Seema Malhotra
MP for Feltham and Heston · Labour (Co-op) · United Kingdom
“Public sector productivity is improving, with the latest Office for National Statistics figures showing output continuing to grow faster than inputs, and Departments being challenged to improve efficiency and modernise outdated processes.”
“I was proud to support the Feltham Convening Partnership’s young leaders summer programme last month. What struck me was their ambition for themselves and their community, as well as their call for more work experience opportunities.”
“We will be working to commence the socioeconomic duty on public bodies in section 1 of the Equality Act to require public authorities to put addressing socioeconomic disadvantage at the heart of their strategic decision making. There will be more on that to follow. Let me again thank my hon.”
“For generations, the message to those who want to enter public life or elite professions has been that if they want to get on, they must sound like everybody else. When Margaret Thatcher became leader of her party in the 1970s, she famously underwent intensive elocution lessons with a tutor from the National Theatre.”
“Whether a young person chooses a degree or a trade, their journey must be determined by merit and their potential—never by whether they have to change their voice or pretend to be someone else to fit in.”
“Interestingly, studies also regularly show that regional accents such as Welsh or Yorkshire are rated by the public as trustworthy, warm and honest. Yet when those same studies measure perceived intelligence or employability, standard southern English and received pronunciation invariably top the metrics.”
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“In Hounslow, around 10% of our officers have been cut. Does my hon. Friend agree that it is extremely important to locate the new officers not only on the streets but in institutions such as schools, given the threats that young people face, including grooming at school gates, which we have seen in my area?”
“My hon. Friend is making an incredibly powerful speech. I pay tribute to her work in her constituency on these difficult, complex and devastating issues, and in seeking justice for those who have been groomed. Paedophile rings behave in ways that we cannot imagine, and people continue to pursue those who are victims in their rings, even once they have gone to jail. Resources must be made available to deal with that issue far more comprehensively than is currently the case.”
“My constituency borders Heathrow, and many of my constituents will be working at Heathrow with the airlines and in many other roles. I appreciate that the risk may be low, but could the Secretary of State update the House on whether advice has been given to Heathrow and airlines on how to give advice to their staff who may have come into contact with people who might be affected so that everybody can be assured that all is being done and that any support they may need is available?”
“My hon. Friend is making an important speech and has just made reference to the cuts to capital budgets. Does he agree that it is staggering that since 2014 we have seen five consecutive switches from capital budgets to revenue budgets, totalling about £4.29 billion? The consequences are now being felt by all our constituents throughout the country.”
“I look forward to meeting officials about the Heston health centre, and to working with the Government on how we can ensure that the other essential services we need are delivered.”
“We are grappling with this in Hounslow, and I am grappling with it with my own mother, who had a stroke two years ago. At the weekend I was very moved when a constituent came to me and said, “What can I do, because I feel like I am starting to lose my memory, but there are no services available to help me? My daughter has said it is just part of getting old.” We must see whether more can be done not just in prevention but to help through these important services with rehabilitation for all our constituents. Today’s debate is important; it goes beyond whether the Bill is actually needed into how the Government are going to be spending our collective resources on the NHS, because going forward we need a plan that funds the NHS properly and provides a comprehensive strategy, addressing all our sectors.”
“I make reference here to community healthcare and social care, particularly in relation to the urgently needed increase in public health budgets following an almost £1 billion reduction in real terms under this Government. I want to raise not just the issue of prevention but recovery from illness and make particular reference to post-stroke and brain-damage related services. Neurocognitive rehabilitation is a particularly underfunded service. Too often we respond to brain damage as a result of illness or even early dementia with slow diagnosis and medication, when research suggests that better and more structured brain activity could help improve memory, planning skills and basic safety in performing day-to-day tasks that we currently take for granted.”
