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Last week, I wrote to my right hon. Friend the Member for Kingston upon Hull, West and Hessle (Alan Johnson)—this shows how much I knew about the reshuffle—asking whether I could meet him and my right hon. Friend the Member for Bristol, South (Dawn Primarolo) to discuss the possibility of improving clause 22 and ensuring that we could achieve a total ban on
cigarette vending machines. I feel extremely strongly about this, as do hon. Members on both sides of the House. I do not claim to feel more strongly about it than anyone else, but I am the grandfather of 10 grandchildren, and I want to ensure that every one of them—representing all children—lives to adulthood and becomes a grandparent and a great-grandparent.
I look around my constituency, and I see too many people in their 40s, and even in their 30s, dying of smoking-related diseases. They never go on to become the best that they could be. They never go on to become a grandparent or a great-grandparent. Some of them die a nasty, tobacco-related death just as their lives are coming to fruition and their relationship with the next generation of their family is just beginning. Why is it that someone in my constituency who is 40 years of age has only a 25 per cent. chance of survival following a smoking-related heart attack? Fifty per cent. of my constituents who have had a heart attack from tobacco-related heart disease die at home, before they even get access to the emergency services. Of the remaining 50 per cent., half die on their way to hospital. Only the remaining 25 per cent. have an opportunity to continue their lives, which might be saved through intervention and heart surgery. This is carnage on a grand scale, and it is unacceptable.
Clause 22 needs to be strengthened. If my right hon. Friend the Secretary of State cannot respond to my request for a ban this evening, will he please meet me and other hon. Members to discuss the matter? It is a matter of life and death. We have come so far and done so much in the teeth of great opposition. People said that the smoking ban would not work, yet it has received major public acceptance. It is not true to say that businesses have closed down as a result of the legislation. In the years to come, hundreds of thousands of our fellow citizens who might otherwise have suffered ill health and premature death will not now do so, because of the work that we have done in the House and the ban that we have imposed.
My proposal represents the final piece of the jigsaw. I implore my right hon. Friend, in his new post, to be brave and not to take heed of those who claim that this would be a regulation too far. I would introduce a thousand regulations if they saved a thousand children’s lives. I would introduce a million regulations if they would save a million lives. Over the next 20 years and beyond, the actions that we have already taken will save that number of lives, but we need to prevent young people from smoking in the first place, and ensure that we do not give them access to cigarettes for the convenience of an industry that wants to use vending machines to get round the existing legislation. We must close this loophole and save tens of thousands of children from illness and premature death in the years to come. Be brave—get the ban in!
9.10 pm
Mr. Lee Scott (Ilford, North) (Con): I congratulate the Secretary of State on his promotion and wish him well.
I start by praising NHS staff—our doctors, nurses and all other staff—for the wonderful work that they do. That is worth putting on the record. I was proud to vote for the ban on smoking, and we have just heard an
impassioned speech on that subject. I truly believe that voting for the ban is one of the best things that I have done since becoming an MP. I hope that the proposal to introduce a display ban is evidence-based. If I am convinced that it is, I will vote for it, but any legislation should take account of any losses to the businesses involved.
It is slightly hypocritical for some Labour Members to say that Conservative Members are addicted to smoking. Unless I am very much mistaken—it may be a selective memory loss—I rather think that the former Prime Minister might have had an addiction to Formula 1 and the advertising of smoking. Perhaps there is some addiction on both sides of the House. [Interruption.] I am pleased to hear that some Labour Members spoke against that.
I welcome the concept of an NHS constitution, but I am of the view that what the Bill proposes needs to go further. We need to stop any interference from Whitehall and the constitution needs to recognise that it should be left to professionals to control the day-to-day running of the national health service. Managers, doctors and other health care workers are frustrated by the one-size-fits-all system and structures imposed from the centre. It is time to set them free and to trust them to use their professional judgment.
Health care inequalities exist, so it is not sufficient to focus purely on treatment. The real priority must be recognising the causes that led to those problems. Poverty, family breakdowns and location all play a part. It is time to start fixing the problems. It is not just where we are born, however, as where we live can have the most devastating impacts on the care that we receive.
