from £5 to £8. Given that we are already seeing such huge increases in parking fees, I would not want to pass a Bill that would see people paying even more.

That point was highlighted by the British Parking Association in 2009, following the scrapping of hospital car parking charges in Scotland. It said:

“Car parks need to be physically maintained, somebody somewhere has to pay. Charges were not introduced to generate income but rather to ensure that key staff, bona fide patients and visitors are able to park at the hospital. Without income to support car park maintenance…funds which should be dedicated to healthcare have to be used instead.”

[Barbara Keeley]

On a point of order, Mr Deputy Speaker. The hon. Gentleman has been speaking for an hour and nine minutes, and we are now getting a lot of repetition. Many other people want to speak.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

In fairness, it is for me to decide whether there is repetition. I certainly do not need any advice. You should not be questioning the Chair’s ability to hold the speaker to account. I am sure that Mr Davies is well aware that many people wish to speak and that he wants to hear those other voices. He is in order, but I am worried that we will get into repetition. I certainly do not want to get bogged down in the maintenance of Scottish car parks. I am sure that he will move on quickly.

[Philip Davies]

I am grateful for that guidance, Mr Deputy Speaker. The hon. Lady has intervened on me more often than anybody else, which has held me up in making my remarks. My advice is that if she wants me to crack on, she should not keep intervening on me so that I have the opportunity to do so.

A big geographical inequality would result from the Bill because car parking charges vary wildly from one part of the country to another—from £4.26 in the north-east to £11.85—

[Mr Deputy Speaker]

Order. The hon. Gentleman has given a great number of examples. I do welcome examples, but there is a limit to how many we need. I think that people can get a flavour of the arguments from the examples he has used. Hopefully he will bring something new to the Chamber. If not, I am sure that he would like to hear somebody else. I am sure that some of his colleagues are desperate to speak.

[Philip Davies]

I am very grateful, Mr Deputy Speaker.

I will turn to the example that the hon. Member for Burnley used in her remarks, which she encouraged me to reflect on. As she said, at the end of last year, Torbay and South Devon NHS Foundation Trust announced that it would offer free parking to registered carers at Torbay hospital. I should point out that that scheme, unlike the Bill, is offered specifically to unpaid carers, rather than people who receive carer’s allowance. That is not what the Bill proposes, despite the impression the hon. Lady wanted to give. The interim chief executive of Torbay hospital, Dr John Lowes, said in December 2014:

“Family members and friends who provide unpaid care to our patients at home are invaluable, so we wanted to do something to make their hospital visits a little less stressful, and to demonstrate that we really do value what they do.”

He explained that the system was being implemented with the involvement of the established local care providers and that

“if someone is registered with either Devon or Torbay Carers Services, they just need to display their Carers Card on the car dashboard whilst they are parked in the public pay and display areas, and they will not be charged for parking.”

There are two points to make about that. First, the hon. Lady argued that what happens in Torbay shows why we can happily roll out the scheme across the country, but my view is that it is a perfect illustration of why we do not need legislation. Torbay has managed to do it without any legislation in a way that suits its local requirements, which is what I want to see.

Secondly, I know from my own experience that there is a problem with having a card displayed on a dashboard in a pay and display area, which is effectively what happens with blue badges. Anybody who has been involved in that area knows that people hand their badge to someone else to use—a member of their family, or whoever. It is not right—it is a terrible thing—but it happens, and we cannot ignore the fact that it would happen under the system proposed in the Bill.

[Mr Rees-Mogg]

I just want to say that I am sure things like that do not happen in Somerset.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. And I am sure that it is not part of the debate for today.

[Philip Davies]

Thank you, Mr Deputy Speaker. Again, I will move on.

As the Torbay scheme is the nearest to the one that the hon. Member for Burnley proposes, I asked some questions through freedom of information requests about the impact and take-up of the scheme. I asked how many people had used the scheme since it was introduced, and the reply from Torbay was:

“We are unable to provide you with the information requested as it is not held electronically or in a central location. We do not record the details of carers, only a verification that they are on the register.”

We do not even know how many people take up the scheme that has been introduced.

[Mr Chope]

Surely that is a good thing, because it shows that there is a light-touch approach without too much bureaucracy and administration.

--- Later in debate ---

[Philip Davies]

I very much agree, which is why I think the Bill is unnecessary. This can be done much better locally than by central Government diktat.

Gloucestershire Hospitals NHS Foundation Trust has also set up a scheme for carers, aiming to support their needs when they visit hospitals. It asks that carers make hospital staff aware of their caring responsibilities, and it also mentions that they may be entitled to a carer’s badge that they can use during a hospital stay. That entitles the carer to exemption from parking fees, but also to reduced meal costs in the hospital restaurants, free drinks on the ward and the use of toilet and washing facilities in the ward area. When we allow local hospitals the freedom to do their own thing, they can give carers an enhanced service that is much better than what the hon. Member for Burnley proposes. I fear that if there were a central Government diktat that was bureaucratic and difficult to implement, areas such as Gloucestershire would scale back the other benefits that they gave carers and instead just meet the requirements of the law.

It is perfectly clear that the Torbay and Gloucestershire schemes have completely different ways of working and of identifying eligible carers. If it works at local level, all is well and good, but that would not be possible under the Bill.

[Mr Rees-Mogg]

Is my hon. Friend saying that carers who currently receive the benefit of free parking would have to be removed from the Torbay scheme if the Bill were brought into law, because they would not qualify and Torbay would have to change the scheme?

[Philip Davies]

That is my reading of the situation. Because the definition of carers in the Bill is different from that used by Torbay—

[Mr Deputy Speaker]

Order. May I just say that we have covered Torbay? The hon. Gentleman has moved on, but unfortunately the hon. Member for North East Somerset (Mr Rees-Mogg) keeps wanting to drag him back to what he has already covered. I know that he does not want to go back to that.

[Philip Davies]

I am pleased that you have acknowledged that I am being led astray, Mr Deputy Speaker.

[Mr Deputy Speaker]

But a little bit too easily.

[Philip Davies]

In which case we must look at the Bill itself, Mr Deputy Speaker, if that is what you are urging me to do.

The Bill is called the Hospital Parking Charges (Exemptions for Carers) Bill, but it would actually apply to all health service providers, both public and private, and not just hospitals. I do not think many people appreciate its true scope. Clause 1 states that bodies that provide healthcare must

“make arrangements to exempt qualifying carers”

from car parking charges. That applies to

“any National Health Service hospital, walk-in centre, GP practice or other health care facility to which patients are admitted, or which they attend, for diagnosis, testing, treatment or other appointment relating to their health”,

so we are not just talking about hospital car parking charges. It also extends to private hospitals, so not only are we dictating what should happen in the NHS, but we are telling private hospitals what they should do. Many people might argue that those who can afford private healthcare treatment can also pay for car parking. Whether that is a legitimate use of resources is a different matter.

[Mr Rees-Mogg]

I wonder whether the Bill’s proponents have considered the human rights implications of taking a revenue source away from a private company without compensation. The Bill makes no provision for compensation.

[Philip Davies]

That is a very good question, and I do not know about that. My understanding is that Bills have to be certified to say that they fulfil obligations under the Human Rights Act and all of that stuff, but I do not know whether that applies to private Members’ Bills. My hon. Friend raises an interesting point, and I am not sure what the answer is.

Clause 2 is an attempt to define who would qualify. It states:

“A qualifying carer under section 1(1) is a person who…receives the Carer’s Allowance, or…has an underlying entitlement to the Carer’s Allowance.”

I have no idea where to begin with that. To claim carer’s allowance, a person must provide at least 35 hours a week of care for a severely disabled person receiving one of the following benefits: the middle or highest rate of disability living allowance; attendance allowance; the daily living component of personal independence payment; constant attendance allowance at or above the normal maximum rate with an industrial injuries disablement benefit, or at the basic rate with a war disablement pension; or armed forces independence payment. The person applying must be at least 16 years old, meet residence and presence conditions, not be subject to immigration control and not be in full-time education or gainfully employed. Anyone entitled to carer’s allowance would automatically receive free parking at hospitals under the Bill, whether they frequently visited hospital or not.

The hon. Member for Burnley has specifically identified that the members of the caring community who should be entitled to free parking are not only those who receive carer’s allowance but those who have an underlying entitlement to that allowance. I do not understand how on earth a hospital is supposed to know whether somebody has an underlying entitlement. The benefits system in this country is incredibly complex, and I would prefer our NHS hospitals to concentrate on the complicated process of providing the appropriate treatment to the right patients rather than have to be bogged down in Department for Work and Pensions rules on who is eligible for a particular benefit. That is what the hon. Lady is asking them to do in clause 2—to understand who is eligible for the benefit, not just who receives it.

As the hon. Member for Worsley and Eccles South made clear in an intervention, many people in this country care for people but are neither recipients of carer’s allowance nor eligible for it, because of the restrictive entitlement definitions. Why would we want to exempt some carers from parking charges but not others? That seems very unfair. I tried to get some information about what defines a carer, and it is not necessarily the same as what qualifies somebody for carer’s allowance. We need some flexibility on that.

I want to move on, because other Members want to speak. Clause 3 sets out provision for the Secretary of State to issue guidance and regulations through statutory instruments about the implementation of the duty to exempt carers from car parking charges. It is an important part of the Bill. It is something that we often see in private Members’ Bills: whether the Bill has merit or not—I am trying to flag up some serious concerns about that—the Member in charge includes a provision that would allow Ministers to extend the Bill’s requirements with the stroke of a pen and with barely a breath being taken. Clause 3 is a dangerous part of the Bill, because a Secretary of State or Minister could come along and say, “Actually, I’ve decided that we’re going to extend this left, right and centre”, and the hospitals will just have to implement it. That is very worrying.

Clause 4 would introduce a

“Duty to establish a scheme for exempting eligible carers from hospital car park charges.”

I think I have sufficiently covered who that would apply to and why it is a dangerous path to go down. Clause 5 states that a person would be eligible for free hospital car parking if they are assessed by a local authority under section 10(5) of the Care Act 2014, and it would change the provisions of that Act. It therefore seems to me—perhaps the hon. Lady will correct me—that under clause 5 eligibility could be granted on an intention to provide care, rather than someone actually being a carer. I am not sure how well that has been thought through.

[Mr Rees-Mogg]

Can my hon. Friend explain whether under clauses 2 and 5 somebody can quality for this allowance but not be eligible, or be eligible but not qualify?

[Mr Deputy Speaker]

If the Bill goes to Committee, such points can be teased out and straightened out there, rather than on the Floor of the House today.

[Philip Davies]

My hon. Friend makes an interesting suggestion. I contend that the Bill is so flawed that it cannot be rescued in Committee, or that rescuing it would involve filleting it to such an extent that it would come out barely recognisable, which would be a pointless exercise. I appreciate that such issues could be considered in Committee—as ever, Mr Deputy Speaker, you are perfectly right.

Clause 7 says that the Act must come into force

“12 months after the day on which this Act receives Royal Assent.”

There are two pertinent points about that. If it is so unjust for carers to pay hospital car parking charges, how can the hon. Lady justify requiring them to pay charges for another year? Why not introduce the change much sooner? I think I know the answer to that question, and it reinforces my argument. I think the hon. Lady realises that the provisions in the Bill would be a logistical nightmare to implement, for some of the reasons that I have already mentioned—I am sure there are also many others. She probably realises that to make anything of the Bill it would require at least a year to come up with anything that makes any sense. It is interesting that such a measure is part of the Bill, and it justifies my concerns. The hon. Lady said that she would like the measures in her Bill to be extended in future to cover other people. She made the point that this is a good start—

[Mr Deputy Speaker]

Order. That is speculation for another day. We are dealing with the Bill before the House, not what might be before us in future. I know that the hon. Gentleman is desperate to hear the views of other hon. Members, and I am sure his colleagues are desperate to speak.

[Philip Davies]

I agree. This is hard work, Mr Deputy Speaker, and you are right—I am anxious to press on.

[Mr Chope]

Before my hon. Friend concludes, will he address clause 7(2) which states that the Act extends to England only? Does he think that, as with free school meals, there will be Barnett consequentials?

[Mr Deputy Speaker]

I reassure the hon. Gentleman that we are not going to open that can of worms today. Philip Davies, I know that you want to get beyond clause 7 and to your conclusion.

[Philip Davies]

I knew it was a mistake giving way to my hon. Friend, and that he would try to lead me astray once again. I will leave him to consider Barnett consequentials in his remarks—I am desperately trying to reach a conclusion.

I appreciate that the hon. Lady genuinely wants to help carers, and if the principle behind her Bill is to support carers, I will happily support that principle. However, of all the worthwhile issues and campaigns championed by different carers organisations and charities, it seems that she has picked the one dud. I would have been happy to support many other campaigns for carers had she raised them. For example, parent carers could be offered an assessment rather than having to request one for their children, and we could introduce measures such as:

“Clear recognition in law that parent carer assessments and services must have the promotion of their well-being at the heart of what they do.

