Oral Answers to Questions

Baroness Blackwood of North Oxford Excerpts

Tuesday 20th December 2016 Commons Chamber

[David Tredinnick (Bosworth) (Con)]

2. What his Department’s definition is of evidence-based medicine; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

Evidence-based medicine is about using high-quality research to guide clinical practice and to achieve optimal results for all patients. The National Institute for Health and Care Excellence plays an important role in supporting evidence-based medicine by translating research into authoritative guidance for healthcare professionals on best practice.

[David Tredinnick]

Is the Minister aware that the author of “Evidence-based Medicine” in 1992, Professor David Sackett, said that it is

“about integrating individual clinical experience and the best external evidence, not just internal evidence”?

Is she further aware that in respect of the interpretation of evidence-based medicine, I have reported the so-called Good Thinking Society to the Charity Commission for the abuse of its charitable status through its use of legal threats to force the Department and health providers to change the law on healthcare?

[Nicola Blackwood]

NICE obviously considers complementary and alternative medicines when developing its guidance, where there is evidence, and it has been able to recommend some therapies, such as acupuncture for tension headaches and a range of complementary medicines for multiple sclerosis. We expect healthcare professionals to take that guidance into account when designing local services, but they must use their best understanding when treating the individual patients in front of them.

[Keith Vaz (Leicester East) (Lab)]

The evidence is very clear that eating more sugar increases the risk of diabetes. Apart from introducing the sugar tax, what further evidence-based research can be used by the Government to reduce the risk of diabetes?

[Nicola Blackwood]

The right hon. Gentleman is a great proponent of tackling the risk of diabetes. He knows that the Government take tackling and preventing diabetes extremely seriously. That is why we have introduced the world’s first national diabetes prevention programme, which we have piloted and are rolling out across the country. It includes not only education programmes but testing, and we are making sure that we use the evidence from the programme to bring about improvement and that we are rolling it out effectively.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

We are all in favour of evidence-based medicine. We are also in favour of decent resources for the national health service but, in the case of Huddersfield and Calderdale hospitals, what we want is good, high-quality management, rather than GPs being promoted to a managerial position that they cannot handle.

[Mr Speaker]

In relation to evidence-based medicine.

[Nicola Blackwood]

The hon. Gentleman is a great advocate of evidence-based medicine and I am pleased to hear about his support for it. He will be pleased that the national leadership programme is one of the evidence-based programmes that we are rolling out to improve the leadership of the NHS across the country.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

3. How the Government plan to show global leadership in tackling antimicrobial resistance.

[Chris Green (Bolton West) (Con)]

14. How the Government plan to show global leadership in tackling antimicrobial resistance.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

The UK is already a global leader in the fight against AMR. This Government’s leadership has secured a UN declaration on AMR and a commitment from the G20 to drive the development of new antimicrobials. We will continue to deliver international programmes to tackle AMR, including the Fleming fund and the Global AMR innovation fund, which represent more than £300 million of investment over the next five years.

[Kevin Hollinrake]

One of the 10 key recommendations of the O’Neill review was to improve the data and surveillance underlying antimicrobial resistance. What plans does the Minister have to routinely test all NHS patients for antibiotic resistance?

[Nicola Blackwood]

My hon. Friend is absolutely right that it is essential that we improve diagnostics if we are to tackle this national threat. A routine part of the clinical management of patients showing symptoms of infections is to take a blood sample. When an infection is identified, those samples are indeed tested for resistance. Part of our AMR strategy is to improve diagnostics and to fund innovation in this area.

[Mrs Villiers]

Will the Government commit themselves to ensuring that their strategy will include discouraging the use of intensive farming, given its overuse of antibiotics which contributes to antimicrobial-resistant problems?

[Nicola Blackwood]

I agree that we must focus on that as well, but we are currently focusing on reducing the need for antibiotics by minimising disease risk in animals through good animal husbandry and on-farm biosecurity. At present, antibiotics provide the only effective means of treatment for a number of animal diseases, and are therefore essential to ensuring the health and welfare of animals. However, we are also working on the matter in an international context with the World Organisation for Animal Health, and we will continue to drive forward the agenda.

