06/12/2016 House of Commons

look forward to seeing what more we can do. Thank you, order. Oh, point

of order. Alison view list. Thank you very much, Madam Deputy Speaker.

I am not sure if you can say this was an order or not. I asked the

Secretary of State four legitimate questions and he refused to answer

any of those until I was more serious. Could you tell me, Madam

Deputy Speaker, how I can resolve this issue? I thank the honourable

lady for raising her point of order and indeed I heard her ask the

questions and I heard the Secretary of State's reply and I have to say

the Secretary of State is at liberty to give whatever reply he wishes as

long as he does so in an orderly and polite manner, which of course he

did. But the honourable lady is also at liberty to ask her questions in

other ways at question time by asking for an adjournment debate, by

putting down other questions to the Secretary of State and by raising

her issues again. It is not a matter for the chair at what the answer is.

I am satisfied the honourable gentleman was orderly in the way in

which he gave the answer to the honourable lady. Further to that

previous point of order, the honourable lady has said she asked

four questions to the Secretary of State. Could the chair give advice?

I thought members were only allowed to ask one question. I am delighted

to give the honourable gentleman that piece of advice. The honourable

gentleman is allowed to ask only one question. But the honourable lady is

here this afternoon in her capacity as a spokesperson for the Scottish

National party. In that capacity she may ask as many questions as she

likes, as long as it takes her only one minute to do so. Order. We now

come to the ten minute rule motion. Mrs Anne-Marie Trevelyan. Thank you,

Madam Deputy Speaker. I beg to move that leave be given to bring in a

bill to make provision for children of the serving members of the Armed

Forces to have a right of high priority admission to schools

outside the normal admissions arounds. It is an honour to stand to

present my first ten minute Law Bill on schools admissions for children

of our serving armed forces. Today is the patron Day of Saint Nicholas,

the patron saint of children and sailors. Tens of thousands of

military schoolchildren. Saint Nicholas is the guardian of children

and I hope very much that the Minister listening today will agree

with me that we have a collective duty to all of those children born

to military families to do everything in our power to reduce

the educational disadvantages which these school moves create, by

ensuring that when they need to take place we have done everything we can

to make the transition as stress-free as possible for parents

and child. This issue was brought to my attention earlier this year when

a serving army officer contacted me in my capacity as the chairman of

the all-party Parliamentary group for the Armed Forces Covenant. I

take the greatest pleasure and responsibility in holding this role

and I am privy to the anxieties of many serving soldier, service man or

a woman. I am honoured to champion their needs as they have no voice of

their own as a result of their service. This bill highlight one

such concern which I believe we must sort out for them. This army officer

was being posted 200 miles from his existing job at seven weeks' notice.

The family had but a few weeks to research local schools and get a

place for their child. This little boy, let's call him James, at the

grand old age of six has lived in four different houses and has been

to three different educational establishments already. That is

making new friends three times over by the age of six. With all the

family support in the world, this little boy is being asked to develop

levels of resilience which few of us would expect from our own children.

Not only did his parents have a very few weeks to find a school all over

the summer holidays, but they were initially told that the choice with

children from neighbouring houses on the base also attending, giving

James supportive friends, was not possible. The local authorities

stated that whilst he was a service child, there is no right of entry

and they are within their rights to refuse admission. This struck me as

extremely stressful for the family, but going wholly against the Armed

Forces Covenant. On the basis that a few local schools were struggling

with armed services children arriving at once, I asked them how

many of their schools had children in receipt of service school

premiums and in what proportions. There are a few servers children in

a very large proportion of any local authorities schools, regardless of

whether they are close to a military base or not. In Northumberland we

have two military bases. But service children are to be found in only

very small numbers, often in ones or twos, in 63% of all of

Northumberland's schools. In another authority, the proportion of schools

with service pupils is 76%, but only six schools have more than 30

children in their cohort. The impact of a single child arriving or

leaving will not have a major impact on numbers. Another distressing part

of trying to sort out the place for James was that the local authorities

stated they would accept him onto the waiting list, but would not

inform the family of a place until the first day of term. Whilst the

family were hopeful that plays would be available, they could not rely

upon it, nor introduced James two other children who he might end up

in the class with since the authority refused to give him any

certainty. This is not meeting our commitment to service personnel and

there. Young James had a place confirmed a week before the school

started thanks to the family's new MP's intervention, but not to a code

that would make cancelled obliged to find a place for a service family's

child. I have met a family with two children who were offered places in

different schools with a parent who does not drive. The child would have

to be late into reception and another would have to be collected

on foot. Another child was offered a place at a failing school and the

mother said, why is it that army kids have to endure the worst

schools alongside all the other pressures they have to endure? Some

go to schools with special needs. The present system is structured

towards two admissions per academic year, meaning any child seeking

admission outside that has to confirm that the school has the

capacity. Military families do not have the luxury of timing their

moves within this timetable. Councils are failing to live up to

the commitment they have pledged to uphold when they signed the

community covenant. Some local authorities do think about how to

apply their commitment in practical terms, but others have not moved

beyond good intentions. One local authority informed a military family

that the Armed Forces Covenant does not apply to them. Our education

system is geared to acknowledge some children face exceptional

circumstances and they won the priority with admissions in order to

offset the difficulties they have already faced. That is why look

after children have top priority. This bill seeks to recognise that

military children face significant upheaval and educational

disadvantages through no fault of their own and they should have high

priority for admissions. The bill would have the secondary effect of

relieving pressure on military families who often have short notice

moves and then have children in schools miles from base. It seems to

often some local authorities are pushing back against the Armed

Forces Covenant, despite having signed up to it, leaving families

anxious and having to fight appeals which are sometimes lost. The

schools admission code is not robust enough to ensure that whatever and

wherever a military family has to live they will find the right school

for their children. We are not doing in practice what we talk about when

we say we are committed to the covenant. I never want to hear again

from a serving member of our Armed Forces who is trying to find a

school for their child the phrase this should not be this hard. I

cannot bear putting my child through this stress every two years, so I

will leave as soon as I am able, even though I love my job. At a time

when we want to retain as many of our committed staff as possible,

this is unacceptable. My wonderful grandmother used to say

that whilst I not be possible to feed 1000 starving children, it is

almost always possible to feed one. We cannot resolve the plight of

children in Mosul or give continuing education to children in camps

displaced from homes. But I am certain that the first -- a simple

change in a lot here, every British trial can be guaranteed that place

at the right school for him and his family's unique needs, regardless of

whether they apply for a place in which ever year group they land. Jon

James and the 40,000 other military children whose parents put their

lives on the line for us deserve nothing less, Madame deputies. The

question is that the honourable member have leave to bring in the

bill. As many allies of the opinion, say aye. The ayes have it. Who will

bring in the Bill? Children of armed services personnel

schools admission bill. Second reading, what day? 20th of January

20 17. The clerk will proceed to read the

orders of the day. Health Service medical supplies costs bill to be

considered. We begin with new clause one, with

which it will be important to consider this on a selection paper.

I rise to speak to new clause one, which stands in my name, in the name

of my honourable friend, the member for Burnley, and other amendments in

the group. On behalf of the opposition, we are not opposing this

bill. The amendments add a constructive attempt to help the

Government stated zone stated aims and close the growing gap between

the UK's record on drugs and the ability of patients to access them.

