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"it does look like somebody has tossed a hand grenade at the PCTs"
"If the expertise isn't there...inevitably they're going to be having to turn more to the private sector."
Dr Hamish Meldrum, chairman of the British Medical Association, says:
"Ploughing ahead with these changes as they stand, at such speed, at a time of huge financial pressure...is a massive gamble."
"We will quickly see failed consortia bought up on the cheap by foreign companies and see bits of the NHS run from abroad."
Sir Richard Thompson, president of the Royal College of Physicians, says:
"The fragmentation of services would have detrimental impacts on the various areas the reforms seek to improve".
Dr Peter Carter from the Royal College of Nursing says:
"The RCN is also concerned that the fragmentation could result in unexplained variations in service, a reduction in collaboration and less sharing of good practice-all of which impact on quality care."
"We don't think it's been properly thought through... In May last year the average waiting time was nine weeks. Our concern at the moment is that short-sighted false economy will end up costing the public money and result in patient care going backwards."
The head of Arthritis Care says that
"the Bill risks creating a 'free-for-all' situation where only those patients who shout the loudest will get the services they need."
In a letter to The Times on 17 January, the leaders of six professional health service organisations said:
"The scale and ambitions of the cost-reform programme are extremely risky and potentially dangerous."
Last Monday, in a letter to The Times, 190 nurses from one trust said that the
"figures from the Royal College of Nursing show 27,000 nursing posts are being cut. These proposed reforms will make matters much, much worse...The proposed reforms will be rapid, costly and staggering in scale: they presage nothing less than the complete reconstruction, if not privatisation, of the NHS".
This morning, in the Newcastle Journal, 12 doctors representing people from Northumberland in the north to Yorkshire in the south said that
"enforced financial competition, creating a health 'market', risks damaging our health service. Forcing GP consortia to tender contracts out...runs the huge risk of seeing large commercial, profit-driven companies entering the market. They will pursue the most profitable contracts...and ignore aspects of healthcare which are not profitable, leaving behind 'Cinderella' services. There can be no doubt that the use of their size to undercut on price...could damage local services in the north-east."
Those are not my words. They are the words of those we as a nation trust to take care of the people who send us here. To rubbish them, like Government Members have done tonight, as the voices of conservatism means just one thing: arrogance. It shows that they are not prepared to listen to the people who take our people forward and look after them. [ Interruption. ] No, I am not going to sit down; other people want to speak. The truth is that the people of this country will never forget that, and they will not forget the human shields in the Liberal Democrats who are giving cover to that policy.
Nick de Bois (Enfield North) (Con): I am very grateful for this opportunity to contribute to the debate. It is a great relief to note that we are now having a debate, having passed the stage where people, such as the previous Government, believed that pouring in more money improved outcomes. We are now debating reform, and we should welcome its scale, so that we can head towards what patients want-improved outcomes.
Whatever the good intentions of the previous Government, there is no question but that, unfortunately, their measures led to reduced productivity, a massive increase in bureaucracy and a distortion of clinical priorities, which meant that, on the outcomes that we seek, patients were not satisfied. I have been more concerned about health outcomes and the fact that patients were becoming remote from the thing that mattered to them most. That is what the NHS is about. Whom do patients trust? Do they trust a remote primary care trust or their local doctor? There really is no
contest, so I welcome these reforms, because they will give commissioning powers to GPs and bring their patients closer to the decisions about their future.
I do not recognise the picture painted by Opposition Members who say that GPs do not welcome the proposals. Already more than half the country is working under the pathfinder shadow consortia, and in Enfield we are already rushing to sign up. We have agreed our consortium, which I warmly welcome. It is keen to seize the opportunity.
Let us turn to local accountability, which goes hand in hand with local commissioning-based services. In the past, it has proved impossible to have genuine local accountability as the NHS processes ultimately all led directly to Whitehall and the Secretary of State. I agree with the Nuffield Trust that the widening involvement of independent providers, the use of social enterprises and community services, and the increase in foundation trusts mean that local accountability mechanisms should indeed be robust.
The right hon. Member for Croydon North (Malcolm Wicks), who, sadly, is not in his place, and the hon. Member for West Lancashire (Rosie Cooper) expressed concerns that the mechanisms would not be robust, but I refer them to clause 170, on independent advocacy services, and to clause 175, which emphasises the scrutiny role of the local health authorities, not to mention the local representation of councillors. [Interruption.] The hon. Member for Leicester West (Liz Kendall) says, "One" from a sedentary position, but I shall not take lectures from a member of a party whose Government carried out no consultation as they tried to reconfigure services in Enfield against the wishes of the public. I shall turn to that now.
It makes no sense that the people who want to hold the health care community to account for their local services should have to go to an intransigent bureaucracy and ultimately up to the Secretary of State. That process is removed from where the local decision making takes place. As I said, in my constituency we are reaching a critical stage now in the future configuration of our acute hospital services. The decision prompted by the previous Government, to downgrade and rip out our vital A and E service and axe the consultant-led maternity services that see 3,000 births a year, is being relentlessly pursued by those same bureaucrats and officials from the health services, despite the fact that the decision will cost lives.
In ignoring the wishes of thousands who took to the streets and the view of the majority of Enfield GPs, those same PCT officials, even at this late hour, are effectively trying to bully the residents into accepting the changes without the consent or consultation of the people. No such arrogance would have been evident if this Bill had been in place. Local people would have been engaged in a genuine process of change because such a proposal would have had to have been agreed by the local health and wellbeing board. As the Secretary of State said yesterday morning, any possible future changes would have to be agreed in the health and wellbeing board of the local authority, which is publicly open and accountable. Gone is the "Whitehall knows best" attitude, to be replaced with local accountability, local engagement and local decision making.
