NHS and Social Care Funding
Robert Flello Excerpts(7 years, 4 months ago)
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Jonathan Ashworth
My hon. Friend makes her point eloquently and represents her constituents powerfully, as she always does in this place. I hope the Secretary of State will respond to some of those points.
Robert Flello (Stoke-on-Trent South) (Lab)
The Royal Stoke in my city is under intense pressure. No doubt, we will hear shortly from the Secretary of State that that is winter pressure. Winter has not really started. We have not really had a winter, yet we have been under this pressure not for a few weeks but for months. The whole NHS system is broken. That is the problem that we really face.
Jonathan Ashworth
My hon. Friend makes an eloquent point about the particular situation that has been facing Stoke for some time, of which many of us are aware. I hope the Secretary of State will touch on the situation in Stoke, because sadly it is one that we have had to raise previously.
Jonathan Ashworth
I will give way in a few moments. If the Secretary of State wants to lead a discussion about the future of the four-hour A&E standard, will he tell us what discussions he has had with the Royal College of Emergency Medicine? It argues that the four-hour standard is a vital measure of performance and safety, and believes the standard should apply to at least 95% of all patients attending emergency departments. If he says he is still committed to that four-hour standard, is he still committed to maintaining it at 95%?
Jonathan Ashworth
My hon. Friend has had one bite of the cherry, so if he does not mind I shall make a little progress and then I will do my best to get as many people in as possible.
Does the Secretary of State agree—
Catherine West (Hornsey and Wood Green) (Lab)
I do not know the collective noun for Government Chief Whips and Opposition Chief Whips, but I believe it is a crop of Whips. Anyway, it is an honour to follow two esteemed former Chief Whips.
I begin on a slightly less happy note by quoting from an educational psychologist who wrote to me this week:
“I and my colleagues are frequently overwhelmed, frustrated and in disbelief about the amount of work we need to manage, the difficulties in working across services because of cuts and changes to policy. Everyone is perpetually exhausted and burnt out. When we’re not at work because of training, illness or leave we feel simultaneously guilty and relieved.”
Her email went on to describe how she is the only clinical psychologist on duty in the whole of a very busy inner-London constituency.
I wish to comment briefly on the juncture between primary and secondary care, and on acute care. In the past 18 months, many of us have had the experience of fighting for a general practitioner’s service. The Westbury clinic, which lies just between my constituency and that of my right hon. Friend the Member for Tottenham (Mr Lammy), has been quite a battleground in the past 12 months. He and I have had to really fight for basic GP services for our constituents. I believe this situation is replicated across the country, and it is obviously what is leading to the build-up of individuals; as the Secretary of State has said, we have so many people turning up to A&E who probably could be seen by a GP but simply cannot get an appointment.
Robert Flello
One problem we face in Stoke-on-Trent is that we are about half a dozen GPs away from the whole GP system collapsing, because as GPs are retiring or leaving for other reasons, their patients are then going to the ever-smaller number of GPs that there are. Two GPs are due to retire shortly, but if we lose half a dozen the whole GP system in Stoke-on-Trent is liable to collapse completely. What will that do to A&E?
Catherine West
That leads to an individual patient waiting 35 hours on a trolley to be seen, as happened this weekend. I know that a number of Members have made this point, but it bears repeating: it is disgraceful that staff are blamed when this is going wrong, given that the responsibility clearly lies with politicians—with the Government. I was upset to see that today’s front page of The Times blames the senior civil servant at the heart of the NHS, as this is really down to poor Government planning.
National Health Service Funding
Robert Flello Excerpts(7 years, 5 months ago)
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Jonathan Ashworth (Leicester South) (Lab)
I beg to move,
That this House notes with concern that the deficit in the budgets of NHS trusts and foundation trusts in England at the end of the 2015-16 financial year was £2.45 billion; further notes that members of the Health Committee wrote to the Chancellor of the Exchequer about their concerns that Government assertions on NHS funding were incorrect and risked giving a false impression; and calls on the Government to use the Autumn Statement to address the underfunding of the NHS and guarantee sustainable financing of the NHS.
I begin by reminding the House that, six years ago, the then Conservative leader promised to
“cut the deficit and not the NHS.”
The previous Chancellor, the right hon. Member for Tatton (Mr Osborne), told us that he would “properly fund public services” and that
“investment in public services would come before tax cuts.”—[Official Report, 27 November 2006; Vol. 453, c. 837.]
Robert Flello (Stoke-on-Trent South) (Lab)
Will my hon. Friend give way on that point?
Robert Flello
My hon. Friend is most generous. He might have missed something. Did the Chancellor not say that he would wipe out the deficit by 2015?
Jonathan Ashworth
My hon. Friend is eagle-eyed, and I congratulate him on reminding us that the Government should have balanced the books by 2015, and that they completely failed on that pledge.
Then the new Prime Minister made this promise:
“We will be looking to ensure that we provide the health service that is right for everyone in this country.”—[Official Report, 7 September 2016; Vol. 614, c. 333.]
Fine words, but it is by their deeds that they shall be known. What did we actually get? An NHS that is going through the largest financial squeeze in its history. Far from protecting the NHS through the years of this Tory Government, NHS spending will represent an average annual increase of just 0.9%—a decade of barely any increase in spending despite an ageing population with increasingly complex needs.
Mr Hunt
It is noticeable that the two potential solutions we have heard have been from Opposition Back Benchers—the right hon. Member for Leicester East (Keith Vaz) and the former shadow Chief Whip, the right hon. Member for Doncaster Central (Dame Rosie Winterton)—and not from the Opposition Front Bench. My hon. Friend makes an important point.
The shadow Health Secretary is right to hold the Government to account for the funding of the NHS and the social care system, but it is a big mistake to distil all issues around the NHS into the simple issue of money. That subcontracts the responsibility for safe, high-quality care to politicians. If we are going to be the safest and the best quality system in the world, that has to be everyone’s job, everyone’s focus and everyone’s commitment—politicians, yes, but managers, doctors, nurses, porters, healthcare assistants and every single person working in NHS.
On the way forward, we first need to move to accountable care organisation models and the “Five Year Forward View”, including the STP process. The shadow Health Secretary called STPs “secret plans”, but in fact 28 of the 44 have been published and the rest will be published before Christmas. Many in the House, on both sides, objected to the Health and Social Care Act 2012 because they felt it did not do enough to support integrated care. Well, now we have a process that is bringing together the NHS and the social care system, acute trusts and primary care, at a local level. That is a big prize and we should support it, not try to make political capital out of it.
Robert Flello
In Stoke-on-Trent, the CCGs sit on the STP group. We have still not seen the report, but we have seen an executive summary. When the STP group suggests one thing, the CCG undermines it by closing community hospitals and cutting community beds. They are not working together; they are working against each other.
Mr Hunt
That is exactly what we need to sort out. We have the STP process to stop people doing their own thing, instead of having a co-ordinated, well-planned strategy. If we stick with this process, embrace innovation and technology and retain a relentless focus on safety and quality of care, in this Parliament we will see a million more people accessing mental health treatment every year; 5,000 more doctors working in general practice and a transformation of services through GPs; a new four-week cancer waiting time standard that will save 30,000 lives a year; more failing hospitals turned around; the weekend effect tackled; more doctors and nurses; and an NHS staying true to the promise made to patients in 1948 that safe, high-quality care would be there for everyone, regardless of income. That is what this Conservative Government will deliver, and I urge the House to support the amendment.
Social Care
Robert Flello Excerpts(7 years, 6 months ago)
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Barbara Keeley
I certainly will join my hon. Friend in commending the council. It is one of the things we talked about to the care staff today. Why should people be paid vast profits from public money, when care staff are so badly paid?
The reasons for the social care funding crisis are clear: insufficient funding in the face of growing demand and a fragile market in the provision of social care. We know that people are living longer and that demand on social care services continues to increase. People aged 85 and over are the group most likely to need care, and their numbers are projected to rise sharply in the coming years. Moreover, the gap between need and funding has grown wider since 2010.