Consolidation of legislation on parent carers from three different Acts”.

I would have been prepared to support such worthwhile campaigns to help carers, but I fear that the hon. Lady has picked the wrong campaign. For future reference I urge her to consider some of the other campaigns that carers organisations would like to be raised. I think she would get a lot of support from across the House and—I hope—from the Government.

In conclusion, the Bill is ill-thought through and many areas are far too vague. It will be a logistical nightmare to enforce and implement, and it would cost NHS trusts up and down the country millions of pounds, forcing higher charges on other visitors, or risking patient services. It would exempt a lot of people who are just as worthy recipients of parking concessions—I think that the Government’s guidance on hospital car parking is far more sensible than the provisions in the Bill, and they encompass more people who deserve to be considered. Hospitals already have power to implement the policy suggested by the hon. Lady if they wish, and perhaps on reflection she should go away and come back at some point in future with a different Bill. I have not mentioned the money resolution consequences of this Bill, but I hope that others will consider that issue. I have not seen any money resolution proposals.

Finally—very finally—I have people visiting Parliament today, so I apologise in advance if I cannot be here for the entire debate. I will try to stay for as much as possible because it is an interesting discussion.

[Mr Deputy Speaker]

Don’t let us disturb you. I think your guests are waiting for you.

[Philip Davies]

Perhaps they are, perhaps they are not—I do not know. I genuinely wish the hon. Lady well in her time in the House, and I do not doubt the worthy sentiment in this Bill. We all support what carers do in this country, but I think the Bill is misguided.

--- Later in debate ---

[Mr Deputy Speaker]

Order. I understand the point that the hon. Gentleman is trying to make, but it has already been well thumbed. As the hon. Gentleman knows, it was covered very thoroughly by Mr Davies, and I do not want him to repeat everything that Mr Davies covered. I think that, in his hour and a half, Mr Davies did not leave a lot of scope, but this is one point that he made sure we were well aware of.

[Philip Davies]

It is worth repeating.

[Mr Deputy Speaker]

Only in your opinion.

--- Later in debate ---

[Philip Davies]

I did not get a chance to talk about this earlier. Does my hon. Friend know whether, under the Bill, the Government would reimburse the hospitals for the lost revenue, or whether the hospitals’ balance sheets would have to take a hit?

[Mr Nuttall]

The Bill is silent on that point. It might well be that, in the mind of the hon. Member for Burnley, some mechanism would be put in place to reimburse the trusts, depending on the number of carers registered with them. Or perhaps she would simply say to them, “Sorry, if you’ve got a lot of carers in your area, you’ll just have to suffer the consequences.” It is not clear what would happen.

I want to turn to a drafting matter that has not been touched on. Clause 1 is entitled “Duty to exempt qualifying carers from hospital car parking charges”, and subsection (1)

states:

“Health Care providing bodies shall make arrangements to exempt qualifying carers engaged in any of the qualifying activities listed in section 2(2) from charges for parking their cars”.

The question that arises is how wide the scope of healthcare facilities actually is. Clause 1(2)(b) states that the duty in that previous subsection is the responsibility of “any private hospital”. I personally believe it would be a step too far if we were to legislate on what private companies were allowed to charge for and to whom they should give exemptions.

Clause 1 provides for “arrangements” to be made for “qualifying carers”, while clause 4 provides for a “scheme” for “eligible carers”. Why does there have to be a difference? Why does one set of carers get arrangements while another get a scheme? It appears that schemes are more complicated than arrangements. Clause 1(4) requires the arrangements for qualifying carers to be in place within 12 months, whereas in the case of eligible carers, 12 months are allowed for a scheme to be submitted to the Secretary of State, and it does not have to be implemented until a year and a half after the Bill becomes law. If the matter is so urgent, why will it take a year and a half for carers to become entitled to the exemption?

It is a pleasure to welcome you to the Chair, Madam Deputy Speaker. I think there has been an error in the printed version of the Bill. In the printed copy that I have, clause 4(1) states:

“Health Care providing bodies shall establish schemes to exempt eligible carers engaged in any of the qualifying activities listed in section 2(1)(b) from hospital car park charges and submit such schemes to the Secretary of State within 12 months of this Act coming into force.”

However, clause 2(1)(b) states:

“A qualifying carer under section 1(1) is a person who…has an underlying entitlement to the Carer’s Allowance.”

The provision in clause 4(1) has been amended online to refer to section 2(2), which is the correct subsection. Section 2(2) is indeed the subsection that sets out what a qualifying activity is. It states:

“A qualifying activity under section 1(1) is transporting, visiting or otherwise accompanying or facilitating”—

--- Later in debate ---

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to respond to the debate. I want to make some general comments before I go into the details of the Bill and before time beats us, but let me first congratulate the hon. Member for Burnley (Julie Cooper) on her success in the ballot, and on using it to present this Bill. I am very grateful to her for discussing it with me in advance—we have met twice—and for prompting others to take an interest in it.

I think I have made it clear to the hon. Lady from the outset that the Government cannot support the Bill, for reasons that have been mentioned by my hon. Friends in connection with the discretion that we need to give to hospitals. I shall say more about that shortly. I think that I also made it clear to the hon. Lady—and she was very generous in remarking on this—that we were willing to change our guidance principles, which I shall read out later in order to show where the changes have been made. Those changes are amendments, and as far as I am concerned, they are the “Julie Cooper amendments”, because if the hon. Lady had not presented them to us, we would not have had them. Although I cannot support a change in the legislation, a material change will be made, and I hope that trusts and hospital authorities will take advantage of it when they feel that that is in their interests and also the right thing to do.

Let me now say a few words about carers. The hon. Member for Worsley and Eccles South (Barbara Keeley) knows a great deal about the subject, having spent considerable time dealing with carers’ issues over the years in her previous role as consultant to the Princess Royal Trust for Carers and on the local council. She understands the carer’s world very well, and I pay tribute to her for that.

Although I will say a little bit about carers, I want to say something about the car parking aspects of the Bill as well. There is no dispute between anyone in this House about the value associated with carers. I felt it was reasonable for me to mention the support I believed carers had from the Government at present. I did that not only because of what we say about valuing what carers do but because of our recognition that the system could not exist without them. However, the system could not exist if it had to compensate carers for every particular cost; that just cannot be done.

The 2011 census identified 5.4 million carers in England. To put that in context, the state spends £16 billion each year on adult social care. The total market is estimated to be worth £22 billion. The Office for National Statistics has valued informal care at about £61.7 billion. Whatever the actual figure may be, it is immense and this could not be done without the voluntary contribution of carers.

[Philip Davies]

If it is the case, as the shadow Minister seems to be indicating, that the only way one can show recognition towards what carers do is to support this Bill on hospital car parking charges, does the Minister agree that the shadow Minister ought to explain why in 13 years of a Labour Government they never passed legislation to exempt carers from hospital car parking charges?

[Alistair Burt]

My hon. Friend, who made a strong contribution to this debate, makes a fair point. The difficulties of life are such that, no matter that we have a string of things we would like to do, the finances do not enable us to do them. It is amazing that when we are in opposition we find things we were unable to do when we were in government.

One or two colleagues also made the point about the basic economics of this. It is tempting to add up a cost and say that because the value given by carers to the national economy is as it is, therefore everything can be netted off against it and it is a benefit. The economics just do not work that way. As hospitals would have to find the money to maintain their car parks and everything else, it is not netted off by the benefit to carers. So tempting though it is, and an understandable argument though it may be, it does not actually work. It only works when we do the difficult things that some of my colleagues have pointed out today, which seem to be very tough. After all, who would not give free car parking to carers? Indeed, who would not give free car parking at hospitals to everyone, which the hon. Member for Heywood and Middleton (Liz McInnes) went down the road of saying? That ignores the fact that it was not done when her Government had a chance to do it, and it ignores the fact that trying to find something like a quarter of a billion pounds when the NHS is stretched is going to be very difficult. These things are lovely to talk about, but they cannot always be done. It is much better to concentrate on what we can do.

Access to Medical Treatments (Innovation) Bill

Philip Davies Excerpts

Friday 16th October 2015 Commons Chamber

[Philip Davies (Shipley) (Con)]

I start by welcoming you to the Chair, Madam Deputy Speaker. It is an absolute pleasure to speak for the first time under your chairmanship on a sitting Friday, and it will be a great pleasure to do so again in the Fridays to come. I hope you enjoy it as much as I do. I congratulate my hon. Friend the Member for Daventry (Chris Heaton-Harris) on bringing forward this interesting Bill, on which we have had a good debate already. It would also be remiss of me not to welcome the hon. Member for Lewisham East (Heidi Alexander) to her position under the new regime in the Labour party. I am sure she will do a splendid job, and I wish her every success in doing it.

I have been contacted by constituents about the Bill, both in opposition to and support of it. It seems to polarise opinion; people seem to be either very for it or very against it in a way that is not always the case with Bills. I want to outline some of the points brought to my attention, many of them by my constituents. I understand that the Bill aims to help doctors to develop safely and responsibly innovative treatments and cures for cancer and other diseases, and that the rationale behind it, as my hon. Friend seemed to confirm, is that the promotion of such medical innovation could lead to the development of new cures and more effective treatments for patients.

To that end, the Bill has two aims: to provide a regulation-making power to enable the creation of a database of innovative medical treatments and to enable doctors to access information on this database; and to provide an option for doctors who innovate to take steps in advance to show that they are acting responsibly, not negligently—which deals with some of the concerns already expressed. It specifically states that it would not apply to the use of treatments in research, thereby keeping that distinction, but rather would support innovation in the treatment of individual patients, while preserving the existing common law safeguards for patients. By bringing forward the legal test of negligence to the point of treatment, it allows doctors to remove the barrier of the fear of litigation when using innovative techniques and working in a manner held as largely responsible. Those all strike me as worthy sentiments, and it is difficult to see why anyone would be against them in principle.

The Bill cannot be seen in isolation from its origin and progression in Parliament. As my hon. Friend made clear, the Bill stems from Lord Saatchi’s Medical Innovation Bill, introduced in the last Parliament, which, it is important to mention, arose from Lord Saatchi’s personal experience of losing his wife to a rare cancer. I think, therefore, that we can all appreciate, and should be mindful of, the Bill’s intention, which was to try and prevent that from happening to other people. It aimed to provide a standard for the legal position surrounding innovation, hoping, in theory, to encourage doctors to use innovative techniques, confident that their good intentions would not be lost.

In taking up issues with the NHS on behalf of constituents, I have often seen its fear of litigation. That might apply if I take up a complaint about one of my local hospitals—I have very good local hospitals, but of course everybody makes mistakes and things do not always go according to plan. Sometimes responses from the NHS can be very defensive, not because it does not appreciate that something has gone wrong, but because it fears the consequences of admitting that something has gone wrong. We should always do what we can to try to help the NHS from that fear of litigation. Anything seeking to do that would be very worthwhile.

[Dr Wollaston]

That is an entirely separate issue. Admitting when a mistake has been made is entirely separate from the fear of litigation, which is some cases can be very reasonable. If a doctor is putting forward an entirely bogus treatment and pretending that it could be helpful when it could in fact be more harmful than existing treatments, that is an entirely separate issue. I hope my hon. Friend will not conflate the two.

[Philip Davies]

I am rather surprised, given my hon. Friend’s background, that she has such little faith in doctors that she sees them wanting to peddle some bogus treatments. I was starting from the premise that the medical profession was far more responsible than that and would never seek to do that sort of thing. I certainly bow to my hon. Friend’s greater knowledge of the medical profession, but as I say, I was starting from the basis that her profession was nobler than she seems to indicate.

[Dr Wollaston]

Of course the overwhelming majority of the profession does behave responsibly, but the whole point about having protections in law is to accept that some would not behave responsibly. My hon. Friend the Member for Daventry (Chris Heaton-Harris) referred to hair loss, for example, which is a field where vast profits are to be made, and I am afraid some doctors might be tempted to behave irresponsibly.

[Philip Davies]

I take my hon. Friend’s point. She is an expert in her field in a way that I am not, and I certainly do not want to decry that. My perspective on the narrow point she raises, however, is slightly different. I would want to set the framework of the law for the overwhelming majority who are doing a good job. Let us try to find other ways to weed out those who are not doing so. Putting in place arrangements that apply to everybody in order to deal with the very small number of doctors about whom my hon. Friend speaks is probably the wrong way of going about it. I am happy to have this conversation with her in a different setting; I do not want to deviate too far from the Bill in going into how many doctors are noble and how many are chancers. I do not know the answer to that; perhaps my hon. Friend does, but I am not getting into that today.