We want to focus on the impact of the bill in three areas. The price

and availability of drugs and medical supplies. Research and

development. And the NHS's legal duty to promote innovation. The

pharmaceutical industry in this country employs over 70,000 people

in predominantly high skilled and well-paid jobs. Just the sort of

jobs members on all side of the Houses would want to encourage. This

has been one of a great success stories but we can't take it for

granted. Particularly as investment decisions are often taken by parent

companies and other parts of the world. There is considerable unease

in the sector about the relatively low take-up of new medicines by the

NHS compared with compatible nations and also the ongoing uncertainty

surrounding the future of the European medicines agency. In

relation to the latter, a number of major companies have placed

themselves here because of the European medicines agency and the

Warriors clearly that they might wish to follow if it was to relocate

following Brexit. The impact assessment for the bill states, as

we might expect, that there will be an impact on the revenue of the

pharmaceutical sector which could lead to in research and development

and consequent losses to the UK economy estimated at ?1 million per

annum. We fully agree with what the Government is seeking to achieve. We

want to review to take place within a reasonable time frame to ensure

there are no unintended consequences and that we can remain confident the

pharmaceutical sector in this country will continue to be at the

forefront. We face competition not a minute but from an urgent nations

such as Brazil and China and we need to ensure the NHS does not drop away

from the take-up of new drugs. 14 high income studies were shown

analyst and the UK ranked ninth of all medicines studies. Studies have

shown relatively low take-up of new medicines in the UK which is bad for

patients in the pharmaceutical industry. The bill means to achieve

balance. We need the best possible access for patients and medication

at the fairest price but we need to encourage the pharmaceutical

industry to increase research and develop them. I will give way. I

intervene in my capacity as chairperson of the all-party group

on diabetes. And the diabetes drugs bill is enormous. It runs into

hundreds of millions of pounds. While I accept what my honourable

friend has said, that we need to make sure pharmaceutical companies

are able to invest in the provision of new drugs for diabetes, there are

also other choices such as lifestyle choices. These also need to be

investigated at the same time as looking for new drugs. Does he

agree? Thank you. Thank you for the question. If I had known he was

here, I could haven't dissipated the tone of the question and he is

absolutely right to raise the issue of diabetes and a real need for us

to increase measures to improve prevention. I was interested to

visit a launch last week with a number of interesting initiatives. I

believe that it was called the diabetes village. It is an

interesting concept that will hopefully reduce the cost of

diabetes treatment on the NHS. Madam Deputy Speaker, in terms of the

amendment, the review would look at the impact of the Bill and the

pricing of medicines and medical supplies. We pointed to the Minister

that the years ago, the Government said it would provide an

unprecedented level of certainty on almost all NHS branded medicines.

That has not come to pass. The review would identify issues at an

early stage and take appropriate action. The Government was not

willing to commit to such a review of the committee stage. The Minister

referred as to the clause referring to give you one year on in the

regulations. This is not the same thing as looking at the impact that

the legislation in its totality. In the way regulations are currently

drafted... The draft regulations talk about the review in a much

narrower sense. Will my friend give way? Certainly. Does he find it

strange, as he has just referred to, that the regulations that might

happen in relation to this act talk about a review being carried out to,

quote, this is 14.2 of the regulations. 14.2 says that the

report must set out objections intended to be achieved by these

regulations. Wouldn't one expect those objectives to be set out

before the regulations were made? Isn't that the cart before the

horse? Thank you for the intervention. He is absolutely

right. That is why there is some anxiety that we might end up with a

self-fulfilling prophecy with these reviews. No doubt the Minister can

address that when he replies. What is not there is anything to assess

the potential impact of these regulations on research development

and innovation. There is nothing on the availability on medicines and

medical supplies. We believe our anxieties on this are well placed

and felt the Minister will reconsider his stance on this

proposal and provide some reassurance on these areas of

concern and that they will be carefully monitored in future.

Turning to amendment eight, this seeks to compel the Government to

invest in rebate from the pharmaceutical sector to improve

access to new innovative treatments. The Secretary of State confirmed

that ?1.24 billion is beam it onto the Department of Health. That is a

considerable amount. Despite numerous questions being asked

through the passage of this bill, we have not heard from the Government

will this money has gone. This new money, which could have delivered a

StepChange in access to treatment to the benefit of patients and the life

sciences sector, could simply be added to the baseline. It would mean

?1 less coming from the Treasury. It would aid transparency to make clear

this money was put over and above Government funding and was

ring-fenced for a specific use. We know for example that in Scotland

the money has been ring-fenced to provide new treatments for

medicines. And there is nothing the Minister has said so far that has

persuaded us from believing that is the correct approach. According to

an expert from the Cystic Fibrosis Trust, this rebate is necessary...

He cites a drug that could increase the lung capacity of someone with

cystic fibrosis considerably. Patients in England cannot access

the winners patients in Europe and Scotland can benefit from this

transformative drug. I quote him when he says, there is no comparable

fund in England. Having your medicines funded and skull and

provides a much greater chance for patients to access these medicines.

We do not see a clear pathway for how patients can access these

medicines. Of course, there are many other examples. The -- it is

shameful that people in England are deprived of these drugs on the basis

of financial rather than clinical judgments. We understood the purpose

of the bill was to deliver certain sea and in any event ring fencing

does not include additional resources. We look the Government

will give serious consideration to this proposal. Madam Deputy Speaker,

timing finally to the remaining amendments, we welcome the father

improvements in relation to the devolved administration is.

Questions have to be asked about the concentration process. --

consultation process. Perhaps this can be reflected on in future

legislation. We will come amendments made by the SNP to Klauss five and

six and welcome consultation on the potential impact of controls on

other medical supplies. These provisions were lacking from initial

consultations. There are some considerable anxiety within the

sector about how controls will be used. This is a matter for future

regulations but it is less than satisfactory for the Government to

ask for powers without telling us how they will be used. We would say

that this is another reason for us to seriously consider the kind of

review we have set out in new clause one as well. New clause one, review

of the impact of the act on pricing, research and development and

innovation. The question is that new clause one

B read a second time. I will not get in the House for

long. That is normal at the start of a very, very long speech. But in

fact I will be very brief. I wanted to rise firstly by declaring my

interest as the chairperson of the all-party diabetes group and as a

type two diabetic to welcome the proposals that have been put forward

by my honourable friend on the front bench. I hope the Government will

accept it, because these are reasonable portals which are

designed to look at the impact of the act. -- reasonable proposals.

And to make sure that achieves what it wants to achieve. That is not

always the case as far as legislation is concerned. There's a

lot of agreement in respect of this bill. The Minister should be

commended for the way in which he has introduced the bill and the

reasons behind this bill, the ever rising cost of drugs to the National

Health Service. We know of the work that was done by the Times newspaper

in particular. It is always a battle for diabetics, especially when they

meet in informal circumstances, such as last week, when we launched our

new report at the all-party group. It was launched by the Secretary of

State, who came along. The Minister was due to come and might have gone

before I arrive. He is nodding. He did not come. I know that you do not

like secondary units as I was tempted to say he nodded. But the

Secretary of State and apartment officials were very helpful to the

all-party group. Our concern is the ever-increasing level of cost to the

NHS for diabetes drugs. Diabetes complications, as the House knows,

Costa National Health Service 10% of its budget. -- cost the National

Health Service. The drugs bill is in the order of 900 or so million. The

problem is that the desire by local GPs to prescribe drugs instead of

looking for alternatives. That is why I very much support what is in

clause one, sub clause C, the duty to promote innovation.

Last week at the invitation to the steno centre in Denmark and to the

Leicester Diabetes Centre, I spoke about looking at innovation. The NHS

is innovating will result in a reduction in the overall cost of the

drugs budget. Now, when I was diagnosed with type two diabetes,

the first thing my GP said to me was he had to put me on drugs. If I had

been aware of the potential of being a diabetic a few years earlier, and

my mother had had diabetes before me, that is usually a family

history, not exclusively in respect to type one diabetes, but certainly

in respect of families in particular from the South Asian community, even

the diabetes affects all communities. My mother had it, but I

was not aware of what diabetes meant because at the time I was in

government, I was Minister for Europe, flying around making Britain

a more integrated into the European Union, unlike 15 years later when it

has all changed, so I never had the opportunity of sitting down with my

mother who subsequently died and finding out how diabetes operated.

As a result I diabetes was caught very late exactly ten years ago. Had

I been told by my doctor I am not putting you on tablets, actually I

am going to send you off to the gym, I am going to prescribe gym for an

hour and you will walk for an hour and you will make these kind of

lifestyle changes, perhaps I would not have stopped the type two

diabetes affecting me, but perhaps I could have delayed the onset. In the

long run I am saving the taxpayer a huge amount of money. That is why

innovation is so vital to what is being proposed. Innovation permits

so much to be done to reduce the cost to the taxpayer. I know that is

not all that is designed in respect of what the government is doing with

this bill, but it is a big chunk of it. If we can reduce the cost to the

taxpayer of the huge amount of money that is spent on pharmaceutical

drugs and given to the pharmaceutical companies, then in

the long term it will help the taxpayer. So, that is why I think it

is very important... Of course I will give way. Would he agree we

have to educate people more, make them aware of what could happen,

particularly with obesity levels rising at the levels they are? The

honourable gentleman is absolutely right and we both served on the

Administration committee and whenever banqueting is raised and we

always raise the need to make sure that the food that members of

Parliament get especially in the tearoom is food that is compatible

with ensuring that our obesity levels are decreased. Madame Deputy

Speaker, you will know that when you have your cup of tea that what you

have on offer is club biscuits and cakes, Victoria sponge, and all

these other things to encourage us to do this. I am not saying whether

this would come within Klaus won the seat, but sometimes we regard

innovation is just being about new technology. There is incredible new

technology around as far as diabetes is concerned. I saw it last week.

