National Health Service

Richard Fuller Excerpts

Wednesday 21st January 2015 Commons Chamber

[Andy Burnham]

That is an absolutely vital point. It is not just about GP locums; there are also A and E locums. The Government have, throughout, cut training places, which were another victim of the reorganisation. Ever since then, the number of places commissioned for doctors—and nurses, I might say—has gone down. That leaves us with a bill for agency staff that is literally out of control—it has gone through the roof—and that means that money is now being siphoned out of the NHS at an alarming rate. That is mismanagement; that is what has happened. How must staff working in the NHS feel when they see the bill for agency staff spiralling in this way and know that they will not even get a 1% increase from this Government? They will draw their own conclusions about how this Government value them.

[Richard Fuller (Bedford) (Con)]

The shadow Secretary of State has spent quite a large part of his speech on diagnosis, but at the beginning he asked for solutions, so in that spirit I offer a creative solution. He will be aware that East of England ambulance service has had very poor response times for a number of months—in fact, a couple of years. Would he support a merger of the Red 1 and Red 2 ambulance response services with the fire and rescue service in the east of England, because such a combined force might be in a better position to provide quicker response times? Does he agree with that idea?

[Andy Burnham]

I am prepared to look at it, but I think that the future of the ambulance service should be in integrating better with the rest of the NHS—with GP out-of-hours services and NHS 111. Greater Manchester’s health service is piloting a critical response service to support the ambulance service, and I do not have any objection to that. However, this Government have not got it right when they say that the future of the ambulance service is to merge with the police and fire services as a single 999 service. For me, the ambulance service is a clinical service that should integrate better with the rest of the NHS, and I would prefer to go in that direction.

I said a moment ago that people could not get a GP appointment, and that is also what the GP survey tells us. An extra 290,000 patients say that they have turned to A and E when they cannot get a timely GP appointment. That includes the Secretary of State, who admitted in this House that he had done exactly the same. So will he today accept that the growing problem of people being unable to get GP appointments has played a significant part in contributing to the increase of 600,000 in the number of visits to A and E?

Fourthly, I turn to social care. In my analysis, this is the root cause of the problems we are now seeing. At the start of this Parliament, I warned the Government about their public spending plans and, in particular, warned them against raiding social care to stack up a claim that they were protecting the NHS budget. Government Members should be familiar with the quote because the PM quotes it every week at Prime Minister’s questions. To be more accurate, they will be familiar with half the quote, because that is all he uses, so let me give the House the full version. I said that it would be irresponsible for the Government to increase NHS spending if the way they did it was by raiding the social care budget. I said further that if that goes ahead, they will hollow out social care to such a degree that the NHS will not be able to function, because a collapse in social care support would end up dragging down the rest of the NHS with it.

That is precisely what is unfolding before our eyes right now in the NHS. A report today from Age UK shows how

“hundreds of thousands of older people who need social care are being left high and dry.”

Contaminated Blood

Richard Fuller Excerpts

Thursday 15th January 2015 Commons Chamber

[Sir Edward Leigh (Gainsborough) (Con)]

I echo the right hon. Member for Knowsley (Mr Howarth) in describing this as a debt of honour. That, I think, sums up what the debate is all about. We caused this. We did not cause it personally, of course, but it was caused by the state and the national health service, so we are responsible.

I congratulate all Members who have spoken—particularly, of course, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who has campaigned so effectively. I also pay tribute to my late friend Jim Dobbin. As has already been mentioned, his memorial service took place yesterday, and, in paying tribute to him, the Bishop of Southwark described him as an MP of causes. I know the House of Commons and politicians are often criticised, perhaps quite rightly, but I think this debate shows the House of Commons at its best. There are many MPs, like Jim, who do not necessarily see their political life as one of holding high office but who realise we are here to try to promote causes, particularly as, because of our constituency system, when we speak here we often do so because our constituents have approached us. In other political systems Members of national Parliaments are perhaps more remote.

One national politician who is not remote is the shadow Secretary of State, the right hon. Member for Leigh (Andy Burnham). We are all very grateful that he is here today given his other responsibilities, and I am working with him on another issue where people’s lives have been ruined through no fault of their own. We value his presence here today.

I have said that many of us are here today because of constituents, and I am here because of my constituent Gary Jones from Scotter, who has raised this issue with me several times. I want to share some of his thoughts with the House. First, however, may I make an apology: I am on the Panel of Chairs and quite soon I will have to go and chair a private Bill, so I may miss the winding-up speeches.

As I have said, I want to talk about the issues Gary Jones has raised and, in particular the Irish compensation scheme. Before doing so, however, I want to echo and emphasise what my hon. Friend the Member for Aldershot (Sir Gerald Howarth) said in an intervention as it makes the point very clearly. I have already said this once and I will say it again, and it will be said several times during this debate: let right be done.

We caused this, and we have to put it right. The state—or the establishment—is responsible. I do not know who is really responsible—probably no particular individual; no doubt everybody was trying their best—but there has been gross negligence over several decades, since perhaps as early as the 1940s when the viral risks associated with the blood products in question were known and patients were not informed. One of the greatest scandals in all this is that so many patients have been kept in the dark.

[Richard Fuller (Bedford) (Con)]

My hon. Friend said that this was an example of gross negligence by the state. In addition to what the Penrose inquiry will show that is specific to the contaminated blood issue, does he agree this is also an opportunity for us to set some guidelines and rules for those occasions when there are failures by the state health service on how it will deal with compensation so that we avoid a patchwork of problems similar to those that affected our constituents?

[Sir Edward Leigh]

I entirely agree, and I do not think this is just a question of money. If we attack the Government just in terms of money, we might not succeed in this campaign. It is also a question of learning lessons, and what the victims want above all is some sense of involvement in future schemes. We must learn lessons, and I am sure we are doing so.

The screening of blood donors was totally inadequate, allowing those with a history of jaundice to donate. Even in response to the rise of AIDS the Government failed to implement the best technology available at the time to render blood products safe. The results of this neglect have been appalling: the infection of over 5,000 haemophiliacs with hepatitis B and C, over 1,000 of whom were also infected with HIV from NHS blood products, resulting in 2,500 deaths. Although there has been compensation in many cases, it has been inadequate—indeed, they would claim it has been miserly. For instance, although there is a one-off payment available for hepatitis stage 1, there is no ongoing payment. All this is plainly unacceptable; I think everybody who has spoken agrees with that. It is also obvious that there must be a suitable scheme for compensation to the victims—not that any monetary amount can repair the damage that has been done.