My hon. Friend the Member for Totnes (Dr Wollaston) made the point that the Bill is unnecessary—the shadow Minister made the same point—and that there is no need for a legal requirement for medical innovation to be made, particularly when the current common law Bolam test is appropriate. Although it may not be popular, however, I believe it important to give serious consideration to this part of the Bill.

The Medical Innovation Bill, although criticised, showed an appetite for more legal work in the area of medical innovation. After a commitment from the Secretary of State for Health, the Medical Innovation Bill was put to consultation in the last Parliament. Many organisations shared their views, some of which have already been mentioned. I shall highlight a couple of those views because they are relevant to today’s Bill.

Cancer Research UK stated in its consultation response:

“There is clearly patient and clinician demand for more innovation to help treat people with cancer. We do sometimes see exceptional responses to treatments from individual patients, and therefore want to be in a position to innovate. Cancer Research UK is supportive of efforts to bring innovative treatments to patients faster and to improve the uptake of innovative treatments in the NHS. Any new legislation seeking to promote innovation should be drafted to ensure doctors have to establish there is sufficient intellectual underpinning and safety data about a treatment before proceeding. There should also be appropriate consultation with other doctors in the same or a related field to ensure patients receive the best care at all times.”

I understood from previous contributions to this debate that Cancer Research UK was against today’s Bill, but it does not strike me from the response I have cited that it was opposed to it. It seems to me that it was looking for ways to bring about more innovation to help treat people with cancer. It seems to be open to the possibility that the Bill might be able to do that.

[Chris Heaton-Harris]

I fully admit that there are a number of critics of the Bill, but not so many critics of the central idea in the Bill. I welcome what the hon. Member for Lewisham East (Heidi Alexander) said about trying to work with those who are genuinely interested in spreading best practice and innovation across the NHS. If one of the Bill’s core features is widely welcomed, even by some of the harshest critics of its later parts, I put it to the hon. Lady that it is surely it is worth taking the Bill forward into Committee to examine the provisions in greater detail, when we could debate it with expert witnesses and others.

[Philip Davies]

My hon. Friend makes a very good point. A Second Reading is, of course, a debate of a Bill in principle, so that we can establish whether people object to it in principle. I have been somewhat confused by the voices in opposition to the Bill because I cannot work out whether they consider the Bill to be dangerous or unnecessary because what it proposes is already being done. It seems difficult to argue that it could possibly be both. Either the Bill’s provisions are already in place so there is nothing to be done, or the Bill is a terrible and dangerous thing.

[Dr Wollaston]

rose—

[Philip Davies]

I cannot understand how it could be both, but perhaps my hon. Friend will explain that for me.

[Dr Wollaston]

On my hon. Friend’s first point about Cancer Research UK, let me be absolutely clear that it is opposed to the Bill. On the second point, what these bodies are all saying is that the Bill is unnecessary, but that if it is put in place, it would be dangerous. That would be the consequence of the Bill, and people think there are other ways of moving forward to improve access to innovative treatments.

[Philip Davies]

I merely read out, word for word, Cancer Research UK’s response to the consultation; I can do no more than quote its words. I will take my hon. Friend’s point in that regard.

[Mr Chope]

If there is such widespread opposition to this Bill, why was it that the Saatchi Bill made such good progress in the other place during the last Parliament, when I understand it had the benign support of the Government?

[Philip Davies]

My hon. Friend often asks me questions that I cannot answer. He has now asked another that I am not in a position to answer. I often think it is a mistake to give way to him; he is far too clever for my liking. Again, he has stumbled across something that I cannot answer. He raises a very good point, so perhaps we shall leave it hanging there for others to have a crack at later in the debate.

The Academy of Medical Royal Colleges said that it applauds the intentions of the promoters of the Medical Innovation Bill:

“The stated purpose of the Bill is to encourage responsible innovation in medical treatment, and accordingly to deter innovation which is not responsible. Those are aims which medical Royal Colleges would wholeheartedly support and welcome.”

That is an important point.

[Dr Wollaston]

The Academy of Medical Royal Colleges robustly rejects this Bill. Like me, it supports the intention of extending access to innovative medical treatments, but it is very clear that it opposes the Bill—and this House should oppose it, too.

[Philip Davies]

I am perfectly happy for people to put their own gloss on what others are saying. That is their right. If I may be allowed to do so, I am merely quoting, word for word, the responses that people made. If my hon. Friend is saying that the Academy of Medical Royal Colleges should not have written that, she should take that up with the organisation. I am merely quoting what it wrote, which I thought was quite clear.

[Dr Wollaston]

rose—

[Philip Davies]

I want to make some progress, but I will give way again to my hon. Friend.

[Dr Wollaston]

I must take issue with my hon. Friend because he is quoting very selectively from the report. When he has finished speaking, I urge him to go online and have a look at the detailed briefing on the Bill from the Academy of Medical Royal Colleges. It applauds the principle of improving access to medical treatment, but it is absolutely clear that it opposes the Bill.

[Philip Davies]

I do not deny that. If the Academy of Medical Royal Colleges wants to shy away from any part of what I have said, the academy probably should not have written it in the first place. I did not write it on the academy’s behalf; the academy wrote it, and I have quoted it faithfully. People can make of it what they will, but what the academy said was that it

“applauds the intentions of the promoters of the Medical Innovation Bill…to encourage responsible innovation in medical treatment, and…to deter innovation which is not responsible. Those are aims which medical Royal Colleges would wholeheartedly support and welcome.”

That is what the academy has said. I did not say it on the academy’s behalf.

The Association of Medical Research Charities summarised its position as follows:

“We welcome the ambition of the Bill in seeking to address the important issue of encouraging medical innovation; innovation and its adoption can be low and slow in the NHS and there is much that can be done to improve this.”

Genetic Alliance UK said:

“There is much more that could and should be done to address the barriers that currently inhibit the adoption and integration of research and innovation into the NHS.”

The Royal College of Physicians said in its consultation document:

“The RCP strongly supports the aims of the Bill, and welcomes the debate and discussion around innovation that has occurred as part of the proposed Bill.”

Others will have different perspectives and will want to make other points as part of the consultation, but it seems clear to me, at least, that—as my hon. Friend the Member for Daventry said in his intervention, and as has been said even by those whom my hon. Friend the Member for Totnes says oppose the Bill—there is clearly something in the Bill that deserves further scrutiny in Committee.

[Heidi Alexander]

Will the hon. Gentleman clarify exactly what he is quoting from? Is he quoting from the consultation responses provided by those organisations, or from the most recent briefings that were provided before the debate? It is well known that opinion among a number of organisations has hardened against the Bill.

[Philip Davies]

I made it clear at the outset, but I am happy to make it clear again, that I am quoting from responses to the consultation. If those organisations want to shy away from any of those points, they are welcome to do so. As I have said, I am merely quoting what they said in response to consultation on Lord Saatchi’s Bill when these issues were first introduced.

[Dr Wollaston]

The point is that we all support the aim of improving access to innovative treatments; we simply do not agree that the Bill is the right way forward. Because my hon. Friend has quoted all those bodies, may I quote back to him the conclusion of the medical royal colleges? They will of course issue consultation responses that will be nuanced in relation to various points, but what we should look at is their conclusion, which could not be clearer:

“In conclusion, Medical Royal Colleges do not believe that the Bill should be supported.”

That is their position.

--- Later in debate ---

[Philip Davies]

I think that my hon. Friend is slightly in danger of arguing against herself. She began her intervention by saying that all those bodies supported the principle behind the Bill, and it seems to me that that is really an argument for supporting its Second Reading. What we are discussing now is whether or not we agree with the principle of the Bill, and my hon. Friend has just said that all those organisations support that principle. She may well wish to scupper the Bill on Third Reading, or amend it in Committee so that it is to her particular taste, but, as I see it, announcing that everyone supports the principle behind the Bill is a call to arms for people to support its Second Reading.

[Dr Wollaston]

rose—

[Philip Davies]

I want to make some progress, but I will give way to my hon. Friend one final time.

[Dr Wollaston]

I thank my hon. Friend. He is being very generous. Can he not see, though, that supporting the principle of improving access to medical treatments is a completely different kettle of fish from supporting the mechanism whereby an individual Bill attempts to achieve that aim? In other words, it is perfectly consistent to say that one opposes the Bill robustly, as, indeed, did a long list of organisations and people, including research charities, medical royal colleges, Action against Medical Accidents and Sir Robert Francis. The list is huge. All those bodies state, robustly and clearly, that the Bill is not the mechanism to achieve those stated aims, and that is why the House should reject it.

[Philip Davies]

It is not for me to advise other Members how to pursue their own agendas. My hon. Friend is a wonderful exponent of ways of implementing her views, but my advice to her, for what it is worth—which she may think is not a great deal—is that if she wants to see more innovation in medicine, as she said at the beginning of her speech, but does not believe that the Bill is the right way forward, she should support its Second Reading and then seek to amend it in Committee so that it achieves the innovation that she would like to see. We shall then review the matter on Third Reading, and she can decide at that point whether the Committee stage has delivered to her what she feels would be a useful way of getting more innovation into the NHS. It seems to me bizarre that someone should stand up and say, “I want to get more innovation into the NHS”, and then block on Second Reading—and this is the principal point of the Bill—any attempt that might actually facilitate the introduction of improved innovation into the NHS. But that is just the way I see the matter; it is up to individual Members to pursue their agendas in the way that they see fit.

[Chris Heaton-Harris]

I believe that the Bill should go into Committee, because it is an evolution: it is a process that we are going through in trying to get the position right. The Royal College of Physicians says that it “generally welcomes” the first part of the Bill, which enables the Secretary of State for Health to establish a database of medical treatments. However, it issues plenty of caveats in respect of how the detail should run. Those should be discussed in Committee, and that is where I want the Bill to go.

[Philip Davies]

My hon. Friend has made a very fair point.

I now want to say something about the medical innovation database provision, which is one of the main differences between the Medical Innovation Bill and the Bill that we are discussing. Clause 2 provides for the Secretary of State to make regulations enabling the Health and Social Care Information Centre to establish a database containing information about innovative medical treatments and their outcomes. As a layman, I consider that to be a significant and fundamental part of the Bill. A central database recording all innovative treatments strikes me as a useful tool from which doctors can learn when tailoring medical treatments for their patients. Again, I speak as a layman, but I think that the creation of a system to enable that knowledge to be shared is a logical step towards medical innovation.

Having said that, I should add that the proposal is not without its worrying aspects. I wanted to raise them earlier, but the interventions from my hon. Friend the Member for Totnes delayed me. One of the main criticisms of clause 2 comes from the Royal College of Surgeons of Edinburgh, which states:

“The proposed database could only be effective if it is compulsory, regulated, has robust quality assurance and be journal-led, ethically framed and rigorously peer reviewed. It will also require an honest culture in which participants are just as likely to register failures as successes”.

The clause provides for the Health and Social Care Information Centre to specify what information should be recorded and how it should be assessed. More experienced people than me will be able to note what standards and specifics need to be recorded to make the database useful and usable. It is certainly not for me to make any suggestions. The database will also be designed in consultation with professional bodies and organisations.

The clause contains the important provision that the database will cover all individual patient innovations, not only those in respect of which doctors have chosen to rely on the steps in the Bill to demonstrate that they have acted responsibly. It is a significant inclusion, as it means that the database will include and cover all treatments and their outcomes—both positive and negative —that take place in England. That is my understanding of the clause, but if my hon. Friend the Member for Daventry wants to correct any misunderstandings, he is welcome to do so. Therefore, this national database not only spreads the knowledge of successful innovations, but also has the benefit of ensuring that innovative treatments that do not work, or perhaps have harmed patients, are not repeated by other clinicians. That should go some way towards reassuring those with concerns. It will also, therefore, create a standard practice that all innovative medical treatment should be recorded in this database, which can be a useful tool for other doctors to draw information from when they are doing their own innovation.

[Bob Stewart]

I came here to listen to my very good friend my hon. Friend the Member for Daventry (Chris Heaton-Harris) and to listen carefully to the debate. It seems to me that if Lord Saatchi’s Bill went into the sand and if this Bill does not make it into Committee and disappears, the one good thing that will come out of it is that the whole subject will be illuminated, and perhaps something good will come out of that. Therefore, the efforts of Lord Saatchi and my good friend the Member for Daventry will not be in vain. I hope very much that the medical authorities will look at this and think of it in that light.

--- Later in debate ---

[Philip Davies]

I take on board my hon. Friend’s point. It seems to me that he was subtly saying he had come to listen to the speech of my hon. Friend the Member for Daventry rather than mine. I had hoped he had come to listen to my speech, but I am clearly mistaken.

[Bob Stewart]

I must intervene. I always come to listen to my hon. Friend the Member for Shipley (Philip Davies). I listen to him outside this hallowed hall and also inside it, and he is always well worth listening to.

