Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 10th May 2016 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I too am glad that the Secretary of State has reopened talks with the junior doctors, but I am a little concerned by the claim that the only issue is Saturday pay, whereas the doctors tell me that they fear the danger of exhaustion. Has he seen the analysis by Cass Business School suggesting that it is impossible to avoid high levels of fatigue under the new contract?

[Mr Hunt]

What I have done in the new contract is precisely to try to address those issues by reducing the maximum number of hours that junior doctors can be asked to work every week from 91 to 72 and by stopping junior doctors being asked to work six nights in a row or seven long days in a row. These are important steps forward, and the hon Lady may want to look at Channel 4 FactCheck and other independent analysis of the safety aspects of the new contract which say that this contract is a safer contract.

[Dr Whitford]

I would just say that stating it does not make it happen. Junior doctors have looked at the rotas that have been put out as exemplars, and they will not be able to avoid high levels of fatigue. Does the Secretary of State not recognise that, now that we have more data suggesting that the weekend effect may just be statistical, we actually require clinical research because he does not know exactly what the problem is that he is trying to fix?

[Mr Hunt]

The new data that the hon. Lady has talked about have been heavily contested this week by some of the most distinguished experts on mortality rates in the country. Academics do sometimes disagree, but Ministers have to decide. The fact is that the overwhelming evidence—whether it is on cancer, cardiac arrests, maternity or emergency surgery, and whether it is in big studies, small studies, UK studies or international studies—is that there is a weekend effect. This Government are determined to do something about it, and I gently say to the hon. Lady that she might consider whether something similar should be done in Scotland.

World Autism Awareness Week

Philippa Whitford Excerpts

Thursday 28th April 2016 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I congratulate the Backbench Business Committee on granting this debate, and the right hon. Member for Chesham and Amersham (Mrs Gillan) on securing it and on being an autism champion. As a clinical psychologist I have worked with many people who have autistic spectrum disorder. I put on the record that it is a privilege to be a member of the all-party parliamentary group on autism and to be a co-sponsor of the debate.

Autistic spectrum disorder is a pervasive lifelong developmental disorder that affects people’s social interactions. It impacts on how people communicate with others, how they relate to people and how they experience the world around them. Being a professional is one thing, but the key lesson we must learn is that the greatest insights come from those who have autistic spectrum disorder and their families. We must listen very carefully to what they tell us.

We know that how we interact with individuals with ASD and their families can have a huge impact on their quality of life. Negative public reactions can encourage people and their families to avoid situations and social contact, leading to their becoming socially isolated and experiencing mental health difficulties.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The debate has covered a lot of the structural and supportive things that need to be done, but does it not also throw down the gauntlet to us about the need to change our view? We think of people with autism as finding it difficult to see the world as we see it. We actually need to see the world as they see it.

[Dr Cameron]

As usual, my hon. Friend makes an excellent point. We must focus not on the difficulties faced by those with autistic spectrum disorders but on their full potential, and we should have greater awareness of the world as they view it.

Research indicates that 66% of autistic people, and 68% of their families, have reported feeling socially isolated, and 70% of autistic individuals are reported to have mental health disorders such as anxiety or depression. Autistic adults have been reported to be nine times more likely to die from suicide. There is a clear need to address comorbidity, and particularly mental health difficulties.

One constituent who contacted me advised that the “Too Much Information” video and campaign, which must be commended, had resonated with her. Her eight-year-old daughter has autism, and she shared with me some of her personal experiences. Her daughter is extremely vulnerable and sensitive to everyday sights, sounds, touches and smells, which cause her anxiety, panic or obsessive worries and despair. She cannot cope with changes to her environment, and she is prone to becoming distressed in public. As a result, she has experienced negative community responses, including from school peers. Her reaction has been reluctance to go back to school, and withdrawal from her extracurricular activities. Sadly, that means that she is at risk of becoming further isolated, and it is clear from this story—such stories were common among those who contacted me—that we all need to do more in many areas.

I recently attended Milton Primary School in my constituency, where the lack of understanding about pupils with autism among peers and their parents was highlighted to me. The headteacher is now engaged in good work to increase understanding through planned awareness sessions, and I commend her on that fantastic local development. Again, that highlights how teacher training and awareness in schools is key.

As has been mentioned, we must raise awareness and understanding among employers to help support people with autism into employment. Having a job is about earning a living, but it also contributes to psychological wellbeing. It can provide people with a sense of belonging and purpose, and build confidence and self-esteem. The autism employment gap is even bigger than the general disability employment gap, and only 15% of autistic adults in the UK are in full-time work. The Association of Graduate Careers Advisory Services has reported that 26% of graduates on the autistic spectrum are unemployed. Mainstream employment programmes currently on offer are failing to capitalise on the potential of those with autism. I urge the Minister to ensure appropriate support for people with autism, and for that to be covered by proposals in the disability and employment White Paper.

In 2011 the SNP Scottish Government launched the Scottish strategy for autism, and declared that autism is a national priority. That strategy attempts to improve diagnosis and assessment, and to create consistent service standards. It also helped to establish one-stop shops. We must continue to support that issue, and I offer my full co-operation and involvement with my hon. Friend the Member for Motherwell and Wishaw (Marion Fellows) to save our local one-stop shop.

We must all be champions of autism, and I ask the Minister to support an awareness campaign, promote training for teachers and local authority staff, tackle issues raised in the White Paper, ensure that more clinicians are trained, and consider waiting time guidelines. Society must not continue to fail people with autistic spectrum disorder, so let us do all that we can together to ensure that we succeed.

Junior Doctors Contracts

Philippa Whitford Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

My hon. Friend has spoken very wisely. She recently wrote, in The Guardian, something with which I profoundly agree: she wrote that there could have been a solution to this problem back in February, when a very fair compromise was put on the table in relation to the one outstanding issue of substance, Saturday pay.

I understand that this is a very emotive issue. The Government initially wanted there to be no premium pay on Saturdays, but in the end we agreed to premium pay for anyone who works one Saturday a month or more. That will cover more than half the number of junior doctors working on Saturdays. It was a fair compromise, and there was an opportunity to settle the dispute, but unfortunately the BMA negotiators were not willing to take that opportunity. I, too, urge them, whatever their differences with me and whatever their differences with the Government, to think about patients tomorrow. It would be an absolute tragedy for the NHS if something went wrong in the next couple of days, and they have a duty to make sure that it does not.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome the absolute commitment that the Secretary of State has given today that this is only about seven-day emergency care, because in the past he has often seemed to move between elective and emergency care. However, Sir Bruce Keogh has criticised the imposition of the contract, and has said that what has lost consensus across the profession has been the conflation of the need for a robust emergency service over seven days with the junior doctors’ contract, when junior doctors already work seven days.

I think that people have also been upset by the use of statistics without analysis. It is not a case of extra deaths at the weekend, which suggests poor care, but a case of extra deaths among people who were admitted at weekends within 30 days. That is quite an odd formula, but we can think of factors that might contribute.

I support the four standards that the Secretary of State mentioned, but none of them relates to junior doctors. Number one is probably access to diagnosis: people lie in hospital over the weekend with no access to scans, and their whole pathway is delayed. When we conducted an in-depth audit of surgical mortality in Scotland, it identified issues such as the insufficient seniority of an operating surgeon and, later, the insufficient seniority of an operating anaesthetist. However, part of the problem is that we have not worked out what the problem is. The Secretary of State may go on about the four standards—about a senior review, 24/7 access to interventional care, and access to diagnostics—but that will not be changed by the junior doctors’ contract.

The Secretary of State calls on the BMA to listen to leaders. What about the 11 royal colleges that have written to him? In his letter to the leader of the BMA over the weekend, he highlighted the things that still need to be sorted out, and that means that there is a need to talk. There has been no talking for five weeks. Surely we should stop the imposition, get rid of the strike, go back to the table, and complete the talking.

[Mr Hunt]

I agree with the hon. Lady on one point: it is a total tragedy when the Health Secretary ends up with no other choice but to impose. Had we had sensible negotiations, that would have not have been necessary. She talked about the royal colleges. They say that the withdrawal of emergency care should not happen. Clare Marx, the president of the Royal College of Surgeons, has said that she personally would not and could not strike. I have tried to be very clear this afternoon about exactly what we are trying to do, and we have been clear on many occasions that this does not apply to elective care.

If the hon. Lady is concerned about the statistics, I would encourage her to read some of the 15 international studies covering stroke, cancer, emergency surgery and paediatric care, including the very thorough Fremantle study published last September. She is right to suggest that many of them talk about senior decision-makers being present. That could be a consultant, but it could also be an experienced junior doctor. As she knows, the term “junior doctor” is something of a misnomer because someone could have been a doctor for seven years and still be a junior doctor.

The hon. Lady also asked about the link with the junior doctor contract. The single outstanding issue is Saturday pay rates, as the BMA has confirmed in private emails that it has sent out. We need to make it possible for doctors to roster more people at weekends, and Saturday pay rates are obviously connected to that. What I have tried to do today is to show that the supply of trained doctors into the NHS will be going up during this Parliament, so we will not be depending on the current workforce to supply the additional Saturday cover in its entirety. There will be more doctors going into the NHS, which will spread the burden, and that is the way that we will get the safe NHS that we want.

Meningitis B Vaccine

Philippa Whitford Excerpts

Monday 25th April 2016 Westminster Hall

[Geoffrey Clifton-Brown]

I could not agree more. That is why the CEMIPP group study should look at not only the medical costs but the educational costs, the cost of carers and so on. There are considerable costs to the public purse. We tend, under our democratic system, to be quite short-termist in our view of such matters. I am involved at the moment in work on drugs for cystic fibrosis, to which exactly the same issues apply. After the considerable cost at the outset, there is a lifelong benefit to babies from getting such drugs. If we are going to carry out a cost-benefit analysis for the meningitisusb B vaccination, that is what we should consider.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I agree with the vast majority of what the hon. Gentleman says. In actual fact, it was not possible to trial Bexsero in humans because this is such a rare condition, and therefore we do not yet know whether the immunity will be for life.

[Geoffrey Clifton-Brown]

I am extremely grateful to the hon. Lady. The benefit of these debates is that we always have a professional on hand who can give us the last word on the subject. My sister is a GP and would no doubt have given me that same advice.