People are no longer able to use the fingerprint test, you can buy a test

at your local chemist. It costs slightly more than a finger prick

test. It will allow you to test your diabetes without having to fast and

it will give you a three-month reading. There are no machines where

you can clamp to the side of your arm and take your mobile phone and

put it onto the device and it will tell you what your glucose levels

are. Incredible innovations and that is why I think this clause is worth

accepting. I think it is very carefully thought out by my

honourable friend who is doing an amazingly important job on the front

bench in respect of these matters. But also it will benefit the

taxpayer because innovation is very, very important as far as an illness

such as diabetes is concerned. It is not just about the technological

revolution that occurs, it is also what we can do with lifestyle

changes. I notice the spokesman for the Scottish National party is here.

Scotland is highly advanced as far as diabetes monitoring is concerned.

You can get statistics in respect of diabetes in Scotland. That is why

new legislation designed to bring down the cost to the taxpayer of the

cost of drugs is very important in respect of a review and that is why

I support very much what is in the clause one C. Finally, some of these

diabetes companies, some of these pharmaceutical companies make an

enormous amount of money. They are some of the biggest companies in the

world. But what we need to do is to make sure that we encourage them to

plough back a good proportion of their profits into research and

development. The Steno Centre in Denmark only exists because of the

money that was given to it by one of the biggest diabetes drug companies

in the world. And there, in the centre, which is where research and

development comes in, you can go to the Steno Centre and you can have

your blood taken by a diabetes nurse and in the next room you can have

your feet looked at by an expert in diabetes. In the next room you can

have your eyes tested, because those of us with diabetes have problems in

respect of our eyes, and in the next room you can have your consultation

with your GP and if necessary you can see a consultant. That is what I

meant when I talked about the diabetes village. It comes from the

concept of the Steno Centre. At the moment I have to go to different

hospitals and see my GP and others. In one case I had to carry my own

blood. I carry mine all the time! In a little test tube I say to my

honourable friend from Wolverhampton. I carried my own

blood to the laboratory because it was the quickest way I could get a

reading. He carries his blood very well if I may say so from looking at

him. The fact is we want this innovation, research and

development. We know the drugs companies should be able to plough

back profits from within the industry because in the long run it

is these innovations that will make a great deal of difference. I went

to New York to attend a meeting concerning Yemen, but I stopped in

at that Diabetes Centre of the Mount Sinai Hospital. They were telling me

about the incredible innovation that is occurring in the united states of

America as far as diabetes is concerned. I then went to see the

diabetes team in New York. As you know New York cut the level of sugar

that was available to people in their soft drinks as we are doing at

the moment, but the centre of their diabetes initiative was a lifestyle

coach, not a GP, but a lifestyle coach. As we look at the subclauses,

Madame Deputy Speaker, we see every opportunity for a cogent and

coherent review that will help in particular and that is my main

argument today. But also it will effect and help others with similar

problems in respect of their illnesses. I would urge the

Minister, who I know is extremely reasonable in respect of this bill,

to look at this clause to see whether if he cannot accept the

clause but at the very least give an undertaking from the dispatch box

that the points from within the clause will be reported back to

Parliament in a few months' time. Doctor Filippo Whitford. And he very

much, Madame Deputy Speaker. As with the shadow health minister, we also

will not be obstructing this bill and we support the basic aim of it,

to try and control prices and achieve a good return to the NHS in

the drugs that they use, and a good price control. With regard to new

clause one put forward by the members of Ellesmere Port and

Neston, we would also support this in principle. I think perhaps six

months out might be a little bit early to technically bring back

together, but I also would tend to suggest it should not just be a

single report. You will only see change over time, and in particular

to look at the success of these actions, we want to see a price

being controlled and to be able to spot prices that are sliding out of

control. I would suggest there should be some degree of looking at

the data and information on an annual basis and laying that before

Parliament to show that the aim of the bill has been achieved and also

that the concerns of the official opposition are actually being laid.

With regards to Amendment eight, we would support this as this is the

approach we have in Scotland. While the cancer drugs found in England is

clearly helpful and has helped many patients, it is limited. If you do

not have cancer, you cannot access the fund. That means people with

rare diseases are left somewhat abandoned. At the moment this was

left to NHS England and frankly they seem to be left in the desert. It is

quite important. There will be significant money hopefully released

from this. It also gains support from the pharmaceutical industry if

they see the money they are returning is actually enabling

innovative medicines to come to the NHS earlier. Sometimes when we

compare ourselves for certain illnesses such as cancer, where we

find the gap is people with more advanced disease struggling to

access the newest medicines. It would be something we would support

if this was a result of this bill. In 2014 the Scottish medicines

Consortium was reformed and we have moved up from passing 53% of all

applications to 77%. There is a further review going ahead at the

moment to look at how to improve this. The aim is not to avoid using

drugs, the aim is to try and access them at a decent price. If

pharmaceutical industries are returning money to the NHS, that

should enable that earlier access. With regards to our own amendment,

amendment nine, did we laid before the Public Bill Committee regarding

clause five which extends a power that already existed but never used,

which is to control the price of medical services and supplies as

well as drugs. I raised again, as I am disappointed we did not manage to

get this taken into the built in time for this reading today, the

issue of quality control and ask the government to consult on that. I

spoke extensively about the issue of surgical gloves, but they are a good

example in that the range of quality is vast. If poorer quality ones are

used, there is either extra cost to the NHS because you can end up

changing your blood two or three times within one operation, or if it

is more subtle that you discover you have been exposed to blood from a

tiny pinhole that was not visible to you. This applies to things like

gowns and drapes and to take off that is meant to be protected and

discover you are soaked in blood through to your skin is a pretty

unpleasant experience and increases risk to staff. The idea that

surgeons are not exposed to diseases like HIV and hepatitis be and

hepatitis C is naive. I have heard colleagues over my career who have

suffered from these conditions that they have caught from patients.

