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“You have the right to be treated with dignity and respect, in accordance with your human rights.”
Under the heading “Quality of care and environment” are the words:
“You have the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality. You have the right to expect NHS organisations to monitor, and make efforts to improve, the quality of healthcare they commission or provide.”
How will that be enforced? Somehow, Monitor let Stafford hospital through. I believe that Monitor could play a key role, and I hope that it will not let through other aspiring trusts that get the sort of complaints about basic quality of care that I am receiving.
I am bothered about the complaints process. The lack of an automatic independent review is a disaster. As the Secretary of State will be only too well aware, to get an automatic independent review, a person now has to go to the ombudsman, who will be completely swamped. Patients and families will lose the will to persevere that far.
It really is awful that a constitution should be needed to enforce such basic things. I am sure that at this time of year several of us go to mayors’ Sunday services in our own patches. I was at one in the little town of Bewdley at the weekend. One of the readings was the parable of the good samaritan, whose moral is “You
shall love your neighbour as yourself.” We have forgotten the morals of such stories; we have forgotten some of the good parts of human nature. That takes me back to one of the things that we heard in New Zealand on our recent trip to look at the quality of care there. It was a question: “Will your hospital pass the granny test?” In other words, it asks whether a person would be happy for their granny to be treated at the hospital.
I am desperately concerned that we have lost some of the basic duties of the caring professions. The Royal College of Nursing is to be congratulated on its work on dignity. I would like to refer the Minister to an article in May’s Journal of the Royal Society of Medicine headed “Doctors and quality improvement”. It is by Hockey and Marshall, and is well worth reading. I have a completely different concern about the NHS constitution. I have learned about the difficulties of whistleblowers in various parts of the country, and unless I have missed it, the protection for whistleblowers is not spelt out in sufficient detail or emphasised enough in the Bill.
I turn briefly to the clauses on pharmacy. Unless I have missed something, they do not address most people’s major concern, which is prescription charges. I know that people with cancer have recently been exempted from paying them, and that is absolutely marvellous. There is also an inquiry, headed by the president of the Royal College of Physicians, into treatment charges for long-term conditions. I would like the Secretary of State to make absolutely sure that prescription charges are likely to be exempted in the case of HIV/AIDS, as that is now a long-term condition. I was amazed to talk to renal experts in the west midlands who did not realise that transplant patients are not exempted from prescription charges. Such an exemption is essential given that they have to take anti-rejection drugs.
A lot has already been said about smoking and the bits in the Bill relating to tobacco. As many Members have observed, as MPs we wear two hats. We are concerned about small businesses and corner shops, but we have a tremendous desire to stop the young taking up the smoking habit. The nanny state argument does not cut much ice with me. In the case of something like smoking in public places, which is so terribly bad for other people, not just the smoker, the nanny state does not come into it. I am afraid that some of these kids, who are starting to smoke at an amazingly young age, need the nannies of the nanny state to try to make them see sense. I have no objection to bans on advertising or on sales from vending machines. As other hon. Members have mentioned, covers are available which at the press of a button will obscure all the shelves with cigarettes on them, while the press of another button will expose everything, so without moving from the counter, the shop assistant can expose the products, get out the right thing, and then shut them up again. Cancer Research UK assures us that those covers cost only about £200. It would be a great help if small businesses could be given some sort of help with finding that £200—if it is true that it is only that much.
Why, in some places, and from some clinical staff, have we lost some of the best features of human nature—politeness and consideration for others? About 400 years ago, Montesquieu, a French political philosopher, wrote:
“The English are busy; they don’t have time to be polite.”
In some parts of the health service, people can claim that they do not have time to be polite, but that is absolutely no excuse. Webster’s dictionary has got it right: it says that politeness is
“marked by or exhibiting an appearance of consideration, tact, deference, courtesy or grace resulting sometimes from sincere consideration of others”.
If the NHS constitution had teeth and reminded all staff that common courtesy and politeness are absolutely necessary, it could achieve improvements in parts of the NHS that have not yet been reached.
