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House of Commons

Tuesday 26 November 2013

The House met at half-past Eleven o’clock


[Mr Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Support for Carers

1. Duncan Hames (Chippenham) (LD): What steps he is taking to improve signposting to support and information for carers by health bodies and local authorities. [901258]

The Minister of State, Department of Health (Norman Lamb): The Care Bill will require local authorities to ensure that information and advice is available to their local populations, including carers, and to co-operate with health bodies in fulfilling this function. The Bill will extend carers’ rights to an assessment of their needs so that carers receive appropriate support and signposting to local services.

Duncan Hames: I welcome those measures in the Care Bill to support carers, but for them to benefit from that support, they first need to be identified. It is estimated that only one in 20 carers of people with cancer, for example, receives a carer’s assessment. How does the Minister propose to get local authorities to work with the NHS and other health bodies to identify carers and ensure that their needs do not go unnoticed?

Norman Lamb: The Care Bill will introduce a right to an assessment for all carers, which I think is an incredibly important advance for them. We are also giving money—£1.5 million—to the Royal College of General Practitioners and other bodies, including nursing bodies, to raise awareness of the vital role of carers in working with GPs to improve the care of those who need it.

Barbara Keeley (Worsley and Eccles South) (Lab): I think the Minister is missing the point, though, in that carers of people with cancer do not have contact with local authorities. Macmillan Cancer Support found that half of those carers are not getting any support at all and do not know where to go for it. They do have contact, however, with GPs and hospital doctors, so what is the Minister going to do to make sure that GPs and hospital doctors identify carers and make sure that they get that support and advice?

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Norman Lamb: First, I pay tribute to the work of Macmillan. It does brilliant work, and this is a really important campaign because it will raise awareness. I do not think I am missing the point, because raising awareness among front-line professionals is critical, and local authorities will also have a duty through the Care Bill to co-operate with the health service and, of course, to integrate or join up care, all of which is in the interests of carers.

Alison McGovern (Wirral South) (Lab): Carers—and, I hope, the Minister—local authorities and GPs will be distressed by this week’s report of care companies being investigated by Her Majesty’s Revenue and Customs, almost half of which were found not to be paying the minimum wage. How does tackling that problem at the heart of our care system fit into the Minister’s plans to help support carers?

Norman Lamb: I completely share the hon. Lady’s concern about care companies that do not pay the minimum wage. All care companies should meet their obligations in law to pay the minimum wage. HMRC has done a lot of work, focusing on the care sector, and I have been absolutely clear that there is an obligation for those care companies to meet their requirements under the national minimum wage legislation. We cannot get good care on the back of exploiting low-paid workers.

Compassionate Care (NHS)

2. Alec Shelbrooke (Elmet and Rothwell) (Con): What steps he is taking to ensure that compassionate care is at the heart of the NHS. [901259]

The Secretary of State for Health (Mr Jeremy Hunt): Last week, we published a full response to the Mid-Staffs public inquiry and set out our ambition to transform the quality of compassionate care in the NHS. We have already put in place a robust new inspection regime and measures to make it easier for doctors and nurses to speak out when they are concerned about standards of care or safety.

Alec Shelbrooke: Compassionate care goes right through from surgeons to GPs. Will my right hon. Friend comment on evidence that epileptic women of child-bearing age are not being shown the compassion necessary during pregnancy from their GPs or neurologists and are not having the risks of taking their epilepsy medication outlined to them? To date, such medication has caused more than 20,000 birth defects.

Mr Hunt: I thank my hon. Friend for highlighting this important issue. The Medicines and Healthcare products Regulatory Agency regularly reviews the evidence relating to anti-epileptic drug use, particularly sodium valproate products, and we check what information is available to doctors so that it can be passed on to patients. I am concerned about the issue my hon. Friend raises, so I have asked NHS England’s national director of patient safety, Dr Mike Durkin, to look into it carefully and get back to me.

Nick Smith (Blaenau Gwent) (Lab): New York has raised the age for buying tobacco products to 21. As a public health care policy, has the Department considered that matter?

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Mr Hunt: As the hon. Gentleman will know, we are constantly reviewing all policies that could reduce tobacco use among young people. Smoking is the No. 1 killer, so dealing with it would be the best way of reducing this country’s premature mortality rates, which are far too high.

23. [901280] Jonathan Lord (Woking) (Con): Does the Secretary of State agree that transparency is critical in improving hospital standards and that, following the Government’s latest measures in response to the Francis report, the health cover-ups by the previous Government will never be allowed to happen again?

Mr Hunt: The Labour party does not like to hear this, but the reality is that micro-managing the NHS through top-down targets failed to deal with the problems of compassionate care. My hon. Friend is absolutely right that the best way to deal with this is through total transparency, so that when we are sure there is a problem, the public find out about it quickly and it is dealt with quickly.

Jim Shannon (Strangford) (DUP): Compassionate care must be central to the NHS. The Health Minister in Northern Ireland has launched “Quality 2020”, a strategy that is intended to improve care in Northern Ireland. What discussions has the Secretary of State had with the Northern Ireland Assembly and the Health Minister about this issue?

Mr Hunt: We are in close touch with all the devolved Administrations about the changes that we are making in the NHS in England, and, interestingly, we are experiencing different levels of engagement. We have had very good discussions with the Northern Ireland Health Minister about some of the changes, but those in Wales are still refusing to commission a Keogh report on excess deaths, which I think shows that Labour in Wales has not learnt the lessons of transparency.

Accident and Emergency Health Specialists

3. Mr Barry Sheerman (Huddersfield) (Lab/Co-op): What steps he is taking to train and retain more accident and emergency health specialists in the UK. [901260]

The Secretary of State for Health (Mr Jeremy Hunt): I have asked Health Education England to consider how we can improve the structure and skill mix of the emergency medicine work force to deal with long-standing shortages in staff at both consultant and trainee levels. Along with the Emergency Medicine Taskforce, we are considering a number of options, such as increasing the non-doctor work force and the number of emergency nurse practitioners.

Mr Sheerman: Just what is going on in medical education in this country? We train doctors, but some never work as doctors, and others move abroad. Calderdale and Huddersfield NHS Foundation Trust has advertised and advertised again, but it cannot recruit accident and emergency staff. It certainly cannot recruit any who have been trained in this country, or who have been trained in paediatrics. What is going wrong with medical education here?

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Mr Hunt: The hon. Gentleman has raised some important issues. We do face big challenges. We have increased the number of doctors in the NHS by 6,600 over the last three years, but it is still very difficult to attract as many people as we need to disciplines such as A and E.

I know that Calderdale and Huddersfield NHS Foundation Trust is especially concerned about A and E staffing. I had a very good meeting with representatives of the College of Emergency Medicine last week to discuss A and E consultants’ terms and conditions and, in particular, their antisocial working hours. We are giving the matter close consideration, but I agree with the hon. Gentleman that we need to do better in this regard.

Mr Philip Hollobone (Kettering) (Con): While it is important to recruit and retain more A and E specialists, part of the problem is that a third of the patients who are dealt with in A and E departments could receive better treatment closer to their homes. What can the Secretary of State do to encourage that?

Mr Hunt: My hon. Friend is absolutely right. One of the biggest mistakes made in health care over the past decade was the introduction of the disastrous changes in the GP contract in 2004, which broke the personal link between GPs and their patients. Hard-pressed A and E departments, including the one at Kettering hospital, say that one of the things that will make the biggest difference to them is the provision of a named GP for the over-75s, so that they know that someone is responsible for those people when they are not in hospital.

Fiona Mactaggart (Slough) (Lab): Is it not the chaotic and overstretched nature of many A and E departments that makes A and E an unattractive discipline for people to work in? Ever since the closure of the A and E department at Wycombe general hospital in my constituency, Wexham Park hospital has been unable to cope. What will the Secretary of State do about that?

Mr Hunt: We have gained more than 600 additional A and E doctors over the last three years, so the numbers are rising. However, the best thing that we can do for A and E staff is to give them a sense that we are addressing the long-term challenges that they face. The issues of integration with social care and delayed discharges are being addressed through the health and social care integration transformation fund, but we must also ensure that there are better primary care alternatives. The named GP for the over-75s will make a big difference in that regard.

Margot James (Stourbridge) (Con): My local hospital, Russells Hall, is experiencing considerable difficulty in recruiting A and E consultants. Would not a good alternative approach be to train more paramedics to serve on ambulances and provide more effective and robust triage at emergency centres, so that patients can be redirected when necessary?

Mr Hunt: As ever, my hon. Friend speaks very wisely about this subject. In his review of A and E services, which was published a couple of weeks ago, Professor Keogh said that paramedics could deal with 50% of 999 calls on the spot, without taking people to hospital. I

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think that there is a big role for ambulance services that are prepared to upskill. It is also important for us to ensure that they have the necessary information. One of the main changes that we intend to make next year will ensure that they have access to the GP records of the people whom they pick up, so that they can give those people the care that they need in their own homes.

Mr Jamie Reed (Copeland) (Lab): The president of the College of Emergency Medicine has said that the Government’s reorganisation has made A and E recruitment worse; the chief executive of the NHS Confederation has said that A and E pressures have been compounded by three years of structural reforms; yesterday, we learnt that the number of nurses choosing to leave their profession had jumped by more than one quarter under this Government; and the Health Secretary himself admits he is worried by the fall in nurse numbers on this Prime Minister’s watch. I hope he listens carefully so that he can answer precisely: will he today give the House a guarantee that every A and E in the country will have enough nurses this winter?

Mr Hunt: Will the hon. Gentleman think about what he has said? He said he was against a reorganisation that got rid of 8,000 managers and put 6,600 doctors on to the front line. That is why we are doing nearly a million more operations every year and why waiting times for longer waits are shorter than they were under Labour. We are recruiting more doctors because we are putting money into the front line.

Miss Anne McIntosh (Thirsk and Malton) (Con): It takes seven years to train a doctor, but, for whatever reason, the new GP contract is looking to end seniority pay in six years. Is my right hon. Friend not concerned that that will lead to a mass retirement of doctors at the end of that six-year period in 2020?

Mr Hunt: We have to make the GP profession attractive to younger GPs as well. The money we save from getting rid of seniority pay will go back into practices, but it should not be given to people just for length of service; it should be related to quality of service too, which will make the GP profession much more attractive.

Ambulance Handover Times

5. Rosie Cooper (West Lancashire) (Lab): What recent assessment he has made of ambulance handover times at accident and emergency departments. [901262]

The Minister of State, Department of Health (Norman Lamb): Patient handover is a key part of delivering good emergency care. Systems are in place to ensure efficient handover, but we recognise that it sometimes takes longer than the recommended 15 minutes, particularly during peaks of demand. We are taking the issue of handover delay seriously, which is why we have introduced financial sanctions for unacceptable delay.

Rosie Cooper: Southport and Ormskirk hospital in my constituency has one of the longest handover times in the north-west, with ambulances queuing outside the hospital and patients lying on stretchers for hours. How does that offer the patient-centred care and dignity that

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the Government keep promising but failing to deliver? What can the Minister do to make it better for my constituents?

Norman Lamb: That sort of experience is not acceptable and has to be addressed, and I am sure the hon. Lady will welcome the encouraging news that the sanctions in the national contracts that clinical commissioning groups enter into with hospitals have resulted in a 38% reduction in delays, comparing the first two weeks of last November with the first two weeks of this November, which is the first period during which we measure winter pressures on handovers. That sign of a significant increase is to be welcomed.