Had the Bill been in place as law, I do not believe that we would have reached the 11th hour for this critical decision in Enfield. The four tests that the Secretary of
State rightly requires would have kicked the issue into touch long ago because of genuine local accountability. The local authority, local GPs and, above all, local residents have spoken with one voice. I am grateful that we have a Secretary of State who believes in local accountability and decision making. In future, the voice that was ignored by the Labour party will be enshrined in this legislation. For years, we have suffered from a lack of local accountability in the health service.
Henry Smith: Had the Bill been law 10 years ago, Crawley hospital would not have lost accident and emergency and maternity services. It seems that my hon. Friend thinks the same about hospital services in his constituency.
Mr Speaker: Order. The hon. Member for Enfield North (Nick de Bois) is being generous in giving way, but I remind him that the Front-Bench winding-up speeches begin at 9.39 pm.
Nick de Bois: Thank you, Mr Speaker.
For years, we have suffered from a lack of local accountability in the health service. The Bill delivers that accountability. For the health service, the Bill is evolutionary, building on the successes and correcting the failures of the past, and leading to improved outcomes. This revolutionary Bill decentralises power to local people.
Derek Twigg (Halton) (Lab): This has been a fascinating debate with some interesting and excellent speeches. Some 17 Labour Members and a similar number on the Government Benches have given a variety of speeches, some showing great knowledge and some not so much. I particularly congratulate my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) on her excellent maiden speech, in which she demonstrated her great knowledge of the health service and her background in it. I am sure that she will make many more such speeches and be a great success in this House.
I would like to thank the NHS staff for all the work they do every day in our health service. That includes those at PCTs; one might sometimes think that they were ogres, given how PCTs are described by some Government Members. They work very hard, and they, too, have to deliver the changes that will take place as a result of this Bill.
The Secretary of State is pushing ahead with the Bill despite criticism from all sides. Patient groups, professional bodies and health experts have attacked the plans as high cost, high risk, a danger to the commissioning of key health services, and a distraction from the need to find efficiencies. The heads of the British Medical Association, the Royal College of Nursing, the Royal College of Midwives and the Chartered Society of Physiotherapy, as well as union leaders, have described the reforms as extremely risky and potentially disastrous. The more they see, the more they become concerned. The clear message that we have been getting is that the proposals have come at the wrong time, they are ill conceived, and a lack of attention has been paid to stakeholders' concerns.
The Secretary of State has ignored the massive improvements that took place under the Labour Government. One would think that he was talking about a different health service, because we had record numbers of doctors and nurses and record low waiting times. I wonder whether the Minister will confirm, as the Prime Minister and the Secretary of State have not done so, that there will be no increase in waiting times during the life of this Parliament. There have been record levels of patient satisfaction, with 71% agreeing that Britain's national health service is one of the best in the world-the highest figure on record. That is also evidenced by the satisfaction levels recently recorded across user groups, with, for instance, 91% of GPs and 90% of out-patients satisfied. The argument that the NHS is in crisis and is not dealing with patients' concerns does not stand up. It is important to look at some of the other improvements that have taken place. In June 2010, 90% of admitted patients and 98% of non-admitted patients were being seen within 18 weeks. The coalition has scrapped the targets that delivered those improvements to patient care.
Several Members referred to international comparisons. Let me take the example of the Commonwealth Fund, which ranked the UK first for efficiency and effective care in a study of seven top health care systems. In its 2010 international survey, it found that 92% of people were confident that they would receive the most effective treatment when sick-the No. 1 figure among comparable nations.
A lot has been said about cancer mortality. From 1997 to 2008, cancer mortality rates in all regions of England decreased by between 17.5% and 23%. Even more pronounced improvements have been observed in mortality from circulatory diseases: between 1995-97 and 2006-08, the mortality rate for England fell by 47%.
There are many uncertainties and unanswered questions about the Bill. There are concerns about who will be involved in commissioning and whether it will include other clinicians such as hospital doctors, physios and, importantly, nurses. How do nurses fit into the structural regime? In an article in today's edition of The Times, the Prime Minister says:
"Nurses too will continue to play a vital role. GP consortia will have a statutory duty to work with nurses and other healthcare professionals, ensuring they have a real voice in shaping better care for patients".
The Royal College of Nursing says that it was interested to see this, because it does not believe that the Bill goes far enough for it to be possible to claim that that is a statutory duty. Perhaps the Minister will respond to that, too. The only provision that the RCN believes relates to that matter is new section 14O in clause 22, which states that commissioning consortia must obtain appropriate advice. It does not believe that the Bill goes far enough in ensuring that commissioning consortia have relevant multi-disciplinary expertise to commission appropriate care.
I should like to turn to Monitor and competition-an aspect that has not been much mentioned. An ideological commitment to competition on price and to a massively increased role for the private sector is at the heart of the Conservatives' proposals, despite their attempts to hide it. On 17 January, in a 700-word article in The Times, the Secretary of State did not mention the word
"competition" once, but the Government have had to reveal where the true thrust of this legislation lies. Of course, he did not mention it much in his speech today, either. The Prime Minister told the House that
"what we want is a level playing field for other organisations to come into the NHS."-[ Official Report, 19 January 2011; Vol. 521, c. 831.]