I am grateful for the chance to speak in this debate. This is a tragic disease with tragic consequences. I urge the Minister to go further, and faster in rolling out a good, safe vaccine that will give immunity to a larger section of the population.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I apologise to the Chamber for being late; that was due to the health statement earlier. I, too, begin by paying tribute to the families who attended the combined Petitions and Health Committees last month. Their bravery in going through their experience again was incredible, and it was obviously very moving for us to listen to.

Funnily enough, this is World Immunisation Week, so the debate could not have been timed any better. Just think of the lethal diseases and conditions that we have tackled across the world because of immunisation. The hon. Member for Totnes (Dr Wollaston) referred to polio; we have not beaten that yet, but we are on the way.

Meningitis is an inflammation of the meninges, the covering of the brain, and that can happen with other diseases, not just meningitis B or any of the meningococcal diseases, but they are the most serious; they are the ones that result in the biggest harm. There is A, B, C, W and Y. When I was a younger doctor, which was a wee while ago, meningitis C was the big concern. It was very common in teenagers as well as in children, and there was always a big peak when people went off to university, but in 1999 the vaccine for that was introduced. It was given to those right up to the age of 18, and 90% of those cases are now prevented, which is a real transformation.

That leaves meningitis B, which is the most lethal type and affects people very quickly. We have heard that from the families and from hon. Members in the debate. There are not many conditions whereby someone will go from being slightly off-colour to either death or permanent disability in less than 12 hours. Having worked in a paediatric hospital and dealt with children with meningitis, I can tell hon. Members that for a doctor, it is terrifying. As was talked about in the Committee, it is not that doctors think, “Och, no, it won’t be that; I’ll ignore it.” It is simply that it is so hard to pick out that child. When they are a little bit hingy, as we would say in Scotland—a little bit off—it is not obvious, but there are signs that people should be looking for.

As the hon. Member for Faversham and Mid Kent (Helen Whately) said, do not wait for the rash. I was delighted to see in the Meningitis Now advice that that is written in big red letters: “Don’t wait for a rash”. Do not wait for the rash if the child is quiet, not reacting normally and very feverish. As a doctor, what I would say is of real concern is cold hands and feet. If a child has a fever, yet has cold hands and feet, that to me is a sign of septicaemia—a sign that the blood supply to the extremities is beginning to shut down. That should be a warning sign long before we get to the rash. Reading the testimony produced by the families and the petitions group is absolutely heartbreaking. In case after case, the first warning sign that the parents or the medical professionals recognised was that horrible rash.

It is important that we take account of the long-term disability. One in 10 of these children will not survive. One in three of them will be left with a severe disability. That includes brain damage, cognitive and sensory impairment and, as we have heard, limb amputation. That is horrific to think of in little children. I can tell hon. Members as a doctor that this impinges on doctors as well. If someone has seen a child and not spotted meningitis, or seen a child and watched them just slip through their fingers, that is absolutely horrific. Meningitis moves so fast that vaccination has always been the holy grail. We now have it, but we probably have not rolled it out widely enough, because of the cost-benefit analysis.

I will echo the hon. Member for Totnes: there is no question but that the decision should not be made in this House. It is not a political decision; it must be made in the cold light of evidence of benefit, but that is not just cost-benefit; it is also risk-benefit. We spend a lot of our time being lobbied by constituents who are against vaccination. Think of the saga we have been through with the measles, mumps and rubella vaccine in the last decade, and here we are with a movie reigniting all of that.

There was no trial with Bexsero, so we are still gathering the data through this year. I am talking about the efficacy, safety, side effects and, crucially, as I mentioned earlier, whether people have permanent protection. We do not know that yet, but questions on those points have to be answered, so it is crucial that the body responsible is the JCVI . On my reading, the key problem has been in the discounting. Of course if people invest money in any treatment, they want a quick return. That is what the City of London would look for as well. But we are talking about preventing things—preventing damage that will be with someone for their whole life. A child’s life is written off, before they are 28, as really not having any additional value in being saved. A discounting of 3.5% means that that value is gone at that age, even though we have perhaps saved 70 years of life. In particular, if the child never got ill in the first place, we would have saved a disabled life; we would have saved a life of suffering, and the cost to society and the family of looking after a child who perhaps faces incredible disabilities and suffering.

Every year, that life is discounted at 3.5% until we reach zero, yet we accept that public health measures, such as smoking cessation, take a long time to give us a return. Having seen the results of people smoking, I am not quite ready to say that we should give up on those public health measures. We need people to stop smoking as that will save us money in the long term. However, we should be using the same rate, because if we were discounting at 1.5% a year, the catch-up up to the age of five would have been considered cost-effective. It is not that the rate should not be down to the JCVI, or that it should not be based on proper medical evidence. The issue is the tool that was given by the National Institute for Health and Care Excellence, based on the Treasury figure of 3.5%, although appraisal committees can consider anything between zero and 6%. The key thing is to ask for that evidence to be looked at—specifically the long-term costs of major disability—and to look at the impact on the decisions of using that lower discount rate.

The other thing mentioned was a study of adolescents. In meningitis C, we were particularly after the adolescents. Babies do not carry meningococcal meningitis; teenagers do. When we vaccinate little children, it is for the individual protection of that child. The protection that is given by teenagers is herd immunity. When they stop carrying it, babies will catch it less. We do not know whether that will happen with Bexsero as it is such a different vaccine. As the hon. Member for Totnes mentioned, the whole structure is totally different. Normally, we are looking at the sugars on the surface of bacteria. Bexsero was done through genomics—identifying protein to create antigens and antibodies. It is so expensive because it has been done in a totally different and novel way.

We need to do a study on adolescents. There seem to have been a couple of years of talking about doing it, yet we have not even started or laid out the terms and parameters. It is really important that we answer the questions with evidence, not just by thinking that we would quite like to splash the vaccine around. The case for extending the catch-up to five years is stronger as half the cases will happen before the age of two and the majority will happen before the age of five. The cost burden for a child who requires 24/7 care for their entire life—particularly when they are older and their parents are no longer looking after them—including the burden on their family, friends and society, is enormous. I find it hard to believe that it would not be cost-effective to prevent that.

For me, as a doctor, vaccination is almost the only way. The one thing I do not recognise in the cost-effectiveness balance is the talk about peace of mind. As we explored with families in Committee hearings, peace of mind caused some of the problem, because some parents thought, “My child is vaccinated against meningitis.” We cannot cast that up. A simple change in the discounting method and the inclusion of long-term social care costs are the most important things.

Even if we roll the vaccination out, we must remember that there are other types of meningitis, and that there is more than one strain of meningitis B. We need to get that great little Meningitis Now card out to families and parents as widely as possible, but we also need to get this message to doctors: do not wait for the rash. Look at the child, listen to the parents, and, as I said earlier, think about cold hands and feet. We have the potential to stop the damage of this absolutely horrific disease, and I hope that we take the issue back to the JCVI.

--- Later in debate ---

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

I thank all hon. Members who have spoken in this important debate. As others did, I start by offering my condolences to the family of Faye Burdett, whose tragic death sparked such interest in the e-petition that led to this debate, and to all the other parents. Their powerful testimony on their personal family tragedies has led us and their Members of Parliament here today, and they have helped to stimulate interest in the petition, which has huge support, with more than 820,000 signatures. The petition goes right to the heart of the concern that parents and the public have about meningitis.

I have listened to the many hon. Members who have spoken this afternoon and, like everyone in the Chamber, I have been moved by the stories we have heard of how both meningitis and septicaemia have affected families and, in some cases, have tragically changed their lives forever. As has been made clear, meningococcal meningitis—the infection and inflammation of the lining of the brain—and meningococcal septicaemia, or blood poisoning, which for simplicity I will refer to as meningitis, are very serious infections that can be severely disabling and even fatal, as has been movingly and, in some cases, starkly demonstrated by hon. Members today. It is right that we should have robust arrangements in place to protect against this disease. In fact, we are the only country in the world with a vaccination programme for all the major causes of meningitis, and it is clear from the strength of feeling today that hon. Members fully support the meningitis and other world-class vaccination programmes that we have in place to protect individuals, particularly children, and the community as a whole by vaccinating against preventable diseases.

For 35 years successive Governments have based decisions on vaccination programmes on independent expert advice from the Joint Committee on Vaccination and Immunisation, and it will help to answer one or two points that have been raised if I clarify the JCVI’s legal basis. Since 1 April 2009, the Health Protection (Vaccination) Regulations 2009 have placed a duty on the Secretary of State for Health in England

“to ensure, so far as is reasonably practicable, that the recommendation of the JCVI is implemented”

where certain conditions are met, including that the recommendation is

“in response to a question referred to the JCVI by the Secretary of State”

and that it is

“based on an assessment which demonstrates cost-effectiveness”.

That is the basis on which the JCVI was constructed and under which it operates.

At the recommendation of the JCVI, as the House knows, we introduced in September 2015 a men B programme, using the vaccine Bexsero, for babies born on or after 1 July 2015. The babies receive a dose of vaccine at two months, with a further dose at four months and a booster at 12 months. To ensure that we have protected as many infants born in 2015 as possible from men B before the usual winter peak in cases, we also offered the vaccine to babies born in May and June 2015 as part of a one-off catch-up programme, which was possible because the vaccinations could take place when the babies were due to attend their routine immunisation appointments at three and four months.

By May 2016, all infants under one will have become eligible for the men B vaccine, and by May 2017 all children under two will have become eligible for vaccination, which clarifies the points made by my hon. Friends the Members for Erewash (Maggie Throup) and, in particular, for The Cotswolds (Geoffrey Clifton-Brown). Obviously, much of today’s debate has focused on extending the men B vaccination programme, and hon. Members and those who signed the e-petition want us to go further, which I absolutely understand. The term “meningitis” strikes fear into the heart of any parent. Public Health England surveys parental attitudes, and its surveys regularly show that meningitis is the disease that parents fear the most. When we hear sad stories and see utterly heart-breaking pictures of children such as Faye, of course it adds to parents’ fear and worry. They want what is best for their children, which includes protecting them from meningitis if there is a means available to do so.