“However, having originally been given the green light to go ahead—the project was identified by the Department of Health as the best value funding option—currently we are in limbo: we do not know how the project is going to go forward and there is no clear sense of direction for my CCG and therefore my constituents. I would be grateful if the Minister could still agree to a meeting with me so that direction can be given for a project that is desperately needed. As we have also heard in this debate, NHS Providers and others have also highlighted how funding is to be allocated under the Bill and what will be further funded.”
“In 2015 the project was the subject of a discussion between the Department of Health, Community Health Partnerships and NHS Property Services, at which the CCG, the LIFTCo and NHS England were all represented. At that meeting it was concluded that CHP would work with the West London Health Partnership, the LIFTCo, to take forward the project as a public-private partnership funded scheme. The problem, however, is that after that decision funding was cut and the CCG was informed in June 2014 that, following the Chancellor’s commitment in 2018, new off-balance PPP-funded infrastructure projects would not be taken forward. I was fortunate to be able to raise this issue with the Chancellor in September, and I am grateful for his offer of having officials meet me.”
“Among all London CCGs, Hounslow has the fourth highest number of patients per permanent qualified GP, while the amount of funding per registered patient is 7% below the London average and 12% below the England average. The chair of Hounslow CCG has described the current Heston health centre as unsuitable to deliver 21st-century primary care. The buildings date from the 1970s, are in need of major repair and are no longer compliant with disability legislation. The proposed new development is desperately needed to provide patients with the quality of care they deserve, offering four GP services in one and providing disabled access as well as a more attractive place for GPs. Hounslow CCG has been working on this development since 2014.”
“The consequence is that buildings and equipment are being left outdated, increasingly affecting the quality of patient care and the reliability of appointments. Poor buildings and equipment also have a knock-on effect on the morale, recruitment and retention of key NHS staff. The Minister has intimated that there will be additional funding for infrastructure, but we await further details. I want to raise the important issue of the Heston health centre, because my constituents will not be the only ones to have been affected by changes in Government policy over the last few years. At the end of August I wrote to the Health Secretary and NHS England about Heston health centre when my local CCG contacted me.”
“I want to focus on two areas that go beyond the Bill specifically and into the Government’s strategy for funding and the NHS. The first is capital funding, and the urgent support that is needed in my constituency to get the rebuild of the Heston health centre back on track. The second is community health services and social care, and the specific issue of neurocognitive rehabilitation services. It is a matter of great concern for the medium and long-term health of our NHS that the NHS capital budget, which invests in our buildings, beds, equipment and IT, is today lower in real terms than it was in 2010-11. That has already been mentioned; indeed, we have had five consecutive switches from the capital budget to the revenue budget for the day-to-day running of the NHS since 2014 totalling over £4 billion.”
“This is a very small Bill—two clauses on five pages—which will put into legislation the current long-term funding settlement for the NHS, as set out 12 months ago. It sets a minimum that must be paid to the NHS for revenue spending in each year until 2023-24, when the provisions will cease to have effect. One might note that that is also likely to be the next election year. It came as a slight surprise to me that the Bill was drafted in this way. If spending needs to be locked in by legislation, it is almost as if the Government are seeking to prevent future Conservative Chancellors in this Government from making cuts to the NHS budget. That is a novel approach for a Prime Minister when the Government, as the House of Commons Library has noted, already have control over their own spending.”
“It is an honour and pleasure to follow the hon. Member for Darlington (Peter Gibson), and to be the first to congratulate him on his excellent maiden speech. It was a delight to hear about his life and experience in the constituency, and also to hear his very generous tribute to the very highly regarded and excellent Jenny Chapman, as well as about his other predecessors. He made a very passionate speech, highlighting the issues of transport, the economy, education and health. I am sure the way he did it—with such confidence and such style, and with humour—will have been heard by his constituents. I wish him great success in his work in this House. At the outset, I want to thank the British Medical Association, Mind, NHS Providers and others that have sent briefings for this very important debate.”