[Chris Green]

What measures are the Government introducing to support the uptake of point-of-care C-reactive protein testing throughout the United Kingdom, given that it is a proven and cost-effective means of reducing levels of inappropriate antibiotic prescribing in primary care?

[Nicola Blackwood]

As my hon. Friend says, we must focus on innovation and better diagnostic tests, particularly bedside tests. The Government are actively reviewing evidence of the benefits of CRP tests. Pilot studies in the United Kingdom are contributing to that, and will be evaluated so that we can see how best to build on what can be shown to be working well.

[Jim Shannon (Strangford) (DUP)]

20. Given that 480,000 people develop multi-drug-resistant tuberculosis each year and that drug resistance is starting to complicate the fight against HIV and malaria, what steps has the Secretary of State taken to increase awareness in GP surgeries and to provide alternative treatments that can be equally effective, and what co-operation has taken place with devolved Assemblies?

[Nicola Blackwood]

I am grateful for that immediate promotion from the hon. Gentleman.

We have made considerable progress in establishing the building blocks of our domestic AMR strategy, including better data, guidance for primary care, and a strengthening of the framework for antimicrobial stewardship, which involves introducing incentives for the NHS to improve the prescribing of antibiotics. That has led, in the last quarter, to the first reduction in such prescribing, which I think we can take as an encouraging sign.

[Thangam Debbonaire (Bristol West) (Lab)]

One of the 10 recommendations of the O’Neill review on antimicrobial resistance was for a massive global public awareness campaign. Given that 700,000 people die each year as a result of AMR, and given the review’s estimate that that figure will rise to 10 million a year by 2050, what assurances can the Minister give that she is behind that awareness campaign?

[Nicola Blackwood]

The hon. Lady is right to identify the scale of the challenge, which is why we have put AMR on our national risk register, and she is also right to point out that no one country can tackle AMR alone. The United Kingdom has played a global leadership role. We co-sponsored the World Health Organisation’s 2015 global health plan and created the £265 million Fleming fund so that we could specifically help poor countries to tackle drug resistance, and we will continue to play that global leadership role.

[Daniel Zeichner (Cambridge) (Lab)]

The O’Neill report was published some six months ago and included recommendations for national Governments. What practical progress have the Government made so far?

[Nicola Blackwood]

On 19 September we published our comprehensive response to the report, which describes a range of actions that we will take on each of Lord O’Neill’s recommendations. The most practical progress that I can report is the fact that the prescribing of antibiotics has fallen for the first time since records began. I think that we can all be proud of that progress.

[Gavin Newlands (Paisley and Renfrewshire North) (SNP)]

4. What assessment he has made of the potential effect of the UK’s decision to leave the EU on the NHS workforce.

--- Later in debate ---

[Margaret Greenwood (Wirral West) (Lab)]

11. If the Government will make a recommendation to NHS England not to renew its primary care support contract with Capita.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is too early to speculate on the renewal of this contract, but it will ultimately be for NHS England to determine the selection criteria for the future procurement of services provided by it. My focus right now is on raising the quality of the existing contract, and I have been clear that the standard of Capita’s work under the contract has not been acceptable and it must improve. I continue to meet regularly with Capita and NHS England as they work to improve the performance of the service.

[Margaret Greenwood]

I thank the Minister for that response. Several GP practices in my constituency have reported serious delays in the transfer of medical records. In some cases the records have gone missing altogether, with serious implications for patient safety. I would like a clear response from the Minister about the assurances she can give to my constituents that the Government—not just NHS England, but the Government—take seriously the safe delivery of their confidential medical records.

[Nicola Blackwood]

I take this issue extremely seriously, which is why I am personally meeting NHS England and Capita fortnightly and ensuring that detailed rectification plans are in place for each service delivery programme. The improvements should happen between January and April next year. I shall be happy to write to the hon. Lady in more detail if she would like to be able to reassure her GPs, optometrists and dentists on those issues.