When we appeared together on "Newsnight" a couple of weeks ago, the Minister of State, Department of Health, the hon. Member for Chelmsford (Mr Burns) said:
"It is going to be a genuine market. It is going to be genuine competition."
The Government have hidden the great bulk of the ideological market and competition changes from public view. There is the introduction of competition on price. Monitor will have the power to direct consortia to put the provision of services out to tender, irrespective of what the GP consortia say. The Minister wants to deny that, but it is what we read in the Bill. Monitor will be driving this, not the GP consortia. Government Members should be reading that part very carefully. NHS resources, such as beds and staff, will be used without limit to treat private patients as the cap on private patients in hospitals is lifted. That means that private patients may jump the queue while NHS patients are waiting for treatment. Services or whole hospitals may be forced to close as the most profitable patients are cherry-picked by private providers.
Robert Flello: Does my hon. Friend recognise the effect when a local MP sets up a big campaign? In my constituency, I may well be doing that with the Sutherland centre, which is under threat. The local MP will have no influence or power at all because of Monitor's role.
Derek Twigg: The issue of accountability for this House-what we can and cannot do-is important and I will come on to it if I have time.
I turn to the Liberal Democrats. The hon. Members for Burnley (Gordon Birtwistle) and for Manchester, Withington (Mr Leech) suggested that the Bill will protect hospitals and wards from closure. I am afraid that it will not. They need to read the Bill again. Monitor will be driving a lot of this, and they need to be clear about what the Bill actually does. They should join the hon. Member for St Ives (Andrew George), who is taking the interesting stance of not voting for the Bill tonight. He understands it better than other Government Members.
Concerns over fragmentation and obstacles to integrated working have been raised by numerous bodies in the health service and by those who work in the health service. The Commonwealth Fund states that the UK has the best co-ordination between health care providers and professionals, with the lowest percentage of patients having experienced co-ordination problems in their care. Only 10% of patients have received conflicting information. The more privatised, competition-driven systems in Australia and the US experience greater co-ordination problems.
The King's Fund brief for this debate states:
"The Bill signals a significant shift towards a more competitive market for health care. While we support increased competition in areas where it demonstrates benefits to patients, the Bill appears to move towards promoting competition at the expense of collaboration and integration."
That is from one of the most respected think-tanks.
One cannot underestimate the huge powers that will be given to Monitor. It will expose the NHS to a rigorous competition regime, with services going out to tender. The explanatory notes state that Monitor will become the
"economic regulator for all NHS-funded health services",
"do anything it needs to in order to exercise its functions."
In other words, the NHS will become like a utility.
Of course, the Government are full of broken promises. The Prime Minister said that there would be real-terms increases in NHS spending, but there are not. He said that there would be no cuts, but there are. He said that there would be no top-down reorganisations, but we have a top-down reorganisation. David Nicholson said that
"no one could come up with a scale of change like the one we are embarking on at the moment. Someone said to me 'it is the only change management system you can actually see from space'-it is that large."
This is a massive change. There are other issues, such as the cuts in staff that are taking place and the vacancies that are not being filled. We are being told about that by people who work in the health service. That is the true nature of the health service under the Conservatives and the coalition.
We are in favour of improving the quality of care, driving up standards, greater clinical involvement and giving a greater say to patients. We are therefore not anti-reform, but we are against this reckless, top-down reorganisation with a cost of £3 billion, which was hidden away during the general election campaign. It is reckless, it is not in our best interests and many believe that it will be the end of the NHS as we know it.
The Minister of State, Department of Health (Mr Simon Burns): When NHS funding has reached the European average, but the outcomes for care have not; when doctors are seeking to improve the quality of care but are hindered by politically imposed targets; and when the defence of bureaucracy is put above front-line services, we know that something has gone very wrong. That is why the coalition Government will act, act now and act with determination to improve and modernise our national health service. The Bill will create an NHS that puts patients first, that frees clinicians to deliver the best and most innovative care they can, and that focuses on what matters most to patients-health outcomes.
This has been an interesting debate, although at times, sadly, not a well informed one. I begin, however, by congratulating the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) on her fluent debut speech in the Chamber. I wish her every success in her future contributions, although I warn her that she will not get such a quiet ride next time around. I also congratulate my right hon. Friend the Member for Charnwood (Mr Dorrell) on an interesting and incisive speech, and my hon. Friends the Members for Boston and Skegness (Mark Simmonds) and for Central Suffolk and North Ipswich (Dr Poulter). The latter has great experience, having worked in the NHS.
I wish also to congratulate a number of my other hon. Friends on interesting contributions, including my hon. Friends the Members for Mid Bedfordshire (Nadine Dorries), for Basildon and Billericay (Mr Baron)-we will certainly write to him with answers to his questions-for Winchester (Mr Brine) and for Loughborough (Nicky Morgan).
It is always a delight to listen to the Member who, I suspect, is probably best described as the old Labour dinosaur, the right hon. Member for Holborn and St Pancras (Frank Dobson). I also enjoyed the elegant contribution of the right hon. Member for South Shields (David Miliband). Having listened to his fluent speech, all that I can say is, what a difference opposition makes. It is interesting that what he supported as part of a Labour Government in power he now seems to have abandoned in opposition. The hon. Member for York Central (Hugh Bayley) asked a number of intricate questions, and given the time that I have, I promise that I will write to him with answers to all of them.
