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The hon. Member for Wyre Forest also stressed the importance of commissioning. He is absolutely right. Again, we need better commissioning and better
accountability in commissioning decisions, which I think will be helped by the recommendations that we expect will be published this summer.
The hon. Member for Wellingborough (Mr. Bone) repeated his affection for a social or private insurance system of co-payments. That is not a position that we hold or, indeed, that his Front-Bench spokesmen support. We do not think that the solution to the problem involves any kind of subsidy for the private sector.
The hon. Member for Hemel Hempstead discussed the funding formula. He will be aware that we are awaiting the final recommendations of the independent body that gives the Government advice on such matters, and we will be making announcements in due course.
Let me turn to orphan drugs, on which my hon. Friend the Member for Norwich, North concentrated. Orphan drugs treat a condition that affects fewer than one in 2,000 people within the population, and it is true that they can often be expensive. However, it is not the case that they are less likely to receive a positive NICE appraisal. Over the past seven years, for example, NICE has completed 46 appraisals of cancer drugs, representing about one third of all its technology appraisals, and 41 of them have partly or fully recommended the treatment.
Up to 2007, NICE had appraised 26 orphan drugs. Three had negative appraisals and the other 23including, for example, riluzole for motor neurone diseasereceived either a complete or partial approval. Indeed, information from NICE suggests that the proportion of orphan drugs that are considered cost-ineffective is not out of line with the technologies that it appraises for more common conditions.
Because cancer drugs are usually given for a relatively short period of time, even quite expensive ones can secure a positive NICE appraisal if they are effective. I know that the communities involved with less common cancers have expressed concerns about the use of cost per quality-adjusted life year in the NICE technology appraisal process for orphan cancer drugs, but, as I
said, that specific concern is being considered as part of NICEs review of its framework for technology appraisals.
The drugs that NICE cannot really deal with are those that are both very expensive and require long-term, sometimes lifetime, treatment; for example, treatments for rare genetic conditions. Such drugs are sometimes referred to as ultra-orphan drugs, and some are considered outside NICE by the national specialised services commissioning group.
If a disease is rare, PCTs can collectively arrange a risk-share through their specialised commissioning group so that the planning and delivery of interventions that cannot be made available everywhere can be made available in enough hospitals to serve their population. Alternatively, if it is important to concentrate expertise, services can be commissioned through the SCG or the national commissioning function. I can tell my hon. Friend that the treatment for some 40 diseases, including primary malignant bone tumours, retinoblastoma, or cancer of the eye, and coriocarcinoma, or cancer of the placenta, is commissioned by the national commissioning group.
I know that my hon. Friend has had an opportunity to discuss some of his concerns with my colleague the Under-Secretary of State for Health as well as officials in my Department, and I understand that those officials are in correspondence about his concerns with representatives of the Rarer Cancers Forum.
I hope that I have managed to go some way to reassuring hon. Members that the Government take this issue extremely seriously. Both the Department and NICE take the issue of access to new drugs very seriously indeed. As I mentioned, NICE is assessing its policy on approval of orphan and ultra-orphan drugs. We recognise that local NHS trusts are in the best position to make decisions for their local populations, particularly for the exceptional cases of individuals, because they know their needs best. However, it is important to remember that mechanisms are in place through the national specialised services commissioning group to resolve some of the issues that have been raised today.
Daniel Kawczynski (Shrewsbury and Atcham) (Con): This is an important and topical debate. We are entering difficult financial times. Many of my constituents in Shrewsbury are facing huge rises in the cost of living, the cost of food and petrol, and mortgage payments. It is important to get the tax credits system right and working properly and effectively, especially as we are entering this difficult time when the budgets of individuals who are the most vulnerable in society are being tightened up. I wrote that last part of my speech in preparation for this debate. The Prime Minister stated the same thing on GMTV today:
We have got this credit crunch, we have got food prices rising, we have got fuel prices rising. I feel very worried about the effect of that on ordinary, hard-working families and on pensioners.
Problems to do with the tax credit system comprise, without question, the single biggest issue facing my office today. The Minister should send my secretary, Mrs. Helen Sheppey, a box of chocolates and flowersnot just today, but every weekfor the work that she does sorting out the tax credit problems. The Ministers Department should have fixed that system a long time ago. My secretary does an enormous amount of work every day, through the Members of Parliament hotline, trying to sort out peoples tax credit problems.