and patients to avoid any and patients to avoid any

possibility of cross contamination. Fairly cheap things like gauze swab

if they are shredding thread can lead to intra-abdominal infection,

something we do not want to see. I think it is asking for consultation

and to look at the mechanism. We have national procurement and

logistics system in Scotland which takes up a sort of Amazon on system

will award will order the supplies they need. They are picked from 9000

items held by national procurement and delivered by national logistics

all the way to the ward. The supply chain, as it is called in England,

has 600,000 items. That suggest that, in actual fact, the proposal

of reverser Carter to try and limit what is used and look at procurement

is not yet happening. -- Professor Carter. There is an option from this

discussion to ensure that comes about. That would be the point at

which quality could be assessed. Anything that is going to go in that

supply chain would be rigorously tested by staff with feedback and it

would be up to a national procurement group to decide whether

they were going to actually stop it. And supply. -- stock it. And

finally, an amendment ten comes back to the issue of sharing information

that will be collected by the Secretary of State and ensuring that

this data, as it relates to devolved administrations and is therefore, in

essence, the data, is freely accessible to them. The Minister

mentioned the memorandum of understanding. I would like to hear

what point along we are fat and whether it is a real-time access to

a database that would be given to the authorities listed here or

whether it would be that they must put in a request. I would suggest it

is absolutely vital that data is provided to the devolved

administration 's when they request it and not on some fixed annual

dates chosen by the Secretary of State year. So that if they perceive

they have an emerging problem, they can do with it. Having been involved

in clinical data collection, there is nothing more frustrating for the

team than to be doing the work to gather data and whenever you want to

interrogate it, you have no option to actually access it. I would

simply ask the minister again if we can find out where we are with the

memorandum of understanding and I would welcome his commitment to this

going forward. Thank you. Overall, as honourable

members know, I welcome this bill. It is broadly socialist bill. Every

forces -- it reinforces pricing controls on big pharmaceuticals

where appropriate. I like to congratulate the Conservative Party

to come further than the socialist road. On new clause one, table by my

honourable friend, it is very central to what we ought to be

talking about in many skills of public life. That is evidenced by

Mike evidence -based policy. -- evidence -based policy. All too

often in this House, policy appears to be made on a political whim. I

remember, I think it was 2008 when the then Leader of the House, the

right honourable member for Blackburn, Jack Straw, wrote

certainly two Labour MPs asking what we wanted in the Queen's speech that

year. I said to Labour MPs that we were in Government, he should have

written to the right honourable member of Cheltenham. As with that

of the House, asking what the members wanted in the Queen's

speech. I replied, because I believe in evidence -based policy, that in

the Queen's speech that year, I wanted not a single piece of

legislation. That want a parliament, after ten years of Labour

Government, to spend a year in scrutiny looking at the legislation

we had introduced over that ten years. To see what had worked and

what had not worked. To my astonishment, the Leader of the

House did not accept that proposal, as those of us who were members

there now, and we had another Phil legislative programme. If you like

the -- allowed me a small bit of attitude you, by the end of the

Labour Government, I stopped putting on criminal bills because we had so

many. This might have happened under the previous Conservative

Government. We had criminal bills that repaired parts of previous

criminal bills brought in by a Labour Government, with parts that

had never been brought into force. Absolutely extraordinary. I urge the

Minister to go with this and when perhaps it catches your eye and you

make some remarks, I hope you conceal at about innovation, which

was so eloquently addressed by my right honourable friend for

Leicester. There is an issue on the right honourable -- about cystic

fibrosis and a drug that was turned down because of lack of sufficient

data. I understand that, weighing up of evidence. Since it was used in

this country but not available on the NHS, since Mice decided the cost

effective and artist didn't stack up, some long-term data from the

states has been made available. I understand that Nice as not reviewed

as this is non-cystic fibrosis -- reviewed its decision on a drug for

use on cystic fibrosis. Did the Minister say, will meet up about the

process of innovation, efficiency and Aussie -based decision-making, a

little bit... Perhaps not about the actual drug itself, but the process

whereby Nice might promptly reviews decisions. This additional issue of

drugs or treatments actually being passed by Nice but not brought in,

like hepatitis C drugs rationed to certain patients per month, or we

are in -- enshrining these drugs. I agree on this. We don't like the

postcode lottery. We have a cross border between England, Wales,

Scotland and Northern Ireland but it is a lot worse when we get different

CCGs within England, some of whom make a drug available that has been,

as I understand, signed off by Nice and that process as safe for use but

not mandatorily available. That is for every patient who it is

medically appropriate do not necessarily get it. That is

regrettable. Moving on to amendment eight... Introduced by my honourable

friend from Burnley. This, as I understand it, would seek to ring

fence the savings made through the provisions of this bill and

legislation to ensure that money thereby saved or paid into the pot

by pharmaceutical companies would be retained for expenditure on medical

supplies. I hope that the Government this afternoon supports that. Very

often, we hear that Government does not like ring fencing. I understand

why. But earlier this afternoon. -- this afternoon, I asked the

Secretary of State whether the education costs would be ring-fenced

because I was concerned the demolition of money to lose and

governors who might be pressed with other budgetary matters, the money

would not be spent on education and prison education would not be

improved. I was greeted with a very welcome one word answer from the

Secretary of State, which was yes. It would be ring-fenced. In a

slightly different context, in relation to amendment eight, I hope

we can be reassured this afternoon because it is an excellent amendment

which clarifies a slight gap in the bill. In terms of the amendment

nine, moved by the honourable member for Central Ayrshire, and she spoke

eloquently, efficiency is of course important but so is quality. It is

the saying about penny wise and pound foolish. The honourable member

is nodded. It is used on my part of the West Midlands and England. We

have seen that time the game of privatisations. Services are

privatised, they go to the lowest bidder, and what do we find? The

service either is not up to scratch or, in fact, all too often, as it

happened with Circle Health, they go bust. Because they find it is not as

easy as they thought it was to make a profit out of, in this case, the

Health Service. That might happen to other suppliers. It is because

quality matters and because the National Health Service is not a

commercial organisation. I will give way. I have listened very carefully

to the honourable gentleman's point about Hinchingbrooke Hospital. My

take tactfully suggest that he goes and looks at it. The provision of

health care, if one spoke to the patients in Huntingdon, was that it

vastly improved. The because of the conditions, they were not able to

make a financial success of it. The company did not go bust. It decided

to withdraw. But the quality of the care, from what had been a failing

hospital, vastly improved in the view of the patients who used it.