[Philip Davies]

My hon. Friend is very kind, although it would have been rather better if he had not had to be prompted to say that. Nevertheless, I will take those comments in the spirit in which I know my good friend intended.

[Mr Chope]

My hon. Friend has not responded to the intervention of my hon. Friend the Member for Beckenham (Bob Stewart). Surely the point is that if we want to discuss this in more detail in Parliament, the ideal opportunity for that is in Committee when it can have detailed scrutiny.

[Philip Davies]

My hon. Friend makes a good point. I have not heard anything so far today to suggest that the Bill should not at least go into Committee for further scrutiny, and perhaps even for some improvement, if I may be so bold as to suggest that may be possible. I do not think I have heard anything today that suggests the Bill should be stopped in principle on Second Reading. I hope that my hon. Friend the Member for Totnes will appreciate, however, that I am also trying to be balanced in setting out some of the concerns that have been expressed, perhaps so they can be considered if we do get into Committee, which would be a useful exercise.

Another concern raised by some of my constituents is that the database may compromise patients’ anonymity. Innovative medical treatments will be applied on a case-by-case basis with a specifically honed technique for one particular individual. The fear is that a degree of detail will be needed in the register, which would end up compromising a patient’s anonymity. That is a valid concern, and protections would need to be put in place to ensure all information is stored securely within the database to protect anonymity. However, that may be at the cost of using innovative treatments. There may well be a tension between those two factors.

While the information stored in the database should only be accessible by doctors, it will need to remain confidential aside from access for medical purposes and, ultimately, it should be the patient’s choice whether to use an innovative treatment that will be recorded for medical purposes. Furthermore, in an age when we want more doctors to spend more time with patients and not at their desks, we need to be careful to ensure that the register does not become overwhelming to the point where doctors are put off from using innovative techniques for the sake of the amount of paperwork and red tape that would accompany it. The Academy of Medical Royal Colleges said

“current experience in the NHS show that establishing an effective register for far more standard procedures is a complex task. Establishing and maintaining a register of innovations would be a costly and potentially burdensome and bureaucratic task.”

My hon. Friend the Member for Totnes made that point. That is another factor that needs to be considered when the database is created. Of course the database and the information gathered should be rigorously checked and regulated. However, that is not always easy when doctors are already busy.

Overall, I believe this clause, originating from an amendment to Lord Saatchi’s Bill, is one of the key clauses. For rare diseases such as some cancers there is a lack of published evidence on which to rely when determining treatments to try. It is also widely regarded that some methods used to treat some types of cancers have remained similar for many years, with only slight modifications to the techniques. With this in mind, a database that allows knowledge to be stored and accessed at a doctor’s level will be not only desirable but probably essential for allowing doctors to innovate responsibly. It will encourage a culture of knowledge sharing, which, importantly, will include both successes and failures. This is a vital part of the Bill, and indeed I do not see how the power to innovate can move forward without the inclusion of a database recording the results of these treatments. I therefore commend my hon. Friend the Member for Daventry on including this clause.

We need to look at what we consider to be a responsible innovative treatment. Clause 2(2) states that a treatment is regarded as

“‘innovative’ if it involves a departure from the existing range of accepted medical treatments”

for a condition. We can therefore assume a wide scope to cover the cases that should be recorded in the new database.

However, concerns have been raised regarding the distinction between innovation and research. While clause 5(2) specifically states that this Bill does not apply to medical research, some medical organisations have raised concerns as to how this would work in reality. The Academy of Medical Royal Colleges states:

“We do not understand the distinction between ‘individual patient innovation’ and ‘research’. The distinction seems false and potentially dangerous. As a college president stated ‘Innovation without research isn’t innovation, it’s more often just advertising’.”

Although the Bill uses the two in harmony, it is important to raise these points and for them to be considered in Committee.

One of the main differences that separates the two is that this legislation allows doctors more freedom to modify and specifically cater treatments towards the individual they are treating. That is very important and worthwhile. Although they will not be finding a brand new cure for cancer, it allows doctors to cater treatment plans more specifically to the patient’s needs and wishes. Many patients will benefit from that, and often would prefer it.

We have discussed the Bolam test. By working from the current common law Bolam test, the Bill identifies the steps a doctor can take to show that they have acted responsibly before innovating. The common law Bolam test is defined as the test

“used to determine the standard of care owed by professionals to those whom they serve, e.g. the standards of care provided to patients by doctors.”

Established from the case Bolam v. Friern hospital management committee in 1957, it shows that if a doctor acts in accordance with a responsible body of medical opinion, he or she will not be negligent. Subsequently this standard of care test was amended—the Bolitho amendment—to include the requirement that the doctor should have behaved in a way that “withstands logical analysis” regardless of the body of medical opinion.

This determination of whether a professional’s actions or omissions withstand logical analysis is the responsibility of the court. The Bill, through clause 3, aims to reflect as closely as possible the steps under the current common law which a responsible doctor could be expected to satisfy when innovating. However, clause 3 has caused specific concern for many of my constituents and I would like to raise some of their concerns today.

Most groups and individuals from the medical profession seem to be satisfied with the current Bolam test as a standard for regarding medical innovation, with the Royal College of Surgeons regarding it as “adequate”, so there are concerns that, instead of clarifying the legal position, clause 3 will confuse the current mechanism for judging responsible innovation.

Subsection (2)(a) requires a doctor to

“obtain the views of one or more appropriately qualified doctors in relation to the proposed medical treatment, with a view to ascertaining whether the treatment would have the support of a responsible body of medical opinion”.

This implies that the innovating doctor need only rely on an interpretation of a responsible body, and need not gain the support from a responsible body itself. In practice this might not be a problem, however, as the Bill specifically states that those supporting views must be obtained from “appropriately qualified doctors”—that is, those with appropriate expertise and experience in dealing with patients with the condition in question. It may therefore be taken that the doctor is qualified in the relevant field, which would provide reassurance. It is this clause that many of my constituents are concerned about, however.

This brings me to another point that was raised by my hon. Friend the Member for Totnes. Some of my constituents fear that the database could be used as a tool by quacks, crooks and charlatans, giving them the flexibility to use devious experimental treatments. Indeed, that concern has been echoed by the Royal College of Surgeons, which claims, in reference to clause 3(2)(a):

“This sub-clause could also provide post-hoc justification for an unethical treatment from a doctor asserting s/he sought the view of one other doctor.”

We must be sure, therefore, that appropriate safeguards are in place to protect patients from such doctors. I do not think that many of them exist, but I do not know. My hon. Friend the Member for Totnes and I might have some disagreement about that. The important point is that there needs to be a safeguard, because it is inevitable that some such doctors will exist.

[Chris Heaton-Harris]

Those safeguards do exist. A doctor has to act responsibly, and if he does not do so, the full weight of the GMC and the law will come down upon him. That situation will not change at all as a result of my Bill.

[Philip Davies]

I take my hon. Friend’s point, and we should recognise the work of the General Medical Council in ensuring that high quality people are in the profession.

Much of the debate has rightly focused on the impact that the Bill would have on doctors and the medical profession, and on whether it would give them further freedom to innovate or whether it could be misused. However, it seems to me as a layman that much of the focus should also be on the patient. Ultimately, it is the patients who will bear the consequences of this legislation. Many of my constituents, on both sides of the debate, have contacted me to offer opposing views on the effects the Bill would have on patient safety. Some are concerned that it would move the focus from determining whether a patient’s care had been negligent to whether the doctor’s decision had been responsible.

However, the Bill would provide another layer of protection for patients in that the assessment would be carried out before the innovative treatment took place. By following the steps of the common law test, the doctor would obtain the views and support of a responsible body of medical opinion before innovating, so that they could be confident in the knowledge that they had support and would thus not be found negligent. This would of course provide reassurance to the doctor administering the innovative treatment, but more importantly, it would also be in the patient’s interest. Patients could therefore be satisfied about the treatment plan they were undergoing. Any innovative treatment plan must, by definition, come with concerns, but at least the patient could be assured that the doctor had satisfied legal and sound tests to show that the proposed treatment was responsible.

The Bill also sets out that during their research enquiries, the doctor must act and record views in a responsible manner. Therefore, if an appropriately qualified doctor were to consult on the proposed innovative treatment and express reservations about it, the innovating doctor could not disregard those reservations without being found negligent. That is an important point that should not be forgotten. Presumably, the powers of the GMC could kick in at that point to deal with any parts of the medical profession that we might not be altogether pleased with. My hon. Friend the Member for Totnes should not discount the fact that this legislation could highlight some of those cases and bring to account certain people who are hidden from such exposure at the moment. The aim of these provisions is to preserve the existing safeguards of the common law for the patient while giving the innovating doctor the additional choice of taking steps to show that they have acted in a responsible manner prior to innovating, thus aiming to encourage most doctors to do so without fear of litigation.

It is also important to touch on the possibility of unintended consequences. On Fridays, we often debate Bills that have a worthy sentiment behind them—indeed, that applies to most of the Bills that we discuss on Fridays—but they often turn out to be accompanied by unintended consequences. Some of the potential unintended consequences of this Bill have been raised with me by my constituents. One such concern is that the Bill could inadvertently undermine the work of clinical trials or discourage patients from participating in clinical trials, instead leaving doctors to focus on individuals on a case-by-case basis.

Clinical trials, by definition, test methods that aim to be of general benefit in combating a disease collectively—that is, they aim to find a common solution that can work with all, or nearly all, patients. The concern is that if doctors are encouraged to use innovative treatments when treating their individual patients, this could harm the development of research and clinical trials, as they may bypass the need for a regular clinical trial, leaving innovation to develop on an individual level. That seems to be a reasonable point for my constituents to have raised.

Having said that, the proposal could provide an opportunity to enhance the work of clinical trials and research. I hope that my hon. Friend the Member for Daventry will look further in Committee at any unintended consequences, and determine what, if anything, needs to be done to the Bill to prevent any harm from being done to clinical trials. It could boost clinical trials, but there is the potential for both consequences, and we must ensure that it results in a good conclusion rather than a bad one.

If a doctor were to use an innovative treatment on a patient that seemed to be successful, and subsequently recorded it on the medical database, a larger-scale clinical trial could be established to determine whether the treatment provides an inclusive solution for the disease or is suitable only for that individual. I hope that such a complementary consequence will occur as a result of the Bill, and that the understandable concerns of my constituents will be unfounded. The Bill does not create the climate for innovative treatment to begin. Doctors already have the freedom to innovate in individual cases, and that has not yet caused any difficulties or concerns for researchers or clinical trials, so there is no reason why it should do so in the future.

When considering the unintended consequences, we must also consider the unintended positive consequences, such as the one highlighted by the Royal College of Surgeons. It has stated:

“We…believe the Bill could potentially help to prevent poor practice in the private sector where decisions to try unconventional treatments are, in some rare instances, taken without adequate evidence or support from a multi-disciplinary team (MDT decision-making is less common in the private sector).”

Passing the Bill, and setting a more robust legal framework, would automatically set a precedent in the medical community for the procedures that would be expected to be followed when using innovative treatments.

[Dr Wollaston]

rose—

[Philip Davies]

I was doing so well! However, I appear once again to have incurred the wrath of my hon. Friend.

[Dr Wollaston]

Not the wrath; I just want to point out to my hon. Friend that he is quoting selectively from the Royal College of Surgeons, which robustly opposes the Bill.

[Philip Davies]

I am only quoting what the RCS has said. My hon. Friend might want to decry my statement, but the RCS’s overall conclusion on the merits of the Bill is a different issue. I am merely pointing out that it has stated that this could be a consequence of the Bill. People can draw their own conclusions from that. I would like to think that I have tried to be as even-handed as possible by outlining the potential benefits of the Bill as well as the other potential consequences. I have quoted organisations that have raised concerns. I am trying to be even-handed, whether my hon. Friend likes it or not—I suspect that she does not—and that is what the Royal College of Surgeons has said.

[Dr Wollaston]

Let me read some conclusions:

“we believe this law is unnecessary and potentially dangerous. It will absolve doctors from any liability for an experimental treatment if they followed the Bill’s low standards and will make it harder for patients to redress malpractice.”

That is the conclusion of the Royal College of Surgeons of Edinburgh and it is pretty clear.

[Philip Davies]

That may well be that body’s conclusion as it stands, but my point is, as I have tried to make clear, that given that it can see there are potential benefits to the Bill, which I have expressed, in dealing with poor practice in the private sector, there is an argument for getting it into Committee to see whether we can make it a Bill that it wholeheartedly supports. That may or may not be possible, but it is certainly worth having a go, given that it has said clearly that the Bill has potential benefits.

Some medical organisations and groups have expressed their concern that the Bill will have an impact on the use of research clinical trials, but that should not be a sufficient reason to stop doctors using innovative treatments on an individual level. This should not be about one or the other—as I said, we should try to do both.

