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12.19 pm
Mrs. Caroline Spelman (Meriden): The quality of many of the speeches in this debate on the National Institute for Clinical Excellence was wholly consistent with the quality of debate that we have come to expect on Wednesday mornings. We hope that debates of such quality will continue in the new surroundings.
I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on securing the debate which, at times, almost raised the blood pressure. The subject needs to be debated in Parliament openly and honestly. We think that there is no dispute that rationing occurs in the national health service. There were moments during the debate when I got quite excited, particularly during the contribution of the hon. Member for South Thanet (Dr. Ladyman) who made perhaps the first such effort. He spoke of the money wasted through the unnecessary prescribing of drugs. That is a topical issue: primary care groups have overspent to the tune of the half a billion pounds that the hon. Gentleman says could be saved. Perhaps there is room for debate on that subject.
Our real purpose this morning is to focus on the role of NICE. I have read carefully the Standing Committee reports on the Health Bill, and the goalposts appear to have been moved since then. On several occasions in Committee, Opposition amendments sought to tease out whether NICE would use affordability as a criterion. The Government response on a number of occasions was that that would not be the case. Yet, as the hon. Member for Oxford, West and Abingdon pointed out, an order was laid before Parliament on 6 August which explicitly changed the constitution of NICE, amending it to take into account the effective use of available resources. That criterion would justify the Opposition's concerns that the institute would be brought in to shield the Government from the very difficult decisions that have to be taken, given that the Government have finite resources at their disposal with which to treat the health of the nation. The institute's original aims--to promote faster access and more effective treatments--might well have to compete with the extra constraint of affordability.
I endorse the concerns expressed by various hon. Members about how such cost-effectiveness will be defined. A definition will be important for all those working in the health service and the research organisations that help it do its job better. Cost- effectiveness will be particularly difficult to determine where new medicines are concerned, as it involves comparison or relativity between treatments, and a new medicine or treatment may have nothing with which to be compared. We look forward to hearing the Minister of State's definition. I endorse the view that it should be wide enough to take account of savings in other Departments. Surely that is consistent with joined-up government. I hope that the Minister will provide confirmation.
One of my greatest concerns about the Government introducing the new criterion will be in the treatment of chronic conditions. Savings could be made if treatments for chronic conditions allowed patients to stay in work longer or reduced their need for social care. That may not always be the case, and it should never be a condition of treatment on the NHS that a treatment can necessarily demonstrate a concomitant economic benefit. That has to be wrong for a publicly provided health service.
The Minister of State, Department of Health (Mr. John Denham):
I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on obtaining this debate. If he is right that this is the last debate of one and a half hours that will take place in the Chamber on a Wednesday morning, I am glad that it has been spent discussing something so critical to the Government's programme for modernising the national health service.
Inevitably, I will not be able to answer all the points that have been raised in this debate. It has been extremely constructive and well informed which, as the hon. Member for Meriden (Mrs. Spelman) said, is so often the case with Wednesday morning debates. However, I shall pick up a few of the major issues and, if the Liberal Democrats pursue their prayer, we may be discussing them in more detail in Committee.
I think that I should welcome the fact that the hon. Member for Oxford, West and Abingdon now feels that he needs to spend about five minutes distancing himself from the official Opposition before he uses the word "rationing". I think that he has begun to understand--although it was not much in evidence this morning--that the official Opposition's loose throwing around of that term in recent months has more to do with attempts to undermine public confidence in the national health service and to promote a private alternative than with the way in which the health service sets priorities. As we have always acknowledged, any system that does not have infinite resources has to set priorities. I realise that that is almost a meaningless statement. It is my belief that the national health service and the principles on which it is based provide us with the fairest, most equitable and efficient way of taking the necessary decisions. It is certainly better than the options that are promoted. I welcome the hon. Gentleman's shift in position.
We have made it clear that we want to tackle what we see as the unacceptable variations in the quality of, and access to, treatment and care in different parts of the
country. The right hon. Member for South-West Surrey (Mrs. Bottomley) suggested that those variations were a good part of the system--she referred to it as diversity. I do not agree. The hon. Member for Oxford, West and Abingdon said that it was all to do with funding. I do not agree. As my hon. Friend the Member for South Thanet (Dr. Ladyman) made clear, differences in the provision and quality of care and treatment arise from different approaches to the same decision based on different interpretations of the evidence, different approaches to best clinical practice, slower spread of the best treatment and slower spread of the best ways to approach different issues.
Several strands in the Government's programme have come together to tackle the unacceptable variations in quality of care and treatment. That is one of the reasons that we are introducing clinical governance; it is one of the reasons that we have set out a programme of national health service frameworks; and it is one of the reasons that we are establishing the Commission for Health Improvement.