And the trade unions agreed to the deal that was done to put the

company there. I am grateful to him for making my point for me. It is

right quality, not just price. I will in a moment. That company got

its price wrong and provided the quality, but not for the price and

it jacked the contract in. What he said at the beginning of his

comments was, we will now only see the official report tomorrow, was he

was using it inaccurately as a point about privatisation and said the

quality goes down. In this case, the company went bust. Wrong on both

points. The right honourable member might well be correct about the

specific thing and I fully accept that. But there is, in

privatisations, E nexus between quality and price. And very often,

not always, those companies who promise quality at a certain price

too often are unable to deliver it. Either they cannot deliver the

quality of service and or cannot do so at the price they promised they

would do so. And we do see it, and the right and will member can get me

on the city wishes, we do this yet time and again with railway

franchisees who come back to the Government and say, we promised a

certain level of service for a certain price, we can't do it, we

need a bigger amount. I thank the honourable gentleman. He might have

stumbled into a quagmire here by referencing something. The committee

I sat on for several years down the issues around pricing are not the

significant issues which led to the ending of the private contractor,

but issues around the wider health care economy and the failure to

discharge insecurities in respect of clinical business, so to speak, for

that hospital. The honourable member has considerable more knowledge than

I do and they told about evidence -based policy making. I am repelled

absolutely to accept the evidence he puts forward. But that company could

not make a go of it. It might not have been the company's fault. I

accept that. It could not make a go of it. But, moving on, if I might,

to clauses 1-5. I hope the Minister can... As I understand it, they are

a package of amendments that go together. I hope that the Minister

can talk us through them little bit because if we look at amendment 40B,

-- Amendment three, which is since Dan -- substantive... I would like

the Minister to talk us through this. There is a trend starting in

some parts of England and is most advanced in Salford, where the GPs

who are providing primary services are directly employed by the

hospital trust. So the hospital trust is no longer just secondary or

even tertiary, it is primary. I wanted to and picked the wording to

make sure that that development of service delivery in England has been

taken into account and the amendments do not assume that the

existing silos between primary and secondary continue. Because that

development has now started in Wolverhampton, when I represent,

well there are three GP practices which are piloting their staff being

employed by the excellent Royal Wolverhampton Hospitals Trust. I say

excellent, it is one of the 15% of hospital trusts in England which

does not have a deficit. After that is related to the fact that it has

only ?15 million of PFI. That is another debate, which I won't get

into just now. In terms of amendment ten from the

Scottish National party, this is a reprieve is of an amendment which

was put in on committee, and I had the pleasure of serving on the

committee. Just like amendment nine relating to quality, it is a

reprieve is of what was put in at the Bill committee. I hope the

Minister can explain, in relation to amendment nine, I had understood

him, perhaps wrongly, to say in the committee that he liked what the SNP

was putting forward in terms of policy but he did not think they got

the wording quite right and he hoped to be able to come back on the

report with an amendment relating to quality. I may have missed

understood what the minister said, but I cannot see on the order paper

and amendment from the government relating to quality and I hope the

Minister this afternoon can explain how that has come about, that he

hopes to be able to bring one forward on quality, but has not yet

been able to do so and whether he will do so at a later stage. Turning

to the final amendment on the order paper of the day, amendment seven,

which is to do with the definition of medical supplies, I have to say

to the minister I am bemused, but no doubt in his usual way he will be

able to elucidate later. I am bemused because in the committee I

managed to persuade the government to clarify the definition of medical

supplies contained in section 260 of the National Health Service act

2006. That definition, as I understand it, relates only to

England. Amendment seven before us this afternoon, as I understand it,

relates only to Wales. But the two seemed to me to be on all four is

because section 260, subsection five of the NHS act 2006 says, quote,

medical supplies include surgical, dental and optical materials and

equipment. I then look at this bill, the part that relates to Wales, page

nine, clause seven, inserting section 2001A into the NHS Wales act

2006, and if we look at line 37 on page nine of the bill, it says,

quote, medical supplies include surgical, dental and optical

materials including equipment, which I think is the same wording, this

time applied to Wales, as it is in section 260, sub-clause five in the

NHS act 2006 applying to England. But this afternoon we then have

amendment seven which amends the Welsh legislation very

understandably to clarify the definition of medical supplies. So

in committee the government did not want and did not see the need to

clarify the definition for medical supplies as applied to England, but

this afternoon it is seeking to clarify the same definition of

medical supplies as it applies to Wales. I am again bemused. I give

way. I am very interested in his analysis of what medical supplies

are because one of the things that strikes me is I would have thought

pharmaceutical things would have been medical supplies. I am

surprised that is not included in that definition. Medical supplies

here in this part of the bill seems to be to do with physical equipment,

but again what is equipment? Hence the definitions. They include

surgical, dental and optical materials. Drugs are dealt with

elsewhere. I think the Minister has got the point. He is seeking

clarification for the Wales legislation by amendment seven when

I understood him to say that he did not think such clarification was

needed for the same definition contained in the legislation

pertaining to England and I would like him to explain that apparent

anomaly. If it is not an anomaly, perhaps he could tell the House he

will clarify the definition in the later stage passage of this bill as

it relates to England. Madame Deputy Speaker, I rise to speak to the new

clause, the government amendments and all other amendments tabled

today for this report stage and I would like to start by expressing my

gratitude to the front bench spokesmen opposite who have both

confirmed an intent to continue the spirit of constructive dialogue that

we have had in taking this bill to this stage thus far. I am pleased

they are supportive of the intent of the bill, and the objectives, and I

will seek to raise during my remarks today a response to the particular

amendments that they have posed. Honourable members will recall that

in relation to new clause one this was an area that we debated at

length during committee and I would like to take this opportunity to

provide some additional reassurance that this is an important issue for

the government. We have already included in the illustrative

regulations for both the statutory scheme in regulation 32 and the

information regulations in regulation 14 an annual review of

the regulations and a requirement to publish our report of each review.

These annual reviews we think go further than the specific single

review which the honourable gentleman speaking for the

opposition has put forward in new clause one. The effect of new clause

one would only require the government to undertake a single

review within six months of the act coming into force. But we accept

reporting is an important principle. However, setting out the

requirements in primary legislation we believe to be too restrictive. We

think the single review as proposed within the first six months of the

act coming into force would not provide a sufficient time frame in

which to assess the impact of these provisions. Whereas the annual

reviews we have set out in the illustrative regulations places a

duty under government to review both the statutory scheme and the

information regulations to ensure the effectiveness and to do it every

year. These provisions will be to consultation. Over time we expect

that both the statutory scheme and the information requirements will be

amended through their respective regulations to reflect changing

circumstances. It is essential that the review reporting arrangements

are able to be similarly flexible so they remain appropriate to the

schemes in operation. The honourable gentleman asks specifically whether

objectives should be set out before the regulations come into force. The

government will consult on regulations before they come into

force. The objectives of the regulations will be explored in the

consultation and set out in the government response. Specifically

the illustrative regulations require an annual review two set at the

objections of the scheme, to assess the extent to which the objectives

have been achieved and to assess whether the objectives remain

appropriate. These requirements will be tested through the consultation

on the regulations and we will take into account those views. I will. I

am very grateful. Again I say I am very grateful to the government for

publishing these illustrative draft regulations to help us debate the

bill. But if I look at the provisional information on page

eight, draft clause 14 it says, the report must set out the objectives

intended to be achieved by these regulations and then assess the

extent to which these objectives are achieved. That seems odd that in one

review you will set out the objective and then decide whether

the objective has been achieved or not. That seems to be a bit wrong

tempura leaf. We will undertake these reviews every year so that the

second element will be impossible to access in the first review, it will

be harder in the first one, there may be some ability to assess it,

but we can look back and see how well the objectives have been

received. I noticed the honourable member for Leicester East is heading

for the exit and before he does so, he has now resumed his seat, while

this is not specifically at the right point in my remarks to pick up

the comments he made, I would like in response to his constructive

contribution on the subject of diabetes, of which he is the

parliament to cheer on the all-party Parliamentary group, and he may

recall in a former period in this house I was the vice-chair of the

all-party Parliamentary group on diabetes having family members with

both type one and type two, so I have considerable sympathy for the

points he was making about the importance of adequate advice for

individuals who may not be aware they have got diabetes and for

adopting innovation through the NHS treatment of those who do have

diabetes. We shared that objective and I do not think any thing we are

proposing in this bill will do anything other than to continue to

encourage innovation. I will be making other remarks perhaps when he

is not with us on the subject of innovation. I just wanted him to be

aware that I have taken his point on board. He may be disappointed by the

conclusion I come to in relation to specific amendments. It has been

addressed in other ways. Reverting to new clause one and the issue of

the regulations, I will make a second point. Much of the

information provided by the Secretary of State will be

commercially confidential. We touched on this in committee. I am

sure suppliers have every confidence that the government will maintain

the confidentiality in anything it publishes. It is important to

reinforce that principle. There is a limit to the level of detail we can

publish and I am sure the honourable member will appreciate that. Any

information we do publish would be at a consolidated level protecting

suppliers' confidentiality, but allowing the Secretary of State to

be clear on the basis of the conclusions of his review. We could

use supporting information to evidence our conclusions. While the

requirements set out in that clause reflect the duties of the Secretary

of State, the content of such a report should not be restricted and

must be able to address the key issues arising during the year that

may affect the operation of the schemes. The other significant

element of the proposed new clause which I have just touched on, in

response to the member for Leicestershire East, which we

discussed at length in committee, is whether it would be appropriate for

such a report to address matters relating to promotion of innovation.

It is not appropriate to link measures in this bill which relate

purely to the cost of medicines and medical supplies to the NHS duty to

promote innovation. Promoting innovation is a high priority, not

only for the government and the NHS, but for many other stakeholders.

Innovation requires action across many different fronts and it would

not be possible to quantify the contribution of the schemes in this

bill to that endeavour in any meaningful way. The NHS is doing

great work to promote innovation and I would like to draw honourable

members' attention to the latest data from the innovation scorecard.

It is a quarterly data publication which shows the uptake of innovative

drugs and medical technologies following approval in England. This

is now a nationally published statistic. In response to the

request from the member for Wolverhampton South West to raise

this specifically, the latest publication of the 12th of October

this year shows the rate of uptake for 85 medicines recommended is

increasing. 77% of these medicines have positive growth uptake in the

year between March 2000 and 15-2016. 54% of the medicines had a growth

uptake greater than 10%. This is available on a quarterly basis and

honourable members can follow this process. The government is taking

broader action to secure the UK's future as an attractive place for

the life sciences sector, particularly in light of Brexit. We

are clear in our commitment to life sciences and to building a long-term

partnership with industry. The honourable gentleman for

Wolverhampton South West also asked me to address the Nice process and

whether this takes into account evidence and the process for the

subsequent review of previous decisions. This is a continuous

process. It does not happen in every drug all the time, but there is a

routine procedure under which Nice will look again at the previous

decision and will decide whether to continue with the decision they had

taken before or to amend that decision and that might allow drugs

which had previously not been approved to become approved on the

basis of new evidence. I hope that reassures the honourable gentleman.