I welcome the fact that, according to the constitution, drugs approved by the National Institute for Health and Clinical Excellence will now be available to all who need them, but how can we explain a doctor having to tell a patient that they cannot have a drug that has not been recommended by NICE? We must look further at that problem. If a national health service is to mean anything, it must mean that treatment is prescribed on the basis of clinical need and not home address. Such key issues should be set out in the NHS constitution handbook only after the Secretary of State has guaranteed a wide consultation with interested bodies. Those involved at the sharp end deserve to have their views taken into account—they know best; far better than us. I believe that many of us would share the view expressed by Age Concern that dignity must be at the heart of the NHS. The constitution must provide a firm guarantee of the care that older patients can expect.
The constitution has some omissions. For example, where is the recognition of the vital role played by dedicated staff and the need to support them? Also absent is any move to give patients a meaningful say over their health care. The Government may say that they are determined to engage clinicians, but is it not true to say that the early drafts barely mentioned general practitioners? It is widely reported that the Royal College of General Practitioners had to fight to get GPs in the constitution. In fact, is it not also true to say that the constitution is, in its current stage, nothing more than engagement and window dressing? I say that without wearing any stiletto heels.
I move on to touch briefly on the issue of innovation prizes. I do not have a problem with rewarding staff, but
I do have a problem with how it will be funded and carried out. Getting the NHS suspension policies absolutely right is vital. If we do not do so, we will end up unable to sack senior managers who have proved to be utterly hopeless—or we will see them walk away with huge payouts. The former chief executive of the Barking, Havering and Redbridge NHS Trust in my area walked away with a payoff after working up a £90 million deficit, which I personally find disgusting. I pay tribute to his successor, John Goulston, and his team for turning the situation round. Rewarding failure should no longer be an option. Failed managers should no longer be re-employed by the NHS as consultants and paid with public money.
The Bill also attempts to deal with the quality of provision, stating that quality accounts must be produced by all health care providers working for or on behalf of the NHS. I seek some reassurance from the Minister on the accuracy of those data. I am sure that I am not alone in asking whether those supplying the information would not be best served by predicting as rosy a picture as possible. There needs to be rigour. That means publishing only the unvarnished truth, including mortality rates and other key data. Patients will not be empowered unless they know the real story. We must stop talking only about patients’ rights. The facts must speak for themselves, so that patients can make up their own minds about where and by whom they want to be treated.
Two years ago, the new Secretary of State for Health told the Fabian Society that the next decade would be all about quality, not quantity. Why, then, is Labour still doggedly focused on targets? Even Tony Blair’s former adviser admits that they are inherently flawed. Perhaps if the Government had not failed to act on the advice of the new Secretary of State for Health to the Fabian Society, the families of those who have died in places such as Mid Staffordshire would not be grieving today. That is a classic example of the way in which clinical judgment suffers when targets are prioritised. Labour saw the problem—the fault line that threatened to rupture the foundations of its own policy—but, instead of being responsible and doing something about it, lumbered on without regard for the consequences. It is time to stop putting one’s own political survival first and to put patients first instead.
I want to make three brief points in the limited time available to me. Over the past three years, medical negligence payouts in the London region have totalled a quarter of a billion pounds, with the first amount going to the legal profession rather than the patients involved. That must be looked into as a matter of urgency. When accusations have been made against doctors—I refer not to malicious accusations, but to accusations with substance—those doctors must be suspended while investigations take place.
I also want to say something about the accuracy of checks on doctors’ qualifications. In my own trust, a Mr. Iwegbu, who used to call himself Professor Iwegbu, has now been told that he can no longer use that title. We do not yet know the reasons, but all qualifications of all doctors must be checked as a matter of principle to ensure that they are what they say they are, and to ensure that the patients on whom they operate know who is treating them.
Earlier, the Secretary of State spoke about what he described as the achievements that had been made
over the lifetime of the Labour Government. All I can say is that this Labour Government may now be receiving life support.
9.18 pm
Mr. Philip Dunne (Ludlow) (Con): I congratulate my hon. Friend the Member for Ilford, North (Mr. Scott) on his impassioned speech. I also thank the Secretary of State for his response to my intervention on his speech at the beginning of the debate, and apologise to him for not being able to be present for the whole of the opening speeches. It was not just the parliamentary Labour party that had other meetings to attend during the debate. I apologise to you, Madam Deputy Speaker, for the fact that I too had other things to do.