Mr Simon Burns (Chelmsford) (Con): As an east of England MP, the Minister will be aware of the problems with the East of England ambulance service and handover times at Broomfield hospital. While I warmly welcome the initiative, through the contract, to bring pressure to bear to reduce handover times to 15 minutes, will he join me in paying tribute to the new management of the ambulance service for what it is doing, through its assessments and monitoring, to deal with this problem?

Norman Lamb: I have had a similar experience at the Norfolk and Norwich hospital. It is clear that the number of delays in the east of England has reduced substantially, and I pay tribute to everyone involved. Getting urgent care right requires collaboration between ambulance trusts, acute care and GPs and social care workers on the ground. Significant improvements have been made in the east of England, as well as across the rest of the country.

Andrew Gwynne (Denton and Reddish) (Lab): The Minister surely knows that deteriorating ambulance handover times are just one of a growing number of signs highlighting what is going wrong with A and E on this Government’s watch. Now we see the Secretary of State and his Ministers in full panic mode after denying for months that there was a problem. The question is: why was the Health Secretary the last person in the entire NHS to realise that there was an A and E crisis?

Norman Lamb: It seems as if Labour is always desperately in search of a crisis, even if there is none to be found. If the hon. Gentleman had listened to the answer that I gave to the hon. Member for West Lancashire (Rosie Cooper), he would have heard me say that there had been a 38% improvement in waiting times for ambulance handovers between last November and this November. I am sure that he will welcome that.

George Freeman (Mid Norfolk) (Con): I congratulate the Minister and the Government on the work that is being done to integrate social and NHS care. Does my hon. Friend agree that, for the many elderly patients moving between hospital care and community social care, integrated patient records across the two areas will significantly improve elderly care? Will he meet me and campaigners following Health questions to discuss my ten-minute rule Bill?

Mr Speaker: The link is a strained and tenuous one, but carry on.

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Norman Lamb: My hon. Friend deserves credit for that one. Of course I would be happy to have a chat with him. He makes a point about integrated care records. We should be focusing on ensuring that we do much more to keep frail and elderly people out of hospital in the first place. The system that we have inherited is dysfunctional, and the shift towards integrated care is exactly what needs to be done.

Out-of-hospital Care (Elderly People)

6. Mark Menzies (Fylde) (Con): What progress his Department has made on improving out-of-hospital care for frail elderly people. [901263]

13. Sir Tony Baldry (Banbury) (Con): What progress his Department has made on improving out-of-hospital care for frail elderly people. [901270]

17. Nick de Bois (Enfield North) (Con): What progress his Department has made on improving out-of-hospital care for frail elderly people. [901274]

The Secretary of State for Health (Mr Jeremy Hunt): Improving the quality of out-of-hospital care is the biggest strategic long-term change that we need to make in the NHS. It will help to make the NHS sustainable. Reforming the GP contract is the first step, but we also need to make major progress on integrating the health and social care systems.

Mark Menzies: I welcome the Government’s announcement of named GPs for older people. What does the Secretary of State envisage that will mean for my older constituents?

Mr Hunt: My hon. Friend is not the only person to welcome that change. After months of telling the House that this was nothing to do with the A and E problems, the shadow Health Secretary said on the “Today” programme that he welcomed the change and that it would make a difference to A and E. So I welcome the return of the prodigal son with great pride and pleasure. For my hon. Friend’s constituents, this will mean that there will be someone in the NHS who is responsible for ensuring that they get the care package that they need. That is incredibly important, because when people are discharged from hospitals, the hospitals worry about whose care they will be under. This change will provide that crucial link and make a real difference.

Sir Tony Baldry: Does my right hon. Friend agree that the 2004 GP contract did enormous damage to the relationship between GPs and their patients, and that the recent changes agreed with GPs should ensure much more proactive care of our most vulnerable constituents and ease pressure on A and E departments?

Mr Hunt: I agree with my hon. Friend, and I am pleased that the shadow Health Secretary also agrees with him in welcoming the reversal of that disastrous contract. The personal relationship between doctor and patient is at the heart of what the NHS stands for, and at the heart of that is a responsibility to ensure that people get the care they need. That is what we need to get back, and I think that the change will make a big difference to my hon. Friend’s constituents.

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Nick de Bois: Enfield CCG is working closely with Enfield council to try to deliver integrated health and social care, particularly for the elderly and the frail. Noting our higher-than-average elderly age demographic in the borough, will the Secretary of State take steps to ensure that those efforts are supported with extra funding?

Mr Hunt: My hon. Friend knows that the funding arrangements are decided independently of the Government, by NHS England, which will make its decision at a board meeting before Christmas. He is absolutely right to suggest that the funding formula should reflect not only social deprivation but the age profile of constituents, because the oldest people are of course the heaviest users of the NHS.

Liz Kendall (Leicester West) (Lab): The Health Secretary claims that he wants the NHS to be the best in the world at looking after the elderly. Nice rhetoric, but the reality is that we now have the highest-ever number of elderly people trapped in hospitals because they cannot get the health and social care they need at home. We now have the equivalent of five hospitals full of elderly people who do not want to be there, and that is costing the taxpayer £20 million a month. Is not the truth that care of the elderly is getting worse, not better, on his watch?

Mr Hunt: The truth is that the previous Government had 13 years to integrate the health and social care systems, but they failed. We are doing that, and we are also providing named GPs to the most vulnerable people, so that, hopefully, they do not have to go to hospital in the first place. That is doing a lot more for older people than the hon. Lady’s Government ever did.

Mr Stephen Dorrell (Charnwood) (Con): Does my right hon. Friend agree that successive Governments over 30 years have talked about the importance of joining up the different bits of the health care system and joining that up with social care? Is not the difference between this Government and their predecessors that, through health and wellbeing boards, the integrated care fund, named GPs and the pioneers programme that he has announced, this Government are actually doing it, rather than just talking about it?

Mr Hunt: I have to pay tribute to my right hon. Friend, because he has been talking about the integration of health and social care for a lot longer than I have, and he is absolutely right. I would add to his list one other really important thing we are doing: we are making sure that whatever part of the system someone is in, doctors can access their GP medical record—with their permission—because that information is vital in showing their allergies, medical history and previous admissions. Breaking down the barriers that prevent that from happening is one of the things that has not been picked up but is in the GP contract.

NHS (Winter Pressures)

7. Graham Evans (Weaver Vale) (Con): What steps his Department has taken to ease the short and long-term impact of winter pressures on NHS services. [901264]

The Secretary of State for Health (Mr Jeremy Hunt): In the short term, a record £400 million has been assigned to help the NHS cope with winter pressures

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this winter, with £250 million announced in August—much earlier than before. For the long term, we will provide better out-of-hospital care for the frail elderly, by restoring the link between GPs and older patients, and looking to integrate the health and social care systems.

Graham Evans: Will my right hon. Friend join me in praising the outstanding work of Age UK and, in particular, Age UK Cheshire, which serves my constituency? It is raising older people’s awareness of seasonal impacts on health and offering support to prevent unnecessary pressures on the health service.

Mr Hunt: I am delighted to do that. As these are the last Health questions before Christmas, all of us would want to pay tribute to the voluntary organisations that do an extraordinary job of making sure that vulnerable older people do not get lonely over the Christmas period. It is heroic what they do—when we are with our families, they are looking after other people—and we should salute them all.

22. [901279] Valerie Vaz (Walsall South) (Lab): One way to ease the pressure on the NHS is by not handing the £2.2 billion underspend back to the Treasury. Will the Secretary of State consider using it for the NHS?

Mr Hunt: I wish the hon. Lady had been as diligent in asking that question of Labour Ministers, who also handed back underspends to the Treasury when they were in power.

Steve Baker (Wycombe) (Con): Along with county colleagues, I wrote to the Secretary of State on this subject, because Buckinghamshire Healthcare NHS Trust is relatively underfunded compared with the rest of the country and it is in special measures following the Keogh review. Further to the answer that he gave to the earlier question, when can we expect the NHS England funding settlement to reflect more equitably the age of the public?

Mr Hunt: I commend my hon. Friend for the campaigning he does for high standards in his local trust. That has not been easy because, as he says, there have been a lot of problems there, although I hope he thinks that we are beginning to turn a corner. The decision on the funding allocations will be made by NHS England before Christmas, and the things that he says will, of course, be taken into account.

Luciana Berger (Liverpool, Wavertree) (Lab/Co-op): Yesterday we learned that the number of people suffering from hypothermia has soared by almost 40% on this Government’s watch. This morning the Office for National Statistics revealed that the number of older and vulnerable people who died unnecessarily last winter jumped by 29%. For every person who tragically loses their life over the winter months, eight more are admitted to hospital, putting huge strains on our crisis-ridden accident and emergency services. Will the Secretary of State please tell us what he is going to do about it?

Mr Hunt: I do not think I have yet answered a question across the Dispatch Box from the hon. Lady, so I welcome her to her post. I just say that she should be careful what she chooses to turn into a political

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football, because hypothermia admissions, as Public Health England said in August, are very closely linked to the number of cold days over a winter and the length of that winter. We had a particularly difficult winter last year, but the number of winter deaths was nearly 20% higher under the previous Government, when the right hon. Member for Leigh (Andy Burnham) was Health Secretary.

Social Care Budget Changes

8. Mrs Mary Glindon (North Tyneside) (Lab): What assessment he has made of the effects of social care budget changes on attendances at accident and emergency departments. [901265]

The Minister of State, Department of Health (Norman Lamb): Joining up health and social care is an absolute priority for this Government. The NHS will provide £900 million this year and £1.1 billion next year to support social care services with a health benefit and to promote joint working. In 2015-16, we will introduce a £3.8 billion pooled budget for health and social care. The number of bed days lost because of delays attributable to social care was nearly 50,000 lower in 2012-13 than it was in 2011-12.

Mrs Glindon: In the first two years of this Government, there was a frightening 66% increase in the number of people aged 90 and over coming into accident and emergency in a blue-light ambulance. When will the Minister accept that cuts to elderly care have increased pressure on the NHS, and are a major cause of the A and E crisis?

Norman Lamb: First, it is worth us all recognising that there is an increase in the number of frail elderly people in our society living with chronic conditions and that that is putting additional pressure on accident and emergency departments. The numbers have increased by over a million a year since 2010. However, the fact that there has been a reduction of 50,000 in the number of delayed discharges demonstrates that the social care system is doing incredibly well, and we should pay tribute to social care workers across the system who are doing so well to ensure that that improvement is taking place.[Official Report, 4 December 2013, Vol. 571, c. 13MC.]

Andrew George (St Ives) (LD): Bottlenecks in A and E are certainly not new, and they are not aided by the mantra that acute hospitals should be able to manage with fewer acute beds. On my hon. Friend’s point about shared and integrated planning, is he prepared to go further and push the Government in the direction of shared and integrated budgets as between health and social care?

Norman Lamb: I thank my hon. Friend for that question. We are creating a pooled budget in 2015-16 with this £3.8 billion fund. I can remember in opposition frequently making the case for integrated care and not really getting much of a positive response from the then Government. As the Chair of the Select Committee, my right hon. Friend the Member for Charnwood (Mr Dorrell), said, the great thing is that this Government are actually doing it.

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9. John Glen (Salisbury) (Con): What steps his Department is taking to improve the health of veterans. [901266]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): We have made excellent progress in improving the health care of our veterans by investing £22 million to support their physical and mental health. The Government have also made available £35 million of the LIBOR bank fines to support veterans and armed forces projects.

John Glen: I thank the Minister for that response. Will he outline the steps being taken to ensure that there is a co-ordinated approach between those commissioning services for veterans, including Salisbury district hospital, which does so much to service the veterans in Wiltshire, so that that they get the right revenue at the right time and do not go into deficit?