The Irish scheme has perhaps not received as much attention as it should have done in this debate so far, and again I am quoting here from the arguments given to me by my constituent. It is not, as I am afraid some of my hon. and right hon. Friends on the Front Bench have suggested, that we want to link the UK compensation payment scheme to that which exists in Ireland. It is worth repeating that campaigners have never expressed a wish to place the Government’s funding of any compensation scheme in Irish hands. For myself, I do not suggest that the compensation should be exactly the same, but the Irish scheme is worth looking at in terms of compassion: it puts compassion first; it accepts liability; and it is substantial enough for the victims to gain closure. So I encourage Ministers to look further into the compensation scheme the Republic of Ireland has established and to see what lessons might be applicable to us here in the UK.

--- Later in debate ---

[Mike Kane (Wythenshawe and Sale East) (Lab)]

I stand in this House in the footsteps of giants. My predecessor Paul Goggins was a tireless campaigner on this issue, and his predecessor, Lord Morris of Manchester and former Member for Wythenshawe, was also a tireless campaigner on it, so I am humbled to stand before the House as their successor.

I pay tribute to the right hon. Member for North East Bedfordshire (Alistair Burt) for securing the debate and congratulate him on his work. There are days in this Chamber, particularly as we approach a general election with the cut and thrust of politics, when I do not know what we do here. Today is not one of those days. The hon. Member for Gainsborough (Sir Edward Leigh) summed it up correctly: this debate shows the House of Commons at its best.

I want to relate the tale of a few constituents of mine: Fred and Eleanor Bates and Peter Mossman. I have been working with them over the few months that I have been a Member of Parliament and we have had the full support of my right hon. Friend the Member for Leigh (Andy Burnham), for which we are grateful. Eleanor is now 60 years old. She has been married to Fred for 38 years. Fred is a haemophiliac who used to have a 5% clotting factor but now has a 0.0001% clotting factor. It is believed that this reduction is a result of the contamination. Before 1982-83, he received plasma and cryoprecipitate on demand when he had a bleed. After that, he was switched to factor VIII. In 1991, he was visited by another constituent of mine, Peter Mossman of the north-west group of the Haemophilia Society, who brought Fred a leaflet about hepatitis C. Fred visited the hospital to check this out and discovered that he did indeed have the condition. In fact, the hospital had known about his condition for almost a decade. Frightened and worried, Fred and Eleanor researched the main symptoms of hepatitis C: fatigue, sclerosis of the liver, liver cancer and ultimately death. They believe that the disease is now having an impact on Fred’s short-term memory function.

Fred worked as a weigher at C. H. Johnson on Bradnor road on the Sharston industrial estate in my constituency. In 1980, he was given a choice by his consultant: he could carry on working and face possible death within a year or retire and live longer. Fred was 31 years of age when he faced that choice. The choice was made more complicated by the fact that he and Eleanor were raising two small children. His income went from a respectable £145 a week to £45 in state benefit.

With hardly any clotting agent left, Fred now receives prophylactic treatment every other day, in the form of 1,500 units of factor VIII. It is not just the victims of this injustice that suffer; it is often their carers as well. Eleanor was unable to return to work after the kids fled the nest, because hepatitis C is an unpredictable disease. Fred can be fine at 8 am but have a bleed half an hour later and have to go back to bed. Eleanor has to dress his wounds, as well as doing the cooking and cleaning. She has felt unemployable for a numbers of years because of her home care duties.

Fred and Eleanor now have to deal with the Caxton Foundation. May I make this promise to the House? If I am ever fortunate enough to stand at either of those Dispatch Boxes, I will never hide behind the fact that we have set up a third-party organisation to pass the buck to. We should accept responsibility here in this House; this is where the buck should stop. Eleanor has described the Caxton Foundation to me as a sheer and utter waste of time; she feels as though she is begging when claiming. The system does not allow a retrospective claim. She put in for a respite holiday, but it did not come through, so she missed her holiday slot. Other issues have been identified. There are no separate forms for carers to apply for their own grants, and winter fuel payments are counted as income. The stress has ruined the lives of many carers of those who suffer from this condition.

I want to talk about some of the organisers. I mentioned Peter Mossman earlier. He is 71 years old, and he has a 5% clotting factor. He was a woodcutter, a machinist and a professional driver with Goodwin’s coaches in Manchester. Like Fred, he too faced the choice between giving up work and carrying on. He gave up work when he was 42. He has searched high and low for answers on the disease. His kids have only ever known him fighting. Working with Alf Morris, he set up the Manor House support group, and I pay tribute to him and Alf for that. He lost his sister, Margaret, recently. She was an affected carrier, and she died at the age of 63, her liver ravaged.

These campaigners believe that there should be no differentiation between stages 1 and 2 when it comes to payments. As has been mentioned, we are one of the few countries not to have adequately compensated the victims. There should be a decent one-off payment with subsequent annual payments.

[Richard Fuller]

A constituent of mine has also raised this point. Does the hon. Gentleman not find it odd that, as a result of this failure by the Government, the victims have to apply for a discretionary payment and that there is no substantial up-front payment? There seems to be a complete imbalance between right and wrong.

[Mike Kane]

I agree with the hon. Gentleman.

Many of the victims have lost the will to fight. There should be greater anger there, but they cannot deal with that anger and fight at the same time. Fred, Eleanor and Peter tell me that they will fight until they die. They have seen their stock of affected friends die horribly, and they feel that that is all they have to look forward to. They believe that it is time to admit that we made a mistake, and to allow those people to get on with their lives. Hope is real. There is no such thing as false hope. There might be false science, and there might have been false starts, but hope is real for those people. We in this Chamber today should help them to reignite that hope.

--- Later in debate ---

[Richard Fuller (Bedford) (Con)]

I shall try to restrict my speech to two minutes, because I know that we want to hear the speeches from the two Front Benchers and, of course, from my neighbour, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who so nobly started this constructive debate, which will be a great comfort to my constituent, whose family life was devastated when she lost her husband at a young age with a very young family.