Hon. Members might find it helpful if I debunk a few of the myths that have sprung up about our plans to modernise the NHS. The first, and perhaps the most insidious, is that they were kept secret and hidden from the electorate. Quite frankly, that is palpable nonsense. In June 2007, my right hon. Friends the Secretary of State and the Prime Minister, when in opposition, published the Conservative party's white paper, "NHS Autonomy and Accountability". It laid out our clear intentions, which we reiterated on pages 45 and 46 of our election manifesto. We said, as a commitment to the British people, that we would
"give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers."
"strengthen the power of GPs...by...putting them in charge of commissioning local health services"
"set NHS providers free to innovate by ensuring that they become autonomous Foundation Trusts".
We also stated that we would create an independent NHS board. It is quite ludicrous to suggest that we did not tell the British people our plans both before and during the election campaign.
A second myth is that our plans to modernise the NHS are revolutionary. In fact they are evolutionary and an extension of the policies of previous Administrations, notably the Blair and Brown Governments. That is particularly true of the move towards the "any willing provider" principle and patient choice. In 2003, when the Labour Health Secretary Alan Milburn moved to introduce a plurality of providers and patient choice, he argued that
"the NHS cannot be run forever like a 1940s-style nationalised industry".
He was right. The NHS needs the constant drive of improvements to raise standards and improve outcomes.
More recently-perhaps Opposition Members would like to listen to this-in 2007, the Labour Prime Minister, the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown), gave evidence to the Liaison Committee. He stated:
"We have been asking in people from the private sector to review what we can do to give them a better chance to compete for
contracts...so the independent sector increases its role, will continue to increase its role and, in a wider and broader range of areas, will have a bigger role in the years to come."
"The test at the end of the day is not private versus public, it is value for money, and it is not dogmatic to support one against the other."
"We will continue to open up acute care with...choice of hospitals trusts across private and public sectors in England...including more than 150 private sector hospitals working as part of the NHS and at NHS cost and standards of quality. We will use all mechanisms available to us to improve our NHS-public, private and voluntary providers can all play their part".
This Government have also been falsely accused of wanting somehow to privatise the NHS. Privatisation is defined as making people pay for their health care. That is not going to happen under this Government. This Government are totally committed to the values of the NHS: paid for through general taxation; free at the point of need; and always based on clinical need and never on a person's ability to pay.
Others have erroneously claimed that any involvement of the private sector will undermine the public sector ethos. That is a rather surprising view, considering that it was the last Labour Government who embraced the private sector. I shall quote Dr Howard Stoate, who was recently elected chair of Bexley's shadow GP consortium. Opposition Members will remember that, until the last election, he was the Labour Member of Parliament for Dartford. In a recent article in The Guardian, he said:
"We have found the idea that services can be offered by any willing provider can actually strengthen the ethos of the NHS rather than weaken it."
Dr Stoate went on to say that, in his experience, GPs
"reveal overwhelming enthusiasm for the chance to help shape services for the patients they see daily...Far from miring GPs in bureaucracy...GP commissioning can free them to operate more effectively."
This Government have one simple objective for the NHS. That is that it should give patients health outcomes that are consistently among the very best in the world, including higher survival rates, greater clinical effectiveness and safer care for patients. Excellence cannot be delivered by having Ministers bark orders down the chain of command. It is done by encouraging innovation and creativity, and by putting the interests of patients ahead of the system and of tomorrow's headlines.
We will free local clinicians to use their expertise to shape local services. We will free patients to choose the best possible care for their specific needs. We will bring a culture of openness and transparency to the health service, and we will allow any willing provider to compete to provide the best patient care. These plans are consistent, coherent and comprehensive, and they will deliver care that is free at the point of use for all. They will build on the best of what has gone before.
Some say that the reorganisation of the national health service will cost £3 billion, but that is factually incorrect. The impact assessment shows that there will be a one-off cost of £1.4 billion. It also demonstrates how the changes will pay for themselves by 2012-13, saving £5.2 billion by the end of this Parliament. They will continue to save £1.7 billion in every year after that,
up to the end of the decade. Every penny of those savings-the equivalent of 40,000 extra nurses, or 17,000 extra doctors or 11,000 extra consultants every year-will be completely and totally reinvested in front-line services, not wasted on back-office costs.
As society evolves, so too must the NHS. The Bill will deliver a modern NHS fit for the 21st century. It is the natural progression of the original vision to deliver the finest health care for all our citizens, remaining true to the founding principles set out by Nye Bevan.
Question put, That the Bill be now read a Second time.
Motion made, and Question put forthwith (Standing Order No. 83A( 7 )),
That the following provisions shall apply to the Health and Social Care Bill:
1. The Bill shall be committed to a Public Bill Committee.
Proceedings in Public Bill Committee
2. Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 31 March 2011.
3. The Public Bill Committee shall have leave to sit twice on the first day on which it meets.
Consideration and Third Reading
4. Proceedings on Consideration and Third Reading shall be completed in two days.
5. Proceedings on Consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the second day.
6. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.
7. Standing Order No. 83B (Programming committees) shall not apply to proceedings on Consideration and Third Reading.
8. Any other proceedings on the Bill (including any proceedings on consideration of Lords Amendments or on any further messages from the Lords) may be programmed.- (Bill Wiggin .)
Queen's recommendation signified .
Motion made, and Question put forthwith (Standing Order No. 52(1)( a )),
That, for the purposes of any Act resulting from the Health and Social Care Bill, it is expedient to authorise the payment out of money provided by Parliament of-
(1) any expenditure incurred by virtue of the Act by the Secretary of State, and
(2) any increase attributable to the Act in the sums payable under any other Act out of money so provided .-(Bill Wiggin .)