Dr Poulter: My hon. Friend is right to highlight the importance of co-ordinating veterans services, and getting the continuity of care right between a soldier or a member of the armed forces leaving the armed forces and being looked after by the NHS. I hope he will be reassured to hear that in terms of specially commissioned services, we now have nine super-prosthetic centres available for veterans who have lost limbs, 10 specialist mental health teams looking after veterans, a 24-hour mental health support line for veterans and many other measures. We are also making IVF available to veterans who have lost genitalia as a result of combat injuries.

Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): Given that health is a devolved matter, is the Minister satisfied that the Administrations in Wales, Scotland and Northern Ireland are providing similarly sufficient services for our veterans?

Dr Poulter: Obviously, we work closely with the devolved Administrations on all such matters. We have UK armed forces, and with health being a devolved responsibility, it comes to each part of the United Kingdom to put in place the right support. On the whole, that is done very well, but I am particularly proud of the efforts the Government have made on veterans’ mental health and on specialist prosthetic centres, which can be commissioned by the devolved Administrations if they wish to make such facilities available.

Penny Mordaunt (Portsmouth North) (Con): Many veterans are young men and women, and I know from my own constituency case work that a tremendous burden is often placed on elderly parents in caring for them, especially if they are suffering from post-traumatic stress disorder. Does the Minister agree that better integration between medical services in the armed forces and the NHS will benefit those families as well as the veterans themselves?

Dr Poulter: My hon. Friend speaks with considerable knowledge of the subject from her tradition and strong record of service. She will know that an important aspect of providing proper support for veterans is ensuring

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that we give their families the right support. We are working very closely with armed forces families and services charities to ensure that we do exactly that. That is why we have also put in place mental health first aid support for the families of servicemen and women to ensure that families know how to support veterans when they run into difficulties with post-traumatic stress disorder.

Children’s Hospices

10. Stephen Gilbert (St Austell and Newquay) (LD): What assessment he has made of the effectiveness of section 64 grants in supporting children’s hospices. [901267]

The Minister of State, Department of Health (Norman Lamb): We are aware how vital the annual grant of more than £10 million is to children’s hospices and we have pledged to continue it while we work with hospices to develop a per patient funding system to ensure that hospice services from 2015 can be funded locally and on an equitable and transparent basis.

Stephen Gilbert: I am grateful to my hon. Friend for that answer. Since the introduction of the grant in 2006, children’s hospices now reach 75% more children and families and provide vital services. Can he assure me that the funding agreement will be in place by 2015?

Norman Lamb: Let me first pay tribute to the amazing work of so many children’s hospices around the country. I know that Little Harbour in St Austell in my hon. Friend’s constituency has benefited from the grant and, indeed, from the increase in the grant last year. It is absolutely the intention both to work with hospices to get this right and to introduce the new system in 2015.

Mr Andrew Turner (Isle of Wight) (Con): Will the Minister join me in sending condolences to Gemma and Aaron Rolf and Jack, the parents and brother of six-year-old Sophie Rolf, who had an inoperable brain tumour and died, sadly, yesterday? Sophie and her family raised thousands of pounds to bring children’s facilities to the Earl Mountbatten hospice on the island. Those facilities were recently opened and will be a lasting tribute to a very special little girl.

Norman Lamb: Absolutely. I offer my condolences to the family of Sophie. The remarkable selfless fundraising done by such families does much to provide care for others and that will be a remarkable legacy for a fine young girl.

Cross-border Health Care (Wales/England)

11. Glyn Davies (Montgomeryshire) (Con): What discussions he has had with NHS hospital trusts on taking account of the interests of patients in Wales who depend on hospitals in England. [901268]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): As my hon. Friend knows, officials from NHS England frequently meet the Welsh Government to discuss the issue of health care provided in England for Welsh patients. He will know that NHS England has

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a duty to consider the likely impact of any commissioning decision it makes on people who reside in an area of Wales that is close to the border.

Glyn Davies: Does my hon. Friend agree that when commissioners for NHS hospital trusts in Shropshire are considering where to locate services, account must be taken of the needs of patients in Montgomeryshire, the vast majority of whom are dependent on Shropshire hospitals, particularly the Royal Shrewsbury hospital?

Jane Ellison: My hon. Friend is absolutely right to highlight the fact that cross-border health care is an area of great concern. There is a requirement to take note, as he says. The work is ongoing and I am happy to have those discussions with him.

Hywel Williams (Arfon) (PC): It is not only patients local to the border who access treatment in England. Patients from as much as 90 or 100 miles away in the west of Wales—for example, young babies—access treatment on the Wirral. However, does the Minister agree that it is in the interests of hospital trusts in England to take patients from Wales, as it has been demonstrated that they often make the difference between a viable and non-viable service?

Jane Ellison: Of course, it is possible, depending on clinical need, for clinicians to recommend treatment in England. The hon. Gentleman knows that there are ongoing discussions, some of which are quite difficult, but the intention is obviously to ensure that we get the best health care for everyone. I would urge the Welsh Government, in particular, to consider ways in which they can review how arrangements are made in Wales. There have been calls for a review of hospitals in Wales, not least the one today from the Royal College of Surgeons.

Daniel Kawczynski (Shrewsbury and Atcham) (Con): Hospitals such as the Royal Shrewsbury hospital, dealing with patients from both sides of the border, have historically incurred additional administration costs in dealing with the two separate authorities. What work is the Minister doing to find out what the costs are and whether she can help meet them in the future?

Jane Ellison: We are aware of those additional costs, and I know that my hon. Friend recently met my right hon. and noble Friend the Under-Secretary of State for Health. We are very conscious of those costs and of the difficult decisions. It is the subject of ongoing negotiation between the Welsh Government and NHS England.

Orthopaedic Surgery

12. Andrew Selous (South West Bedfordshire) (Con): What lessons he has learnt from the findings of the report of Professor Timothy Briggs on improving the orthopaedic surgery published in September 2012, entitled “Getting it right first time”. [901269]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): In 2012 Ministers welcomed the publication of the report and acknowledged that its recommendations

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could help build on improvements in orthopaedic care. I believe that my right hon. Friend the Secretary of State met Professor Briggs.

NHS England is now responsible for securing high-quality outcomes. Peter Kay, the national clinical director for musculoskeletal services, is also supportive of the report’s findings.

Andrew Selous: Growing numbers of orthopaedic consultants accept that collaboration across networks of hospitals could improve the quality of orthopaedic care, which frankly has not always been good enough in the past. Will my hon. Friend accept the recommendations of the “Getting it right first time” report?

Jane Ellison: We know that NHS England has welcomed Professor Briggs’ recommendations. They are contributing to a substantial body of work on orthopaedics, with the sole objective of improving outcomes for patients. I am sure that my hon. Friend will welcome the fact that this year for the first time data about surgical outcomes have been published at both hospital and consultant level, with the objective of driving up quality and supporting patient choice.

“Our Children Deserve Better”

14. Paul Burstow (Sutton and Cheam) (LD): What steps he has taken in response to the findings of the report by the Chief Medical Officer, “Our Children Deserve Better: Prevention Pays”, published in October 2013. [901271]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): The chief medical officer’s report warmly welcomes the Government’s commitment to increasing health visitor numbers and support in the early years, and I shall be working with the children and young people’s outcomes forum to inform future improvements in children’s health.

Paul Burstow: My hon. Friend the Minister will know that about half the burden of mental health disease can first be identified during the teenage years. In her report, the CMO says that our information about the prevalence of childhood mental health problems and the level of under-diagnosis of mental health problems among that population is out of date. When will the Government commission the next survey? The last one was done in 2004. Is it not time to do another?

Dr Poulter: My right hon. Friend raises important issues. I should like to pay tribute to the work that he did in expanding children’s talking therapies and IAPT—improving access to psychological therapies—services to make better provision for mental health support. He is right to highlight, as the CMO did, the fact that we do not have enough data on children’s mental health. That has been a historical problem, and we are looking at ways to improve the data so that we can use them to improve health outcomes in mental as well as physical health.

Dr Sarah Wollaston (Totnes) (Con): In Devon and Cornwall since the beginning of this year there have been three occasions when children as young as 12 and 13 with acute mental illness have been detained in police

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cells instead of an appropriate place of safety, and 25 occasions when children of 17 and under have been so detained. Will the Minister meet me to discuss how we can end this appalling situation and make sure that all children who are detained under section 136 are seen in an appropriate location?

Dr Poulter: My hon. Friend is right to highlight this problem, which is unacceptable. My hon. Friend the Minister of State is looking into it. A lot of anecdotal evidence is stacking up that this practice is happening. We do not find it acceptable, and I or my hon. Friend will be happy to meet her to discuss the matter further and ensure that it is stopped.

NHS Walk-in Centres

15. Karl Turner (Kingston upon Hull East) (Lab): How many NHS walk-in centres have (a) closed and (b) restricted their opening hours since May 2010. [901272]

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): The information is no longer collected centrally. Since 2007, under the changes introduced by the previous Government, the local NHS has been responsible for walk-in-centres, and it is for local commissioners to decide on the availability of these services.

Karl Turner: Official NHS figures show that attendances at accident and emergency departments have increased more than three times faster under the Tory-led Government than under the Labour Government. Does the Minister regret allowing so many walk-in centres to close?

Dr Poulter: As I outlined, there are not any official figures, because the data are now held locally. Monitor carried out a survey of some trusts, but that is not a measure of all trusts. The hon. Gentleman wants to look at the reasons why there have been changes to walk-in centres. There was a reduction in central funding of over 90% under the previous Government. I believe that the right hon. Member for Leigh (Andy Burnham) was a Minister at the time; if the hon. Member for Kingston upon Hull East (Karl Turner) wants to look at the reasons for that, he should perhaps ask his right hon. Friend why he reduced central funding for walk-in centres by 90%.

Henry Smith (Crawley) (Con): In 2005, under the Labour Government, Crawley hospital had its accident and emergency department closed. Now we have an urgent treatment centre that has increased its operating hours and the services that it provides. What advice can the Department give to clinical commissioners about how we can expand urgent treatment centres?

Dr Poulter: My hon. Friend is absolutely right to highlight that these are local decisions that need to be made by local commissioners, because what looks good in Crawley will be very different from the needs in Bradford. That was the very reason that underpinned the previous Government’s decision to transfer responsibility for these services to local commissioners, but we often need more co-located services, because the Monitor survey picked up the fact that in the past, far too often, walk-in centres were isolated in the community; people

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did not know how to access them, or when they could do so. Monitor also recognised that there was duplication of effort, and sometimes patients who needed to be seen in accident and emergency were treated, inappropriately, in walk-in centres.

Mr Speaker: I am deeply obliged to the Minister, but we must leave time for Mr Mowat.

Alternative Therapies

16. David Mowat (Warrington South) (Con): What recent consideration he has given to banning the use of NHS funds for provision of alternative therapies. [901273]

The Parliamentary Under-Secretary of State for Health (Jane Ellison): As my hon. Friend will know, the provision of alternative and complementary therapies is decided by clinical commissioning groups, which obviously must take into account local health needs and priorities.

David Mowat: I thank the Minister for that answer. Many parts of the NHS are under intense, relentless financial pressure, so how can it be right that we spend millions of pounds a year on remedies that have no scientific basis, other than through their placebo effect?

Jane Ellison: My hon. Friend is quite right to highlight that value for money is very important. It is for local commissioners, not the Department, to decide how funding is spent to meet the needs of the populations whom they serve, but crucially, clinical commissioning groups are responsible for achieving value for money as regards the services that they commission, as well as for delivering improvements in the quality of care, and better outcomes for patients.

Topical Questions

T1. [901248] Simon Danczuk (Rochdale) (Lab): If he will make a statement on his departmental responsibilities.