The Government feel the same, which is why we became the first country in the world to introduce a programme using Bexsero. However, although meningitis is a much-feared disease, it is now much rarer, thanks in large part to the success of this country’s immunisation programmes. Cases are currently at their lowest numbers in more than two decades. To give the House an example drawn on by the hon. Member for Central Ayrshire (Dr Whitford), who spoke for the Scottish National party, cases of meningitis C have dropped from a peak of around 900 in 1998-99 to about 30 cases in 2014-15. Very few children will get meningitis, and thankfully, deaths are uncommon, although no less tragic.

The hon. Member for Central Ayrshire also mentioned teenagers. As I have enough time, I will draw the House’s attention to the men ACWY programme that we have introduced. Men W is the strain of meningitis that has increased; cases have been increasing since 2009. There were about 50 cases in 2012-13, about 100 in 2013-14 and around 180 in 2014-15. We rapidly introduced a vaccination programme this year as part of an emergency response to control the national outbreak of group W meningococcal disease. Provisional data show men ACWY vaccine uptake at around 34% in the urgent catch-up cohort aged 17 to 18 in 2014-15. I say that to enlist the help of hon. Members when we try to increase awareness of the men W campaign again this year. We need any help that can be given in publicising it. As I remarked with one colleague before the debate, it is considerably harder to get teenagers to the GP than small infants. It is an important campaign involving a very dangerous strain of meningitis that we must continue to bear down on.

However, the petition is about men B. It calls for the men B programme to be extended to children up to 11 years, although several hon. Members have suggested that up to five years may be a compromise. I fully understand why parents and the public want the extension, but as we have begun to explore in this debate, it is not a simple matter; I hope that hon. Members agree. Some of the reasons for that have been teased out, and I will say a little more about them.

Any Government must make the best use of the resources that they have to ensure that they deliver the maximum health benefit to the population. The greatest burden of meningitis B falls on the under-ones, who have therefore been our focus, on expert advice. As we have heard, such judgments are based on NICE’s rules on cost-effectiveness, which have helped successive generations of Ministers to make difficult decisions that are none the less fair and justifiable and reflect, as the Chair of the Health Committee said, the many challenges across our healthcare system.

I have spoken in detail to Professor Andy Pollard, the chair of the JCVI, to understand what process the committee went through when considering the men B vaccination and to be assured that the committee’s recommendation is robust. I have been reassured that the programme we have is the right one, targeting the group of children at highest risk of disease and death. Professor Pollard confirmed that a catch-up programme for one to four-year-olds would not be cost-effective at a realistic vaccine price. Also, the disease is so rare in those aged five to 11 that a programme for that age group would not be cost-effective, and the JCVI could not recommend it.

[Dr Whitford]

Is it not the case that the JCVI did a cost-effectiveness analysis using a 1.5% discount, which is the same as in public health, and at that level a catch-up programme for one to five-year-olds would be cost-effective?

[Jane Ellison]

I am coming to that point, but I thank the hon. Lady for her intervention.

As it stands, on the evidence and advice that I have received, I cannot support extending the men B vaccination programme to older children, but I emphasise that the JCVI keeps under review the evidence relating to all vaccination programmes, and I know that it will consider all the points made in this important debate. If the committee’s advice changes, I will consider it as a priority. The JCVI also keeps the eligibility criteria under review. I wrote to the chair on 17 March this year, following the evidence session with parents, asking the committee to review the cost-effectiveness evidence for one to two-year-olds, which Professor Pollard mentioned in his evidence to the committees. I await formal advice on that. Again, if the JCVI’s advice changes, I will consider it as a priority.

Many of the contributions made by hon. Members in this debate have queried whether the cost-effectiveness methodology used by our experts is right for immunisation programmes. The shadow Minister drew out that point, as did others, including my hon. Friend the Member for Bath (Ben Howlett), who led the debate on behalf of the committees. As some hon. Members said, an independent expert group—the Chair of the Health Committee gave it its full title, but I will call it CEMIPP for ease—is considering the cost-effectiveness methodology for immunisation generally. It includes factors such as peace of mind, cost of long-term social care for surviving children and how prevention is taken into account, all of which have been mentioned in this debate, as well as the issue of discounting.

The CEMIPP review is considering whether current discount rates are appropriate for vaccination in general, and it will report in the summer. I will consider any recommendations on that, although obviously I cannot pre-empt decisions in this debate. As I indicated to the Chair of the Health Committee when she made her contribution, I look forward to receiving the report in the summer. I have committed to publishing the report, and I do so again. If it is of interest, I will also provide the Petitions and Health Committees with a written briefing summarising the report and the Government’s proposed next steps when we get it.

Several hon. Members have expressed concern about whether the research requested by JCVI into whether a men B vaccination programme for adolescents would be cost-effective will take place and how long it might take. I can confirm that a preliminary study of the meningococcal strains carried by teenagers is now under way and will report in February 2017. It will inform a larger study of the effect of men B vaccination in that group. As the Chair of the Health Committee said, it is about exactly how the impact of the larger group would bed down on the impact of the disease in smaller children. I commit to the House to commission the second, wider study following on from the preliminary study now under way on strains.

I recognise that Members have concerns—again, the hon. Member for Central Ayrshire mentioned this issue—about how long the research is taking. I have had extensive discussions about that, because like hon. Members, I want quick answers. However, things are sometimes difficult to weigh in the balance. Robust scientific studies on which long-lasting and important decisions can be taken take time. My scientific advisers have told me that this is a particularly complex study, and that a previous study had inconclusive findings. We want to get this one right and ensure that we have a definitive answer. I am hopeful that this study could start in December 2017. The House has my complete assurance that we will always go with as much speed as we can while maintaining important robustness, so that we reach answers on which evidence-based policies can be made.

Much has been made about the importance of raising awareness and ensuring quick treatment. As many have said, no matter what the nature of the vaccination programme, there will still be cases, and we need to bear that in mind. Many Members have spoken of the reassurance that vaccinations offer and how they set minds at rest; it came out particularly in some of the evidence sessions. Although it is important that it reassures parents, I take this opportunity to underline and stress that vaccination is not a silver bullet. Even with a vaccination programme up to the age of 11, there would still be men B cases in under-11s, as we think that the vaccine covers only about three quarters of all men B strains and no vaccine is 100% effective.

A number of people have made the point, including the hon. Member for Central Ayrshire in an earlier intervention, about understanding the impact of the programme. No other country has introduced a free vaccination programme.

There is as yet no evidence regarding the real-world effectiveness of Bexsero in preventing meningococcal disease in a population—that is different from the safety issue—because, as has been said, incidence is too low for clinical trials to provide a reliable measure of effectiveness.

In response to points made by my hon. Friend the Member for The Cotswolds, I will say that we should have some indication later in 2016 of how effective the vaccine has been. However, establishing an accurate measure of how effective the vaccine is, how long the protection lasts and what proportion of strains it will prevent will take many years of detailed observation by Public Health England, and that clearly will feed into the ongoing review and the important decision-making process that we have. It is worth making that point.

Junior Doctors Contracts

Philippa Whitford Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

My right hon. and learned Friend speaks with huge wisdom and experience. He makes a point about what happened under previous Labour Governments. He might also have said that those were the same Governments that gave us the current badly flawed contracts. Because those previous Labour Governments did not stand up to the BMA and because they ducked difficult decisions, we saw the pay bill balloon and some shocking failures of care. Leadership is not just about talking and negotiating; it is also about acting. That is what Ministers have to do, and in this situation we have a very simple decision to make after three years of talks: do we proceed with the measures necessary to deliver a seven-day NHS and better care for patients, or do we duck those decisions? This Government choose to act.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Yet again, I must pull up the Secretary of State. It is not a case of excess deaths at weekends; it is a case of people admitted at weekends dying within 30 days. He said the same thing again today, and it is being repeated over and over.

The Secretary of State has described, within the same pay envelope, having more doctors at weekends, not fewer during the week, and reducing a maximum of 91 hours to 72 hours. I do not see how the maths of that can possibly add up. We are not managing to cover the rotas that we have, and those rota gaps pose a danger to patients.

I was very disappointed that the equality impact assessment dismissed the impact on women and other people who train less than full-time as acceptable collateral damage. We are facing the first ever all-out strike next week, and I cannot believe that we are not in negotiations. We should be at the table trying to prevent that strike. May I ask the Secretary of State how he plans to get us out of this? He should come back to the table, because that is the only way in which an impasse can ever end.

[Mr Hunt]

Let me gently ask the hon. Lady how long she expects us to sit round the table. We have been trying to discuss this for three years. She asked how the maths added up. I will tell her how the maths adds up. It adds up because we are putting an extra £10 billion, in real terms, into the NHS over the course of this Parliament. Conservatives put money into the NHS. The Scottish National party, incidentally, takes money out of the NHS.

The hon. Lady referred to the equality impact assessment selectively. She normally pays very good attention to detail, but the paragraphs from which she quoted related to changes that were agreed to by the BMA. What she did not quote was paragraph 95, which says that the overall assessment of the new contract is that it is “fair and justified” and will promote “equality of opportunity”. Why is that? Because shorter hours, fewer consecutive nights and fewer consecutive weekends make this a pro-women contract that will help people who are juggling important home and work responsibilities.

Brain Tumours

Philippa Whitford Excerpts

Monday 18th April 2016 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Thank you for calling me to speak in this debate, Ms Buck; it is incredible to see the Chamber so full. I pay tribute to the Committee and to the hon. Member for Warrington North (Helen Jones) for her incredible opening speech. As many hon. Members know, I am a breast cancer surgeon, so I have worked in a field that has seen a transformation since the ’70s. When I was a student, half our patients would survive, whereas now, about 85% of our patients survive. We have been the recipients of the benefit of research, but what we are talking about today is an area that seems just to have been forgotten.

Although people are talking about this being a rare cancer, we are still talking about 10,500 cases a year, the majority of which are not in young people. They will be in older people. The biggest impact is in those under 40, where it is the biggest killer. We have heard that only 20% will survive five years, but what is even scarier is that only 40% will survive one year. That means that the family have very little time to come to grips with the situation or even to get their head around what is happening to them. It is therefore important that as well as research, which is the topic of this debate, we look at the service that we provide.