“Labour Members recognise the importance of faster broadband. Indeed, I have worked with previous Ministers on this, and on the issue of notspots in my constituency. Does the Minister agree with me on the importance of the issue to young children, who need to study and do their school homework, and to people working at home? Issues have been raised about that in my constituency. Does he agree that the essential criterion of affordability must also be part of the Government’s strategy?”
“May I make a point of clarification? I was talking about children studying at home, and being able to do their homework. That is the issue raised with me by my constituents, particularly in areas where there are leasehold properties.”
“I thank the Minister for giving way again. Will he clarify how he envisages the Government working with the devolved Administrations and councils —we should bear in mind the very good work with Transport for London on connectivity through tube stations—so that we get the maximum for the investment made from the public purse?”
“My hon. Friend is making an important contribution to the debate. Does she agree that it is important to assess what this will achieve in practice, and to establish whether we will then be getting anywhere near the levels of full-fibre coverage in leading nations such as South Korea or Japan? Should we not measure the outcomes to ensure that the poorest and most distant communities can have the broadband that they need and deserve, and—as I said earlier—should we not also ensure that affordability remains at the core of the Government’s strategy?”
“My hon. Friend is continuing to make an excellent speech. Does she agree that it is important to address the issue of notspots as well as the issue of speed of broadband access, and not just in rural areas? Thousands of households even in big cities like London, and more than 1,000 in my constituency, have little or no access to broadband.”
“I echo the concerns raised about farmers’ need for continuity, but may I ask a slightly different question? What protections for vulnerable habitats does the Secretary of State envisage this Bill supporting?”
“My hon. Friend is making a good speech, and I join him in paying tribute to colleagues who are no longer in this place but have done so much work in this area, including Sue Hayman and others. Does he agree that it is incredibly important, as we debate these Bills, to ensure that there is an assessment of when the UK agricultural sector will achieve net zero?”
“This issue raises fundamental public policy questions about ethics, fair rules and controls, and the responsibility of the Government to protect the most vulnerable from exploitation. It also fundamentally calls into question the judgment of the FA. The chief executive officer of Bet365, Denise Coates, was paid £277 million in basic salary in the last financial year. Does that not suggest that something is fundamentally wrong with our gambling system and industry, and again highlight the need for fundamental root-and-branch reform?”
“On a point of order, Mr Speaker. May I ask your advice about what may happen during the parliamentary Dissolution? I am particularly concerned about how I may raise the case of Mr Benjamin Williams from my constituency. A wheelchair-bound young man with degenerative spine disease, he has had great difficulty getting the services he needs from Shepherds Bush Housing Group, which seems to have been obstructive in every respect in relation to leaks, the fact that his windows do not close and other matters. Can you give me some advice about how I can raise this issue further, particularly to make sure that he gets the support he needs prior to Christmas?”
“Further to that point of order, Mr Speaker. This is a slightly unusual circumstance, so may I seek your clarification? Can you confirm that the report cannot be published without that confirmation from the Prime Minister, or is this just a matter of best practice?”
“You have done incredible work, often behind the scenes, to secure a proxy vote for colleagues who are benefiting from that now. You have been committed to increasing diversity in senior and significant positions in the House, and the visibility of that diversity has gone a long way towards making the House seem feel more relevant and inclusive, not just to us here, but to those outside.”
“My brother Sundeep in Australia has just texted me to say that he, too, wants to extend his best wishes and his thanks to you, particularly for your support when we were going through extremely difficult times, notably the illness and death of my father. You were accommodating when I had to leave before a debate ended; you came to our last family tea downstairs; and your letter to my father wishing him good health was a huge boost to his spirits in his final months. Your commitment to equality and wellbeing has been second to none in the House. I know how much you have done. It has indeed been an honour to serve on your Speaker’s Committee on equality, diversity and inclusion since very soon after I was elected, and I am grateful for the opportunity to do so.”