The Secretary of State for Health (Mr Jeremy Hunt): I need to correct the record. In the House on 30 October, I said that it took 21 minutes longer for the average person to be seen in A and E under the previous Government—a figure that was repeated by the Prime Minister in Prime Minister’s questions. My Department made a statistical mistake: it turns out that under Labour, the average person took not 21 but 44 minutes longer to be seen. I apologise for underestimating the improvements made under this Government.

Simon Danczuk: When people have mental health problems, waiting too long for talking therapies can lead to poor recovery, relationships falling apart, and job loss. What progress has the Minister made in establishing and delivering maximum waiting times for talking therapies?

Mr Hunt: The hon. Gentleman is absolutely right: this is a big priority for the Government. We are a big fan of talking therapies. We have taken huge strides in improving take-up, but there is still a long way to go, and we are looking at introducing access standards, so that there is a maximum time beyond which no one has to wait.

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T3. [901251] John Pugh (Southport) (LD): What measurable progress is being made in improving data sharing, not just between hospitals and general practitioners, but between the NHS and social services, to avoid bureaucracy and additional cost?

Mr Hunt: My hon. Friend has taken a great interest in this topic, and he is absolutely right to do so, because if we are to give integrated, joined-up care, in which people deal with NHS professionals who know about them, their medical history, their allergies and all the other important things, it is vital that, if they give their consent, their medical record can be accessed. That needs to be from GP surgery to hospital to social care system. Under the named GP policy that we have announced, there is a big opportunity for care homes to access GP records and keep them updated daily, so that GPs are kept in daily contact with how some of the most vulnerable people are doing.

Andy Burnham (Leigh) (Lab): Today I want to put to the Secretary of State new evidence that the A and E crisis is deepening, and having a serious knock-on effect on ambulance services. Information from police forces reveals that cases in which police cars have to ferry patients to A and E are far more widespread than people realise; in some areas, it happens on a daily basis. One ambulance service is now using retained firefighters to attend calls, and—this is how bad things have got—another ambulance service has seen a 350% increase in the number of 999 calls attended by taxis. Does the Secretary of State think that it is ever acceptable that when a patient dials 999, a taxi turns up?

Mr Hunt: I am afraid that that is utterly irresponsible. We are hitting our A and E target, and we are hitting our ambulance standard. When the right hon. Gentleman was Health Secretary he missed the ambulance standard for October, November, December and January. He is trying to talk up a crisis that is not happening. He should think about people on the front line and, just for once, put patients before politics.

Andy Burnham: The country will have heard the complacency from the Secretary of State. He needs to explain why he spent Friday afternoon making panicked phone calls to hospitals up and down the country that were missing their A and E target. He did not condemn the use of taxis, which is unacceptable but is happening on his watch because ambulances are trapped at A and E, unable to hand over patients. That means that 999 response times have got worse and large swathes of the country, right now, are without adequate ambulance cover. Is it not time that the Secretary of State was honest with the public and admitted the scale of the crisis facing the NHS this winter, and took action now to prevent it from engulfing other emergency services?

Mr Hunt: We will take no lessons in complacency from the party that did so little to sort out excess deaths in hospitals such as Mid Staffordshire, Morecambe bay, Basildon and Colchester, and many other hospitals. The truth is that, compared with when he was Health Secretary, we see nearly 2,000 more people every single

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day within the four-hour standard. We are doing much, much better: we have more A and E doctors, and the NHS is doing extremely well. I know that for him it is always politics first and patients second but, for once, he should be responsible and think about the people on the front line.

T4. [901252] Neil Carmichael (Stroud) (Con): In contrast to the previous Government’s lack of focus, what have this Government done about hospital infection control, with particular reference to data management systems?

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): My hon. Friend makes an important point, and I hope that he will be reassured that under the current Government, clostridium difficile and MRSA rates are both about 50% lower than they were under the previous Government. We will continue to make sure that we reduce unacceptable hospital infections.

T2. [901249] Rosie Cooper (West Lancashire) (Lab): Following Francis and Keogh, and in creating a more open and accountable NHS, will the Secretary of State, in the spirit of total transparency that he favours, order foundation trusts to publish all their board papers, have exactly the same publishing requirements as non-FTs, and hold all their board meetings in public?

Mr Jeremy Hunt: I absolutely encourage that transparency. In fairness, the hon. Lady will accept that this Government have done more to improve transparency in the NHS than any Government have ever done. I would encourage all FTs to be transparent about their board meetings, but they are independent organisations, and we have learned—[Interruption.] Well, this was legislation that her Government introduced, and we have learned that it is important to give people autonomy and independence, because they deliver a better service for patients.

T6. [901254] Dr Julian Huppert (Cambridge) (LD): Cambridgeshire and Peterborough clinical commissioning group receives one of the lowest amounts of funding per head in the country. The Government’s own fair shares formula, which takes account of factors such as population, age and deprivation, says that we should have £46.5 million more each year. I know that it is not his decision, but does the Minister think that the new formula should be implemented?

Dr Poulter: My hon. Friend makes some important points about the funding formula. He will know that for the first time this year, it will be set independently by NHS England, and I am sure that it will take on board the points that he has made. He will recognise, however, that there are many other determinants of the funding formula, such as deprivation, which it will want to look at and take into account.

T5. [901253] Caroline Lucas (Brighton, Pavilion) (Green): The last time I asked the Secretary of State about the £30 million-worth of cuts forced on hospitals in Brighton and Sussex, he said that it was all down to local discretion. Does he admit that behind his rhetoric about protecting the NHS budget there still lies a real

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4% cut to the centrally dictated national tariff? Does he acknowledge, therefore, that hard-working nurses and doctors have to do more with less money while patients suffer? Will he reverse those cuts?

Mr Jeremy Hunt: Can I explain to the hon. Lady that the reason for the 4% efficiency savings is that, although we protected the budget in real terms, demand for NHS services has gone up by 4% year in, year out, so we need to find those efficiencies? Within that, it is incredibly important that we do not make false economies in relation to the number of nursing staff, which is why last week’s announcement on our response to the Francis report will make a big difference, and we have already begun to see more nurses.

T7. [901255] Jonathan Evans (Cardiff North) (Con): Given the more than 30% increase in the past five years in the cost to the NHS of prescribing stoma appliances, what action is the Minister taking to promote training for stoma patients in alternative management techniques, such as colostomy irrigation?

The Parliamentary Under-Secretary of State for Health (Jane Ellison): My hon. Friend may know that specialist NHS stoma nurses offer a range of support and advice to help patients adapt to life with a colostomy, and this advice can cover colostomy irrigation, if appropriate. This is supplemented with patient literature on colostomy, which is widely available in the NHS.

John Cryer (Leyton and Wanstead) (Lab): Further to question 15, I understand that responsibility for walk-in centres has been devolved. Why does that necessarily prevent central Government from collecting those figures centrally? It is pretty staggering that a Minister should turn up and say, “Well, the decisions are made locally so we just don’t bother finding out.”

Dr Poulter: That is a question that the hon. Gentleman had much better address to his own Front Bench, who made the decisions to devolve these responsibilities locally. When it comes to commissioning health services, we believe it is down to doctors and nurses, who are now leading clinical commissioning on the front line, to determine which services are appropriate in local areas. There were clearly concerns about the way that urgent care centres had previously been commissioned. That is why so many of them are now being relocated and co-located in accident and emergency departments.

T8. [901256] Mr John Baron (Basildon and Billericay) (Con): The Secretary of State is well aware that the all-party group on cancer has campaigned long and hard for the monitoring of one and five-year survival rates as a means of promoting earlier diagnosis, cancer’s magic key. Is he confident, though, that the mechanisms are sufficient to ensure that those clinical commissioning groups that are underperforming in relation to their one and five-year survival rates will face concrete action to improve earlier diagnosis, given the recent OECD report suggesting that 10,000 lives a year could be saved in this country if we matched European average survival rates?

Jane Ellison: My hon. Friend is right to champion early diagnosis and he has raised these issues in the House on many occasions and with me. Improving

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cancer survival is a key priority for this Government. We aim to save an additional 5,000 lives each year by 2014-15. Clinical commissioning groups have a duty on early diagnosis. It is part of their crucial outcomes indicators set, and they will be held to account for that because we cannot deliver those improvements in cancer outcomes without early diagnosis.

Helen Jones (Warrington North) (Lab): When the Government decided to slash council budgets and, therefore, adult social services, did they know what effect that would have on hospitals, particularly A and E, and decide to carry on anyway, in which case they are too callous to be running the NHS, or did they not know, in which case they are too stupid to be running the NHS?

The Minister of State, Department of Health (Norman Lamb): Throughout this Parliament we have ensured that extra funding has gone into social care to recognise the fact that council budgets have been under strain. The point that I made earlier—that there has been a 50,000 reduction in delayed discharges to social care—demonstrates just how well they are doing under significant pressure.

T9. [901257] Andrew Stephenson (Pendle) (Con): What progress have the Government made in driving up standards and transparency in hospitals, social care and general practice?

Norman Lamb: The Government’s response to the Francis report demonstrated that openness and transparency are critical. As a result of the steps that we have proposed, this will be the most open health system anywhere in the world. That is something we should be very proud of.

Robert Flello (Stoke-on-Trent South) (Lab): I need to press the Minister on this. Does he really expect people to believe that cutting £1.8 billion from local authority care budgets—Stoke-on-Trent has lost a third of its overall funding—will have no impact on the A and E crisis?

Norman Lamb: Labour still seems to be in complete denial about the crisis in public finances that we inherited in 2010 owing to failures by the Government whom the hon. Gentleman supported in managing public finances. What we are doing is introducing a £3.8 billion fund to pool health and social care. It amounts to a substantial shift of resources to preventing ill health and it will do exactly what we need to do for social care.

David Morris (Morecambe and Lunesdale) (Con): May I thank the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), for recently opening a walk-in centre in Morecambe? May I also set the record straight, because the centre had been closed under the previous Government? Does he not think that it is a shocking indictment that in 2006 the NHS was cut by 9% in the region—

Mr Speaker: Order. First, topical questions are supposed to be brief. Secondly, the Minister is not responsible for what happened in 2006. We will have a very brief reply and then perhaps we can move on.

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Dr Poulter: It was a great pleasure to open the walk-in centre in Morecambe, which was led by local commissioners to meet local clinical need.

John Healey (Wentworth and Dearne) (Lab): The European Union has just agreed a trade deal with Canada that excludes health care, so will the Secretary of State ensure that the proposed EU trade and investment agreement with the US also excludes health care?

Mr Jeremy Hunt: We are looking at that very closely. We are big supporters of having a free trade deal between the EU and the US, but we do not want to do anything that would affect the fundamental principles, values and practices of the NHS.

Stuart Andrew (Pudsey) (Con): The new review into children’s heart units feels very different, and I am pleased that everything is on the table. However, I was concerned to learn that the task and finish group has decided to meet in private. Given the group’s importance in decision making, and remembering the experience of the Safe and Sustainable review, does my hon. Friend agree that, in the interests of openness and confidence, the group should meet in public?

Jane Ellison: My hon. Friend has been a great and sustained champion of that cause in this House and in speaking up for his local hospital and his constituents. NHS England is clear that all substantive decisions on the new review on congenital heart disease will be made by its full board, which meets in public, so there is no question of a major decision being taken in private. With regard to the sub-groups, including the one he mentioned, their papers and minutes are all published, but for practical reasons none of them meets in public, and that is normal practice. However, all major decisions will be taken in public by the full board.