I was contacted, as I am sure many other Members were, by a concerned mother who is desperate for this Bill to pass so that it can benefit her young daughter, who suffers from a rare condition. As has been pointed out, the difficulty with rare diseases and conditions is that because they are so specific, research and clinical trials are not only costly, but very time-consuming. Many people suffering from these diseases do not have this time in finding a cure. The mother who contacted me explains that her daughter, Grace, is already awaiting the commencement of two clinical trials that may, in the long run, be able to help to treat her condition. Although she is appreciative of these movements, the mother explains that if, after the six-month or 12-month clinical trial, the drug is proven to be effective, her daughter will still not be able to have access to it for several years because of the lengthy approval system used by the National Institute for Health and Care Excellence. We should not forget that in a hurry. Although I do not doubt that the trial times and approval systems that new treatment methods must go through to be considered standard medical care are necessary in order to make sure they are safe, they are far too long for many people, given their particular illness.

[Bob Stewart]

Too late.

[Philip Davies]

Absolutely, this is too late for them. Therefore, patients may be willing to use innovative treatments, or even treatments that may be used elsewhere in the world but have not been approved in the UK, because in many cases they have nothing to lose. If that is the case, doctors should be allowed, and encouraged in many respects, to make informed choices on behalf of their patients.

During my research, I contacted NICE to ask for its opinion on the Bill, but it did not really have much of one. It responded by saying:

“NICE’S Chief Executive has met with Chris Heaton-Harris to discuss the Bill and will respond constructively to any further approaches for advice and comment”.

That was NICE’s comment on the Bill, so I am not sure whether NICE supports it or opposes it—I could not get anything further out of NICE. I hope it means that NICE will be happy to work with my hon. Friend the Member for Daventry to try to make the Bill a success, although it does not say that.

Why is this Bill necessary? As we have heard, one main criticism of the Bill has been that it is unnecessary: the status quo does not currently prevent or discourage doctors from innovating, and therefore this change will not encourage further responsible innovation. The Royal College of Surgeons of Edinburgh stated:

“As existing Clinical trial regulations provide a safe and patient centred framework for innovation, there is no evidence that doctors are being deterred from testing new drugs and treatments. None of the medical Royal Colleges, patient groups or research charities have evidence that litigation, or the fear of litigation, is preventing new treatments or hampering doctors from innovating. The overwhelming experiences of our members and fellows leads us to believe that an additional, parallel structure for innovation is unnecessary”.

I hope my hon. Friend the Member for Totnes is happy with my quoting from that passage and does not claim that it is a selective quote. I am trying to be even-handed in respect of the points that people are making.

That point made by the RCSEd is echoed by other medical groups, and these points are clearly valid, but my hon. Friend, too, should be even-handed in accepting that for every organisation suggesting there is no need for these changes, probably just as many organisations and doctors support the Bill. Let us take just one. Dr Max Pemberton was reported in The Daily Telegraph in 2012 as supporting the Medical Innovation Bill and writing:

“It is a tragic indictment of modern medicine that innovation is too often jettisoned in favour of the status quo—not because it is in the patient’s best interest, but because of the fear of being sued. This defensive medicine is at the heart of so much clinical practice now.”

Furthermore, in its consultation response to the Medical Innovation Bill, the NHS Health Research Authority stated:

“We recognise that the fear of litigation may influence behaviours of clinicians”.

That shows not that every doctor who does not use innovative methods takes that approach because of a fear of litigation, but instead that it may be a possible cause for some doctors. I am not advocating that every doctor in the NHS is concerned about the fear of litigation, because to do so would be absurd, but although litigation may not be a huge barrier to some innovative treatments within the NHS, to totally disregard it as a problem, as many critics have done, is not justifiable. There is clearly sufficient concern about litigation for it to need addressing.

[Heidi Alexander]

What assessment has the hon. Gentleman made of the survey by the Royal College of Physicians on the views of a range of clinicians about the barriers to innovative treatment? When asked, 70% said funding was the issue, 69% said that applying for funding requires too much effort and 69% said that their employer would not grant them the time they need to assess the benefits of carrying out that innovative treatment. If a fear of legal action is so serious, why does it not appear in those survey results?

[Philip Davies]

When the survey says that employers are not allowing people to carry out the innovation, the shadow Minister may have not appreciated why that may be the case. One reason may be the fear of litigation. She should not take it that just because it was not mentioned expressly it is not one of the factors involved in why some employers do not want that innovation to be performed by their employees. She perhaps ought to have asked: why do the employers not want to give them the time to do it? She may well find that the fear of litigation is one of the reasons.

In his speech to the Lords, Lord Saatchi summed up his Bill using the words of Professor Norman Williams, President of the Royal College of Surgeons:

“Protect the patient: nurture the innovator”.—[Official Report, House of Lords, 27 June 2014; Vol. 754, c.1450.]

Perhaps, therefore, this Bill is necessary in order to reassure doctors; society has become more and more litigious over the years. We even have a specifically assigned part of the NHS to deal with the cases of medical negligence claims—the NHS Litigation Authority. I am sure that if litigation was not an issue within the NHS, we would not need an NHS Litigation Authority, whose role is to manage and help resolve claims against the NHS. Despite resolving 96% of claims out of court, in order to keep legal costs low, the most recent information shows that in 2014-15 annual expenditure on NHS clinical negligence claims was £1.2 billion. For total liabilities, the figure is £28.6 billion, £16.1 billion of which is included to cover claims that have not yet been reported. These figures have increased year on year, showing that we live in a more litigious society. Between the financial years 2010-11 and 2013-14 the amount of new clinical claims rose year on year by 6%, 10.8% and 17.9% respectively. The amount has almost doubled since 2009-10, moving from 6,652 new clinical claims to 11,945 in 2013-14, and even non-clinical claims have risen from 4,074 to 4,802 in the same time. In stark contrast, the outstanding liabilities bill for 2013-14 was £26.1 billion, which was the equivalent to almost a quarter of the annual health budget for the same year. In July, the Triennial Review of the NHS Litigation Authority spoke of

“A significant challenge to the NHS LA in managing litigation on behalf of the NHS is the rising growth in clinical negligence claims.”

With a spending round forecast for 2015-16 of £1.4 billion, a 35% increase, and projections up to 2018-19 of £2.1 billion in spending on claims, it is clear that projections show that the litigation culture will continue to grow. An unintended consequence of this litigious culture is surely to act as a deterrent to medical innovation. We must therefore ensure that no doctor with the knowledge to help a patient should be deterred by fear of litigation.

It is also significant to point out that some of the most fearsome critics of this Bill have been medical negligence lawyers. However, we must be assured that they are not speaking out with vested interest—for example, how it might affect their business. In 2010-11, the NHS Litigation Authority reported total legal costs to be £257 million, £200 million of which was paid to claimant lawyers. That is a significant point to note and explains why they might be so opposed to this Bill.

[Dr Wollaston]

There tends to be an assumption in this debate that all innovation is a good thing. Some medical innovations turn out to be extremely dangerous and irresponsible. We need protections in law to protect patients from unscrupulous doctors. The reason Action against Medical Accidents and the Patients Association oppose this Bill is that they recognise that it will unravel some very important protections that are in place. We need to proceed with great caution.

[Philip Davies]

I do not think that anyone would disagree with my hon. Friend. Everybody is concerned about patient safety. I have stated at length some of the concerns that my constituents have raised about, for example, anonymity and safety. I hope that all those points will be considered by my hon. Friend to see whether anything further needs to be done in Committee. No one disagrees with that, but saying that we cannot have a Bill that does not protect patient safety is probably not the same as my perspective.

[Chris Heaton-Harris]

What my hon. Friend the Member for Totnes (Dr Wollaston) has to answer is what provision she would put in place to recognise failure of innovation. If this database is not the right way forward, what is?

[Philip Davies]

I do not propose to be the central hub of a three-way conversation involving my hon. Friends. I am sure that they are perfectly capable of sitting down in the Tea Room afterwards and going through this in some detail with each other, and they can leave me alone. They do not need me to speak on their behalf. We will leave the three-way conversation there, and I will press on.

Finally, I wish to raise the accelerated access review, which my hon. Friend the Member for Totnes mentioned. In 2014, an external review of the development, assessment and adoption of innovative medicines and medical technologies—the accelerated access review—was announced. This is expected to make recommendations to Government on speeding up access for NHS patients to cost-effective, innovative medicines, diagnostics and medical technologies. Some medical organisations have said that they wish to wait to see the recommendations of this review before implementing changes to rules around innovating treatments. I think that was the main thrust of the speech of my hon. Friend the Member for Totnes. The Royal College of Surgeons said:

“The Government’s consultation on the Accelerated Access Review recently closed and this is likely to prove a more productive route for identifying ways to encourage innovation.”

However, in an article earlier this year, my hon. Friend the Minister for Life Sciences—just to prove that I do read his articles—linked this Bill specifically to the Government's accelerated access review. He stated:

“The Medical Innovation Bill highlighted some of the important issues and obstacles to the adoption of innovation in the NHS. The growing pressure from patients and medical charities for faster access to innovation, and the potential of the NHS as a world beating research ‘engine’ in 21st century life and health science creates an opportunity for the UK to deliver benefits for patients, NHS and economy. This is the aim of my accelerated access review of NHS adoption of medical innovation. I look forward to working with Chris Heaton Harris to help him shape a Bill to help unlock this exciting opportunity.”

I look forward to the Minister’s comments in due course, but it seems to me that, rather than the accelerated access review being an alternative or something different from this Bill, the thinking is that these two things can go hand in hand with each other, and that one does not contradict the other.

Although the AAR is expected to report recommendations back to Government at the end of the year, its briefing specifically lists

“barriers that currently prevent the uptake of transformative healthcare within the NHS and the healthcare industry.”

Three areas are specifically mentioned: insufficient skills to adopt innovation; lack of leadership support for innovation; and lack of accountability for innovation. Those are just three points I have picked out from the list of areas identified for recommendations by the AAR. It seems that it is those issues that my hon. Friend’s Bill aims to target and it is therefore within the scope of what the AAR is trying to achieve.

In conclusion, this Bill attempts to provide leadership and support for innovation by setting a precedent that innovation should be encouraged and nurtured. It specifically pinpoints accountability by providing doctors with a test to satisfy prior to the beginning of any innovative treatment in such a way that satisfies doubts that the innovating is of a responsible nature. Finally, and most significantly, it sets a base for sufficient skills to adopt innovation by providing a database from which other doctors can work together and learn.

Ultimately, this Bill is not only for doctors; it must and should focus on the patients it affects. Although doubts are cast over whether the regulation to ensure innovating treatments are created responsibly, we must also consider the principle that responsibility can be satisfied before the innovating treatment is administered, thus reassuring the patient as well as the doctor. There is also a compelling argument that those patients who want innovative treatments—they may not be able to wait for lengthy research and approval systems—should be given the option to use innovative treatments. Those treatments should not be withheld because a doctor fears litigation. The patient should always be at the centre of what we do, and we should provide legislation that allows them to use the medical treatments of their choice that have that doctor approval.

I commend my hon. Friend for introducing this Bill, because he has hit on something that matters to a great deal of people. I have constituents on both sides of the argument. There are legitimate concerns, but I have heard nothing today that does not persuade me that this Bill should go forward from its Second Reading. I hope that some of the concerns that I have outlined today will be considered by my hon. Friend in Committee and that we end up with a Bill that is welcomed by those who support it and that deals with all the concerns that have been raised.

--- Later in debate ---

[Mr Nuttall]

I am grateful that the sponsor of the Bill agrees with me on this, because it is the key point of the whole debate. Those who oppose the Bill have alleged that it will somehow put patients at risk. If that were the case, I would not be supporting it. I am supporting it because having read it carefully, and having considered all the evidence and all the views of all the professional bodies that are ranged against it, I have come to the conclusion that patients would have all the safeguards after the Bill has been passed that they do now.

The Bill has the potential to increase and improve the range of medical treatments available to my constituents.

[Philip Davies]

My hon. Friend is setting out a very good case. Does he accept, though, that the concerns of some of my constituents that I outlined are valid, and that in Committee we should look at ways in which they can be dealt with if necessary? We should not just accept the Bill in its current state; we should look to see whether we can improve it in Committee.

[Mr Nuttall]

I am grateful to my hon. Friend. The arguments are finely balanced. As he said, he has constituents who support the Bill and constituents who are against it. If the Bill receives its Second Reading, as I hope it will, the concerns of those who have reservations about it, and those who go further and are outright opposed to it, can be considered in detail in Committee and, if possible, reflected and taken into account by way of appropriate amendments at that stage or on Report.