Robert Flello (Stoke-on-Trent South) (Lab)
The sustainability and transformation plan for Staffordshire, some of which has been leaked to me, NHS England and NHS Improvement having categorically refused to make it available to Members of Parliament, shows a deficit for Staffordshire over the coming years of more than £250 million. Is that not appalling?
Barbara Keeley
It is dreadful. The deficit in Greater Manchester is £1.75 billion, so the problem is the same up and down the country.
We have had six years of Government cuts to local authority budgets, and that has seen local authority spending on the care and support needs of older and disabled people fall by 11% in real terms. In fact, the number of people getting publicly funded support has plummeted: 400,000 fewer now than in 2009-10. Such facts are shocking, but behind the statistics are real issues: the impact that cuts to social care are having on the NHS, on people who need care and on unpaid family carers.
First, I will deal with the issues that the crisis in social care causes for the NHS. As the Nuffield Trust states:
“Hospitals have struggled to meet the needs of the older age group in a timely way, in both emergency departments and inpatient admissions”.
The most visible manifestation of the pressures caused by cuts to social care budgets is the rapid growth of delayed transfers of care from hospital. The September figure of over 196,000 delay days is another record—the highest figure for six years—and it comes not in winter but at the end of summer. That means for the NHS 6,700 patients stuck in hospital. The most common causes are waiting for a care home placement and waiting for a nursing home placement.
The funding that was supposed to help with these issues is the better care fund, but there is no extra funding for social care in the fund this year and only £100 million next year.
Mr Hunt
The hon. Gentleman is absolutely right to say that the presence of social workers in hospitals is vital in discharging people, but I think he will be quite shocked to know that 50% of all the delayed transfers of care in the entire NHS happen in just 20 local authority areas. There are many places that are doing these things well, even in the current challenging financial circumstances, but there are others that, frankly, could do a lot better.
Overall, what we see is a picture where the best councils have expanded funding and provision. For example, last year, Windsor and Maidenhead increased its spend by 6.4%, and the number of people accessing long-term care is up by 8%. That was a Conservative council, but the Labour council in Doncaster also chose to increase its social care budget by 10%—nearly £8 million—and it is looking after nearly 7% more people.
This is not just about funding; it is also about the speed of health and social care integration and about local leadership. Where such leadership exists, important changes are happening even now. For example, in Cheshire East, dedicated workers are supporting people with early-stage dementia, saving more than £4,000 a year per client in social care costs while improving the service for patients. Milton Keynes is another good example: its innovative pilots have cut delayed days attributable to social care by nearly three quarters.
Others, regrettably, have chosen to cut funding and provision. There are many reasons for that, but the one thing that is difficult to explain to the public is why, at times of such challenge, local authority reserves have increased by nearly £10 billion since 2010. The hon. Member for Worsley and Eccles South made a fair point when she said that there has never been greater financial or operational pressure on all councils. Like the NHS, there is huge pressure, but unlike the NHS, it has not been possible to protect their budget since 2010.
What is the way forward in this very difficult situation? I think that it is a combination of the right financial decisions locally and recognition by local authorities and the NHS that they are part of the same team. That is why, as has been said, the sustainability and transformation plan process is so important.
It is easy to knock a process whereby local areas come together to have yet more meetings, which we are pretty good at doing in the NHS and social care system, and it is also easy to characterise those meetings as secret, but the fact is that people do not want to publish their plans until they are ready, and they will all be published by the end of this year. Many Members on both sides of the House criticised the Health and Social Care Act 2012 because they felt that it did not do enough to promote integrated care, but now we have a process to do that. That is massively important for the social care system, as this is the first time that local authorities are properly involved in NHS planning. Indeed, four of the STPs—namely those for Greater Manchester, Norfolk and Waveney, Nottinghamshire, and Birmingham and Solihull—are headed by local authority leads. On Monday, the head of operations at NHS England told me that there was not one STP meeting that he had been to where a local council was not represented. At the moment, it is a planning process and it needs to be delivered, but planning needs to happen collaboratively. It is a significant change for the NHS and social care system, but it is finally happening.
Robert Flello
So why is it that Stoke-on-Trent City Council tells me that no council officers or councillors have been involved in the Staffordshire STP? Given that it covers the whole of Staffordshire, the more deprived areas of Stoke-on-Trent and north Staffordshire will, in effect, subsidise south Staffordshire, because it has greater debts. Why cannot MPs have input into the plan? It is absolutely disgraceful.
Mr Hunt
Everyone will have input into the plan, but the hon. Gentleman might want to ask his council why it is complaining about pressures on the social care system when it has refused to use the social care precept and raise extra money, which could be desperately used for social care. That would make a real difference to his constituents.
Where councils and local NHS organisations are working together, we are seeing some real financial savings that are having a big impact. For example, Northumberland has saved £5 million through integrated services with Northumbria NHS Trust, and there has been a 12% reduction in demand for residential care as a result. In Oxfordshire, where the local authorities, clinical commissioning groups and trusts are all working together, discharge delays are down 40% in six months, and those due to social care have more than halved.
Land Registry
Robert Flello Excerpts(7 years, 10 months ago)
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Mr David Lammy (Tottenham) (Lab)
I beg to move,
That this House notes the important role the Land Registry plays in registering the ownership of land and property in England and Wales; further notes that the Land Registry has made a surplus in 19 of the last 20 years and paid back £120 million to the public purse in 2015 alone; believes that any privatisation of the Land Registry will have serious consequences for transparency and accountability in the UK property market and hinder efforts to crack down on corruption and money entering the UK property market via offshore jurisdictions; expresses grave concern that all the potential bidders for the Land Registry have been found to be linked to offshore tax havens; notes that the Government has acknowledged that property can provide a convenient vehicle for hiding the proceeds of criminal activity; notes that the Prime Minister stated in July 2015 that there is no place for dirty money in Britain; regrets the Government’s decision to seek short-term profit at the expense of the public interest; opposes the proposed privatisation of the Land Registry; and calls on the Government to reconsider that proposed privatisation.
I thank the Backbench Business Committee for enabling me to bring this important debate before the House. In supporting this motion, signing the letter I sent to the Business Secretary on 2 June and signing early-day motion 160, well over 100 Members drawn from eight political parties have made clear their opposition to the privatisation of the Land Registry. I hope that the Government take note of the strength of opposition to the proposal before it is too late.
Robert Flello (Stoke-on-Trent South) (Lab)
I congratulate my right hon. Friend on securing this important debate. I am sure that, like me and almost every Member of this House, he has been inundated with emails on the subject. Our constituents are up in arms.
Mr Lammy
My hon. Friend is absolutely right: the strength of the deep concern felt in the country is expressed in the letters that hon. Members have received. I look forward to hearing what the Minister says, because he will be aware that it is with regret that I must bring the debate to the House today, so soon after the Government last attempted to privatise the Land Registry in 2014.
John Stevenson
My hon. Friend makes an interesting point, and unsurprisingly I could support many of the arguments for privatisation, but I will come to that in due course.
I want to make two specific contributions to this debate. First, I shall comment as a practitioner—as someone who actually uses the services of the Land Registry and whose firm works with the Land Registry on a daily basis. Secondly, I shall comment as a Conservative politician.
Speaking as a practitioner, the Land Registry is an extremely important aspect of the conveyancing and land ownership process. Indeed, it is central to the whole system as over 75% of land is already registered and ultimately all land will be registered, at which point no physical deeds will be required. Therefore, the accuracy and integrity of the register is absolutely vital. Each day thousands of transactions are logged through the Land Registry portal, queries are raised, and in some cases disputes are resolved. It is part of the everyday work of the conveyancer.
However, we have to accept that the Land Registry is not in any way perfect. Most practitioners would confirm this and I suspect the Land Registry itself would also acknowledge it. The Land Registry does make mistakes, it has backlogs, it needs investment, and it needs to modernise—it is in many respects just like many other organisations that have similar issues.