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Steve McCabe (Birmingham, Selly Oak) (Lab): The Minister will know that following the neuromuscular services review an explicit commitment was made to fund a care adviser and paediatric consultant post for the west midlands. Is he willing to meet me, patients and representatives of the Muscular Dystrophy Campaign to discuss the service and that commitment?

Norman Lamb: I would be happy to do so. I understand that NHS England is scheduling a meeting with Birmingham Children’s Hospital NHS Foundation Trust, which I hope will make some progress in ensuring that there is sufficient co-ordinated care for people with muscular dystrophy in the west midlands.

Several hon. Members rose—

Mr Speaker: I fear that this will almost certainly be the last question. Karen Lumley.

Karen Lumley (Redditch) (Con): In the past two weeks I have had to visit accident and emergency units in Redditch and in north Wales, unfortunately with members of my family. Although health is a devolved matter in Wales, will my right hon. Friend the Secretary of State invite his counterpart in Wales to spend some time at the great A and E unit in Redditch to see for himself the stark differences between the two services?

Mr Jeremy Hunt: I would be delighted to do so. He will see the impact of not cutting the NHS by 8%, which is what Labour has done in Wales, which means that in this country we are hitting our A and E targets and in Wales they have not hit them since 2009.

Mr Speaker: I am sorry to disappoint colleagues, but we must move on. Demand usually outstrips supply.

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Electronic Patient Records (Continuity of Care)

Motion for leave to bring in a Bill (Standing Order No. 23)

12.33 pm

George Freeman (Mid Norfolk) (Con): I beg to move,

That leave be given to bring in a Bill to allow patients access to and ownership of their own electronic patient records; to require medical professionals to maintain and share electronic patient records as part of individual care plans; and for connected purposes.

Mr Speaker, do you know your NHS health number? How many colleagues in the House know theirs? I ask because it is an important little number, for reasons I want to expand on, a number that opens a door on to a whole new world. It is the world of personalised medicine and patient empowerment.

As you are aware, Mr Speaker, from your support for medical research charities, medicine and health care are being transformed by an explosion of new technologies around the world. We are living through a biomedical revolution every bit as profound as the agricultural and industrial revolutions that came before us. Health care is moving from being something done to us by Government to something we do for ourselves. It is a revolution that is transforming the traditional world of drug discovery, in which I worked before coming to the House.

The UK is pioneering a new model of patient-centred biomedical research. Across the world, the life sciences industry is radically reconstituting itself around what everybody is coming to recognise as the most important asset of all—the ability to work with patients and their clinicians, and with biopsies, patient records and data, to design a new generation of targeted and personalised medicines.

This model of targeted medicine unlocks the biggest prize of all—a new model of reimbursement where, instead of sitting in smoke-filled rooms every five years to negotiate prices for one-size-fits-all blockbuster drugs which neither we nor the industry can afford, we get to be the country getting drugs at reduced prices, reflecting the value we have delivered through our NHS infrastructure. That is why the Prime Minister’s leadership in grasping this opportunity through the life sciences strategy matters so much, as do the vision and the measures contained within it—the £1 billion a year investment in the National Institute for Health Research, the catalyst fund, the patent box, the NHS open data initiatives, and now the £100 million Genomics England project. Ultimately, linking clinical and genomic data and using the power of modern computing provides the opportunity to turn the NHS from a major driver of the structural deficit into a major driver of growth in life sciences and a catalyst for public sector innovation, reform, and patient and citizen empowerment. This really matters.

But there is a problem—in fact, a series of problems. The data are not yet integrated. Connecting for Health was a disaster. The landscape is getting better, but it is still very patchy. The best GPs are streets ahead of the worst. Hospital records are very fragmented. There is almost no proper integration of patient records with the care system. Electronic patient records are not yet mainstream in our health or care sectors for patients nor clinicians. This matters, not just because it is holding

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back our ability to lead in research, but here today for patients too. We need only look at Mid Staffs and Winterbourne View to see that our inability properly to monitor patient treatment and care is having a profound impact on patients.

The Bill has two simple provisions. Clause 1 would provide for ownership of and access to our patient records and health data to empower patients in everyday health care and in research. Clause 2 would create a new statutory duty of care on NHS professionals to use and update the information and to ensure that the next professional on the patient’s care pathway is using properly maintained patient records.

The Bill is intended to have a number of key effects. First, it would reassure patients by establishing in law that ultimate control lies with us, the patients—that these are our data and we are clear that they belong to and are controlled by us, not the Government or the European Union, whose latest data protection laws risk holding back this revolution in medicine. We need to raise awareness of the power of patients to access our own data. We need to change the culture inside the NHS so that patients who request data are not sneered at or resented as troublesome but treated as enlightened health care citizens taking an interest in and responsibility for our own or our loved ones’ life prospects.

The Bill would allow us to log on and check our medical histories, including prescriptions, dates of when we saw who, and key medical information—or to check for a loved one using their NHS number—and to check and submit any changes or additional information, any side effects or symptoms, and our compliance. This is crucial information lying at the heart of modern medicine. We could use our EPR—electronic patient record—to plug into the exploding world of online health apps, which are transforming health care with devices such as in-house diagnostics and watchstrap heart and blood pressure monitors that can automatically upload data to our electronic health record and transmit it to our clinician. We could use the EPR to give permission for our data to be used in any NHS medical research and/or to enter clinical trials. Ninety-nine per cent. of patients say, when asked, that they would not only be happy for their data to be used in trials but are amazed that they are not already.

On the health care side, the Bill would mean that every health care professional would have a duty to use the EPR system and keep our records up to date, and to record treatment and ensure that the records are passed on to the next person on the care pathway. Thus the EPR becomes not a boring chore but the central tool for ensuring continuity of care. If a person or their loved one, or a constituent, passes from GP to hospital to community care sector and back again, as do an increasing number of elderly patients, in particular, it would be easy for them, their loved ones and their doctors and carers instantly to track and monitor their status, condition, diagnosis and treatment, and whose care they are in.

In a few years’ time it will be unimaginable to think of health records and patient monitoring as it is today, with paper records, cardboard boxes, partial digitisation, fragmentation across hospitals, and community care a black hole. It will be as unimaginable as the world of banking before electronic and telephone banking empowered millions of banking consumers to take more

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responsibility for their finances. The same revolution is happening in health care. Of course, there are a number of issues, challenges and things to get right as regards the sharing of data. I am aware of those and I am working on them with opinion leaders as we draft the Bill to make sure that we get this right.

Without the measures in this Bill there is a clear and present risk of the UK—far from leading in this world of personalised medicine; far from winning in the global race for investment; and far from the NHS pioneering new models of health care and productivity and patient empowerment—becoming a backwater and talking the talk but not walking the walk.

In the past two weeks since I made public the Bill’s aims, it has already secured extraordinary support from a wide range of key opinion leaders in the field, including more than 50 medical research charities, leading professor clinicians at the front line of UK research medicine, the NHS data commissioner and the Ethical Medicines Industry Group, which is not big pharma, but small, emerging companies pioneering the new treatments and diagnostics that are all too often locked out by our current system of NHS innovation rationing.

Most important of all is the support of patients, whose data, NHS and health care we are discussing. Patients have had to be patient for too long. They include Graham Hampson Silk, who has told me that this revolution in research-based medicine saved his life. Ten years ago, he was given six months to live—yes, Members heard me correctly. His life has been saved by the team of clinicians and NHS staff at Birmingham royal infirmary and the Institute of Translational Medicine, led by the inspiring Professor Charlie Craddock, who is here today. He found a drug in development in the USA, raised money through local fundraising to fund a trial for Graham and is now pioneering personalised cancer treatment here in the NHS with NHS patients and their data, so that every patient becomes a research patient, helping prevent the next generation from suffering unnecessarily.

I commend this Bill to the House.

Question put and agreed to


That George Freeman, Charlotte Leslie, Dr Phillip Lee, Mr Dominic Raab, Jesse Norman, Geoffrey Clifton-Brown, Damian Hinds, Dr Sarah Wollaston, Nick de Bois, John Glen, Dr Julian Huppert, Rosie Cooper and Natascha Engel present the Bill.

George Freeman accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 17 January 2014, and to be printed (Bill 134).

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Gambling (Licensing and Advertising) Bill

Consideration of Bill, not amended in the Public Bill Committee

New Clause 1

Facilities for remote gambling

‘(1) Section 235 of the Gambling Act 2005 (gaming machines) is amended as follows.

(2) In subsection (2)—

(a) in subparagraph (h)(ii), leave out “and”, and

(b) after paragraph (i) insert—

“(j) a machine is not a gaming machine by reason only of the fact that it is remote gambling equipment (within the meaning of section 36) which is made available for use in a casino.”.

(3) After subsection (4) insert—

“(4A) The Secretary of State may by regulations provide for the maximum number of machines to which subsection (2)(j) applies that may be made available for use in a casino.”.’.—(James Duddridge.)

This amendment clarifies that a remote gambling terminal provided in a casino is not a gaming machine and provides for the Secretary of State to be able to make regulations setting the maximum number of such machines which may be made available in a casino.

Brought up, and read the First time.

12.42 pm

James Duddridge (Rochford and Southend East) (Con): I beg to move, That the clause be read a Second time.

Mr Speaker: With this it will be convenient to discuss the following:

New clause 2—Licence compliance, stipulations and control

‘(1) Notwithstanding the regulation of spread betting by the Financial Conduct Authority, operators licensed for remote gambling by the Gambling Commission shall, to ensure their continued fitness as such, be obliged to comply with Condition 15.1 of the Consolidated Licensing Conditions and Codes of Practice 2011 (or its equivalent from time to time) in relation to all areas of their gambling operations, including spread betting and any other operations not within the jurisdiction of the Gambling Commission.

(2) In the event of any breach of subsection (1) which the Gambling Commission believes calls into question the fitness of the relevant operator, the Gambling Commission may require the operator to provide an explanation of such breach within one month and may, if not satisfied with such explanation, revoke the operator‘s licence.’.

New clause 3—Kite mark

‘(1) The Gambling Commission shall require all licensed online gambling operators to display a standard kite mark on all their promotional materials, websites and webpages, to indicate that such operators are licensed by the United Kingdom Gambling Commission.

(2) The Gambling Commission shall design and determine the form of the kite mark, which will provide a link to information and advice on its website for customers.’.

New clause 4—Remote gambling licensees and customer protection

‘Holders of licences for remote gambling operations shall be required to participate in a programme of research into and treatment of problem gambling in accordance with arrangements to be determined by the Secretary of State in regulations in the

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form of a statutory instrument approved by both Houses of Parliament, and a levy for that purpose may be imposed under section 123 of the Gambling Act 2005.’.

New clause 5—Reporting of suspicious activities and power to obtain financial information

‘(1) In order to promote consistency of sports betting regulation, regulation of remote sports spread betting operators and of all sports spread betting as defined herein shall be transferred from the Financial Conduct Authority to the Gambling Commission, which shall thereupon—

(a) have power to require and obtain from its licensees including spread betting organisations information concerning actual or potential suspicious activities in relation to sporting events, and to share such information with the relevant sports governing body;

(b) have power to require and obtain information on financial transactions by licensees which it reasonably suspects might be germane to the investigation of suspicious betting activity, money laundering or other criminal activities, or the protection of vulnerable individuals.’.

(2) “Sports spread betting” shall for this purpose mean spread bets in relation to sports as governed under Schedule 6, Part 3 of the Gambling Act 2005.’.

New clause 6—Consultation on self-exclusion

‘Having regard to the significance of the remote gambling market in relation to potential problem gambling, the Secretary of State shall consult on a system of standardised self-exclusion for the gambling industry, to include means of addressing exclusion from remote gambling access in the context of other gambling media.’.