8.48 pm
Mr. Ian McCartney (Makerfield) (Lab): I apologise to my right hon. Friend the Secretary of State and to Opposition Front Benchers for not being here at the beginning of the debate. It has been a busy day in the House, with a range of important meetings that I have attended—and enjoyed. In response to the hon. Member for Wyre Forest (Dr. Taylor), I am not an Englishman who is too busy, but I am a Scotsman who represents an English constituency, and I want to be busy on the issue of NHS reform and NHS investment. When I was a Member of this House in 1992, my first Front-Bench job was as Labour health spokesperson. My right hon. Friend the Member for Rother Valley (Mr. Barron) is here. We are where we are today only because he campaigned on issues such as smoking and preventive strategies in primary care and because of his commitment and engagement during that period, when the then Government refused to listen to any arguments about investing in the acute sector and in preventive strategies in primary care to improve health care, particularly in working class communities.
I welcome my right hon. Friend the Secretary of State to his new post. He and I share a borough, and we share a friendship; indeed, we live minutes away from each other. The fact that he has got this job is a breath of fresh air; that is not because the individual who had it before was not a breath of fresh air, but because ever since he was elected to this House and before, he has seen the importance of a preventive strategy in health care through investment in sport and sport-related issues. As Secretary of State for Culture, Media and Sport, he was the first Secretary of State to link the preventive strategy in health care with other strategies across Government, including sport.
As a consequence our local authority, Wigan council, was the first to introduce free swimming not just for young people but for every single person in the community. We now have thousands upon thousands of individuals taking up healthy pursuits, and the preventive strategy has improved their health due to the intervention of my right hon. Friend. If there had to be a reshuffle, I cannot think of anybody better to take on the portfolio, and I wish him and his colleagues the very best in their efforts to build on the success of the Labour Government’s record investment in health care.
May I ask a favour of my right hon. Friend? I will be leaving this House after 22 years for health reasons. I am probably the reason the NHS has had financial problems in the past few years. At least once in each of my 22 years in the House, I have been hospitalised. Because of the NHS, I am looking a very healthy ill
person. But given my role as a patient in the NHS, my right hon. Friend could do me a favour if there is any work going after the next election and he is still Secretary of State, as I believe he will be. If he is looking for full-time NHS mystery shoppers, I am up for it.
This Bill and previous innovations in Bills like it are about empowering patients, and it is important that health care provision should not be a passive relationship between health care authorities, doctors, clinicians and other health care professionals. It should be about engagement with the patient, to maximise their opportunity to help manage both their illness and the process of improving from ill health to sustained good health in the years ahead. The Bill will assist in that process.
I have been in favour of direct payments for many years. In the case of social care, I argued the case in Government for direct payments, not to weaken public or community provision but to empower individuals to have a real say in their life as it relates to their health and social care. Yes, direct payments can be controversial, as many changes have been in the modernisation of NHS. My right hon. Friend should engage with trade unions and health care professionals, but he should do so on the basis of taking them on that journey. Direct payments, if well managed, well organised, accountable and in the context of NHS principles and the constitution, will benefit tens of thousands of individuals and their health care in the years ahead. I ask him to pursue that issue with vigour.
As we evolve and develop the role of NHS foundation trusts, it is important that we find ways to make them even more accountable to the local communities in which they operate. Whether a foundation trust is acute or non-acute, it is critical that the bureaucracy of establishing it does not create barriers to the community’s involvement in its management and decision making in a wider sense. That could include decisions on the professionalisation of the board memberships, or ensuring that individual communities—particularly working class communities, if Members do not mind my saying so—can engage in the decision-making process about the services that the trust provides. Trusts must reflect the priorities of the communities in which they reside.
As we establish foundation trusts, for which I argued in government, it is important that communities are engaged to the fullest extent. We must bring together local government and other partners to plan and provide services, and we must ensure that community groups and organisations are an integral part of the consultation process on the development and improvement of those services. Where it is appropriate, local community organisations should be involved in the delivery of those services as well.