Robert Flello
The hon. Gentleman lists a number of things that, understandably, need to be done, but the Land Registry makes a profit. Why are the Government not putting the profit back into improving it?
John Stevenson
The Land Registry does make a profit, and it is quite rightly trying to modernise. It also continuously develops its programmes, and all conveyancers are aware of that.
Like many other practitioners, I acknowledge that the Land Registry plays a vital and central role in the property market. Practitioners greatly value and respect the services that it provides. As a legal practitioner, I see the worth of the Land Registry and its services. We should also not forget the many skilled people who work for the Land Registry, all of whom ensure that the legal profession, the owners of land and the financial institutions are well served.
As a Conservative politician, not unsurprisingly I believe in a market economy, in competition and in competitive markets. I have absolutely no issue with the privatisation of businesses or industries, as I firmly believe that, more often than not, private sector ownership leads to greater efficiency and innovation and better value for money for the taxpayer and the consumer. I do, however, believe in a strong liberal democracy, in the importance of the rule of law and in the significance of property rights in a market economy—in this case, the rights relating to the ownership of land. We must therefore tread very carefully when considering the future ownership of the Land Registry, given its central role in the property market.
The Land Registry is at the very centre of land and property rights in this country, and the integrity of the system is critical. Its importance is such that all solicitors, property owners, leaseholders, lenders and financial institutions must have complete confidence in its integrity, openness and honesty. It has to be trusted. Any doubts or concerns about its integrity, about possible conflicts of interest or about misuse of information could affect this central part of our capitalist system. We must also recognise the fact that the Land Registry is a natural monopoly, a bit like the police or other institutions that do not lend themselves to competition. Such monopolies, which are of great importance to the very fabric of our system, must be treated with great care.
A&E Services
Robert Flello Excerpts(8 years, 10 months ago)
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Mr Reed
I congratulate the right hon. Gentleman on his knighthood—it is remiss of me not to have done that. He will know that real-terms increases and cash increases are not the same. He will also know, because he voted for it, that the budget in Wales has been cut by this Government by more than £2 billion. Let us compare like with like.
The Royal College of Nursing has calculated that almost £1 billion—£980 million—was spent on agency staff in the last year alone. Those and other choices made by this Government have meant that, collectively, trusts in England reported a total deficit of £822 million in 2014-15. That is simply unsustainable. A recent survey by the King’s Fund found that 90% of trust financial directors and 85% of commissioners are concerned about the financial state of their local health economies, and that view will be shared by many Members on both sides of the House. An investigation by Pulse revealed that clinical commissioning groups were being forced to use their 2015-16 winter pressures allocations just to maintain regular services.
Questions must also be asked about this week’s revelations that thousands of foreign nurses working in our NHS could be forced to leave the country as a result of the Government’s immigration rules. The RCN points out that this would cause chaos for the NHS and waste tens of millions of pounds—the Secretary of State laughs as I mention that. It would make matters much worse for patients and for front-line clinicians. Will the Minister tell us how many nurses will be lost from A&E and how many will be lost in total as a result of this move? Where in the country will they be lost? How will the vacancies be filled? What will this cost? Has he or any Minister in his Department made representations to the Prime Minister about the effects of this policy? If so, will he share those with the House? When did Health Ministers know that this policy might cause so much damage?
Robert Flello (Stoke-on-Trent South) (Lab)
When the Minister replies it will also be interesting to hear him say exactly how that cut and restriction on nurses will impact on the Royal Stoke university hospital, which had the great misfortune, for patients and the public more generally, of topping the list for the longest waits last winter of more than 12 hours on trolleys.
Mr Reed
My hon. Friend is absolutely right. Stoke deserves better, and no one has worked harder than him to ensure that it gets something better. Let us ensure that the Minister answers those points.
The understaffing crisis represents a dire situation that will only get worse unless the Government demonstrate an understanding of these issues and give them the attention that they deserve. We know that, as well as deficits this year, the“Five Year Forward View” is based on assumptions that the NHS can save £22 million by 2020. Will the Minister assure us that this will not result in any fewer medical staff or cuts to hospital or community services? Will he also commit to placing the analysis and the assumptions behind the efficiency plans in the public domain so that we can have an informed and honest debate about NHS funding? We do not want a programme of services being set up to fail and then being cut by stealth.
Mr Reed
I am grateful to the hon. Gentleman for his intervention. I absolutely agree that models such as that and local best practice can exist in pockets all over the country. It is just a shame that so many health economies are getting cut to the bone, because that stops them developing such care models. He is right that it is precisely that kind of integration that points the way to the future. Have the effects of these public health budget cuts on primary care and accident and emergency been modelled by the Department, and will the Minister share that work with the House? If that work has not been done, will he explain why? Has the Department consulted on these latest cuts, and what was the response?
I now wish to turn to the situation in general practice. In the previous Parliament, we saw a marked increase in the number of people waiting longer for a GP appointment. By 2013-14, almost 6 million people could not get a GP appointment. If the trend continues, that figure could be around 10 million by the end of this Parliament. Those people are often left with little option but to turn to accident and emergency. The GP patient survey suggests that almost 1 million patients went to A&E last year because they could not get a convenient GP appointment. It is clear that the GP workforce crisis is a major driver of the issues under discussion today.
Robert Flello
My hon. Friend is making an extremely good speech and is being very generous in giving way. On that point, Stoke-on-Trent has traditionally had far more patients per GP than the national average, and the age of that population is rapidly approaching, and often way past, retirement age. What we are seeing is not that people cannot get an appointment when it is convenient, but that they cannot get an appointment for days on end.
Mr Reed
My hon. Friend makes the case. What is happening in Stoke, I regret to say, appears to be something of a canary in a coal mine for the NHS around the country, and its issues will increasingly be seen in areas all over the country.
It is clear that the GP workforce crisis is a major driver of the problems. The number of full-time equivalent GPs per head has fallen over the past five years, even as demand has increased.
Ben Gummer
It is a matter of importance, Madam Deputy Speaker, because in this episode of “Health Handbags”, we have been given an insight into the crisis within the Labour party and Labour Members’ inability to understand what the priorities are for the NHS and for the country.
If the NHS and A&E services are of such importance to the Labour party, one would expect the shadow Secretary of State—
Madam Deputy Speaker (Natascha Engel)
Order. If the Minister could sit down for a moment, I will take the point of order, which I imagine is very similar to the previous one. It would be nice if we could move the debate on, as there are several maiden speeches waiting to be taken. It is an important subject and I would like to move on, rather than get bogged down in this. I will take the point of order, and then I hope we will move on.
Robert Flello
I am grateful, Madam Deputy Speaker. For the benefit of new Members on both sides of the House, I think it would be helpful if you spent a moment clarifying when it is in order to challenge the Chair’s ruling on something and when it is not.
Madam Deputy Speaker (Natascha Engel)
Thank you very much. It is the person in the Chair’s decision whether something is within scope or not. I did not take the Minister’s response to my decision as a challenge to the Chair; I merely wanted to point out that it would be nice to get on with the debate and to allow other hon. Members to speak, especially new Members who wish to make their maiden speech. If the Minister could move on, we would all be very grateful.
Child and Adolescent Mental Health Services
Robert Flello Excerpts(9 years, 2 months ago)
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Dr Wollaston
I thank the Minister for that intervention. It is very welcome that we now have waiting time targets as a right for people with mental health problems, alongside those for people with physical health problems, but the challenge is not so much about the budget for children and young people’s mental health services, but what we take that from, because there are no areas of slack in the mental health budget, as he will know. I think that the mental health budget overall must achieve some parity. Again, if we look at prevention and the really small amounts of money, in relative terms, that are required to keep excellent voluntary services running in our communities, we see that it would be the greatest waste and tragedy to lose those vital services in our communities for the want of what are really quite small sums. When children, young people and voluntary services came to give evidence to our inquiry, we heard time and again that what they need is stable, long-term funding. They do not require a great deal of money, but they are currently limping from one short-term budget to another. Another issue raised was that if funding is available, it often gets directed to a new start-up project, not towards a project in the same community that may have proven value.