Motion made, and Question put forthwith (Standing Order No. 52(1)( a )),
That, for the purposes of any Act resulting from the Health and Social Care Bill, it is expedient to authorise-
(1) the imposition of charges in connection with the functions of the Secretary of State relating to public health,
(2) the imposition of charges on providers and commissioners of certain health care services in connection with the functions of Monitor relating to securing the continued provision of those services, and
(3) the payment of sums into the Consolidated Fund.- (Bill Wiggin .)
Motion made, and Question put forthwith (Standing Order No. 118(6)),
That the draft Protection of Vulnerable Groups (Scotland) Act 2007 (Consequential Modifications) Order 2010, which was laid before this House on 14 October, be approved.- (Bill Wiggin.)
Before the hon. Member for Wycombe (Steve Baker) presents his petition, I appeal to right hon. and hon. Members to leave the Chamber quickly
and quietly, extending the same courtesy to the petitioner that they would want to be extended to them.
Steve Baker (Wycombe) (Con): The petitioners of the residents of Wycombe declare that they are
concerned and unhappy about the continuing loss of control in the hospital services that are in the constituency.
therefore request that the House of Commons urges the Secretary of State for Health to take steps to ensure that the constituents of Wycombe are given the freedom to use the latest health reforms to work towards fair funding, make the hospital subject to greater local control, and that clinical staff have freedom from centralised planning and targets.
Following is the full text of the petition :
[The Petition of residents of Wycombe,
Declares that the petitioners are concerned and unhappy about the continuing loss of control in the hospital services that are in the constituency; and notes that, in recent years, the petitioners have witnessed the closure of Accident and Emergency, the temporary closure of the maternity unit, and the potential loss of urology services at Wycombe Hospital.
The Petitioners therefore request that the House of Commons urges the Secretary of State for Health to take steps to ensure that the constituents of Wycombe are given the freedom to use the latest health reforms to work towards fair funding, make the hospital subject to greater local control, and that clinical staff have freedom from centralised planning and targets.
And the Petitioners remain, etc.]
Motion made, and Question proposed, That this House do now adjourn. -(Bill Wiggin.)
Mr David Burrowes (Enfield, Southgate) (Con): I am pleased to have secured this vital debate. At first sight, a debate about umbilical cord blood might seem highly specialised and marginal in terms of its interest and application, but I hope that the debate that I have initiated will highlight the importance of the issue, and its wide application to the saving of lives and money. We have just completed the Second Reading of the Health and Social Care Bill, and this debate chimes with the Government's policy of creating a modern health service that is open to innovation and excellence, providing life-saving treatments.
I described this as a vital debate. "Vital" is a word used commonly in the Chamber. In fact, a quick search of Hansard will reveal that it was used 2,997 times in 2010-that is, an average of about 20 times each sitting day. It has been used in connection with banking reform, the G20, libraries and ladybirds. While all those are no doubt crucially important subjects and worthy of parliamentary attention, my use of the word "vital" in this debate relates to the number of people who, sadly, die each year from blood disorders and cancers without the vital resource of umbilical cord blood.
I introduced the issue of umbilical cord blood to the House on 8 January 2008 through a private Member's Bill on the subject. A number of hon. Members approached me afterwards, in a state of ignorance to which they openly confessed, to ask what it was all about. Since then the issue has been raised on a number of occasions-notably the debates on the Bill that became the Human Fertilisation and Embryology 2008-and great progress has been made in raising parliamentary awareness of the benefits that these life-saving cords can provide for people suffering from tragic illnesses. In 2008 an all-party parliamentary group was established, and I see that its chair, the hon. Member for Alyn and Deeside (Mark Tami), is present. I am sure that the House will wish to join me in paying tribute to the work of organisations such as the Anthony Nolan Trust, whose efforts have helped to keep the importance of cord blood at the forefront of the minds of many hon. Members, including Ministers.
I hope that tonight's debate will remind Members of the value of this vital resource. Blood cancers are killers. According to Cancer Research UK, 4,000 new myeloma cases are diagnosed each year in Britain, and 2,500 myeloma sufferers die. There are 11,000 lymphoma diagnoses each year and 4,000 deaths; there are 7,000 leukaemia diagnoses each year and 4,000 deaths. For many sufferers, the only hope is a blood stem cell transplant. It may result from a bone marrow match, or from the taking of blood cells from the bloodstream of an adult donor or an umbilical cord donated by a mother after childbirth.
The procedure is complex, and there can be a range of complications that pose a threat to the patient. However, although it may seem awful that only 50% of blood transplant patients survive the treatment, almost none would survive without it. Blood stem cell transplants really are the last chance for people to whom no other treatment is available. For some of those people, a
transplant is not just a treatment that saves their lives for a while, but an outright cure. At any given time, about 1,600 people in Britain are waiting for a matched donor for a transplant, hoping to survive long enough to get that chance.
Five-year-old Sorrel Mason was one such person. Three years ago Sorrel's father noticed that she was looking pale, and she was eventually diagnosed with a rare strain of acute myeloid leukaemia. Her mother Samantha recalled the terrible fear and sense of helplessness that they felt at the time. She said:
"I remember the first time I saw her hooked up to all those machines. It broke my heart."
After two doses of chemotherapy Sorrel was able to have a transplant, and received suitable stem cells from a mother's umbilical cord from Tokyo-albeit an expensive imported cord; that is a point to which I shall return later. Thankfully, the procedure was a great success. In Samantha's own words:
"Every day we waited for the daily blood counts. It was a miracle when eventually they came up okay."
We are on relatively new ground here, because the first time a stem cell transplant took place using cells retrieved from a donated umbilical cord was in 1988. Since then, scientists have been discovering many advantages to the use of cord blood. You, Mr Speaker, will be relieved to know that I will refrain from reciting numerous tracts from the many academic papers on this subject. However, one especially noteworthy example of the great research work being carried out is the Cancer Research UK-funded trial being led by Dr Rachel Hough into the use of umbilical cord blood from unrelated donors for people who have cancer of the bone marrow or lymphatic system. Her team aims to investigate whether a transplant using cord blood cells can help cancer patients who cannot be matched to a bone marrow donor. This is an exciting and promising development that highlights the great potential for uncovering further benefits of cord blood.
The immediate benefit of a transplant from cord blood is that it achieves the same level of success for the patient at a significantly lesser degree of tissue matching. When I first raised this subject three years ago, we relied on speculation about the number of cord blood units needed for this country's health needs. Now we know from evidence and with authority that a cord blood bank would have to maintain only 50,000 units to provide for the bulk of Britain's unmet need for stem cells beyond the 770,000 registered adult donors. A great advantage of umbilical cords is the availability of the stem cells retrieved. They are collected, tissue-typed and frozen after the birth of the child, and then made available as soon as a patient requires them. That radically reduces the waiting time before a patient can access a transplant. Currently, the average time it takes for a patient to receive their transplant after the search for a match is started is some 160 days, during which time many patients become progressively weaker and the likely success of the transplant can thus be reduced.
Cord blood transplants save lives that other methods cannot, so it is no surprise that, globally, the proportion of transplants undertaken using cord blood is increasing every year. Great Ormond Street hospital, a leading transplant centre, will now use only cord blood where it is available. The pace of advance in this arena is excellent. Each year, the prognosis for patients treated is better
than for those treated the year before, and that is because of the research taking place in the UK and around the world. Not only are blood cancers and similar disorders subject to increasingly effective treatments, but an active investigation is taking place into the use of cord blood in the treatment of sickle cell anaemia and HIV.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): The hon. Gentleman will be aware that minority ethnic patients make up almost 20% of the unmet need for stem cell transplants, which is disproportionate to our 10% representation in the population. Does he agree that one of the important uses of this blood is in enabling ethnic minority patients, who find it more difficult to get a match, to have some hope?
Mr Burrowes: I am very grateful for that intervention. The hon. Lady and I share an interest in both sickle cell anaemia and the thalassaemia issue. The UK Thalassaemia Society, whose headquarters are in my constituency, has great interest in this area and, in particular, in the black and minority ethnic communities, who are not able to get matches through the bone marrow register and are acutely in need. That is particularly the case for mixed-race families, who struggle to find any match and are sometimes wholly reliant on a cord blood solution. That is why it is welcome that over the years the previous Government and this Government have increased the number of collection centres to make more of those units available.
However, more needs to be done because, sadly, where Britain once led, it is now falling behind the United States, France, Germany and Spain. All those countries now outstrip our cord blood collection, inhibiting our research capacity. There are 700,000 births each year in the UK and in almost every single instance the cord blood is discarded as medical waste. I am not proposing routine collection, but we must question the health and economic value of throwing all these potentially life-saving cords away. I welcome the fact that the Government are nudging people to agree voluntarily to donate their organs upon death, and I would encourage a similar nudge in encouraging mothers to consider donating umbilical cord.
Progress has been made, but more needs to be done. There are 1,600 people waiting for a stem cell transplant, but the unmet need in annual terms is only 440 transplants per year. A bank of just 50,000 umbilical cords would provide the bulk of that need. Sadly, simply increasing the size of the adult register is not an alternative to having cord blood. We already have access to more than 16 million donors on registers worldwide. The work of the Anthony Nolan Trust and others helps us to access that adult register, but we would need a UK adult register of a similar size to approach the effectiveness of a 50,000-unit cord blood bank.
Mark Tami (Alyn and Deeside) (Lab): I thank the hon. Gentleman for his earlier comments. It is difficult to talk in financial terms about such issues, but with patients who do not get a transplant, there is a huge ongoing medical cost for their treatment, whereas a transplant could save that money, which could then be reinvested in the health service.
Mr Burrowes: We often talk about investing to save, but this is an area in which investment would save both money and lives. I shall go into that in more detail.
A report on transplantation by the UK Stem Cell Strategic Forum, ably chaired by Professor Charles Craddock, was published in December 2010 by NHS Blood and Transplant. The Minister discussed the report, which makes important recommendations, with the all-party group on the day of its publication. The report recommended, first, investing in expanding Britain's cord blood bank capacity to 50,000 units. Those proposals have been properly costed and the costs have been balanced against effectiveness by NHS Blood and Transplant. For an investment of £50 million, spread over five years, Britain could have that 50,000-unit cord blood bank.
Nadine Dorries (Mid Bedfordshire) (Con): I thank my hon. Friend for giving way. I want to congratulate him on the work that he has consistently put into this issue over the past three years, which is to be commended. Would he endorse the proposal that certain hospitals or regions could be piloted or allocated as regions to collect and donate the necessary 50,000 units? Rather than having routine testing across the country, it could be just in specific regions or units.
Mr Burrowes: I am grateful to my hon. Friend for making that point. There has been some progress on the areas that could retrieve unit cords, particularly from members of BME communities who lack those matches, but we also need to look further at matching that up with regional centres of excellence. I shall return to that point.
First, let me deal with the money issue, which we cannot ignore in this area of health. For an investment of £50 million over five years, we could get that 50,000-unit blood bank. Although it would be difficult to find £10 million a year for five years in these austere times, the financial benefits make sense. The blood bank would provide economies of scale that would reduce the cost to the NHS of every treatment and would radically reduce the need to import expensive stem cell units from abroad, which is, sadly, too common a practice today. The saving that would bring to the NHS has been calculated at £6 million a year in perpetuity. Within 10 years, the entire investment would have been repaid and the programme would save the NHS money for the foreseeable future-and then there are the 200 lives we can choose to save each year by taking that step. So, it would save £6 million and 200 lives a year, and those figures are with currently available treatments at success rates that are currently being achieved.
Thomas Docherty (Dunfermline and West Fife) (Lab): I am very grateful to the hon. Gentleman for giving way. He has mentioned money several times. Is he aware of the work of the round tables around Britain and Ireland, of which I am a member? They have consistently raised large sums for the Anthony Nolan Trust. Will he place on record his thanks to the round table movement for its support for the trust and this matter?
Mr Burrowes: I am grateful to that movement and other groups and charities that support this important work.
We need to ensure that we do well what we can do well by adopting the report's second recommendation to establish regional centres of excellence in cord blood
transplants. That would reduce the number of UK centres from 30 to 12, leading to a £12 million saving over 10 years. The report makes the point that that would, crucially, ensure that we had specialised, life-saving therapies in safe, publicly accountable environments. That is fully in line with the Government's commissioning policy for specialised procedures and would provide great benefit.
The third, really exciting recommendation is about providing an opportunity to build on Britain's unique strategic advantages, encouraging world-class research and private and voluntary sector growth that will provide new jobs and save further lives. The proposal to create a national trial programme in stem cell transplantation would take advantage of world-class centres of scientific research and the easy and sustained access to patients that the NHS provides. The proposal offers the potential for inward investment, private sector job creation and third sector involvement, as is well demonstrated by the success of the Centre for Clinical Haematology at the Queen Elizabeth hospital in Birmingham. To quote Professor Craddock:
"The unique international trials network will be highly attractive to pharmaceutical and biotechnology companies who wish to rapidly evaluate new drug therapies and can be anticipated to make a major contribution to the growth of private sector jobs in this sector."
The Government, as we know, are encouraging growth. Where better than in the field of cord blood stem cell transplantation? The Minister has been kind enough to keep me informed of the progress that her Department is making in the development of a response to the proposals in the report. I hope the time is nearing when she will be able to make a statement on her plans in this area. I trust that in the complexities and scientific details of that report, her Department will be clear about the central message that 200 lives and £6 million can be saved each year.
In conclusion, I draw upon the story of Sorrel Mason. Prior to her life-saving procedure, her parents had never heard of the importance of cord blood donation and its benefits for stem cell transplant patients. No one could put it better than they did when they said:
"It's quite hard in this country to donate your umbilical cord. Hopefully as time goes by there'll be more places that offer this lifesaving opportunity."
In a Parliament that will be characterised by the difficult decisions that it makes, this is one decision that we cannot afford not to take, and yes, I will say it again: it is vital to do so.
The Parliamentary Under-Secretary of State for Health (Anne Milton): I thank my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) for securing this debate on a topic that is vital. He is right to state that this is yet another opportunity to highlight the issue. All opportunities are useful to raise it in the minds not only of those in the House this evening, but of the public and of those in a position to influence what goes on.
The Department recognised the importance of this issue when it asked the NHS Blood and Transplant Authority to review the UK's collection, supply and use of stem cells from both bone marrow and umbilical
cord blood. The general consensus was that the UK Stem Cell Strategic Forum did a superb job on the review. Its report, which was published in December last year, involved a well thought through, strategic and costed analysis. It provided us, probably for the first time, with an honest appraisal of the use of stem cell units in the UK in the public and charitable sectors. Unfortunately, as is often the case if such reports are honest and frank, some of it made uncomfortable reading.
The review found that the delivery of stem cell units for transplant in the UK is not as efficient or effective as it should be. As my hon. Friend stated, we lag behind many other comparative countries, including Germany and the United States. Some 400 patients each year fail to find suitable donors. Then delays in the system mean that those who find a donor are sometimes, sadly, much too ill to receive a transplant. For these patients the prognosis is very poor.
As the hon. Member for Hackney North and Stoke Newington (Ms Abbott) pointed out, for patients from a black or minority ethnic background, the problem is compounded by the lack of donors or suitable stem cell units available in the first place. Disadvantaged from the outset, their chances drop drastically. On average, about 90% of Caucasians can find a suitably matched donor, compared with only 30% to 40% of those from other ethnic backgrounds. That is unacceptable and pretty shocking. As I said when I announced the report's publication at a meeting of the all-party group on stem cell transplantation, I am determined to do all that I can to see services improve. I want service providers to develop plans for providing the most effective and efficient service possible in the interests of both the patient and the taxpayer.
My hon. Friend has highlighted a rapidly developing area. Some progress has been made, but the pace is going at an extraordinary rate. The report not only highlighted what needs to be done, but contained 20 recommendations for the improvement and development of services for the benefit of patients. They include comprehensive changes to the way services are delivered, with a view to establishing the UK once again as a world leader; a more streamlined collection, processing and delivery service, with much more of a focus on results, rather than process; and a radical reconfiguration of transplant services.