Oral Answers to Questions

Philip Davies Excerpts

Tuesday 13th October 2015 Commons Chamber

[Mr Jeremy Hunt]

The hon. Lady is absolutely right; we need more midwives. We recruited more midwives in the previous Parliament, and we do need to expand maternity provision as we have a growing birth rate. I am happy to look at the problems in her area. However, we also have a maternity review coming up early next year, led by Baroness Cumberlege, that will help us to address this problem sustainably.

[Philip Davies (Shipley) (Con)]

What health problems are caused by first-cousin marriages, and how much does dealing with those problems cost the NHS each year?

[Jane Ellison]

I cannot give my hon. Friend a specific answer, but I would be very happy to get back to him because I know there has been some local discussion about this in the city that he represents. I know of the issues to which he refers.

Dementia Care Services

Philip Davies Excerpts

Wednesday 9th September 2015 Westminster Hall

[Edward Argar]

I am grateful to my hon. Friend, and I am beginning to think that I must be careful about what I think, because yet again a Member has touched on a paragraph I was about to begin. He is absolutely right. The Government’s dementia research funding now stands at £66 million. That is double what it was in 2010, but we need to be clear that we must not stop there. I was pleased that earlier this year the Government reaffirmed their commitment to doubling the dementia research spend by 2025. That is vital, and I know that Members on both sides of the House, in the spirit of constructive support, will help to hold the Government to that. Will the Minister commit to collating information on that spend centrally, and to publishing it annually, so that we can track progress? Coming to my hon. Friend’s point, I would be grateful if the Minister updated the House on the plans for a dementia research institute to drive forward research in a truly world-leading way. I pay tribute to my hon. Friend for the work he did in City Hall, and as a Deputy Mayor, in pushing that agenda forward.

Finally and most importantly—I declare an interest as a member of the Alzheimer’s Society—I pay tribute to such organisations as the Alzheimer’s Society, Alzheimer’s Research UK, Age UK and myriad others for the work they and their members do to ensure that we in this House and society never forget this cause, and that we continue to support the tens of thousands of people with dementia—and the voluntary carers, who are the real heroes and heroines. We have a duty to recognise what they do, and to do everything we can as a country to support them. I look forward to the Minister’s comments on what we can do to support carers.

I will close by quoting from a moving and powerful article by Alice Thomson about her father’s dementia. It was published in The Times this summer. She said:

“Old age shouldn’t be seen as a humiliation but more as the other bookend to your childhood; a time when you can rely on the help and patience of others to reach the end but can also still be a central part of family and community life”.

I echo those words and ask the Minister, the Government, all of us and society as a whole to continue to rise to the challenge and to make that a reality for all those who have dementia in this country.

[Philip Davies (in the Chair)]

It may be helpful if I point out that for hour-long debates, we need 20 minutes for the Front Benchers: five minutes each for the two Opposition Front Benchers and 10 minutes for the Minister. If the Minister leaves any time at the end, Mr Argar may get a few seconds to wind up. I will be going to the Front Benchers no later than 5.10 pm. As I understand it, three Members are seeking to catch my eye to make a speech. I will not impose a time limit, but if they think of taking seven minutes each, that would give everyone a fair crack of the whip.

--- Later in debate ---

[Ann Coffey]

On free personal care, the budget in Scotland is capped. Free personal care is probably welcome, but the problem is that sufferers do not necessarily get the required level of care because demand is managed by stopping the supply. That is the problem with a capped budget. Free personal care is not really a panacea for families seeking the care that their relatives need.

[Philip Davies (in the Chair)]

Order. Before I call Dr Whitford, may I ask that she bring her remarks to a close?

[Dr Whitford]

Okay. Free personal care is obviously not a panacea, but some families have someone coming in four times a day to offer support and people of different levels are coming in. The request for such care is made through the general practitioner, so a health assessment is made. As I said when I first stood up, Scotland does not have a magic answer, but we are coming at the issue from a different angle. Some of what is being done in Scotland can be shared and clearly the same goes for some of the things being done elsewhere.

Remembering who these people are and helping them to remember is important. The volunteer projects involving music and football to help people find themselves are really important. We must remember that they are still in there. They are still a person, and they require our sympathy and to be able to keep their dignity.

--- Later in debate ---

[Debbie Abrahams]

Fantastic. As the first MP to become a Dementia Friends champion, I ran a Dementia Friends session in Parliament to launch the “dementia-friendly parliament” last year.

We have also heard about the importance of involving young people. A lot of work has been done in my constituency, where, for example, the youth council has received training to be Dementia Friends. Making Oldham a dementia-friendly community is a priority of mine and, after starting with just a few hundred, we now have 2,000 Dementia Friends. I am proud that Oldham is one of more than 100 communities across the country that is working towards becoming dementia friendly, but we need to go further. Our ambition should be to ensure that everyone living with dementia feels included in their community and feels that they have control over their lives.

Secondly, we need improvements in the quality of care and support for people with dementia and their carers, which, as we heard today, is just not good enough in some parts of the country. Too often, people with dementia receive no care and their families get no support. Over the last Parliament, cuts of £3.5 billion were made to adult social care services, which have had a real impact on people with dementia and their families. Some 87% of social services departments can provide care only for people with critical or substantial need. For example, I called on a woman in her late 70s in the middle of the afternoon during one of my regular door knocks. She opened the door, looking dishevelled and confused, and had an empty bubble pack of medication in her hands. Her first words to me were, “I don’t know what I have to do.” I was able to call the pharmacy and to get support for her, but what if I had not been there? She obviously needed support and was not getting it.

Councils are doing their best to save money through changing the way that care is provided and working more closely with the NHS, but the scale of the cuts is forcing many to cut the support that would have helped to keep people out of hospital. As a consequence, more and more people with dementia are ending up in hospital, with some estimates suggesting that one in four hospital beds are occupied by someone with dementia. The NHS has also seen delayed discharges from hospital hit a record high in recent months, costing some £526 million since 2010. Once people are in hospital the support is simply not in place in the community to enable them to return home.

In 2009 the then Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), called for national care services to be developed and to be provided on the same basis as for health. He has repeated that call. We will not be able to improve the quality of dementia services until we find a solution to the funding crisis facing social care.

At a meeting with the Saddleworth carers group in my constituency, I listened to predominantly elderly carers describing the hundreds of hours of often back-breaking work that they were providing for their loved ones. They did that because no support or respite was available. How are they meant to cope? Given that the Government have delayed the implementation of the care cap until 2020, or possibly later, and have gone back on their promise to raise the £118,000 assets threshold before someone has to pay for their own care, will the Minister tell us what assessment has been done to estimate the number of families with a family member with dementia who will be affected by that between now and 2020? In addition, is the Minister committed to the Alzheimer’s Society proposal to drive up the quality of residential care for people with dementia? If so, how is that being monitored, for example in the use of anti-psychotics?

My final point is about research. Research for a cure for dementia provides hope for people in the future. In addition, however, we must focus research into the cause and prevention of the different forms of dementia, and into how we can best care for people who are living with dementia today. The Government’s commitment to double dementia research by 2025 is welcome, but we are starting from a low baseline. Other countries have shown much greater ambition.

Last month Alzheimer’s Disease International called for a significant upscale in research support, given the 35% increase in the global cost of dementia since 2010. It estimated that by 2018 the cost will have increased to $1 trillion, equivalent in size to the 18th largest economy in the world. Will the Minister report on the progress made, as has been asked by other Members?

[Philip Davies (in the Chair)]

Order. I have to ask the shadow Minister to bring her remarks to a close.

Deprivation of Liberty Safeguards Assessments

Philip Davies Excerpts

Wednesday 17th June 2015 Westminster Hall

[Alistair Burt]

The hon. Lady, in her concluding remarks, suggested that there might be a legal challenge to the Chief Coroner, but at this stage, I am not persuaded that that would be the best way forward. Perhaps we might leave it at this: depending on the Chief Coroner’s response to my letter, I might seek a meeting with him, so that I might have the opportunity to talk to him in a slightly different manner about some problems that the hon. Lady has raised and get an opportunity to take things further. I ought to get the Chief Coroner’s written response in the first place, but I appreciate her point of view.

We want to encourage an approach that minimises relatives’ potential distress, which, as the hon. Lady set out, can be severe. The key to best practice is good communication and information exchange between partners in the system. Leicester City Council is indicative of a local authority that has worked closely with its local coroner. Together they have designed a shared protocol that includes the clear steer that, unless there are suspicious circumstances, notification of a death can wait until office hours, negating the need for distressing out-of-hours visits from uniformed police officers. In the vast majority of those cases, police involvement will not be necessary. Certainly, 999 calls are not appropriate.

I am grateful to the hon. Lady for stressing the importance of this issue. The Law Commission, which I will refer to in a second, is also looking at the issue of coroners’ investigations, and I want to see the results of that.

Let me say more about the Law Commission, having dealt with coroners to an extent. The Government’s policy is twofold in dealing with the significant challenge that has been given to local authorities and health and care providers now charged with implementing DOLS. First, we seek to understand whether legislative change can provide a system that is sustainable in the long term and that better balances the protection of individuals against the need for minimum bureaucracy to ensure that existing limited resource is maximised. Secondly, we are seeking to provide practical support and guidance to manage the challenges in the interim.

The case for a thorough review of the legislation in this area is unambiguous. The legislation underpinning DOLS was introduced by the then Government in 2007. It was criticised by Select Committees of both Houses, even before the implications of the Supreme Court judgment became clear. Following the judgment, the Government are funding the independent Law Commission to review the legislation underpinning DOLS. It will launch a four-month public consultation on a proposed new scheme on 7 July 2015.

Following the hon. Lady’s intervention, it has occurred to me that she and other parliamentary colleagues may appreciate a dedicated consultation event with the Law Commission on the parliamentary estate. If she agrees, I shall endeavour to make arrangements for that. I will contact the Law Commission to suggest such an event and I hope that it might want a session here so that it can listen to the expertise of colleagues. I am sure the commission would benefit from such expertise, and I will write to her and let her know what it makes of that suggestion.

Given the criticism of the current DOLS legislation, and bearing in mind the likelihood of unintended consequences, I strongly believe that it is important for the Law Commission to be given the time to consider the entire legislation in the round and, if appropriate, propose a comprehensive solution. It would be unwise to rush into specific legislative changes, the repercussions of which might not be clear, so I am not tempted at the moment to make any changes to the regulations.

However, I agree with the hon. Lady on greater urgency. The Law Commission’s review was scheduled to be completed, in the form of detailed policy proposals and a draft Bill, in the summer of 2017. I think, having taken up my duties, that that needs to happen quicker. Accordingly, I have proposed, and the Law Commission has agreed, an acceleration of the review to ensure that it will now be completed, in the form of detailed policy proposals and a draft Bill, by the end of 2016. I know that that is still some time away, but bearing in mind the complexity of the issue, I do not think we can afford to get the next bite at this wrong, so I hope that the hon. Lady welcomes that news.

In the interim, my Department has been working with various partners to support the system’s response to the Supreme Court judgment. I reiterate now that the response to that judgment must be rooted in the principles and values of the Mental Capacity Act. Our efforts have to be focused primarily on realising real benefits for individuals. DOLS are about people, not paperwork. My Department has issued clear guidance that has emphasised the importance of a proportionate Mental Capacity Act-centred approach, and emphasised that so-called bulk applications for all the residents of a care home are not acceptable. DOLS apply only to those who lack the specific capacity to consent to their accommodation. Many in care homes and hospitals will have that capacity and so not be eligible for DOLS. That must be made clear.

We recognise that the scale of the challenge set by the Supreme Court means that some local authorities will be unable to process DOLS applications within the 21-day legal timeframe. The Care Quality Commission has been clear that providers will not be unfairly punished for such technical breaches. However, the CQC has been equally clear, quite rightly, that a do-nothing approach is unacceptable, so providers and local authorities must have a plan in place for ensuring that those who stand to benefit most from a DOLS assessment receive one in a timely manner.

The Department has funded a reduction in the non-statutory bureaucracy accompanying the DOLS process, reducing the number of application forms from 32 to 13. The Association of Directors of Adult Social Services, which delivered that project, deserves particular praise for the support it has provided to its member organisations since the Supreme Court judgment.

The Department has funded the Law Society to produce excellent comprehensive guidance, in collaboration with practitioners, to assist in identifying a true deprivation of liberty, and in March this year, the Government announced that they would provide local authorities with an extra £25 million to support their efforts on DOLS in 2015-16.

I reassure the hon. Lady that I understand the concerns that some local authorities have about the cost of DOLS, and I praise the hard work of local DOLS teams. However, I am aware that there is considerable variation among local authorities as regards the number of applications that they have been able to process. Clearly, it is important that we identify and learn from current best practice, so my officials are in close contact with providers and local authorities, and I have instructed them to make further visits across England this summer to continue to understand the local response.