I hope that this debate will raise awareness not just among parents, who obviously have been going to their GP, but among GPs. Doctors need to see HeadSmart cards, or go to lectures or be updated. They also need to feel enabled to refer someone to a specialist or to refer them for a scan, because we are hearing that, when things start to get more dramatic and someone gives in and goes to A&E, they are being diagnosed. Can we not move that out of A&E? The survival rates for people diagnosed in that way are much lower, yet 53% of those under 40 will be diagnosed in that fashion.

As well as there being a poor survival rate, 60% of younger people will be left with significant disability. For one third, there will be an impact on their personality. For a half, there will be an impact on memory. A quarter will lose cognitive function or have sensory loss. That means that this is not only about those who have lost life, but about those who have lost quality of life, for whatever life they have.

This is not just an illness of the child or adult with brain cancer, or brain tumours. As we have heard, it is a disease of the whole family and everyone who is connected with it. That is why support is important. In my constituency, there is Malcolm Sargent House, which is a hospice to support children and families with cancer—CLIC Sargent contributed to the briefings that many Members received.

We talk about brain cancer and brain tumours, but actually, we should say “brain tumours”, because although in other parts of the body, as with breast, we talk about “benign” and “malignant” and are delighted to get a benign diagnosis, that is not the case in the brain, because it is where we live. Therefore, even removing a benign lesion can have a huge impact on the person. That is where early diagnosis is important because the bigger it is, the more damage there will be with surgery, which is the key treatment for these patients.

We have heard about the difficulty of chemotherapy. The hon. Member for Warrington North mentioned the blood-brain barrier. That is simply a protective mechanism of the brain to stop the poison that is knocking around in the body from getting in there, but it means that the big molecules, which chemotherapy often are, simply cannot cross the blood-brain barrier.

The right hon. Member for Oxford East (Mr Smith) mentioned his wife developing secondary brain cancer. We see this in breast cancer now; we are so good at preventing liver and lung metastasis, the first sign of trouble can be someone presenting with brain metastasis. That is not even included within the type of patients we are talking about today. Those patients, however, do gain in the same way from increased knowledge about managing cancer or lesions in the brain.

As my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) mentioned, since 2011 in Glasgow, there has been a large biobank at the Institute of Neurological Sciences, which is in the same campus as the New South Glasgow Hospitals. Many centres have biobanks. What is different about this one is that it is willing to provide tissue not just UK-wide, but internationally. Perhaps other UK biobanks could think about trying to receive and share samples with areas of the country that have no chance of having their own biobank. We read that only 30% of patients are able to donate a sample but that 90% would like to do so.

As others have recognised, this is not one disease. There are multiple sub-types, and there is a difference between childhood brain tumours and adult brain tumours, which means that, to have any meaningful research, we need to gather those small numbers together—that is not UK-wide but Europe-wide and internationally. One problem that has been mentioned is diffuse pontine glioma, which accounts for 80% of such deaths among young children. There is no treatment and no drugs; there is not even a trial. Part of what we need to do is not just funding but organisation. Representations about brain tumours need to be made on bodies, such as the Medical Research Council, that make decisions about funding.

The hon. Member for Erewash (Maggie Throup) mentioned breaking down the silos. In Glasgow, the Glasgow University brain tumour research fund not only brings in the ideas and contributions of front-line workers but is working with the tissue banks and biobanks to try to identify markers that might give us a prognosis or identify sensitivities to treatment. The institute is also considering the development of using chemotherapy and radiotherapy at the same time and of using MRI to plan that radiotherapy, because radiotherapy has an impact on people’s brain and cognitive functions thereafter.

Brain tumour patients have not had the chances that we would like to see for other cancers. We have heard about many charitable groups, and I pay tribute to my constituent Amy, whose father died at 65 of glioblastoma. She set up the Small But Mighty fund, which is simply getting friends together to run, cook, bake or do whatever to raise money for brain tumour research. The country is covered with people who have turned tragedy into something positive, but the Government are giving less money than Cancer Research UK to tackle brain tumours —£7.7 million against £9 million—which is not how it should be. Charities should be topping up and giving us wider or more innovative corners to consider, but the foundation stone needs to be Government research.

We have seen a change in mortality rates for cancers across the country, with a drop of 11%—I work in a specialty that has seen that drop. When we invest in better research, we will also have to commit to using the drugs or treatments that are developed. How often do we talk in this Chamber about the difficulty of accessing drugs for rare diseases? I call on the Minister to fund research and to remember that, when the research comes to fruition, we need to commit to using it. Other cancers have benefited, it is about time that brain tumours do, too.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

I thank you, Ms Buck, and also your predecessor this afternoon, Sir Edward Leigh, for your excellent chairing of this debate. It has been a pleasure to serve under the leadership of both of you.

I echo many of the points made, not least those just made by the hon. Member for Denton and Reddish (Andrew Gwynne): today we have seen the House of Commons at its best, with strong cross-party support for those who put us here and who expect us to listen to them and work for them. I congratulate the Petitions Committee. One does not get to the Front Bench by rebelling against the Government very often, but I am proud that one of my first acts on arriving here as an MP was to vote for more Back-Bench powers, and I think that this is a great initiative. To see direct democracy in action, with the public petitioning the Government and bringing debates like this one, is—although challenging for us—a great thing.

I thank the Speaker for his support for the cause. I recently joined him at the Speaker’s Palace at a reception for Brain Tumour Research. He has quietly done a lot of work behind the scenes in support of that and other medical issues. I congratulate the hon. Member for Warrington North (Helen Jones) and thank her not just for her excellent speech, which framed and kicked off this debate, but for all the work she has been doing behind the scenes. Equally, my hon. Friend the Member for Castle Point (Rebecca Harris) has done extraordinary work behind the scenes to bring the subject to fruition.

It would be odious to pick out individual Members, but we have had some wonderful speeches. Having said that, I will mention my hon. Friend the Member for Hexham (Guy Opperman), who has spoken powerfully here and elsewhere. For those who are not aware, he collapsed with a tumour, which was luckily diagnosed quickly. It is a sign that Members of Parliament experience the things that we are sent here to deal with. The right hon. Member for Oxford East (Mr Smith) also spoke powerfully about his experience of diagnosis in his family, as did the hon. Member for Sheffield Central (Paul Blomfield). Disease does not respect party boundaries, and nor should we in tackling the issues that it throws up.

I want to mention Maria Lester, whose extraordinary campaigning work has fuelled much of the campaign and still fires behind the scenes, driving it with personal passion, energy and experience, as well as all the charities that have done and continue to do so much. Of course there is Cancer Research UK, but as is so often the case in my work, I see the work of the small charities, which survive on so little—on the contributions of patients and their loved ones, and on voluntary work: Brain Tumour Research, the Brain Tumour Charity, Marie Curie, the HeadSmart campaign, CLIC Sargent and Children With Cancer.

Most of all, I want to pay tribute to the patients and their families and loved ones whose experiences and whose pain drive this campaign and this issue. It is my great privilege as the Minister to see that across different disease areas, and today in the debate, and in your work, you are lifting a torch and joining a magnificent history of people who, through their suffering of disease, insist on our doing better and who drive campaigns and raise awareness, leading to increased funding. On behalf of all the right hon. and hon. Members who have spoken on your behalf, I want to say that you have spoken very clearly here today and I have heard you. As you know, Ms Buck—some people in the Public Gallery may not—Westminster Hall is often a magnificent forum for raising in the House issues of, shall we say, marginal interest in the House: important issues that do not command widespread support. Today we have seen this Chamber and the Public Gallery packed, and phenomenal interest online as well.

As the Minister for medical research, I know that what drives most patients when they experience a diagnosis is the knowledge—the reassurance—that their disease, their suffering and, in many cases, their death, will not be in vain. What people want is to know that their suffering will do some good, and through our extraordinary research and science infrastructure we are so often able to deliver on that promise. Most of the people I speak to say, “I just want to make sure that through my pain and suffering you are able to help prevent someone else’s; and if my experience of disease helps you to do that, I will have done some good.” I think that is the request that sits deeply underneath what has been said this afternoon.

There are many issues. There are issues to do with awareness, with research funding—clearly—with diagnosis and the care pathway, with treatment, whether surgery, chemo or radiotherapy, and with quality of life and aftercare. There is also a complex range of issues to do with the research, development, procurement and reimbursement pathway, with which I am dealing in a number of the reforms I am leading as Minister for Life Sciences.

It is true that there is no simple solution. It is true that there are lots of competing claims, believe me, on every pound that we spend. It is true that we all have responsibility. I worked in biomedical research for 15 years and none of the companies I ever worked with got anywhere close to working out how we get drugs over the blood-brain barrier. The brain is an extraordinary organ that sits in a privileged place in the body, and that makes it a difficult organ to treat and diagnose. In many ways, it is the last frontier of the extraordinary biomedical revolution we are living through. We have got to the point where we can pretty much take a heart out, strip it apart, replace most of the parts, put it back in and treat disease with an exquisite range of chemicals, but we are not at that stage yet with the brain.

It is equally true that we do not run the allocation of science and research spending on the basis of political lobbying—nor should we. We allocate the funding on the basis of applications, clinical excellence, need and academic excellence. But I believe it is also true that we are sent to this place to reflect the priorities of the people who put us here, and the debate has illustrated, in a loud, civilised, cross-party and non-partisan way, that there is an extraordinary call from people for the disease to be given higher priority. I believe that democracy is about people influencing us. I did not knock on 15,000 doors to come here and say, “We’re doing enough. We’re doing something, and that’s enough.” We need to do more, so I will today announce a package of measures that I hope will go some way to address the points that have been made.

[Dr Philippa Whitford]

Is not part of the problem that funding has been allocated on the basis of incidence—how often people get brain tumours—rather than on the basis of impact, as in the deaths caused and the life years lost?

[George Freeman]

The hon. Lady, with whom I work closely on a number of issues, makes an excellent point. There are a number of criteria that drive how funding is allocated, and that is one of the things we ought to look at. If I can get to the end of my speech, I will make some recommendations about how we might pick that up and look at it.