I turn to the specific issue of children’s smoking. I do that not just because of the extensive work of my right hon. Friend the Member for Rother Valley—I was a supporting act to him when I was on the Front Bench in the 1990s—but because I represent a constituency in the north-west of England that has been devastated by the twin effects of poverty and smoking-related diseases. Literally thousands upon thousands of untimely deaths in the past decade can be attributed to smoking.
Smoking takes a heavy toll on the lives of the people in the communities of the north-west, with 14,000 deaths a year in our region. It exacerbates health inequalities and has a negative impact on children and young people.
That is the history of the north-west of England. As a consequence of decisions in previous legislation, we now have the capacity to break that horrific cycle of smoking, poverty and inequality. However, there is a loophole, and I shall talk about that in a moment.
The prevalence of smoking in the north-west region is the highest in England, with 23 per cent. of the population smoking—25 per cent. of men and 22 per cent. of women. As many as 22 per cent. of 14 to 17-year-olds smoke in the north-west, despite the fact that it is now illegal to sell cigarettes to under-18s. In November 2007, leaders of local authorities, community groups, the NHS and young people’s organisations came together to set out a bold vision of a tobacco-free future for our children and young people in the region. In June 2008, local authorities and health service leaders throughout the region decided, on a non-party-political basis, to build on that initiative. They made a new pledge to
“make smoking history for the region’s children”
and agreed that a fully funded and effective national tobacco strategy needed to be developed.
There was a public consultation exercise, and 60,000 responses from people in the north-west accounted for around two thirds of the total 96,000 responses that the Department of Health received to its future of tobacco control strategy. That was a huge response from a community devastated by the effects of smoking.
The response is consistent with the findings of the survey conducted last June, with north-west residents expressing overwhelming support for further measures to protect children from tobacco. Smokers and non-smokers expressed such support. It is interesting that smokers themselves recognised the dangers to young people of either commencing or being encouraged to commence smoking and continuing to do that. The survey was not simply of people who are opposed to smoking in all circumstances. It included a huge proportion of smokers, who were encouraged to start smoking in their earlier years.
Mr. Stephen O'Brien: As a fellow north-west Member of Parliament, I know that some of the evidence that covers our region, in particular areas where there is a high prevalence of clubs and private premises, shows that the availability of vending machines is one of the main reasons for children’s early access to cigarettes. Is the right hon. Gentleman therefore moving towards supporting our approach on the relevant aspects of the Bill?
Mr. McCartney: The hon. Gentleman needs to hear the rest of my speech. I will comment on that particular approach—I am not so sure that it is a Conservative party approach, although I welcome that party’s late conversion. It used to be a mouthpiece for the tobacco industry— [Interruption. ] The hon. Member for South Cambridgeshire (Mr. Lansley) may say, “Oh no, he’s being partisan”, but I was here year after year, in debate after debate, for Queen’s Speech after Queen’s Speech, when Conservative Ministers refused to take action. Consequently, thousands of unnecessary deaths and illness occurred in the defence of the tobacco industry.
Mr. Barron: My right hon. Friend will recall that Labour Members often said that the Conservative party was addicted to the tobacco industry.
Mr. McCartney: It was addicted to that, to the drinks industry and to anything that required defending the indefensible. However, I understand the point of the hon. Member for Eddisbury (Mr. O'Brien), whom I like. He has been very kind to me—indeed, he sometimes offers me lifts to the House. I have not been able to persuade him to vote Labour, but I have been trying to get him to stop smoking for years, and I hope that he has.
Mr. Stephen O'Brien: For four years.
Mr. McCartney: It just shows how much I notice on those journeys, but I welcome the fact.
The survey was interesting. Eighty-nine per cent. agreed with banning retailers from selling tobacco if convicted of selling to under-age smokers. The overwhelming majority took the position that if people continue to sell illegally, they should not be able to trade. Another significant figure is that 86 per cent. supported licensing retailers to sell tobacco, with licences being revoked if retailers sold to under-age smokers, while 81 per cent. agreed with the idea of a ban on smoking in cars with passengers aged under 18.