Although some may baulk at the idea of 100,000 DOLS applications a year, we should remember that every one of those applications represents a person having their care independently scrutinised. DOLS can help to shine a light on care that is unnecessarily restrictive and does not put the person’s views first and foremost. Therefore, we should strongly back the principles of DOLS. Our shared challenge now is, through the Law Commission review, to understand how those principles can be better applied in the day-to-day reality of the health and care system and after the unintended consequences of the judgment.

I thank the hon. Lady for raising these important issues. My Department and I would be grateful for any further insight she may have, conscious as we are of her expertise in the social care field. I hope that we have touched this afternoon—

[Philip Davies (in the Chair)]

Order.

Motion lapsed (Standing Order No. 10(6)).

Health and Social Care

Philip Davies Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right, and I want to thank him for his tireless campaigning on parity of esteem for mental health in the last Parliament. One in 10 children aged five to 16 has a mental health problem, and it is a false economy if we do not tackle those problems early, before they end up becoming much more expensive to the NHS as well as being extremely challenging for the individual involved. We are absolutely determined to make progress in that area.

[Philip Davies (Shipley) (Con)]

The Secretary of State has quite rightly said that the NHS needs to become more efficient. May I encourage him to visit Advanced Digital Institute Health, based in Saltaire in my constituency, so that he can see at first hand the wonderful work it is doing using modern technology to improve the quality of healthcare in our communities and to make it much more efficient, helping NHS resources go as far as we need them to go?

[Mr Hunt]

I would be delighted to visit my hon. Friend as soon as I can find the time, but I have already seen some great technology at Airedale hospital, which I think is in or near his constituency. It had some incredibly innovative connections with old people’s care homes, where people could talk to nurses directly, so there is some fantastic technology there, and I congratulate his local NHS on delivering it.

In the election campaign, the right hon. Member for Leigh talked constantly about NHS privatisation that is not actually happening. Now that he is the entrepreneurs’ champion, will he speak up for the dynamism that thousands of entrepreneurs bring to the NHS and social care system, whether they be setting up new dementia care homes, researching cancer immunotherapy, developing software to integrate health and social care or providing clinical services in the way he used to approve of when, as Health Secretary, he privatised the services offered at Hinchingbrooke hospital?

Oral Answers to Questions

Philip Davies Excerpts

Tuesday 24th February 2015 Commons Chamber

[Jane Ellison]

I am certainly very happy to talk to my hon. Friend about his particular constituents. I am aware of the work that he has done in his local area. He will be interested to know that in 2013 the Government published “The UK Strategy for Rare Diseases” precisely to address such issues and the complexities around them, and aspects of that strategy speak directly to the challenges that he has just outlined. May I also take this opportunity to mention that there is an event tomorrow in Parliament organised by Rare Disease UK to mark rare disease day, at which the Under-Secretary of State for Women and Equalities, my hon. Friend the Member for East Dunbartonshire (Jo Swinson), will be speaking?

[Philip Davies (Shipley) (Con)]

15. What estimate he has made of the number of admissions to A & E in the last three years for patients with palliative care needs in (a) areas with a 24-hour palliative care helpline or palliative co-ordination centre and (b) areas that do not offer such services; and if he will make a statement.

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

We know from local examples that areas that offer 24/7 community palliative care services have been able to reduce the number of A and E attendances and inappropriate hospital admissions, including emergency admissions, for people with palliative care needs. I would encourage all areas to offer these services in line with the NICE quality standard.

[Philip Davies]

A poll conducted by Sue Ryder shows that 82% of people expect advice to be available 24/7, yet only 8% of CCG areas have a dedicated around-the-clock palliative care helpline and co-ordination centre. As I am sure we all agree, carers do wonderful work and need as much support as possible. Will my right hon. Friend’s Department work with Sue Ryder and others to ensure that there is a dedicated 24/7 palliative care service, which would certainly help to take the strain away from A and E, which is already under great pressure?

[Norman Lamb]

I pay tribute to the professionals in my hon. Friend’s area, which is one of the leading areas for providing strong support in the community, which prevents unnecessary hospital admissions. I am very happy to work with Sue Ryder and others to try to get the message across that if this can be provided throughout the country we will improve the experience of people at the end of life, but critically also save costs further down the line by stopping inappropriate hospital admissions.

Health and Social Care (Safety and Quality) Bill

Philip Davies Excerpts

Friday 9th January 2015 Commons Chamber

[Jacob Rees-Mogg]

My hon. Friend makes an interesting point. It is possible that that is taken care of by other parts of the Bill. Clause 1 contains the fundamental commitment that unreasonable risks should not be taken, and language could be seen to be part of that. The reason I like the new clause is that it makes it absolutely clear that language is fundamental.

It is very hard to think of a circumstance where a lack of communication could possibly be safe. There may be cases where a patient cannot speak, or absolutely dire emergencies where there is no alternative form of treatment, but in the ordinary course of events language skills must be essential for somebody who looks to work in this country for any length of time.

I hope that the Government will think about this new clause very seriously, and perhaps consider whether a “notwithstanding” aspect is necessary, and that if they do not accept it today, they will look at the matter again in another place.

[Philip Davies (Shipley) (Con)]

I apologise for not being here when my hon. Friend the Member for Stone (Sir William Cash) opened the batting on this new clause.

I very strongly support the sentiment behind the new clause. It should go without saying that people who are practising medicine should be able to communicate properly in English. It is a sad state of affairs when we have got to a point where we feel the need to introduce legislation in this regard. Whatever the rights and wrongs of the matter, sufficient examples have been reported around the country to indicate that we do have a problem. It may not be widespread—it may only occur in pockets—but it is perfectly clear that in some areas there is a problem that needs to be addressed. If the Government do not intend to accept the new clause, I would like to know what they intend to do about this genuine problem that people have identified.

My hon. Friend the Member for Stafford (Jeremy Lefroy) made a reasonable point about the measures that were put in place, partly by the previous Government, relating to new doctors and people who are currently going through training. The problem with that, however, is that it does not deal with the people who are already practising.

[Jeremy Lefroy]

My hon. Friend makes an extremely important point. Does he accept—perhaps the Minister will comment on this as well—that the revalidation process that doctors now have to go through should include, if it does not already, as I am sure that it must, language and, indeed, communication skills?

[Philip Davies]

I take my hon. Friend’s point. I am not entirely sure, though, how robust that process is or whether the same test is applied for people who are currently practising as for those who are starting out on their training. I suspect that there may well be a slight difference in the standard that is expected. I hope that I am wrong and he is right; it will be interesting to hear what the Minister says. I would be interested to know how many people have been struck off because they are unable to communicate effectively—if it is hardly any, or none, that would indicate that the current regime is not working effectively—and how often the measures that my hon. Friend mentions have been invoked.

As ever, my hon. Friend the Member for North East Somerset (Jacob Rees-Mogg) made an interesting point about the European Union. I do not intend to get bogged down in that today, but it would be interesting to know what the Minister’s understanding of this is. If he will not accept the new clause, is my hon. Friend’s point a factor in that, or is it his position, and that of the Government, that nothing in EU law would prevent such a provision from being introduced?

Although I agree with the sentiment behind the new clause, I wonder whether its wording is deficient and could lead to some unintended consequences. My hon. Friend the Member for Stone made great play of the need for people to be able to communicate effectively in English, and he is absolutely right, but unfortunately there is no mention of English in his new clause. That seems to be a rather glaring omission that could lead to unintended consequences at a later date. The new clause merely says that people who practise medicine should

“have appropriate language skills to communicate effectively with their colleagues and patients.”

I think what he is really trying to say is that they should have appropriate English language skills to communicate effectively with their colleagues and patients. As drafted, the new clause would place an onus on people practising medicine to have appropriate language skills in general to communicate effectively with their patients. In the case of a patient who speaks no English whatsoever and speaks Urdu, for example, would the new clause insist, in effect, that their doctor must be able to communicate effectively with them in the only language that they are capable of speaking? That would seem to be a possibility, because the crucial word that has been omitted is “English”.

[Jacob Rees-Mogg]

I have just checked the territorial extent of the Bill, and parts of it apply to Wales as well, so we should not forget the need perhaps to be able to communicate in Welsh where appropriate.

[Philip Davies]

My hon. Friend makes a good point. That enhances the complication that could arise as an unintended consequence. I agree wholeheartedly with the sentiment of the new clause and the intention behind it, but I wonder whether its wording may lead to unintended consequences in relation to languages other than English that were not foreseen when it was tabled.

[Sir William Cash]

As my hon. Friend will appreciate, the new clause says:

“The Secretary of State shall by order make regulations enabling the General Medical Council to ensure that all doctors…have appropriate language skills to communicate effectively”.

I am not prejudging this—I will be interested to hear what the Minister says, if he can take advice on the matter, and of course there is the House of Lords to come—but it may well be that the regulations can identify how my hon. Friend’s points, which I completely understand, can be addressed.

[Philip Davies]

I am grateful to my hon. Friend. He may be right that the points I make can be overcome in one way or another, whether through his existing wording, which may well work, or perhaps a slightly amended version in another place. I just wanted to flag up this issue because I would not want any unintended consequences to come about as a result of the new clause. The whole point is that the onus should be on everybody to be able to speak English, and I would not want anything to allow for a loophole that prevented that from happening.

I wholeheartedly support the sentiment underlying the new clause. Integration is essential in this country and speaking the language is one of the key forms of integration. I do not see how it is possible to integrate into society if one is not competent in speaking English. I support the idea that people who come to this country should be able to speak English, whether they are patients or doctors—the requirement should apply to both equally. I shall be interested to hear the Minister’s view.

--- Later in debate ---

[Philip Davies]

I welcome what the Minister has said and commend him for that initiative. In order for us to be able to see how robust the revalidation process is, can he tell us how many people have been through it and how many have failed as a result?

[Dr Poulter]

The revalidation process is ongoing and is reviewing everybody on the medical register. It is very easy to revalidate someone who is training to be a specialist as a surgeon or in some other hospital position, because they are assessed annually as part of their specialist training. The revalidation process for the consultant and general practice work force—which kicked off as a five-year programme—is ongoing. Some people have volunteered to come off the medical register, including retired doctors who have not practised for some time. I would be happy to write to my hon. Friend to update him on the revalidation process. It will not be completed for another couple of years, but once we have gone through the first cycle of revalidation the process will be easily repeated. I stress that doctors will be revalidated on a maximum of a five-yearly basis. It is possible for the GMC to seek reassurance with regard to certain specialties by requesting more regular competency tests as part of the annual appraisals.

The revalidation process is an important new power that is being implemented effectively. We need to keep it under review because it is important that all doctors, regardless of the proposed new clause on language testing, are competent, keep up to date with medical practice, able to communicate effectively and empathetically with their patients, and work as part of a multidisciplinary team for the benefit of patients. That applies to general practitioners, hospital specialists and those working in mental and physical health. It is an important step for which the GMC has been asking for many years and in which other health care professions are taking an interest. The Nursing and Midwifery Council is considering revalidating nurses in a similar way in future. It is a welcome measure that will help protect patients and the public. It is making good progress and I will write to my hon. Friend with further details in due course.

Medical revalidation is the process by which the GMC evaluates whether doctors can keep their licence to practise in the UK. In addition, a doctor wanting to work in general practice in the UK must also be on the national medical performers list, which is managed by NHS England. To be included on the list, the doctor must hold a licence to practise from the GMC and, as a consequence of the revalidation programme, he or she must have effective communication skills.

As I outlined earlier, the key step to improving checks on language competency for EEA doctors was the Medical Act 1983 (Amendment) (Knowledge of English) Order 2014, which made changes to the Medical Act 1983. My hon. Friend the Member for Shipley will be pleased to hear that the title of the order refers to English. After all, the General Medical Council regulates doctors on their ability to speak primarily that language, and I hope that that reassures him.

The order gave the General Medical Council the power to refuse a licence to practise to a medical practitioner from within the EU who is unable to demonstrate the necessary knowledge of English. It created a new fitness to practise category of impairment relating to language competence to strengthen the General Medical Council’s ability to take fitness to practise action where concerns are identified.

For example, if I, as a doctor, worked with a doctor about whose language competency I had concerns, or if a doctor was not able to communicate effectively in their day-to-day work, I, fellow health care workers and patients could report the doctor to the GMC, which—in addition to the existing initial point-of-entry language testing powers and the revalidation process—now has new powers to take action specifically in relation to such language concerns. That is another important measure that the Government have introduced to strengthen the GMC’s powers on language testing.

The change enables the GMC to require evidence of English language capability as part of the licensing process in cases where language concerns are identified during registration. Just as doctors from outside the European economic area can be tested on their language competency, the same competency tests now apply to doctors coming to work in the UK from within the European economic area, thanks to the new regulations. We hope that the wrongs identified following the dreadful Daniel Ubani case and the tragic death of David Gray have now been righted through very strong legislation to ensure the competency and ability to communicate in English of all doctors coming to work in the United Kingdom. As I have outlined, additional measures are now in place to enable the GMC to take action if concerns are raised during the ongoing medical practice of any doctor about their ability to speak English and to communicate effectively with their patients.