[Several hon. Members rose—]

[Kate Green (Stretford and Urmston) (Lab)]

Will the Minister advise GP practices in my constituency, who have been massively inconvenienced by the chaos of the Capita contract, that full compensation will be available for the inconvenience they have been put through?

[Nicola Blackwood]

At the moment, NHS England and Capita are focusing very hard on improving service delivery, which I think must be the top priority, but we are also looking into exactly what inconvenience and costs GPs have suffered, along with dentists and optometrists, and that will be considered and discussed with GPs.

[Rob Marris (Wolverhampton South West) (Lab)]

13. How many patient days of delayed discharge attributable to the levels of suitable social care available at the Royal Wolverhampton NHS Trust there were in (a) 2010 and (b) 2016.

--- Later in debate ---

[Natalie McGarry (Glasgow East) (Ind)]

15. What assessment he has made of the potential effectiveness of introducing (a) a ban on price-cutting promotions on unhealthy food in supermarkets and (b) restrictions on advertising of unhealthy food during family television programmes in reducing childhood obesity.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

In developing the childhood obesity plan, we considered the latest research and evidence on promotions and advertising, including Public Health England’s evidence package “Sugar reduction: the evidence for action”. We have made no secret of the fact that we considered a range of policies before finally settling on those set out in the childhood obesity plan. The plan includes the soft drinks industry levy and taking 20% of sugar out of certain products. We concluded that our plan is the right approach to secure the future health of our children.

[Natalie McGarry]

I associate myself with the Secretary of State’s words of sympathy for the people of Berlin, and I also add my thoughts for the people of Aleppo, Yemen, Gaza, Mosul and all the forgotten conflicts of the world.

Public health experts have dismissed the Government’s obesity strategy as a weak approach and a wasted opportunity. The Government say that they are committed to evidence-based policy making, but they have failed to acknowledge that relying on voluntary food action without tackling cost and availability is inherently flawed. Will the Minister commit the Government to getting a grip and bringing forward a ban or restrictions on advertising and price-cutting promotions on junk food?

[Nicola Blackwood]

I am happy to reassure the hon. Lady that current restrictions on advertising in the UK are already among the toughest in the world. For example, there is a total ban on the advertising of less healthy food during children’s television programmes. Those have been shown to be very effective. However, we also welcome action that has been taken by forward-thinking retailers on promotions elsewhere. In particular, Sainsbury’s has committed to removing multi-buy promotions across its full range of branded and own-brand soft drinks, confectionery, biscuits and crisps, removing more than 50% of its multi-buy promotions from its grocery business while lowering regular prices for products. It should be congratulated on leading the way.

[Mr Speaker]

We now feel considerably better informed.

[Mr Alan Mak (Havant) (Con)]

Advertising agencies and industry bodies can play a key role in ensuring that adverts are appropriate. Will the Minister continue working with the industry to tackle child obesity?

[Nicola Blackwood]

Yes.

[Margaret Ferrier (Rutherglen and Hamilton West) (SNP)]

Certain supermarkets persist in placing less healthy foods on promotion near the entrances to their stores, where they are unavoidable. Does the Minister agree that it is not just at checkouts that healthy options should be promoted, and that retailers should exercise more responsibility?

[Nicola Blackwood]

I absolutely agree that putting healthier options near checkouts and helping people to make healthier choices are part of retailers’ responsibilities. What has been notable in my discussions with retailers is that the penny is starting to drop that this is the direction of travel and what the public want, and I think we are going to start seeing a real sea change in the way retailers are advertising.

[Several hon. Members rose—]

[Philip Davies (Shipley) (Con)]

May I urge the Minister not to go down this ridiculous nanny-state route—which one would not expect from a Conservative Government—of setting up an unhealthy food police to go round telling people what they should be eating and what they should not be eating? No food eaten as part of a balanced diet is in itself particularly unhealthy. If the Government are so concerned about families that are just about managing, why on earth would they even contemplate increasing costs for working families?