The debate has been constructive and we have heard of a number of measures that have been taken over a number of years. We also have the constructive recommendations from the all-party parliamentary group, which have featured heavily. I do not wish to sound a discordant note in this constructive debate, but I believe that despite all that there remains a suspicion to which I want to give voice. The suspicion is that all the responses from the Department of Health over the years have had to be drawn out of it and have not been freely given. The measures are often seen as a contrivance to ensure that a full answer has never been given, and people do not know why. The compensation provided is a construction of a response, but there is a belief that beneath this lies a darkness—a darkness that breeds suspicion about the root causes of all we have talked about today and about who was responsible, and about the feeling that those people remain faceless and nameless, fearing exposure for actions that may have led to what might have been a mighty, mighty wrong, and having an absence of courage to repent of those actions.

We all have to remember that it is our NHS. It does not belong to a political party or to the Department’s officials—it belongs to the people. My request to the two Front Benchers is: will they, to the extent of their powers, shine a light on this darkness and, beyond any financial consideration, provide that comfort to the hearts and memories of the victims?

NHS (Five Year Forward View)

Richard Fuller Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

The system involves Barnett consequentials. As a result of today’s announcement, extra money will go to the devolved Administrations and we hope that they will use it for health purposes, but they do have a choice. The hon. Lady has just made the case extremely elegantly for that money to be put into health. She mentioned north Wales, and I know that Members on this side of the House will be hoping that the Welsh Government will also use the extra money for the NHS, given the profound problems in the Welsh NHS.

[Richard Fuller (Bedford) (Con)]

Dementia care for our parents, grandparents and loved ones is a growing issue for my constituents, and I congratulate my right hon. Friend on putting dementia care at the centre of what he is trying to do. I also congratulate the Bedfordshire clinical commissioning group on its recent review. Will he tell us what today’s announcement will do to help to support those parts of the country that are trying to make progress on dementia care?

Regulatory Reform

Richard Fuller Excerpts

Tuesday 9th September 2014 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

The draft order makes important changes, so I welcome the fact that we can debate it properly on the Floor of the House. Hon. Members will forgive me if I say that the reason we are here today is to try to clear up yet another problem created by the Government’s NHS reorganisation and by the Health and Social Care Act 2012, which will go down in the annals of parliamentary history as one of the worst pieces of legislation this House has ever seen.

[Richard Fuller (Bedford) (Con)]

Will the hon. Lady give way?

[Liz Kendall]

No. I will make some progress. The hon. Gentleman may want to listen to what the Secretary of State for Health admitted in a letter to the chair of Healthwatch England on 11 August:

“The Health and Social Care Act, when it established CCGs, did not make provision for CCGs to form joint committees and other CCGs. PCTs previously had this provision in legislation and many formed joint committees to progress partnership work.

Health organisations, including CCGs, have expressed concerns about CCGs’ inability to form joint committees that are able to make binding decisions. This inability has brought many practical challenges in working together on issues that cut across boundaries, such as continuing healthcare, patient specific funding requests and service change”

across the country. I do not know whether the Minister wants to explain why the Health and Social Care Act removed that provision, as the Health Secretary admitted in the letter to Healthwatch England. Does he want to stand up? If not, I will make some progress.

The Minister was fortunate not to be on the Committee that looked at the Health and Social Care Bill twice, so he will not know that Opposition Members repeatedly warned during its passage that CCGs would often be too small to secure effective changes to services across wider areas. We have consistently made it clear that the only way we can get the big changes we need to be able to improve care for patients, including by specialising some services in regional centres and shifting others out of hospitals into the community and towards prevention, is by working in partnership across larger areas.

In principle, we support the need for collaboration and for CCGs to come together both with one another and with NHS England, particularly in wanting to commission good services across primary, secondary, community and specialist care. However, serious concerns have been raised about the draft order by local healthwatch organisations, Healthwatch England and some of the organisations that responded to the consultation, and my hon. Friends may want to raise real concerns. I will go through the concerns in some detail.

The Minister has talked about the fact that CCGs will remain autonomous, but many of them are concerned that that is not written into the draft order. Many CCGs feel that they are coming under increasing pressure from NHS England and some of its local offices. They are concerned that the draft order might take away their autonomy, forcing them into committees and decisions that they do not think are in the best interests of local people.

--- Later in debate ---

[Richard Fuller (Bedford) (Con)]

It is truly a pleasure to listen to my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) and to follow him in the debate. I am a member of the Regulatory Reform Select Committee and it was my vote that enabled the House as a whole to debate this measure, which might, on paper, seem rather arcane. The hon. Member for Blackley and Broughton (Graham Stringer) asked why we are debating it in this way. We are doing so because the core dilemma in much health reform involves the tension between local decision making and common advance. For many people, there is a tension between the priority to localise decision making and the need, as seen by professionals such as the doctors and clinicians whom we trust, for some decisions to be made on a common basis in order to achieve overall advances in health care. It can be difficult to find the appropriate boundaries as we try to resolve that tension.

I felt that it was important to bring this matter to the House so that other hon. Members could have a chance to talk about the experience in their own localities. The issues in Greater Manchester have already been mentioned, and my hon. Friend the Member for Stafford (Jeremy Lefroy) has mentioned the issues in his own area. I also felt that it was important to herald one of the most important attributes of the reforms that my right hon. Friend the Member for South Cambridgeshire introduced, which was to enable, as far as possible, decision making on these issues to take place locally and to ensure that those local decisions were led not by politicians or bureaucrats but by doctors. A concern has been expressed that this change would somehow draw us away from those reforms.

The shadow Minister, the hon. Member for Leicester West (Liz Kendall), asked some extremely pertinent questions, although she perhaps got off to a bad start by taking the political apparatchik line and suggesting that certain problems were the result of the reforms. This is actually about one of the best parts of those reforms, which allows local people to make decisions. That was reflected in the widely quoted comments made by Anna Bradley, the chair of Healthwatch England. In her note, she said that

“we are concerned that the proposed reforms could create the conditions for CCG decision-making to become disconnected from the transparency and accountability mechanisms put in place by the Government’s health reforms”.