The process for determining whether a person has the necessary knowledge of English is set out in the General Medical Council (Licence to Practise and Revalidation) Regulations Order of Council 2012. The GMC has published guidance setting out the evidence required to demonstrate that a person has the necessary knowledge of English. With regard to the fitness to practise changes that have been introduced, a new category of impairment relating to English language capability has been created, which allows the General Medical Council to request that a doctor about whom concerns have been raised undertakes an assessment of their knowledge of English during a fitness to practise investigation.

The changes have hugely strengthened the General Medical Council’s ability to take fitness to practise action where concerns about language competence are identified in relation to doctors already practising in the UK. We are in the process of bringing in similar powers for the Nursing and Midwifery Council, the Pharmaceutical Society of Northern Ireland, the General Pharmaceutical Council and the General Dental Council to ensure that the health care professionals they regulate—nurses, midwives, pharmacists, pharmacy technicians, dentists and dental care professionals—will also have appropriate language skills for the roles that they perform. The consultation on our proposed legislative changes for those four regulators closed on 15 December, and we will publish the outcome shortly with a view to immediate legislation.

I want to pick up the good point made by my hon. Friend the Member for North East Somerset about the need for primary legislation. I hope that he is reassured that the existing legislation, and the ability to bring in regulations underpinning that through section 60 orders underpinning the Medical Act 1983 and other Acts, provides the ability to bring in strong regulations to protect patients and the public in respect of language competency. The Government have done exactly that. There will be future opportunities to legislate in the form of a Law Commission Bill, which would make it possible to neaten up the already very robust and strong regulation on language testing that we have introduced. I am sure that we will consider doing so at the first opportunity.

I hope that such measures will reassure my hon. Friend the Member for Stone. Thanks to this Government, strong laws have been passed, and very strict new rules are now in place to ensure that doctors practising medicine in the UK can do so only if they can communicate with patients using a high standard of written and spoken English. With that reassurance, I hope that he will withdraw his new clause.

National Health Service (Amended Duties and Powers) Bill

Philip Davies Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford]

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

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

[Philip Davies (Shipley) (Con)]

Will the hon. Gentleman give way?

[Clive Efford]

Yes, I will, because I have lost my place.

[Philip Davies]

I am delighted to help the hon. Gentleman out. Helpful as ever! He talks about stopping what he calls privatisation and about putting the Secretary of State in charge. At the moment, there is a cap on the amount of private income that a hospital trust can gain, but does he agree that clause 7 of his Bill would remove that cap, giving discretion to the Secretary of State? Does he acknowledge that the amount of private income a hospital could receive could actually go up under his Bill?

[Clive Efford]

There are a number of provisions relating to the Secretary of State which state that everything that is decided has to put patients first, rather than competition. That is the key difference in this Bill. The Secretary of State will have to be satisfied that every penny raised from private income serves the needs of patients. The Secretary of State will set the limit, which can be variable, but it will have to come down because this House will demand that.

--- Later in debate ---

[Clive Efford]

I am grateful for my hon. Friend’s kind words and for the support of all the thousands of people, particularly health service staff, who have supported the Bill.

[Philip Davies]

Will the hon. Gentleman give way?

[Clive Efford]

I hope the hon. Gentleman does not mind, but I am going to make some progress.

Never before have we had market tendering of the health service as we have today, and it is breaking down our NHS. The Bill is not a solution to all the mistakes that this Government have made in their top-down restructuring of the NHS, but it is an important block on enforced privatisation. The argument can be simplified into two distinct sides. If people believe the NHS should be a pure market, open to competition regulations, where the interests of competition are put before those of patients, they belong on the side of the Government. If people believe the NHS is a public service that should be free of competition rules, where the interests of patients are put first, they should vote for the Bill today.

We know that No. 10 did not understand what was going on in 2012. The Chancellor was asleep at the wheel, and the Liberal Democrats, suffering from some form of terminal Stockholm syndrome, were led by the nose to turn the NHS from a public service into a free market. My Bill takes a scalpel to cut the heart out of the hated 2012 Act and put right the worst of the Government’s mistakes. It will remove the sections that require the tendering of NHS services for competition with the private sector, the result of which has been millions of pounds being diverted from patient care into the pockets of lawyers and accountants through the tendering process. NHS bodies are spending millions either bidding or managing bidding processes, and that is all money being diverted from patient care. That must stop, and this Bill will end it.

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[Clive Efford]

Absolutely. It is the capacity of the NHS to continue to provide services in the future that is under threat. Eventually and inevitably, with continuing privatisation of all its services, the NHS will end up as just a patchwork of contracted-out services, and that will put us at the mercy of the private sector.

[Philip Davies]

The hon. Gentleman talks about money being diverted away from patient care and about extended privatisation, but will he comment on the private finance initiatives that the previous Labour Government imposed right across the NHS, bankrupting many of its institutions and taking money away from patient care?

[Clive Efford]

There are issues about PFI, which we need to sort out. I must say, though, that the hon. Gentleman has picked on the wrong Member of Parliament. I have one of the very first PFIs in my local hospital. When was it advertised in the European Journal? In March 1995. It was a Tory PFI and it is one of the most expensive in the national health service; it is costing millions of pounds for my local hospital. Both Governments have something to answer for when it comes to PFI. There are issues that need to be put right, but people must understand that that will not happen under a Tory Government.

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[Sir Tony Baldry]

The point I am making, which I shall develop, is that the Bill is completely unnecessary. I also want to make the point that all Opposition Members seem to wish to deny that there has been any involvement of the NHS with the private sector. It is important to remind the House of the fact that it was the Labour party, and a Labour Government, who introduced the private sector into the NHS, and the 2012 legislation in no way significantly changed that relationship.

[Philip Davies]

Does my right hon. Friend agree that those people who support the Bill would be supporting the removal of the cap on the amount of private income that hospitals can receive? Does he think that, when 38 Degrees was encouraging people to write in about the Bill, it made that clear to the people who signed its petition?

[Sir Tony Baldry]

My hon. Friend makes a good point. I think the Labour party will regret signing up to every 38 Degrees campaign, because if 38 Degrees starts drafting the Labour party manifesto rather than the Labour party, the Labour party will never sort out whether it is new Labour, old Labour or any other sort of Labour, which is why it did so incredibly badly yesterday in the Rochester by-election.

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[John Healey]

Patients say exactly the opposite of what the hon. Gentleman has just argued. However, I understand that he feels he has nothing to apologise for. If he fundamentally believes that the NHS should be a system based on full-blown competition, delivered by the private sector, then of course he would want to legislate in that way.

[Philip Davies]

While the right hon. Gentleman is going back to fighting some 1980s ideological warfare, I think most constituents are bothered about what happens in practice. Is he really asking me to apologise to my constituents for the fact that there are now 9% more professionally qualified clinical staff at Bradford teaching hospital and 42% fewer senior managers, or that there are 7% more professionally qualified clinical staff at Airedale NHS Foundation Trust and 14% fewer managers, or, I might add, for the brand spanking new, state-of-the-art A and E department at Airedale hospital? Does he really think that is something to apologise for?

[John Healey]

The hon. Gentleman normally finds a common touch in the way he makes his points. I have to tell him that if he tries to trot out those sorts of figures on the doorstep in the next five months, he will find that they cut no ice with the public, because they know what is happening to their NHS day to day, and we will make sure they understand why it is happening.

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[John Pugh]

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

[Philip Davies]

The hon. Gentleman is making a thoughtful speech, as is typical of him. Does he agree that what we are dealing with today is an Opposition party in desperate straits that knows exactly what it is doing in using the word “privatisation”? It knows that people out in the country associate it with having to buy private health care, but actually nobody is proposing to change the fundamental ethos of the NHS, which is that treatment is free at the point of need. The Labour party is conflating the two as a desperate political tactic.

[John Pugh]

The hon. Gentleman is not altogether wrong, but if we are to continue to deliver, in stressed circumstances, a service that is free at the point of need, we cannot run the NHS as an internal market for ever. In fact, the NHS is already trying to morph into something different. We now have health and wellbeing boards, which mean that commissioners and providers get together to try to agree a local plan. They are struggling in every way to behave like a health board, but they do not have the executive powers to do so. There has been the move away from tariffs, which have been used to try to adjust the market, and we are now talking about whole-treatment costs. There is also talk about integration.

What is clearly entirely disruptive, though, is the intrusion of competition where it is not needed—where it is simply dogma; where it is seen as a panacea for producing good results, whether or not there is a good case for saying that; where it derails sustainable services; or where it becomes a central operating principle of the NHS. None of those things is particularly helpful.

I do not want to comment on TTIP, because I do not think it is well understood at the moment, but we will certainly need to look at how it plays into the competition agenda.

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[Mark Reckless]

That is an excellent website, which I recommend to all Members. The Minister has said that my hon. Friend made those observations when most of the Committee stage of the Bill had been completed. Was that during the “pause” that had been invented as a new mechanism for Parliament? My hon. Friend is not here at the moment, but I think he would agree with me that the 2012 Act is not as it was billed to us by those on the Government Front Bench. It has led to an extraordinary degree of additional complexity in the NHS, and the introduction of competition bodies—and, in particular, European competition law—into the NHS is not welcome.

[Philip Davies]

Will the hon. Gentleman give way?

[Mark Reckless]

No, I will continue for a bit, if I may.

I do not think that the extent of the difficulties that doctors and others would encounter as a result of section 75 of the Act and the bureaucratic, market-based—or quasi-market-based—commissioning rules that it requires was any more apparent to my hon. Friend the Member for Clacton than it was to other Members, although some Opposition Members may have had premonitions of it. I thought that the Bill was intended to allow the various local bodies to get on with running the NHS in their areas. Some would run it better than others; there would be local decision-making and discretion, and people would learn from each other. Now, however, there are centrally determined rules that force everyone into, in particular, commissioning or contracting behaviour, but do not make sense in the context of the service that is being delivered.

[Philip Davies]

I congratulate the hon. Gentleman on his victory in last night’s by-election. It was an excellent result for him and it would be churlish not to point that out. I know that he is a long-standing believer in localism. Is he not worried by the British Medical Association’s concerns that the Bill would give much wider powers to the Secretary of State, thereby centralising powers and taking the day-to-day running of the NHS away from clinical staff and putting it in the Secretary of State’s hands? As a champion of localism, is he not worried by that?

[Mark Reckless]

I am grateful to the hon. Gentleman for his congratulations; that is very decent of him. I am not a fan of quasi-autonomous bodies, of great amounts of regulators or of overlapping layers of bureaucracy; they rarely work. Given the degree of complexity that has now been brought into the NHS, I think it is possible—although I am not certain—that the centralisation of power in a single Secretary of State who is at least accountable to the House might be better than the current diffusion and fragmentation of powers, which does not seem to be working effectively. My party would like to replace the alphabet soup of regulators and the overlapping layers of bureaucracy with a single, elected health board for each county area. That would give a degree of clarity to the oversight and management of the NHS.

[Mark Reckless]

There is an argument for doing that, and a judgment has to be made. It might be possible, depending on the different areas of the countries—particularly in the devolved Administrations—that the solution to that question might be different. My general view is that it is much better to have democratic accountability than not to have it, and in many areas I would prefer that to be local. My party wants to see health boards elected on a county basis.

My party also wants European competition law to be taken out of the NHS, and the Bill is exemplary in that regard. I strongly support that provision.

I have signed a pledge on TTIP, along with most other candidates in the by-election, except for the Conservative—[Interruption.] No, not the Liberal one—that was not a good one to sign—although I did vote against tuition fees, along with most Opposition Members. I would like to see the NHS excluded from TTIP. There are arguments as to whether it will be or not, but those arguments should be settled in the House as per this Bill, rather than being left to the unpredictability of future legal actions.

[Philip Davies]

Will the hon. Gentleman give way?

[Mark Reckless]

I am just reaching my conclusion, if I may.

The hon. Member for Eltham made a mistake in talking about the UK negotiating on TTIP. That is an area of exclusive competence for the European Community, and it is therefore the EU Commission that will negotiate with the United States on that matter. When I first heard about TTIP, it sounded as though it would be all about free trade and I thought that it would be broadly a good thing. The more I looked into it, however, the more it seemed to be not about free trade but about the creation of a single set of transnational regulations between the US and the European Union, and that it would be illegal for anyone not complying with them to sell goods and services. I am therefore very sceptical about TTIP and I am not sure it is something that I would want to support. I certainly do not want to see the NHS included in it.

I congratulate the hon. Member for Eltham on his Bill, and I look forward to supporting him in the Lobby.