This is the first time that I have spoken at any length in the House of Commons about my secretary. Helen is extremely attentive to everybody who comes to see her about tax credits. She listens to constituents and sorts things out efficiently. Many people write, but when somebody comes in off the street without making an appointment, she drops everything and prioritises somebody with a tax credit problem. I will come in a minute to why everything is dropped to sort out peoples tax credit problems and why the issue is so important.
Helen is coming under huge extra strain, as the number of cases that she has to deal with is soaring on a weekly and monthly basis. She has to deal, like many other constituency secretaries, with a great number of things: she has to manage me, which is a nightmare in itself. I sympathise greatly with her in managing my diary and my constituency engagements but, ultimately, those are the thingsthe main tasks of a constituency secretarythat she was hired to do. Yet we have estimated that she now spends about 30 per cent. to 40 per cent. of her time dealing with tax credits. That is astounding. I am deeply concerned about the amount of time that she is having to spend dealing with these cases. The numbers are staggering and growing.
What worries me even further is that the Government have said to us that they intend to try to clear up the mess of the 10p tax band fiasco, over which they have backed down, by using tax credits. So they are going to bring more people into tax credits. I understand that the Government are going to compensate those people who have lost out as a result of the 10p band being abolished by bringing them into the tax credit system. There will now be a huge extra strain on a system that is already not working and not operating efficiently, with even more people potentially facing chaos when trying to get their tax credits rectified and paid appropriately on time.
I come now to the most important part of my speech: not my comments as a Conservative Back-Bench MP, but the views of my secretary, Mrs. Helen Sheppey, for which I asked her in preparing for this debate because I wanted to put her words, not mine, to the Minister. In between sorting out tax credit issues, she has typed a one-page document containing some of the real problems that she faces daily in dealing with tax credits.
The staff on the MP Hotline are very helpful and knowledgeable,
because she acknowledges that. I thank the Minister for the MP hotline. There is no doubt that its staff are courteous, polite, helpful and will go to the nth degree to help MPs secretaries try to resolve some of the problems. In fact, my secretary wanted me to put in a special plug for them, because she wants me to acknowledge just how helpful they have been to her. However, she continues:
Constituents are very frightened when faced with a Tax Credit demand. Some constituents have told me when they receive a letter from Tax Credits they are too frightened to open it and ask a friend to come around and open it on their behalf.
I am staggered that my constituents are receiving official communications from the Government but are too frightened to open a letter and need a friend to help them open it and give them support. What sort of a system is this that is terrorising peopleI do not want to be over-melodramaticand frightening them in this way? You will know, Mr. Pope, that these are the most vulnerable people in my constituency, and in yours, and throughout the United Kingdom.
My constituents have had to borrow money from banks to pay off the debts. Suddenly, the Government realise that they have overpaid tax credits to a certain individual and send a demand for this money. In the meantime, these vulnerable constituents have spent the money, thinking, quite rightly, that they were entitled to it and, suddenly, they have to find the money to pay the Government back. They go to relatives, friends and banks to try to borrow money. Given the credit crunch, it will be increasingly difficult for them to find the money to pay the Government back.
Some constituents have had such a frightening experience
they no longer claim Tax Credits, even though they are fully entitled.
These are the words of my secretary, not myself as a partisan MP. What sort of system is it that leaves some of my constituents too fearful to claim something that they are entitled to, simply because of their experience?
In the old system of Tax Codes, these problems did not exist.
Constituents telephone the Helpline to advise them of a change of circumstances (usually an increase in income). Constituents then receive a new Award Notice which does not show the new income details. When constituents telephone the Helpline they are assured the information on the computer is correct, thus the payments they received are correct. It is only when the Award is finalised it is discovered the changes were not in fact made, and constituents have been receiving too much money. The onus is on the constituent to prove the date of their telephone call and the name of the person they spoke to.
Constituents have to return an Annual Declaration to Tax Credits at the end of the financial year to confirm the figures they have provided are correct. Constituents return the Annual Declaration and hear nothing further. Their payments later stop and they are informed the Declaration was not received.
If a joint claim ceases because a relationship has ended, it can be extremely difficult for the parent with care of the children. If the absent parent does not return an Annual Declaration, any overpayment is usually reclaimed from the parent with care.