I would like to draw your attention to the Access review which would

accelerate reforms to access to medicines and facilities to NHS

patients. The government and partners are considering those

recommendations. We want to make the UK the best place in the world to

design, develop and deploy life science products. We do not believe

the bill will have any material impact on Matt at that, other than

the minor impact noted in the impact assessment. This is backed by

evidence which suggests there is no obvious reason why national health

service pricing policy for pharmaceuticals or the time taken to

make decisions on reimbursement should affect decisions to invest in

research and development in pharmaceuticals in the United

Kingdom. The evidence instead, suggests the most important traction

for companies to invest in research in the UK is the availability of

world-class scientific expertise which is the focus of the

government's effort to ensure the UK remains at the forefront of Global

Research Chartered development. The honourable member Astra for reports

to be laid before Parliament. We will be publishing these reports on

an annual basis and I am happy to commit the first report will be laid

before Parliament and we can see how much interest there is in it to see

if we need to do that in subsequent years of whether we publish it in

the normal way. On that basis, I hope the honourable member, the

Shadow minister, will withdraw his new clause will stop turning to

amendment eight. This aims to require the income from the

voluntary scheme and the statutory scheme to be ring fenced to

reimburse the NHS for expenditure on medicines and medical supplies in

order to increase access to new and innovative if treatments. We are

committed to ensure patients have faster access to new and innovative

of medicines and treatments. We know that investing in new medicines and

treatments where they are proven to work and our clinical priority has

the potential to transform the care of patients and lead to improve

outcomes. It is a fundamental principle of the NHS funding should

be allocated according to clinical priorities based on the judgment of

commissioners. That might include new treatments, but it just as well

might include scaling up older, effective treatments or investing in

more staff. While we can and do understand the intention behind this

amendment, it is for NHS England and clinical commissioning groups, in

our view, to determine clinical priorities and spend this money on

what is clinically most important. The honourable lady for Central

Asher has supported this amendment and while it is not for me to

comment on the policies of the Scottish Government, we do know the

NHS in Scotland has raised concerns the new medicine fund she has

referred to only funds medicines at the end of life or for red diseases,

meaning funding for other areas are not getting the same priority. She

is shaking her head as though that is not the case. That was my

information. If you would like to enlighten me further, perhaps we can

discuss it now or later. New medicines and red diseases funds and

it often includes end of life. Also for rare diseases, was my

understanding. I stand corrected. However, the concern is one in which

my primary point is it should be for clinicians to decide across the

range of activity what funding is spent on, whether that is ring

fenced into a specific fund for new medicines, our concern is that it

might not always be the right clinical decision. Does the Minister

not accept it is a slightly PR and slightly bizarre thing to have a

medicine fund that is only for cancer and rules are people who have

other life-threatening illnesses, which is the case here in England?

Then new cancer drug fund was set up to provide funds for dealing with

one of the most common causes of mortality in the country and was a

priority of the previous government. I am not going to go into the

reasons for that. I would like to come back to the amendments, if I

may, and refer to the fact that all income generated through both the

voluntary and statutory scheme is reinvested in the NHS and there was

a suggestion made that it is not clear what happens to any receipts

made under these schemes. Estimates of income under the PPR rests are

part of the baseline used in the Department's spending review model.

This model was used to calculate the increase in funding the NHS was

seeking at the end of the spending review in 2015 and helped secure the

?10 billion of real terms funding in the course of this Parliament. The

income from the voluntary and stature she scheme can and does

fluctuate. This is the biggest problem we see with ring fencing

funding. Ring fencing this money to this specific area could bring risk.

And just to give an example, the annual income from the PPRS has

varied between ?310 million and ?839 million in a full financial year in

England. So it has the potential to have quite wide variability in the

income it generates and for that reason, primarily, we think it could

potentially disadvantage patients by making treatment dependent on income

from a pricing scheme whose income generation is not steady. I

understand where he is going, but I would caution him, when he was

talking about flexibility, he gave the example that a CCG or medical

body might wish to spend some of this money on staffing. I caution

him because of the fluctuation to which he refers, deciding to spend

it on staffing is probably not a good idea. I am grateful to be

honourable gentleman for his advice and I am afraid I don't think it is

very relevant to my point on fluctuation of income coming out of

the scheme. I think it is relevant in relation to whether or not it is

NICE or politicians who make these decisions. It needs to be made by

clinicians. I will, then I will make some progress. I thank the Minister

for giving way. Is it not the case Cancer Drugs Fund has a budget of

approximately 350 million and therefore if he is saying the money

retrieved from this is varying from 300 million to over 800 million, it

would allow an expansion of a new medicine fund. It might if it always

moved in the same direction. That is my concern, it could conceivably

decline between one year and the next and not always go up, certainly

not up in a straight line. Separately, government is taking

action to secure the UK's future as an attractive place for the life

sciences sector. I have touched already on the recently published

accelerated access review which sets out the ways in which to increase

the speed 21st-century innovation in mental technology and products get

to NHS patients and their families. Recommendations under this review

included bringing together organisations from across the system

in an accelerated Access partnership and creating a strategic commercial

unit within NHS England which can work within industry to develop

commercial access arrangement. Considering these recommendations

with partners and we will respond in due course. NHS England and NICE are

consulting on a number of proposed changes to NICE proposals and

specialised technology appraisals including around speeding up the

appraisal process. The Department of Health works closely with NHS

England and other stakeholders to improve the uptake of other

stakeholders and the innovation scorecard on uptake is what I have

proposed. What is proposed in amendment eight, I would ask the

honourable lady to withdraw her amendment. Turning to amendment

nine, the government recognises the act has currently drafted does not

explicitly state in the relevant section 260 that the government is

obliged to consult industry. I'm worthy act in relation to

controlling the cost of medicines does state there is an obligation on

the government to consult. A similar amendment was tabled by the

honourable lady in committee. I would like to reiterate to her that

I am happy to consider with her, how we could best introduced the

requirement to have a general requirement to consult industry in

section 200 60. I know my officials have been in discussion with her and

I'm grateful for the time she has given and the constructive comments.

I note the honourable member reference to the effect of any

pricing controls for medical supplies on the maintenance on the

quality of these products and I can assure head the government were take

into account all relevant factors, including any concerns raised by

industry about the quality of medical supplies when making an

consulting any price controls for medical supplies. The government

would not however, be in favour of putting one of these many factors on

the face of the bill. The medicines and health care products regulatory

agency is responsible for the safety and efficacy and quality of medical

supplies and this bill will not change that. MHRA has assured me any

use of the control powers in this bill would not affect any quality or

safety requirements that must be met before medical supplies could be

placed on the market. I would also like to assure the honourable lady

the government is committed to procurement across the NHS and she

has referenced the procurement system in Scotland. She is aware of

the Carter report, which concluded there is considerable variation

between trusts as to what value they extract from expenditure on goods

and material from medical supplies. The NHS Supply chain is working hard

to deliver these procurement deficiencies. They are working to

meet recommendations to price transparency, lower costs and

deliver economies of scale. She referred to 600,000 products. They

had success in reducing the product range in the effective catalogue

from that figure down to the current figure of 315,000 to help NHS

organisations purchase products more efficiently. They are continuing to

work to reduce that number. I am aware of the similar work in

Scotland and in England we are using Carter to deliver this. What I

understand the intent, I am not fully convinced that as drafted, it

would have the effect she is hoping to achieve. If she will continue to

work with me and my officials, the government would be happy to

consider, while the bill is in the other place, how we could best

introduced the requirement to consult in section 260. On that

basis I would invite her to withdraw the amendment for now. I must press

on to cover the government amendments, which are in two groups.

Amendments one to five address a loophole in the bill. Clause six of

the bill amends the NHS act to give the secretary of State the power to

make regulations to obtain information from any UK producer. A

UK producer is defined in the bill as anyone involved in the

manufacture, distribution or supply of health service medicines, medical

supplies or any other related products required for the purposes

of health services in the United Kingdom. An accepted person is

defined as any person providing pharmacy or GP services for the

health services in Scotland, Wales and Northern Ireland. The purpose of

these provisions was to reflect the agreement with the devolved

administrations the devolved administrations would collect

information from pharmacies and GP practices in their nations. But

there may be circumstances when a company which supplies products and

the devolved Administration is also provides products in England but

could claim the language as drafted would allow them to become accepted

person is because they were operating in the devolved

Administration is. This is not the intent of the bill and we have

therefore propose these amendments in order to address this potential

loophole. Amendments six is a minor amendment which was an intentionally

omitted. It relates to clause six of the bill which provides the

Secretary of State power to disclose information to the list of bodies

stated. It includes those persons providing services to the regional

business services organisation in Northern Ireland. Which had been

previously omitted. I hope members will access these amendments. I have

a couple of remarks to make immigration to amendment ten from

the honourable lady from Central Ayrshire.

New section 264 B enables the Secretary of State to give

information to NHS, other government departments and the devolved

administrations. The government has concerns about the proposed

amendment. We are dealing with confidential and commercially

sensitive information that can only be used for specific purposes and we

are reluctant to introduce a requirement to disclose information

to any government department or NHS England. It is important the

government can be trusted with the information they collect. I would

like to conclude a point to the honourable lady because I think it

will satisfy her. Her concern is how the government will behave in

relation to the request from devolved administrations. We

recognise we need to give reassurance to devolved

administrations that in light of the very constructive conversations we

have already had with them that they will have full access to all

relevant data that the government collects. We are happy to do that.