“May I take this opportunity, Mr Speaker, to put on record my thanks to you and my appreciation for all your guidance and support since the day I was elected? You are an extraordinary parliamentarian, human being and friend to so many—and I extend that to your family, who also deserve our thanks. As I know, your welcome to new MPs goes a long way towards settling them in the House at a very daunting time for them, when everything is so confusing. It went a long way towards giving me the confidence to stand up in the House and do my duty on behalf of my constituents, and I thank you for that. May I also say thank you on behalf of my family?”
“I know, however, that this will not be the end of a sterling career and that whatever you do next will be a great contribution to our democracy and to our country. I am excited, as well as intrigued, about what it might be.”
“You have, for instance, been generous in respect of urgent constituency matters—including events such as the life, and then the death, of young Charlie Gard from my constituency—and, indeed, in respect of policy matters such as those relating to young offenders in Feltham young offenders institution. You have allowed us to raise those issues at moments of great importance, and I am grateful to you, as are my constituents, for the times when that has made the difference. Mr Speaker, you have touched the lives of hundreds of thousands who have walked through the doors of this place. You are loved by many across the House, political friend and foe alike, and you will be deeply missed.”
“You have led us through unbearable times—events that have stunned the nation, such as the terror attack on Parliament and the murder of our dear friend Jo Cox. You have also seen us through the unconventional but extremely important and peaceful unveiling, on a Saturday, of her coat of arms here behind us, by her husband and her children. I was honoured to be here that day, along with local councillors Adriana Gheorghe, Candice Atterton and Samia Chaudhary, and others who came to support the family at that time and to remember Jo. In the Chamber, Mr Speaker, you have been tough and fair when that has been needed for either Front or Back Benchers, but you have also been generous when that has been needed.”
“You have opened up Speaker’s House, where we have held events such as National Sikh Awareness and History Month. Indeed, you hosted an event marking the first anniversary of the launch of a project in Hounslow, Hounslow’s Promise, which seeks to advance the educational attainment, social mobility and employability of our young people. I also pay tribute to you for your defence of this House and our democracy. This is a House that is a beacon of democracy across the world. Its integrity and its reputation as a national institution go beyond us as individuals and must never be taken for granted. It is indeed for each of us to protect and safeguard the House, because it is our democracy that keeps our nation safe.”
“These are responses to a statement. Mr Speaker, your work on the Education Centre has been extraordinary. You are an agent of change, and you set a standard for how to push the boundaries to achieve the reform and revitalisation that are so desperately needed, no matter what the organisation. I also thank you on behalf of my constituents, because I know that hundreds, if not thousands, have been through the Education Centre. Young people, many of primary school age, have been able to experience the House and build a connection with a place that is their House and is fighting for their future, too. I have no doubt that future parliamentarians, and indeed future Speakers, will embark on their roles in public life as a result of their experiences of our fantastic Education Centre and all who work in it.”
“I thank my right hon. Friend for giving way. Does he agree that the timing of this proposed general election, not whether we have a general election, is yet another example of the art of voter suppression, ensuring that students are less likely to have a vote and that older people and people with disabilities are less likely to go out and vote? If the Prime Minister truly believed in democracy, we would hold the election when people are able to go and cast their vote.”
“Further to that point of order, Mr Deputy Speaker. Further to some of the comments that have been made, may I seek your advice about the accountability of the Prime Minister? Truly, he is accountable to the Liaison Committee as well as to the House, and in other matters—”
“Yesterday, the hon. Member for Basildon and Billericay (Mr Baron) said: “I am doing my best to persuade colleagues…who, like me, voted three times against Theresa May’s deal, to look at this in a favourable light…provided we can get that clear assurance, and I have been given it so far by people like Michael Gove and Dominic Raab…that…if those trade talks fail up to December 2020, we will be leaving on no-deal terms.” Have members of the Prime Minister’s Cabinet given those assurances? If, indeed, no deal is therefore not ruled out by supporting the Prime Minister today, why will he not tell the country the truth?”