The greatest improvements and the quickest gains will be delivered by better bone marrow and umbilical cord blood stem cell services. By making services more efficient, we will see a marked improvement in the treatment, care and support received by patients. We will be able to reduce the time it takes to find a matching donor, address any inequalities in the current system and provide a better service with fewer resources. That will lead to better quality, better management, better planning, better delivery, better outcomes and, crucially, more lives saved. We want those principles to be diligently and consistently applied across the board. The objective is clear: to improve the life chances of those in need of a stem cell transplant.
A considerable amount of work has been done behind the scenes since the publication of the report to see that vision implemented. I have asked officials to work with the forum, NHS Blood and Transplant and Anthony Nolan to develop ways to get a single bone marrow register and cord blood inventory for the NHS in England.
We will explore what can be achieved by collective effort, using what is already available and planning for the provision of future services.
Thomas Docherty: Further to that point, has the Minister had any discussions with the Scottish Government on their plans for ScotBlood, which is the equivalent service in Scotland? Does she agree that the solution is to have a single register for the whole UK?
Anne Milton: There is no doubt that close discussions with all the devolved Administrations are critical. We have a patchy and disjointed service, but as the hon. Gentleman rightly says we need a single register. I am pleased to say that some work is already bearing fruit. At the last meeting of the forum, well-advanced plans were put forward on how NHSBT and Anthony Nolan can work together in future, with targets for reducing the average search time by six weeks and the establishment, for the first time in England, of a single bone marrow register and cord blood inventory. However, we must go further. I cannot praise enough that type of innovative and professional approach. It is collaboration like that that means real improvement for patients. We must have notable improvements on the wards, not just on the spreadsheets.
The UK Stem Cell Strategic Forum review was a Department initiative, and the work was paid for by the Department. We have heard of the efforts of organisations such as Round Table. I would like to take the opportunity to thank Lynda Hamlyn, the chief executive of NHSBT, Henny Braund, her counterpart at Anthony Nolan, and their dedicated, hard-working staff for the work they have done so far. I have no doubt that there is more work to be done and that it will continue in the future.
Claire Perry (Devizes) (Con): I am grateful to my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) for securing this incredibly important debate. I confess that this is something about which I knew nothing. He mentioned the importance of education and the need for a programme that is similar to that for organ donations so that mothers are informed about the value of umbilical blood and blood products before giving birth. Certainly, that is something that I was never informed about. Is the Department considering any sort of education programme so that people can opt in to the system as donors?
Anne Milton: I thank my hon. Friend for that intervention. It would be terribly simplistic to think that it is just a matter of donors coming forward. We know from organ donation-it is also the case for umbilical cord blood-that it is important to streamline the processes, because there are unacceptable delays. The report's recommendations cover the whole process from beginning to end. I do not underestimate the need to raise the importance of this issue. Many hon. Members can play a critical role in their local areas and with their local media by highlighting the importance of organ donation.
Mark Tami: Will the Minister give way?
Anne Milton: I am conscious of the time but happy to give way, because the hon. Gentleman has done a lot of work on this issue.
Mark Tami: Does the Minister agree that Anthony Nolan has done an awful lot-particularly with the introduction of spit and swab tests-to help people to take that first step on the ladder? Before, when it was a case of just giving blood, that put a lot of people off, particularly males, such as myself, who are rather squeamish about these things, but it is very important to get the maximum number of people to take that first step forward.
Anne Milton: Yes, absolutely. The hon. Gentleman is quite right to highlight yet again the work of Anthony Nolan, which is crucial, but I urge him and all male Members to remember that they have nothing to fear from needles and no need to be squeamish about those things; it is about potentially saving lives.
It is a challenging time financially, and we cannot put that behind us. It is important that we get the UK back on a secure financial footing, and that means funding will be tight, but I want to reach out further to our partners in charities to see how we can work together. We are not short of offers in that field. My hon. Friend the Member for Enfield, Southgate will know that I am shortly meeting Cord Blood Charity to see what part it can play, and Anthony Nolan is making every effort to provide additional funding for the important work that I have spoken about.
On Government funding, the Department of Health will provide some £4 million in additional funding to help with service development, but, more than that, we will continue to help in other ways, bringing together key stakeholders to ensure that all opportunities to bring about those further improvements and to implement those recommendations are taken. We are also working towards increasing the size of the cord blood bank by funding NHS Blood and Transplant to increase the bank to 20,000 units by 2013-an increase in stored units of almost 100% since 2008. I know that my hon. Friend would like to me go on, and as part of future strategic planning I shall ask NHS Blood and Transplant to consider the options for developing the bank even further, with the final goal of reaching a stock of 50,000 stored cord blood units, accessible to all NHS patients.
In the development of that new commissioning structure within the NHS, we will listen closely to the recommendations of the forum report, with respect to improving NHS practices and commissioning. The forum has met since the report's publication, and I hope that it will continue to meet to advise the sector on best practice and to provide innovative solutions to implement those recommendations. I shall keep closely in touch with all those who have shown such a close interest.
Improving the health care pathway for stem cell transplantation to treat life-threatening diseases is a vital part of that work. I use those words cautiously, but I want to see NHS patients having access to the best possible services. We are meeting my hon. Friend soon to discuss the issues raised in the report and some that have come out of this debate. As always, his contributions to the debate are welcomed, highly respected and, like those of many Members, motivated by the best possible intention, which is to save lives.