We have indicated we will be entering into a memorandum of

understanding and that will be discussed with the devolved

administrations and agreed and those discussions will consider whether

they have automatic access to this information, whether that is in

real-time or some other format, and whether that is through direct

access to the systems or by forwarding data we collect

immediately on request. We need to get onto the detail of that in

discussing the memorandum of understanding rather than committing

it to the bill at this stage. On that basis I hope the honourable

lady will withdraw her amendment. I welcome the comments from the

Minister and I am happy to withdraw the amendment if we can get to a

clear point on the memorandum of understanding. All my amendment does

it say that the groups listed by the bill should be able to ask for data

on request. I understand my attempts to move the amendment in committee

included groups that it should not have. That has been corrected. It is

not spreading confidential information any more widely. I am

grateful to the honourable lady for that clarification. I think this is

better dressed in the memorandum of understanding. Finally, Madame

Deputy Speaker, I would just like to address a couple of amendments,

amendment seven, which provides a definition for equipment. The

honourable gentleman for Wolverhampton South West took us

through this specific drafting for a definition of medical supplies. This

clause provides a definition of equipment in the NHS Wales act 2006

to ensure consistency within the NHS act 2006. Equipment is defined as

including any machinery, apparatus or appliance, whether fixed or not,

and any vehicle. This definition is broad enough to be able to capture

any medical supply when taken in tandem with the common definition of

medical supplies on the market from a bandage to an MRI scanner. The

point is about the definition of equipment which is a subset of

medical supplies. I hope honourable members will accept that amendment.

I have spoken at some length of these amendments, but I hope I have

made my position clear and honourable members opposite will

withdraw their amendments and accept the government amendments. I would

like to withdraw new clause one and amendment eight. Is it your pleasure

that new clause one be withdrawn. As many as are of the opinion, say

"aye". To the contrary, "no".. The ayes have it. New clause one is

withdrawn. We shall take government amendments 1-7 together. I called

the Minister to move the amendment formally. The question is that

amendments 1-7 be made. As many as are of the opinion, say "aye". To

the contrary, "no".. The ayes have it. Third reading. Now. Minister to

move third reading. Madame Deputy Speaker, as we have already

discussed, this has been a pleasure to take this short, albeit

technical, Bill through the House with a wide degree of consensus from

all parties who have participated. I will formally beg to move that the

Bill now be read a third time. We have had a very constructive debate,

points have been raised by honourable members from all sides

through amendments and in debate and we have sought to take on board

their comments and will look to take some of those forward at the next

stage as the bill moves into the other place. I would like to, if I

may, thank honourable members who have spoken for the opposition, the

honourable member for Ellesmere Port, the honourable member for

Burnley who is just about in her place, and the honourable member for

Central Ayrshire leading for the SNP. We have had some strong

contributions from backbench speakers, the honourable member for

Wolverhampton South West who serves on the committee in his diligent

fashion, the honourable member for Leicestershire East. We have also

had contributions from honourable members on my side of the House and

I would like to die in particular the honourable member for Torbay who

was active in committee. I would like to thank my private secretary

for his support and the whips on both sides. The purpose of this bill

has been to seek to ensure that from the ?15.2 billion spent on medicines

in the most recent full-year an increase of nearly percent since

2010 and 2011, 7% higher than last year, that such loopholes are closed

down to ensure that the NHS that she was as much value for money as it

can from this very significant spending on pharmaceutical and

medical products. We are looking to clarify and modify positions, to

control the cost of health service medicines and to ensure that sales

and purchase information can be appropriately collected and

disclosed. Briefly, Madame Deputy Speaker, the bill puts beyond doubt

that the Secretary of State camera acquired companies in the statutory

scheme to make payments to control the cost of health service

medicines. This will save the health service across the UK some ?19

million a year. Secondly, the bill would enable the Secretary of State

to require companies to reduce the price of an unbranded, generic

medicine. Or to impose controls on that medicine even if the company is

in the voluntary scheme. Honourable members will recall examples raised

during the second reading debate and in committee where companies have

charged the NHS unreasonably high prices for unbranded, generic

medicine. Without competition companies have raised prices and in

the most extreme case by as much as 12,000%. Companies can do this

because we rely on competition to keep prices down and while this

generally works well, the government needs the tools to be able to

address the situation where a small number of companies are exploiting

the NHS, patience and the taxpayer by raising prices when there is no

competition. Thirdly, the bill enables the Secretary of State to

make regulations to obtain information on sales and purchases

of health service products in all supplies and in all parts of the

supply chain. These purposes are reimbursement of community

pharmacies and GPs determining value for money in the supply chain and

schemes to control the cost or prices of medicines. By bringing

these requirements together the bill streamlines and clarifies all the

relevant requirements in place providing a statutory footing for

them all. This includes the existing statutory requirements already in

the NHS Act 2006 and those agreements that have a voluntary

basis only. At committee stage the government tabled an number of

important amendments that reflect the reviews and requests from the

devolved administrations. We tabled these amendments following

constructive discussions which resulted in an agreement that the UK

Government will collect information from wholesalers and manufacturers

from the whole of the UK. It would not make sense for each nation to

collect information which would lead to duplication of effort and lead to

increased costs. Each nation will collect information from its own

pharmacies and GPs. The devolved administrations will have full

access to all information that the government collect and I have

committed again today to develop a memorandum of understanding to

underpin these arrangements. My officials are working closely with

officials in the devolved administrations to do this. To

ensure the bill makes clear the government's intentions, I would

also highlight the small number of technical amendments we have

introduced at report to bring clarity to the bill. These closed

down a potential loophole that would enable some companies not to provide

us with any information if they also provide pharmacy or GP services to

the devolved health services. This has been a relatively small bill,

technical in nature, which has received considerable support from

across the House for which I am extremely grateful. The bill will

help to secure better value for money for the NHS on its ban on

medicines while ensuring decisions made by the government are based on

more accurate and robust information. I would like to thank

you, Madame Deputy Speaker, for presiding over today's sessions. I

would like to thank members of the chairman's committee, in particular

the member for Telford, under whose chairmanship I served for the first

time. I would like to thank the Parliamentary clerks, the Hansard

writers and the doorkeepers for making this bill proceed. The

honourable member for The Wrekin, I am corrected, I would like to thank

all of those people for helping us proceed to our conclusion today.

Thank you, Madam Deputy Speaker. As we have heard from the ministers

today, this bill seeks to allow the NHS to better control the costs of

medicines and medical supplies and to control and close loopholes in

the system would have been the subject of abuses in recent years.

In seeking to achieve those aims the government has our support. I would

like to place on record our appreciation for the Minister and

the amiable way he has dealt with this bill. Although he has not

agreed with our amendments, he has explained why in a reasonable and

constructive manner. I would like to record my appreciation to the

members who served on the committee. The member for Central Ayrshire who

spoke on behalf of of the Scottish National party and other thanks go

to the honourable member for Wolverhampton South West who has

engaged and informed in equal measure throughout the entire

passage of this bill. Expenditure on medicines is a significant and

growing proportion of the NHS budget, standing at ?15.2 billion,

which is an increase of over 20% since 2010-2011. This reflects the

incredible advances that we see in the development of innovative

medicines, often by our own bile and life sciences industries in the UK.

It is clear tax payers and patients have not always been well served by

the market. It is important we do everything we can to secure value

for money for the NHS, particularly following six years of

underinvestment by normal standards. When the price regulation scheme was

agreed in early 2014, the government said it would provide an

unprecedented level of certainty. But as was reported by the

honourable member for Mid Norfolk, estimated PPI payments were ?647

million, a considerable reduction from the ?800 million received in

2015 when at a time the overall drugs bill has been increasing at a

pace. So, those figures and the fact we are debating these measures in

the bill showed the original scheme has not gone entirely to plan. There

is much in the bill to be welcomed and we would like to see an end to

the playing of the system that has been going on and we hope the bill

will put an end to such antics and it will seek consistency being

derived in appropriate circumstances. We support the

rationale behind the statutory schemes and it will give a much

better chance of delivering savings to the taxpayer. We support measures

to tackle regulations to stop companies exploited a loophole.