She recognises, as do many hon. Members, the importance of the tension. She also referred to it in a press release, in which she stated:

“We understand the benefits of commissioners working collaboratively but it remains crucial that local people are involved, asked what they want and understand how decisions will affect the way services are delivered in their area.”

In my own area in Bedfordshire, we have been having a collaborative exercise between two clinical commissioning groups, and they have done an extraordinarily good job of communicating and maintaining local decision making.

[Graham Stringer]

The House owes the hon. Gentleman a debt of gratitude for bringing the order before us today. Will he tell us whether, in the example he is giving, the order would help, hinder or be neutral?

[Richard Fuller]

I am not an expert, but in that particular instance I do not think I would fear the joint committee making a different recommendation from the current committee in common, although it has yet to come back with its report. The point is that the hon. Gentleman and others have aired important questions for the Minister to answer. He has answered some of them, and that has been the purpose of the debate today.

Underpinning all this is the fact—whose importance I hope the Minister will emphasise in his response—that people want important health decisions to be taken locally. They can be persuaded of, and they can understand, the issue of common advance, but they want to know that a decision is being taken locally. I think that the Minister dealt with this in his response to the shadow Minister, but I would be grateful if he answered these points quite specifically. First, am I right in thinking that he said that decisions on the part of commissioning groups to go into joint committees were voluntary, rather than compulsory, and that it would therefore remain possible for them to continue to set up committees in common if they so wished? My second question—

[Norman Lamb]

rose—

[Richard Fuller]

I am happy to give way to the Minister iteratively, or he can wait until I have given him the full menu. Which would he prefer?

[Norman Lamb]

The answer to that question is yes, absolutely; I repeat that this is a voluntary act by any CCG. To address one of the concerns raised by the shadow Minister, let me say that there may well be circumstances in which CCGs want the rules of the game established at the start of the joint committee saying that there will be circumstances in which they can withdraw from that committee. So there are no circumstances in which any CCG needs to feel that it will be oppressed in any way by its neighbouring CCGs, NHS England or anyone else.

[Richard Fuller]

I am grateful for that clarification. My second question is on the issue of voting on the joint committees. To be effective, is it a requirement that joint committees should be based on unanimous voting only and that all CCGs would have to agree, or will joint committees be substantially based on majority voting? Is it open to CCGs to create joint committees with majority or unanimity voting depending on how they wish to set those up?

[Norman Lamb]

rose—

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. May I say to the Minister that I know he is trying to be helpful, but he will soon be seeking to answer this debate? We have only one more speaker to go, so to help the flow of the debate perhaps Members could finish their speeches and then he can respond.

[Richard Fuller]

I am grateful for the direction, Madam Deputy Speaker. My third question relates to the legalities and costs, which were mentioned by the Minister and were in the justification for making this change from committees in common to joint committees. I am still a little at a loss as to what those legalities and costs are. What costs are currently incurred or are anticipated to be incurred, and why would the costs be substantially less with joint committees? I am not looking for a generic answer such as, “There are some legal costs here and legal costs there.” I am looking for something specific, because if we are to make a change, we have to demonstrate that a substantial administrative burden has been taken away.

My fourth question relates to the impact of the change on existing committees in common. I think it would be correct to say that the Healthier Together review in Manchester is proceeding as a committee in common, not as a joint committee. Would that be the case if this change is made, or would it be possible, either automatically or by choice, for existing committees in common to be transferred to joint committees with the same decision rights that joint committees would have? I am not too clear as to the position for committees that are already extant.

My fifth question relates to the Minister’s statement that committees in common somehow place a “burden”. I would be grateful for his clarification that he does not believe that the essence of localism, which was a substantial intention behind the reform introduced my right hon. Friend the Member for South Cambridgeshire, is the burden to which reference is being made. Sometimes one fears that there is tension between localism and common advance. If we allow the people who are on joint committees and their decision making to get further and further away from the people, the burden of having to go back to get local approval is lost. I hope that the Minister can clarify that that is not what is meant in the order’s reference material.

Finally, there has been a lot of commentary about the fact that it is up to committees to change their minds later on and to decide whether it is a joint committee or not. But the Minister can be clear that not all the consequences of what a committee will find can be known at the outset. Can he clarify whether it is possible for CCGs that are already signed up to joint decision making on joint committees by majority voting to change their rules, or are they bound by those rules once they have signed up to them? I am very grateful for the opportunity to debate these issues on the Floor of the House, and I look forward to hearing the Minister’s response.

Pancreatic Cancer

Richard Fuller Excerpts

Monday 8th September 2014 Westminster Hall

[Mr Stewart Jackson (Peterborough) (Con)]

It is a pleasure to serve under your chairmanship, Mr Chope, and to follow the hon. Member for Worsley and Eccles South (Barbara Keeley). I am impressed by the standard of the speeches in the debate. The hon. Member for Scunthorpe (Nic Dakin) made a powerful opening speech, and the remarks of my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) were moving, passionate and heartfelt.

At the moment we feel that pancreatic cancer is an unfashionable issue that is low on the agenda politically and even in the health world, but other causes have been in that position, and have risen up the agenda because of pressure from this place. Pancreatic cancer is an issue that unites people across parties, and it needs attention. I would compare it to dementia and autism, which were once unfashionable, but then were the subject of landmark legislation and rose up the political agenda. That led to some success, and a huge impact on the people affected by the conditions, and their families.

I want to thank the charity Pancreatic Cancer UK for its brilliant work to raise the issue—and particularly David Park, whom I met a few months ago for a briefing—as well as the all-party group on pancreatic cancer. Seldom do all-party groups make an impact, but that one has set an agenda with the report it produced last year. I also thank Maggie Watts, of course, for her fantastic work. Her diligent, committed efforts got the e-petition going. It would have been easy for her to step back and say, “This is not something I want to get involved in. It is Government and politics, and I will leave it to someone else.” However, her sheer passion and commitment to doing what she thought was right, to right a wrong and raise an agenda, have been utterly commendable, and I congratulate her.