Robert Flello (Stoke-on-Trent South) (Lab)
The hon. Lady is no doubt aware that some of the small, really good charities will find that a bigger charity that is very good at filling in application forms will get the funding and then subcontract the work back to the small charity that was doing it before, having taken a cut of the funding as well.
Dr Wollaston
I absolutely agree. The other problem is that sometimes those larger national charities may have no local presence or understanding.
We need greater flexibility so that commissioners within health and local authorities are able to provide stable, long-term funding and to set the priorities for these new pots of money. It is always easy to announce new projects, but we must allow funding to be directed at existing services that have a fantastic proven track record. The value for money that we get from these services is extraordinary, as is the value that young people place on them. Young people have told me—this applies particularly to a rural constituency such as mine—that it is no good having a CAMHS service in a neighbouring town if they cannot get to it because there is no transport. That is why voluntary services are so particularly valued.
I was going to discuss our comments on schools, but my hon. Friend the Member for Brigg and Goole (Andrew Percy), as a former teacher, is far better placed to talk about that, so I will leave it to him to elaborate. I just want to touch on the new challenges that young people face with cyber-bullying, sexting, and image sharing. This is a 24-hour pressure; there is no safe haven for them in these circumstances. I welcome the fact that the taskforce will comment on not only the challenges but the opportunities that the internet may give us to assist young people.
Paul Blomfield
My hon. Friend makes a powerful point. It is a relatively small sum of money. Perhaps that indicates that a relatively small level of resource intervention could make a significant difference.
As I was saying, the consequence of the rising demand and falling resource in Sheffield is that some 18% of young people—almost one in five—wait over 13 weeks for treatment. The cuts not only impact on young people up to the age of 17, but have a knock-on effect on adult mental health services and on acute and emergency provision.
Robert Flello
Although demand is rising, there is still a current of demand that does not even present itself. There is a huge level of unmet demand, simply because people do not present themselves to systems such as CAMHS, but try to self-medicate or whatever.
Paul Blomfield
I am very grateful to my hon. Friend for that intervention. While on one level we have seen enormous progress in the openness with which we confront mental health issues and the willingness of people to come forward, we must be deeply conscious that there is still a wider problem of people who do not present. The absence of resource and the inability of the system to support people with needs when they do seek help sends out a powerful message, because young people are very well networked. Those who might be on the tipping point of coming forward to seek help will get the message from their friends, “What’s the point, because you have to wait so long?” That is an important point.
That brings me to the second point that young people raise with me, which is the importance of early intervention. Again, that was emphasised by the hon. Member for Totnes. In the words of STAMP:
“Act now, tomorrow could be too late!”
I want to share the harrowing words of one 18-year-old young woman who is involved in the STAMP project in Sheffield:
“Sometimes I think, do I have to kill myself to get help? I probably do. It happens all the time. People are desperate for help, the only way they can get it is if they are at harm, so people harm themselves or attempt suicide just to get put on another waiting list. It just shouldn't be like that.”
She is right; it clearly should not be like that. Nobody should have to reach crisis point before receiving the support and care that they need, and certainly not our young people.
At a time of increasing need, we need to look at how we can do more with less money. Early intervention is a way of doing that. The hon. Member for Totnes made that point powerfully.
Robert Flello
I appreciate my hon. Friend’s speech very much. He has put a thought in my mind about a point that the hon. Member for Totnes (Dr Wollaston) also raised about early intervention. Given that the cuts to other local authority front-line services have been worse than decimated in places such as Stoke-on-Trent, those services that would have been early intervention-type services—and, indeed, pre-early intervention services—are just not there any more.
Paul Blomfield
I thank my hon. Friend for making that powerful point. The situation in Stoke, Sheffield and Coventry underlines his point that there used to be a hinterland beyond the NHS of youth groups, activities and support networks, many of which were supported by local government funding in combination with funding that was often raised within communities. The withdrawal of that funding, as local authorities have increasingly had to focus on statutory services, has put many of those groups at a tipping point and left the support that is available very weak.
The third point that young people have made to me is about being abandoned at 16. Historically, CAMHS in Sheffield have worked with people up to the age of 16, leaving those beyond that age—before they turn 18 and become part of adult provision—to fall through a hole. Things looked a bit brighter for 16 and 17-year-olds when the clinical commissioning group committed just £300,000 a year to a service for them, although I am not sure why it did not include 18-year-olds as well. However, budgets are squeezed and it has since been announced that the funding will be cut by a third. That is another example of the budget pressures being experienced and it is happening within the NHS as opposed to local authorities, which we have discussed.
In effect, £200,000 allows the service to work with little more than 100 young people aged 16 to 17 in a given year. On funding relative to need, there are 12,627 young people aged 16 to 17 living in Sheffield and it is estimated that 10% of them have some sort of mental health challenge. That leaves more than 90% of those we could expect to need support with no service at all. We cannot keep talking about reducing stigma, eradicating stereotypes and parity of esteem between physical and mental health without funding services properly when people—especially young people—need that help. We have serious questions to answer on the challenges posed to us by the issues raised with me by young people in Sheffield and those raised by the Youth Parliament.
We know that, nationally, mental health problems account for 28% of morbidity, but only 13% of expenditure is committed to mental health. Where is the parity in that? I hope the Minister will address that when he responds to the debate. We need to put our money where our mouth is. I am pleased that Labour has committed to increasing the proportion of mental health spend on CAMHS, which is currently a tiny amount of 6% even though three quarters of adult mental illness begins before the age of 18.
Robert Flello (Stoke-on-Trent South) (Lab)
It is a pleasure to follow the hon. Member for Southport (John Pugh) and his contribution to the debate. He made extremely good points.
I should like to refer to an experience I had some 12 or so years ago of running an organisation in Birmingham called Malachi Community Trust, which worked with young people with emotional, behavioural and mental health issues. More often than not, it also worked with their families, including parents and their wider families, to resolve their issues. We worked with qualified cognitive behavioural therapists and teachers—they were primary age children—in the school setting. It is interesting but deeply saddening that so many items in this extremely good report take me straight back to some of the conversations of 12 or 14 years ago.
I want to give a brief outline in the unfortunately few minutes that are available of what Malachi did—it is still going strong. It used musical theatre to engage with young people and as a tool to identify their issues. It enabled processes to be set up to work with those children and young people who had more profound mental health issues. Pertinently for today’s debate, it acted to stabilise the situation for children who were on waiting lists to see CAMHS staff. Back then, there were three, four and five-month waits, or longer. Malachi was not the only group that did that work, although it was and still is particularly good—I have fond memories of what it did. Malachi and other organisations were very good at that stabilisation. They were good at holding those young people in a place where they were not deteriorating while waiting for CAMHS workers. My fear then, and sadly now, is that an awful lot of children—some of our most vulnerable citizens—are waiting for CAMHS workers and their conditions are deteriorating, and their needs are getting worse and not better, because of the waiting lists.
One of the big issues we identified was family breakdown. Parental conflict and family breakdown is a very strong factor in mental ill health in children. A statistic suggests that one in four young people in Stoke-on-Trent are affected by family breakdown and divorce. That means that approximately 15,500 children in Stoke-on-Trent alone will be affected by parental breakdown and divorce. That does not immediately mean that those children will have a mental health issue, but it is a factor that makes them more vulnerable. To pick up on some of the comments made by the hon. Member for Southport, children need the skills and the ability to have resilience, so that if there are factors that might tip them into having mental ill health issues, they have the resilience to address them. Sadly, for all too many of our children there is not the ability to build that resilience.