I want to announce today that the Government accept that we need to do more in this space, committing to a number of specific actions that reflect the concerns that have been raised, both here and in the Petitions Committee and the all-party group report. I suggest that I should convene in the Department of Health a task and finish group to examine a number of the issues that have been raised here today, and to ask a question. I do not believe that as a Government we are not doing enough. We have put £0.7 billion a year into the Medical Research Council, to do the deep science on the medical frontier. We have put £1 billion a year—ring-fenced—into the National Institute for Health Research’s clinical infrastructure. We are funding the genomics programme and putting £4 billion into digital health and the informatics that go around it. The question we should ask is: surely there is more we can do to help to make that resource and that infrastructure support this particular disease area? I will say a little more about why I think that case has been made and what we might do about it.

I will not repeat all the numbers—hon. Members have heard them—but about 4,000 brain cancer cases are diagnosed each year in this country, resulting in about 3,500 deaths a year. We all know that brain tumours are very complicated—there are about 130 different types of them—and the truth is that we do not know what causes most of these cancers. Old age is a risk factor, but as many hon. Members have said with great passion today, it is those children who are diagnosed who drive us. Four-hundred children a year are diagnosed, and we just do not understand or know exactly what is driving it. There are various hypotheses around genetic conditions and some exposures.

Unlike for most other cancers, brain cancer mortality rates have increased. According to figures from the Office for National Statistics, in the last 30 years the mortality rate for brain cancer has increased by 15% for men and almost 10% for women. Improvements in diagnostics and treatments have helped to improve short-term survival in adults, with around 49% of people diagnosed with brain cancer now surviving for at least a year, compared with around 25% 30 years ago. Long-term survival has also improved, with around 20% of people now surviving for five years or more, compared with around 10% 30 years ago. We have also recently seen an increase of more than 25% in GP referrals for magnetic resonance imaging for potential brain tumours, from about 30,000 to 50,000. Veterans of these issues will know that those are relatively small numbers over quite a long period, compared with the explosive pace of progress in a number of the other disease areas that we often discuss.

A number of Members have talked about early diagnosis, which is clearly absolutely key with this cancer, as with all cancers. Last year, a report by the independent cancer taskforce set out 96 recommendations, broadly covering six strategic priorities, including early diagnosis, and NHS England is working with partners to establish a new cancer programme to implement those recommendations. By the end of this Parliament, everyone referred with a suspected cancer will receive a definitive diagnosis or the all-clear within four weeks.

Contaminated Blood

Philippa Whitford Excerpts

Tuesday 12th April 2016 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

I, too, pay tribute to the hon. Member for Kingston upon Hull North (Diana Johnson) for her amazing campaigning work, and indeed to the other hon. Members who helped secure this debate. I also pay tribute to the organisations Tainted Blood, the Contaminated Blood Campaign and the Haemophilia Society, which have campaigned for years to get justice for so many people. We should also pay tribute to the many individuals who have fought on and on for justice, often in very difficult circumstances.

The Minister should reflect on the extraordinary unanimity of view in this debate, on the reflections in the consultation, on the proposals that the Government have put forward and on the need to think again. This is not a party political issue, because all Governments are to some extent culpable—Labour Governments, Conservative Governments and, indeed, the coalition Government. This is a moral imperative—there is no doubt about that. We have to offer these people justice, and the Government must accept that.

The Government set out the principle right at the start, in their introduction to the consultation, by stating that they accept and recognise their responsibility to everyone infected as a result of NHS treatment, but that leaves out those people affected. This is about not only those infected, but those affected. What about all the loved ones, the children, the spouses and the partners bereaved as a result of loss of life? The Government should accept responsibility for them as well. They have to accept that when they respond to this consultation exercise.

Serious concerns have been raised about this set of proposals. The Prime Minister said—his words were very clear—that:

“We will help them more”—[Official Report, 11 March 2015; Vol. 594, C. 289.]

Yet the proposals, when we see the detail, include a proposal to cut the amount of money that individuals receive. That is not consistent with what the Prime Minister said, so surely the Government must think again. It is surely unconscionable that people in very real need will lose out financially as a result of these proposals. What assessment have the Government made of the winners and the losers? How much will some people lose? It is really important that the Government are open about that. If the Minister cannot respond today, I would be grateful if she wrote to hon. Members to set out the assessment of the amount some people will lose, and of how many people are likely to lose, as a result of these proposals.

As my right hon. Friend the Member for Orkney and Shetland (Mr Carmichael) and others have said, it is surely not right that people in Scotland benefit more than people in England. Surely everyone should be treated exactly the same as a result of this scandal.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Will the right hon. Gentleman give way?

[Norman Lamb]

I will not, because I am concerned about the time.

Ending inflation-proofing actually means that we plan a cut to what people are paid every year for as long as there is inflation. Surely we cannot begin to justify that.

I have a problem with the principle of funding new medical treatments at an early stage by taking money from people’s financial support. That surely confuses two principles. We should leave intact the money that is available for people’s financial security.

I am concerned that the money will come from the Department of Health. The impact assessment talks about the other things that cannot be done as a result. Surely the money should come from the Treasury. In the Budget, the Government cut capital gains tax. I heard recently of one individual who will benefit to the tune of nearly £1 million as a result. These are political choices. Do we as a country want to cut capital gains tax and give large sums to very wealthy people at the same time as cutting financial support for people who have lost out as a result of a national scandal? That is surely unacceptable.

I therefore say to the Minister: accept what the Haemophilia Society says, withdraw these proposals and think again.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

We have paid tribute to many of the people who have come from across the UK to listen to today’s debate, but there is one group missing: members of Haemophilia Scotland, who are in Tayside attending a funeral of one of their members, the second of three brothers who have haemophilia. The remaining brother has had a transplant because of liver damage. I expect that everyone here would want to send their condolences to the family.

Let us recall that this scandal has been going on for over 40 years. People have been dying without being recognised and without being looked after for all that time. It really is a disgrace. We talk about not accepting liability. I have my specs on because I want to read out some quotations, which, as Members know, I do not normally do. I have a letter here. According to a leading doctor in the Food and Drug Administration in America, in May 1985, heat treatment of blood products had been available for some time, but non-heat-treated blood could continue to be produced with the current licences because the FDA was not going to do anything about it. It could have regulated the practice out, but it wanted things to be tidied up quietly. The doctor explained that although the FDA could revoke the licences through regulatory process, it did not want any attention to be paid to the fact that the practice had been allowed to continue for so long; it wanted the issue to be

“quietly solved without alerting the Congress, the medical community and the public.”

I have a copy of a letter from John Major, the former Prime Minister, who was at the time Chief Secretary to the Treasury. In 1997, he wrote to Tony Newton, then a Health Minister, raising the possible consequences of a sympathetic response to the Haemophilia Society:

“It could lead to an open-ended commitment of huge dimensions

and

“give rise to court action against the Government because of the implication of negligence”.

He asked Tony Newton to “consider the points” made by the society, but

“with no implication that the Government will take action.”

Here we are, nearly 30 years on, in almost exactly the same situation.

As has frequently been mentioned, this is the biggest treatment disaster in the NHS, and it happened because we were importing American coagulation products and American blood—blood taken from prisoners, or units of blood that were sold. Who sells their blood for donation? People living on the streets; people who are drug addicts. The main reason haemophiliacs and others are suffering is that making factor VIII meant using the blood products of multiple donors, which meant an increase in the risk of a positive result. Moreover, the haemophiliacs received those products over and over again.

Here we are, all these years on. When I graduated in 1982, and when I worked as a young surgeon throughout the 1980s, this was just beginning to emerge and be discovered. It certainly left me, as a surgeon, with an absolute fear of transfusing blood. I used to go to great lengths to use electrocautery and other techniques to avoid shedding blood in elective cases, because we did not know what other problems were there.

Some of my colleagues have drawn attention to the exact terms of the Scottish settlement, but the first three can be summarised thus. People who are suffering from hepatitis C, HIV or co-infection will receive more money, allowing them to receive at least the equivalent of an average income of £27,000. People with stage 1 hepatitis C will receive £50,000 instead of £20,000, and those who have received compensation of £20,000 in the past will be eligible for £30,000 now. It is totally accepted by the Scottish Government that focusing solely on cirrhosis is a rather bizarre way of assessing people, and they are entirely open to an evidence-based piece of work in the future looking into how people should really be assessed.

I think that one of the biggest differences in Scotland is the recognition of the bereaved families. They will receive the money for another year, and will then receive a lifelong pension of 75%. Our flexible fund will continue to be topped up to the point of £1 million a year. As has already been said, that will not give people back their lives, but it can allow them to live with dignity.

The right hon. Member for Orkney and Shetland (Mr Carmichael) and the right hon. Member for North Norfolk (Norman Lamb) suggested, with a degree of criticism, that Scotland had gone ahead rather than seeking a United Kingdom solution. How long should we wait? Scotland was criticised because although we were ready to screen blood in 1990, we waited until 1991 so that there would be UK screening of blood donations. We made that mistake then, and we cannot make it again now.

[Norman Lamb]

Will the hon. Lady give way?

[Dr Whitford]

I am sorry, but I do not have enough time.

I do not think that we would be debating this matter with the same urgency if there were not the contrast with what Scotland is doing. This is not just about financial support and recognition. All patients in Scotland with hepatitis C for whom Sofosbuvir is appropriate can receive it. I find it shocking that people in England who have been infected with contaminated blood should have to use any of their funding to buy a drug that can increase their quality of life and reduce the risk of giving the condition to their family. We are doing this not just for those patients but as a public health measure. If we reduce the burden of virus in the community, we will reduce the number of new cases.

A year ago, the Prime Minister and our First Minister responded to the Penrose inquiry. That inquiry was carried out in Scotland; the UK has never had a public inquiry on this matter. Both of them apologised, and our First Minister has used this first year to set up a group to look into changing support, and ensuring that people can access treatment and that families are recognised. I call on the Prime Minister to honour his apology and to ensure that patients in the rest of the UK receive the same treatment.

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Mr Hunt]

As ever, my hon. Friend speaks with great knowledge about NHS matters, and she is right to say that some of the underlying issues have nothing to do with contractual terms but are about very big changes in the way that training has happened over recent years, in particular the loss of the firm system and the sense of camaraderie that was part of the deal for junior doctors in training. We would like to see whether we can rectify some things that have gone in the wrong direction, but we have not yet had the co-operation of the British Medical Association for that independent review, which is led by the highly respected Professor Dame Sue Bailey. I hope that the BMA will co-operate with that, because it is a big opportunity to sort out some long-standing problems.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

There are currently 4,500 gaps for trainees in the NHS. Junior doctors often have to cover those gaps, which can mean having to do extensive extra shifts, or even covering two roles at the same time. It looks as if that situation will get worse, because fewer than half of the most junior trainees have applied for ongoing training this year. Does the Secretary of State accept that that represents a serious threat to patient safety?