New clause 7—Dormant accounts

‘(1) The Secretary of State shall consult on appropriate ways to require licensed remote gambling operators to disclose (as a condition of their licence) the amounts held by them by way of—

(a) winnings of UK customers unclaimed for a period of more than one calendar year; and

(b) sums in dormant accounts of UK customers.

(2) A dormant account shall for this purpose be an account which has been inactive for at least one calendar year.’.

New clause 8—Discussions between gambling regulatory bodies and sports governing bodies

‘The Secretary of State shall have power to make regulations, to be laid before and approved by both Houses of Parliament, stipulating the manner and time of regular meetings between any and all of the gambling regulatory bodies and sports governing bodies.’.

New clause 9—Advertising watershed

‘The Secretary of State shall consult on the current regulatory position concerning advertising of gambling before the nine o‘clock watershed and shall lay before the House a report of the findings not later than the final sitting day before the summer recess 2014.’.

New clause 10—Application of the horserace betting levy

‘In article 2 of the Gambling Act 2005 (Horserace Betting Levy) Order 2007/2159, for paragraph 3 substitute—

“(3) Subject to paragraph (4), expressions used in sections 24 to 30 of the 1963 Act shall have the meanings given to them by section 55(1) of the 1963 Act (as that provision had effect immediately before 1st September 2007).

(4) For the purposes of paragraph (3), the definition of ‘bookmaker’ as set out in section 55(1) of the 1963 Act (as that provision had effect immediately before 1st September 2007) shall be modified by—

(a) replacing the comma at the end of paragraph (b) of the definition of ‘bookmaker’ with ‘; or’; and

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(b) after paragraph (b) of the definition of ‘bookmaker’ inserting—

‘(c) holds a remote gambling operating licence under the Gambling Act 2005 which authorises that person to provide facilities for betting,’.”.’.

New clause 11—Power to extend the horserace betting levy to overseas bookmakers—

‘(1) The Secretary of State may by regulations amend any provision or provisions of the Betting, Gaming and Lotteries Act 1963 (c 2) (at a time when the provisions listed in section 15(1)(a) to (c) of the Horserace Betting and Olympic Lottery Act 2004 (horserace betting levy system) have not been entirely repealed by order under that section), the Gambling Act 2005 and/or the Gambling Act 2005 (Horserace Betting Levy) Order 2007/2159 for the purposes of ensuring that each person who holds a remote gambling operating licence under the Gambling Act 2005 which authorises that person to provide facilities for betting shall be—

(a) liable to pay the bookmakers’ levy payable under section 27 of the Betting, Gaming and Lotteries Act 1963 (c 2); and

(b) subject to the provisions of section 120 of the Gambling Act 2005 (as modified in accordance with the Gambling Act 2005 (Horserace Betting Levy) Order 2007/2159) if that person is in default of such bookmakers’ levy.

(2) Regulations under this section must be made by statutory instrument.

(3) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.’.

New clause 12—Financial blocking

‘After section 122 (information) of the Gambling Act 2005, insert—

“122A (1) The Commission may give a direction under this section if the Commission reasonably believes that a person or organisation who does not hold a remote gambling licence is providing remote gambling services in the United Kingdom.

(2) A direction under this section may be given to—

(a) a particular person operating in the financial sector;

(b) any description of persons operating in that sector; or

(c) all persons operating in that sector.

(3) A direction under section (1) may require a relevant person not to enter into or continue to participate in—

(a) a specified transaction or business relationship with a designated person;

(b) a specified description of transactions or business relationships with a designated person; or

(c) any transaction or business relationship with a designated person.

(4) Any reference in this section to a person operating in the financial sector is to a credit or financial institution that—

(a) is a United Kingdom person; or

(b) is acting in the course of a business carried on by it in the United Kingdom.

(5) In this section—

“credit institution” and “financial institution” have the meanings given in Schedule 7, paragraph 5 of the Counter-Terrorism Act 2008;

“designated person”, in relation to a direction, means any of the persons in relation to whom the direction is given;

“relevant person”, in relation to a direction, means any of the persons to whom the direction is given.”.’.

This New Clause allows the Gambling Commission to prevent a person or organisation without a remote gambling licence from accessing the UK market by financial transaction blocking.

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New clause 13—Comparison of codes and technical standards in white listed jurisdiction with UK

‘(1) The Commission shall review the social responsibility provisions of the codes of practice and technical standards of—

(a) EEA states; and

(b) the places to which section 331(2) of the Gambling Act 2005 has applied.

(2) The Commission shall amend the codes of practice and technical standards issued in pursuance of section 24(2) of the Gambling Act 2005 so that the code and technical standards reflects the strongest social responsibility provisions identified in subsection (1).

(3) In this section “social responsibility provisions” means a provision of the code identified as—

(a) ensuring that gambling is conducted in a fair and open way.

(b) protecting children and other vulnerable persons from being harmed or exploited by gambling; and

(c) making assistance available to persons who are or may be affected by problems related to gambling.’.

This New Clause requires the Gambling Commission to review the codes of white listed jurisdictions to establish which has the most comprehensive and sophisticated provisions to protect problem gamblers and to ensure that the UK codes and technical standards provide as robust standards for consumer protection.

New clause 14—Self-exclusion for remote gambling

‘After section 89(1) (remote operating licence) of the Gambling Act 2005, insert—

“( ) The Commission shall hold a list of persons who have registered to be excluded from remote gambling.

( ) It shall be a condition of a remote operating licence that an operator must exclude any person who has registered for self-exclusion with the Commission.”.’.

This New Clause would give the power for the Commission to hold a list of those who wish to self-exclude. It would be a condition of a remote operating licence that individuals on the list must be excluded.

Amendment 1, in clause 1, page 2, line 11, at end add—

‘(8) The Secretary of State shall publish a report to Parliament one year after the commencement of this Act, and annually thereafter, on the enforcement activity of the Gambling Commission in respect of unlicensed operators attempting to provide facilities for gambling in the UK.’.

James Duddridge: New clause 1 seeks to allow online as well as offline gambling in casinos. In other words, it seeks for casinos to be able to provide people with the type of gambling offered by smartphones and tablets.

I think in all candour that the Department for Culture, Media and Sport has an old-fashioned view of the world—one that was once true and where there was a clear division between on and offline gaming. I suspect there is also an element of divide and rule involved. The gambling industry is a powerful body and it would be attractive to regulate both forms of gaming separately and get them to compete actively against one another.

The reality is different: online and physical provision of services have been merged in many industries. It is possible to order a product online from Asda and then collect it from a bricks-and-mortar store. It is possible to visit the clothing department at Marks & Spencer and order boxer shorts online for delivery. The on and offline worlds have merged in a number of environments. I hope that my examples are not an advertisement for those two institutions.

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Mr Speaker: I would not accuse the hon. Gentleman of advertising for one moment. It is always of great interest to the House to learn about his personal arrangements.

James Duddridge: Thank you, Mr Speaker. For a moment, I feared that I was getting my knickers in a twist.

My constituency of Rochford and Southend East is home to three, soon to be four, casinos, which are bricks- and-mortar or physical ones. Such establishments employ thousands of people nationally. Locally, 277 people are employed in the existing three casinos, which will go up to about 400 when the fourth casino is launched. About 80% of the staff have been issued with personal licences by the Gambling Commission, while 100% of them receive annual training in responsible gambling, so they are well qualified.

Reports, such as an excellent one from GamCare, have outlined the details of the significant work that the industry is already doing, with much greater protection of vulnerable individuals being provided in casinos than online. I do not necessarily want more gambling, but I want more of the existing gambling to take place in such licensed and heavily regulated environments.

I am glad to say that new clause 1 is supported by my hon. Friend the Member for Maldon (Mr Whittingdale), the Chair of the Select Committee on Culture, Media and Sport, who did an awful lot of work with the Committee on pre-legislative scrutiny of the Bill; by the hon. Member for Bradford South (Mr Sutcliffe), an ex-Minister with responsibility for gambling, who is well respected, particularly in relation to gambling problems and the care of those with such problems; by the hon. Member for Manchester, Withington (Mr Leech), which shows that all parties support this cross-party issue; and by my hon. Friend the Member for Shipley (Philip Davies), who is a guru of all things gambling.

Bricks-and-mortar casinos are highly regulated. They are at the top of the regulatory pyramid in gambling. They are one of the safest places to be in Southend because of the security; they are certainly one of the safest places in which to gamble. I therefore find it hard to understand why casinos are restricted from offering a full range of products to their customers.

A bricks-and-mortar casino can advertise online products inside its premises, but it is not allowed to provide a remote gaming machine for customers to play inside its walls. That anomaly certainly needs to be corrected. Bizarrely, if it had a small area outside, customers—rather like having a fag at the back of a pub—would be able to gamble there, but they cannot do so inside.

Mr David Nuttall (Bury North) (Con): Given that the Government have told us that the Bill’s whole rationale is to protect gamblers, can my hon. Friend think of any reason why they would not want to support his new clause?

James Duddridge: In an ideal world, I would hope that the Government supported new clause 1, or tabled a suitable amendment in the House of Lords or, in the broadest sense, took note. The argument against the new clause is one made against several others in the group, which is that it will add complexity when, for good reason, we want to move quickly. New clause 1 is quite tightly worded, however, and for a little complexity, it would give a lot of benefit.

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Some people have been critical of my speech on Second Reading and my contributions in Committee, fearful that I was promoting irresponsible gambling, but that is a lazy and incorrect interpretation of my view and new clause. I am not attempting to liberalise regulation within casinos—that could not be further from the truth—but to get a level playing field to allow online customers to play online games in casinos with proper protection.

Mr John Leech (Manchester, Withington) (LD): I pay tribute to the hon. Gentleman for tabling the new clause. Does he agree that making online gambling available in casinos is far better than people spending hours and hours in the completely uncontrolled environment of their own bedrooms?

James Duddridge: I could not agree more with the hon. Gentleman, who makes his point eloquently. That arrangement is better for those who have a developing problem, because they have the support of professionals who are there to monitor their behaviour. There is nothing to stop someone sitting in their bedroom and gambling away a fortune while drinking half a bottle of Scotch, but that would not be allowed at a roulette table. Under my new clause, someone gambling in that way would be stopped by staff within the casino, so the hon. Gentleman’s point is absolutely true.

Paul Farrelly (Newcastle-under-Lyme) (Lab): We have tried to avoid complexity in the Bill because there is the prospect that it might be challenged. However, it will not be challenged on the grounds that it clears up a simple anomaly, which is what new clause 1 would do. I thoroughly support the new clause. Does the hon. Gentleman agree that it is odd that we have gone through extensive pre-legislative scrutiny, but the Government have ignored this central recommendation of the Culture, Media and Sport Committee?

James Duddridge: I agree with the hon. Gentleman. It is disappointing that more has not been taken on from the pre-legislative scrutiny. Otherwise, what is the point of having it? However, the Government have been right to resist the obvious temptation to tag too many things on to the Bill. There is a balancing act to be done, but some kind of enabling legislation in the Bill would allow the tinkering to take place later and with more consultation.

Customers should be allowed to choose what they want to do and where they want to do it. Customer choice is moving in favour of gambling in casinos and the legislation should not stand in the way of that. In many ways, the new clause is deregulatory.

Robert Neill (Bromley and Chislehurst) (Con): My hon. Friend is making a powerful case. I hope that the Minister listens to it sympathetically. His experience corresponds to my experience of speaking to organisations in my constituency that deal with the problem of gambling. It is much better if gambling happens in a regulated environment. Does he agree that his approach is consistent with the approach that the Government have adopted in promoting drinking in pubs because they are a safe and controlled environment in which to indulge in a

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practice that is lawful, but that can be abused? It is better to do such things in a controlled environment than at home.