My hon. Friend the Member for Sheffield Central (Paul Blomfield) referred to local authorities. The ability to gain that resilience from services such as those offered by local authorities is not possible in Stoke-on-Trent, where local budgets have almost been wiped out for some children’s services. I seem to be constantly talking to people who used to work for the local authority in children’s services, but have now gone off to do other things because they can no longer be afforded. The main thrust of what I want to say is that more than 10 years ago there was a shortage of access to CAMHS. We do not seem to have gone anywhere with that. It seemed to get better, but it is now getting dramatically worse.
Healthwatch Stoke-on-Trent helpfully brought to my attention a list of issues that they are concerned about. When I say “they”, I mean children, young people and the adults supporting them. It makes deeply saddening reading. The first item on their list of what they want is a single point of access for real-time professional advice and guidance that can refer them to mental health services with the support they need when there is a crisis. This was again being talked about more than 10 years ago when I was attending meetings in what was still then, despite the fact it had been going for 10 years, a fledgling CAMHS. Nevertheless, even back then there was talk about having a single point of access. We have come full circle on the need for a single point of access.
Those children, young people and the adults supporting them talk about information, options and guidance to navigate the range of services and pathways available to them, and evidence-based interventions that are appropriate to them, with follow-up support as needed—the right service, first time. It is sad that here we are, so many years later, without that service—or, where a service has been developed, it has gone because of the cuts. The Government are now having to undertake a review to take us back to the probably better work being done in the period leading up to 2010.
These people want a greater use of technology and access to online support. Technology has come a long way in the past 10 years, and I welcome that good suggestion from the children and young people themselves. They would like more support from schools and direct interventions on school premises in the school day, such as counselling, peer mentors and quiet spaces. There are quiet spaces in some of the good schools that I am blessed to have in Stoke-on-Trent. For example, St Thomas More school has a specific arrangement and understanding that young people who feel that they need to go out and get their head together can use the space that has been made available. I am sure other schools do that as well, but that example was highlighted to me. Malachi was doing innovative work on support in schools 15 or 20 years ago. I made the point in an intervention on the hon. Member for Totnes (Dr Wollaston) that when Malachi lost bids to big national charities, those charities would then subcontract back to Malachi, because they knew they had an in with the schools and could provide the service.
Going back to the list, those children and young people and the adults supporting them want clearer step up, step down work given that their mental health needs change and fluctuate, as well as more early support from non-mental health practitioners and their peers and/or older mentors. Their final point is that they do not want to be stigmatised when seeking and accessing help, which is so important. In addition to those things that the children and young people want, they have asked for clear referral routes and pathways through services, so that they get the intervention they need quickly, without being referred to multiple services—often waiting some time for an assessment—before finding that the service is not the right one for them anyway: having waited three or four months to get into the system, they then find that it is not what they needed and they have to start all over again.
The children and young people have also asked to be involved in planning their own care, to be part of setting their own outcomes and goals, to be consulted when changes are made to service provision and for their parents to be given support so that they can support them. The parents themselves, the carers, have asked for there to be clear access to services—that comes up time and again—and parenting support in the community that is easily accessible and non-stigmatising. Going back to my Malachi days, one of the hugely important things we did was to work with the parents, supporting and helping them, enabling them to take on a lot of the work of maintaining and helping their own children.
There are a few more items on the list, but I am conscious that I will rapidly run out of time if I am not careful, so I want to move on to a few of the risk factors. Again, they are not new, but things that we have come across too often, and it is important to raise them in the context of Stoke-on-Trent. In a report on this, the first factor listed among those that will have an impact on children and young people’s mental health is—this comes up time and again—deprivation and poverty:
“The close association between mental disorder”—
as it is termed—
“and economic disadvantage was clearly illustrated by income analysis in the Mental Health of Children and Young People in Great Britain in 2004 survey”,
so this is not new evidence. That is a huge problem in places such as Stoke-on-Trent, where we still have such high levels of deprivation—indeed, they have been made worse recently.
I have mentioned parental conflict and breakdown, but there is also communication/speech and language delay. In Stoke-on-Trent there is a huge problem with language delay. Fantastic projects such as Stoke Speaks Out are addressing it, but if a child is having difficulty expressing their needs, how much more difficult will it be for that child—that young person—to be able to eloquently, or indeed adequately, put across what they want from the system that is trying to help them? Attainment in education is still an issue, despite the dramatic improvements that we saw in Stoke-on-Trent. Then there is housing and homelessness; and again, the poor standard of so much housing still in Stoke-on-Trent is a tragedy.
I want to make an observation about children in care and some of the organisations. The local authority in Stoke-on-Trent has seen a rise in the number of children in care in just a short period. From July 2010 to June 2013, there has been an increase of 38% in the number of children needing support in care in Stoke-on-Trent. That is a massive increase in the number of young people in the care system, which is a huge risk factor for mental ill health.
I close by observing a couple of things about Stoke-on-Trent. There is, as I have mentioned, Healthwatch Stoke-on-Trent and the good work it does. There are other organisations doing fantastic and excellent work, including Young Carers—part of North Staffs Carers Association. I have had the huge privilege on a number of occasions to meet the young people from Young Carers and hear about the amazing things that they—children—are called upon to do, quite often looking after their parents, and the huge impact that has on their mental health. Finally, there is another scheme, whose details I have unfortunately lost in the pile of papers in front of me. Home Start has been running in Stoke-on-Trent for about 30 years. Sadly, because the local authority is so strapped for cash and has had to cut its budget, after all that time and after helping thousands of families, Home Start is now closed. It is gone. It is another resource that is no longer there to help the people of Stoke-on-Trent.
That is the backdrop to the report by the hon. Member for Totnes and to what the Minister is doing with his investigation, both of which I welcome. It saddens me so much, however, that we seem to have gone nowhere in 10 years. Let us try to make sure that we do something about this in the coming months rather than in the years ahead.
Norman Lamb
I agree. It is intolerable. One can only imagine the impact on the family having to travel such long distances. My hon. Friend and I had that discussion in Brecon with the family concerned. It is shocking that that practice continues. It must be a priority.
My hon. Friend the Member for Totnes said that the importance of early intervention is a central theme of the report. There is great scope for much more to be done on public mental health. It was revealed recently that a tiny proportion of public health budgets in localities is spent on public mental health, and yet we know—there is loads of evidence—that, if we invest in public mental health, we can achieve a significant return on it. I welcome the report.
The hon. Member for Sheffield Central (Paul Blomfield) talked about what young people had told him. It was great that they were given a voice directly in this place. I welcome his comments.
In a very thoughtful speech, as always, my hon. Friend the Member for Southport (John Pugh) talked about a continuum. Many of us are susceptible to poor mental health in certain circumstances. That makes the point about the importance of schools, which other hon. Members mentioned, in building resilience and keeping youngsters stronger so that they can cope with all the challenges they inevitably face these days.
The hon. Member for Stoke-on-Trent South (Robert Flello) talked about Malachi, an organisation he was involved with, and about the triggers that can cause mental ill health among youngsters. Family breakdown is one, but bereavement can have a significant impact, as can bullying at school, which another hon. Member mentioned.
Norman Lamb
I am conscious that I need to get through quite a lot in the time available to me.
I thank my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) for his kind comments. He was absolutely right about the potential for online access. The hon. Member for Windsor made a similar point. There is enormous potential. One platform is called Kooth. Good evidence is developing about the impact that online access can have. Given that so many youngsters with poor mental health get no support at all, we can do a lot to increase access, not as a replacement for other services, but as a complement. He, too, talked about the importance of the role of schools.
I worked in Parliament as a junior researcher in 1980, for a Labour MP. I shared an office with the secretary of the hon. Member for Coventry North West (Mr Robinson). He is still here 35 years later. He is clearly the great survivor. He referred to the most appalling wait of 44 weeks in Coventry, which is totally unacceptable. I do not know what is going wrong in that locality, but that is not matched in many other places. There may be particular problems that need to be faced. In a way, that makes the case I have been making throughout my time as Minister that the same access and waiting time standards for physical health should exist for mental health. That is the big discrimination against mental health, and it has existed for a very long time.