NICE will provide guidance on the clinical effectiveness and cost-effectiveness of treatments and protocols. We are implementing all the elements of that important agenda in the national health service, and I think that they will enable us to tackle unacceptable variations in treatment and care. As my hon. Friend the Member for Shrewsbury and Atcham (Mr. Marsden) said, the approach has been widely welcomed across the health service.
My hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey) reinforced the point. She said that for general practitioners to keep up with all the new research evidence currently produced, they would need to read about 17 scientific papers each day, 365 days a year. That is not realistic. NICE will provide a single source of authoritative guidance and advice on clinical effectiveness and cost-effectiveness that is necessary to inform health professionals' decisions. It will not override decisions made by clinicians with their patients in the consulting room.
If Ministers decide that something needs to be banned entirely from the national health service, there are procedures to do so. In pre-NICE days, that happened with Viagra, and the decision was properly debated in the House. The truth is that, overwhelmingly, health professionals--
Dr. Ashok Kumar (Middlesbrough, South and Cleveland, East):
I am grateful for the opportunity to introduce a brief debate on a serious issue that is causing great concern to many of my constituents and the people of Teesside as a whole: Operation Lancet.
Operation Lancet is an inquiry overseen by the Police Complaints Authority into alleged malpractice and corruption in Cleveland police. My speech reflects the results of tabling many parliamentary questions over the past eight months and detailed investigative journalism on the part of local newspaper reporters who are also appalled by the way in which the inquiry has descended into farce. In my speech, I shall give the background to the inquiry and set out the lessons we should learn. I shall also make some suggestions regarding changes and improvements to the procedures and policies governing such inquiries. In addition, I shall issue a call for action to complete the Lancet process by imposing a time limit on its work.
The inquiry is wide ranging: so far, 560 disciplinary notices have been issued to a total of 60 officers, informing them that they are under investigation. The inquiry has been running for more than two years and has cost the council tax payers of Cleveland almost £2.5 million. Eight Cleveland detectives have been suspended, including Detective Superintendent Ray Mallon, the man whose zero tolerance approach to policing led to Cleveland police achieving a greater reduction in crime than any other force in 1997.
In December 1997, Mr. Mallon was suspended from duty and accused, in the words of Robert Turnbull, the then deputy chief constable, of
In the meantime, the burglary rate in Mr. Mallon's former beat, Middlesbrough, has risen by almost 30 per cent., and street crime and muggings are on the increase. That Cleveland ratepayers have now been handed one of the highest police precept increases in Britain is due in no small part to the cost of Lancet. Part of my constituency postbag shows that a key element of community concern is Lancet, its impact on police morale and the knock-on effects on my constituents.
Operation Lancet displays alarming similarities to a PCA probe into allegations against police officers on Humberside. That investigation ended a month before Mr. Mallon was suspended: it took six years to complete, cost £4 million pounds and resulted in more than 20 officers being investigated, but ended without a single disciplinary or criminal charge being brought. It appears that the PCA is able to operate with an open time scale, an open remit and an open cheque book. There is no concern about the effect that lengthy suspensions and damaging unproven allegations can have on officers who have spent many years serving the public.
In Operation Lancet, it is of great concern that the majority of suspensions and disciplinary notices have arisen from complaints from known criminals or those
facing criminal charges. In some cases, those criminals have not, as might have been expected, made complaints to their solicitors or the courts; instead, their complaints have emerged after Lancet officers visited them in prison. It is crazy that hard-working detectives who have dramatically reduced crime by targeting and locking up offenders now find themselves suspended on the word of criminals whom they put behind bars. Unfortunately, it appears that Lancet is being used within Cleveland police force as an excuse to settle old scores and petty jealousies. Office politics has led to elderly people in my constituency suffering from crime and the fear of crime.
No one, least of all me, is suggesting that allegations of malpractice by police officers should be ignored. However, I share the concerns of Lord Mackenzie, a former serving senior police officer, that Operation Lancet has not been properly ring-fenced. Rather than being a tightly focused operation, the probe is taking on the appearance of an expedition to a hitherto unexplored river, as explorers investigate every minor tributary.
I am also concerned by the way in which senior officers can launch inquiries such as Lancet but escape future accountability. Ray Mallon and other senior officers were suspended from duty by the then deputy chief constable of the Cleveland force, Robert Turnbull. If Mr. Turnbull had grave concerns or, indeed, any sense of duty or responsibility, he would surely have seen the inquiry through. Instead, he took the opportunity to tell his employers, the police authority, that he wanted to retire; he was allowed to do so only 20 months into his five-year contract.
Mr. Turnbull's retirement did not last long: within weeks, he had applied for and was promptly appointed to the post of deputy commissioner for the sunny Turks and Caicos Islands--a few thousand miles away from Cleveland and Operation Lancet. The Cleveland public have not been given a satisfactory explanation of the circumstances surrounding Mr. Turnbull's rapid departure; nor have they been allowed to see the reference provided by the chief constable of Cleveland police that helped Mr. Turnbull to land his job in the sun. It is generally known that serious allegations have been made in respect of Mr. Turnbull's conduct, but he will not have to answer them or justify his decision to suspend Mr. Mallon and his colleagues.
Within the past month, Mr. Andrew Timpson, the head of Lancet and chief constable of Warwickshire, has also had to leave his employment under a cloud. He, too, should have to answer questions about issues that he dealt with in his time, one of the most serious of which emerged only this week.
I am informed that, when Mr. Turnbull left to seek his fortune in the Caribbean, a colleague of his, Mr. David Earnshaw, was appointed by Cleveland's chief constable to assume responsibility for complaints and disciplinary matters within the force. That means that Mr. Earnshaw now has direct day-to-day involvement with the Lancet inquiry and that he would adjudicate in the inquiry and advise the Lancet team. However, I have learned that, prior to his departure, Mr. Timpson was clearly told by several people that Mr. Earnshaw could be implicated in serious allegations about his role and conduct.
I have been told by solicitors acting for Ray Mallon that Mr. Earnshaw was to have been the recipient of a regulation 6 notice, which would have told him that
investigations were to be carried out to establish the truth or otherwise of the allegations. However, it appears that Mr. Earnshaw has not yet been served with that notice.
It is incumbent on the House to ask why such a senior officer has been allowed to remain in post with the specific remit held by Mr. Earnshaw when there is doubt about his conduct. That prompts the questions of why the notice has not been proceeded with and whether Mr. Earnshaw is a suitable person to occupy his current position. Only Cleveland's chief constable and Mr. Timpson can answer those questions, and it appears likely that Mr. Timpson's answer would be the most relevant.
The problems do not end there. More people are jumping ship: in the past few weeks, Mr. Richard Brunstrom, who was effectively number two in the Cleveland police authority, has left to take up a new post in north Wales. The Police Complaints Authority, which appointed Mr. Timpson, has replaced him with Mr. Lloyd Clarke, the deputy chief constable of west Yorkshire. He faces the unenviable task of wading through the 26,000 documents that Operation Lancet has produced so far. The Police Complaints Authority is to investigate Mr. Timpson after serious allegations by members of his staff.
It is wrong that senior officers such as Mr. Turnbull, and possibly Mr. Timpson, who make the serious and far-reaching decisions to suspend serving officers, can escape accountability by retiring or stepping down. I hope that my hon. Friend the Minister will ensure that, in future, officers who are members of the Association of Chief Police Officers, and who make such serious decisions, are accountable for their actions--whether they are still in service or not--when such inquiries are completed.
My hon. Friend should also revise the way in which police investigate themselves. In the case of Mr. Mallon, it is no longer a matter of establishing the truth but of desperately trying to justify the enormous cost, time, manpower and hype that Operation Lancet has generated.
It would focus minds if the Police Complaints Authority were given a fixed budget rather than an open cheque book that is underwritten by the hapless council tax payer. It would mean that inquiries were not launched without firm evidence on which to base them. There should also be a limit on the time a police officer can be suspended from duty without charges being brought. I have met and listened to Cleveland police officers who have graphically described the devastating impact of such lengthy suspensions on their lives. Marriage break-ups, suicide attempts and severe illnesses have ensued as Lancet continues its seemingly endless task.
I resent it when outsiders, who seem to have no knowledge of Lancet's impact on the morale of serving police officers on Teesside and its generation of a lack of confidence in the police, criticise me for investigating and highlighting those anxieties. If officers who investigate murder and other serious crimes have to work to set limits, why cannot the Police Complaints Authority do the same? Time limits will ensure that the serious step of suspending an officer will not be taken without solid evidence for doing so.
No one wants to protect the small number of officers who are corrupt and a disgrace to their badge. However, a better regulated and more focused Police Complaints Authority should devote time and resources to rooting out corrupt cops instead of making sweeping accusations, which are never proven, against many officers. Too many people wring their hands and claim that Lancet and similar inquiries should be allowed to run their course, whatever the cost, the impact on the public, the public purse and public confidence. I do not agree with that view; enough is enough. The people of Teesside want a police force that investigates and roots out crime, not a force whose senior management team is made to devote its energies to investigating every nook and cranny of its force.
Ray Mallon and his colleagues have been suspended for more than two years. In my opinion, and that of many of my constituents, that is long enough for those investigating to charge them or allow them to return to work. I believe that Ray Mallon is an honest and sincere man, who merely wants to return to doing what he is best at: rooting out and eradicating crime on the streets and in the communities of Teesside.
12.30 pm
"activity that could be construed as criminal".
That allegation has been hanging over Mr. Mallon for more than two years; his expenses and his private life have been probed. However, like the other suspended officers, he has yet to have a single disciplinary or criminal charge brought against him as a result of Lancet.
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