James Duddridge: My hon. Friend draws a strong parallel and teases out the point that if something is done in the open in society, there is greater protection than if it is done in private, whether it be drinking or gambling.

The Minister has been exceptional in listening to the concerns that have been raised. There has been a strong dialogue with the industry and the Culture, Media and Sport Committee. I hope that she reflects on the debate and is able to assist us. The ideal response would be for her to say that new clause 1 is absolutely perfect and fabulously crafted, that there are no errors whatsoever, and that the Government are desperately thankful for all our work and will accept it immediately. I suspect that that will not be the case. It is not normal practice for a lowly Back Bencher to craft a perfect amendment that takes all points into consideration.

If the new clause is flawed, perhaps the Minister will consider bringing forward a consultation on the issue and setting a time scale for it. It would be unsatisfactory if consultation was offered, but it did not happen for several years and the report sat on the shelf for several months afterwards. In addition to considering a timed consultation, will she go into a bit more detail about what will happen if the consultation shows that the substance of the new clause is needed? We will not have another gambling Bill in the next couple of years, so if primary legislation is required, it needs to go into this Bill. That might not happen today, but it could happen in another place. There is significant concern in the industry that there is no mechanism for making this change through secondary legislation if a consultation shows that it is the right change to make.

I look forward to hearing the Minister’s comments. I will be happy if she restricts herself to commenting on the Bill, rather than my shopping habits. I thank hon. Members for their help in drafting the clause and for their support.

Mr Gerry Sutcliffe (Bradford South) (Lab): I will speak in support of new clause 1 and other new clauses in the group. I refer colleagues to my declaration in the Register of Members’ Financial Interests, which states that I am a trustee of the Responsible Gambling Trust.

I support new clause 1 for the reasons set out so ably by the hon. Member for Rochford and Southend East (James Duddridge). The Culture, Media and Sport Committee discovered that the Gambling Act 2005 had been the first piece of legislation on this matter for more than 40 years. It was controversial to say the least. The provisions on the casino industry were messed about with a bit in the final stages of the passage of that Act. I have always felt that there has been a problem with how casinos have been treated. The former Minister for Sport, Richard Caborn, admitted in evidence to the Select Committee that we did not get everything quite right in the casino legislation. That was a brave thing for him to say, but he was right.

As the hon. Member for Rochford and Southend East has said, we are unlikely to see another gambling Bill in the next two years or even longer. It has taken

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three years for this small Bill to reach this stage. Although I accept that the Government do not want to widen the Bill’s remit, it is important to put things right that have been wrong. The Government want better regulation and to help businesses to create more jobs. The hon. Gentleman was right to point to the impact that the casino industry and the gambling industry in general have on the economy and on jobs. Gambling is an important industry, but it attracts unwelcome attention from the likes of the

Daily Mail

, who do not want to see people enjoying gambling. Gambling is an integral part of our way of life. One need only look at the people who bet on the national lottery and at how people enjoy horse racing and sports betting in general.

New clause 1 sets out what needs to happen in casinos. Casinos are the most regulated and, I would argue, the safest environments in the gambling sector. I hope that the all-party support for new clause 1 will give the Minister some cover in arguing elsewhere that it is important to put this anomaly right. The hon. Member for Rochford and Southend East said that we might not press the new clause today, but there is a strong feeling among Members that something must happen during the passage of the Bill. That is a strong message for the Minister. I hope that she will hear it and support the proposal. We look forward to hearing what she has to say about the timetable of meetings that she will have with the casino industry and what she intends to do during the passage of the Bill through the other place.

I will briefly mention some of the other new clauses. The purpose of the Bill is consumer protection. I fully agree that it is important that there is consumer protection. There is a school of thought which says that the Bill is about raising tax revenues. I hope that that is not the case. I know that the hon. Member for Shipley (Philip Davies) will speak about tax revenues and what would be a fair rate of tax.

There is an important relationship between sports and the betting industry. That is why I support new clause 5, which was tabled by my hon. Friend the Member for Eltham (Clive Efford). It relates to the reporting of suspicious activity and the power to obtain financial information. The relationship between sports and gambling is unique. The problem is that there is no sports betting right. Sports governing bodies have no control over the bets that gambling companies offer on their sports. For instance, in football, there might be betting on the number of times the ball goes out of play or on the number of corners. The concern is that such bets can lead to match fixing and betting irregularities. The Government need to consider this issue, with regard to the scandals in cricket and football that have emerged in recent months and years.

New clause 7 relates to dormant accounts. The Minister heard people’s feelings on that matter loudly and clearly in Committee. There is money on the table that could go into sports or into research, education and treatment. I look forward to hearing what she has to say about that.

I also wish to consider the advertising watershed. I was the Minister responsible for introducing the clauses on advertising and advice about betting and gambling, and our view was that such advertising would be shown around horse races and sports matches. We did not envisage so much advertising for sports betting before the 9 pm watershed. As I said in Committee, I am a big

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fan of Ray Winstone, but he almost pressures people into betting in those adverts. There is a need to consider advertising in terms of the watershed and gambling, as in new clause 9.

1 pm

Perhaps the most important provisions for the sector are new clauses 10 and 11 on the horserace betting levy, and the British Horseracing Authority is keen to ensure that we address that issue in the Bill. I was impressed that both sides of the equation—the betting and horse racing industries—came together, and we have a new four-year arrangement on the levy. However, when the Bill is enacted it will be a nonsense if people offshore do not contribute to that levy, and it is important to pursue that issue. Now that there is an agreement for the next four years, there will be a tendency to put the issue to one side, but I think that would be a grave mistake for both racing and betting. We have an important opportunity to try and put things right, and those who are offshore should certainly contribute to the horserace betting levy when they come onshore. That levy maintains support for the horse racing industry, which is important to many Members of the House, whether they have a race course in their constituency or are involved in promoting horse racing through a variety of support mechanisms.

The all-party racing and bloodstock industries group recently visited Wincanton and looked at the yard of Paul Nicholls, a race horse trainer. We saw the impact of racing on that local community. Not only were the horses being trained by a well-respected trainer, there were other jobs supporting the horse, and veterinary surgeons. That is why the horserace betting levy is important and should be supported.

I have experienced the frustrations in negotiations between both sides, but I urge the Minister to consider the issue because it is important for the industry to move forward in the knowledge that it will get the money it deserves. As I understand it, even if the Bill is enacted, contributors will not contribute until the end of December next year, so there is an opportunity to ensure that the levy is updated and supported by those who need to contribute, to ensure that racing can move forward.

I think this is an excellent Bill and we considered each clause appropriately in Committee. There is cross-party support for new clause 1, and I hope the Minister will accommodate requests for that in support of the casino industry. As the hon. Member for Rochford and Southend East said, this is not about promoting more gambling or being irresponsible. The industry takes its responsibilities seriously, which is why more than £5 million has been raised for the Responsible Gambling Trust for research, education and treatment. It is important that such work continues, but those in the industry are getting frustrated by regulations that seem to hit them hardest, even though they are perhaps the ones that protect gamblers the most. I hope we can support the new clauses before the House, and I wish the Bill well.

Philip Davies (Shipley) (Con): As ever, it is a pleasure to follow the hon. Member for Bradford South (Mr Sutcliffe) who, as people have said, is an expert in these matters and did an excellent job when he was the Minister responsible for them. I agree with his comments about new clause 1, although I think he was

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characteristically —and perhaps unnecessarily—generous to his Front-Bench colleague, the hon. Member for Eltham (Clive Efford), about his new clauses.

Before I go any further I refer Members to my entry in the Register of Members’ Financial Interests. I congratulate my hon. Friend the Member for Rochford and Southend East (James Duddridge) on new clause 1, which is absolutely spot on and follows the conclusions we reached in the Culture, Media and Sport Committee during pre-legislative scrutiny. His point about the clear anomaly in this area is right. It seems ridiculous that somebody can play on a tablet or remote machine three paces outside the door of a casino, but is not allowed to do so three paces inside that door. It is about time legislation in that area caught up with modern technology. We cannot allow the law to be so behind the times; some of us may be considered luddites, but the law should not exist to protect luddites in such a way.

Paul Farrelly: Before the hon. Gentleman goes on to being under-generous to the shadow Minister, does he agree that throughout this debate, the Government have yet to give a reason for why they are rejecting a provision such as new clause 1 to remove that anomaly?

Philip Davies: I agree with the hon. Gentleman; he is absolutely right and I am sure we all look forward to the Minister’s response. I hope we can look forward to hearing her accept new clause 1. It seems that Governments often refuse to accept amendments and new clauses simply because they have been tabled by a Back Bencher rather than the Government. It would be to the Government’s credit if they were to accept that the new clause is sensible and has cross-party support and support from the Select Committee that scrutinised it. The new clause does not add a great deal of complexity to the Bill; it is fairly straightforward and would be easy to implement. When the Minister responds, I hope she will say that she has listened to the argument and realised that we should pursue this sensible measure.

Mr Nuttall: I am grateful to my hon. Friend for giving way on that point. Clause 5 provides that

“Section 1(4) to (7)…come into force on the day on which this Act is passed…The other provisions of this Act come into force”

on whatever day the Secretary of State determines by way of statutory instrument. Does my hon. Friend agree that there is therefore no reason why the new clause could not be inserted in the Bill and the Secretary of State could trigger it at some point in the future?

Philip Davies: My hon. Friend is right and if the Minister felt it necessary, she would be able to do that. The other point that has been well made is that we are not likely to have another suitable Bill in the foreseeable future to deal with this issue. To be honest, it would be unacceptable for the Minister simply to give the House some warm words and agree to look into it at some future date, as that would, in effect, be kicking it into the long grass for an indeterminate time. If we are going to implement this measure, as seems sensible, there seems to be no reason why we cannot just crack on and do it now. I support new clause 1, and if the Minister will not accept it, I encourage my hon. Friend the Member

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for Rochford and Southend East to push it to a vote. I think he will see that the new clause finds a great deal of favour in the House, although I hope it does not come to that.

The next group of new clauses are tabled by the hon. Member for Eltham and I consider them a combination of the unnecessary and the undesirable. I will attempt a quick canter round the course for each of them. I do not intend to delay proceedings for long, but it is worth setting out why I would not agree to any of the new clauses, and why I hope that the Minister will follow suit.

New clause 2 on licence, compliance, stipulations and control of spread betting seems completely unnecessary, and I hope the Minister will reject it on those grounds. New clause 3 has an interesting idea about ensuring there is a kitemark on all licensed and legitimate websites. I understand why some might think that idea superficially attractive, but my view is that the new clause is completely pointless. A kitemark does not attract people to a particular gambling website or company—it tends to be the odds being offered that attract people to those websites or companies. I admire the naivety, I suppose, of the shadow Minister who thinks that if we put a kitemark on the bottom of every licensed website, every punter in the country will ignore all better odds available and just bet blindly because of the kitemark. It would be nice if the world worked that way, but that is cloud cuckoo land. It is completely naive and unnecessary.

New clause 4 concerns remote gambling licensees, customer protection and making sure licensees participate in a programme of research into and treatment of problem gambling. I do not have a problem with that; it is quite desirable that all of those companies participate in providing finance to research problem gambling and to provide treatment. The issue with the new clause putting that into statute is that it is already happening on a voluntary basis by the gambling industry. The hon. Member for Bradford South knows all about this because he was involved in it.