Francis Report: Update and Response
Robert Flello Excerpts(9 years, 3 months ago)
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Mr Hunt
I have not seen the letter, so I hope that my hon. Friend will understand if I do not comment on it, but I strongly agree with his broader point. Any chief executive or manager in the NHS needs to understand that the best way in which to reassure the public, and to reassure Members of Parliament who speak out for their constituents, is to be honest about the problems.
My local trust was the first in the country to be given an “outstanding” rating. When I last went to see its chief executive, I said that I had three constituency problems, and I raised all three of them with him. He said, “Yes—we were wrong on that one; we should not have done that; and we were wrong on that one.” One of the best trusts in the country was being totally honest about its problems, and wanted to do better. We need to make managers understand that that is the right thing to do, and that we will back them if they do it.
Robert Flello (Stoke-on-Trent South) (Lab)
Longton cottage hospital had to close because the local trust could not recruit enough nurses to ensure its safe operation, yet the Government slashed nurse training places. Now the Department refuses to release the secret KPMG report on “distressed” health economies. The people of Stoke-on-Trent deserve to know what is happening to their local hospitals and to local health care. The Secretary of State rightly says that we need to stop secrecy and have openness, but when will he whistleblow his Department’s own report? The Department is setting a very bad example when it comes to openness and transparency.
Mr Hunt
I will look into the issue that the hon. Gentleman raises, but let me deal now with the issue of nurse training places. The cuts began under the Labour Government, and we have been gradually reversing them. The main point, however, is that, in all parts of the House, there was a lack of understanding of the importance of safe staffing in wards before the Francis report, which is why successive Secretaries of State made mistakes in their projections of what was needed.
We have 8,000 more nurses in our hospital wards, including those at Stoke, and I hope the hon. Gentleman welcomes that.
Human Fertilisation and Embryology
Robert Flello Excerpts(9 years, 3 months ago)
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The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I beg to move,
That the draft Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015, which were laid before this House on 17 December 2014, be approved.
Mitochondria are present in almost every cell in the body and produce the energy we need to function. This is why they are often referred to as “the battery pack” of the cell. Unhealthy mitochondria can cause severe medical disorders, known as mitochondrial disease, for which there is no cure. The techniques provided for by these regulations offer the only hope for some women who carry the disease to have healthy, genetically related children who will not suffer from the devastating and often fatal consequences of serious mitochondrial disease.
First, I would like to bring the House up to date with the process followed since the principle of mitochondrial donation was first debated by Parliament during the passage of the Human Fertilisation and Embryology Act 2008 in 2007-08. There has been much consideration of this issue in this Parliament. Over the last five years, there has been extensive engagement and consultation with the public on this issue, including an ethical assessment by the Nuffield Council on Bioethics in 2012; a public dialogue and consultation exercise carried out by the Human Fertilisation and Embryology Authority in 2012-13; and a public consultation on draft regulations carried out by the Department of Health in 2014.
There have been three reports on the safety and efficacy of mitochondrial donation techniques by an expert panel convened by the HFEA which were published in 2011, 2013 and 2014. The expert panel members were selected for their broad-ranging scientific and clinical expertise, and for having no direct or commercial interest in the outcome of the review. Indeed, Professor Frances Flinter, a genetics consultant who works with affected families, has said:
“There has been more scientific review of this proposed process than any other medical technology.”
Robert Flello (Stoke-on-Trent South) (Lab)
The Minister says that there is no point in further review, but the safety tests recommended by the HFEA in its three reports have not yet been completed, written up or peer reviewed. Does that sound like a completed analysis?
Jane Ellison
I will come to that point in my remarks.
There has been much parliamentary scrutiny of the proposals, including three parliamentary debates and over 200 parliamentary questions in both Houses. As part of this parliamentary scrutiny, the Science and Technology Committee held an evidence session on mitochondrial donation in October last year. Following the hearing, the Chair, the hon. Member for Ellesmere Port and Neston (Andrew Miller) who I see in his place, wrote to me on behalf of the Committee, expressing the opinion that there was sufficient information for Parliament to make an informed decision, and urging the Government to bring forward regulations. Given the extensive scrutiny in this Parliament, I believe it is right to allow this Parliament to decide whether to take the next step for mitochondrial donation, which can progress only with these regulations.
The two proposed techniques, maternal spindle transfer and pro-nuclear transfer, are covered by the regulations. They are about replacing the battery pack that contains a small number of unhealthy genes with a healthy battery pack. Mitochondrial DNA is just 0.054% of our overall DNA and none of our nuclear DNA, which determines our personal characteristics and traits and is not altered by mitochondrial donation.
I would like to take this opportunity to pay tribute to the scientists at Newcastle university, who have led the world in the development of the new techniques—an area where Britain is at the forefront of life sciences.
Robert Flello
The Minister is extremely generous with her time. She says that these scientists are leading the way, but is she not aware of the work done in China over a decade ago in exactly this area? It was clearly pioneering, and it led to the Chinese Government outlawing the use of these techniques because of the appalling, tragic outcomes.
Jane Ellison
I am aware of that work, which has been the subject of extensive parliamentary questions. The expert panel considered all of those issues, including that piece of work, during the course of their deliberations.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
The impassioned and thoughtful contributions to the public debate that we have heard in recent weeks and months are testimony to what a sensitive and complex matter this is. Only last night, an event held in Committee Room 10 was attended by hundreds of people who are interested in the debate, and we heard representations from both sides.
On the one hand, we have celebrated the triumph of science that these new techniques represent. It is thanks to years of pioneering research by the university of Newcastle on how we can prevent the transmission of genetic mutations that we are finally reaching the point at which we can consider using these transformative techniques in humans. We have within our reach the possibility of eradicating mitochondrial disease from families who have been blighted by it for generations: families who have endured a disease for which there is no cure, who have suffered daily battles with painfully debilitating symptoms, and who have sadly lost their children prematurely. Those families have had to face up to the risk, and perhaps the certainty, that to be a parent must come at the expense of a difficult and, in too many cases, painful life for their children. Not only would children born through such techniques be free of such conditions, but so would their children and grandchildren. This treatment would break a chain of misery that would otherwise have ruined generations of lives.
On the other hand, we are grappling with the serious ethical and moral questions that are raised by the proposed introduction of such techniques. Members have previously shared their anxiety about the uncharted territory in which we now find ourselves. The proposed regulations would make Britain the first country to legalise mitochondrial transfer, and scientists have acknowledged that there would always be a “leap of faith” the first time the technique was used.
Robert Flello
I think we need to dispel the myth that there will be a “first time”. This was done more than a decade ago. In its recent analysis, the HFEA ignored the Zhang study. The Minister is shaking her head. She has clearly not read the study, which showed that when the technique was first tried, triplets were conceived. One was terminated almost immediately—within 30 days—and, of the other two, one was stillborn and the other died as a result of miscarriage. That is the reality. This is not groundbreaking; it has been done before.
Luciana Berger
I shall be dealing with the expert panel reviews that have been conducted since the date to which my hon. Friend has referred.
It is right that we have had a chance to hear all the arguments and to give them full and proper consideration, but it is critical to the integrity of the decision that is eventually reached for the debate to be based on the facts. When debating matters such as this, we will naturally hear a number of contradictory assertions. I am sure that the Minister will reassure the House about any further issues that are raised during the debate.
Robert Flello
There is a lot of muttering around the Chamber that there will be clinical trials, but there cannot be clinical trials because they would breach the EU directive.
Fiona Bruce
That is exactly the point I was about to make. As has been highlighted in a letter from 44 MEPs who have written from the European Parliament this week to the Secretary of State for Health, the EU directives—the European clinical trials directive 2001, which was confirmed by the 2014 directive in the same area—state:
“No gene therapy trials may be carried out which result in modifications to the subject’s germ line genetic identity.”
