Abortion - Northern Ireland & Alabama
See Northern Ireland
Abortion - Practitioner-recommended Termination
I completely understand what an incredibly emotive issue this is, and I appreciate the strength of feelings on both sides. It is for this reason that, as with other matters of conscience, the Government adopts a neutral stance on abortion, allowing Conservative MPs to vote freely according to their moral, ethical, or religious beliefs. This is a convention which I support wholeheartedly.
The approach to abortion in Great Britain is set out in the Abortion Act 1967, which states that two doctors must certify that, in their opinion, a request for an abortion meets at least one and the same ground laid out in the Act. These grounds include "risk to the life of the pregnant woman", and "substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped".
I have read reports of the case you outline. Whilst I appreciate that the specifics of this particular case are very difficult and it would not be appropriate for me to comment on the independent judgments made, I believe it is important that the views of both the clinicians and the individual and their family members should be taken into account in such cases. I understand that in this case the decision has been overturned, and the pregnancy will not be terminated. If there has been an error of judgment in this case, and law is a matter of interpretation rather than certainty, I could not accept that this alone invalidates the practice of health practitioners considering abortion in relation to the health of the patient. In certain very specific cases, where there is an obvious risk to the expectant mother or unborn child, it can be very necessary indeed.
I agree with you that work is really important for ensuring that people with arthritis are able to lead fulfilling lives. Indeed, I am proud to be one of Versus Arthritis' 'Parliamentary Champions', and I recently led a debate on this topic encouraging improvements to the Access to Work scheme. I can assure you that as part of the Green Paper on work, health and disability, Ministers have explored ways to improve support for people with conditions such as arthritis to find and remain in work. Musculoskeletal conditions are one of the two key areas, along with mental health, which the Green Paper placed specific focus on.
The Government response to the paper recognised the important role of musculoskeletal care services, including physiotherapy, and launched new trials to help support people move back into work. It is also important to work more closely with employers to raise awareness of issues around disabilities and health conditions, and to share best practice. The Disability Confident campaign has done great work in this area in recent years, and a new Disability Confident Business Leaders Group was announced in the Green Paper to work alongside ministers and officials to increase employer engagement around disabled employment.
The Access to Work scheme is also being expanded to help more disabled people start or remain in work. Access to Work is receiving a real-terms increase in resources, enabling increased marketing of the scheme to raise awareness among those who could benefit from it. The new Personal Support Package announced in the Green Paper will also mean that people with health conditions such as arthritis will be able to receive employment support which is more tailored to their specific individual needs.
The recent debate I led on this topic can be found here: https://www.billgrant.org.uk/news/debate-arthritis-and-employment
Brexit and the NHS
Care Home Quality
I believe that improving the quality of elderly care in the UK should be one of our highest priorities. 1.4 million people work in the country's social care sector, and I would like to pay tribute to their excellent work.
Caring for the elderly is one of the most significant challenges facing our ageing society. The independent Care Quality Commission (CQC) rightly holds our care system to the highest possible standards, and has recently completed a comprehensive survey of social care in England. CQC ratings are authoritative and independent, and publicly available, so people can make well-informed choices when they come to choosing a care home.
I am encouraged by the latest report from the CQC, which has found that, despite financial pressure, four out of five adult social care services in England rated good or outstanding. The CQC report has, however, highlighted areas for concern, such as the regional disparity in quality of care, and the rate of improvement of care services. I will make every effort to persuade the Government to build on its recent improvements to social care.
I am encouraged that short-term measures have been introduced to support councils to manage adult social care. In total, the Government has given councils access to up to £10.29 billion more dedicated funding for social care over the three years up to 2019-20. Money alone will not fix the problem and Ministers are clear that far-reaching reform is needed to encourage high standards across the whole country.
Furthermore, the Department of Health and Social Care is implementing Quality Matters, a vital scheme committed to improving the care sector for patients, families, and carers alike. This scheme makes it clear care home providers must be transparent and work closely with the public, to develop care homes which are not only of the highest quality possible, but adapted to the needs of their locality.