The chaos of the system is taking a huge amount of resources out of my budget as an MP. I give the Minister three options to consider. First, I could send her an invoice. I come from business, where there was a lot of accountability in respect of finances. I can happily send her a quarterly invoice for the 30 per cent. to 40 per cent. of my secretarys time in dealing with all these issues. Although I will not go into my secretarys salary and remunerations, I could work it out for the Minister and send her an invoice. I genuinely believe that her Department should be sorting this matter out.
Secondly, I can collate all the inquiries from people who are frightened and frustrated, and send to them the Ministers e-mail address and personal telephone number so that she can deal with them herself.
Thirdly, the Minister could ask the Exchequer to give MPs money for a full-time assistant to deal just with tax credits, because if the system continues as at present MPs will need one staff memberI am not being melodramaticto deal just with tax credit problems. Those are the three options for the Minister.
I have three questions. First, why is the system not working, and why is it so chaotic? The Labour party believes that supporting the most vulnerable people in society is important, and is determined to redistribute wealth in this country, so why is its flagship and pivotal policy of helping the most vulnerable not working? Is it because of the system, or because of the computers? I do not know.
Secondly, what plans does the Minister have for reform? Does she acknowledge that there is a problem? I do not know, but I would like to hear from her, now that she has heard about the problems that we face in Shrewsbury. If she acknowledges that there is a problem, what plans does she have for reform?
Thirdly, what extra resources will the Minister secure from the Treasury to deal with the extra work involved in processing many new claims as a result of the 10p fiasco? Many more people will come into the system in the coming months and years as a result of the 10p fiasco, so what extra resources will she secure from the Exchequer to deal with the huge increase in demand when the system is buckling under the strain and is not fit for purpose?
My only party political comment[Interruption.]My neighbour, the hon. Member for Telford (David Wright) is snorting at that. The cynical part of me believes that the Government are happy to allow this mess to continue because MPs are tied up with the problems. I have spoken a great deal about my secretary, but I also spend a great deal of time on Fridays and Saturdays dealing with peoples tax credits. If the system was working effectively, I could spend that time campaigning for extra resources for infrastructure projects in Shrewsbury, scrutinising the Government, thinking of debates, and
so on, but I cannot do that at the moment because I spend hundreds of hours every month dealing with tax credits, which should be working smoothly and purring along like a Rolls-Royce engine without MPs having to involve themselves. The cynical part of me believes that the Government are happy about the matter because it allows us less time to scrutinise them.
Until this mess is sorted out, we are very happy to help constituents. Some people may ask why this MP is whingeing about having to deal with tax credits. I am not. I am more than happy to deal with any tax credit problem for any constituent. I go further and urge any constituent in Shrewsbury and Atcham who has a problem with tax credits immediately to get in touch with my office. Until the problem is sorted out, I or my secretary will be happy to help. They can get in touch with me at my office in Harlescott lane, Shrewsburymost of my constituents know where my office iswhere we are more than happy to help them. I will do everything that I can to help them. Why should they have to pull their hair out in frustration? Their MP is there to help them, and I want to get that message across, but I have a duty at the same time to raise my concerns about a system that is not working. I want to scrutinise the Minister to find out what will happen to make it work more efficiently.
At the end of the day, what angers me most is that many of my constituents are treated as numbers, unlike me. The MPs hotline purrs along beautifully, and when a Member of Parliament telephones the service is first class and the problem is rectified, but when a member of the public telephones, they must listen to music for hours on end, no one comes back to them, and they pull their hair out with frustration. People come to see their Member of Parliament because they are frustrated by their interaction with the system.
I do not believe that Members of Parliament should be treated differently from those whom we represent, and I want the excellent service that the Minister has provided for me through the MPs hotline to be universal for all my constituents so that they can sort out their tax credits on time and receive the appropriate money. I very much look forward to hearing the Minister address some of the issues that I have raised.
I congratulate the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this debate. I am grateful to him because it allows me to address the genuine problems that he is raising, and to explain some of the work that we are doing on an effective policy that is made difficult by its administration. I shall deal with one or two of the points that he raised.
I am grateful to the hon. Gentleman and to Helen Sheppey for their complimentary remarks about the MPs hotline. The staff will also be grateful to have them recorded publicly. I acknowledge the work that Helen is doing. She, like probably one member of staff in almost every MPs office, has an almost personal relationship with staff of the MPs hotline. There is a high degree of awareness of the problems in the system, but as for sending her a box of chocolates every week
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