[Mr Hunt]

The purpose of the changes is to improve patient safety, and particularly to deal with the issue that we have higher mortality rates for people who are admitted to hospital at weekends than for those admitted during the week. Because of the confrontational approach taken by the BMA, it has been difficult to negotiate an agreement, but we are committed to doing the right thing. What is right for patients is also right for doctors. We have been talking about morale, and the biggest way to dent doctors’ morale is to prevent them from giving the care that they want to give patients, so we must sort that issue out.

[Dr Whitford]

I suggest that what is good for doctors is also good for patients, and if people are being texted four or five times a day and asked to do a second shift to cover for a junior and a senior post at the same time, that is not good for either. On 11 February the Secretary of State said that he was imposing the contract to bring stability to the NHS, but that has not exactly gone well. What is his plan to re-establish his relationship with junior doctors and get us back out of where we are now?

[Mr Hunt]

With the greatest respect, we are trying to solve a problem that in Scotland is being ducked. We want a seven-day NHS with mortality rates that are no higher at weekends. There is no plan in Scotland to deliver that across the whole NHS. Rather than sniping, the hon. Lady should recognise that, in the interests of patient safety, we need to take difficult decisions. In the end, doctors will see that it is the right thing for them, too.

BMA (Contract Negotiations)

Philippa Whitford Excerpts

Monday 21st March 2016 Westminster Hall

[Andrea Jenkyns]

I am going to finish. Can a policeman say that he does not want to cover a Friday night? Can a firefighter turn down a shift because it is a Sunday morning? No.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I thank the hon. Lady for giving way. I want to point out that the opt-out clause for consultants is for routine work at the weekend. If they run an emergency service they are not allowed to opt out of emergency care.

[Andrea Jenkyns]

I thank my hon. Friend for that. We work together closely on many matters. At the end of the day, life has moved on from the time when the NHS was set up. Life has got to change.

Moving on to my next point, firefighters cannot turn down shifts. They are public servants, just like doctors. The new contract proposed by the Government is safe and fair. No doctor working legal hours will get a pay cut thanks to the 13.5% increase in basic pay and the unsociable hours pay for nights, Saturday evenings and Sundays. The NHS must adjust to the modern world if it is to survive. Seven-day working is vital to that, and the BMA needs to recognise that. The Government and the Secretary of State have gone out of their way to talk to the BMA and to accommodate its demands. A negotiation in which someone gets 90% of what they want would seem pretty successful to me, and it is a shame that the BMA does not see it that way.

--- Later in debate ---

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Sir David.

It is a privilege to be able to say that I worked in the NHS as a physiotherapist for 20 years—I remain on the professional register—and to bring that experience to the debate. The service that I worked on was changed to cover seven days. The complement of staff was the same, but spread over the whole week. To provide a full seven-day service with every specialism in place would require a massive investment of resources on a scale nothing like what the Government are talking about, given that they are set on making £22 billion of efficiency savings. Before being elected to Parliament I had a dual career, because I was also head of health at Unite, representing more than 100,000 health workers. I therefore have real experience of dealing with the Government and of how the Department of Health handles disputes.

On 5 December 2011, proposals were introduced to cut unsocial hours for all “Agenda for Change” staff. The proposals were discussed with NHS employers throughout the country and with the trade unions. We sat around tables and discussed the proposals, and they were turned away, but the fear is that they could be coming back on to the table. The NHS Pay Review Body report said that the Department of Health and NHS employers recognise that

“the cost of the unsocial hours premia makes the delivery of seven-day services prohibitive”.

That is why the whole NHS is worried: the real prize for the Government is the savings they will make from cutting unsocial hours throughout the NHS.

If the Government are planning to expand services to cover seven days, if only in name, they will need more people to work at weekends. The cost of having more people working at weekends cannot currently be met, so if the service is to be expanded, obviously the prize the Government are after is the NHS’s “Agenda for Change” staff, who are often very low paid. According to a survey I conducted of these professional NHS employees, they are giving eight hours of unpaid overtime to the NHS every week, doing the many things we have already heard that NHS staff do. Why? Because they care, because they are professional, and because that is what happens in the NHS.

I do not recognise at all the caricature painted by the hon. Member for Morley and Outwood (Andrea Jenkyns). What she described is not my experience of some of the most highly professional people in our land. They deserve our respect and awe, not to be degraded as she degraded them today and as the Secretary of State has previously. I am ashamed to have heard her comments. I had a meeting with junior doctors in my constituency on Friday and listened to their concerns. They are seriously concerned about recruitment and retention in the medical profession, particularly in accident and emergency, where there is a serious recruitment and retention problem in my local hospital.

They explained to me that as junior doctors are leaving they are being replaced by locums. That destabilises the multi-professional team. It destabilises the ability of clinicians to work in teams where clinicians know one another, which is the safest way to operate. All the tutoring, mentoring and other input that staff so value and need—learning on the job right through their professional careers—is lessened by that destabilisation. They are seriously concerned about recruitment and retention because they want to get the best professional development so that they can give the best service to patients. That is why we are seeing junior doctors applying to work overseas: they want to ensure that their careers are enriched so that they can give patients the best care.

We should be really concerned that there are such problems with recruitment and retention in many of the specialisms that require weekend working and are involved in emergency services. We are not discussing some of those services that, frankly, could operate according to clinical need during a Monday-to-Friday service because the demand is not there for such professionals to be there at the weekend. We should be very worried, as should the public, because the reality is that if doctors are not in A&E, who is going to care for us in our time of need? That is the reality of what is happening.

Psychiatry is another profession that is currently finding it difficult to recruit, as are other areas of emergency medicine and the intensive therapy unit at my local hospital. They face real challenges, and they have concerns about the new regime that is being introduced to try to deter hospitals from making doctors work long hours—the new guardian of safe working role. They are concerned because the new regime is like the trust marking its own homework. If doctors report that they are working excessive hours, the trust will be fined, but the fines will go into a training and development fund, so we will just see less money going into that fund in the first place. It is a case of playing with the accounts and shuffling the deckchairs on the Titanic as it is sinking under the proposal.The reality is that it will not be an effective measure for preventing people from working longer hours, and doctors have real concerns about it.

[Dr Whitford]

I, too, have concerns about the hours guardian, because it will require junior doctors to complain. The NHS is a hierarchical system, and those doctors, who are often on the lowest rung of the ladder, will have to step up and make a noise. Something that depends on their whistleblowing on their own hours will not provide strong protection.

[Rachael Maskell]

The hon. Lady is absolutely right. Although Government Members say that the NHS has a much more open culture, the reality on the ground is that it is difficult to raise concerns in the NHS. Shopping the boss if they are making someone work longer hours will be difficult. The hon. Lady makes an excellent point.

We want to maintain the best in our NHS; we do not necessarily want to give that gift to the world. That is why it is so important that we return to the negotiating process. There was pressure from the Opposition to ensure that there was a process of independent arbitration so the talks could be resumed. When Sir David Dalton became involved, the dynamic of the dialogue changed, so a deal could be brokered and progress could be made. All that we ask—hundreds of thousands of people who understand industrial relations have written to us about this—is for professional dialogue with professionals to ensure a proper negotiating process so we can find a solution to this dispute. That is how negotiations work. That is the process of industrial relations. It is about sitting around a table and working through the difficult issues before us. When great minds come together, solutions can always be found.

I urge the Minister not to impose the contract and to withdraw from that position. Of course it is possible to do that. Anything is possible if the will is there. Withdraw, calm down, stand back and let some dialogue continue. We need to find a solution that is good for NHS employers, for our doctors—do they not deserve a solution to this dispute?—for the rest of the NHS, for patients and for the public. Why not make that small concession and open talks immediately?

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

We seem to have been negotiating this topic relentlessly since last summer. The Secretary of State has cited multiple papers showing the “weekend effect”, as it is described. Twice in his statement on 11 February—the day he imposed the contract—he talked about increased deaths at weekends. That is clearly not the case—it is increased deaths among those admitted at weekends. Despite being pulled up on that in the Chamber, he used exactly the same phrase on “Newsnight” the same evening.

I am very uncomfortable about the conflation of what the problem is and what the cause is. The papers show a statistical excess of deaths among those admitted at weekends. We know that those people are sicker: any patient admitted electively on a Sunday is considerably sicker. Studies of elective patients only show that anyone admitted electively at the weekend has a 92% increased chance of death. Frankly, in the modern NHS we do not get to admit our patients the day before, so they have to have a lot wrong with them and a lot of morbidity.

What has not been done is to dig into that to discover what the issue is. Some of the papers that the Secretary of State cites discuss excess mortality and have no relationship to a weekend effect at all. Ozdemir’s paper clearly identifies—it is categorical—the fact that excess deaths do not relate statistically to the deployment of junior doctors, yet those doctors are described as a blockage to the achievement of seven-day services. We have not had a proper definition of what is meant, and we keep waxing and waning, going from one track to the other: do we mean to strengthen urgent and emergency care, which no doctor would argue against, or do we mean routine? That keeps slipping in.

Patients shop in Tesco seven days a week, and some shops are 24 hours—the NHS should be the same. As I have said in debates before, if someone goes to Tesco at 2 o’clock in the morning, the fresh bakery counter is not open, nor is the alcohol counter or the fish slab—it is not exactly the same. The NHS is comparable: the reason we have more doctors and more things happening Monday to Friday is that we do elective work. Quantitatively, that totally overwhelms the numbers on emergencies.

Some papers suggest that the biggest issue, as identified in the Francis report, is the ratio of trained nurses to patients. Other issues were also identified by our Scottish Audit of Surgical Mortality, which looked at every single surgical death in the ’90s and early noughties. It identified the fact that some patients were operated on by surgeons who were too junior. That was discussed with the profession, and it changed. A couple of years later, the audit showed that we had consultant surgeons in, but that the anaesthetist was too junior for certain very sick patients, so that changed. That is what can be achieved through dialogue and development.