As we have heard, the issue is not one that can be tackled by pressing one or two buttons. The dreadful comparisons that can be made between pancreatic cancer survival rates and those for others including breast cancer and prostate cancer have been pointed out. For example, in 1971 the survival rate for prostate cancer was 31% and it is now 81%. My view is that because pancreatic cancer is now so prevalent and such a major killer, it is no longer acceptable, as a matter of NHS governance, that it should be left solely to the discretion of clinical commissioning groups. I am not a born-again centralist, but I believe we need very strong guidance, at least, from the Department of Health and the NHS, to bring the experience of the best, such as the University Hospital Southampton priority jaundice clinic, to the rest of the country. That is enormously important.

Progress has of course been made in the past few years. NICE is improving outcomes for upper gastrointestinal cancers and of course a pancreatic cancer quality standard is in development. Those things, and the cancer outcomes strategy of 2013, are all very welcome. Of course, they are focused on the quality and efficiency of cancer services, improving patients’ experience of care, and the quality of life of patients and cancer survivors. The hon. Member for Scunthorpe made the point that it is vital for the Government to have both quantitative and qualitative data at their disposal, to make value judgments about research.

I came to this subject almost by accident. It is an often overlooked aspect of being a Member of Parliament that we may stumble on issues, and then have the capacity—the honour and privilege, through being elected—to ask awkward questions and make ourselves a bit of a pain in the backside by doing so, sometimes.

[Richard Fuller (Bedford) (Con)]

Or frequently.

[Mr Jackson]

Or frequently, in my case, as my hon. Friend says.

A good friend of mine—a non-political friend in my constituency—was utterly shocked at the premature death of the husband of a very good friend of hers. He was, I think, 48, and the father of two young children. He had visited his general practitioner several times and was told over again that he was suffering from a very bad case of back pain. By the time he had his scan it was too late; the tumour was inoperable and was wrapped round other vital organs. It was not possible to operate and the poor gentleman died, leaving a young family, a matter of weeks later. That account prompted me to think and research more. Of course, I read the moving article that my hon. Friend the Member for Lancaster and Fleetwood wrote for The Daily Telegraph about his experience and the tragic death of his partner such a short time after diagnosis, and that, too, prompted my interest.

Figures have already been given about the comparative spending on different cancers. The current figure of 1% of research spending, representing £5.2 million, is pitiful for a cancer that is so prevalent. If 8,800 people were being knocked down on the roads every year or killed on level crossings or through any other possibly preventable cause, we would demand immediate action; but it seems we are prepared to countenance little if anything being done by central Government on pancreatic cancer. That is not a party political view, obviously. The comparative data show that the USA has a 6% survival rate after five years and Australia has a rate of 5%; but in the UK it is only 3.3%. We must address that. My hon. Friend the Member for Stevenage (Stephen McPartland) made the point that it is shocking that people attend accident and emergency jaundiced and clearly seriously ill before it dawns on anyone that they are in the advanced stages of pancreatic cancer. I just feel that something more can be done, not least because, according to the briefing we have received, one in six people attend a general practitioner or other health care facility more than seven times, yet they do not receive the treatment they need.

Care Bill [Lords]

Richard Fuller Excerpts

Tuesday 11th March 2014 Commons Chamber

[Andy Burnham]

Is the Minister listening to the debate and to what I am saying? I have explained to him carefully that that was a vehicle for financial and administrative reconfiguration. Yes, a neighbouring trust might have had to come and help with a solution to carry on with the administration and the running of that trust. That is the point, and that is what he has just read out. It was never a vehicle for service change—I do not know how many times I can make that point to the Minister before he actually listens.

[Richard Fuller (Bedford) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way one final time, and then I will complete my remarks.

[Richard Fuller]

For clarity, the shadow Secretary of State is talking about in extremis and financial failures. What policy did he put in place for in extremis care failures, and why is it not appropriate to have others help out in such circumstances?

[Andy Burnham]

I will come on to that point, but the CQC had existing powers on care failure, and powers to move more quickly than clause 119 provides for. Adequate powers were in place to deal with the point the hon. Gentleman has just made.

In truth, it is arrogance in the extreme for the Government to be coming along today—and worse, it seriously risks damaging public trust in how change in the NHS is made. That will be the real loss if the clause is accepted. It threatens to destroy any public faith in a sense of fair process governing these crucial decisions, and any prospect of cross-party consensus on a way to make changes to hospital services.

Making changes to those services is about the most difficult decision that politicians have to make, but the fact is that hospitals need to change if we are to make services safer and respond to the pressures of an ageing society. We did not shy away from that in government, and we do not say something different now. However, there is a right way and a wrong way of going about such things.

The Government’s answer—to use a brutal administration process to take decisions above the heads of local people—is a spectacularly wrong response to a very real problem, and precisely because those decisions arouse such strong emotions, we must find better ways of involving people, not shutting them out. If people suspect a stitch-up, and see solutions imposed from on high, they will understandably fight back hard. Does the spectacle of tens of thousands of people marching in Stafford or on the streets of Lewisham not give Ministers pause for thought that this new approach might seriously set back the goal of better public engagement in the NHS?

--- Later in debate ---

[Dr Poulter]

I thank all my hon. Friends and other hon. Members for their contributions to this important debate. I shall respond to as much of what has been said as I can in the time available.

The House is being asked to consider specific changes the Government are making to the existing trust special administrator regime, which was introduced under the previous Government. I stress at the outset that the TSA regime will not be used routinely, and will only be used when all other processes at a local level to deal with the challenges of hospitals have been exhausted. The usual approach for locally led reconfigurations will remain. TSAs are for rare and extreme cases of failure. This is not a power to be used to reconfigure services routinely—we need to get that right at the outset. This is a system of last resort, and other actions will of course be taken first to address the problems of trusts in difficulty.

[Richard Fuller]

Let me make the Minister aware of a real and live example: the decision of Bedford and Milton Keynes clinical commissioning groups to look at their hospitals in an ongoing review. Will the Minister provide me with a hand-on-heart, job-on-the-line assurance that these powers will not be used in that review?

[Dr Poulter]

I can assure my hon. Friend absolutely that these are locally driven reviews of clinical services—driven by local commissioners, clinically led and absolutely nothing to do with the TSA process which we are discussing today. Any scaremongering that is taking place locally is, frankly, outrageous and to the detriment of the hard work that local professionals are doing to design the right health care services.