My hon. Friend the Minister indicated that in some way these particular procedures were excluded from these trials. That cannot be correct. The European clinical trials directive 2001 applies to clinical trials involving germ-line engineering. It applies to all clinical trials using medicine, and to these procedures. For the Department of Health to argue that it can move straight to using these procedures on children without clinical trials gives us, apart from anything else, one reason to vote against these regulations.
If anyone doubts that, Lord Brennan QC has given a legal opinion on these regulations, which is of central importance. He says:
“It is a well-established principle that EU law is to be interpreted…in light of the purpose, values, social and economic goals the provisions aim to achieve. Given that…both the Directive and the 2014 Regulation…ban any gene therapy trials that involve modification of the subject’s germ line identity, then it would clearly fall within their purposes and values to prevent their use in clinical practice of any procedure with that effect without investigation or trials first having taken place.”
I believe that this Government are at risk of infringement proceedings being brought against them if these proposals go ahead.
Robert Flello (Stoke-on-Trent South) (Lab)
The hon. Member for Birmingham, Yardley (John Hemming) almost caught me napping.
It would be ridiculous to suggest that anybody in this House does not want a cure for mitochondrial disease; it is a horrible disease. But if we understood properly how mitochondrial DNA worked, we might find ourselves closer to finding a cure for that disease. My right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) said that we had heard all these arguments before. Well, yes, we did hear an argument before. It was back in 2007 when Members were marched through the Lobby to support the human-animal hybrid legislation. That legislation was going to solve numerous problems, and some Members said, “How could anybody dare to object to such legislation?” But what has happened to that legislation, that panacea? Well, nobody can get a grant for that work now because it has been proved that it does not work. All the concerns, hopes and heartache of the time got us nowhere. I really fear for the families today. If this motion passes today and it does become law, those families, who are, understandably, pinning everything on it, will be tragically let down.
Robert Flello
I will take an intervention shortly. Reference has been made to the Zhang study. That study was not considered by the HFEA. Even if we said that Chinese medicine is terrible and that 10 years ago it was irrelevant and not ethical, the HFEA should still have considered it, but it did not. A number of Members have claimed that mitochondrial donation is like blood transfusion—nothing more than that. Well, no it is not like that. It is modifying the human germ line. As the HFEA has said, maternal spindle transfer is genetic modification of the egg and pronuclear transfer is genetic modification of the embryo. Think about it, colleagues. Why are we in the Chamber today to discuss this procedure if it is not genetic modification? If changing the germ line is not genetic modification, we do not need the statutory instrument. The HFEA could get on with it. It has therefore answered itself.
Dr Huppert
I listened to what the hon. Gentleman said about hope, and he is right that we do not know how this will play out. There might be people who have hope who will not succeed. What I cannot understand is why he is saying that to avoid people having their hopes dashed later, we should dash them today.
Robert Flello
It is simply that this legislation will open up research that is illegal, as I shall describe in a moment. I also think there are greater concerns about generations down the line.
The EU clinical trials directive, which applies to all clinical work, states:
“No gene therapy trials may be carried out that result in modification to the subject’s germline genetic identity.”
The HFEA itself has said that this procedure does. In the legal opinion on the regulations, Lord Brennan QC has said that they are caught by the directive and that they are
“likely to be in breach of EU law”
on clinical trials.
The Department of Health examined the legal opinion but rejected it, saying that the licence will not be granted for clinical trial but for treatment and therefore will not be caught by that law. Apparently, this is not about clinical trials and furthering the science but about going straight for treatment.
Lord Brennan’s opinion anticipated that. He set out the relevant paragraphs from the 2011 report on safety from the review panel set up by the Secretary of State to monitor the procedures to the HFEA, which said:
“Once assessed as safe to use in clinical practice, the panel strongly recommends that permission is sought from the parents of the children born from MST and PNT to be followed up for an extensive period”
and that such permission should be sought from the children themselves once they are old enough. In the case of females, that should ideally be to the next generation. Those recommendations should also apply to pre-implantation genetic diagnosis for mitochondrial DNA genetic disease.
Robert Flello
I think they are doing that because the legislation on the EU clinical trials directive will be tightened up even more next year.
Until knowledge has built up that says otherwise, the panel recommends that any female born following MST or PNT should be advised, when old enough, that she herself might be at risk of having a child with a significant level of mutant mitochondrial DNA. The HFEA is putting that child and, if they are female, subsequent generations at risk.
I have only a minute left but my speech would cover more than that time. It is nonsense to try to ram through this statutory instrument in no time at all. This is not about whether we should be helping families afflicted by this appalling disease but about saying we should get things right. We should ensure that this is done properly, with proper parliamentary scrutiny. The ultimate role of Government is to protect the safety of the citizens of this country and the regulations do not do that. They open the gates to a procedure that is completely untested, with no pre-clinical trials or clinical trials. The regulations talk about going straight to treatment and that has all been done so that the Department of Health can wangle its way around the legislation, or so it thinks. This is terrible. It is not good for the families with this chronic, horrible disease. We need proper and considered research. If these regulations were on genetically modified crops, we would all be up in arms. That is what is happening here.
Jim Shannon
I am glad my hon. Friend raised that point.
We cannot have a real debate today without the evidence. New Scientist, typically a champion of progress in all areas of research, warned of a lack of understanding of the links between mitochondria and nuclear DNA. The fact is that the procedures for creating children are so controversial that no other country makes legal provision for them. The Council of Europe convention on biomedicine expressly prohibited them. The fact that experiments recommended by the Human Fertilisation and Embryology Authority itself have not been concluded, written up and peer-reviewed raises extensive safety concerns. Yet we as parliamentarians are asked to make a decision today without having all the clinical evidence before us.
In the preclinical tests that have been carried out, one of the techniques was tried in humans and resulted in three foetal deaths. The obligations in international law, specifically the European directive on clinical trials—
Jim Shannon
I am sorry, I cannot give way. I do not have enough time.
The legal opinion of the Labour QC Lord Brennan seemed to suggest that the Government will not bother with clinical trials. That seems extraordinary and will come as a shock to many who spoke in favour in the debate on 1 September. My colleague Lord Morrow spoke to the Northern Ireland Attorney-General about the attempt of the Department of Health to argue in the response to Brennan that these regulations are not caught by the clinical trials directive, on the basis that the intention is to skip clinical trials. The Attorney-General told Lord Morrow that in his opinion the Department of Health is wrong and the regulations do indeed contradict the clinical trials directive. If the regulations go through today, they will contradict international law as well. The same point was made by 44 Members of the European Parliament. I urge the House to vote against the regulations.
Robert Flello
On a point of order, Mr Speaker. We have just had a 90-minute debate during which a number of right hon. and hon. Members from across the Chamber and with different views had to rush through their speeches. We had people putting on the record views—sometimes genuinely held views although not necessarily correct—that nobody was able to challenge. Some hon. Members did not even have the chance to contribute to the debate.
Could you confirm, Mr Speaker, that there were indeed hon. Members who indicated that they would have liked to speak? Secondly, do you think it right that we have had a 90-minute rush and will now have three hours on a Backbench Business Committee motion?
Mr Speaker
I thank the hon. Gentleman for his point of order, and I confirm that two hon. Members who wished to speak were unable to do so. I expressed sympathy at the start of the debate for the hon. Member for Enfield, Southgate (Mr Burrowes) who would have preferred a longer allocation of time, but I must operate within the rules and procedures of the House. It is also fair to emphasise that 12 Back-Bench Members representing different viewpoints were called. That is the factual answer.
The hon. Member for Stoke-on-Trent South (Robert Flello) invites my view as to the propriety or otherwise of this matter, and I can say only that we have operated entirely in accordance with procedure. There has been no impropriety and nothing disorderly. I understand that some people are discontented, but I hope people will not take offence if I say that to a degree, I think there will always be people who are discontented. It is difficult to get unanimity on these matters, either on the merits of the issue or on the procedure. However, I think we have done our best, and people have done their best today to help each other, which is worthy of note.