As regards the abuse uncovered at the Whorlton Hall care home, I am aware the Secretary of State has confirmed he will work with NHS England to ensure the care of all people with learning disabilities in in-patient settings will be assessed to ensure they are receiving safe, appropriate, high quality care. The Government has also allocated over £1.4 million for further reviews so that it might continue to learn more about how to improve care offerings and reduce the number of preventable deaths claiming the lives of people with learning disabilities
Health and Care Professions Council (HCPC) Fees
First I would like to recognise the important work done by independent regulators like the HCPC. These organisations help to protect the public and to ensure high levels of service and professionalism. As I understand, the proposals put forward by HCPC would increase renewal fees from £90 per year to £106 per year (on the basis that that payment is only taken once every two years, this works out at an increase from £180 to £212 every other year).
While this does represent an increase of 18 per cent, my understanding is that this fee remains the lowest among all regulators of health and care professionals overseen by the Professional Standards Authority. This increase has been precipitated by a number of factors, including the need to reduce the likelihood of fitness to practice cases through earlier engagement, to keep pace with the cost of inflation, and to offset the impact of the establishment of Social Workers England in 2019 and the subsequent decrease in subscribers. The regulation of social workers and social service workers is devolved in Scotland and carried out by the Scottish Social Services Council. HCPC has also taken steps to reduce their internal costs in response to these changes.
Although I recognise that any increase in subscription can have an impact on the individuals required to pay for membership in order to work, the importance of an independent regulator in this sector cannot be underestimated, and helps to protect workers as well as the British public. These fees are tax deductible, and the fee rise will amount to just over £1 a month extra for most of HCPC's registrants.
As requested, I have signed EDM 2069.
I am relaxed about cannabis use for medicinal purposes and I was pleased to support a colleague's recent application for a debate on 'Medical Cannabis on Prescription'.
Whilst there is scientific evidence to support the assessment that cannabis is a drug which can in certain cases harm people's mental and physical health, recent cases have shown the need to look more closely at the use of cannabis-based medicine in the healthcare sector in the UK. This is why the Government decided it was appropriate to review the scheduling of cannabis.
The decision of the Home Secretary to reschedule these products is welcome. This decision means that senior clinicians will be able to prescribe the medicines to patients with an exceptional clinical need. Following short term advice issued in September 2018 the ACMD are to review the current rescheduling and its appropriateness by November 2020 and provide further initial advice on synthetic cannabinoids by summer 2020. I recognise that there might be a natural reticence amongst practitioners to prescribe cannabis-based products but I am hopeful that the new National Institute of Health and Care Excellence Guidelines, which have been brought forward, will help to clarify the situation. I am pleased that this process has been brought forward as it clear that there have been delays.
It is crucial that this country keeps in step with the latest scientific evidence, so that patients and their families have access to the most appropriate course of medical treatment. My Ministerial colleagues have also been clear that, given the nature of the medicine, it should only be prescribed by specialist doctors and on a case-by-case basis. I believe these strict controls are necessary to develop clinical expertise and an evidence base for this treatment's effectiveness, and whether to prescribe an individual with medicinal cannabis should therefore not be a political or a financial decision but one made by a medical expert who will have considered whether it is the most effective treatment based on an individual's particular condition.
Medicine Shortage under a No-deal Brexit
I do not expect the UK to leave the EU without a deal, but preparations have been made for all eventualities. Over £4 billion has been provided to help government departments prepare for the UK's exit and this includes a no deal situation.
The Department for Health and Social Care has been working closely with the pharmaceutical companies to ensure they have a minimum of six weeks' extra supply so that they are able to fulfil their contractual obligations over the supply of medicines and medical devices in the event of a no deal exit from the EU. I am pleased to learn that in some instances companies have gone over and above the six-week minimum. In the case of insulin, for example, providers have already stockpiled at least twice this much. Ministers have asked that medicines with a short shelf-life be transported by air if necessary.
I am aware that the Scottish Government has been working with the UK Government to seek to maintain supplies to as close to normal as possible. A substitution will occur only if it is allowed under the serious shortage protocol. There is no automatic generic substitution of branded medicines by pharmacies. The protocol itself will be developed with and signed off by clinicians who will take into account any risks to patients and it will set out the alternatives medicines that can be dispensed, over what period and for which patients.
The Scottish Government has also said “We are in a strong place in Scotland to ensure that these protocols can be underpinned with electronic support using the ePharmacy Programme, which includes electronic communications on any amendments between pharmacies and GP practices”. Pharmacists would in addition retain the professional discretion to decide whether to issue a medicine against the shortage protocol or refer a patient back to a medical practitioner for a prescription.