In Scotland, we have a seven-day care taskforce, but we are not imposing a contract—we are doing it through dialogue. Two of our biggest hospitals, the Edinburgh Royal in Edinburgh and the new Queen Elizabeth in Glasgow, already have seven-day working. In my own hospital, we have consultant radiologists all day Saturday and all day Sunday, but not through shifts. It can be achieved without the all-out battle we seem to have had for the past nine months.

The standards produced for the Government identified increased consultant involvement—in assessment, review and, if necessary, consultant-led intervention. There should be more diagnostics and more radiology. Those things relate to senior medical staff and to support staff such as radiographers and laboratory technicians, not to junior doctors, who are already there. Another problem is the flow of patients through hospital and back out into the community. That is why A&E gets so backed up. The problem cannot be solved in A&E; people have to be moved out to the community. We need physio- therapists, rehabilitation and the ability to discharge. None of that is junior doctors’ work.

As we have touched on before, the term, “junior doctors”, describes people up to their mid-30s. Senior doctors and senior trainees may be committed to a place and may not move, but very junior doctors are not; they rotate every year, and they can easily go overseas, as mentioned—or if they want to come up the M74, we will welcome them with open arms, roll out the red carpet and bring them in. In 2011, 71% of foundationers—people at the end of their first two years—were applying for a post in the NHS to continue training. That figure has dropped every single year: last year it was 52%; and now, just after closure, 47%. Less than half of England’s junior trainees are applying to stay on in the NHS, which is a catastrophe.

Not recognising antisocial hours means that the very specialties that involve a large proportion of antisocial working time will become even more unattractive. Will the Minister tell us why consideration was not given to the BMA proposal? It was cost-neutral and had a lower basic rise, but it kept a stronger recognition of antisocial hours. It would allow antisocial jobs such as those in psychiatry, A&E, obstetrics and gynaecology, and general surgery to remain at least accommodated by salary.

We already have rota gaps. We are short of 4,500 doctors. I have read articles in the Health Service Journal that describe a rota in Basildon that should include 22 doctors, but has 13, so it has been decided that only one doctor will be on duty at night, instead of two. Social media is full of people who are carrying two pagers—the senior pager and the junior pager. What happens if they become busy?

For the Secretary of State, the biggest issue is the attack on junior doctors. He seems to be claiming that he is the only person in England who cares about patient safety. I am sorry, but I have been a doctor for 34 years, and every single doctor, nurse and member of the NHS is working to deliver care and to protect patient safety. It is insulting to imply that they are not.

How do we move on from where we are now? I agree that the imposition needs to be stopped. After Sir David Dalton had made so much progress in just a month, I was really shocked, the morning after the strike, having tweeted to say, “Great, let’s get back to the table”, to find a couple of minutes later on the BBC that the Secretary of State was imposing the contract. If Sir David Dalton got that close in four weeks, why could that process not continue? Why could consideration not be given to the junior doctors’ own cost-neutral solution?

We need research to understand the issue. Do we require more senior nurses, or better nursing ratios? Do we not need to ensure that it is consultants and, in particular, radiologists who are available? The problem is that with the rota gaps that we already have, we are endangering patients, because people are constantly being emailed or texted, “Can you do another shift?”, “Can you do a split shift?”, or “Can you stay on tonight?” Exhausted doctors are dangerous. I am asking Ministers to step back, to cool things down, to remove the imposition, and to allow both sides to come back to the table. That is important for patients and the NHS itself.

The situation is not unsolvable. A decision was made simply to raise the temperature, which has created a desperate attitude among junior doctors. To describe them as radicals or lefties—no insult to Labour Members —is flippant. Doctors are not generally known for being particularly radical, and this was the first junior doctors’ strike in four decades. I went through my entire career without ever seeing a junior doctors’ strike. It is not something that people have embarked on lightly. We need a change of direction and a massive change of tone. Do not insult the junior doctors. They are the people who already provide a lot of seven-day work; they are not the obstruction.

People cite Salford Royal and Sir David Dalton, but I was there this morning, and he is clear that what he means by seven-day work is urgent and emergency work—and he is managing it on the existing contract. Let us be a bit more imaginative and get a solution.

--- Later in debate ---

[Ben Gummer]

I will, and by way of return I hope that the hon. Lady will consider what the Secretary of State has actually said on a number of occasions, which—I am sure completely unintentionally—she misrepresented at numerous points. The hon. Lady said that the existing contract had moments of imperfection—I cannot remember her exact words. However, it had rather more imperfections than that, which is why the BMA recognised many years ago there was a need for significant change, and why the coalition Government entered into negotiations with the BMA early in 2013. The heads of terms were agreed between early 2013 and July 2013. The negotiations began in October 2013 and broke down a year later, with no notice to the Government. The BMA just walked out, and it took some time to explain why. It claimed, generically, that it was to do with patient safety, which was an odd thing to say given that there were doctors negotiating on the management side who were also concerned about patient safety. The negotiations were not rejoined until we involved ACAS in November last year.

[Dr Whitford]

When we had a debate about the issue in October, the Secretary of State was reluctant to go to ACAS, yet only when the negotiations went to ACAS was some progress made. The BMA wanted the contract changed to include recognition of quality training. The junior doctors are future consultants and leaders, and at the moment, while they hold multiple pagers and cover rota gaps, they feel that they are getting no training at all.

[Ben Gummer]

I will come on to the hon. Lady’s sensible points about rota gaps, which have persisted for many years and need to be addressed as a separate issue, and about training. However, the negotiations have been going on for more than two years. There is an idea that the Secretary of State somehow ended them peremptorily, but throughout the period of the negotiations there was a serious attempt to engage with the BMA. Progress was very slow, and the BMA unilaterally broke off the negotiations in October 2014. It did not come back to the table until the offer was made to go to ACAS.

On why the Secretary of State took the stance that he did, I have a different interpretation from the hon. Lady, because I was with him through that whole process. We were very keen to return to negotiations via ACAS, but we needed to ensure that the BMA would give its representatives full negotiating powers.

--- Later in debate ---

[Ben Gummer]

I will happily arrange for the hon. Lady to have a clinical explanation of the various studies that she has cited, because I think she will then understand why the part that she has quoted needs to be understood in context—[Interruption.] I am asking her a direct question: does she—and do other hon. Members, who are tittering about this on the Opposition Benches—really propose that there is no weekend effect? If they are saying that is the case, or if they are saying that there are 500 or 1,000 deaths and that somehow is acceptable and the Secretary of State should not address himself to it, that is a worrying statement of intent.

[Dr Whitford]

rose—

[Helen Jones]

rose—

[Ben Gummer]

I will not give way to the hon. Member for Warrington North. I give way to the hon. Member for Central Ayrshire.

[Dr Whitford]

The problem here is about exactly what it is the paper shows. What do any of these papers show? They show a statistical excess of deaths. We know that 25% more of the people are in the sickest category. We know that 15% more of them die on a Sunday. Maybe the NHS did an absolutely amazing job in saving the other 10%. We do not know the answer, so we do not know how many are avoidable. However, I would point out to the Minister, who referred to the standards, that the only mention of junior doctors in the 10 standards is with regard to review of outcome and focus on training. Not one of the 10 standards says there should be a change in how junior doctors work.

[Ben Gummer]

One of the studies that the hon. Lady cites does a control for acuity, which she has raised. I know that there is an understandable change in the acuity of patients and one of the studies allows for that.

As for the point about the 10 clinical standards—and here I will just move on from the points that the hon. Member for Warrington North was making—

--- Later in debate ---

[Dr Whitford]

Will the Minister clarify whether the protection for GP registrars has been re-established? We obviously do not have access to the terms and conditions that have been agreed, because they have not been published. However, one of their concerns was that they had pay protection when they became GP registrars, and that was going to be taken away.

[Ben Gummer]

All trainees working within legal hours will have pay protection and that includes GP registrars. That was one of the bottom lines of our negotiations all the way through the process and precisely why we are so disappointed that the BMA consistently misrepresented our position.

I have addressed the point the hon. Member for Hornsey and Wood Green raised about the 20% fall in income. She asked me to say expressly whether that is right or wrong. It is wrong. No one will see a fall in their income if they are working the legal hours. Indeed, we think that 75% of doctors will see an increase through the course of this pay contract.

The hon. Lady raised the issue of maternity and cited a doctor who claimed that they were earning £22,600. I would be interested to know the detail of that because the foundation year one minimum pay rate is £23,768, which is slightly above the figure she quoted. She made an entirely valid point about the need to make sure that women especially, but I hope under shared parental arrangements, women and men in the service have the flexibility to be able to take time out of the service to bring up children. That is why the increased base rate of pay is particularly good because it will increase the parental pay, as we should now call maternity pay, under shared parental leave when people take time out to look after children.

The hon. Member for York Central (Rachael Maskell), who is no longer in her seat, talked about guardians, but was factually wrong to claim that there would be no payment to junior doctors. They will be able to get one and a half times their salary as part of the payment fines made to guardians. The guardians will not, as the hon. Lady suggested, just respond to complaints. They will have an overall duty to maintain the wellbeing of junior doctors. Theirs will be a critical position in trusts and I hope it will grow into being a substantial one, making sure juniors have the opportunities for training they wish for and the levels of welfare to which they are entitled.

The hon. Lady spoke about whistleblowing, and her comments concerned me because this is precisely an area where we should be asking juniors to speak up. If working longer hours is dangerous—we all agree with that—like any other patient safety issue, not only should they morally speak up to their guardian, but they are under a duty to do so under GMC guidelines.

[Dr Whitford]

Does the Minister recognise that if someone is the most junior person in a very hierarchical system, it is difficult and harder for them to complain about something they perceive is being done to them as opposed to something they see concerning a patient?

[Ben Gummer]

I recognise that speaking up is difficult in the current NHS culture. It is precisely what lies at the heart of Sir Robert Francis’s second report. That is why we need to change that culture. It is also the reason why we said that guardians, in receiving proactive complaints from juniors, should have an overall duty of care for the juniors in their trust and make sure they are treated properly. That is why this is an exciting role. It is a tutorial role in sense with a responsibility, especially for the youngest trainees, to make sure they are in the right place and supported in what can be difficult times.