Some 79 per cent. would also support a crackdown on smuggling, which is a critical issue in the north-west, so perhaps we can discuss smuggling when the Bill comes back to the Floor of the House. Indeed, my right hon. Friend the Secretary of State may know this, but an anti-smuggling exercise has been conducted in our borough over the past few days that has led to a massive haul of illicit cigarettes and financial resources from organised crime networks. Around two thirds of respondents supported ending the sale of cigarettes through vending machines, stopping the sale of packs of 10 cigarettes and the removal of displays of tobacco on premises on which it is sold. Such surveys demonstrate a desire among smokers and non-smokers alike across the north-west to protect children from tobacco and its effects.
This excellent Bill has been through the other place, but clauses 22 and 23, which deal with the power to prohibit or restrict sales from cigarette vending machines, should go further and allow for a full ban from the outset. I accept that we should strike a balance, particularly in the current economic climate, between the rights of businesses to carry on legal trade and the need to stop children from purchasing cigarettes, but let us be quite clear. Tobacco is the only product that can be sold legally that kills its customers on a daily and recurrent basis. That is why the tobacco industry requires the fuel of publicity and investment to restrict the effects of legislation aimed at preventing people from taking up smoking in the first place. Given that the industry has that view of itself and given the disproportionate number of children using such machines, as compared with adult smokers, we should put children’s health first and ban such machines completely.
In 2006, one in six children in England who were regular smokers usually bought their cigarettes from vending machines. In contrast, in 2008, only one in 20 adult smokers said that they had bought cigarettes from vending machines over the previous six months. Vending machines are a convenience to get round bans and encourage young people to take up smoking, which will lead to premature death and, with absolute certainty,
cause injuries to their hearts, lungs and other parts of their anatomy. The British Heart Foundation has estimated that machines are the source of cigarettes for around 46,000 children in England and Wales. We could fill up my right hon. Friend’s Everton ground with children who regularly use vending machines and still have 11,000 outside. Think about it, Madam Deputy Speaker: the whole of Goodison Park filled with children smoking their heads off who will not see Everton win the European cup 20 years from now— [ Laughter ]—this is a serious point—because they will fall ill prematurely and die, because they have been encouraged to take up smoking by the tobacco industry.
Calculations by the British Heart Foundation in 2006 suggested that around 45 million cigarettes were sold to 11 to 15-year-olds through cigarette vending machines. Think about it, Madam Deputy Speaker: that is equivalent to the size of a major European country, almost the total population of England. Think about it: children as young as 11 and under being able to buy cigarettes from vending machines. It does not seem feasible, but that is the reality. Would we allow children to seek access to vending machines for alcohol, fireworks or other products, such as glue? Of course we would not: they are dangerous to children. However, the most dangerous substance of all to children, with absolutely certainty, is tobacco, yet we allow them to purchase it in their thousands on a daily basis through vending machines.
That is why the British Heart Foundation, Cancer Research UK, Smokefree Northwest and other organisations have been campaigning for a ban. That is also why more than 110 Members have supported early-day motion 768, tabled by my hon. Friend the Member for Vale of Clwyd (Chris Ruane), which calls for such a ban. Imposing such a ban would close a loophole. I have said that it is hard to imagine the sale of solvents, alcohol, fireworks or knives in vending machines; if it is not right to sell those products in that way, it is certainly not right to sell tobacco in that way either.
The fact that cigarettes remain available in vending machines is an anomaly, and we need to tackle it in order to stop the harm being done to our children, and to prevent another generation from missing out on longevity and a healthy and safe lifestyle. We cannot simply leave this to an industry that needs to replenish its dying customer base on a daily basis by allowing our children to be undermined in this way. The only thing that our nation has to ensure its longevity is its younger generation. What we hand on to them must be different from and better than what was handed on to our generation. Yet, each year, we stand back and watch the undermining of the capacity of another generation of young British children to be the best that they can be, because we are doing nothing to prevent the tobacco industry and its allies from allowing our children to gain free access to tobacco products through vending machines.
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