“Does my right hon. Friend agree that the challenges of rising child poverty, compounded by the mental health issues that young people face and rising special educational needs not being met due to our education system lacking the resources it needs, are contributing to the next generation growing up in despair, for which the country will pay the price for generations to come?”
“The hon. Lady is making an important point about an area of concern. The explanatory memorandum says, “HMRC will only use the power if needed to respond to business un-readiness that is greater than anticipated.” It is not clear how “greater than anticipated” will be determined, how transparent the use of the power will be, or who will not be granted an extension.”
“My hon. Friend is making an important and powerful speech. Does she believe that the Bill will do enough to support the role of schools in the lives of families? I know the amount of work that goes on in many schools in my constituency to support parents and children when there is domestic abuse at home. One primary school has told me that it suspects about five children in one class are subject to domestic violence.”
“PML affects the brain by damaging the nerves. The symptoms include muscle weakness, visual disturbance, impaired speech and cognitive difficulty.”
“In my work on this case, I have been struck by parallels with the campaigns by the late Dame Tessa Jowell on the more experimental use of drugs for very rare conditions, for which there will never be the sample sizes in one country, or potentially across the world, for a full clinical trial, but for which the anecdotal evidence is positive and the patient voice should be heard. Some of my contribution today will be slightly technical, but I hope it will be clear. Ms Rai was sadly diagnosed with multiple sclerosis in 2013 aged 34. She was prescribed Natalizumab, but sadly as a consequence she contracted PML, a highly rare and often fatal viral disease that affects only a handful of people across the UK. She has since been rendered disabled with no functional use of her right arm. She has other debilitating effects.”
“I am glad to be able to discuss an issue that I have been working on closely with my constituent, Ms Amarjit Rai. This is an urgent matter and I believe it is important to put this issue on public record and to seek greater flexibility in NHS policy on the commissioning of the drug Maraviroc to treat Natalizumab-induced progressive multifocal leukoencephalopathy, and in NHS England’s approach to individual funding requests. I thank Amarjit, her advocate, Kartik, her consultants and Mary Jo Bishop and Neha Soni in my office, as well as the House of Commons Library, for their assistance with this debate.”
“Will the Minister tell me how her Department liaises with and challenges NHS England on cases such as this, and how well-researched the Department’s responses to me have been? Will she tell me with what medical advice the treatment has been refused, although three of the leading experts in the country support it in this rare case, and whether their advice can be shared with my constituent and her consultant, Professor Ciccarelli? Will she also agree to a meeting with me, my constituent and her consultant, and a senior member from NHS England to discuss the IFR process? This is a matter of £500 a month, and of demonstrable medical benefits to my constituent. I should be grateful for the Minister’s response, and her advice on how we can move forward.”
“Given that very few options are available, she is not the only patient for whom, in anecdotal studies, the drug Maraviroc has shown remarkable results. With no other options available, my very ill constituent has been paying £500 a month privately for the past year to fund Maraviroc herself, but she can no longer afford to do so. Amarjit’s consultant neurologist and other specialists support her receiving the treatment. There is an irony in the fact that more is potentially being spent by the NHS in a month on treatment and tests that do not benefit her as much, and have damaging side-effects. The IFR system in the NHS should be able to review and respond to that situation on the basis of medical need, and I cannot see how that has been done in this case.”
“The research is more nuanced, the medical benefits for my constituent are undeniably clear, and the denial of funding is inexplicable to her and renowned experts in the country. Maraviroc, or Celsentri, as defined by the European Medicines Agency—formerly in London, it is now based elsewhere in the European Union—is a medicine that is routinely prescribed for HIV. Although it does not cure HIV infection or AIDS, it may hold off the damage to the immune system and the development of other infections and diseases. Medical research has identified that the JCV most associated with HIV patients with low immunity has found another context in patients with PML. My constituent’s condition is incredibly rare, affecting, potentially, 10 or fewer people in the country.”