[Nicola Blackwood]

My hon. Friend flatters me by saying he thinks I am a nanny—it is really quite a disturbing thought. However, what we have here is an obesity plan that balances the need to cut the sugar in young people’s diets, as a way to make sure they get a healthy diet, and individual choice, which we know is absolutely a Conservative ideal.

[Chris Green (Bolton West) (Con)]

T2. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

[Fiona Bruce (Congleton) (Con)]

T8. Has the public health Minister had an opportunity to consider the recent report sent to her by the all-party parliamentary group on alcohol harm on the shocking impact of excessive drinking by members of the public on the dedicated people who work in our emergency services? Will she meet the APPG to discuss this?

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I pay tribute to my hon. Friend for her dogged campaigning on this issue, on which she is a true champion. I have not had a chance to read the report in detail, but I have seen a number of its recommendations and we are taking action on some of them, including the publication of the chief medical officer’s low risk guidelines and Public Health England’s One You campaign, which runs over Christmas and the new year. We are embedding alcohol measures into the NHS health check and we have introduced a national CQUIN—Commissioning for Quality and Innovation—because evidence shows that intervention by a health professional is the most effective way of disrupting problem drinking.

[John Mann (Bassetlaw) (Lab)]

T4. Zac from Worksop is three years old, wheelchair-bound, unable to speak and blind, and is regularly admitted on an unplanned basis to Bassetlaw Hospital’s children’s ward. As the people of Bassetlaw are standing with Zac in opposing the proposed overnight closure of the children’s ward, which will create chaos for his small life and that of a number of other very poorly children like him, will democracy prevail, or are the Government going to pick a fight with Zac, me, and the people of Bassetlaw?

--- Later in debate ---

[Adam Afriyie (Windsor) (Con)]

Despite some of the obvious challenges in the healthcare service, this is a wonderful time of year when hundreds of thousands of people choose to quit smoking by putting down their cancer stick and picking up an electronic vaping device. Does the Minister share my concern, however, that we must be very cautious in any implementation of the EU tobacco products directive so that it does not act as a barrier to people quitting smoking and taking up vaping?

[Nicola Blackwood]

The Government are very clear that vaping is significantly less harmful than continuing to smoke. Under the current regulatory regime, huge numbers of smokers are successfully using these innovative products as an effective quitting tool. We have already committed to reviewing the TPD and we will fully explore the opportunities that Brexit may provide, but until exit negotiations are concluded we remain a full member of the EU.

[Mr David Hanson (Delyn) (Lab)]

T5. On contaminated blood, will the Government confirm that they still plan to use a private profit-making company such as Atos to administer the scheme, and if so, why?

[Nicola Blackwood]

I absolutely cannot confirm that. The tendering process has not even begun. Therefore, we are not considering any form of company, private or otherwise.

[Dr Sarah Wollaston (Totnes) (Con)]

The Health Committee has just published its interim report on preventing suicide. I thank all those who gave evidence to our inquiry and all members of the Department of Health advisory group. We support the strategy, but the clear message that we heard was that implementation needs to be strengthened. Will the Secretary of State meet me to discuss our report’s recommendations, and will he join me in thanking members of the Samaritans and other voluntary groups around the country who will be working tirelessly over Christmas, as they do every day, to support those in crisis?

--- Later in debate ---

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

TB rates are currently higher in bits of Ealing than in Rwanda. Could the Government better the bilateral innovation fund to which they have committed with China and go for the O’Neill report recommendation to work towards a truly global fund, in conjunction with other nations, to fight antimicrobial resistance?

[Nicola Blackwood]

As I have already answered, we are a world leader on AMR. We have not only the bilateral fund with China but the £265 million Fleming fund, through which we will deliver bilateral national action plans with a number of developing nations. We are committed to going further than that through the global action plan with the UN.

[Tom Pursglove (Corby) (Con)]

A fortnight ago, I visited the pharmacy at the Corby urgent care centre to thank the dedicated staff for all that they do all year round, and to have a flu jab as part of the ongoing campaign. Does the Minister agree that exactly that sort of proactive working is crucial in trying to tackle winter pressures?