As I said, the TSA system is one of last resort. It is about ensuring that local solutions are initially found for trusts in difficulty. That may include support from the NHS Trust Development Authority or Monitor, as part of a special measures process, or it may involve more rigorous inspections by the CQC. Other support may include requiring the publication of action plans to tackle quality or financial problems, buddying with other trusts, or making management changes. All other such processes will have had to be exhausted before the TSA process would be necessary.

Oral Answers to Questions

Richard Fuller Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

I know that the care services Minister would have liked to be here but he is at his son’s graduation today. I will pass on the hon. Gentleman’s question and ensure that he receives a full response.

[Richard Fuller (Bedford) (Con)]

At the end of this month, the East of England Multi-Professional Deanery will remove junior doctors in paediatric services from Bedford hospital. That will reduce paediatric services, which will obviously cause major concerns for families with children in Bedford and Kempston and north Bedfordshire. Will my right hon. Friend join me and my hon. Friend the Member for North East Bedfordshire (Alistair Burt) in calling for an open and independent inquiry into why clinical supervisory failures continued at Bedford hospital and were not addressed, and into the terrible consequences that resulted from that?

[Dr Poulter]

I am sure my hon. Friend will be pleased that Health Education England, supported by the General Medical Council, took such rapid action to address concerns over patient safety and the supervision of junior doctors at his hospital. It is right that a rapid action plan has been brought in by local health care commissioners and Health Education England in order to support that, put in place the right supervision for medical staff, and ensure we put things right as quickly as possible.

Health and Care Services

Richard Fuller Excerpts

Wednesday 3rd July 2013 Commons Chamber

[Mr Dorrell]

I will come on to the impact on pay later. My hon. Friend is right that the challenge antedates the election of this Government and that it increasingly looks beyond this Parliament, as did last week’s public expenditure announcements. There are specific challenges implicit in the Nicholson challenge for the coalition and for the Opposition. To my colleagues in the Conservative party, who sometimes ask why we have a ring fence around the national health service, I simply say, “Understand what you are asking.” We are already strapping ourselves to the mast indefinitely into the future of meeting a rise in demand of 4% per annum without substantial growth in real resources. Looking back, we see that the national health service has delivered a 1% efficiency gain trend rate over its first 60 years, and the national average for the rest of the economy is 2%. We are expecting the health and care system to deliver a 4% efficiency gain. To anyone believing that we are likely to be able to meet demand for health and care to acceptable standards against a background of reduced resources—in other words, more than a 4% efficiency gain year on year—I say, “Do the maths.” That is the challenge to the Conservative party.

[Richard Fuller (Bedford) (Con)]

Will my right hon. Friend give way?

[Mr Dorrell]

Will my hon. Friend forgive me if I complete the challenge so as to be even-handed, as the Chair of a cross-party Committee should be?

Some Labour Members may wish to look for ways to avoid the difficult questions posed by the Nicholson challenge, but we need to remember that if we were to try to meet demand without addressing any of the efficiency questions—to take it to the other extreme—we would need £5 billion a year of new money over and above keeping up with inflation. That is more than 1p on income tax year on year, or 6p on income tax in the lifetime of a Parliament, to meet demand in the health service, unless we address the Nicholson challenge.

The conclusion that the Committee puts to the House is that the Nicholson challenge is unavoidable. Anybody who takes any serious interest in health and care has to address it. Nobody seriously believes that any Government will put up income tax by 6p in the pound in the life of one Parliament simply to fund health and care, and nobody in my party seriously thinks that we can avoid meeting demand for health and care. If we cannot avoid meeting that demand, we have to deliver a 4% efficiency gain out of the service merely to allow it to live within the current real resource available to it. That is the Nicholson challenge, and it is why the Committee—from a cross-party standpoint—has said, from the beginning of this Parliament, that it is the most important challenge facing the health and care system.

[Richard Fuller]

I wish to challenge my right hon. Friend on the 4% efficiency requirement that is, essentially, the 4% increase in demand that we expect. I am a big believer that history is a good guide to the future, and I understand the changes in demography that will push that challenge. How much of the demand comes from a quantum increase in demand and how much from a price increase for the inputs into the health budget?

[Mr Dorrell]

I do not wish to detain the House for the whole of the time available for this debate, but my hon. Friend raises an important question about how that demand is made up. The interesting thing about the drivers of demand—rising expectations, the cost and availability of modern medicine and the implications of an increasingly elderly population—which each new Front-Bench spokesman reveals as a newly discovered truth, is that they were first discovered by Rab Butler when he became Chancellor of the Exchequer in 1951. He set up a commission to ask whether the health service was an insupportable burden. The conclusion reached then, and by every successive Government since, in this and in similar processes in other countries, is that demand can be met, but it requires a serious analysis of the nature of the demand and how resources are used effectively to deliver it.

There is a danger in discussing health and care as if they were purely an economic question, especially for those of us who have been employed in the Treasury—like you, Madam Deputy Speaker, and me. There is a danger of sounding like a Treasury Minister and implying that the economic questions are the only issues in this regard. I need only offer names to the House to demonstrate that economics is not the only issue here—Winterbourne View, Mid Staffordshire and Morecambe Bay. Our system faces huge challenges, not just to do with economics but in respect of the quality of service that is delivered on a daily basis. Put simply, it is not enough just to go on delivering the service as it is now because, too often, it fails. Implicit in the Nicholson challenge is the requirement to face profound quality challenges, as they exist in the system, at the same time as squaring the financial circle I have been describing. In some quarters, it is suggested that that is a counsel of despair—that the circle is unsquareable.

The Committee disagrees, which is why the report states, at paragraph 30:

“At a time when steadily rising demand for health and care services needs to be met within very modest real terms funding increases for the NHS and even tighter resource constraints on social care, the Committee remains convinced that the breadth and quality of services will only be maintained and improved through the full integration of commissioning activity across health and social care.”

In other words, it is the Committee’s cross-party view that it is the integration—the reimagining of what health and care need to look like—that is the answer to the questions posed both by the Nicholson challenge and the quality challenges implicit in the names that I mentioned. It is important to be clear why that is the Committee’s view.