“However, an article in Neurology Times in January 2018 states that in PML treatment options are limited. Maraviroc has been used successfully in some PML patients to avoid IRIS, although not all patients respond to Maraviroc. It recommends further research and testing in identifying patients at risk of IRIS and tailoring treatments accordingly. In that context, let me make reference to the urgent clinical commissioning policy statement on Natalizumab-induced PML, which was published by NHS England in March 2018. It said: “It has been assessed that the development of a full policy is not needed at this time as there is currently little evidence into its effectiveness for this indication”. I do not believe that that policy statement takes account of all the research available or indeed that which has appeared subsequent to its publication.”
“In summary, the condition for which the cause is believed to be the John Cunningham virus, which infects the central nervous system in patients with low immune conditions, became more prevalent and was observed in around 5% of patients with HIV prior to the availability of highly active antiretroviral therapy, or HAART. The article goes on to describe how the era of “monoclonal antibodies for immune-mediated conditions such as Natalizumab for MS and Crohn disease heralded another context for PML. As of November 2016, there have been 698 reported cases of PML under natalizumab.” The research goes on, and it is true that some research such as that published in The Journal of the Neurological Sciences in July 2017 confirms that it does not work in all circumstances, and steroids may be more effective in some patients.”
“A subsequent article was published by the American Academy of Neurology entitled “Maraviroc as possible treatment for PML-IRIS in natalizumab-treated patients with MS” in December 2016. It cited a 34-year-old man treated with Natalizumab for three years without previous immuno-suppression. After a period of time, the patient was admitted with seizures, headaches, and impaired memory, and an MRI scan subsequently confirmed PML. Twelve months after diagnosis with PML and six months after the start of Mariviroc, PML-IRIS lesions were resolved, and no new MS disease activity was detectable. An article in 2017 by Steiner and Benninger published by the American Academy of Neurology built the medical explanation for why Maraviroc had been effective in cases of PML in MS sufferers.”
“In December 2016, the American Academy of Neurology published an article entitled “Severe early natalizumab-associated PML in MS: Effective control of PML-IRIS with maraviroc”. A summary of a case involving a 55-year-old Caucasian HIV-negative man diagnosed with relapsing, remitting MS in 2013 shows that that led to a subsequent diagnosis of PML. Clinically, the patient deteriorated rapidly, according to the article. Oral Maraviroc was initiated six days after his admission. Eight days after Maraviroc initiation, MRI follow-up revealed stable PML lesion size. Over the following weeks, the patient improved continuously. After 25 weeks of Maraviroc treatment, the John Cunningham virus DNA was no longer detectable. Maraviroc was continued and well tolerated at a stable dose. The patient survived both PML and IRIS.”
“A fourth Health Minister, the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries), responded to my question. The response I received today was mind-boggling: “Maraviroc is currently authorised for the treatment of patients who are infected with HIV type 1. The Medicines and Healthcare Products Regulatory Agency which is responsible for the regulation of medicines in the UK is not aware of any application for use in patients with PML and therefore cannot comment on the efficacy of this drug in patients with PML.” It might be helpful if I highlight for the Minister findings from wider medical journals that the House of Commons Library has helped me to compile.”
“Member for South Ribble (Seema Kennedy), wrote: “We are informed by NHS England and NHS Improvement that it does not commission Maraviroc for progressive multifocal leukoencephalopathy… NHS England and NHS Improvement have published a do not commission policy for ‘Natalizumab-induced progressive multifocal leukoencephalopathy in relation to immune reconstitution inflammatory syndrome in multiple sclerosis.’” That response seems to contradict earlier responses and advice. First, “does not routinely commission” is different from “does not commission”. Secondly, it made no reference to the IFR process, which two Ministers had previously mentioned. I tabled a further parliamentary question last week to ask what assessment the Secretary of State had made of the effectiveness of Maraviroc in patients with PML.”