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The Parliamentary Under-Secretary of State for Health (Jane Ellison)
It is a pleasure to serve under your chairmanship, Mr Gray. I thank the hon. Member for Ealing North (Stephen Pound) for his kind words and congratulate him on securing this important debate. Hepatitis is a significant health issue that has been overshadowed by others for too long, in part because of many of the people who are most affected, so I welcome this opportunity to discuss it. In nine minutes I cannot possibly respond to all the points that have been made, so I will say straight away that I am going to put the issue of contaminated blood to one side as there will probably be another debate on that at some point. Work is ongoing with regard to previous problems with contaminated blood in the NHS. We are still awaiting the findings of Lord Penrose’s much delayed inquiry, which, as it addresses pre-devolution issues, is highly relevant. Nevertheless, I must put that issue to one side.
Jane Ellison
I cannot take an intervention on that point because I must deal with the rest of the debate.
On presumed consent, within the past year we have had two good, thorough debates in this Chamber on issues of organ donation and consent. It is a very interesting area of discussion. I am watching the Welsh experience with interest; I do not dismiss it, but it is very complex. I would be happy to debate it at any time with any Member because it is a topic to which I have given quite a lot of thought and consideration.
I pay tribute to the Hepatitis C Trust for its work. More recently, I have met the Hepatitis C Coalition, which has impressed on me with great force some of the issues that it wishes to see addressed—issues that were picked up by the hon. Member for Ealing North.
The NICE appraisal of the first of the new hep C therapies is due very soon, so this debate is timely. Understandably a lot of the focus is on the new therapies, but focus on prevention runs right through the NHS long-term strategy. That is highly relevant because if people are to be treated with good, new and expensive therapies, it is important to address issues such as re-infection rates and good public health prevention. Members should be in no doubt about the Government’s commitment, which I suspect would be shared by any Government, to reducing the big killers—the main reasons for premature mortality in our country—one of which is liver disease. We cannot tackle the big killers if we are not tackling hepatitis C. We are clear that the contribution that tackling hepatitis C can make to reducing current rates of end-stage liver disease is an important part of any premature mortality strategy.
Grahame M. Morris
Will the Minister take this opportunity to put on record the fact that hepatitis C is indeed curable and clear up any misunderstandings inadvertently created by her predecessor?
Jane Ellison
I have read the transcript of the previous debate and dealt with some of the issues subsequently raised in correspondence, so there is no need to go over that again. I am well aware of the issue.
The single biggest risk group for hepatitis C is people who inject drugs, or have done so in the past. Public Health England estimates that such people comprise about 90% of all those infected in England. There are also high rates of hepatitis C among the prison population, which presents significant challenges for the NHS, particularly in terms of re-infection and changing risky behaviours. We obviously need to prioritise making the best possible treatment available to people who are suffering the worst ill health. From a public health perspective, the starting point must be prevention. Some of the new treatments will clearly be focused on people who are the most ill. Although it is right to focus on the exciting opportunities offered by new drugs and treatments, we must not lose sight of the fact that we have to make sustained progress on reducing infection in the first place. I therefore welcome the emphasis on prevention in NHS England’s five-year forward view.
Public Health England has been working with drug treatment services to improve health promotion resources for injecting drug users and those sharing needles, and to increase coverage of opiate substitution therapies and needle syringe exchange programmes. Joined-up drug treatment services commissioned by local authorities are important. We are very conscious of the need to raise the priority of hep C in local authorities and their joint strategic needs assessments—I note that it is mentioned in Ealing’s, but it is not mentioned by some authorities that face a significant challenge. That is one reason why, early this year, I will host a joint hepatitis C and tuberculosis summit with elected members from those local authorities with the highest rates of both diseases in England. The aim of the summit will be to explore how we can bring together different parts of local health systems with local authorities to control TB and hepatitis C rates in particular communities. Distinctly different communities are affected and need distinctly different approaches to tackling the problem.
As the hon. Member for Ealing North said, NHS England and Public Health England are working together on a framework. I apologise that it has been delayed, but it is due to be published this year and I will use this debate as an opportunity for another discussion about the timetable. Nevertheless, those bodies are working together very carefully on the framework, which will set high-level aims for the public health system towards the elimination of hepatitis C-related liver disease as a public health issue, with specific, time-bound objectives that feed into the overarching plan. I think that that deals with one of the issues raised earlier.
Clearly, the framework must have key targets, involve clinical commissioning groups and address co-commissioning. PHE has been working with a range of local partners—such as GPs, CCGs and NHS commissioning—to look at the rates of testing, diagnosis and treatment for people at risk of hepatitis C. That will be a core part of the framework. I will pick up the issue and write to Members when I have more detail on when we are going to publish the framework, but it will be very thorough, which is why it is taking a little longer to finalise.
In recent years, the Hepatitis C Trust has played an important role in piloting innovative ways of increasing testing rates through the use of a mobile testing van and pharmacy-based testing. We always underestimate what can be done in pharmacies, but I am very keen to make far more of what we can deliver through them. It is important that people can access early diagnosis. Those accessing drug treatment services should routinely be tested for hepatitis C, as recommended in NICE guidance. I welcome data from PHE that show increasing rates of testing. Nevertheless, we clearly must do more to ensure high levels of professional awareness about that.
PHE has also been working with NHS England and other commissioners to look more generally at how best to commission to meet the needs of patients with hepatitis C. For example, its work has included issuing extremely informative liver profiles to each local authority area, including information about hepatitis C. Every single local authority in England was sent the liver profile for its area, in the hope that that would provide the basis on which services could be planned. I urge Members to look at those profiles, and if any Member has not seen the one for their area, I would be happy to supply it.
Time is very much against me and I have not really had the chance to discuss the new therapies. We are very conscious of the potential that they offer, but I must also put on record the fact that there are existing therapies. They come with great challenges, as the hon. Member for Ealing North outlined, and they are also more difficult for people who struggle to access health care and keep to regular therapy programmes. We see great potential in some of the new therapies, but careful thought must be given to how they are delivered to patients. More than 700 patients have already been treated through the policy on access to new therapies for patients with liver failure, which has cost about £38 million, with specialist centres established to deliver early access around the country.
I am afraid that time has beaten me, as I thought it might given the interest in this subject, but I hope that I have given hon. Members the sense that we have real momentum, with the summit and the plan to come. I will write to them with further detail.