Mr Sutcliffe: The hon. Gentleman is quite right that this would provide statutory underpinning. One of the difficulties is that it is a voluntary arrangement. A large percentage of the companies contribute, but there are a few notable exceptions. One thing that might flow from the clause is that the Minister might be able to support the Responsible Gambling Trust in getting those companies that do not contribute to do so.

Philip Davies: I take his point and, as Minister, he basically got the gambling companies to agree to the voluntary levy, which raises around £5 million or £6 million a year. It was he who said that if they did not do it voluntarily, he would legislate to ensure that they did it. How voluntary that would have made it is a different matter; we can debate the definition of “voluntary”. The upshot is that the companies are doing this and are doing so on a voluntary basis. The hon. Gentleman is absolutely right; not every single gambling company contributes and it relies on some of the larger ones—such as Ladbrokes and William Hill—to make what might be considered a disproportionate contribution to raise the required amount. But the money that is being requested is being raised each year. We do not really need new clause 4; the money that people are seeking, properly, for the treatment of problem gamblers and

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research into problem gambling is already being raised. New clause 4 is unnecessary. If the money were not being raised, I could see the point.

Dame Angela Watkinson (Hornchurch and Upminster) (Con): Does my hon. Friend agree that the percentage of gamblers who could be called “problem gamblers” is very small? It is important that they have the proper treatment and that establishments are aware of the problem and have active policies. However, the vast majority of gamblers are controlled.

Philip Davies: My hon. Friend is absolutely right. The proportion of gamblers who are problem gamblers is 0.9 per cent, according to the latest research. Obviously it is right that anyone who has an addiction to or a problem with gambling has treatment made available to them to try to help them. That is what we should be focusing on and the gambling industry is contributing to ensure that that is the case. It is a small number, but that does not detract from the problems it causes for those individuals and their families. That is why it is right that that finance is provided.

The gambling industry provides finance to people who have a problem with gambling in a way that other industries do not; for example, for alcoholics or for people with an addition to tobacco. I do not notice the cream cake industry producing a voluntary levy to deal with the problem of obesity. The gambling industry, to its credit, does make this contribution and we should recognise that it does, even if it is for a small number of people.

New clause 5 is about the reporting of suspicious activities and the power to obtain financial information by the Gambling Commission. I do not think that this is necessary. As far as I am aware from all the evidence that we have had from the Gambling Commission, it gets the information that it requests from gambling companies, so I do not see that there is a problem. It seems to be a solution looking for a problem. I have not heard evidence from the Gambling Commission that it has not been able to access the relevant information from the people that it regulates and licences.

On the issue of match fixing and sports betting there are two points that make the new clause undesirable as well. The first thing, which never comes out, is that bookmakers are the victims of match fixing, not the cause of it. It is usually people involved in a particular sport, or referees or umpires, who conspire in effect to defraud bookmakers. On the principle that the polluter should pay, it seems bizarre to say that the bookmakers are being ripped off by people involved in sport and that we should therefore penalise bookmakers for being the victims of the crime. The people who should be paying to clean up their sports are the sports. It is the participants, umpires or referees who are causing the problem and causing a cost to the bookmaker.

Mr Sutcliffe: I am with the hon. Gentleman most of the way, but part of the problem is that the sports are not in control of the types of bet that can be put on their sport. That is how players—particularly young players—can be corrupted. There is an issue in terms of the relationship between betting and sports and it would be better if the sports had control over what could be bet upon.

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Philip Davies: I never like disagreeing with the hon. Gentleman, not least because he is a constituent of mine and it might jeopardise my chances of him voting for me at the next election. But to say that bookmakers offer products that therefore encourage sportsmen to fix matches is like blaming retailers for shoplifting by putting products on display. It is a bizarre way of looking at things and it is certainly not the way I look at it.

The other point on match fixing—for example, all the issues recently in cricket, with no-balls being bowled and issues related to the Pakistan team—is that much of the money gambled was not with legitimate bookmakers in the UK but with illegal bookmakers in the far east. All the proposals in new clause 5 will not make a blind bit of difference because much of the activity is not taking place with legitimate bookmakers. It is completely pointless and I hope for that reason the Minister will reject it.

New clauses 6, 7 and 9 in effect ask the Government to legislate to be able to consult on something. It seems bizarre that we would put into law a requirement on the Government to consult. The Government can consult on all these issues without legislating to do so. I suspect that, as all these issues are important, the Minister will be consulting the industry and others on an ongoing basis. It is rather bizarre that these new clauses should seek to put into a Bill a statutory obligation for the Minister to consult. If we started going down that line and placing in Acts of Parliament requirements on Ministers to consult, legislation would look very bizarre in this place. I hope that my hon. Friend the Minister will reject all those new clauses, too.

It is sad that the Labour party is once again resorting to its nanny state instincts on the advertising watershed. This ludicrous idea of a watershed for advertising is a complete nonsense particularly when children are not even allowed to gamble. If the issue is that children are gambling, the best way to deal with it is to enforce the existing law that prevents children from gambling. I am wholly opposed to children gambling. I am one of the few Members who believe that it is wrong for 16-year-olds to play the national lottery; I think it should not be played until people are 18, which is the right age for people to be allowed to gamble. If the issue that the hon. Member for Eltham is trying to address is one of children gambling, we should make sure that the law as it stands is enforced.

I have heard the argument that we need to deal with “marketing grooming”—the idea that people are subjected to adverts when they are very young, so that when they become adults, they are addicted to the product before they have even started. I used to work in marketing for Asda, and the idea that any company would spend its marketing budget to try to get a new customer eight years down the line is one of the most ridiculous things I have ever heard in my entire life. I would like to meet anyone working for any marketing department that has that as its strategy, as I have never encountered any such person. Most business organisations cannot see beyond the end of their nose; they certainly cannot see beyond the end of the financial year in which they are operating. The idea that they would use marketing on TV to boost their sales in five or eight years’ time is absolutely ridiculous. New clause 9, therefore, is not only unnecessary; it is completely ridiculous.

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New clauses 10 and 11 relate to a horse racing levy. I spoke on that on Second Reading, but given that most of my speeches—or probably all of them—are not memorable, I will briefly repeat for the benefit of Members why I think these provisions are unnecessary. First, I think the Minister will confirm that extending the Bill to include a levy would introduce a legal problem, or certainly a complication, that might scupper the Bill in its entirety. It is not worth risking the Bill as a whole to introduce the levy.

As I mentioned on Second Reading, it seems to me as an onlooker that what tends to happen if any Government have to determine the levy—let us hope that we keep the current position of an agreement being reached between bookmakers and the racing industry without the intervention of Ministers—is that they look to produce a certain figure that they think should be raised by the gambling industry to pay towards the levy. Most Ministers would think £75 million was a roughly appropriate sum. The formula for the levy is then worked out to generate the £75 that the Government think should go to the industry.

All that will happen by forcing through these new clauses is that the Government will still come to the conclusion that the gambling industry should pay about £75 million, and will adjust the formula accordingly to make sure that that amount is raised in this way rather than in another way. The new clauses are completely unnecessary and I do not think they will generate an extra penny piece for racing and the racing industry. To risk legally scuppering the whole Bill to put in a provision that will not make any difference is pointless.

Mr Sutcliffe: Will the hon. Gentleman go through what he believes the legal impediments are? If he is referring to the European Union, it appears that the French have overcome any problems emanating from that. Is he arguing that the advice of the DCMS lawyers is inappropriate?

Philip Davies: As the hon. Gentleman knows, I am no lawyer and no legal expert. I am regurgitating the Government’s position when they said that this might cause a legal problem. We have seen in the past how legal decisions taken by the European Court of Justice on gambling issues related to the levy came as a great surprise to all concerned at the time. We are not in a position to be clear about what the result of any legal challenge would be. All we could be clear about is that there would be a legal challenge, at which point the result would become uncertain. I do not see any great gain—to be honest, I do not see any gain—in precipitating such a legal challenge. For that reason, I hope that new clauses 10 and 11 will be rejected.

New clause 12 is about financial blocking for illegal sites. Superficially, it seems attractive that measures should be taken to try to stop people gambling through sites that are not properly licensed or illegal. The problem with new clause 12, however, is that other countries have shown that financial blocking does not work. Other countries have tried to restrict online gambling and tried to make licences available only to a few operators, but this has failed in every single country that has tried it. It fails because there are ways around financial blocking—by

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using PayPal and other methods, for example, which cannot be blocked by the banks. It does not work. New clause 12 is well meaning, and I understand why the shadow Minister wishes to pursue it, but it is pointless because it simply will not work.

New clause 13—the last of the new clauses proposed by the hon. Member for Eltham—is also unnecessary, so I hope that the Minister will reject all the shadow Minister’s new clauses. Although I do not doubt his motives in bringing them forward—the motives are good—I think that they are either unnecessary or undesirable.

New clause 14 was tabled by the hon. Member for Strangford (Jim Shannon), who represents the Democratic Unionist party. Again, I think it has much to commend it on a superficial level and I understand exactly what he is trying to do and why he is trying to do it. Again, too, the motives are very good. I doubt whether many people would disagree with the principle of what is suggested. The hon. Gentleman wants to make sure that there is a register of people who should be self-excluded. The self-exclusion is done through the Gambling Commission and would then apply to every operator who had a licence with it. If someone is self-excluded once, they are self-excluded with everybody. We would like to get to that scenario.

The problem with putting this provision into statute is that it will put many gambling operators in a very difficult position. Once someone who has self-excluded goes on to gamble, the gambling operator would be breaking the law, but the new clause does not provide for a sufficient “due diligence defence”. If someone self-excludes and tries to use different names, different addresses, different bank accounts and slips through the net in that way, my worry would be that, through no fault of their own, they will be in breach of the law.

If we are to go down the line of the new clause—as I say, I have no problem with the principle and view it as a desirable outcome for someone self-excluded from one operator to be self-excluded across the industry—without some kind of due diligence defence, it could put gambling operators in an impossible position. We would be asking them to do something that would be impossible to achieve if someone were determined to get round it. Perhaps the other place could consider the problem and I would be happy for the Minister to look further at it. As the new clause stands, however, I cannot support it.

I would like to think that, unusually for me, my amendment 1 is non-controversial and could easily be accepted by the whole House. It simply requests:

“The Secretary of State shall publish a report to Parliament one year after the commencement of this Act, and annually thereafter, on the enforcement activity of the Gambling Commission in respect of unlicensed operators attempting to provide facilities for gambling in the UK.”

One of my concerns about the Bill—certainly one I expressed on Second Reading—is that it might lead to an increase in the number of people gambling with unlicensed operators, with the tax bill encouraging some companies to go outside of the licensing regime. The Treasury forecast of how much tax will be collected—about 20%—seems to confirm the danger that 20% of gambling will take place with unlicensed operators. If we are to go down the route suggested by the Bill, we need to focus the Gambling Commission’s attention on stopping gambling with unlicensed operators.

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Justin Tomlinson (North Swindon) (Con): May I suggest to my hon. Friend—who is making a characteristically powerful speech—that it is a question not just of tax, but of advancing technology? Who would have thought, a few years ago, that there would be such a big growth in online gambling? There will always be something new coming forward, and this just helps to sharpen the mind.

1.30 pm

Philip Davies: I agree with my hon. Friend, and I take it from what he has said that he agrees with my amendment. The fear has been expressed, both in the Treasury’s forecast and during the debate, that the number of people gambling with unlicensed operators could increase. I therefore think it only right for the Government to present a report to the House once a year—it need not be an oral report; it could be in written form—to update us on what the Gambling Commission has been doing and how successful it has been, so that we can decide whether it is dealing properly with a problem that we all fear may arise.

Paul Farrelly: The hon. Gentleman said that the report need not be in written form, but the amendment says: