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The Parliamentary Under-Secretary of State for Transport (Chris Mole):
I congratulate my hon. Friend the Member for Bedford (Patrick Hall) on securing this debate. As
chair of the all-party group on the Thameslink route, he obviously has a particular interest in the subject. I will try not to be diverted by questions on the recent performance of First Capital Connect, because there will be an hour-and-a-half debate on the subject tomorrow.
I welcome the opportunity to outline the good progress that is being made in delivering this vital programme that will transform the travel experience for many thousands of commuters in London and the south-east of England. The Thameslink programme is one of the Government's key transport priorities announced in the 2007 White Paper, "Delivering a Sustainable Railway".
The programme is a crucial part of our strategy to tackle chronic overcrowding on commuter routes-the hon. Member for Orpington (Mr. Horam) illustrated that well in his contribution-to provide capacity for future growth; and to deliver long-term benefits for passengers, the environment and the UK economy. Such a strategy is being achieved through a comprehensive modernisation programme, which will provide new and longer trains, upgraded stations and more frequent services through the centre of London, with up to 24 trains per hour in both directions.
The Thameslink programme aims to reduce crowding on current Thameslink and other commuter services; and to provide for the introduction of new cross-London services, so improving public transport accessibility in south-east England. For example, it will be possible to take a train direct from Cambridge to Gatwick airport, which must be good news for my hon. Friend the Member for Crawley (Laura Moffatt). The programme will also reduce the need for interchange between mainline and London underground train services and therefore reduce overcrowding on the underground, especially the Victoria and Piccadilly lines and the City branch of the Northern line. It will improve the reliability of train services operating through the core route section between London Bridge or Elephant and Castle and St. Pancras.
The programme itself delivers very substantial transport and revenue benefits in the region of £10 billion over the life of the programme. Those benefits are primarily due to the increased capacity and frequency that the scheme provides into and through central London, which, I think, answers the question of the hon. Member for Lewes (Norman Baker). The strength of the business case is such that everyone should support the scheme.
To deliver such benefits, major project works will be required in central London, which some have described as the equivalent of doing open-heart surgery on the centre of London. The most significant works will be at London Bridge station, where it will be necessary to widen the railway viaduct at the western side of the station at Borough, which the hon. Member for North Southwark and Bermondsey (Simon Hughes) mentioned.
Blackfriars and Farringdon stations are also being rebuilt and platforms are being extended at a large number of stations, both north and south of London, to enable them to be used by 12-carriage trains. Moreover, a new state of the art fleet of trains is being procured to replace the existing fleet and provide the capacity for the 24 trains per hour service. They will be the next-generation electric commuter trains and will be fully accessible for mobility-impaired users. I note the comments of my hon. Friend the Member for Bedford about freezing conditions. The new trains must be able to cope
with 24 trains per hour through the core. They will have high specifications, which will deal with issues such as freezing conditions.
I am pleased to say that significant progress has been made in delivering the programme, which has been split into three distinct phases. Key output 0 was an enabling phase and saw the introduction, on 22 March 2009, of a new Thameslink train timetable requiring dual voltage trains. My hon. Friend the Member for Luton, North (Kelvin Hopkins) referred to the challenges of operating with the dual voltage train regime.
Key output 1 involves the construction of Blackfriars and Farringdon stations, which, together with platform extensions along the midland main line, will allow longer 12-carriage trains to operate from Bedford to destinations south of London, and there will be up to 15 trains per hour through central London. The infrastructure capability from such works is due to be available at the end of 2011.
Key output 2 provides the full functionality of the Thameslink programme. There will be 24 trains per hour through the central core section, which will be achieved through the resignalling and reconstruction of London Bridge station and its approaches together with a new fleet of approximately 1,200 vehicles. That stage is scheduled to be completed from December 2016.
The first enabling phase of the programme was successfully introduced on 22 March 2009. It involved the closure of the bay platforms at Blackfriars and the closure of the Thameslink Moorgate branch. That was achieved by linking the north and south services together and running them through the core central London Thameslink route using additional new dual voltage trains.
The key output 0 element of the programme was delivered on time and on budget despite supply difficulties with the new trains. Much of the success can be attributed to excellent co-operation across the rail industry, where temporary measures were put in place to supply dual voltage trains to mitigate supply problems.
I am pleased to report that all the required 23 dual voltage trains have been delivered and are now in service with First Capital Connect. All temporary rolling-stock mitigation measures that were in place since March 2009 have now been withdrawn.
The objective of key output 1 is to deliver interim benefits before the full scheme-key output 2-is completed. By December 2011, key output 1 will deliver the infrastructure capability to operate longer 12-carriage trains from the midland main line through the central core route and beyond. The scope of the works includes lengthening platforms on the midland main line to 12-carriage trains; major rebuilding of Farringdon station, including new ticket halls and interchange with Crossrail; the total reconstruction of Blackfriars station, including a new underground station, new platforms spanning the Thames on a widened bridge and an additional south bank ticket hall; and enhancements to rail systems involving signalling, power, communications and track, which should address some of the concerns of my hon. Friend the Member for Luton, North.
Network Rail made excellent progress over the Christmas period in completing critical works at Blackfriars where a new bridge was installed, at Farringdon where work
to enable the integrated Crossrail ticket hall began, and at St. Pancras where new signalling was installed. Network Rail forecasts that the works for key output 1 can be completed to budget and on time. The 12-carriage infrastructure capability will be delivered by the baseline target date of December 2011. Such an improvement will provide significant crowding relief benefits to commuters on the midland main line and will be the first significant step change in capacity arising from the Thameslink programme.
The full functionality of the Thameslink programme, which is 24 trains per hour through the central London core section, is achieved through the resignalling and reconstruction of London Bridge station and its approaches, together with a new fleet of approximately 1,200 carriages, referred to as key output 2, and is scheduled to be delivered from 2016.
Key elements of scope include: major reconstruction of London Bridge station and approaches, including a new flyover at Bermondsey and a new viaduct at Borough market; a link to the east coast main line, north of St. Pancras Thameslink station; 12-carriage length platforms on outer areas south of London and on the east coast main line to Cambridge; enhancements to signalling, communications, power and track; stabling and depot connections; and automatic train operation through the core central London section. That answers the concern of the hon. Member for Wimbledon (Stephen Hammond) about the future of ATO.
In relation to depots, let me tell my hon. Friend the Member for Bedford that the Bedford depot will be kept in the short term to service the residual class 319 fleet until the full fleet of new trains arrive. In the long term, it will be kept for stabling for the eight-car element of the fleet of new trains.
Work has already started on widening the viaduct at Borough to the west of London Bridge station. That section of track is one of the most congested in the country, and is currently the key bottleneck for existing Thameslink services. For the remainder of key output 2, planning and optioneering are progressing very well, with final options being examined in detail by Network Rail. Significantly, a major upgrade is due to start at London Bridge station in the autumn.
Chris Mole: My hon. Friend stopped me from getting to my next paragraph. I wanted to say that the construction works at London Bridge are due to start in the autumn of 2012, following the closure of the Olympic games.
The Department for Transport is closely monitoring the costs of the Thameslink programme. We and our industry partners are both committed to and totally focused on delivering the full 24 trains per hour output to an affordable budget. Costs are constantly challenged across the entire programme to ensure that it remains affordable.
I have been involved with multiple sclerosis issues for many years now. I am chairman of the all-party group on MS and patron of two MS organisations, the North Wiltshire branch of the Multiple Sclerosis Society and Mutual Support, which is the military forces' branch of the MS Society. I am glad to have the opportunity to bring a very important issue related to MS to the Minister's attention.
In doing so, I want to start by paying tribute to the outstanding work of the MS Society, without which it would not be possible to raise these issues. It is a first-class organisation and shortly I will be talking about the manifesto that it intends to publish-later this week, I think-in the run-up to the forthcoming general election, which will raise a variety of issues related to MS. I know that all Members of Parliament will be sent a copy of that manifesto in due course and hopefully they will find time to pay attention to it.
Of course, this is not a party political issue of any kind at all. It is one that we in this place ought to pay attention to, because there are ways of making things better for the 100,000 or so people in England who suffer from this most debilitating disease. Sometimes I feel that cancer and heart disease achieve a higher profile in public awareness or in Parliament, but MS, in many respects and for many people who suffer from it, is no less debilitating and no less wicked a disease than those two more high-profile ones.
MS is a curious disease. However, we are getting closer to understanding what causes it and therefore to finding a cure, or at least a partial cure. There are oddities with MS. For example, the further one gets from the equator, the less likely one is to suffer from MS. Also, if one lives in a largely vegetarian society, such as those in Japan or China, one is much less likely to develop MS than people who live in western Europe. It is because of such curiosities that we are beginning to achieve some understanding of this dreadful disease, and as a result we can begin to find a cure.
Today's debate, however, is not about the attempt to find some cure for MS; it is about those drugs that ameliorate the symptoms of the disease. In particular, I am referring to the disease-modifying drugs, such as beta interferon and glatiramer acetates. Some 10 years ago, there was a terrible postcode lottery associated with those types of drugs. I remember very clearly being much engaged in the campaign to allow them to be prescribed on the NHS. I remember the particular example of Stephanie Millward, the Olympic swimmer from the village of Box in my constituency, who was not allowed to have beta interferon prescribed for her MS. She lived about 100 yards away from the border with
Bath and at the time the local health service in Bath was prescribing beta interferon. That was a terrible postcode lottery and we campaigned very hard against it.
As a result of that campaign, we came up with a new scheme, the risk-sharing scheme. Under that scheme, it was established that, although the National Institute for Health and Clinical Excellence had said that beta interferon and the like were not cost-effective for the treatment of all MS sufferers, if the drug companies producing the drugs could demonstrate that the drugs were effective, the cost element could be balanced out at a later stage, as it were, by the NHS being given a discount for the provision of the drugs.
That is a broad-brush description of the scheme that we agreed to some 10 years ago. I remember that, seven years ago, there was a reception in Portcullis House and we all welcomed the introduction of the scheme, which was a very good outcome both for MS sufferers and for the NHS. Having said that, the purpose of this debate is to consider whether the risk-sharing scheme has worked to benefit either those people suffering from MS or the NHS.
The scheme has delivered some benefits. To begin with, more people have been prescribed beta interferon or the other disease-modifying drugs than would otherwise have been the case. For example, Stephanie Millward has been prescribed beta interferon for the last seven years. I see her very often and she tells me that it has definitely improved the symptoms of her MS. So, it is a good thing that more people have had such drugs than would otherwise have been the case.
There have been one or two positive side effects of the scheme. There are now about 200 specialist MS nurses provided to the NHS, which is hugely beneficial. They do a superb job and it is very important that we find ways of keeping them going in our local communities, although they have been somewhat challenged in recent years.
Has the risk-sharing scheme really and truly worked, however? Do we now know more about whether beta interferon and the other drugs work? Do we now know whether they work for particular types of patient? Also, is the scheme cost-effective?
One would have thought that, after a seven-year scheme such as this one, the Government would be ready to come forward with a few answers to those questions and would be able to say that the scheme is working, that it is working for some patients, that it is saving us money, or that it has made the world a better place. That is why those of us in the MS community, as it were, find it very curious that we still do not know the answers to those questions. The Government have delayed publishing the first analysis of the scheme. I hope that the Minister, in his winding-up speech, will be able to tell us when the Government plan to publish that.
Those people who know about these things-particularly those who work for the MS Society and other such organisations-have detected what seem to me to be absolutely fatal flaws in the scheme as a whole. The whole methodology of how the scheme was put together is flawed. It has taken us seven years to realise that, but the statistical and methodological inadequacies of the scheme mean that, even when the Government come out and publish the interim report on whether it has worked, we will question whether an accurate conclusion has been reached.
Of the 5,000 people who were part of the tests under the scheme, quite a large number are sadly no longer with us and others are unable to say whether the scheme has worked. Since there was no cohort of people who were not suffering from MS but who were tested on the drugs, it is very difficult to say statistically whether the scheme has worked.
The first two-year cost-effectiveness analysis of the scheme, which took a very long time to produce, finally appeared in the British Medical Journal in December 2009. That analysis appears, at first sight, to show that the progression of the disease was worse than predicted for those people who were on the disease-modifying drugs and it was also worse than it was for those people with MS who had not taken the drugs. So, at first glance at that BMJ article in December, it would appear that the scheme has not worked and that the drugs themselves do not work. However, the article goes on to undermine its own conclusions by saying that the methods used in coming to them were flawed, so the conclusions can be questioned.
What is more, under current plans the scheme will run for another five years and the same flawed methodology will be used for that time. So, conclusions reached in 2015 as to whether the scheme is a good thing will be made using flawed statistical analysis. In any case, by 2015, when those conclusions come out, most of the drugs in question will have reached the end of their patent date, and so it will no longer be interesting to know whether they have worked.
Furthermore, the cost adjustments that the drug companies may or may not have to provide to the NHS at the end of that time are not retrospective. The scheme will have been running for 10 or 15 years; it may be concluded that the drug companies should pay money back to the NHS; but because the scheme is not retrospective, it will not matter. Any cost adjustments will apply only looking forward from 2015, not looking back. Therefore, there is no financial benefit for the NHS.
Perhaps the scheme is working for people with MS. After all, its purpose was to try to demonstrate that the drugs are available to people with MS on an equitable basis. However, a glance at the league table of the drugs' availability across Europe demonstrates that Britain is near or at the very bottom. Anywhere else in Europe, people with MS stand a better chance of getting the drugs on their national health scheme. We do not supply the drugs ourselves; the scheme that we implemented to judge whether they work is not working because the arithmetic that it uses is flawed; and people with MS here are less likely to get the drugs than those in France, Germany or elsewhere.
In addition, the prescribing theory for the drugs is out of step with medical science. They are injectable drugs, but since the scheme was implemented, a variety of non-injectable oral drugs to treat MS or its symptoms have been introduced. It is widely presumed that within a year or two, the oral drugs will be better than injectable beta interferons for treating symptoms. In other words, the scheme is desperately trying to prove whether a drug works, but by the time the proof arrives, the drug will be out of date anyhow. It is entirely flawed.
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