Efficiency, as implicit in the context of the Nicholson challenge, is not just about buying a bit more cleverly or holding down costs. It is about understanding what the demand is that we are trying to meet and putting in place the structures—incidentally, I do not mean the management structures—for the delivery of care that are likely to be able to meet the demands placed on them, not over the last 50 years but over the next 20. It is reimagining and driving a process of change through the health and care system that is the only realistic challenge to the financial and quality challenges that I have articulated.

--- Later in debate ---

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I recognise that there is almost no prospect of a return to the 4% annual rises in the health economy that we had got used to, and the right hon. Member for Charnwood (Mr Dorrell) explained the impact on income tax of such a move. The Institute for Fiscal Studies reported that to return to that would require a budget freeze on every other Government Department for the foreseeable future, even allowing for significant growth in our economy. We have to recognise that the NHS will have to make do, therefore.

The NHS is currently halfway through finding efficiency savings of more than £16 billion up to 2016. The savings are coming primarily from pay restraint, administrative cuts and reductions in centrally determined payments. In the long run, pay restraint may lead to a shortage of essential staff and, of course, poor pay and conditions is a factor in the poor-quality social and residential care we already see. As my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) pointed out, social services directors say that reductions in payments to care providers are leading to a fall in the quality of the care they are able to commission, and that often leads to a cycle of admissions to hospital.

Although it is politically convenient to scapegoat administrators, even the Minister must recognise that there is a limit to efficiency savings in administration. In these circumstances, the decision to waste so much on a top-down reorganisation now looks a little stupid.

[Richard Fuller]

The hon. Gentleman has raised the issue of low pay in certain sectors. He will know from the evidence of the Select Committee report that 16 of the 42 trusts stated that pay amounts to at least 50% of the total cost pressures. Does he think there is a case throughout the NHS for looking at managing down the pay of the more highly paid, so that those on the bottom can get higher increases?

[Steve McCabe]

There is some merit in looking at that, but when the people at the top end are scarce, we must be careful not to lose them to other countries. That is a challenge.

Today’s announcement about charging foreign nationals was strange in the sense that it seems to undercut existing private providers such as BUPA. I am not quite clear how that will save money. I fear it is the kind of posturing that may well end up costing us money, rather than saving money.

Like others, I welcome the Chancellor’s decision to allocate £3.8 billion to the joint NHS social care budget, but I would like to know an awful lot more about how it will be allocated and spent. In particular, I would like to know how the Minister hopes to measure its impact on medical services such as accident and emergency and hospital beds.

I would like us to have a statement on the proposed pathfinder integrated care pilots, because many of us are curious to know where that is going. It seems to me that there is not an awful lot of point in proclaiming the virtues of pooled budgets unless we know exactly what the Secretary of State thinks he is going to achieve. We have an idea from the Health Committee about where it thinks that might go, and the shadow Secretary of State has sketched a vision, but so far we have had an announcement from the Chancellor about making money available yet we do not have any idea what the Secretary of State hopes to achieve through that measure.

I would like to make one suggestion to the Minister: he should take a look at the home from hospital care service, which I understand operates in several parts of the country, and which was inspired by the work of Geraldine Amos almost 40 years ago now. In Birmingham, that service helps people move from hospital back into their own home and community and, of course, frees up hospital beds. It is quite a limited service in Birmingham at present, as it is currently financed by a grant from Birmingham city council, and I am not sure how much longer that will last, given the pressure on local authority budgets. That is, however, one example of how quite a small amount of money can be used to make quite a big impact in getting people back and settled at home, and trying to stop repeat admissions and bed-blocking. The recent NHS Confederation survey of chairs and chief executives revealed that 50% of respondents believed that the financial pressures have affected waiting times and access in the past 12 months and that 70% believe that waiting times and access will be affected by the continuing financial pressures in the next 12 months. So it is slightly strange that we have heard so little from the Government about how they plan to redesign services so that they are able to unlock more sustainable efficiencies for the future.

Given the answers I have received to some written parliamentary questions, my impression is that far from having a vision for the NHS, Ministers are seeking to evade responsibility for it. I have lost count of the number of written answers I have received advising me to contact this body or that body when I have asked the Minister for basic information and figures. We need a bit more clarity about the Government vision, and local communities and their representatives, including local and national politicians, should be properly engaged in that vision. That is one area where we could all be in it together; we could all be party to some kind of change programme, which would help us to redesign the services and to plan an NHS that will have to operate with fewer resources in future.

My recent experience of trying to obtain straight answers on the future of the NHS walk-in centre at Katie road in my constituency does not fill me with any optimism. Why on earth should clinical commissioning groups be allowed to keep private and secret a report on the future of walk-in centres, given that the report was not even commissioned by them? Why should the local Members of Parliament not be given access to that report? Why on earth set up a body such as HealthWatch if it does not get automatic access to it?

I would really like to know a bit more about that Government vision, and I would be particularly interested to know what they want to do to manage some of the growing pressures to which hon. Members have referred. I would like to know the Government’s policy with regard to the greater prevalence of long-term conditions such as diabetes and dementia. Like the hon. Member for Southport (John Pugh), I think it is hard to see the impact of health and wellbeing boards in that area, not because they are not bringing the right mix of people together, but because their chairmen are currently engaged in a line-by-line review of budgets designed to exclude everything that is not a statutory obligation. It is difficult to see how such bodies will be the ones with vision about long-term conditions when that is the level at which they are currently operating.

The Secretary of State should give a clear commitment to tackling the problem of conflicting incentives in the NHS. Acute trusts are paid for their activity through the tariff, while primary care and community care is paid through block contracts which actually serve as a disincentive to activity. I welcome the news that Monitor and NHS England are to examine this problem, but we need some response to it fairly quickly.

In conclusion, I recognise that we are discussing the estimates made possible by the economic circumstances of the country, but it remains the responsibility of the Secretary of State to provide vision and leadership for the NHS, even in such difficult times.