[Dr Whitford]

May I ask the Minister again about not having the chance to see the details? One concern of junior doctors is that they would not have a voice or a role within the guardianship. They asked to have a representative as part of that function. Has that changed, or are they still excluded from that?

[Ben Gummer]

They are not excluded. It is important that that person does not become a BMA nominee, but we want the guardian to make sure they command the respect not only of the junior doctor workforce, but the trust itself. It is important to make sure that person gets that degree of buy-in from both sides, and I hope that the final solution we arrive at will satisfy that.

[Ben Gummer]

There has been a problem for decades with whistleblowers being listened to. That is what gave rise in part to the tragedy at Mid Staffs and the Secretary of State is trying desperately to do something about it. He cares passionately about it and his recent speech, which the hon. Member for Lewisham East (Heidi Alexander) welcomed, was about trying to create those safe spaces within trusts so that people feel they can speak openly. Indeed, recently at the social partnership forum, which I chair and where we hear contributions from trade unions, I heard of a very effective scheme recently developed in Somerset which showed a good way of getting people of all grades in a trust able to speak up.

I, too, am delighted that the hon. Member for Bristol West (Thangam Debbonaire) has been able to take her seat again. She has come back at an exciting time in politics—one that may be more exciting for her than the last six months. She asked about the funding for seven-day services. All I would say is that within the five-year forward view are two parts that are connected. The first is the commitment to have seven-day services in urgent and emergency care, which is reflected in our mandate for the service, our manifesto pledge at the last election and the request for £8 billion of cash funding connected with the £22 billion of efficiency savings in the service. That is the funding that is being provided to achieve not only that commitment, but everything else in the five-year forward view. Hon. Members have questioned whether that money is sufficient and I point them to the statement by NHS England today in which it was very clear that that is the amount that was asked for and that is the amount that they were glad to get.

The hon. Member for Central Ayrshire spoke about the opt-out, and I want to give clarification for the record to ensure that we are clear about it. In parts of the emergency care pathway, the opt-out has an effective impact and indeed affects part of the urgent care pathway. Ensuring the opt-out is removed is one of the areas we are keen to progress and was the origin of the Secretary of State’s statement, which related to that and not to junior doctors at the beginning of this process. It is important that we do that specifically around urgent and emergency care, and other hospital services, but we have never, ever wanted to extend by the process of our negotiations elective care at weekends. That is not part of our commitment, which has always been squarely about ensuring consistency of standards in urgent and emergency care.

[Dr Whitford]

I am afraid that I have sat in the House and listened to the Secretary of State talking about having elective services across seven days and how great that would be for patients. Of course it would be great, but we would need thousands more doctors whom we have absolutely no chance of finding. It has not been clear. In Salford Royal today, Sir David Dalton again said one crucial thing is for the Government to define exactly what they mean by seven days. Doctors have not objected to strengthening urgent and emergency care.

[Ben Gummer]

The hon. Lady, in repeating that, as have other hon. Members, makes it harder for us to state again—she knows I have done so on numerous occasions—that this is to do with urgent and emergency care. It is true that some hospitals—Salford Royal is one—do elective work at weekends. I have no doubt her hospital might do some elective work at weekends. That is part of the trust’s decision-making. It is for the hospital to make that decision. Our key in changing these contracts has been to concentrate on urgent and emergency care. That is the focus of the contract changes.

The hon. Lady also spoke about the tenor of the language that has been used and I know that she cares deeply about this, for understandable reasons. I, too, enormously regret the way this has been portrayed. Although to a lesser degree than the Secretary of State, I have been on the other end of language that one would hope professional doctors would not wish to use.

The whole debate has become intemperate in an extremely unfortunate way, but I have sat through every single speech that the Secretary of State has made on this matter and every single press utterance—I have also made a number myself—and never once has he attacked junior doctors as a body. He has only the utmost respect for them, not least because, like everyone else in this Chamber, he has been the beneficiary of their care. But it is true that they have been let down by their trade union.

I repeat—I know that the Opposition Front Benchers know this—that the BMA has let down its members, because first, it has allowed a series of statements to persist that it knows to be untrue, and secondly, the junior doctors committee has not engaged in meaningful negotiations in the way that it should have done and in the way that other parts of the BMA have been happy to do, and they have concluded better contracts as a result.

That brings me to the points that the shadow Minister, the hon. Member for Ellesmere Port and Neston, made. He asked quite a lot of questions, and I commit to giving a full answer later to the ones that I do not answer today.

The hon. Gentleman asks whether there will be any further steps to avoid industrial action. We will do whatever we can to ensure that junior doctors understand the nature of the contract, and we hope that they will therefore not feel the need to go on strike. We have contended all the way through that that is a needless endangering of patient safety. It is certainly a massive inconvenience to patients, many thousands of whom have now seen their operations cancelled as a result. The contract dispute does not have anything to do with safety, as the BMA itself has implicitly accepted. It is to do with Saturday pay rates. The BMA and its members really have to think about whether they wish to take the dispute about Saturday pay on to the street time and time again.

The hon. Gentleman asked whether there has been a risk assessment on patient safety. We have risk-assessed that at every single stage, and the way in which we have dealt with the industrial action has been concentrated solely on the effect that it has on patient safety, but the best way of ensuring patient safety is for the BMA to cease its unnecessary action.

In relation to an assessment of recruitment and retention, the whole contract has been framed to try to ensure that doctors have a better work-life balance. That is precisely why we have reduced the number of consecutive long days, consecutive long nights and consecutive weekends, and it is why the contract is better for junior doctors and why we hope that it will aid recruitment and retention in the long term. However, we are conscious of the fact that there are ongoing morale issues that go all the way back to 1999 and beyond. In fact, when the previous contract was negotiated, precisely the same points were made about morale as are being made now, so clearly the old contract did not fix those issues. That is why we have asked Professor Dame Sue Bailey to look at wider issues of training and morale in the service as they pertain to junior doctors, to see what else needs to be done to ensure that they are getting the training opportunities that they require, the welfare standards that they expect and the quality of work-life balance that they rightly wish to have.

The hon. Gentleman asked about the BMA’s proposal that it claimed was cost-neutral. Our judgment was that it was not cost-neutral, and given that the BMA was refusing to negotiate on the contract that was on the table and had been worked on for several years, it was rather odd—and, one might think, a political gesture—to throw an entirely new idea on to the table, knowing it not to be cost-neutral. I would say that that was more for effect than to actually try to further the aims with which everyone approached the contract renegotiation.

In short, I am afraid that I reject the premise of the petition, because the Secretary of State has attempted at every stage in the process, over a period of nearly three years, to have meaningful contract negotiations with the BMA. At every point at which contract negotiations have broken down, it has been the instigator of that breakdown, so the petition would better serve itself by being addressed to the junior doctors committee of the British Medical Association, which has broken off meaningful contract negotiations not just once but three times. It is with that committee that the responsibility lies for the failure to find a solution to the final 10% of the contract negotiation, as Sir David Dalton concluded.

NHS: Learning from Mistakes

Philippa Whitford Excerpts

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

I thank my right hon. Friend for her campaigning work on sepsis. Indeed, I have met the Mead family with her. She does a fantastic job with the all-party parliamentary group on sepsis. We announced a plan in January last year as this is a major area where we need to increase knowledge both inside the NHS and among the general public. As I mentioned a couple of weeks ago at a meeting organised by the all-party group, we are now looking at putting in place a public information campaign. We need to establish whether that should be about just sepsis, or whether it should be a more general public information campaign to help parents to understand when they need to worry about a fever, which is very common among small children and might be due to reasons other than sepsis, with meningitis being an obvious one. We are doing that detailed work now and we want to get this absolutely right, but I commend her persistence in ensuring that we deliver our commitments in this area.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome the statement from the Secretary of State, particularly with regard to the establishment of medical examiners, which we have had in Scotland since last year. I, too, ask why there is a delay of another two years before that comes on stream. As a doctor, the thing that always seemed obvious to me was what might have made a difference with Shipman. Of all the things that have been enacted, someone reviewing deaths might have made that difference. I do not underestimate the importance of audit, and learning from routine audit, rather than depending on just whistleblowing.

In Scotland, we had an audit of surgical mortality in the 1990s. The first thing that that showed was the people dying who had not had a sufficiently senior surgeon involved in their case. That was discussed with the profession, and practice changed. Future years identified a situation with a consultant surgeon at the front line and a junior anaesthetist, but that, too, changed. The audit identified the lack of high-dependency nursing units for the sickest patients. I suggest that working with such an audit and the profession, as we have done for coming up to 20 years, would have allowed the evolution of a stronger, safer seven-day emergency service. I again call on the Secretary of State to commit to looking at a surgical approach, the things that are missing—access to scans and radiology—and perhaps more senior review and senior involvement. This is not about junior doctors and it is not blanket.

We also need to look at the ratio of staff. Francis and other research have shown the importance of nursing staff. Staff who do not have a minute to stop and think will make mistakes, and will not have time to report them. We need to make this easy. There must be a culture in which people have the time to minimise mistakes.

I have a final plea. The Secretary of State is offering more support to whistleblowers, but a review and reconciliation for those who have been badly treated in the past might give people more confidence that, if they step up and report something significant, they will not be hung out to dry, as has been the case previously.

[Mr Hunt]

I contrast the tone of the hon. Lady’s response with that of the shadow Health Secretary. Although I by no means agree with everything she said, she does make some important points.

It is not the case that we have delayed the medical examiners scheme. In the previous Parliament, we had pilots so that we could understand exactly how the examiners would work. That is relevant to the hon. Lady’s other point about audit, with which I completely agree. One thing that medical examiners will be able to do is to look for unexpected or unexplained patterns in deaths. Obviously, the vast majority of deaths are routine, predictable and expected, but those examiners will be able, looking at audit tools, to identify where there are things to worry about, which is why this is an important next step.

With respect to whistleblowers, I will reflect on what the hon. Lady says. We are trying to eliminate the need for things ever to get to the point where someone has to become a whistleblower. We want to ensure that people are supported to speak out about mistakes they have seen or made and concerns that they have, and that they are confident that they will be listened to. We are publishing a table today about the quality of the reporting culture. Much of the raw data that allow us to rank trusts on the quality of reporting data come from the NHS staff survey, which asks staff how valued they think they are, and how safe and easy it is to raise concerns. That is why this is a big step forward.