National Health Service (Amended Duties and Powers) Bill
Robert Flello Excerpts(9 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Clive Efford
It is not possible to compare what went on under the last Government with what has been introduced by the raw market mechanisms of the 2012 Act.
Robert Flello (Stoke-on-Trent South) (Lab)
I, too, congratulate my hon. Friend. Is he aware that in north Staffordshire, cancer and end-of-life care is going into the private sector on a 10-year contract worth £1.2 billion?
Clive Efford
There are numerous examples of contracts that are going out to tender, and the cost to the national health service of lawyers and accountants is increasing. The Government have made so much of the issue of bureaucracy in the NHS, but when I asked the Secretary of State about the cost of those lawyers and accountants to oversee the tendering process, what was the response? It was, “We do not collect those figures centrally.” I wonder why that is.
Andy Burnham
The Bill before us deals comprehensively with that threat from any proposed TTIP treaty. I am glad to see the hon. Gentleman in his place today.
Robert Flello
Is my right hon. Friend aware that the companies on the list of preferred bidders to provide cancer care in north Staffordshire include CSC computer services, which was responsible for the £10 billion IT failure, the Lorenzo system, and Interserve Investments, which was fined £11 million by the Office of Fair Trading for anti-competitive bid rigging? These are the sort of firms that our cancer services might go to.
Andy Burnham
Those examples will alarm people. In Greater Manchester, a bus company has been running ambulance services. We had news this week that an arms manufacturer is bidding for a GP contract. These are the things that are beginning to happen to the NHS. Nobody’s constituents have ever given their permission for any of this to happen.
We heard speeches from the hon. Member for Bosworth (David Tredinnick) and the right hon. Member for Banbury (Sir Tony Baldry), who said that nothing had changed and what was happening in the NHS now was just a continuation of what the previous Government were doing. No, it is not. The right hon. Member for South Cambridgeshire said in a speech on 9 July 2005:
“The time has come for pro-competitive reforms in…health”
and he help up the example of utilities and rail. That was the specific inspiration for his reorganisation. He sold his Bill on the basis that doctors would decide, but doctors tell us that they have no choice but to put services out to the market. Section 75 says that commissioners may not run a tender if there is only one available provider. That is never the case, which is why CCG lawyers conclude that they have no choice but to put services out to tender.
That is why we see, according to figures from the NHS Support Federation, that 865 contracts for NHS services, worth £18.3 billion, have been offered to the market. Some 67% of the contracts awarded so far have gone outside the NHS. It is this decision to mandate the tendering of services which places the NHS in the full glare of EU procurement and competition law. Because Ministers have refused to exempt the NHS from the TTIP treaty, we could soon have private US health care providers ringing up CCGs to challenge them on their commissioning decisions.
This Bill legislates to remove that threat. It repeals section 75 and it really does let doctors and local commissioners decide. It restores the role of the Secretary of State and brings much needed ministerial accountability back to this House. No longer will Ministers be told to write to NHS England when they have concerns. Instead, there will be answers from the Government Dispatch Box about the service that matters most to their constituents. It removes the role of the competition authorities that the Government’s Act introduced. It stops the ludicrous situation where hospitals such as Bournemouth and Poole are not allowed to collaborate. Importantly, it stops hospitals devoting half their beds and half their facilities to the treatment of private patients.
Mitochondrial Replacement (Public Safety)
Robert Flello Excerpts(9 years, 8 months ago)
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Robert Flello (Stoke-on-Trent South) (Lab)
I thank the hon. Member for Congleton (Fiona Bruce) for securing this important debate. Some in this House are in favour of the treatment and oppose the motion, whereas others, like me, support the motion and oppose the procedure. The important thing is to have the debate and to put down a marker, and I hope that the Government do not try to rush these things through, as I believe they originally intended.
Frank Dobson
Consultation on this started in 2003. If this is a rush, how would my hon. Friend describe something that was slow?
Robert Flello
I am grateful to my right hon. Friend for that. I have been in this House since 2005 and this is the first debate I have had here on this matter, even though the consultation may have started in 2003. I will return to the issue of the consultation shortly, if I am able to do so in the four minutes and 10 seconds remaining to me.
There is no doubt that this disease affects many children—I believe the figure is one in 6,500—and has some horrendous and devastating consequences. However, the chief medical officer seems to believe that perhaps 10 lives a year might be changed as a result of this treatment. That is absolutely important for the 10 people involved and their families, but my understanding of the science is that it is very hard for the researchers to know who those 10 people might be and how to decide which children might benefit and which might not.
I agree with a number of speakers who say that two issues are involved. I have grave concerns about this from not only a moral, ethical point of view, but a public safety point of view. Whatever someone’s position on mitochondrial transfer, I am sure we must all agree that we cannot authorise new research techniques that are unsafe or might be unsafe. In this context “unsafe” does not only mean that procedures may not work; it means that they may result in disabilities and illnesses. To put it crudely, there is every possibility that we could be legislating to allow techniques that could cause damaged embryos, resulting in further damaged children. That is not spin; it is a reasonable assumption based on the available data. Newcastle university’s own paper concluded that, compared with control experiments, 50% fewer eggs fertilised through pronuclear transfer reached the blastocyst stage—in other words, pronuclear transfer is twice as likely to cause the embryos to fail. No further work was conducted on why so many of these embryos developed abnormally, despite consistent calls from concerned scientists.
Based on the available data, therefore, we cannot rule out the possibility that these techniques could cause the people born as a result to have illnesses or disabilities. The Government have a responsibility, as we all do, to avoid such eventualities, and we cannot take that lightly. We might not know the result for many generations. We might not know whether some damaged has been caused until three, four or five generations later. We simply cannot know that. Indeed, in a conversation I had with an hon. Friend in this House not a few hours ago there was talk of how science is about probabilities and risk; it is not fact but about what may or may not happen.
Steve Brine
I am listening carefully to what the hon. Gentleman says, and the way in which this debate is being conducted shows the House of Commons at its best. He is one of the co-sponsors of this debate and he is speaking out of a great deal of fear about what might happen. Is his wish, in supporting the motion, to kick this into the longest of long grass or to see it stopped dead in its tracks? Will he be clear about that?
Robert Flello
I can be even clearer than that, because it is neither of those things. I want further research done on the safety implications and I want the consultation to which my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) referred a while ago actually to be taken forward. Let us consider the polling the Government did. Their response to the consultation on mitochondrial transfer, published the day before the summer recess, tells us that
“700 expressed general support for the regulations and 1,152 opposed the introduction of the regulations with the remainder not expressing a view either way.”
Yet the same day the BBC quoted the Department of Health as saying:
“A public review into the three person IVF technique has been broadly supportive”.
That in turn enabled Dr Jeremy Farrar, director of the Wellcome Trust, to say:
“As the Government’s latest consultation has again shown, there is broad public support for making mitochondrial replacement therapy available to patients”.
That raises the question: in which world does 1,152 against and 700 in favour equate to “broadly supportive”? Does the Minister support her Department’s briefing that the consultation responses were “broadly supportive”? What further action does she intend to take to correct the highly misleading statement? Someone may think that the public were misinformed or that only a small group of people were responding and the responses were thus disrupted, but what is the point of having that consultation if no notice is going to be taken of it?
At the end of the day, there is concern about this matter. I have a concern—perhaps I am the only Member in this House who does—but if, as I fear, this legislation goes ahead in the autumn, I do not want to have to come back to this House to say to future generations, “Look what we did.” Once we go down this route and children start being born, there will be no turning back—[Interruption.] Yes, it is the power sell of the cell. There is not enough research on what the mitochondrial part does. Is it just a battery pack, or is it more? We just do not know. I do not want to have to stand up in this House and explain to generations of future children why we let them down.