Thalidomide Trust (Grant)

Richard Fuller Excerpts

Thursday 20th December 2012 Commons Chamber

[Richard Fuller (Bedford) (Con)]

I join other right hon. and hon. Members in praising the dedicated, intelligent and sensitive leadership of the Thalidomide Trust over many years. The news from the Minister will be welcomed by thalidomide survivors throughout the UK, including in my constituency by a friend of mine and his wonderful family. The issue for many thalidomide survivors is the pursuit of an independent everyday life. Will the Minister advise me and the House why the decision was made to have a 10-year grant rather than a lifetime grant, which would have eliminated all uncertainty? I am very interested in the Minister’s comments on that.

[Norman Lamb]

We had a genuine judgment to make. On the one hand, I wanted to provide a good deal of certainty for a lengthy period, but this is a unique group of people. Their health is deteriorating, but we do not yet know what the prognosis is for the rest of their lives. It therefore might have been dangerous to allocate a sum of money for the rest of their lives. For all we know, their needs may grow considerably. It is therefore right to take stock in 10 years’ time and make a judgment on their needs at that stage.

Adult Social Care

Richard Fuller Excerpts

Monday 16th July 2012 Commons Chamber

[Liz Kendall]

I was stating the facts about the care crisis, which have been made clear not by me but by organisations representing older and disabled people, by local councils and by the NHS. It is the Government’s denial of the existence of the care crisis and their insistence that there is enough money in the system that I am seeking to correct.

As I have said, the Government have failed to recognise, let alone tackle, the care crisis, and they have failed to face up to the difficult decisions that we need for the future. Their progress report on funding merely says that the Government support the principles of Andrew Dilnot’s commission on the funding of long-term care and support. They now claim that it is only right for Dilnot’s proposals to be considered as part of the spending review. That was not their view two years ago, when they made a clear promise in their NHS White Paper to legislate on a new legal and financial framework in the current parliamentary Session. Now we have only a draft Bill to reform social care law alone. At best that means that there will be no change in funding before the next general election, and at worst it means no change at all if the Government return to power.

[Richard Fuller (Bedford) (Con)]

Will the hon. Lady give way?

[Liz Kendall]

I want to make a little more progress.

According to yesterday’s edition of The Sunday Telegraph, Andrew Dilnot has said that the delay has left older and disabled people in fear and misery. He expressed serious concern about the possibility that the Government will set the cap at a far higher level than that proposed by his commission—at £75,000 or even £100,000 rather than £35,000. He also said:

“if you go beyond £50,000 it is less effective in giving reassurance to the population and ceases to be a way of helping people with lower levels of assets.”

Instead of making real progress on funding reform, the Government trumpeted proposals for a national deferred payment scheme, providing loans to cover the costs of residential care.

[Liz Kendall]

It was Labour Members who proposed cross-party talks, and it was Government Members who decided unilaterally to publish the progress report on which we had been trying hard to agree. The hon. Lady accuses Opposition Members of not being serious about funding reform. We are, and I will set out what we would like to happen so that those talks can proceed.

The deferred payment schemes that were announced last week already exist in some parts of the country and are currently interest-free, but according to the Government’s plans interest will be charged, which will make loans more expensive than they are now. Many councils remain utterly unclear about how they will find the money to pay for those schemes. As the Local Government Association says,

“Councils are not banks and the implication of this level of debt in an already overstretched system needs urgent attention.”

The truth is that the Government have so far ducked the care challenge, and the reasons for that are clear. First, owing to their disastrous economic policy, they are now borrowing £150 billion more than they originally planned to borrow. The Treasury has pulled the plug, and has kicked long-term care funding into the long grass.

[Richard Fuller]

I thank the hon. Lady for giving way. As she recognises, cross-party consensus is required if we are to solve the social care problem. Care workers—the people who actually provide the care to people—do not get sufficient attention, however. One of the problems they have suffered from over many years is per-minute billing. Does she recognise that our changes to get rid of per-minute billing are worth while, and what impact does she envisage that will have on the provision of care over the long term?

[Liz Kendall]

The hon. Gentleman raises a serious point. I know from shadowing care home assistants in my constituency that commissioning by the minute can cause considerable problems. For instance, it does not allow the staff to meet the individual needs of those who are most desperate for help and support. As I have said, we welcome many of the proposals in the White Paper, but they need to be properly funded, and that is why I am so concerned that the issue of long-term care funding has been kicked into the long grass.

The second reason why the Government have failed on this issue is that the Health Secretary’s obsession with reorganising the NHS has been a disastrous distraction. Two years have been wasted on an unwanted and unnecessary reorganisation, when everyone should have been relentlessly focused on the key challenge of our ageing population: meeting rising demand for care at a time of unprecedented financial pressure.

The third reason is the most fundamental of all. Many Conservative Members have still not grasped the basic principle that we must collectively and universally pool the risks of facing catastrophic care costs, as we do in the NHS, in order to make things better and fairer for us all. A voluntary system that leaves it up to individuals and their families alone will not work. The only way forward is through an effective partnership between individuals and the state.

--- Later in debate ---

[Paul Burstow]

When there is a crude race to the bottom and contracting is by the minute simply to ration access to the service, resulting in a care home provider or home care provider delivering care on a very time-and-task oriented basis, that is totally unacceptable. We know that in places such as Wiltshire, where home care services are organised on an outcomes basis, that is delivering better results for the service users and releasing resources to reinvest in services.

[Richard Fuller]

When I intervened earlier, Mr Deputy Speaker, I forgot to refer hon. Members to my entry in the Register of Members’ Financial Interests as the director of two care companies.

The Minister is absolutely right to say that there is a patchwork of responses from local authorities. I absolutely welcome the end of per minute billing, which is a tremendous step forward, but I draw the Minister’s attention to the comments made by the hon. Member for Stretford and Urmston (Kate Green). She talked about the pressures of meeting the minimum wage and the pressures that local councils are putting providers through. The Government must consider that issue, because there is exploitation in some areas. As businesses and charities try to meet the requirements local councils are putting on them, workers are finding it difficult to achieve a sustainable wage in providing care services.

[Paul Burstow]

My hon. Friend is absolutely right to highlight that issue, which the Low Pay Commission has commented on over a number of years, including before this Government came into office. In our White Paper, we make it very clear that local authorities, as the commissioners of such services, must be mindful of their responsibilities in ensuring that the resources they provide to providers are sufficient to allow them to fulfil their legal obligations.