Before I comment on the details of the Bill, I want to return to the point that I made in my intervention. The Secretary of State has a large in-tray, and he has demonstrated today that he is getting on top of it quickly. One of the items he will find in it is the apparent disappearance of the community hospital development fund. I remind him that in 2005-06, when the NHS faced substantial deficits in trusts around the country, more than 82 community hospitals were threatened with closure. That caused a furore across the country.
When he took up his post, the Secretary of State’s predecessor, the right hon. Member for Kingston upon Hull, West and Hessle (Alan Johnson), sought to end the furore by magicking up a capital pot of money—some £750 million—for community hospital redevelopment. That was very welcome. The issue went away, and those campaigning to save their hospitals were able to divert that energy to seeking to improve their community hospitals. In the first full year, close to £250 million of the funds were allocated for community hospital rebuilding. It was a three-year programme of £250 million a year, and the first year’s sum was allocated.
One of three threatened hospitals in my constituency, Ludlow community hospital, was in dire need of investment. It was still operating in old Victorian workhouse premises as well as having facilities that had wards closed, and therefore the property was beginning to deteriorate and decay. The community got behind it and worked hard with the local authority to put together a base-case business plan for a renovation of the hospital, which, with the support of the primary care trust and the active support of the strategic health authority, turned into a bid for a significant sum for rebuilding the hospital.
It was an innovative project to co-locate the hospital and the GP surgeries in the town. The bid was supported as a top priority by West Midlands strategic health authority, or so we were told, and it went to the Department for approval. Having been encouraged to submit such a proposal, the PCT received a letter from the SHA less than a month ago saying that the funding had been put on hold and that no more funds would be made available, and that we would have to look elsewhere if we wished to fund the project going forward. The community is determined to do so and a great deal of work is continuing, but the sudden news that no money was available, our having been told that a further £500 million would be available, was immensely disappointing. I sincerely hope the Secretary of State will do his utmost to find out where that money has gone and to put it back on the
table, and thereby allow communities throughout the country to access it. I look forward to his fulfilling the commitment to review that decision, which he gave at the beginning of the debate. That does, of course, square with the Government’s plans to bring forward public sector investment to help rejuvenate the economy from the recession, so it is in line with Treasury thinking.
I want to make two points about the Bill. First, I welcome clause 33 on the investigation of complaints about privately arranged or funded adult social care, which also has resonance for my constituents. My constituency has a significantly above-average elderly population. Some 24 per cent. of my constituents are above retirement age and the proportion of over-80s rises inexorably every year as both the standards of health care and longevity increase. As a consequence, there is an increasing need for adult social care provision and many of my constituents make contributions to their provision as they come to need it. At times, of course, problems arise with the arrangements for their adult social care and therefore a proper complaints procedure is required.
It is right that the Government are seeking to put in place an effective mechanism to allow for complaints to be dealt with, so that redress can be given for decisions affecting some of the most vulnerable elderly people in our community. They currently do not have much of a voice at that stage, but they will now be able to make appeals and, hopefully, secure redress where previously none existed. I look forward to seeing the detail that emerges in Committee to ensure that the system is effective, and that it is not merely window dressing so as to give a complaints procedure without teeth. Therefore, at least in principle, the proposal is to be applauded.
I am less keen on the proposals for the display ban on advertising, which has taken up a lot of time. I am no advocate for the tobacco industry, although it was suggested that some Conservative Members are. I suspect that almost every Member could bring to the attention of the House heart-rending tales of relatives, friends or constituents who have suffered the effects of a lifetime of smoking. My grandfather died from lung cancer. I have never smoked in my life—I have no intention of taking it up—and I encourage my children not to do so, but I firmly believe that if we are to introduce further measures to restrict the availability of tobacco to young people, it must be done on an evidential basis.
There is an illogicality in the Government’s approach. They use taxation as the main means of reducing smoking in this country—I have sat through enough Finance Bills to know the arguments in favour of that. This country has the second highest price of tobacco in the EU, at £5.85 for a packet of 20; only Ireland levies more tax than we do on tobacco products. The tax that the Government generate from every sale of duty-paid tobacco is greater than the retail price in every country in the EU save Ireland and France.
Taxation is, appropriately, the major mechanism used by the Government to restrict the consumption of tobacco, but many other measures have been introduced in recent years, most of which have yet to take effect. The proportion of young people taking up smoking has declined in this country year on year, which is to be applauded and
welcomed. My concern is that some of the measures, in particular the display ban, will have perverse, unintended consequences and are unnecessary at this time for two reasons.