Sometimes the price of medicines was inflated by ?262 million a year as a

result of this practice. Those issues impact on patients. The

example is a drug that has been found to be effective in treating

muscular dystrophy. Until 2005 this was relatively inexpensive. It was

discontinued by its only factor until recently one pharmaceutical

company decided to manufacture it again. But their price is ?35,000

per patient per year, despite the fact there has been no new research

and development costs incurred by the company and it was difficult to

see what justification there could The NHS in England is refusing to

provide reimbursement for the drug which means patients lose out. It is

this deliberate manipulation of the system we want to see dealt with and

we hope this bill puts an end to such scandalous practice. Whilst we

support the broad aims of the bill, we have some wider concerns. Perhaps

what is missing from the bill and the government's policy on access to

medicines and treatment. This country has a world leading

pharmaceutical sector, there is a relatively low take-up of medicines.

Members from across the House will have received correspondence from

their constituents concerned about the lack of availability of

medicines they or their relatives are trying to obtain. We see

clinical commissioning groups rationing treatment in ways that

would have previously been seen as unthinkable. To create a level

playing field for drugs we should be doing the same for patients as well.

One measure is to ring fence future rebates from the sector and improve

access to medicines and treatments. ?1.24 billion of new money has been

returned on rebate since it was established. There could be no more

logical use for this money and use it to tackle developing new drugs.

We know the government are not willing to back the amendments, but

I would urge the Minister to look again how this measure has worked in

Scotland. We have heard in the debate on this today, and there

seems to be difference of opinion on how that has worked. We know the

member for Central Ayrshire has spoke strongly in support. We note

in terms of the issues of devolution a number of amendments have been

tabled by the government which have sought for the devolved regions to

be subject to the same. I recall when the minister responded to my

questioning on this point, he suggested ring fencing might lead to

chaos as their allocation from NHS England includes an element of

income from the rebates. I do think the minister underestimate his

ability to resolve this and overestimates the difficulty that

would ensue. The annual budget for Greater Manchester is around ?6

billion, half of the Scottish budget and less than the Welsh budget. It

is not the budget that is an issue, but what is an issue is transparency

and consistency. While I am not expecting a late change of heart, we

will watch the developments in English devolution and accompanying

budgets with some interest. The other areas of concern how these

proposals will impact the future. We will be keeping a close eye on both

the operation of the scheme and general health of the sector,

particularly in terms of future investment in research and

development. To conclude, we support the broad aims of this bill and what

the government is seeking to achieve in terms of controlling better, the

costs of medicines. We do think they should be doing more to tackle the

present situation to prevent patients missing out on treatments

made available particularly when we compare our record to countries with

similar well. We do hope the annual review envisaged in the draft

regulations is broad enough in its scope to produce a effectiveness. We

look forward to the government response. This is a small Bill

Butler sums at stake are considerably large and I believe we

should hopefully see a positive outcome for the NHS as a whole as a

result of this. Only leaves me to conclude by thanking yourself for

chairing today and thanking the members who are standing in the bill

committee, the staff and civil servants who have successfully led

this passage through the chamber today. Thank you. I will open with

my thanks, this is the first bill I have taken through and I am grateful

to yourself, the chairs in the bill committee and all the staff who have

worked on this and the procedural hub. That someone who is a new beat

to be able to say, what happens next has been helpful. We have welcomed

the basic premise of this bill and particularly now clauses one to four

do give the Secretary of State power to control prices of drugs and in

particular to avoid the excesses we have seen recently and the

highlighted in the article in The Times. Companies in the voluntary

scheme who also produce generics and therefore the price of those

generics is not controlled and also these companies that have picked up

drugs no longer produced by anyone else as an orphan status and have

literally basically robbed the NHS by increasing them by many thousands

of percent. It is unacceptable. One of the things I would point out,

when we accept relatively high prices for new drugs, we often

excuse that on the basis of research and development. Not all research

and development is done by big pharmaceutical companies. They are

often small, spin out companies from universities and from the point of

view of generic or repurposed patented drugs, this work is done

within the NHS by clinicians or academic university departments. It

has been admitted in the past by companies that they are not always

pricing these drugs in relation to the cost of research and

development, but what the market will bear. It is something we need

to not always give them this excuse that they are expending huge amounts

on R, because that is not always the case. I did raise two new

clauses in committee and now the Secretary of State will have the

power, I have those issues will be dealt with. One was the issue of

specials, the handmade preparations, usually point met for a

dermatological use and I did arrange that the briefing from the

Association of dermatology, who highlighted companies who had a

Scottish price list and an English price list, I have these powers will

be used. In Scotland it is used by using an NHS producer, who makes the

drug and keeps the price down, rather than paying simply a

pharmaceutical company or a pharmacy company, because the pharmacy with

which the patient is dealing may have a mother or sister company and

they are simply taking a very high price from them. The other one is

the issue that was raised last November of repurposed patented

drugs. Exact same things can happen, as was raised by the Shadow Minister

of health, which is a drug which is of paint and maybe picked up by a

new company and used for a new purpose, such as the statin in

multiple sclerosis but with just a tweak, can be put out as a new drug

at a price that people cannot access. Doctors must prescribe the

licensed version before an unlicensed version. If a licensed

drug came on the market that was just a version of Anne off patented

drug, doctors would be under pressure to prescribe it. I

understand there has been work going ahead, I just exhort the miniature

and threw him the Secretary of State, to ensure the powers that are

given by this bill are used in all of the circumstances to ensure

prices are controlled. Because otherwise what happens is not

expenditure to the NHS on its own, but usually CC jays will not allow

these drugs to be accessed and that is what is happening in this case of

specials. It is weird we have the powers, and we welcome mat but hope

they will be used. I propose not to take the remaining three hours. The

Minister earlier, when he wouldn't take in intervention seemed to think

there was a rush on time, I read we had another three hours of this

bill. But I wanted to put the bill into some context. This is a

socialist bill. It builds on the Labour government's NHS act which

applied to England. Looking round, it may be the case that you and I

are the only members present who voted for the 26 NHS act, before you

were in your esteemed position. It is worth reviewing before we put the

current bill in context what it is building on with the previous act.

The 2006 act was the pharmaceutical price regulation scheme, the PPRS.

Those voluntary schemes were to do with limiting the profits of

pharmaceutical companies. Can I stress to the House, my party and I

are not opposed to pharmaceutical companies. They do fantastic

research and there are probably millions and millions of people who

are alive now who would not otherwise be alive, because of the

research and development done by pharmaceutical companies, many of

them happily based, or having major operations in the United Kingdom.

They are very welcome here, but they have to play by the rules and so do

those who buy up of patent drugs and horse surrounded them and put up

their prices by hundreds and hundreds of percent. Sometimes it is

a minority of private equity companies who are doing that and

they are not welcome here. Pharmaceutical companies must act

responsibly and they may need statutory encouragement to do so.

The 2000 SIS act started the process of statutory encouragement with a

statutory scheme, which enabled Her Majesty's governments, in

appropriate cases, to limit prices and limit profits of pharmaceutical

companies. And that is why I say it is a socialist scheme. Before the

government benches get area weighted about this, I and my party do not

wish to nationalise or control the prices in every corner store in the

country. But there are big operations where market intervention

is helpful and is needed where there is market failure. And it was

perceived I think, rightly, by the Labour government, that there was

some market failure and it needed some stern measures to sort it out.

This bill builds on that work from ten years ago because, as averted to

buy my honourable friend, there were some, and minority of drug supply

companies who were, frankly, taking the Mickey, because they were

leaving the voluntary scheme in favour of the statutory scheme

because that was more advantageous to that company. I understand why

they would do that, they which to maximise their profits but they must

act in a responsible way. If they will not do so through the urging of

corporate social responsibility, which some of them will not, then we

need statutory measures. That is what the bill before the House this

afternoon bills. One of the things it does is addressed that issue of

companies leaving the voluntary scheme to go in a statutory scheme

because it was a better deal. It resets the schemes, as it were, this

bill, to make sure our company is not encouraged to do so because

there is not that comparative advantage. The bill also makes

provision for a new power which will enable the Secretary of State for

Health to require a company, which is in the voluntary scheme, to pay

sums due under that scheme. Even though it is a voluntary scheme,

this would give the Secretary of State the power to pursue such a

non-payers through the courts. I regard that as progressive

legislation for those companies which knocked acting responsibly,

which are taking the Mickey, as characterised it. That is a good

thing. This government has come down the socialist path to agree with

that market intervention. It has also come down our path in wanting

to martial information so that we can treat these companies equally