The first reason relates to the evidence base, to which reference has been made, in particular by the hon. Member for North-West Leicestershire (David Taylor). He made a powerful speech, but I fear that he has not captured the essence of the evidence—it is, at best, not clear-cut. We need to see clear-cut benefits—the reduction of young people’s smoking—before we embark on a display ban that will have significant ramifications for the people who will be most directly affected: the retailers, in particular the convenience store retailers, the corner shops and the confectioners, tobacconists and newsagents.
Every community in our country benefits from such shops. Some 48,000 or so outlets sell tobacco, the vast majority of which are community shops that serve their local communities and happen to sell tobacco as one of their products. Such shops are typically independently owned. Some may be part of a small family-owned chain. Few of them have the capital resources to invest significantly in fulfilling the requirements of the display ban and many of them generate a substantial proportion of their turnover from the sale of tobacco products. It has been estimated that close to 12 per cent. of them—more than 2,500 shops—would go from generating profit to generating loss as a result of the proposal, and that would put close to 2,500 communities out of touch with their local shop, which provides their convenience shopping and allows them to shop within their own community. That significant potential negative of introducing a display ban has not been adequately thought through in the economic impact assessment that the Government have undertaken in examining the measures. As a result, the proposal should be put on hold. We should wait to see the impact of some of the other legislation that the Government have put through—
Mr. Dunne: I am about to finish, so I am not going to give way.
In particular, we should see the impact of measures that came into effect only on 1 April under the Criminal Justice and Immigration Act 2008, which specifically introduced the concept of negative licensing for retailers who are found to be selling tobacco to under-18s. That provision has been in force for two months and there has not been a single prosecution under it, because it requires three offences before a prosecution can be brought. Thus, it seems completely nonsensical to introduce additional legislation precisely to target that user group—the under-18s—and stop them smoking when there is legislation that will have an opportunity to be much more effective in directly addressing the Government’s concerns. We should see how that works before introducing this unnecessary and potentially very damaging measure.
9.30 pm
Mr. Stephen O’Brien (Eddisbury) (Con):
If we needed any more evidence that this Government are a tad short of support, we only have to recall the notable absence of Labour Members from the debate on this so-called flagship Bill. There was a notable absence of almost
every Labour Member between 6 pm and 7 pm, for some reason or another— [ Interruption. ] It is interesting that they do not want to be reminded of that.
The Bill’s 36 pages contain 10 policy areas that are completely inconsistent with each other. There is little vision for our NHS and much tinkering with legislation that the Government should have got right first time round. As with so many of this Government’s Bills, much of the substance lies in secondary legislation, for which drafts are not yet available, even though the Bill has already been through the other place and there has been plenty of time for the Department to prepare them. The Government probably would not provide time to debate them anyway. This is a wash-up Bill from a washed up Government.
Nevertheless, owing to the wide-ranging nature of the Bill we have had an interesting debate with contributions, in the end, from those on both sides of the House. I take this opportunity to welcome the right hon. Member for Leigh (Andy Burnham) back to our health debates, now as the Secretary of State. We will see whether his loss to the blue shirts at Goodison Park will be a gain to the blue scrubs of our hardworking NHS staff. Also, I congratulate the Minister of State, the hon. Member for Corby (Phil Hope), on retaining his post and I welcome the Minister of State, the hon. Member for Lincoln (Gillian Merron). I welcome too the Minister of State, the right hon. and learned Member for North Warwickshire (Mr. O’Brien). As well as surnames, we have shared debates before, and I look forward to his generous acceptance of many of our amendments in Committee.
The NHS constitution was published in January this year. It is typical of the Prime Minister, who wants to return power to Parliament, that he held a closed signing ceremony in Downing street for this booklet, the contents of which have never been debated in Parliament—and still had not been at the time of the launch. It is right that our NHS should have a constitution. Like a number of proposals in this Bill, it is resonant of Conservative pledges of some years ago. But for such a constitution to be more than just print on paper, it must be put on a statutory footing. It is questionable whether this would make it a lawyers’ charter: as the Government have said, many of the principles of the constitution are already underpinned by legislation.
We have called for the 10 core principles of the Government’s NHS plan to be put in the legislation. It is worrying that a Labour Government, even such a tired one, have cut that number down to seven. The Government’s own Back Benchers, along with everyone on this side of the House, should worry that the Government have discarded principle 7, which is:
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